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“The Nurses’ Caring Factors and Coping Mechanisms of Patients with
pulmonary Tuberculosis undergoing directly observed treatment
short-course (DOTS) PROGRAM”
BSN406-GROUP21
Aguirre, Kevin Sam
Alarcon, Mikko Anthony
Aliga, Keith
Alupani, Queenie Ann
Andalecio, Micah Grace
Arboleda, Jungie Grace
Bartido, Ma. Mennet
Baylon, Anne Nickol
Binauhan, Pauline Rubie
Castro, Kathleen Cris
RESEARCH ADVISER:
Esther O. Salvador-Dela Cruz, R.N, M.A.N.
March 14, 2013
TABLE OF CONTENTS
Title page…………………………………………………………….…………………………..1
1
Table of Contents……………………………………………………………………………….2
CHAPTER I
Background of the Study……………………………………………………………………….4
Statement of the Problem……………………………………………………………………...6
Significance of the Study…………………………………………………………………….…7
Scope and Limitation……………………………………………………………………………9
CHAPTER II
Review of Related Literature and Studies…………………………………………………..10
Theoretical Framework……………………………………………………………..…………18
Research Hypothesis………………………………………………………………………….22
The Main Variables of the Study……………………………………………………………..22
Definition of Terms…………………………………………………………………………….23
CHAPTER III
Research Design………………………………………………………………………………25
Population and Sample……………………………………………………………………….25
Research Locale……………………………………………………………………………….25
Research Instruments…………………………………………………………………………27
Data Collection Procedure……………………………………………………………………27
Statistical Treatment of Data…………………………………………………………………29
Ethical Principles………………………………………………………………………..….….31
Reference………………………………………………………………………………………32
CHAPTER I
INTRODUCTION
2
BACKGROUND OF THE STUDY
Tuberculosis is a disease caused by a bacterium called Mycobacterium
tuberculosis that is mainly acquired by inhalation of infectious droplets containing viable
tubercle bacilli. The organism may attack other tissues in the body, but in Europe and
North America, the lungs are most frequently the primary site of invasion-although most
organs in the body can be attacked (Walsh, 2002) and this kind of tuberculosis is called
Pulmonary Tuberculosis.
Pulmonary Tuberculosis (PTB) is a contagious bacterial infection that involves
the lungs, but may spread to other organs. Only about 10% of people infected with M.
tuberculosis ever develop tuberculosis disease. Many of those who suffer TB do so in
the first few years following infection, but the bacillus may lie dormant in the body for
decades. Pulmonary tuberculosis frequently goes away by itself, but in 50%-60% of
cases, the disease can return.
People infected with TB bacteria have a lifetime risk of falling ill with TB of 10%.
When a person develops active TB, the symptoms (cough, fever, night sweats, weight
loss etc.) may be mild for many months. This can lead to delays in seeking care, and
results in transmission of the bacteria to others. People ill with TB can infect up to 10-15
other people through close contact over the course of a year. Without proper treatment
up to two thirds of people ill with TB will die (World Health Organization, 2012).
Philippines has the ninth highest number of Pulmonary Tuberculosis (PTB) cases
in the world and the highest in Southeast Asia (World Health Organization, 2012).
Globally, there were more than nine million new cases and about 1.7 million deaths
3
from the disease in 2006; the WHO estimates there are more than 14 million people
living with PTB, which kills 75 Filipinos each day (Department of Health, 2012).
Over the years, the government, with the private sector and humanitarian
community, has steadily made gains against tuberculosis. The Directly Observed
Treatment Short-course (DOTS) program, recommended in the mid-1990s by the WHO,
played an important role in this success (Humanitarian News and Analysis, 2012).
DOTS required patients to take their medicine in front of a health worker to ensure
proper compliance with the entire treatment program. It is considered as one of the
most effective methods of ensuring patient compliance. With DOTS, health care
providers can achieve a higher cure rate and expand services to detect more TB cases.
The program is open for all suspected TB patients regardless of one’s status life
(Humanitarian News and Analysis, 2012).
Patients who are diagnosed with TB are distressed and face challenges that they
need to cope up with it. As healthcare providers, listening to these patients is important
because it will help them cope up with their disease. According to Lazarus, copingis
defined as “constantly changing cognitive and behavioral efforts to manage specific
external and/or internal demands that are appraised as taxing or exceeding the
resources of the person” (Lazarus &Folkman, 1984, pp. 141). This definition is
intimately related to the concept of cognitive appraisal and hence to the stress-relevant
person-environment transactions. Most approaches in coping research follow Folkman
and Lazarus (1980, pp. 223) efforts made to master; tolerate or reduce external and
internal demands and conflicts among them (Folkman and Lazarus, 1980). Lazarus and
Folkman’s concept of coping defines how a person reacts to a stressful event. An
4
individual’s way of coping to stressful encounters can be assessed based on the
cognitive-phenomenological theory of stress and coping by Lazarus and Folkman. For
instance, young people uses proportionately more active, interpersonal problem-
focused forms of coping than do the other people, while the older people uses
proportionately more passive, intrapersonal emotion-focused forms of coping than do
the younger people. Coping, when considered as a process, is characterized by the
dynamics and changes that are a function of continuous appraisals and reappraisals of
the shifting person-environment relationship (Folkman, et.al, 1986).
The coping of Pulmonary Tuberculosis patients undergoing DOTS in relation to
Folkman and Lazarus way of coping is to describe what type of coping has the client
have and these types are: confrontive coping, distancing, self-controlling, seeking social
support, accepting responsibility, escape-avoidance, planful problem solving and
positive reappraisal.
These coping mechanisms of TB patients may be affected by how the nurse’s
caring factors will be applied.The carative factors deal with those features of caring that
mainly involve appraising patient health preferences and requirements, planning to
address those preferences, sharing to meeting patient health targets and assessing the
usefulness of the caring processes in developing gradually patient health and healing
(Backer , 2003 )
The changes in the health care delivery systems around the world have
intensified nurses’ responsibilities and workloads. Nurses must now deal with patients’
increased acuity and complexity in regard to their health care situation. Despite such
5
hardships, nurses must find ways to preserve their caring practice and Jean Watson’s
caring theory can be reviewed in this study (Cara, 2003).
The study aims to correlate caring abilities of nurses as perceived by patients
with Pulmonary Tuberculosis (PTB) undergoing DOTS program and the patient’s ability
to cope in the said disease. The results or solutions of this study will serve as an
indicator of the quality of care rendered by nurses in practice to pulmonary tuberculosis
patients. Furthermore, the results will identify the present type of coping of these
patients which will help the nurses adjust the care that they are currently giving to the
patients with PTB.
STATEMENT OF THE PROLEM
The purpose of the study is to determine the nurse’s caring factors and coping
mechanisms of patients diagnosed with pulmonary tuberculosis undergoing Directly
Observed Treatment Short-course (DOTS) program in a selected hospital.
Specifically, the study would like to answer the following questions:
1.) What are the caring factors of nurses as perceived by patients with pulmonary
tuberculosis undergoing Directly Observed Treatment Short-course (DOTS) program?
2.) What are the coping mechanisms of patients with pulmonary tuberculosis
undergoing Directly Observed Treatment Short-course (DOTS) program as perceived
by nurses?
3.)Is there a significant relationship between nurse’s caring factors and coping
mechanisms of patients with pulmonary tuberculosis undergoing Directly Observed
Treatment Short-course (DOTS) program?
6
SIGNIFICANCE OF THE STUDY
This study will discuss the new information and evidences of the nurses’ caring
factors and coping mechanisms of patients with PTB. Provide information that
establishes the rationale for selecting the research problem as important for society in
general and for nursing in particular and it is expected to contribute to the following
beneficiaries:
Nursing Practice
The study will greatly aid the nursing practice as it will expand more thoughts to
nurses in caring patients with pulmonary tuberculosis. In using the carative factors of
Jean Watson’s theory in the nursing practice, it will help develop a good patient-nurse
interaction that could give systematic approach in decision making by developing a
more enhanced interventions in the nursing practice. The patient-nurse interaction will
highly contribute in the progress of the patient’s health condition and this will also
develop a multidisciplinary approach that would ensure successful outcome. The study
will provide the provision for the supportive, protective, mental, physical, sociocultural
and spiritual environment in the nursing practice.
Nursing Administration
This research study aims to help the nursing administration to have increase
knowledge to inform the members of the health care team, and to guide nursing staff to
the most appropriate nursing caring factors that will surely have an effect to their
patients coping and healing process. They can gather data about the research study
that will help increase their ability to improve nurses’ caring factors.
7
Nursing Education
In relation to nursing education, this research study can help the nursing
educators in teaching their students with the proper nursing care management related
to the nurses’ caring factors and coping mechanisms. This will help them give more
knowledge and holistic care to patients with Pulmonary Tuberculosis. This will also help
the nursing educators andclinical instructors in teaching thestudents about the factors of
nursing care and its relation to coping mechanism of Pulmonary Tuberculosis patients
under Directly Observed Treatment Short-course (DOTS) program. Nursing educators
or clinical instructors will be informed based on the findings of the research study for an
improved quality care for the patients.
Nursing Research
This research study aims to help researchers to have general information about
pulmonary tuberculosis patients undergoing DOTS program in a selected hospital
regarding their coping mechanisms and nurses’ caring factors. The results can become
useful data to improve the future researchers’ knowledge and understanding about the
topic. The study can also be a guide to have a better research studies.
8
SCOPE AND LIMITATION
The study will cover the topics about the nurse’s caring factors and coping
mechanisms of pulmonary tuberculosis patients undergoing Directly Observed
Treatment Short-course (DOTS) conducted from a selected hospital. The study will
focus on the nurses’ caring factors as perceived by the patients and also the coping
mechanisms of patients perceived by the nurses.
Through the process, the respondents of the study will be chosen randomly. The
study will cover approximately 20-30 patients with pulmonary tuberculosis undergoing
DOTS program from a selected hospital and about 5-10 nurses who provide care to
these patients.
The study will be conducted in a selected hospital in Quezon City. The hospital
was selected by the researchers because it has numbers of tuberculosis patients
undergoing DOTS.
The study will be accomplished through a step-by-step process. Starting with
data gathering procedure by means of structured interviews and surveys to the selected
respondents namelythe PTB patients and the staff nurses assigned to these specified
patients.
The exclusion criteria includephysically, mentally and emotionally disabled
patients. Only patients willing to cooperate with the researchers’ study are allowed to
answer the survey. The study will be conducted with a span of 2-3 months starting June
2013.
9
CHAPTER II
REVIEW OF RELATED LITERATURE AND STUDIES
In this chapter, related studies and literature about Pulmonary Tuberculosis and
coping mechanism and carative factors will be discussed in relation to the research
study.
Tuberculosis in the Philippines
The Department of Health (DOH) reported lower Tuberculosis (TB) prevalence.
The Philippines has itself made great strides in fighting TB. From a high mortality rate of
38.2 deaths per 100,000 population in 1990, the Philippine Health Statistics reported a
lower rate of 31/100,000.
According to the WHO, more than two billion people – one third of the world’s
total population – are infected with TB bacilli. One in every 10 of those people will
become sick with active TB in their lifetime. People living with HIV are at a much greater
risk. A total of 1.77 million people died from TB in 2007 (including 456,000 people with
HIV), equal to about 4,800 deaths a day. TB is a disease of poverty, affecting mostly
young adults in their most productive years. The Philippines is among the 22 high
burden countries for tuberculosis, according to the WHO. According to the 2nd National
Prevalence Survey done in 1997, most TB patients belong to the economically
productive age-group (15-54 years old).
Overcoming Tuberculosis
Thorn (2007) stated that Isolation is the hardest part of having TB, wherein
patients must stay away from other people who are vulnerable in developing and active
TB disease. Isolation of the patients contributes a unique set of coping problems. The
10
study has considered a long period of isolation to patients and was found out that they
have developed depression, anxiety and disorientation. Some patients also experienced
odd sleeping patterns and mood swings. Patients were advised to temporarily isolate
themselves from a great number of people to avoid spreading their disease. Isolation
does greatly affect patients in a very subtle way. He also stated the benefits of DOTS
program that would greatly help in coping with regards to the problems of those patients
with TB having a difficulty in adjusting.
According to Lewis and Newell (2009), health workers should be aware of all
aspects regarding the caring and treatment they will render to patients with tuberculosis.
Effective medical treatment is just one of the procedures that will help patients recover
from tuberculosis. Healthcare workers should also interact with these patients so that
they will be engaged in the curing process of their disease. With this, patients will have
the advantage of gaining knowledge about the disease and its treatment for healthcare
workers will also complement the medical treatment with health teachings about the
disease. Thus, another study supports the same principle in taking care patients with
tuberculosis.
National Tuberculosis Controllers Association (2011) said that healthcare
workers provide consistent and concise documentation throughout the case
management and treatment process. Expected documentation provides an ongoing
clinical picture of the patient and the patient’s progress to cure, while ensuring continuity
of care. Case management, with appropriate documentation, provides the framework
that enables the public health nurse to ensure that the TB patient completes treatment
and is able to be discharged from the TB program.
11
Coping Strategies
Coping is the way people act to lessen the burden they are carrying or the stress
they feel. They do certain things to fit or somehow manage their current situation
(Kiel,2004).
Being healthy or sick is related to the knowledge the person has regarding the
disease or illness and it also depend on the available coping resources. Their body feels
what it feels according to their interactions to others and to their environment. It is in
their will and capacity on how to deal with it for it is part of being human and permeates
their whole life if they find it hard to solve thus other researchers have the same idea for
it happens to each historical period of humanity (Burtson and Stichler, 2010).
In the study of Lyon (2010), she paid attention with regards to reconciling the
diverse views of stress, coping, and health for nursing. She used different theoretical
approaches for her to be able to interrelate stress, coping, and health. And it was seen
in her study that those three concepts are interrelated. Meaning, each concept indicated
directly affects the other. It stated that coping involves managing the stressful situation
that will lead to persons coping with his/her environment.
However, another study of Naughton stated that there are effects of stress that
are directly related to coping mechanisms. All of fields of psychology such as health
psychology, environmental psychology, neuropsychology and developmental
psychology are the start of encompassing a huge variety of disciplines to the fields of
medicine including the area of anthropology and sociology. The three broad
components of coping strategies will provide a better understanding of what the
seemingly immense is about.
12
According to Plotnik and Kouyoumdjian (2008), there are two kinds of coping and
these are Problem-focused coping which means the patient try to decrease stress by
solving the problem through seeking information, changing own behavior, or taking
whatever the action is needed to resolve the difficulty and second, emotion-focused
coping which means that the patient do things primarily to deal with their emotional
distress, such as seeking support and sympathy or avoiding or denying the situation.
Reichman (2000) places the blame at the feet of the medical sector and
politicians. Perhaps their reluctance to change current practice is understandable,
although wrong. Changes in the design of treatment delivery do not always dramatically
reduce costs to the health department; and it is these costs that health professionals
and politicians care about most. But as has been shown in this study, the treatment of
tuberculosis, particularly with the DOTS regime, substantially reduces the costs of the
illness to patients and their families. Once these costs are taken into account, there is a
compelling case for treatment for tuberculosis to be given a high priority by decision-
makers and for DOTS to be adopted as the treatment regime.
Stressors, coping mechanisms and quality of life among TB patients
Somaya (2012) stated that patients with TB have many related illness such as
pain, financial problem and dependency, stigma and threat to self-esteem. It was stated
that a patients with illness related stressors may affect their emotional, physiological
and behavioral reactions. With this, according to the study, nurses could provide
optimum health by proving support, information, critical analysis and alternative
problem-solving strategies.
13
Caring and the Professional Practice of Nursing
Jean Watson stated that, “Caring is a science that encompasses a humanitarian,
human science orientation, human caring processes, phenomena, and experiences.
Caring science includes arts and humanities as well as science”. A caring science
perspective is grounded in a relational ontology of being-in-relation, and a world view of
unity and connectedness of all. As such, caring science is rapidly becoming an
Interdisciplinary Transdisciplinary field of study. It has relevance to all the health,
education human service fields and professions (Watson, 2003).
Caring takes place when nurse and patient meet. Nurses interact with patient
and that reveals the nature of care (Shoenhofer, 2002). Thus, caring from nurses
enhance patients health and this explains that caring exists even with caring otherwise
curing cannot be attain without caring (Watson, 2003).
There are ten carative factors and these are: Formation of a humanistic- altruistic
system of values; installation of faith-hope; cultivation of sensitivity to one’s self and to
others; development of a helping-trust relationship; promotion and acceptance of the
expression of positive and negative feelings; systematic use of the scientific problem-
solving method for decision making; promotion of interpersonal teaching-learning;
provision for a supportive, protective and /or corrective mental, physical, socio-cultural
and spiritual environment; Assistance with the gratification of human needs; allowance
for existential-phenomenological forces (J. George, 2008).
According to Watson, promotion of health, prevention of illness, caring for the
sick and restoration of health are prominent factors in nursing and practice of caring in
this field is based on holistic care that is essential for the well-being of patients and
14
aside from the assistance given by nurses to promote quality care, nurses are also
active participants for patient to gain self-actualization.
Watson’s theory of Human Caring
Adeline (2000) states that a humanistic altruistic value system of a person begins
at birth and continuously developed through consciousness and introspection by
interacting with the society we live in which enhance the caring – healing where it
interacts with the carative factor she called as “faith - hope”. That allows the nurse to be
authentically present with patients. She also said that human caring is influenced by the
values of person such as loudness, concern, and love of self and others which enhance
therapeutic effects of faith – hope.
According to Watson as inspired by Carl Roger’s work in order for the nurse to be
able to do his responsibilities to his patients, the nurse must have a balanced sensitivity
to self which is the foundation to empathy. Sensitivity to self can be developed by
reflecting values, beliefs, thoughts, feelings and experiences in life as well as in the
clinical area and the evaluate transpersonal caring (Adeline, 2000).
The transpersonal caring relationship
According to Adeline (2000) Watson’s have four carative factors that focus on the
transpersonal caring relationship. Faith hope is one of the important carative factors on
nurse patient relationship. Faith Hope extends beyond the nurse’s understanding of the
integration of mind, body spirit it involves posturing faith hope based on the patient’s
belief system. Sensitivity to self is important for the preparation of nurse to care. Helping
trusting is also an important carative factors that involves in nurse patient relationship,
15
Watson states that the development of this factor helps in maintaining the integrity of
the patient (Adeline, 2000)
As noted she focus her thinking on the therapeutic relationships and
communication to the work of Carl Roger’s and found out that congruency, empathy and
warmth are the found action that helps in the expression of patient’s emotions.
Congruency refers to authenticity and genuiness while empathy means understanding
both the content and emotion of the patient and warmth is the degree of which the nurse
conveys caring to the patient.
Caring processes
According to Adeline (2000), the five remaining carative factors which are primarily
involved in assessing patient health, prioritizingthe patient health goals and evaluating
the effectiveness of caring processes in promoting client health and healing. These
carative factors are effective if nurses and patient are together in deciding caring
processes. These involve creative and reflective problem solving or nursing care
process that is helpful in guiding content and organizing assessment of patients in
which permits interaction of multiple factors that also includes the personal on intuitive,
aesthetic and ethical knowledge.
Transpersonal teaching learning is one of the nursing activities where in both
nurse and patient will teach and learn from each other. It involves the entire significance
of the patient’s response to the health concerns and also explores patient’s perception
about his condition. So teaching – learning is based on gaining knowledge and skills
that are important in developing self-efficacy (Adeline, 2000).
16
THEORETICAL FRAMEWORK
The study will be conducted to determine the nurse’s caring factors and coping
mechanisms of patients diagnosed with pulmonary tuberculosis undergoing Directly
Observed Treatment Short-course (DOTS) program in a selected hospital.
Jean Watson’s Lazarus’ Concept
Carative Factors of Coping
17
Formation of a humanistic- altruistic system of values
Installation of faith-hope
Assistance with the gratification of human needs
Promotion of interpersonal teaching-learning
Allowance for existential-phenomenological forces
Development of a helping-trust relationship
Cultivation of sensitivity to one’s self and to others
Systematic use of the scientific problem-solving
method
Provision for a supportive mental, physical…env’t
Promotion& acceptance of the expression of positive &
negative feelings
Pulmonary Tuberculosis
Patients undergo Directly Observed Treatment Short-course (DOTS)
Program
Positive reappraisal
Planful problem solving
Escape-avoidance
Accepting responsibility
Seeking social support
Self-controlling
Distancing
Confrontive
Watson’s Ten Carative Factors are based on a dynamic phenomenological
approach related to the nurse-patient relationship.
The first factor is the formation of humanistic and altruistic values. It is learned
early in life but continues to be influenced through interactions with parents, family,
friends, and others, including nurse educators (Neil, 2002).
The second factor is the instillation of faith and hope. It integrates humanistic and
altruistic values, aid the promotion of holistic nursing care and positive health within the
patient population. This factor also states that by helping patients adopt health-seeking
actions, the nurse can help develop an effective nurse-patient interrelationship (Neil,
2002).
The third factor is the cultivation of sensitivity to self and others. It means self-
acceptance and acknowledgement of feelings for both nurse and patient (Neil, 2002).
The fourth factor is the development of a helping-trust relationship. It is very
important for transpersonal caring. A helping-trust relationship encourages the
expression of both positive and negative feelings (Neil, 2002).
The fifth factor is the promotion and acceptance of the expression of positive and
negative feelings. It is a risk-taking experience for both nurse and patient. Nurses
should be ready for a positive or negative expression of feelings carried out by the
patient (Neil, 2002).
The sixth factor is the systematic use of the scientific problem-solving method for
decision making. It is the utilization of the nursing process in the provision of care to
patients. Thus, this factor eliminates the belief that nurses are handmaids of doctors
(Neil, 2002).
18
The seventh factor is the promotion of interpersonal teaching and learning. It
separates nursing from curing. This factor allows the patient to have a sense of
responsibility over his/her own health. The nurse helps the patient in acquiring this
responsibility through teaching-learning techniques. These techniques are geared at
enabling patients to provide self-care, determine personal needs, and provide
opportunities for their personal growth (Neil, 2002).
The eighth factor is the provision for supportive, protective and corrective mental,
physical, sociocultural and spiritual environment. It implies that nurses must recognize
the influence internal and external environments have on the health and illness of
individuals (Neil, 2002).
The ninth factor is the assistance with the gratification of human needs. It
involves the nurse’s recognition of the biophysical, psychological, psychosocial and
intrapersonal needs of patients. Following Maslow’s hierarchy of needs, patients must
answer lower needs first before moving up to satisfy higher needs (Neil, 2002).
The last factor is the allowance for existential-phenomenological forces. It
describes the relevant information needed by an individual to understand the present
situation. This factor aims to a better understanding of self and others (Neil, 2002).
The caring factor survey tool will be used to assess the perception of care that
patients with pulmonary tuberculosis receive from the nurses.
Coping, when considered as a process, is characterized by dynamics and changes that
are a function of continuous appraisals and reappraisals of the shifting person-
environment relationship. Shifts may result from coping efforts that are directed outward
19
toward changing the environment or efforts that are directed toward changing the
meaning of the event (Lazarus and Folkman, 1988).
The patient’s perception of Watson’s caring factors is assessed using the caring
factor survey tool and it will describe the interrelationship to the ways of coping
questionnaire by Lazarus. The caring factor survey will determine whether or not the
nurses are providing the carative factors to the patients as based on the patients’
perception per se. the utilization of the carative factors on patient care will be correlated
with the extent of the patient’s coping mechanism in a healthcare environment.
RESEARCH HYPOTHESIS
20
Based on the specific questions raised in the statement of the problem, the
researchers hypothesized the following:
1.) There is no significant relationship between the nurse’s caring factors to the coping
mechanisms of patients with pulmonary tuberculosis undergoing Directly Observed
Treatment Short-course (DOTS) program.
THE MAIN VARIABLES OF THE STUDY
The major variables under investigation are the nurse’s caring factors and the
coping mechanisms of pulmonary tuberculosis patients undergoing Directly Observed
Treatment Short-course (DOTS). The independent variable is the nurse’s caring factors
whereas the dependent variable is the coping mechanism of pulmonary tuberculosis
(PTB) patients.
The researchers will be using the Caring Factors Survey developed by Jean
Watson and her colleagues to measure the nurses caring factors to patients undergoing
Directly Observed Treatment Short-course (DOTS) Program in the selected tertiary
hospital in Quezon City. The patients would be asking to answer fifteen questions about
their perception regarding the care that they receive from the nursing staff.
After the study, the hospital administrator will be able to note if the caring factors
of the nurses help in improving the condition of their patients.
The coping mechanism will be measured using the Ways of Coping
Questionnaire. This questionnaire is used to identify the extent of coping of individuals
with stressful events they encounter in the institution. It comprises of thirty two item
cognitive and behavioral strategies under eight-coping scales.
DEFINITION OF TERMS
21
For better understanding of the terms used in the study, the following
terminologies were conceptually and operationally defined.
1.) Coping
It consists of constantly changing cognitive and behavioral efforts to manage
specific external and/or internal demands that are appraised as taxing or exceeding the
resources of the person (Lazarus and Folkman, 1984).
Refers to the patient’s response on the coping strategies they utilize when given
a stressful situation. The extent of coping is measured in this study by using a
standardized questionnaire developed by Lazarus. For each question, they will be
asked to indicate, by circling 5 for “always”, 4 for “frequently”, 3 for “occasionally”, 2 for
“rarely”, and 1 for “never”, to what extent they used it in the situation.
2.) Directly Observed Treatment Short-Course Program
It is a comprehensive strategy endorsed by the World Health Organization
(WHO) and International Union against Tuberculosis and Lung Diseases (IUATLD) to
detect and cure TB patients. There are five elements of DOTS that need to be fulfilled.
These are: political commitment; quality sputum microscopy for diagnosis; regular
supply of anti-TB drugs; standardized recording and reporting of TB data; and
supervised treatment by a treatment partner (Department of Health, 2012).
Refers to a program by the Department of Health utilized by the patients
diagnosed with pulmonary tuberculosis. The respondents of the study are those TB
patients undergoing DOTS within 6-8 months.
3.) Nurse’s Caring Factors
22
The act of providing Nursing care that attempts to honor the human dimensions
of nurse’s work and the inner life world and subjective experiences of the people we
serve (Cara, 2000).
Refers to the patient’s response about how they feel regarding the care they are
currently receiving from the nursing staff. The nurse’s caring factors are measured in
this study by using a standardized questionnaire developed by Jean Watson and her
colleagues. For each questions, they will be asked to indicate how much they agree or
disagree with the statement. They would be marking their response by filling in the
circle, 5 for “always”, 4 for “frequently”, 3 for “occasionally”, 2 for “rarely”, and 1 for
“never”, that best represents their opinion.
23
CHAPTER III
RESEARCH METHODOLOGY
RESEARCH DESIGN
The study is a quantitative non-experimental correlation design, because it
describes the existing phenomena which are the nurse’s caring factors and the patient’s
coping mechanism without manipulating the conditions that affects the subject’s
responses. It also does not involve manipulation of the independent variable which is
the nurse’s caring factors. Thus, the research tends to correlate the existing variables
involve in the study.
POPULATION AND SAMPLE
The population of the study includes TB patients undergoing Directly Observed
Treatment Short-course (DOTS) program and nurses that are contributing caring
attributes to gain their optimal health on a selected hospital where the study will be
obtained. The population includes 20-30 patients undergoing Directly Observed
Treatment Short-course treatment (DOTS) program and 5-10 nurses who provide care
to these patients as the respondents of the study. Patients who are physically, mentally
and emotionally disabled are excluded in the population and sample.
Randomized sampling was used as the sampling technique, wherein the willing
and available participants were assigned to treatment conditions at random. Through
this the researchers can avoid systemic biaswhich could affect outcome variables.
RESEARCH LOCALE
The study will be conducted at the selected tertiary hospital located in Quezon
City, with the Pulmonary Tuberculosis patients undergoing Directly Observed Treatment
24
Short-course (DOTS) program and the staff nurses providing care to them as
respondents.
The researchers chose the tertiary hospital to get their study population for being
a well-known institution for lung diseases which provides quality health care through
excellent service, training and research as greatly emphasized to their mission and
vision. Moreover, the researchers have already started communicating to the research
and training department of the said institution.
The selected tertiary hospital is situated at the heart of Quezon City. At present
the center has 210 bed capacities along with numerous programs and services
specifically focused on lung diseases. One of the said services where it was established
in early 2000 and was a self – installed public – private mix DOTS clinic certified by the
Department of Health (DOH), and accredited by the PhilHealth Insurance Corporation. It
became a satellite DOTS Plus Clinic in the year 2004 through tripartite coordination
between the DOH, Tropical Disease Foundation Inc., and the selected tertiary hospital
in Quezon City. According to the institution data statistics, the treatment outcome of
patients treated for pulmonary tuberculosis at the center has seen remarkable success.
Eighty-eight percent of their cases were cured in 2004 and partial result for 2005
revealed a success break of one hundred percent among the smeared positive cases.
These results have surpassed the expected global outcome of curing at least 85% of TB
cases detected. Thus, the tertiary hospital in Quezon City being in the process of
acquiring state-of-the-art facilities and providing top quality care at affordable costs to
the thousands of Filipinos is indeed a place of choice for the study.
25
RESEARCH INSTRUMENTS
The researchers will be using three instruments for the study. The first instrument
is Demographic profile. The second instrument is a 15 item Caring Factors Survey tool
developed by Jean Watson and her colleagues to measure the nurses’ caring factors to
patients undergoing Directly Observed Treatment Short course (DOTS) Program in the
selected tertiary hospital in Quezon City. The researcher’s instrument is a standard tool
and was reconstructed by eliminating items from Watson’s Caring Assessment tool
reducing it from 100 to 15 questions.
The third instrument is the Ways of Coping Questionnaire by Lazarus that will
measure the coping mechanism. It is a standard tool which comprises of 32 item
cognitive and behavioral strategies under 8-coping scales. The instrument will measure
the caring factor of nurses that affects the coping mechanism of tuberculosis patient
undergoing Directly Observed Treatment Short Course.
Lazarus ways of coping mechanisms was restructuredfrom 66 to 32 questions
due to the fact that some questions have the same thought. The researchers also made
sure that the questions are applicable for Filipino respondents diagnosedwith
Pulmonary Tuberculosis who are currently undergoing DOTS. The questionnaires were
pre tested in a pilot study that was conducted last February 5, 2013.
DATA COLLECTION PROCEDURE
The focus of the study is on the coping mechanism of patients undergoing
Directly Observed Treatment Short course (DOTS) Program and the Caring Factors of
the patients and the nurses providing care in the selected tertiary hospital in Quezon
City. Before the data collection, the researchers made a letter of consent in the selected
26
tertiary hospital in Quezon City. The initial visit to the selected institution was to
seek their consent for the study. After getting their permission, the researchers’ second
visit was to collect data using questionnaires developed by Jean Watson which is the
Caring Factors Survey and the Ways of Coping Questionnaire by Lazarus. The design
was used by the researchers is experimental randomized design wherein the table of
random numbers in choosing the respondents. Due to the limited population of patients
undergoing DOTS Program the researchers ended up with twenty (20) respondents.
The respondents needed in the study should be undergoing DOTS Program and
included in the middle age range. The researchers will collect the data starting June 30,
2013.
The steps that the researchers did in data gathering procedures are as follows:
First, the researchers made a letter of consent to be given in the selected tertiary
hospital in Quezon City to ask for their permission for the researchers to instigate study.
After the researchers made the letter and had it signed by their adviser, the researchers
submitted the letter together with the questionnaire to the head of the institution and
waited for the confirmation for them to initiate and collect the data needed in the study.
Third, the researchers went to the selected tertiary hospital in Quezon City to collect
pertinent data in the study using caring factors Survey by Jean Watson and ways to
coping questionnaire by Lazarus. The day after the researchers have collected our data,
the researchers tallied and interpreted the results and compared it with the norms and
standard.
27
STATISTICAL TREATMENT OF DATA
For this study, the researchers used the weighted arithmetic mean in getting the
results for questions 1 and 2.
In answering question number 1and 2 which is asking for the caring factors of
nurses as perceived by patients with pulmonary tuberculosis undergoing Directly
Observed Treatment Short-course (DOTS) program and coping mechanisms of patients
with pulmonary tuberculosis undergoing Directly Observed Treatment Short-course
(DOTS) program as perceived by nurses respectively, the weighted arithmetic mean
used is that:
x = w1x1+w2x2+...+wnxn
w1+w2+...+wn
Where
x = weighted arithmetic mean
∑wx= sum of all products of x and y is the frequency of each option and x is the
weight of each option
∑w= sum of all subjects
In answering question no. 3 which is asking for the significant relationship
between nurse’s caring factors and coping mechanisms of patients with pulmonary
tuberculosis undergoing Directly Observed Treatment Short-course (DOTS) program,
spearman’s rho will be used. Spearman’s rho is a statistical calculation that takes two
rankings and produces a numerical relation from 1 to -1. A score of 1 means that the
lists are identical (1,2,3,4 vs. 1,2,3,4). A score of -1 means that the lists are reversed
(1,2,3,4 vs. 4,3,2,1). A score of zero means that there is no relation whatsoever
28
between the two lists.It was developed by CharlesSpearman and will be used when
testing the significance of the relationship between two variables.
The Spearman correlation coefficient is defined as the Pearson correlation
coefficient between the ranked variables. For a sample of size n, the n raw
scores are converted to ranks , and ρ is computed from these:
Identical values (rank ties or value duplicates) are assigned a rank equal to the
average of their positions in the ascending order of the values.
In applications where duplicate values (ties) are known to be absent, a simpler
procedure can be used to calculate ρ. Differences between the ranks of
each observation on the two variables are calculated, and ρ is given by:
Where
di= difference of rank of order between the two variables
n= number of scores in each group
29
ETHICAL PRINCIPLES
Within the study it encompasses the ethical principles such as the principle of
beneficence, respect for human dignity and justice. Firstly, the principle of beneficence
because the study’s main goal is to produce benefits and alleviate their sufferings rather
than to cause harm and discomfort to the patients with pulmonary tuberculosis
undergoing Directly Observed Treatment Short-course program. Also, the respondent’s
rights from exploitation were protected by having the time allotment for the respondents
to participate in the study clearly discussed and negotiated.
Second is the principle of respect for human dignity wherein it gives the
respondents the right to decide if they will participate in the study or not. The
respondents, whoever refused to be interviewed shall not be forced nor obligated to
answer the questionnaires for it is purely voluntary. The objectives and instructions of
the questionnaires during the interview were also clearly elaborated to the respondents
to promote full understanding of the respondents regarding the questions to be asked.
The researchers even translated it in the Filipino language.
Lastly, the principle of justice, for all the respondents should be treated equally
and fairly regardless of their social status and so on and so forth. Their answers and
other related information were also kept in confidentiality to promote and provide the
respondents with privacy. Informed consent was also secured and settled. Thus,
abiding all their rights into the overall ethical principles provided for each of our
respondents participated in our study.
30
REFERENCE
Websites:
1.) Adeline, F. (2000). Watson's Philosophy, Science, and Theory of Human Caring
as a Conceptual Framework for Guiding Community Health Nursing Practice. Aspen
Publishers, Inc., volume 23, pages 34-49. Retrieved from
http://watsoncaringscience.org/images/features/library/Falk_Adeline.pdf
2.) Aye R., Wyss K., Abdualimova H., Saidaliev S. (2011). Factors determining
household expenditure for tuberculosis and coping strategies in Tajikistan. Retrieved
from http://web.ebscohost.com/ehost/detail?vid=12&sid=6e353808-496a-
4853819e5230184907c2%40sessionmgr4&hid=112&bdata=
JnNpdGU9ZWhvc3Q%253 d%3d#db=rzh&AN=2010969456
3.) Balita, Ph (2010). DOH reports lower TB prevalence as it marks 2010 World TB
Day. Retrieved from http://balita.ph/2010/03/25/doh-reports-lower-tb-prevalence-as-it-
marks-2010-world-tb-day/
4.) Boot, C. (2009). ‘‘My Lung Disease Won’t Go Away, it’s There to Stay’’: Profiles
of Adaptation to Functional Limitations in Workers with Asthma and COPD. Retrieved
from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=04703717-e4c8-492f-
ba62-bdce494c8370%40sessionmgr115&vid=2&hid=110
5.) Burtson, P., Stichler, J.(2010). Nursing work environment and nurse caring:
relationship among Motivational factors. Retrieved from
http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=56109e10-88d0-49b1-b00e-
7c10e88aa84f%40sessionmgr4&vid=2&hid=15
31
6.) Cara, C., (n.d.). A pragmatic View of Jean Watson’s Caring theory. Retrieved
from http://www.humancaring.org/conted/Pragmatic%20View.doc
7.) Damazo, L. (2012). PHILIPPINES: Tuberculosis remains a major killer. Retrieved
from http://www.irinnews.org/Report/78539/PHILIPPINES-Tuberculosis-remains-a-
major-killer
8.) Drach-Zahavy, A. (2009). Patient-centred care and nurses’ health: the role of
nurses’ caring Orientation. Retrieved from
http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=5a48b389-b890-465d-a7bd-
9afec0c57f8f%40sessionmgr14&vid=2&hid=15
9.) Hudacek, S. (2008). Dimensions of caring: A Qualitative Analysis of Nurses’
stories. Retrieved from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?
sid=db2ab9b9-02b9-4765-b87e-73faa1600ef1%40sessionmgr114&vid=2&hid=9
10.) Johnson, M., et.al (2000). Patients' Perceptions of Physicians' Recommendations
for Comfort Care Differ by Patient Age and Gender, Vol.15, Number 4, pages 248-255.
Retrieved from PubMed Central Database:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495435/
11.) Krohne, H. (2002). Stress and Coping Theories. Page 4-6
12.) Lazarus, R. (1993). Coping Theory and Research: Past, Present, and Future,
pages 234-247. Retrieved from http://www.emotionalcompetency.com/papers/coping
%20research.pdf
13.) Lewes, C., Newell, J. (2009). Improving tuberculosis care in low income
countries-a qualitative of patients’ understanding of “patien t support” in Nepal. BMC
Public Health. Retrieved from http://www.biomedcentral.com/1471-2458/9/190
32
14.) Lyon, B. (2010). A conceptual overview: Stress, coping and health. Retrieved
from http://www.sagepub.com/upm-data/44174_1.pdf
15.) National Tuberculosis Controllers Association (2011). TUBERCULOSIS
NURSING: A comprehensive guide to nursing care, 2nd ed.. Retrieved from
http://www.ndhealth.gov/disease/tb/Documents/TBNursingManual06132011.pdf
16.) Naughton, F. (1997). Stress and coping. California State University, Northridge.
Retrieved from http://www.csun.edu/~vcpsy00h/students/coping.htm
17.) Nursing theories (2012). Jean Watson's Philosophy of Nursing. Retrieved from
http://currentnursing.com/nursing_theory/Watson.html
18.) Program: Tuberculosis case finding and treatment ("DOTS" approach), 2009.
Retrieved from http://www.givewell.org/international/technical/programs/DOTS
19.) Smith, C. and Kirby, L. (n.d.). “The Role of Appraisal and Emotion in Coping and
Adaptation”. Handbook of Stress Science: Biology, Psychology and Health, Section III,
Chapter 15, page 197. Retrieved from http://books.google.com.ph/books?
id=EXVlk8pnEKIC&pg=PA197&lpg=PA197&dq=definition+of+coping+by+lazarus+and+f
olkman&source=bl&ots=nRJyFEsdNC&sig=fHYv06IfGL4jhm8ggP-
UFMleQe0&hl=fil&sa=X&ei=GMT4UNzZG4rprQfS7IHQBw&ved=0CEgQ6AEwAw#v=on
epage&q=definition%20of%20coping%20by%20lazarus%20and%20folkman&f=false
20.) Reichman, D. (2000). The economic impacts of tuberculosis: The stop TB
initiative, Section 2, Page 16. Retrieved from
http://www.stoptb.org/assets/documents/events/meetings/amsterdam_conference/
ahlburg.pdf
33
21.) Republic of the Philippines Department of Health (2011). National Tuberculosis
Control Program. Retrieved from http://www.doh.gov.ph/node/367.html
22.) Rhodes, M., Morris, A., Lazenby, R. (2011). Nursing as its Best: Competent and
Caring. The Online Journal of Issues in Nursing (OJIN). Retrieved from
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/
ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No2-May-2011/Articles-Previous-
Topics/Nursing-at-its-Best.html
23.) Somaya, A. (2012). Stressors, coping mechanisms and quality of life among TB
patients page 156. Retrieved from
https://www.lappublishing.com/catalog/details//store/gb/book/978-3-8484-8820-9/
stressors,-coping-mechanisms-and-quality-of-life-among-tb-patients
24.) Suliman, W., et. al. (2009). Applying Watson's Nursing Theory to Assess Patient
Perceptions of Being Cared for in a Multicultural Environment. Retrieved from
http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=ce01b50f-df0c-4efa-a624-
817978847fba%40sessionmgr112&vid=2&hid=9
25.) The American Heritage Dictionary of the English language, 5th ed., 2008.
Retrieved from http://ahdictionary.com/word/search.html?
q=hospital&submit.x=52&submit.y=19
26.) Thorn, P. (2007). Overcoming Tuberculosis: A Handbook for Patients, chapter 1,
pages 1-4. Retrieved from http://www.tbsurvivalproject.org/OVERCOMINGinside.pdf
27.) Vance, T., (n.d.). “Caring and the Professional Practice of Nursing”. Retrieved
from http://rnjournal.com/journal-of-nursing/caring-and-the-professional-practice-of-
nursing
34
28.) Ver, J. (2010). Tuberculosis in the Philippines today. Retrieved from
http://thepoc.net/thepoc-features/health-and-wellness/health-and-fitness-features/5266-
world-tuberculosis-day-awareness-philippines.html
29.) Watson, J. (2007). Watson’s theory of human caring and subjective living
experiences: Carative factors/Caritas processes as a disciplinary guide to the
professional nursing practice, volume 16, pages 129-135. Retrieved from
http://www.scielo.br/pdf/tce/v16n1/a16v16n1.pdf
30.) Williams, G., et. al (2007). Best Practice for the care of patients with
tuberculosis. International Union against Tuberculosis and Lung Disease, page 23.
Retrieved from https://www.google.com.ph/url?sa=f&rct=j&url=http%3A%2F
%2Fwww.theunion.org%2Findex.php%3Fid%3D92%26cid%3D2110%26fid
%3D57%26task%3Ddownload%26option%3Dcom_flexicontent%26Itemid
%3D240%26lang
%3Den&q&esrc=s&ei=l3gxUazTOK6yiQf7uYDYDQ&usg=AFQjCNG3vXHll8tMCzM24Y
AzodsRjsF0Qg
31.) World Health Organization (2012). “Tuberculosis”. Retrieved from
http://www.who.int/topics/tuberculosis/en/
32.) World Health Organization (2013). Tuberculosis Fact sheet N°104. Retrieved
from http://www.who.int/mediacentre/factsheets/fs104/en/
Books:
1.) Carlson, N., et.al (2007). Psychology: The Science of behavior. Chapter 16:
Lifestyle, stress and health pages 536-539. Ref#: Cir BF121 P88 2007
35
2.) George, J.(2008). Nursing Theories: The Base for Professional Nursing Practice, 5th
ed., pages 410. Ref#: Cir RT 84.5 N8 2008
3.) Nelson, K., Williams, C. (2007). Infectious Disease Epidemiology Theory and
Practice, chapter 18, pages 653-689. Ref#: Cir RA 643 I5 2007
4.) Plotnik, R., Kouyoumdjian, H. (2008). Introduction to Psychology, module 21: Health,
stress, coping, 8th ed., pages 499. Ref#: Cir BF 121 P6 2008
5.) Tomey, A., Alligood, M. (n.d.). Nursing Theorists and their work, 5th ed., chapter 11,
pages 145-150
6.) Walsh, M. (2002). Watson’s Clinical Nursing and Related Sciences, 6th edition, page
352. Ref#: Cir RT 65 W3 2002
7.) Walsh, M., Crumbie, A. (2007). Watson’s Clinical Nursing and related Sciences, 7th
ed., chapter 14, pages 344-346. Ref#: Cir RT65 W3 2007
8.) Weiten, W. (2008). Briefer Version Psychology: Themes and Variation, 7th ed.,
chapter 13, page 381. Ref#: Cir BF121 W4 2008
Theses:
1.) Anchenar, I. (2010). Factors Affecting non-adherence to TB DOTS program
among patients: basis for a proposed health education guide. Ref#: Thesis RC 306 I5
2010
2.) Enriquez, K., et al (2009). The relationship between the Nurse's Caring Factors
and the extent of Coping of Lung Cancer patients in a selected special tertiary hospital
in Quezon City.
3.) Joel, M. (2011). Proposed Sanitarium Complex: Incorporating Green Architecture
to TB disease.Ref# Cir RC 309.5 P5M4 2011
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