Patient’s Sociocultural Differences and the Delivery of Nursing Care Needs among patients in Tagum Doctor’s Hospital, Tagum City, Davao Del Norte A Thesis Presented to the Faculty and Panel of Tagum Doctor’s College, Inc. Tagum City, Philippines In Partial fulfilment of the Requirements for the Bachelor’s Degree in NURSING by: Cliff Mark S. Babalcon Mark Janrel G. Genito Eddie King B. Manguilimotan Sheguila V. Milan Sahar Ayesha Maong Zumbaga January 2020 ACKNOWLEDGEMENT The completion of this research study would not be possible without the help and assistance of many people, whose may not be enumerated. Their contribution are sincerely appreciated and gratefully acknowledged. Moreover, we would like to express our deepest appreciation to the following: The researchers would like to extend our warmest gratitude to the panelist, particularly Mrs. Anabelle Franada, RN, MN, our chairman for research study for her patience, dedication and support during the process of finalizing our research study. As well as to Manuel Dennis Molina our school vice president, and to Hon. Joel A. Padoran, MD our school president; To our dean, Mrs. Willyn B. Adrias, RN, MN, for her valued time shared, patience, understanding, and brilliant ideas to improve our study; To our clinical instructor and research adviser, Myka Allene Catoto, RN, USRN, our for her valuable time shared, patience, understanding, guiding and sharing her brilliant ideas and suggestions to improve our research study. We would like to express our warmest gratitude and thank you for this endeavor; Our sincere thanks to Hon. Joel A. Padoran the president of Tagum Doctors Hospital inc., for giving us the permission to conduct our study. Our utmost appreciation to the respondent who helped in the completion of this research; and To our parents, who gave us the never ending and unconditional love and support, and above all, to our Almighty God and Allah, who is always the source of inspiration, strength and wisdom to the researcher in the completion of this work. Sincerely yours, The Researchers TABLE OF CONTENTS APPROVAL SHEET ABSTRACT ACKNOWLEDGEMENT INTRODUCTION Background of the Study 01 Review of Related Literature 02 Theoretical and Conceptual Framework 18 Statement of the Problem 20 Significance of the Study 22 Definition of Terms 22 METHODS Research Design 24 Research Instruments 26 Data Collection Procedures 28 Treatment of the data 29 RESULTS AND DISCUSSION Presentation and Analysis of Findings 30 Summary of Findings 42 Conclusion, Recommendations 42 REFFERENCES 44 APPENDIX Appendix A 49 Appendix B 55 LIST OF FIGURES Figure 1: Paradigm of the Study 20 Figure 2: Map and picture of Tagum Doctors Hospital, Tagum City, 25 Province of Davao del Norte where the study will be conducted. LIST OF TABLES a.) Table 1: Extent of Patient’s Socio-Cultural Differences 30 in term of cultural beliefs. b.) Table 2: Extent of Patient’s Socio-Cultural Differences in terms of Attitude. 31 c.) Table 3: Extent of Patient’s Socio-Cultural Differences 32 in terms of Educational attainment. d.) Table 4: Extent of Patient’s Socio-Cultural Differences 33 in terms of Religion. e.) Table 5: Extent of Patient’s Socio-Cultural Differences 34 in terms of Economic Status. f.) Table 6: Summary on the Extent of Patient’s Socio-Cultural 35 Differences. g.) Table 7: Extent of delivery of Health care needs 36 in terms of Assessment. h.) Table 8: Extent of delivery of Health care needs 37 in terms of Diagnosis. i.) Table 9: Extent of delivery of Health care needs 38 in terms of Intervention. j.) Table 10: Extent of delivery of Health care needs 39 in terms of Evaluation. k.) Table 11: Summary on the Extent of delivery of 40 Health care needs. l.) Table 12: Relationship between the Extent of the patients’ sociocultural differences and to the delivery of nursing care needs among patients in Tagum doctor’s hospital, Tagum City Davao del Norte. 41 INTRODUCTION Background of the study The make-up of the world population is changing as a result of people’s movement across borders. This movement is giving rise to ethnically, culturally, and linguistically diverse populations residing in many parts of the world. The impact of this diversity presents unique challenges to the practice of medicine. When individual providers and health care organizations fail to address possible differences in the perceptions, occurrence, management, and outcomes of health problems among different cultural groups, the result may be miscommunication and reciprocal frustration ultimately leading to misdiagnosis and mistreatment (Ahmed, 2017). The growing ethnic minority population groups will bring unique needs to health care interactions that may result from cultural differences between care provider and receiver (Betancourt, 2014, 2003; Berger, 1998). Differences in cultural values and beliefs between the health care provider and the receiver account for many misunderstandings in health interactions (Cline & McKenzie, 2018). When such differences are not accommodated, poor health outcomes arise. Fadiman (2017) described that the culture clash between the Merced Community Medical Center in California and a refugee family from Laos over the care of Lia Lee, among child diagnosed with epilepsy. Fadiman explained how the fundamentally different notions of disease that divided among sense of health and disease from the views of American scientific medicine eventually cost the life of Lia Lee. Although Lia’s health was in the best interest of both her parents and her doctors, miscommunication between the two cultures led to a tragedy and brings to attention the issues of medical ethics and cultural differences. The Department of Health of the Philippines (2017) fines that Filipinos are considered fatalistic in that they tend to accept fate easily, especially when they feel they cannot change a situation. Moreover, the acceptance of fate or destiny comes from their close relationship and health respect to nature. The acceptance 2 of fate or destiny comes from their close relationship and health respect to nature. The acceptance of events they cannot change is tied to their cultural religious faith. A common expression uttered by Filipinos is “bahala na”, originating from “bathala na” it is up to God (Enriquez, 2014). Malaybalay City, the Department of Health, Department of the Interior and Local Government and the National Commission on Indigenous Peoples (NCIP) signed a Joint Memorandum Circular 2015-01, which was introduced to the provincial government. The circular seeks to address inequity in the delivery of health care services, discrimination and insensitivity to culture, beliefs and traditions. The implementation will involve the Federation of Manobo Matigsalug Tribal Councils, Inc. in Bukidnon, Subanen tribe in Zamboanga del Sur, Dibabawon Mangguangan tribe in Compostella Valley, Arumanen-Manobo tribe in North Cotabato and the Banwaon and Talaandig tribes in Agusan del Sur, T’boli of South Cotabato in Southern Mindanao, Higawnun of misamis oriental and subanon tribe in misamis occidental. According to the circular, the physical segregation and socio-cultural exclusion of IPs contribute to the barriers in their access to health services. The order noted that health care providers should not see traditional and cultural beliefs and practices as obstacle or barrier to health care service delivery. Culture sensitivity in health is among the guiding principles pushed for the delivery of basic services to indigenous cultural communities and indigenous peoples in the country, according to the guidelines. It stressed that indigenous peoples are considerably vulnerable to inequities in health services (Walter I. Balane, 2015, Mindanao News). Ideally, health care needs provider seeks to address all necessary preparations in order to provide good expectations of their clients. The above mentioned problems of socio-cultural differences of patients serves as the basis of the researchers to conduct the study about the impact of patients’ sociocultural differences in the delivery of health care needs. This seeks to find if there is a significant relationship between patients’ sociocultural differences and the delivery of health care needs. 3 Review of Related Literature This section contains related materials from books, journals and internet articles that would give strength and support to the findings of this research. The following are the Review of Related Literature of Independent Variable. Socio-cultural Differences Cline and McKenzie (2018) states that socio-cultural attributes that place health care providers and receivers on two different ends of the health care spectrum. Giving rise to cultural beliefs, attitudes, education, religion and economic status. The impact of this diversity presents unique challenges to the practice of medicine. Cultural Beliefs. As stated on the journal of Immigrant Minority Health (2014) cultural views are also emerging as a highly charged health care issue. Ethnic and its counterpart’s xenophobia, prejudice and discrimination are being increasingly implicated in racial and ethnic disparities in health and health care and in disparities in the safety and quality of health care of ethnic minority groups. Another concept of (Equity, 2015) states that Irrespective of whether it is direct or indirect, intended or unintended, cultural opinion harms people in enduring ways. In order to better understand the harms of Ethnical differences, an examination of the notion of ‘harm’ itself is required. Cultural analysis cannot be done in the abstract because moral meanings of health care goods are rooted in history and culture, and they can be transformed or rendered obsolete by scientific and technological advances as well as changes in economic and other social and institutional circumstances. Hence, we need to understand some of this history. Accessing culturally appropriate and acceptable health services is vital for engendering the trust of clients who are Indigenous peoples, and extends beyond the establishment of relationships to respecting their worldviews and cultural preferences. Failure to identify key cultural beliefs and practices, or the 4 worldview of health, well-being, and illness risks providing health care that lacks relevance and compromises its efficacy. When interventions 'go wrong' or outcomes are not achieved, it is not unusual for clients to be blamed and labelled 'non-compliant'. This is a phenomena experienced by many Maori women (Indigenous to Aotearoa New Zealand) who are often subjected to victim blaming, negative labels and racism, mistakenly reinforced by their underutilization of, and late presentation to, health services when they are unwell. This situation is similar to other Indigenous women in countries where they have been subject to colonization (Baker & Daigle 2000; Browne & Fiske 2001; Dodgson & Struthers 2005), and is an approach that denies who they are and their unique health needs. The provision of safe, high quality health care relies on health services responding appropriately to this cultural and linguistic diversity. Barriers and competing priorities exist at the organizational (leadership/workforce), structural (processes of care) and clinical (provider-patient encounter) levels (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003). Although discussion of culture and its impact on health beliefs and health seeking behaviors runs the risk of oversimplification and stereotyping, this article seeks to enhance our understanding of the clinical barriers faced by migrant populations in accessing health care and to present tools and strategies for addressing these challenges. The concepts presented are exploration of the impact of culture on perceptions of health and illness and how this can affect access to care, communication, adherence to treatment, and perceptions of racism and discrimination in the health context, all of which directly impact on child and youth health outcomes (Kirmayer et al., 2010; Priest et al., 2013). These concepts can be applied across cultural groups and understanding them is of benefit in any setting where clinicians are treating children and families from culturally and linguistically diverse backgrounds. Health care delivery to families from migrant and refugee backgrounds can be improved by addressing the "cultural competence" of the health system, including understanding the importance of cultural influences on patients' health 5 beliefs and behaviors, considering how these factors interact at multiple levels of the health care delivery system, and developing models of care that assure quality for diverse populations. The evidence suggests that cultural competency training of staff, use of multidisciplinary teams and interpreters, low cost services, longer clinic opening times, outreach, free transport, home visiting, patient advocacy for housing and welfare, gender-sensitive providers especially for women, case management and integration across health and non-health providers are effective in increasing access and quality (Joshi et al., 2013). Patients may hold multiple beliefs blending Biomedical, Spiritual and Traditional concepts and, at times of stress and illness, or in the face of complex medical problems, traditional health beliefs and cultural practices may become more dominant (Kalowski, 2014a; Kalowski, 2014b). Individuals within families can vary enormously in their belief systems, often creating tensions between generation’s in the extent to which they integrate the Biomedical model into their Spiritual or Traditional health practice (Raman, Nicholls, Ritchie, Razee, & Shafiee, 2016). Cultural practices play an important role in shaping people's health behaviors and choices, for example delaying antenatal care due to concealment of pregnancy for fear of malevolent spirits, making culturally responsive care essential in optimizing health and wellbeing (Raman et al., 2016). Effective cross-cultural communication is a marriage of the expertise and knowledge of the clinician and the patient, their family and community. Rather than assuming the expert role, seeking to "educate" the patient, the health care team that comes to understand the patient's health belief systems has a greater chance of creating a therapeutic relationship. Clinicians may need to alter the setting and their communication style so that the patient and family feel the levels of comfort necessary for them to communicate (Kalowski, 2014a; Kalowski, 2014b; Mezzich et al., 2009). At all times, even if agreement is not possible, the role of the clinician is to maintain the patient's sense of dignity and to facilitate their understanding of what is happening (Kalowski, 2014; Kalowski, 2014b). 6 Attitudes. Patient satisfaction is a set of attitudes and perceptions of patients towards health services. It is the degree to which an individual regards health-care as useful, effective and beneficial. In other words it is the judgment of the patients about their needs and expectations met by the care provided, or an evaluation based on the fulfillment of expectations of the user. It is actually determined by the interplay of two factors i.e. patient expectations and experience of the real services. If the performance falls short of expectations, he is dissatisfied and if it matches the expectations, then vice versa. Patient satisfaction is therefore a match of expectations with experiences of the patient during a treatment process (Journal of Medical Sciences July-December 2017, Vol. 9, No. 2 183). Predictors of patient satisfaction Patient perceptions are influenced by sociocultural background of patients, their beliefs, attitudes and level of understanding. Successful outcome depends on how far the doctor understands these expectations and social context of his or her illness.22 Research findings from developed world simply do not apply in the set-up of developing countries including Pakistan (Journal of Medical Sciences July-December 2011, Vol. 9, No). Educational attainment. The relationship between education and health is never a simple one. Poor health not only results from lower educational attainment, it can also cause educational setbacks and interfere with schooling (Chimere 2018). In today’s knowledge economy, an applicant with more education is more likely to be employed and land a job that provides health-promoting benefits such as health insurance, paid leave, and retirement. Conversely, people with less education are more likely to work in high-risk occupations with few benefits (Brenda 2018). Completing more years of education confers health benefits after leaving school, such as better health insurance, access to medical care, and the resources to live a healthier lifestyle and to reside in healthier homes and 7 neighborhoods (Virginia Commonwealth University Center on Society and Health, 2014) Religion. The influence of religion on health disparities remains obscure. To date, religion and health research has tended to focus on the impact of generalized religiosity (e.g., religious importance and attendance at religious services), and in a limited way, specific religious practices on health outcomes without much attention to the way religion shapes health behaviors of individuals from a minority community (Levin et al. 2015). Health disparities research, on the other hand, typically groups individuals by race, ethnicity, and socio- economic status, assuming that relevant health-related beliefs, social experiences, and cultures aggregate by these categories. As many have noted, this assumption can be only partially true (Aspinall and Chinouya 2018; Karlsen and Nazroo 2010. A shared minority religion is one health-related factor that often cuts across and often unites individuals from disparate racial, ethnic, and socioeconomic categories. Empirical research provides ample evidence that religions shape their adherents’ understanding of disease and illness, their health-related behaviors, their interactions with and expectations of the healthcare system, and their adherence to medical recommendations (Ahmed et al. 2016; Carroll et al. 2007; Suwaidi et al. 2004). Despite both theory and data to support the influence of religion on health, little research has systematically examined the extent to which religious factors contribute to health disparities. The few studies that have tried to tease out the relationship between religion and health in minority communities suggest that religion exerts an independent influence upon health indicators when people from the same ethnic but different religious groups are compared (Karlsen and Nazroo 2014). Social-Economic Status. (Van Manen, 2016) states that barriers have been identified among those in the lower social economic status (SES). These barriers impede health care utilization and negatively fret health status. However, 8 studies show that among some African Americans when health care is affordable and available, the utilization of health care systems is not maximized. This suggests there are noneconomic barriers impeding access to and the utilization of health care systems for some African Americans. Supported by (Powell, 2017, Gomick et al., 1996) Barriers have been identified which impede the utilization of health care systems. These barriers are both economic and noneconomic. Economic barriers are caused by lack of financial resources. Less is known about noneconomic barriers which exist at income levels where insurance or other means of financing health care are available. Comprehensive and accessible primary health care is known to improve health outcomes and help reduce health inequities. While the introduction of universal health care in Canada has gone a long way towards reducing inequities in health care accessibility, significant gaps remain in the quality of care received by individuals of high versus low socio-economic status. For example, individuals with low income or low education are less likely to have undergone cancer screening than wealthier and better-educated individual. This is disconcerting, as socio-economically disadvantaged individuals have poorer self-rated health, higher rates of obesity and alcohol consumption, ischemic heart disease. Type two diabetes, and other chronic conditions, and greater chances of premature mortality. (Reducing Gaps in Health: A Focus on Socio-Economic Status in Urban Canada (https://secure.cihi.ca/free_products/Reducing_Gaps_in_Health_ Report_EN_081009.pd, Retrieved; May 2019) There is an evidence that socioeconomic status (SES) affects individual’s health outcomes and the health care they receive. People of lower SES are more likely to have worse self-reported health, lower life expectancy, and suffer from more chronic conditions when compared with those of higher SES. They also receive fewer diagnostic tests and medications for many chronic diseases and have limited access to health care due to cost and coverage. (Adler, NE, 9 Newman, K. Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood). 2002;21:60-76.) Compared with other patients, physicians are less likely to perceive low SES patients as intelligent, independent, responsible, or rational and believe that they are less likely to comply with medical advice and return for follow-up visits. These physician perceptions have been shown to impact physicians’ clinical decisions. Physicians delay diagnostic testing, prescribe more generic medications, and avoid referral to specialty care for their patients of low SES versus other patients. Some physicians believe that tailoring care options to a patient’s socioeconomic circumstances can improve patient compliance and thereby improve health outcomes. However, other studies have shown that physicians believe that the financial and coverage restrictions faced by low SES patients limit access to care and results in worse health outcomes for these patients. There are also some physicians who do not care for patients of lower SES with publicly financed insurance due to low reimbursement rates. (Woo, JK, Ghorayeb, SH, Lee, CK, Sangha, H, Richter, S. Effect of patient socioeconomic status on perceptions of first- and second-year medical students. CMAJ. 2004;170:1915-1919). Nursing Care Needs Nursing Care encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people. (Abdallah AK and Nussairat A, 2016) Assessment. The purpose of assessment is to establish a database about a client’s physical and emotional well-being, intellectual functioning, social relationships, and spiritual condition. This information is used to identify healthpromoting behaviors as well as actual and or potential health problems. The American Nurses Associations (ANA) in its classic publication, Nursing: Scope and standards of practice (2004), supports the use of the nursing process as a standard of practice for the registered nurse and outlines the essential 10 components of assessment within the nursing process. The data must be relevant to client’s needs, collected from variety of valid sources, obtained using appropriate techniques and in a systematic manner, and documented in a usable format. Through assessment, the nurse determines the client’s functional abilities and the absence or presence of dysfunctions. The client’s normal routine for activities of daily living and lifestyle patterns are also assessed. Identification of the client’s strengths provides the nurse and other members of the treatment team information about the skills, abilities, and behaviors the client has available to promote the treatment and family support, intelligence, spiritual beliefs, and coping skills. The assessment phase also offers an opportunity for the nurse to form a therapeutic interpersonal relationship with the client. (Fundamentals of Nursing, Volume 1, Rick Daniels RN, COL, PhD, Ruth N. Grendel RN, DNSc, Fredrick R. Wilkins RN, BSN, MSN, CNOR) The initial nursing assessment, the first step in the five steps of the nursing process, involves the systematic and continuous collection of data; sorting, analyzing, and organizing that data; and the documentation and communication of the data collected. Critical thinking skills applied during the nursing process provide a decision-making framework to develop and guide a plan of care for the patient incorporating evidence-based practice concepts (Papathanasiou, Kleisiaris, Fradelos, Kakou, & Kourkouta, 2014). This concept of precision education to tailor care based on an individual's unique cultural, spiritual, and physical needs, rather than a trial by error, one size fits all approach results in a more favorable outcome (Cook, Kilgus, & Burns, 2018). Part of the assessment includes data collection by obtaining vital signs such as temperature, respiratory rate, heart rate, blood pressure, and pain level using an age or condition appropriate pain scale. The assessment identifies current and future care needs of the patient by allowing the formation of a nursing diagnosis. The nurse recognizes normal and abnormal patient physiology and helps prioritize interventions and care. A health assessment is a plan of care that identifies the specific needs of a person and how those needs will be addressed by the healthcare system or 11 skilled nursing facility. Health assessment is the evaluation of the health status by performing a physical exam after taking a health history. It is done to detect diseases early in people that may look and feel well. It is the evaluation of the health status of an individual along the health continuum. The purpose of the assessment is to establish where on the health continuum the individual is because this guides how to approach and treat the individual. The health continuum approaches range from preventative, to treatment, to palliative care in relation to the individual's status on the health continuum. It is not the treatment or treatment plan. The plan related to findings is a care plan which is preceded by the specialty such as medical, physical therapy, nursing, etc. (Moss, JR; Sullivan, TR; Newton, SS; Stocks, NP (Jan 2014). "Effectiveness of general practice-based health checks: a systematic review and meta-analysis". The British Journal of General Practice. 64 (618): e47–53.) In the 21st century, the nurse’s role in assessment continues to expand, becoming more crucial than ever. The role of the nurse in assessment and diagnosis is more prevalent today than ever before in the history of nursing. Current focus on managed care and internal case management has had a dramatic impact on the assessment role of the nurse. Assessment is the first and most critical phase of the nursing process. If data collection is inadequate or inaccurate, incorrect nursing judgements may be made that adversely affect the remaining phases of the process: diagnosis, planning, implementation and evaluation. Although the assessment phase of the nursing process precedes the other phases in the formal nursing process, be aware that assessment is ongoing and continuous throughout all phases of the nursing process. (Health Assessment in Nursing, 5th edition, Janet R. Webber RN, EdD, Jane H. Kelly, RN, PhD) During emergency procedures, a nurse is focused on rapidly identifying the root causes of concern for the patient and assessing the airway, breathing and circulation (ABCs) of the patient. Once the ABCs are stabilized, the emergency assessment may turn into an initial or focused assessment, depending on the situation. If the nurse is not in a health care setting, emergency 12 assessments must also include an assessment for scene safety so that no other individuals, including the nurse himself, are hurt during the rescue and emergency response process. (David McGuffin, December 2018) Nursing Diagnosis. A nursing diagnosis may be part of the nursing process and is a clinical judgment about individual, family, or community experiences or responses to actual or potential health problems or life processes. Nursing diagnoses foster the nurse's independent practice (e.g., patient comfort or relief) compared to dependent interventions driven by physician's orders (e.g., medication administration). Nursing diagnoses are developed based on data obtained during the nursing assessment. A problem-based nursing diagnosis presents a problem response present at time of assessment. Risk diagnoses represent vulnerabilities to potential problems, and health promotion diagnoses identify areas which can be enhanced to improve health. Whereas a medical diagnosis identifies a disorder, a nursing diagnosis identifies the unique ways in which individuals respond to health and/or life processes and/or crises. The nursing diagnostic process is unique among others. A nursing diagnosis integrates patient involvement, when possible, throughout the process. NANDA International (NANDA-I) is body of professionals that develops, researches and refines an official taxonomy of nursing diagnosis. The diagnosing phase involves a nurse making an educated judgement about a potential or actual health problem with a patient. Multiple diagnoses are sometimes made for a single patient. These assessments not only include a description of the problem or illness (e.g. sleep deprivation) but also whether or not a patient is at risk of developing further problems. These diagnoses are also used to determine a patient's readiness for health improvement and whether or not they may have developed a syndrome. The diagnoses phase is a critical step as it is used to determine the course of treatment. (Potter, Patricia A.; Perry, Anne Griffin; Stockert, Patricia A.; Hall, Amy M. (2013). Fundamentals of Nursing 8th edition) 13 The nursing diagnosis is both pivotal step in the nursing process and a diagnostic reasoning process. As a second step in the nursing process, it is professional clinical judgement about individual, family, or community (aggregate) responses to actual or at-risk health problems, to wellness states, or to life process events. As a diagnostic reasoning process, nursing diagnosis includes the nurse’s critical thinking and interpretation of the meaning and significance of evidence, or cues, derived from assessment data. The purpose of diagnosis is to effectively communicate the health care needs of individuals and aggregates among members of the health care team and within the health care delivery system. When nursing diagnosis is a part of the client’s plan of care, the nurse is able to communicate the client’s needs to other professionals involved in that care. These needs encompass physiological, role function, self-concept, interdependence, and spiritual dimensions. In order to determine individualized therapeutic nursing interventions, the nurse must first collect and organize assessment data before developing appropriate nursing diagnoses. (Fundamentals of Nursing, Volume 1, Rick Daniels RN, et. al..) Plan of Care. The third step of the nursing process encompasses outcome identification and planning. After a nurse thoroughly assesses a client and determines the client’s unique nursing diagnoses, or health problems, a plan of action is developed. Client-specific outcomes are established to resolve the diagnoses that are measureable within a time frame for attainment. A priority outcome statement describes the expected client status (behavior or function) when a problem-focused nursing diagnosis has been resolved, the modification of condition that places the client at risk for a diagnosis, or a client’s positive adaptation that has been enhanced, as with a wellness diagnosis. Expected outcomes encompass biological, psychological, sociocultural, and spiritual aspects of health, or related knowledge and skills. The purposes of setting expected outcomes are to provide guidelines for individualized nursing interventions and to establish evaluation criteria to measure the effectiveness of the nursing care plan. (Fundamentals of Nursing, Volume 1, Rick Daniels RN, et. al..) 14 Nursing care plan provides direction on the type of nursing care the individual, family, and or community may need. The main focus of a nursing care plan is to facilitate standardized, evidence-based and holistic care. Nursing care plans have been used for quite a number of years for human purposes and are now also getting used in the veterinary profession. A care plan includes the following components: assessment, diagnosis, expected outcomes, interventions, rationale and evaluation. According to UK nurse Helen Ballantyne, care plans are a critical aspect of nursing and they are meant to allow standardized, evidence-based holistic care. It is important to draw attention to the difference between care plan and care planning. Care planning is related to identifying problems and coming up with solutions to reduce or remove the problems. The care plan is essentially the documentation of this process. It includes within it a set of actions the nurse will apply to resolve/support nursing diagnoses identified by nursing assessment. Care plans make it possible for interventions to be recorded and their effectiveness assessed. Nursing care plans provide continuity of care, safety, quality care and compliance. (Hooks, Robin (2016). "Developing nursing care plans". Nursing Standard.) Provide direction for individualized care of the client. A care plan flows from each patient’s unique list of diagnoses and should be organized by the individual’s specific needs. The means of communicating and organizing the actions of a constantly changing nursing staff. As the patient’s needs are attended to, the updated plan is passed on to the nursing staff at shift change and during nursing rounds. The care plan should specifically outline which observations to make, what nursing actions to carry out, and what instructions the client or family members require. They serve as a guide for assigning staff to care for the client. There may be aspects of the patient’s care that need to be assigned to team members with specific skills. Care plans serve as a guide for reimbursement. Medicare and Medicaid originally set the plan in action, and other third-party insurers followed suit. The medical record is used by the insurance companies to determine what they will pay in relation to the hospital 15 care received by the client. If nursing care is not documented precisely in the care plan, there is no proof the care was provided. Insurers will not pay for what is not documented. The exact format for a nursing care plan varies slightly from place to place. They are generally organized by four categories: nursing diagnoses or problem list; goals and outcome criteria; nursing orders; and evaluation. As defined by the North American Nursing Diagnosis Organization-International (NANDA-I), nursing diagnoses are clinical judgments about actual or potential individual, family or community experiences or responses to health problems or life processes. A nursing diagnosis is used to define the right plan of care for the client and drives interventions and patient outcomes. Nursing care plan (NCP) is a formal process that includes correctly identifying existing needs, as well as recognizing potential needs or risks. Care plans also provide a means of communication among nurses, their patients, and other healthcare providers to achieve health care outcomes. Without the nursing care planning process, quality and consistency in patient care would be lost. Nursing care planning begins when the client is admitted to the agency and is continuously updated throughout in response to client’s changes in condition and evaluation of goal achievement. Planning and delivering individualized or patientcentered care is the basis for excellence in nursing practice. Interventions. Implementation is the fourth step in the nursing process and involves the execution of the nursing plan of care formulated during the planning phase of nursing process. In the implementation phase, the nurse and other members of the health care team put the care plan into action. Nursing is a dynamic process, and every nurse must continually incorporate new assessment and diagnostic information into the implementation of the care plan (Estes, 2006). Nurses, therefor draw from a broad base of clinical knowledge, careful planning, critical thinking and analysis, and judgement. In implementing the plan of care, the skilled nurse considers all aspects of the presenting illness as well as the environmental, personal, and cultural 16 elements that make each client a unique individual. In addition, the nurse is responsible for delegating appropriate task to staff members and ancillary personnel, and documenting the entire process, including what the nurse does and how the client responds. (Fundamentals of Nursing, Volume 1, Rick Daniels RN, et. al..) Nursing Interventions Classification (NIC) system is designed to categorize and describe every possible intervention a nurse might perform. This system is constantly used, evaluated and updated. Nursing Interventions Classification (NIC) 6th Edition describes a number of uses for the system. They include: Clinical documentation, Standardized communication regarding care, Research on intervention effectiveness, Productivity measurement, Evaluations of competency, Curriculum design. There are different classifications of nursing interventions that can involve care of the entire patient. This can be anything from promoting bowel functioning, educating the patient on new medication side-effects or just keeping the patient safe. Interventions can be focused on basic physiological needs, complex physiological needs, behavioral functioning, promoting safety, caring for the family, using the health system and/or the overall health of the community. As nurses, we are caring for the total patient, so there are can be interventions concerning every area of the patient's design. Some of the nursing interventions will require a doctor's order and some will not. There are different types of interventions: independent, dependent and interdependent. Independent, these are actions that the nurse is able to initiate independently. The following would be an example of a health promotion nursing intervention, which is an independent nursing action. Dependent, these interventions will require an order from another health care provider such as a physician. Interdependent, these are going to require the participation of multiple members of the health care team. (Health Assessment 2016) Once outcomes have been developed and agreed, nursing interventions that facilitate their achievement are planned and implemented. Planning and 17 using nursing interventions based on good quality evidence of effectiveness is of importance to ensure that the desired outcomes of care are achieved. Identifying, appraising, and incorporating the best currently available research into evidencebased nursing practice promotes clinically effective quality care. A nursing Intervention is defined as “A single nursing action, treatment, procedure, activity, or service designed to achieve an outcome of a nursing or medical diagnosis for which the nurse is accountable’ (Saba, 2007). A physician usually initiates the medical orders for patient services which are reviewed by the hospital admitting nurse. As part of the admission process the primary nurse interprets the medical orders and prepares nursing orders based not only on the medical orders, but also on the signs and symptoms, diagnoses, and other presenting problems together form the nursing plan of care (POC) which also includes the goals/expected outcomes that require the specific Nursing Interventions and Action Types to resolve (Saba, 2007). Evaluation. Evaluation is the fifth step in the nursing process and involves determining whether the client goals have been met. Even though it is the final phase of the nursing process, evaluation is an ongoing part of daily nursing activities. Ongoing evaluation can determine if the client has achieved these outcomes or if care needs to be modified to help achieve these outcomes. Evaluation also modified also is an integral process in determining the quality of health care delivered. (Fundamentals of Nursing, Volume 1, Rick Daniels RN, et. al..) Are the central measures used in learning about the effectiveness of costsensitive, quality health care. Additionally, outcomes have been used to provide a quantitative basis for making clinical decisions, to measure the effect of care on patients, to measure the efficacy of care and to determine areas for care improvement. Despite the importance of the patient outcomes concept, there has not been enough focus on all aspects of this complex concept in the nursing discipline. Furthermore, different researchers have provided different definitions. The purpose of our concept analysis is to clarify and describe the multifaceted nature of patient outcomes within the field of nursing. 18 The World Health Organization defines an outcome measure as a “change in the health of an individual, group of people, or population that is attributable to an intervention or series of interventions.” Outcome measures (mortality, readmission, patient experience, etc.) are the quality and cost targets healthcare organizations are trying to improve. Measuring outcomes is an important component of physical therapists practice. They are important in direct management of individual patient care and for the opportunity they provide the profession in collectively comparing care and determining effectiveness. The use of standardized tests and measures early in an episode of care establishes the baseline status of the patient/client, providing a means to quantify change in the patient's/client's functioning. Outcome measures, along with other standardized tests and measures used throughout the episode of care, as part of periodic reexamination, provide information about whether predicted outcomes are being realized. As the patient/client reaches the termination of physical therapy services and the end of the episode of care, the physical therapist measures the outcomes of the physical therapy services. Theoretical and Conceptual Framework This study is anchored on the theory of Lev Vygotsky on Sociocultural Theory, which states that sociocultural differences are emerging principles in psychology that looks at the important contributions that society makes to individual development. The theory stresses the interaction between developing people and the culture in which they live. Sociocultural theory also suggests that human learning and needs are largely a social process. In this development carried many factors that influence towards human health. Furthermore, sociocultural theory focuses not only how adults and peers influence individual learning, but also on how cultural beliefs, attitudes, education, religion and economic status played an impact on how health care needs take place. 19 This study is anchored on the theory of Jean Watson “Human Caring Theory” on which the theory states that nursing care is the philosophy and science of caring, four major concepts: human being, health, environment/society, and nursing. Watson’s definition of environment/society addresses the idea that nurses have existed in every society, and that a caring attitude is transmitted from generation to generation by the culture of the nursing profession as a unique way of coping with its environment. The nursing model states that nursing is concerned with promoting health, preventing illness caring for the sick, and restoring health. It focuses on health promotion, as well as the treatment of diseases. Watson believed that holistic health care is central to the practice of caring in nursing. She defines nursing as “a human science of persons and human health illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human transactions.” The nursing process outlined in the model contains the same steps as the scientific research process: assessment, diagnosis, plan, intervention, and evaluation. The assessment includes observation, identification, and review of the problem, as well as the formation of a hypothesis. Nursing diagnosis are developed based on data obtained during the nursing assessment and enable the nurse to develop the care plan. Creating a care plan helps the nurse determine how variables would be examined or measured, and what data would be collected. Intervention is the implementation of the care plan and data collection. Finally, the evaluation analyzes the data, interprets the results, and may lead to an additional hypothesis. Figure 1 presents the schematic diagram of the variables of this study. The independent variable is the patients’ sociocultural differences with its indicators cultural beliefs, attitudes, education, religion and economic status. The dependent variable is the providing health care needs with its indicators basic healthcare, medically-necessary treatment, health enhancement, optimum health and environmental health. The moderator variable of the study are age and sex. 20 Statement of the Problem This study is conducted to determine the relationship between the patients’ sociocultural differences and the delivery of nursing care needs among patients in Tagum doctor’s hospital, Tagum City, Davao del Norte. The specific sub-problems of the study are as follows: Independent Variable Dependent Variable Nursing Care Needs Sociocultural differences ï‚· ï‚· ï‚· ï‚· ï‚· cultural beliefs attitudes educational attainment religion economic status ï‚· ï‚· ï‚· ï‚· ï‚· Assessment Diagnosis Plan of care Intervention Evaluation Figure I: Paradigm of the Study A paradigm is a standard, perspective, or set of ideas. A paradigm is a way of looking at something. The word paradigm comes up a lot in the academic, scientific, and research. The two main variables in an experimental are the independent and dependent variable. An independent variable is the variable that is changed or controlled in a scientific experiment to test the effects on the dependent variable. In our study, the independent variable is sociocultural differences, it has five 21 indicators, namely; cultural beliefs, attitudes, educational attainment, religion, and economic status. A dependent variable is the variable being tested and measured in a scientific experiment. The dependent variable of our study is nursing care needs, namely; assessment, diagnosis, plan of care, intervention, and evaluation. 1. 2. What is the extent of patients’ Socio-cultural differences in terms of: 1.1 cultural beliefs; 1.2 attitudes; 1.3 educational attainments; 1.4 religion; and 1.5 economic status? What is the extent of the delivery of health care needs in terms of: 2.1 assessments; 2.2 diagnosis; 2.3 planning; 2.4 intervention; and 2.5 evalutaion? 3. Is there a significant relationship between the patients’ sociocultural differences and to the delivery of nursing care needs among patients in Tagum doctor’s hospital, Tagum City, Davao del Norte? Null Hypothesis 1. There is no significant relationship between patients’ sociocultural differences and the delivery of nursing care needs among patients in Tagum doctor’s hospital, Tagum City, Davao del Norte. 22 Significance of the Study This study will be significant for the Department of Health Officials, Hospital personnel, School administrators, Clinical Instructors and other researchers of nursing profession as they will focus on addressing medical assistance and complete nursing care delivery of patients. Department of Health Officials. This is important in the Department of Health as a whole since it provides sufficient bases of health care delivery of health care provider towards socio-cultural diversity particularly patients in the province of Davao del Norte. Hospital personnel. This study will provide the awareness and aid of the hospital personnel problem in promoting quality medication needs of patients. School administrators. This study will provide the awareness and aid of the administration to their clinical teachers as part of developmental education and additional information. Clinical Instructors. This will help them to determine Health Care Delivery of Health Care provider has the positive implication to the Socio-cultural Diversity among patients in Tagum doctor’s hospital, Tagum City, Province of Davao del Norte. Students. This study will benefit the students since they are the recipients of the knowledge will be acquired. Thus, give them an avenue for an informative factors. Other researchers. This study will serve as a guide or reference in making their own research which are beneficial to professionals, non-professionals and institutions. DEFINITION OF TERMS The following terms are defined operationally. Sociocultural differences. It refers to different factors in providing nursing care needs to patients. 23 Cultural beliefs. It refers to patients’ perception on how to deal with providing nursing care. Attitude. It relates to the act of treatment to the health care needs, it could be a positive or negative responses. Educational attainment. It refers on how the patients’ knowledge relate on the delivery of care needs. Religion. It refers to the sacred norms in giving nursing care to the patients. Economic status. It refers to the availability of income that allotted to any financial health problem of the patients. Nursing Assessment. It refers to the gathering of information about a patient's physiological, psychological, sociological, and spiritual status by a licensed Registered Nurse. It is used to identify current and future patient care needs. Diagnosis. It relates to the identification and statement of the problem present at the time of assessment. It focuses on the signs and symptoms of the patient at the time of the assessment. Plan of Care. It relates to the direction of what type of nursing care the individual, family, and or community may need. It focuses to the plan of care to facilitate standardized, evidence-based and holistic care. Nursing Intervention. It focuses on promoting patient’s physiological needs and relates to complex physiological needs, behavioral functioning, promoting safety, caring for the family, using the health system and/or the overall health of the community. Evaluation. It focuses on the outcomes of the effectiveness of nursing interventions to measure the efficacy of care and to determine areas for care improvement. METHODS This chapter presents the research design, research subjects, research instruments, data gathering procedure and statistical treatment. Research Design The researcher used the Descriptive Correlational design in conducting this study. This method is a design which describes the nature of a situation as it exists at the time of the study and to explore the course of a particular phenomenon. This investigates possible relations with the use of questionnaire or instrument to be prepared by the researcher. It will help determine the relationship between the patients’ sociocultural differences and the delivery of health care needs among patients in Tagum Doctors Hospital, Tagum City, Province of Davao del Norte. Research Subject The respondents of this study are patients who are admited in Tagum Doctor’s hospital, Tagum City, Davao del Norte. The researchers will be using Convenience sampling method to determine the sample. Convenience sampling method is defined as a non-probability sampling technique where subjects are selected because of their convenient accessibility and proximity to the researcher. Figure 2 shows the map and picture of Tagum Doctors Hospital, Tagum City, Province of Davao del Norte where the study will be conducted. 25 Figure 2. Map and picture of Tagum Doctors Hospital, Tagum City, Province of Davao del Norte where the study will be conducted. 26 Research Instrument The instrument to be used in gathering the data for this study will be distributed to the respondents are a researcher-made questionnaire. The researchers make use of two sets of questionnaires which suit to evaluate the extent of patients’ sociocultural differences and the delivery of nursing care needs among patients in Tagum doctor’s hospital with the following indicators that corresponds to the two significant variables. The questionnaires contain checklist using the Likert scale which consist of five categories in numerical values that corresponds to the descriptive equivalents. The rating scale to be used and the following scale and parameter limits will be applied. The scale of 4.50-5.00 for Very much extensive; 3.50-4.49 for very extensive; 2.50-3.49 for moderately extensive; 1.50-2.49 for some extensive; and 1.50-2.49 for some extensive. Data will be interpreted and analyzed using the scale limits with descriptive rating equivalent as provided below: Delivery of Health Care Needs Parameter Descriptive Limits Equivalent 4.50-5.00 Very much extensive Description This means that the delivery of Health Care needs is observed in all occasions. 3.50-4.49 very extensive This means that the delivery of Health Care needs is observed in most occasions. 27 2.50-3.49 moderately extensive This means that the delivery of Health Care needs is observed in some occasions. 1.50-2.49 some extensive This means that the delivery of Health Care needs is rarely 1.00-1.49 Not at all observed. This means that thedelivery of Health Care needs is not observed. Patients’ Socio-cultural Differences Parameter Descriptive Limits Equivalent 4.50-5.00 very much extensive Description This means that the Sociocultural Differences among patients is observed in all occasions. 3.50-4.49 very extensive This means that the Sociocultural Differences among patients is observed in most occasions. 2.50-3.49 moderately extensive This means that the Sociocultural Differences among 28 patients is observed in some occasions. 1.50-2.49 Some extensive This means that the Sociocultural Differences among patients is rarely observed. 1.00-1.49 not at all This means that the Sociocultural Differences among patients is not observed. Data Gathering Procedure The researcher have undertaken the following procedures in order to gather the data needed for the study: Seeking Permission to Conduct the Study. The researcher asked permission and sought the approval from the office of the Administrator of Tagum Doctor’s College and to the CEO of Tagum Doctor’s Hospital to ask permission to conduct the study about the employment Health Care Delivery of Health Care provider and Socio-cultural Diversity among patients in Tagum doctor’s hospital. Administration and Retrieval of Questionnaires. Upon the approval of the Administrator of Tagum Doctor’s College and the CEO of Tagum Doctor’s Hospital, the researcher proceed to all the subject hospital to distribute the questionnaires to the respondents. Retrieval of questionnaires will be done by the researcher after the respondents thoroughly answered all the questionnaires. Checking, Collating and Processing. Right after the retrieval of questionnaires, the researcher checked, collated and tabulated all the responses given by the respondents. Results of the tabulated data were submitted to the statistician for analysis and interpretation in order to answer the problems raised in the first chapter of this research. 29 Statistical Treatment The following statistical tools were used in the computation of the result as well as in the testing of the hypothesis at a 0.05 level of significance. Mean. This was used to determine the extent of implementation of the delivery of nursing Care needs among patients in Tagum Doctor’s Hospital. Thus answers the first and second statement of the problem. Pearson r. This was used to determine significant relationship between patients’ sociocultural differences and the delivery of nursing care needs among patients in Tagum Doctor’s Hospital. This answers the third statement of the problem. Linear Regression. Was used to determine the degree of influence of sociocultural differences to the delivery of health care needs among patients in Tagum Doctors’ Hospital. This will answer the fourth statement of the problem. (note: needs statisticians opinion about linear regression) RESULTS AND DISCUSSION In this Chapter, the researcher discusses the findings and results from the data gathered. The researcher also tested the null hypothesis formulated in the study. Extent of Patients' Socio-Cultural differences in term of cultural beliefs Item 1 Mean Interpretation 3.59 Very Extensive 4.00 Very Extensive 3.51 Very Extensive Moderately Extensive Moderately Extensive Moderately Extensive Moderately Extensive 2 3 4 3.00 5 3.43 6 3.05 Total Mean 3.43 Table 1 Extent of Patients' Socio-Cultural Differences in term of cultural beliefs Table 1, presents the extent on Patients’ Socio-cultural differences in terms of cultural beliefs. “The people around you understand easily your cultural beliefs” got the highest weighted mean of 4.00 with descriptive equivalent of very extensive. It is followed by “Cultural beliefs affects the way of people (who does not share the same cultural beliefs) treat you” that obtained a weighted mean of 3.59 with a descriptive equivalent of very extensive. The lowest weighted mean of 3.00 with descriptive equivalent of moderately extensive goes to “Someone quarrel/disagree with people who are far from what you believe”. The extent on Patients’ Socio-cultural differences in terms of cultural beliefs has a mean of 3.43 with a descriptive equivalent of moderately extensive. 31 The result means that the delivery of Health Care needs is observed in some occasions. The result is supported by the finding of Kalowski (2014a & 2014b) that patients may hold multiple beliefs blending Biomedical, Spiritual and Traditional concepts and, at times of stress and illness, or in the face of complex medical problems, traditional health beliefs and cultural practices may become more dominant. Extent of Patients' Socio-Cultural Differences in term of Attitude Items 1 2 3 4 5 Total Mean Mean 3.38 Interpretation Moderately Extensive 3.97 Very Extensive 3.65 Very Extensive 4.08 Very Extensive 3.51 Very Extensive 3.72 Very Extensive Table 2 Extent of Patients' Socio-Cultural Differences in term of Attitude In Table 2, the presentation of the extent on Patients’ Socio-cultural differences in terms of attitudes. Based on what you have observe, “How satisfied are you with the care you receive” got the highest weighted mean of 4.08 with descriptive equivalent of very extensive. It is followed by “Do you feel secured when people around you share the same beliefs” that obtained a weighted mean of 3.97 with a descriptive equivalent of very extensive. The lowest weighted mean of 3.38 with descriptive equivalent of moderately extensive goes to “Someone perceive in a situation where the people based on your beliefs.” 32 The extent on Patients’ Socio-cultural differences in terms of attitude has a mean of 3.72 with a descriptive equivalent of very extensive. The result means that the delivery of Health Care needs is observed in most occasions. According to the journal of medical science (December 2017, vol.9 no.183), the Patient satisfaction is a set of attitudes and perceptions of patients towards health services. It is the degree to which an individual regards healthcare as useful, effective and beneficial. Extent of Patients' Socio-Cultural differences In term of Educational Attainment Items 1 2 3 4 5 Mean Interpretation 3.97 Very Extensive 3.68 Very Extensive 3.70 Very Extensive 3.89 Very Extensive 3.68 Very Extensive Total Mean 3.78 Very Extensive Table 3 Extent of Patients' Socio-Cultural Differences in term of Educational attainment Table 3, presents the extent on Patients’ Socio-cultural differences in terms of Educational attainment. “How likely do you keep yourself updated to new trends on health care programs” got the highest weighted mean of 3.97 with descriptive equivalent of very extensive. It is followed by “How likely do you watch educational television program” which obtained a weighted mean of 3.89 with a descriptive equivalent of very extensive. The lowest weighted mean of 3.68 with descriptive equivalent of very extensive goes to “How likely does your community conduct programs/seminars that promotes new information about health” and “How likely do you participate in your community in events that will educate you and your neighbors”. 33 The extent on Patients’ Socio-cultural differences in terms of Educational attainment has a mean of 3.78 with a descriptive equivalent of very extensive. The result means that the delivery of Health Care needs is observed in most occasions. According to (Virginia Commonwealth University Center on Society and Health, 2014) completing more years of education confers health benefits after leaving school, such as better health insurance, access to medical care, and the resources to live a healthier lifestyle and to reside in healthier homes and neighborhoods. Extent of Patients' Socio-Cultural Differences in term of Religion Items 1 2 3 4 5 6 Total Mean Mean Interpretation 3.00 Moderately Extensive 4.24 Very Extensive 3.76 Very Extensive 4.19 Very Extensive 3.89 Very Extensive 3.89 Very Extensive 3.82 Very Extensive Table 4 Extent of Patients' Socio-Cultural Differences in term of Religion Table 4, presents the extent on Patients’ Socio-cultural differences in terms of religion. “How often do someone pray” got the highest weighted mean of 4.24 with descriptive equivalent of very extensive. It is followed by “Do you reinforce your belief in God/Allah” that obtained a weighted mean of 4.19 with a descriptive equivalent of very extensive. The lowest weighted mean of 3.00 with descriptive equivalent of moderately extensive goes to “Does your religion affects your decisions to take any health care services”. 34 The extent on Patients’ Socio-cultural differences in terms of religion has a mean of 3.82 with a descriptive equivalent of very extensive. The result means that the delivery of Health Care needs is observed in most occasions. According to Levin (2015), religion on health disparities remains obscure, religion and health research has tended to focus on the impact of generalized religiosity. On the other hand, Aspinall and Chinouva (2018) states that health disparities groups individuals by race, ethnicity, and socio-economic status, assuming that relevant health related beliefs, social experiences, and cultures aggregate by these categories. This assumptions can only be partially true. However, a shared minority religion is one health-related factor that often cuts across and often unites individuals from disparate racial, ethnic, and socioeconomic categories, this provides ample evidence that religions share their adherents’ understanding of disease and illness, their health-related behaviors, interactions and expectations of the healthcare system. Extent of Patients' Socio-Cultural Differences in term of Economic Status Items 1 2 3 4 5 6 7 Total Mean Mean Interpretation 3.95 Very Extensive 3.81 Very Extensive 3.86 Very Extensive 3.78 Very Extensive 4.00 Very Extensive 3.70 Very Extensive 3.97 Very Extensive 3.88 Very Extensive Table 5 Extent of Patients' Socio-Cultural Differences in term of Economic Status Table 5, it presents the extent on Patients’ Socio-cultural differences in terms of Economic status “Do you see your community leader/s participate in the 35 community” got the highest weighted mean of 4.00 with descriptive equivalent of very extensive. It is followed by “Do you encourage your neighbor to help clean the surroundings” that obtained a weighted mean of 3.97 with a descriptive equivalent of very extensive. The lowest weighted mean of 3.78 with descriptive equivalent of moderately extensive goes “How often do you follow your community's”. The extent on Patients’ Socio-cultural differences in terms of Economic status has a mean of 3.88 with a descriptive equivalent of very extensive. The result means that the delivery of Health Care needs is observed in most occasions. According to Powell (2017), non-economic barriers which exist at income levels where insurance or other means of financing health care are available. Summary on the Extent of Patients' Socio-Cultural Differences Indicator Cultural Beliefs Attitude Educational attainment Religion Economic Status Mean Interpretation 3.43 Moderately Extensive 3.72 Very Extensive 3.78 Very Extensive 3.82 Very Extensive 3.88 Very Extensive Total Mean 3.73 Very Extensive Table 6 Summary on the Extent of Patients' Socio-Cultural Differences Table 6, presents the Summary on the Extent of Patients' Socio-Cultural differences in terms of cultural beliefs, attitude, educational attainment, religion and economic status. 36 It is shown in the table, the indicators with their corresponding mean and descriptive equivalent. Economic Status got the highest mean of 3.88 with a descriptive equivalent of very extensive. It is followed by religion that obtained mean of 3.82 with a descriptive equivalent of very extensive. The lowest mean of 3.43 with a descriptive equivalent of moderately extensive goes to indicator cultural beliefs. Based on the results, the Extent of Patients' Socio-Cultural Differences has a grand mean of 3.73 with a descriptive equivalent of very extensive. This means that the Extent of Patients' Socio-Cultural Differences is observed in most occasions. According to Cline and McKenzie (2019), socio-cultural attributes that place health care providers and receivers on two different end of the health care spectrum. Giving rise to cultural beliefs, attitudes, education, religion and economic status. The impact of this diversity presents unique challenges to the practice of medicine. Extent of Delivery of Health Care Needs in term of Assessment Items 1 2 3 4 5 6 7 Total Mean Mean Interpretation 4.54 Very much Extensive 4.35 Very Extensive 4.30 Very Extensive 4.30 Very Extensive 4.24 Very Extensive 4.05 Very Extensive 4.30 Very Extensive 4.30 Very Extensive Table 7 Extent of delivery of Health Care Needs in terms of Assessment 37 Table 7, presents the extent of Delivery of Health Care Needs in terms of Assessment During your hospitalization, “How quick does the doctor and nurses attend to your concern” got the highest weighted mean of 4.54 with descriptive equivalent of very extensive. It is followed by “On the day of your admission, how would you rate the care and attention they gave you” that obtained a weighted mean of 4.35 with a descriptive equivalent of very extensive. The lowest weighted mean of 4.05 with descriptive equivalent of moderately extensive goes “How often does the staff nurses and doctors show courtesy before doing a test or procedure”. The extent of Delivery of Health Care Needs in terms of Assessment has a mean of 4.30 with a descriptive equivalent of very extensive. The result means that the delivery of Health Care needs is observed in most occasions. According to David McGuffin (2018) assessment is the first and most critical phase of the nursing process. The data must be relevant to client’s needs, collected from variety of valid sources, obtained using appropriate techniques and in a systematic manner, and documented in a usable format. Extent of delivery of Health Care Needs in terms of Diagnosis Items 1 2 3 4 5 6 7 Mean Interpretation 4.32 Very Extensive 4.35 Very Extensive 4.54 Very Much Extensive 4.46 Very Extensive 4.41 Very Extensive 4.16 Very Extensive 4.43 Very Extensive 4.38 Very Extensive Table 8 Extent of delivery of Health Care Needs in terms of Diagnosis Total Mean 38 Table 8, presents the Extent of delivery of Health Care Needs in terms of Diagnosis. “How often does the nurse validates your identity?” (How satisfied are you with the approach of care given by the nurses with a rating of 4.54) with descriptive equivalent of very extensive. It is followed by “How comfortable are you when the nurses are taking your vital signs” which has 4.46 mean rating and a descriptive equivalent of very extensive. The lowest weighted mean of 4.43 with descriptive equivalent of very extensive goes to “Does the nurse motivates you for faster recovery and healing?” (Listens to what you have to say and addresses the concerns). Extent of delivery of Health Care Needs in terms of Diagnosis mean of 4.38 with a descriptive equivalent of very extensive. The result means that the delivery of Health Care needs is observed in most occasions. According to Potter (2013), the diagnoses phase is a critical step as it used to determine the course of treatment. In addition, it is both pivotal stem in the nursing process and a diagnostic reasoning process. The purpose of diagnosis is to effectively communicate the health care needs of individuals and aggregates among members of the health care needs to other professionals involved in that care. (Rick Daniels, Fundamentals of Nursing Volume 1). Extent of delivery of Health Care Needs In terms of Intervention Items 1 2 3 4 5 6 7 Total Mean Mean Interpretation 4.24 Very Extensive 4.16 Very Extensive 4.27 Very Extensive 4.38 Very Extensive 4.22 Very Extensive 4.22 Very Extensive 4.41 4.27 Very Extensive Very Extensive Table 10 Extent of delivery of Health Care Needs in terms of Intervention 39 Table 10, presents the Extent of delivery of Health Care Needs in terms of Intervention. ”How often does the nurse validates your identity?” (Ask for the name of the client and/or checks the wrist band) got the highest weighted mean of 4.41 with descriptive equivalent of very extensive. It is followed by “How often does the staff nurses show courtesy before doing a procedure” that obtained a weighted mean of 4.38 with a descriptive equivalent of very extensive. The lowest weighted mean of 4.16 with descriptive equivalent of very extensive goes to “How satisfied are you with the care given to you during your stay in the institution?” The extent on delivery of health care needs in terms of intervention has a mean of 4.27 with a descriptive equivalent of very extensive. The result means that the delivery of Health Care needs is observed in most occasions. According to Saba (2007), a nursing Intervention is defined as “A single nursing action, treatment, procedure, activity, or service designed to achieve an outcome of a nursing or medical diagnosis for which the nurse is accountable’. Extent of delivery of Health Care Needs in terms of Evaluation Items 1 Mean 4.24 Interpretation Very Extensive 2 4.32 Very Extensive Total Mean 4.28 Very Extensive Table 11 Extent of delivery of Health Care Needs in terms of Evaluation Table 11, presents the Extent of delivery of Health Care Needs in terms of Evaluation. “How likely does your concerns addressed immediately” got the highest weighted mean of 4.32 with descriptive equivalent of very extensive. The lowest weighted mean of 4.24 with descriptive equivalent of very extensive goes to “How likely does your health care provider attend to your needs.” 40 The extent on delivery of health care needs in terms of evaluation has a mean of 4.28 with a descriptive equivalent of very extensive. The result means that the delivery of Health Care needs is observed in most occasions. According to Rick Daniels, RN (Fundamentals of Nursing, Vol. 1), it is an ongoing evaluation that determines if the client has achieved these outcomes or if care needs to be modified to help achieve these outcomes. Summary on the Extent of Delivery of Health Care Needs Indicators Assessment Mean 4.30 Interpretation Very Extensive Diagnosis 4.38 Very Extensive Plan of Care 4.18 Very Extensive Intervention 4.27 Very Extensive Evaluation 4.28 Very Extensive Total Mean 4.28 Very Extensive Table 12 Summary on the Extent of delivery of Health Care Needs Table 12, presents the Summary on the Extent of delivery of Health Care Needs in terms of assessment, diagnosis, plan of care, intervention, and evaluation. It is shown in the table, the indicators with their corresponding mean and descriptive equivalent. Diagnosis got the highest mean of 4.38 with a descriptive equivalent of very extensive. It is followed by assessment that obtained a mean of 3.30 with a descriptive equivalent of very extensive. The lowest mean of 4.18 with a descriptive equivalent of very extensive goes to indicator plan of care. 41 Based on the results, the Extent of delivery of Health Care Needs has a grand mean of 4.28 with a descriptive equivalent of very extensive. This means that the delivery of Health Care needs is observed in most occasions. According to Abdallah AK and Nussairat A (2016), nursing care encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people. Relationship between the Extent of the patients’ sociocultural differences and to the delivery of nursing care needs among patients in Tagum doctor’s hospital Variable Mean Patients’ SocioCultural Differences Delivery of Nursing Care Needs r Interpretation 3.73 Negatively -0.039 4.28 p-value low 0.849 correlation Decision Fail to Reject Ho Table 12 Relationship between the Extent of the patients’ sociocultural differences and to the delivery of nursing care needs among patients in Tagum doctor’s hospital, Tagum City, Davao del Norte. Table 12 shows the significant relationship between the Extent of the patients’ sociocultural differences and to the delivery of nursing care needs among patients in Tagum doctor’s hospital, Tagum City, Davao Del Norte. The coefficient of correlation between the Extent of the patients’ sociocultural differences and to the delivery of nursing care needs among patients in Tagum doctor’s hospital, Tagum City is -0.039. This indicates a negatively low correlation. Since the computed p - value is greater than 0.5, 42 therefore, the null hypothesis is accepted. It means that there is no significant relationship between the Extent of the patients’ sociocultural differences and to the delivery of nursing care needs among patients in Tagum doctor’s hospital, Tagum City. Summary of Findings. The summary of finding in this study is as follows: 1. The extent of patients' socio-cultural differences had a grand mean of 3.73 with descriptive equivalent of Very Extensive. 2. The extent of delivery of health care needs had a grand mean of 4.28 with descriptive equivalent of Very Extensive. 3. Computed revealed that there is no significant relationship between the extent of the patients’ sociocultural differences and to the delivery of nursing care needs among patients in Tagum doctor’s hospital, Tagum City.. Thus, the null hypothesis is accepted. Conclusions On the light of the aforementioned finding of the study, the following conclusions are drawn. 1. The Extent of Patients' Socio-Cultural Differences is observed in most occasions. 2. The Extent of the delivery of Health Care needs is observed in most occasions. 3. There is no significant relationship between the extent of the patients’ sociocultural differences and to the delivery of nursing care needs among patients in Tagum doctor’s hospital, Tagum City 43 4. There is no racial, cultural, and religious discrimination, which means, the nurses in Tagum Doctors Hospital provide equal quantity care regardless to the patient’s sociocultural differences. 5. There is no prioritization of patients base on their sociocultural beliefs and the delivery of nursing care needs remains unbiased and top priority of the health care team in the Tagum Doctors Hospital. Recommendations Since the result shows that there is no significant relation between the delivery of nursing care needs to sociocultural differences; we recommend that the health care team: 1. may focus on the other aspects like the compensation of patient to nurse ratio to augment the health care delivery; 2. may incorporate the use of new technology to lessen the work load of the nurses; and 3. make use of time rendering patient care rather than doing paper works. 44 REFERENCES Ahmed, 2017, Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn, R. L., & Syme, S. L. Socioeconomic status and health: The challenge of the gradient. , 49, American Psychologist (1994):15–24. [PubMed] American Psychiatric Association. (1994)Diagnostic and statistical manual of mental disorders (4th ed.), Washington,, DC. Author. Steve Graham, EdD, 2019 Li, J. (2003). U.S and Chinese cultural beliefs about learning. Journal of Educational Psychology, 95(2), 258-267. Allen, J. (2010). Improving cross-cultural care and antiracism in nursing education: A literature review. Nurse Education Today, 30, 314--320. doi:10.1016/j.nedt.2009.08.007 Cline and McKenzie (2018) Andrews, M.M., Cervantez Thompson, T.L., WehbeAlamah, H., McFarland, M.R., Hanson, P.A., Hasenau, S.M. & Vint, P.A. (2018). Developing a culturally competent workforce through collaborative partnerships. Journal of Transcultural Nursing, 22, 300--306. doi:10.1177/1043659611404214 Caffrey, R.A., Neander, W., Markle, D. & Stewart, B. (2005). Improving the cultural competence of nursing students: Results of integrating cultural content in the curriculum and an international immersion experience. Journal of Nursing Education, 44, 234--240. 45 Campesino, M. (2008). Beyond transculturalism: Critiques of cultural education in nursing. Journal of Nursing Education, 47, 298--304. doi:10.3928/01484834-20080701-02 Dunagan, Pamela B, PhD, RN; Kimble, Laura P, PhD, RN, FAAN; Gunby, Susan Sweat, PhD, RN; Andrews, Margaret M, PhD, RN, FAAN, CTN-A. (2014). Attitudes of Prejudice as a Predictor of Cultural Competence Among Baccalaureate Nursing Students, 5, 19--30. Kardong-Edgren, S. & Campinha-Bacote, J. (2008). Cultural competency of graduating US bachelor of science nursing students. Contemporary Nurse, 28, 37--44. doi:10.5172/conu.673.28.1-2.37 Hughes, K.H. & Hood, L.J. (2007). Teaching methods and an outcome tool for measuring cultural sensitivity in undergraduate nursing students. Journal of Transcultural Nursing, 18, 57--62. doi:10.1177/1043659606294196 Bruce Gahir 2014, E-leader Budapest 2010, Pluralistic Virtue Ethics and the Corporate. Theodore M. Brown 2018, World Health Organization, The World Health Organization and the Transition From “International” to “Global” Public Health. Davies H. 2016, 1999, Falling public in health services: Implementations for Accountability, Journal of Health Services Research and Policy, 4: 193194 Betancourt Joseph R, Green Alexander R, Carrillo J Emilio, 2014. Why the disease-based model of medicine fails our patients. West J Med. 2002 Mar;176(2):141–143. 46 Eric J. Hwang PhD, OTR/L Associate Professor, Department of Occupational Therapy, California State University, Dominguez Hills. tperalta@csudh.edu http://doi.org/10.15453/2168-6408.1170 Smith, B. J., Tang, K. C., & Nutbeam, D. (2016). WHO health promotion glossary: New terms. Health Promotion International, 21(4), 340–345. Physical Activity Guidelines Advisory Committee. (2018). Physical activity Guidelines advisory committee report, 2008. Washington, DC: US Department of Health and Human Services, 2008. health.gov/paguidelines/report/pdf/CommitteeReport.pdf. http://www. Accessed 28 Mar 2013. Miller, W. R., & Thoresen, C. E. (2015). Spirituality, religion, and health: An emerging research field. American Psychologist, 58(1), 24–35. Park, C. L., & Folkman, S. (2017). Meaning in the context of stress and coping. Review of General Psychology, 1(2), 115–144. Chandler, C. K., Holden, J. M., & Kolander, C. A. (1992). Counseling for spiritual wellness: Theory and practice. Journal of Counseling & Development, 71(2), 168–175. Hill, P. C., & Pargament, K. I. (2018). Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research. Psychology of Religion and Spiri- tuality, S(1), 3– 17. Maton, K. I., & Wells, E. A. (1995). Religion as a community resource 47 for well-being: Prevention, healing, and empowerment pathways. Journal of Social Issues, 51(2), 177–193. Levin, J., Chatters, L. M., & Taylor, R. J. (2015). Religion, health and medicine in African Americans: Implications for physicians. Journal of the National Medical Association, 97(2), 237–249. Aspinall, P. J., & Chinouya, M. (2018). Is the standardised term ‘Black African’ useful in demographic and health research in the United Kingdom? [Review]. Ethnicity & Health, 13(3), 183–202. doi:10.1080/ 13557850701837294. Karlsen, S., & Nazroo, J. Y. (2010). Religious and ethnic differences in health: Evidence from the Health Surveys for England 1999 and 2004. Ethnicity & Health, 15(6), 549–568. doi:10.1080/13557858. 2010.497204. Ahmed, S., Atkin, K., Hewison, J., & Green, J. (2016). The influence of faith and religion and the role of religious and community leaders in prenatal decisions for sickle cell disorders and thalassaemia major. Prenatal Diagnosis, 26(9), 801–809. Carroll, J., Epstein, R., Fiscella, K., Volpe, E., Diaz, K., & Omar, S. (2007). Knowledge and beliefs about health promotion and preventive health care among somali women in the United States. Health Care for Women International, 28(4), 360–380. Suwaidi, J. A., Bener, A., Suliman, A., Hajar, R., Salam, A. M., Numan, M. T., et al. (2004). A population based study of Ramadan fasting and acute coronary syndromes. Heart, 90, 695–696. Karlsen, S., & Nazroo, J. Y. (2014). Religious and ethnic differences in health: Evidence from the Health Surveys for England 1999 and 2004. Ethnicity & Health, 15(6), 549–568. doi:10.1080/13557858. 2010.497204. 48 Journal of Medical Sciences July-December 2017, Vol. 9, No. 2 183). Predictors of patient satisfaction Potter, Patricia A.; Perry, Anne Griffin; Stockert, Patricia A.; Hall, Amy M. (2013). Fundamentals of Nursing 8th edition Fundamentals of Nursing, Volume 1, Rick Daniels RN, COL, PhD, Ruth N. Grendel RN, DNSc, Fredrick R. Wilkins RN, BSN, MSN, CNOR Health Assessment in Nursing, 5th edition, Janet R. Webber RN, EdD, Jane H. Kelly, RN, PhD https://www.omicsonline.org/scholarly/nursing-care-journals-articles-pptslist.php?fbclid=IwAR3q2PCvIeke_fhvASxsjLNQARE4-4VWlXekJ15ieASPSs_tLgeKrekzp0 49 APPENDIX A TAGUM DOCTOR’S COLLEGE, INC. National Highway, Tagum City NURSING DEPARTMENT ________________________________________________________________________ Dear MA’AM/SIR, We would like you to answer the given questionnaire for the research work entitled: “Patients’ Sociocultural Differences and the Delivery of Nursing Care Needs among patients in Tagum doctor’s hospital, Tagum City, Davao del Norte.”. In partial fulfillment of the requirements for the Bachelors’ Degree in Nursing. Your answers to the questions regarding Patients’ Sociocultural Differences (SET A) and the Delivery of Nursing Care Needs (SET B) will be great help for the success of the study. We assure you that all your given answer shall be held confidential. Thank you very much. Very truly yours, THE RESEARCHERS 50 Questionnaire on Patients’ Sociocultural Differences Name: (Optional) ______________________________________ Hereunder are items concerning the Patients’ Sociocultural Differences and the Delivery of Nursing Care Needs among patients in Tagum doctor’s hospital. Put a check ( ) on the blank provided on the right column that correspond to your answer according to the scaling presented below. 4.50-5.00 3.50-4.49 2.50-3.49 1.50-2.49 1.00-1.49 - Very much extensive Very extensive Moderately extensive Some extensive Not at all 5 Cultural Beliefs 1. Cultural beliefs affects the way of people (who doesn't share the same cultural beliefs) treat you. 2. The people around you understand easily your cultural beliefs. 3. Cultural belief affects on how you get a proper medical attention. 4. You quarrel/disagree with people who are far from what you believe. 5. How often do people with different cultural belief ask you about your cultural belief? 6. How often people label you as a stereotype of your cultural belief? Attitudes 1. Do you perceive in a situation where the people based on your beliefs? 2. Do you feel secured when people around you share the same beliefs? 3. How likely do you feel uncomfortable when the health Rating 4 3 2 1 51 care providers assess your family background specifically in your traditional practices? 4. Based on what you have observe, how satisfied are you with the care you receive? 5. How likely do you count yourself as one of the stereotype people often described your beliefs? Educational attainment 1. How likely do you keep yourself updated to new trends on health care programs? 2. How likely does your community conduct programs/seminars that promotes new information about health? 3. How often does your community leaders organize events/activities to improve the community information about diseases? 4. How likely do you watch educational television program? 5. How likely do you participate in your community in events that will educate you and your neighbors? Religion 1. Does your religion affects your decisions to take any health care services? 2. How often do you pray? 3. Did you participate in religious activity in your community? 4. Do you reinforce your belief in God/Allah? 5. Do you read a Bible or religious artifacts? 6. Do you spend your time with your family and pray? Economic status 1. How likely do you give budget for your health insurance? 2. How likely does your income affects the health care service you received? 3. Do you participate in your community? 52 4. How often do you follow your community's 5. Do you see your community leader/s participate in the community? 6. Do you participate in your community's livelihood program? 7. Do you encourage your neighbor to help clean the surroundings? Thank you and God bless. Questionnaire on the Delivery of Nursing Care Needs Name: (Optional) ______________________________________ Hereunder are items concerning the Delivery of Nursing Care Needs. Put a check ( ) on the blank provided on the right column that correspond to your answer according to the scaling presented below. 4.50-5.00 3.50-4.49 2.50-3.49 1.50-2.49 1.00-1.49 - Very much extensive Very extensive Moderately extensive Some extensive Not at all 5 ASSESSMENT 1. During your hospitalization, how quick does the doctor and nurses attend to your concern? 2. On the day of your admission, how would you rate the care and attention they gave you? 3. Are you with the process of admission? 4. Are you satisfied with the approach of the nurses and doctors in the institution during your admission? Rating 4 3 2 1 53 5. Are you comfortable are you with the assessment given to you by the doctors and nurses? 6. How often does the staff nurses and doctors show courtesy before doing a test or procedure? 7. Are you satisfied are you in the service of the staff in Emergency Room? DIAGNOSIS 1. How satisfied are you with the procedures of diagnosing your conditions? 2. How quick does the doctors diagnosed your condition? 3. How comfortable are you when the doctor explains personally the findings of your tests? 4. How comfortable are you when the doctor explains your condition? 5. How often does the doctors show courtesy before doing a additional test? 6. Does the doctor explain what and why the procedure is needed to further validate their diagnosis? 7. Does the doctor explains what the diagnostic test is for? PLAN OF CARE 1. How satisfied are you with the care of nurses gave to aid you in your healing process? 2. How satisfied are you with the care given by the doctors in the institution? 3. How satisfied are you with the approach of care given by the nurses? 4. How comfortable are you when the nurses are taking your vital signs? 5. How comfortable are you when the nurses explains the procedures? 54 6. Does the nurses explains the procedures? 7. Does the nurse motivates you for faster recovery and healing? (Listens to what you have to say and addresses the concerns) INTERVENTION 1. From the day of your admission, how satisfy are you on how the nurses and doctors address your concerns? 2. How satisfied are you with the care given to you during your stay in the institution? 3. How quick does the staff address your concerns? Thank you and God bless. 55 APPENDIX B Items 1. Cultural beliefs affects the way of people (who doesn't share the same cultural beliefs) treat you. 2. The people around you understand easily your cultural beliefs. 3. Cultural belief affects on how you get a proper medical attention. 4. You quarrel/disagree with people who are far from what you believe. 5. How often do people with different cultural belief ask you about your cultural belief? Mean Interpretation 3.59 Very Extensive 4.00 Very Extensive 3.51 Very Extensive Moderately Extensive 3.00 3.43 6. How often people label you as a stereotype of your cultural belief? 3.05 Total Mean 3.43 Moderately Extensive Moderately Extensive Moderately Extensive Table 1 Extent of Patients' Socio-Cultural Differences in term of cultural beliefs Items 1. Do you perceive in a situation where the people based on your beliefs? 2. Do you feel secured when people around you share the same beliefs? 3. How likely do you feel uncomfortable when the health care providers assess your family background specifically in your traditional practices? 4. Based on what you have observe, how satisfied are you with the care you receive? 5. How likely do you count yourself as one of the stereotype people often described your beliefs? Total Mean Mean Interpretation 3.38 Moderately Extensive 3.97 Very Extensive 3.65 Very Extensive 4.08 Very Extensive 3.51 Very Extensive 3.72 Very Extensive Table 2 Extent of Patients' Socio-Cultural Differences in term of Attitude 56 Items 1. Does your religion affects your decisions to take any health care services? 2. How often do you pray? 3. Did you participate in religious activity in your community? 4. Do you reinforce your belief in God/Allah? 5. Do you read a Bible or religious artifacts? 6. Do you spend your time with your family and pray? Mean Interpretation 3.00 4.24 Moderately Extensive Very Extensive 3.76 Very Extensive 4.19 Very Extensive 3.89 Very Extensive 3.89 Very Extensive Total Mean 3.82 Very Extensive Table 3 Extent of Patients’ Socio-cultural Differences in terms of Religion Items 1. How likely do you give budget for your health insurance. 2. How likely does your income affects the health care service you received. 3. Do you participate in your community. 4. How often do you follow your community's 5. Do you see your community leader/s participate in the community. 6. Do you participate in your community's livelihood program. 7. Do you encourage your neighbor to help clean the surroundings. Total Mean Mean Interpretation 3.95 Very Extensive 3.81 3.86 Very Extensive Very Extensive 3.78 Very Extensive 4.00 Very Extensive 3.70 Very Extensive 3.97 Very Extensive 3.88 Very Extensive Table 4 Extent of Patients’ Socio-Cultural Differences in terms of Economic Status 57 Indicator Cultural Beliefs Attitude Education Religion Economic Status Mean Interpretation 3.43 Moderately Extensive 3.72 Very Extensive 3.78 Very Extensive 3.82 Very Extensive 3.88 Very Extensive Total Mean 3.73 Very Extensive Table 5 Summary in the Extent of Patients’ Sociocultural Differences Items 1. During your hospitalization, how quick does the doctor and nurses attend to your concern. 2. On the day of your admission, how would you rate the care and attention they gave you. 3. Are you with the process of admission. 4. Are you satisfied with the approach of the nurses and doctors in the institution during your admission. 5. Are you comfortable are you with the assessment given to you by the doctors and nurses. 6. How often does the staff nurses and doctors show courtesy before doing a test or procedure. 7. Are you satisfied are you in the service of the staff in Emergency Room. Mean Interpretation 4.54 Very much Extensive 4.35 Very Extensive 4.30 Very Extensive 4.30 Very Extensive 4.24 Very Extensive 4.05 Very Extensive 4.30 Very Extensive Total Mean 4.30 Very Extensive Table 6 Extent of delivery of Health Care Needs in Terms of Assessment 58 Items 1. How satisfied are you with the care of nurses gave to aid you in your healing process. 2. How satisfied are you with the care given by the doctors in the institution. 3. How satisfied are you with the approach of care given by the nurses. 4. How comfortable are you when the nurses are taking your vital signs. 5. How comfortable are you when the nurses explains the procedures. 6. Does the nurses explains the procedures 7. Does the nurse motivates you for faster recovery and healing (Listens to what you have to say and addresses the concerns) Mean Interpretation 4.32 Very Extensive 4.35 Very Extensive 4.54 Very Much Extensive 4.46 Very Extensive 4.41 Very Extensive 4.16 Very Extensive 4.43 Very Extensive Total Mean 4.38 Very Extensive Table 7 Extent of delivery of Health Care Needs in terms of Diagnosis Items 1. How satisfied are you with the care of nurses gave to aid you in your healing process? 2. How satisfied are you with the care given to you during your stay in the institution. 3. How quick does the staff address your concerns. 4. How often does the staff nurses show courtesy before doing a procedure. 5. How often does the nurses explains what the medication is for. 6. How often does the nurses come fully prepared for the procedure to be done? 7. How often does the nurse validates your identity. (Ask for the name of the client and/or checks the wrist band) Mean Interpretation 4.41 Very Extensive 4.24 Very Extensive 4.35 Very Extensive 4.11 Very Extensive 4.27 Very Extensive 4.08 Very Extensive 3.81 Very Extensive Total Mean 4.18 Very Extensive Table 8 Extent of delivery of Health Care Needs in terms of Plan of Care 59 Items 1. From the day of your admission, how satisfy are you on how the nurses and doctors address your concerns? 2. How satisfied are you with the care given to you during your stay in the institution? 3. How quick does the staff address your concerns? 4. How often does the staff nurses show courtesy before doing a procedure? 5. How often does the nurses explains what the medication is for? 6. How often does the nurses come fully prepared for the procedure to be done? 7. How often does the nurse validates your identity? (Ask for the name of the client and/or checks the wrist band) Mean Interpretation 4.24 Very Extensive 4.16 Very Extensive 4.27 Very Extensive 4.38 Very Extensive 4.22 Very Extensive 4.22 Very Extensive 4.41 Very Extensive Total Mean 4.27 Very Extensive Table 9 Extent of delivery of Health Care Needs in terms of Intervention Items How likely does your health care provider attend to your needs? How likely does your concerns addressed immediately? Total Mean Mean Interpretation 4.24 Very Extensive 4.32 Very Extensive 4.28 Very Extensive Table 10 Extent of delivery of Health Care Needs in terms of Evaluation 60 Assessment Indicators Mean 4.30 Interpretation Very Extensive Diagnosis 4.38 Very Extensive Plan of Care 4.18 Very Extensive Intervention 4.27 Very Extensive Evaluation 4.28 Very Extensive Total Mean 4.28 Very Extensive Table 11 Summary on the Extent of delivery of Health Care Needs Variable Mean r Interpretation p-value Decision Patients’ SocioCultural 3.73 Negatively Differences -0.039 Delivery of Nursing Care low correlation 0.849 Fail to Reject Ho 4.28 Needs Table 12 Relationship between the Extent of the patients’ sociocultural differences and to the delivery of nursing care needs among patients in Tagum doctor’s hospital, Tagum City, Davao del Norte. ABSTRACT Title of the Research: PATIENTS’ SOCIOCULTURAL DIFFERENCES AND THE DELIVERY OF NURSING CARE NEEDS AMONG PATIENTS IN TAGUM DOCTORS HOSPITAL, TAGUM CITY, DAVAO DEL NORTE Authors: BABALCON, CLIFF MARK S. GENITO, MARK JANREL G. MANGUILIMOTAN, EDDIE KING B. MILAN, SHEGUILA V. ZUMBAGA, SAHAR AYESHA MAONG Degree: BACHELOR OF SCIENCE IN NURSING Date of Completion: JANUARY 2020 OBJECTIVE: This study was conducted to give clarifications and verify the hypothesis on the delivery of nursing care needs in patient’s sociocultural differences in Tagum Doctors Hospital, Tagum City, Davao Del Norte. METHODS: The researcher used the Descriptive Correlational design in conducting this study. This method is a design which describes the nature of a situation as it exists at the time of the study and to explore the course of a particular phenomenon. RESPONDENTS: The respondents of this study are patients who are admited in Tagum Doctor’s hospital, Tagum City, Davao del Norte. The researchers will be using Convenience sampling method to determine the sample. CONCLUSION AND RECOMMENDATION: Result shows that there is no significant relation between the delivery of nursing care needs to sociocultural differences; we recommend that the health care team: 1. may focus on the other aspects like the compensation of patient to nurse ratio to augment the health care delivery; 2. may incorporate the use of new technology to lessen the work load of the nurses; and 3. make use of time rendering patient care rather than doing paper works.