Competency of Level 4 Nursing Students on Immediate Newborn Care free essay sample

Chapter 1 Background of the Study Introduction A nurse’s responsibility requires safe and effective care within constantly evolving health care systems (â€Å"Patient safety and nursing,† Wikipedia. com). One such area to be checked is neonatal nursing in which a nurse is to provide immediate newborn care. Such care is critical at this stage for it may distinguish whether the wellness of the care given can improve the condition of the newborn or further worsen the condition of the newborn. Immediate newborn care is a step by step procedure in caring for a newborn to ensure comfort and security while providing their needs. Basically focuses on certain procedures done on a newborn upon delivery from the mother. Such procedures include clearing of their airways upon delivery, providing warmth and attachment to mother, cord care, APGAR scoring, temperature taking, anthropometric measurements, eye prophylaxis, Vitamin K administration, immunization, bathing, initial feeding and proper documentation. It is important that nurses should do the procedure accurately and with confidence. Since skills and knowledge are learned through experience, constant practice and good instructions, the practice of this procedure should be started as early as possible, especially during the internship of student nurses in the hospitals in DR and NICU areas. The researchers came up with this study to know the level of competency of level IV nursing students on immediate newborn care. Knowing the level of competency of the student nurses on this procedure may give good insights on how well does the students perform the procedures and may suggest any possible reforms in their learning process. Theoretical Framework According to Bandura, people learn from one another through observation, imitation, and modeling. People learn through observing others’ behavior, attitudes, and outcomes of those behaviors. â€Å"Most human behavior is learned observationally through modeling: from observing others, one forms an idea of how new behaviors are performed, and on later occasions this coded information serves as a guide for action† (Bandura). Social learning theory explains human behavior in terms of continuous reciprocal interaction between cognitive, behavioral, and environmental influences. Necessary conditions for effective modeling: 1. Attention — various factors increase or decrease the amount of attention paid. Includes distinctiveness, affective valence, prevalence, complexity, functional value. One’s characteristics (e. g. sensory capacities, arousal level, perceptual set, past reinforcement) affect attention. 2. Retention — remembering what you paid attention to. Includes symbolic coding, mental images, cognitive organization, symbolic rehearsal, motor rehearsal. 3. Reproduction — reproducing the image. Including physical capabilities, and self-observation of reproduction. 4. Motivation — having a good reason to imitate. Includes motives such asA past (i. e. traditional behaviorism), promised (imagined incentives) and vicarious (seeing and recalling the reinforced model). Bandura believed in â€Å"reciprocal determinism,† that is, the world and a person’s behavior cause each other, while behaviorism immediately states that one’s environment causes one’s behavior. Bandura, who was studying adolescent aggression, found this too simplistic, and so in addition he suggested that behavior causes environment as well. Later, Bandura soon considered personality as an interaction between three components: the environment, behavior, and one’s psychological processes (one’s ability to entertain images in minds and language). Bandura bases his theory on the acquisition of complex behaviors on a triangular diagram illustrating the interactive effect of various factors. These three factors are behavior (B), the environment (E), and the internal events that influence perceptions and actions (P). The relationship between these three factors is known as reciprocal determinism. A major difference between Banduras social-cognitive theory of learning and earlier theories is his definition of learning. He noted that persons acquire internal codes of behavior that they may or may not act upon later. Therefore, he divided learning and performance as two separate events. Learning was the acquisition on the internal symbolic representations in the form of verbal or visual codes, which could serve as guidelines for future behavior. These memory codes of observed behaviors are referred to as representational systems and divided into two types of systems, visual and verbal-conceptual. The first is concerned with abstractions of distinctive features of events instead of just mental copies; the second would be the verbal form of details for a particular procedure. The modeled behavior serves to convey information to the observer in one of three different ways. One is by serving as a social prompt to initiate similar behavior in others. The second is by acting to strengthen or weaken the exiting restraints of the learner against performance of particular behaviors. The third influence is to transmit new patterns of behavior. Bandura describes three types of modeling stimuli, which are live models, symbolic models, and verbal descriptions or instructions. Of these three, in American society, the greatest range of exposure is in the form of symbolic models through mass media. Bandura (1977) states: Learning would be exceedingly laborious, not to mention hazardous, if people had to rely solely on the effects of their own actions to inform them what to do. Fortunately, most human behavior is learned observationally through modeling: from observing others one forms an idea of how new behaviors are performed, and on later occasions this coded information serves as a guide for action (p22). Conceptual Framework The researchers based their study on the assumption that the immediate newborn care is an area of health and nursing care services that should be given emphasis, for newborns are very fragile and should be handled with care especially in their first few hours of life. In the professional nurse’s role, performance of her responsibilities and functions to competently perform the immediate care for newborns and prevent any untoward trauma on the client. The paradigm shows in Column I, the profile of the respondents as to age, sex and their assigned hospitals and the level of competency on the immediate newborn care. This would be a tool to know if there’s any difference as to respondents’ age, sex and their assigned hospitals (DR-NICU) it also includes the level of competency of the respondents on immediate newborn care as to: airway clearance, attachment and warmth, cord care, activity/muscle tone, pulse/heart rate, grimace, appearance, respiratory effort scoring, temperature taking, anthropometric measurements, eye prophylaxis, vitamin K administration, immunization, bathing, initial feeding and proper documentation. Column II shows the implementation of data gathering utilizing a descriptive design using a questionnaire, which in Column III the output, results in the measures to address any possible findings in the level of competency of level IV nursing students on immediate newborn care. Research Paradigm INPUT (I) PROCESS (II) OUTPUT (III) Statement of the Problem General Purpose: This study will determine the Competency of Level IV Nursing Students on Immediate Newborn Care. Specifically, dealing successfully with the main problem, this study will answer the following questions: 1) What is the profile of respondents as to: a) Age b) Sex c) Assigned Hospitals (DR, NICU) 2) What is the Level of competency of level four nursing students on immediate newborn care as to: a) Airway Clearance b) Attachment and Warmth c) Cord Care d) Activity/Muscle Tone, Pulse/Heart Rate, Grimace, Appearance, Respiratory Effort Scoring e) Temperature Taking f) Anthropometric Measurements g) Eye Prophylaxis h) Vitamin K Administration i) Immunization j) Bathing k) Initial Feeding ) Proper Documentation 3) What is the difference in the level of competency among the level four nursing students on immediate newborn care as to: a. Age b. Sex c. Assigned Hospitals 4) What is the difference in the level of competency on the respondents who were assigned to government hospitals and private hospitals? Hypothesis There is no significant difference in the level of competency among the lev el four nursing students as to: a. Sex b. Age c. Affiliated Hospital Scope and Delimitation: This study will identify the level of competency of level IV students on immediate newborn care. The respondents include level IV nursing students of the University of Pangasinan who were assigned to DR and NICU in both public and private hospitals. The study centered on the level of the competency of the respondents on immediate newborn care as to: a) airway clearance, b) attachment and warmth, c) cord care, d) activity/muscle tone, pulse/heart rate, grimace, appearance, respiratory effort scoring, e) temperature taking, f) anthropometric measurements, g) eye prophylaxis, h) vitamin K administration, i) immunization, j) bathing, k) initial feeding, l) proper documentation. The checklist type questionnaire will be used as the data collecting tool. The questionnaire included items corresponding to all areas expressed in the specific questions asked and carefully prepared by the researcher to guarantee the collection of all data necessary to answer the main problem. Significance of the Study: The findings of the study will be highly significant to the following: To the Level IV Student Nurses. This study can determine the respondents’ level of competency on immediate newborn care and what improvements may be made for the betterment of service to the involved patients, which are the newborn and their family. To the Newborns and Their Parents. Newborns as the direct recipient of care and their parents will benefit much on any possible findings in the performance immediate newborn care by nursing students in the field. To the Nursing Professors and Clinical Instructors. The study done can provide information on the performance of their students and what needs to be restated, reinstructed, and practiced for the betterment of the knowledge and skills of the level IV student nurses To the Researchers. This research presented can determine the level of competency of level IV student nurses on immediate newborn care and what improvements may be done for the betterment of the different procedures. To the Nursing Professionals. Both nursing educators and clinical practitioners in the area of newborn care practice, will be able to utilize the findings from this study to integrate these to their teaching and practice accordingly towards the full development of nursing education and practice. Definition of Terms The researchers present the following terms appropriately defined according to their usage in the study to aid readers in easily comprehending the contents of the whole study. Competency ? Having the sufficient knowledge and skills in doing a procedure. Level IV Nursing Students ? The correspondents of the study who have already attained immediate newborn care knowledge and skills. Immediate Newborn Care ? This regards the procedures done in caring for newborns upon delivery. a) Airway Clearance ? A procedure done to clear secretions in the mouth and nose of a newborn upon delivery for the patency of airway. ) Attachment and Warmth ? Skin to skin contact of newborn with the mother and the immediate drying of newborns to prevent hypothermia and to promote mother and child bonding c) Cord Care ? The proper clamping and cutting of the umbilical cord. d) Activity/Muscle Tone, Pulse/Heart Rate, Grimace, Appearance, Respiratory Effort Scoring ? An assessment scale used as standard since 19 58 (APGAR et al. ,1958). Done at 1 minute and 5 minutes after birth. e) Temperature Taking ? It is the checking of the newborn’s temperature with the use of a digital thermometer. ) Anthropometric Measurements ? Taking measurements of newborn’s weight, length, and head and chest circumference. g) Eye Prophylaxis ? Procedure done by instilling a medication in the newborns inner to outer canthus of the eye to prevent infections. h) Vitamin K Administration ? Injection of vitamin K intramuscularly to newborns which is necessary for blood coagulation to prevent bleeding. i) Immunization ? Vaccination against Hepatitis B that all newborns receive within 12 hours after birth. And vaccination of BCG (Bacillus Calmette Guerin) at birth. j) Bathing ? Procedure done 6 hours after birth of newborn with the use of soap and water. k) Initial Feeding ? Feeding of a Newborn through breastfeeding by the mother. l) Proper Documentation ? Performed by placing proper identification on the newborn, foot printing for birth registration is filed with the infant’s birth record, birth record documentation, including the time of birth and the procedures done. Chapter 2 Related Literature and Studies Foreign Literature †¢ Effect of Training for Care Providers on Practice of Immediate Newborn Care in Hospitals in Sri Lanka. By:Upul Senarath , Dulitha N. Fernando , and Ishani Rodrigo Training programs for health care providers are commonly viewed as the key strategy to promote health care practices. Previous studies highlighted that the implementation of such programs is followed by moderate improvement in ENC practices in hospital settings ( Harris et al. ,1995; Vidal et al. , 2001 ). Among the programs that addressed specific areas, breastfeeding training has shown remarkable Effects with significant increase in breastfeeding indicators ( Cattaneo Buzzetti, 2001; Vittoz, Labarere, Castell, Durand, Pons, 2004; Westphal, Taddei, Venancio, Bogus, 1995 ). Findings of the present study suggest that the implementation of a comprehensive 4-day training Program of ENC can be followed by a significant improve improvement in the practices of cleanliness at delivery, thermal protection, preparedness for resuscitation, and neonatal Assessment in the labor room. The training may possibly have an effect in reducing undesirable health events among low-risk newborns during the postnatal stay. This intervention may not be sufficient for health care providers dealing with high-risk newborns who need care in specialized settings. In general, the practices that were at a lower level during the baseline improved significantly after the training program. There were some differences in the baseline level of practices between the intervention and the control groups, such as immediate skin-to-skin contact, hand washing before handling baby, and providing information to mother after examination. However, the statistical comparisons were made between before and after samples rather than between the intervention and the control groups. The higher levels of immediate skin-to-skin contact in the control group could mainly be attributed to the lower caesarean section rate in this group compared to the intervention group. There were some declines in the control group 3 months after the intervention (e. g. , keeping newborn on a clean surface), but these changes were statistically insignificant. The significant effect of our intervention on practice may be predominantly attributed to the assessment of learning needs of the care providers and developing the Learning objectives and content based on this assessment. Before designing the intervention, a baseline survey was conducted to assess the knowledge and practices of the health care providers and mothers, and high priority was given to poor areas. Our results emphasize that in-service training programs tailored to the local situation after an initial assessment would be more beneficial than standard training using all the sections of a given manual. Another reason for changes is that the present program contained more interactive methods in the training such as demonstrations, hands-on training, and practical assignments than merely didactic sessions. Interactive training sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice ( Davis et al. , 1999 ). The present intervention was not effective in improving some immediate practices such as maintenance of a clean delivery surface and hand washing in the postnatal ward. These results are in contrast with the Brazilian study, where significant improvements were reported in hand washing in postnatal wards following training (Vidal et al. ,2001 ). Failure of our intervention in improving practice of cleanliness in general suggests the need to look for the availability of facilities for maintenance of cleanliness in the labor room and hand washing facilities in the postnatal ward. Thus, we recommend health managers ensure availability of immediate resources in the obstetric units especially facilities for maintenance of cleanliness in labor room and hand washing in postnatal ward. The baseline survey showed that 98. 7% of the newborns under study were exclusively breastfed at the time of discharge . Successful breastfeeding practices among the low risk newborns at hospital were attributed to the consistent efforts made by the health services in training health care providers and educating mothers during pregnancy, delivery, and postpartum periods on breastfeeding (Family Health Bureau, 2001; Jayathilaka Fernando, 2002; Senanayake Wijemanne, 1992). Social and cultural aspects, which were in favor of breastfeeding, would also have contributed in promoting these practices. However, the present study revealed that there is room for improvement in some areas such as management of breastfeeding difficulties, delay in initiation of breastfeeding especially following caesarean deliveries, and lack of support by The staff for breastfeeding in the postnatal ward. Even though preparedness for resuscitation improved following the training, we could not evaluate the resuscitation procedure in the labor room, since very few needed active resuscitation within the study sample. Evidence For effect of training on resuscitation practices in the labor room is limited except for a few studies that showed significant improvement in such practices following implementation of neonatal resuscitation programs (Ryan, Clark, Malone, , 1999; WHO SEAR, 2002 ). Further studies are needed to evaluate the impact of Entraining on resuscitation of the asphyxiated newborn. In our study, the reason for the significant improvement in Preparedness for resuscitation in the control group was not clear. Local Literature What every mom should know about newborn care? By: AMYLINE QUIEN CHING February 12, 2010, 6:41pm Doctors may be the experts in healthcare but they are not gods. They also make mistakes and unfortunately, most subscribe to old practices that seriously need updating. â€Å"Knowledge is still the best safeguard against anything. We cannot just rely on medical professionals for everything. This is especially true for newborns. The first two days of life is very crucial and it is vital that parents, especially moms, also know the right ways of doing things,† says Dra. Christia Padolina, officer of the Philippine Obstetrical and Gynecological Society (POGS) during the launch of the Immediate Newborn Care (ENC) Protocol. The ENC protocol is a project of the Department of Health (DOH) in collaboration with the World Health Organization (WHO). It hopes to cut down the number of newborn deaths in the country by standardizing the practices inside hospitals. According to DOH National Disease Prevention Director Dr. Yolanda Oliveros, there is now a wide variation in the practices of health professionals especially in provincial hospitals. There are even reports of inappropriate care being given to newborns. Dr. Padolina cites several practices that moms (and dads) should keep an eye on after delivery: 1. Babies must be thoroughly dried to stimulate breathing, one minute after delivery. 2. Clamping and cutting of the umbilical cord in about one to three minutes, not under one minute which 99 percent of hospitals do. 3. Babies should not be placed on a cold surface. 4. They should not be washed or given a bath immediately. Wait until after six hours. 5. They must be given to their moms immediately for early skin to skin contact. 6. Babies should not be separated from their moms within an hour after delivery to initiate breastfeeding. 7. Babies should be roomed with the mom immediately and not transferred to a nursery. According to Dr. Padolina, some medical professionals are not aware of these practices while others do not do them at the prescribed time. â€Å"The ENC protocol will help a lot in correcting these mistakes but of course, it is still important that moms know what should be done because it is their aby’s life and wellbeing that is at stake. † Foreign Studies †¢ Competency Assessment: Methods for Development and Implementation in Nursing Education. By: Richard Redman, PhD, RN,Carrie B. Lenburg, EdD, RN, FAAN and Patricia Hinton Walker PhD, RN, FAAN Competent performance by health care professionals is expected throughout society. However, defining what it is and teaching students how to perform compete ntly faces many challenges. This article provides a brief overview of the contemporary focus on competency assessment in nursing education. The redesigned nursing curriculum at the University of Colorado is presented as an exemplar of a practice-oriented model that requires competent performance among students. Methods for implementing a competency-based curriculum and lessons learned during the process are discussed. Increased accountability has become a common theme in contemporary society. In the public marketplace, the theme of let the buyer beware has been replaced with the philosophy of excellence is defined by the customer. This perspective has general application across all types of industries. When the public good relates to education or health care, standards of acceptable performance are clearly defined by regulatory and professional bodies and society holds practitioners fully accountable when performance is unacceptable or questionable. Whether the focus is on public officials, health care professionals, or educators, the expectation is that standards of acceptable performance will be adhered to and the publ ic trust will be safeguarded. Operationally defining acceptable, competent performance is one of the most challenging and immediate components in this accountability paradigm. Those in nursing education face many challenges. Students approach the learning institution with the assumption that they will be taught the requisite knowledge and skills to become competent nurses. Employers of nursing graduates assume that the nursing degree and the state licensure certify competent performance. Many definitional and methodological issues evolve from these assumptions. The social mandate for accountability, however, does not tolerate ambiguous assumptions or debate. While the assessment of competent practice in the service sector has received considerable attention the past 25 years, the implementation of competency assessment models in nursing education has moved at a much slower pace. The purpose of this paper is to examine selected assessment methods designed to accurately document competence within the context of escalating and changing needs in education and practice. The University Of Colorado School Of Nursing (CU-SON) is currently in the process of implementing a competency-based, outcomes-focused curriculum in its four nursing education programs: baccalaureate (BS), master’s (MS), nursing doctorate (ND), and doctor of philosophy (PhD) programs. The Colorado experience described in this article serves as an exemplar for rationale, methods, and process used to develop and implement a practice-oriented model to promote competence among students and practitioners. The methods used in this comprehensive transition provide examples that can be adapted by others in education and practice settings. Multiple requirements for competent nursing practice in the health care system have been established by national associations and agencies. These include the American Nurses Association, the American Association of Critical Care Nurses’ Standards for Nursing Care of the Critically Ill and their Education Standards for Critical Care Nursing (Alspach, 1992). The Joint Commission for Accreditation of health care Organizations requires that clinical competence be assessed for all nursing staff and holds institutional leaders accountable for ensuring that competency of all staff is assessed, maintained, demonstrated, and continually improved (JCAHO, 1999). The legal and financial implications of employee performance and safe practice in a rapidly changing practice environment make continuing professional competence a major concern for all providers and health care organizations. Stressing the importance of assessing what employees can  do, not what they  know, del Bueno describes the commonly known gap between excellent test takers who have difficulty performing a procedure or recognizing warning signs in a patient experiencing difficulty. The use of criterion-based performance measures determines practice competencies in employees as well as identifies where need exists to correct skill or knowledge deficiencies (del Bueno, Weeks, Brown-Stewart, 1987). Competency assessment is always outcome oriented; the goal is to evaluate performance for the effective application of knowledge and skill in the practice setting. Competency assessment techniques address psychomotor, cognitive, and affective domains. Competencies can be generic to clinical practice in any setting, specific to a clinical specialty, basic or advanced (Benner, 1982;  Gurvis Grey, 1995). Competency-based education has been found to be equally effective in both didactic and self-learning approaches (Lenburg, 1990;  Schlomer, Anderson, Shaw, 1997). Alspach(1984) presents hallmarks of competency-based education that make them applicable both in practice and in educational settings. These include competencies based on validation of what performance by competent practitioners actually comprises. In addition, competency assessment is based on criterion-referenced evaluation methods where the learner’s performance is evaluated against a set of criteria provided to the learner so that both the learner and the assessor are clear on what performance is required. Finally, competency-based education is learner-centered in that outcomes are specified and describe what the learner must do to demonstrate competency. Masson Fain (1997) discuss the value of a competency-based system in cross-training, which is commonly used in today’s cost-containment environment. They illustrate the effectiveness of a comprehensive system of competency validation for long-term staff, orientees, and nursing students. Del Bueno reports it took approximately eight months of clinical experience before new BSN graduates felt confident and competent in their clinical judgments. Given the array of individual differences in nursing performance, she recommends that employers and educators assess competencies before assigning nurses to practice settings or advancing them in educational programs (del Bueno, 1990). While examples of competency-based assessment are more prevalent in the nursing practice literature, limited examples can be found in the nursing education literature as well. Lenburg has provided major contributions in the use of competency-based assessment as an immediate component of nursing education (Lenburg, 1991). Her Competency Outcomes and Performance Assessment (COPA) Model provides a framework for assessing the full range of core competencies immediate for nursing practice. These include psychometrically sound techniques for assessment across psychomotor, cognitive, and affective domains in all specialty content areas of nursing education (Lenburg, 1979;  Lenburg Mitchell, 1991). Luttrell and colleagues (1999) successfully employed the COPA model to develop a competency-based undergraduate nursing curriculum and used a variety of competency performance examinations and assessments to measure student performance and achievement. Two methods are used to assess competence in learners. Competency Performance Assessments (CPAs) are used to assess all class assignments that have consequences for the course grade, such as papers, projects, participation and presentations. Competency Performance Examinations (CPEs) are used in clinical situations to evaluate clinical outcomes. Both CPAs and CPEs are comprised of critical elements that collectively define competence for particular skills or abilities. Critical elements are single, discrete, observable behaviors that are mandatory for the specific competencies being evaluated. They specify exactly what is required for acceptable performance in clinical and non-clinical courses; the course grade is based on this pre-determined foundation. Faculty, who are clinical experts, work in collaboration with colleagues in practice settings to specify the critical elements for CPEs and CPAs. Approximately 30 % of the faculty are active practitioners who participate in the School’s faculty practice plan and teach in one or more of the educational programs. This faculty provided immediate input in defining the competencies immediate for practice in different settings. In addition, designated clinical scholars from clinical agencies affiliated with CU-SON became active participants in the process of defining outcome competencies for all students. All faculties participated in this curriculum redesign to address how these competencies might be learned and assessed. Critical elements are created within the context of accepted standards of practice, evidence-based research literature, and course objectives. Specific CPEs are then constructed using these critical elements as immediate items for defining and measuring competent performance in the learner for designated modules or courses. Learners in each course are oriented to the specific competency outcomes and all related critical elements that establish the mandatory level of performance for that course. In testing situations, students are presented with one or more focused clinical cases — actual or simulated — and examined in terms of their ability to demonstrate the required critical elements for competent practice to meet the specific needs of that clinical situation. The advanced health assessment course required in the MS and ND programs provides an example of what the faculty wanted to accomplish in the redesigned curriculum, given the guiding principles described above. The graduate level course consists of a series of modules, each one credit, which are available to students in both the MS ND programs. The modules cover core assessment concepts, and one or more of the following specialty areas: adult, geriatric, women’s, children’s, newborn, and prenatal assessment. Students complete only those modules necessary for their specialty option requirements. Entry level competencies have been set for each module. Any student who has completed the content of a required module at another point in their education, or has had extensive clinical practice in that area, or has completed a continuing education program on that content may demonstrate their competency by completing the designated clinical performance examination (CPE). If successful, that student has met the competency requirements for that module and may progress on to a subsequent requirement. Students who are deficient in basic health assessment knowledge and techniques are urged to complete an intensive basic assessment module and demonstrate competency before beginning the advanced modules. This enhances their ultimate success, confidence and competence. Students taking Advanced Health Assessment complete the didactic portions of the various modules in a web-based format. They also have the opportunity to attend lab sessions where they can demonstrate assessment techniques, ask questions of supervising lab faculty, practice particular techniques and demonstrate their proficiency with faculty direction. At various points, testing situations are required and students are presented with a focused clinical scenario and evaluated using the designated CPE and related critical elements. Results of the completed CPEs are part of the official course records, just as any other test result or grade. Specific evaluation comments, therefore, must be written to withstand legal scrutiny. The faculty established the policy that a failed CPE may be repeated only once. Students cannot advance into a subsequent assessment module until they have demonstrated proficiency for prerequisite competencies necessary for entry into that module. Although still in the early implementation phase, this competency-based approach has worked well to date. All enrolled graduate students in both the ND and MS programs are required to complete the modules appropriate to their specialization. In addition, nurses who are seeking prescriptive authority from the State of Colorado Board of Nursing enroll in the appropriate modules if they are deficient in the advanced assessment requirements. This can be done on a continuing education basis or as an enrolled Post-MS Certificate student. Some health care agencies are considering contracting for various modules for their staff as a means to acquire required competencies for incorporation into practice in the agency. Regardless of the purpose for taking the modules, learners are required to pass the designated CPEs and/or CPAs. The experience with the competency-based curriculum at CU-SON over the past 15-18 months has been very positive, although not without numerous challenges. Considerable faculty development in the methods of competency outcomes and performance assessment has been ongoing and will continue for the next one to two years. From the outset, faculty need a comprehensive orientation to the multiple and interrelated components of the COPA Model; they also need ongoing reinforcement and encouragement, and the time to learn and implement new methods. The curriculum committee has provided oversight through review of every course in all programs, whether on campus or web-based. This has been an ongoing process as courses are revised and new courses designed. Each course is reviewed from the competency-based perspective, including review of competency outcomes, interactive learning strategies, and the CPEs and CPAs proposed for that course. In addition, each course is reviewed for its relationship to the overall mission, philosophy, conceptual framework, and program outcomes for the unified curriculum. This process promotes internal consistency immediate to the overall success of the school and its graduates. The syllabus for every course uses a template that includes a standard set of definitions, explanations, and other information related to competency-based approaches and methods. This insures that students are continuously reminded of the performance expectations required for the course within the context of contemporary practice. The redesign also has required the development of a new evaluation plan for the curriculum. This includes new evaluation instruments to measure achievement of competency-based outcomes, effectiveness of learning strategies and assessment methods, and the satisfaction of students, graduates, faculty and employers. These evaluation methods and ongoing focus groups held with students and faculty provide the foundation for continuous quality improvement; they help faculty determine which components are working effectively and which need improvement. Both process and outcome data have provided important insights as additional courses are designed and implemented. The competency-based approach to nursing education has been endorsed by our stakeholder groups, particularly our colleagues in the clinical agencies. This model is very familiar to them and one that they believe has demonstrated validity and reliability. Overall, implementation of the competency-based COPA Model at CU-SON is an evolving success story. It has provided an exciting and educationally sound pathway as the school begins its second century of educational programs for local and distant learners and the consumers they serve. The experience in converting to a competency-based curriculum has been both successful and challenging. Faculty and student experiences to date have been positive. The redesigned curriculum is viewed as responsive to the competency-oriented environment and employers believe the transition of graduates into practice settings will be more effective, efficient, and successful. This competency-based approach to education can serve as a model which offers a wide variety of applications to education and service environments. Local Studies †¢ Performances of BPSU Level II Nursing Students in Rendering Immediate Post-partum Care of the Newborn. According to Blanco (2009), there’s no denying that performing well in clinical is a major challenge for just about any nursing student but for minority students –including male students , as well as students of color-success in the clinical rotation often is linked to faculty members’ sensitivity to issues these students face that may differ from what minority students experience. It also can depend on adapting teaching strategies to diverse learning styles, advocating for students who encounter biased in the clinical setting, and creating effect interventions for students who run into obstacles or need to improve their performance. Stott (2007), states that male nursing students face particular challenges from an academic and clinical practice perspective during their university experience. For example, themes identified from interviews and narratives highlighted the fact that there is a tendency for male nursing students to feel isolated and excluded from an academic and clinical perspective. As well as this, the informants of this study clearly highlighted their preference for engaging in the technical aspects of nursing. The implications for nurse educators are emphasized and from this, educational strategies are suggested to facilitate the retention of male nursing students in undergraduate nursing courses. This give male nurses an insufficient experience in rendering care and execution of their skills. Furthermore, Snavely (2001) reveals that numerical underrepresentation, not cultural factors, causes tokens to experience greater performance pressure, social isolation, and role entrapment. Subjects were 322 male and female nursing students from two similar Midwestern nursing schools. Subjects completed instrument measuring social isolation, upward communication distortion, performance pressure, and communication apprehension. The mentioned statements about the performances of male nurses in newborn care vary. In these citations, our study can serve as a helpful tool to show what causes or factors affects the performances of male nursing students in relation to newborn care. Male nurses face challenging situations whether or not they are allowed to handle women. This causes them alteration on experiences on their part. It gives male nurses minimal experience thus, not acquiring the needed level of performance they need to obtain. The mentioned statements above shows the importance of other experiences learned by the students not only in school but especially in the hospital because it is very necessary for the students to apply what has been previously learned in the classrooms for community, sequence and integration of principles, concepts, skills, and values which are basically the practical application of it. It must be continuously developed so as to ascertain that BSN graduates are clinically competent to undertake hospital works. Moreover, enough clinical or RLE exposures are beneficial to nursing graduates taking the board examination for the fact there might be questions which they actually experience in their hospital duties. Justification of the Study There are no other records or any studies which is similar to researchers. As a result, there is no chance of duplication, forgery or repetition. Sources: †¢ http://www. scribd. com/doc/52566380/Research-Newborn-Care †¢ http://cms. nursingworld. org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume41999/No2Sep1999/InitialandContinuingCompetenceinEducationandPracticeCompeten yAssessmentMethodsforDeve. aspx †¢ http://www. nejm. org/doi/full/10. 1056/NEJMsa0806033#t=article Chapter 3 Research Design and Procedure This chapter presents the method utilized by the researchers in presenting the findings, together with the procedures employed in gathering the data needed for the research study itself. It includes the profile of the respondents, the formulation and the validation of the data-gathering tool, and the statistical tools used in the treatment of the data gathered The Research Design In conducting the study, the researchers used the qualitative method which is a subjective approach used to describe life experiences and give them meaning (Marshall Rossman, 2006, and Munhall, 2001). The mentioned method was chosen due to the researchers’ agreement to the belief that truth is both complex and dynamic and can be found only by studying persons as they interact with and within their sociohistorical settings (Marshall Rossman, 2006, and Munhall, 2001). Population and Locale The respondents involved in the study conducted are all of ___ fourth year tudent nurses from the University of Pangasinan of who were or are interning in the delivery room (DR) and/or neonatal intensive care unit (NICU). These respondents were selectively chosen from the total population of ___ fourth year student nurses from the University of Pangasinan due to the specification of their interned area which serves as the basis of this study. Data Gathering Tool In this research study, the r esearchers will use formulated questionnaires as the main data for gathering the needed information. The researchers based their questionnaires Competency of level IV Nursing Students on Immediate Newborn Care and self constructed questions. The questionnaire that the researchers made is easy to understand by the respondent. The researchers also classified the questionnaires according to the following: 1. Airway clearance 2. Attachment and Warmth 3. Cord care 4. APGAR scoring 5. Eye prophylaxis 6. Anthropometric measurements 7. Vitamin K administration 8. Immunizations 9. Bathing 10. Identification The level IV students will rate according to: HC ? Highly Competent; PC ? Partially Competent; and PyC ? Poorly Competency. The researchers’ questionnaire will evaluate the level IV competency in immediate newborn care. Data Gathering Procedure The data gathering process will start with the distribution of the survey questionnaire. Prior to the distribution, the researchers agreed upon a standard explanation for each of the following questions in the survey tool. The respondents will be selected from nurses who agreed to participate in the study, who meet the inclusion criteria and are able to speak and understand the English language well enough to answer the survey questions. The researchers will ensure that the respondents will be able to complete the survey questionnaire. Treatment of Data The data to be collected will be carefully tabulated, organized, analyzed and interpreted. The formula for average weighted mean is (Downie and Heath, 1984): __ X-EX/N Where: __ X- is the average weighted mean/points EX- the sum of the frequencies or measures N- is the number of cases The weighted mean is: WM- NR x CP/N Where: NR- is the number of responses registered in an item in any of the categories CP- is the number of point assigned to any of the categories N- is the number of respondents Measures to address any possible findings in the level of Competency of level IV Nursing students on Immediate Newborn Care. Descriptive Design Using Questionnaire 1. Profile of the Respondents a. Age b. Sex c. Assigned Hospitals 2. Level of Competency on Immediate Newborn Care a s to: a) Airway clearance b) Attachment and warmth c) Cord care d) Activity/muscle tone, Pulse/heart rate, Grimace, Appearance, Respiratory Effort Scoring e) Temperature taking f) Anthropometric measurements g) Eye prophylaxis h) Vitamin k administration i) Immunization j) Bathing k) Initial Feeding l) Proper Documentation l) Initial Feeding