Quality of Nursing Education in Philippines: Difference in Quality of Nursing Programme in relation to Profile of Faculty Members

The subject of continuous quality of nursing education programme is an extremely sensitive issue worldwide, particularly in Philippines where high number of their trained registered nurses are exported to both developed and developing countries. The assessment of quality of nursing education programmes are usually measured using passing rates in licensure examinations by several government organizations. However, few studies have associated quality of nursing education to the quality of nursing instructors, this study probed further and determined whether the quality of nursing education programmes differs according to profile of faculty members in Philippines colleges of higher education in higher educational institutions. A cross-sectional survey study design was employed in this study. One hundred and eight-five (185) faculty members in fifteen (15) higher educational institutions were selected for the research using purposive sampling. The study was carried out with the period of January 1 – June 30, 2017. Close-ended structured questionnaires based on study objectives were used to collect data. Frequency and Percentages were used to analyse the profile of faculty members whereas weighted means from a four liker’s scale was used to interpret the extent of perceived quality of nursing education programme. administration of education, faculty development programme, physical student assurance


Abstract Background
The subject of continuous quality of nursing education programme is an extremely sensitive issue worldwide, particularly in Philippines where high number of their trained registered nurses are exported to both developed and developing countries. The assessment of quality of nursing education programmes are usually measured using passing rates in licensure examinations by several government organizations. However, few studies have associated quality of nursing education to the quality of nursing instructors, this study probed further and determined whether the quality of nursing education programmes differs according to profile of faculty members in Philippines colleges of higher education in higher educational institutions.

Methods
A cross-sectional survey study design was employed in this study. One hundred and eight-five (185) faculty members in fifteen (15) higher educational institutions were selected for the research using purposive sampling. The study was carried out with the period of January 1 -June 30, 2017. Closeended structured questionnaires based on study objectives were used to collect data. Frequency and Percentages were used to analyse the profile of faculty members whereas weighted means from a four liker's scale was used to interpret the extent of perceived quality of nursing education programme.

Results
Majority, 39% and 46% of faculty members had 1-5 years' clinical experience and 6-10 years of teaching experience respectively. Study participants with a grand weighted mean of 3.84 out of 4.00 strongly agreed that quality of nursing education programme is synonyms with other universities in the world. Significant differences existed in the quality of mission/vision/goals/objectives (p-value = 0.008), curriculum and instruction (p-value = 0.038), administration of nursing programme (p-value = 0.025), faculty development programme (p-value = 0.003), physical structure and equipment (p-value = 0.016), student services (p-value = 0.017), admission of students (p-value = 0.010) and quality assurance system (p-value = 0.009) in relation to teaching experience of faculty members.

Conclusion
Faculty members strongly perceived nursing education programmes to be of good quality in this study. Teaching experience of instructors predicted significant differences in the quality of nursing education programme in all the quality matrix indicators. However, clinical experience and job category of faculty members rather showed that quality of nursing education is the same throughout all the higher educational institutions.

Background
The fundamental focus of nursing education is to produce nursing professionals that are clinically competent and can contribute immensely to the provision of quality and safe nurse care (Forsberg, Georg, Ziegert, & Fors, 2011;Tseng et al., 2011). Quality nursing education can be attained if nursing faculty are have a balanced experienced in both theory and clinical and can consequently results in nurses workforce that are able to apply the theory and lessons learnt in simulation laboratories into delivery of health care in everyday living (Lauder, Sharkey, & Both, 2004).
Worldwide, nurses are known to play a vital role in the rendering of health care services including many fundamental health related services, particularly in rural areas. The increase of workforce without compromising on quality is imperative to help achieve Sustainable Development Goals (SDGs) targets that are set by the United Nations and its member countries, especially the one focused on universal health coverage (Dovlo, 2007;United Nations, 2019). Quality of nursing education programme can be viewed as a long-term contributor to attaining quality universal health coverage in the production of qualified nurses.
The assessment of quality of nursing education programmes globally have usually been based on the passing rates in licensure examinations by several government organizations (Cabanda, 2017).
Although, several quality factors such as accreditation, students' practical exposure and profile of faculty are sometimes considered to some extent (Giddens, 2009). The issue of quality of nursing education programmes in Philippines colleges of higher education is an extremely sensitive due to the high number of trained registered nurses exported to other countries such as United States of America, United Arab Emirates and Germany (Castro-Palaganas et al., 2017;Uy, 2016).
The quality of nursing education programme has been strong associated with quality of curriculum, faculty and resources. These resources such as teaching materials and facilities are required to assist instructors in their delivery of nursing education (Chaatit, Smith, & Legrouri, 2015). The World Health Organization has also affirmed some standard criteria or area that quality of nursing education programmes should be measured with of which faculty profile or development is included (World Health Organization, 2009). This activates the discussion into whether quality of nursing education programme hinges on the profile of faculty.
Aside the challenge of quality of faculty members in nursing education programmes, there are also problems of shortage of nursing instructors which usually affects the clinical teaching and learning environment and this clinical training feature of the nursing education programme results in long term detrimental effects in practicing nurses if not well taught (Ironside, McNelis, & Enright, 2014).
Also, other issues associated with quality of faculty members which consequently affects quality of nursing education programme includes aging nursing faculty, less attractive faculty positions and length of education required to secure a faculty appointment (Siela, Twibell, & Keller, 2009).
According to a study conducted in Ghana, shortage of qualified instructors and insignificant upgrade of previous infrastructure are critical issues facing the quality of nursing school and subsequently nursing education programme (Bell et al., 2014). As far back as 27 years ago, some authors have connected the quality of nursing education in the aspect of teaching and practical gap to nursing faculty inability to assume a commanding role in clinical learning and teaching (Gerrish, 1992). Earlier researches have related quality of nursing education to the quality of nursing instructors and this study therefore determined whether the quality of nursing education programmes differs according to profile of faculty members using Philippines colleges of higher education as a case study.

Study Design
A cross-sectional survey study design was used in this research. This was executed by employing a purposive sampling method to recruit one hundred and eight-five (185) faculty instructors in fifteen (15) higher educational institutions. Questionnaires centred on the aim and study objectives of the study were self-administered after the consent of participants was sought. The study was carried out with the period of January 1 -June 30, 2017.

Study Area
The study was conducted in fifteen (15) private owned higher educational institutions in the National Capital Region (NCR) of the Philippines. The central government seat is in the National Capital Region and the city holds the highest number of higher educational institutions which comprises those offering nursing education programmes. Majority of these institutions offer health related programmes at both undergraduate and postgraduate levels. These institutions are mostly monitored by a regulating body; however, some are highly autonomous.

Sampling Procedure
An initial number of all twenty-two (22) recognized higher national institutions owned by private entities in the NCR were contacted to take part in the study, yet, a considerable number of fifteen (15) institutions gave approval for their school and faculty members to partake in the study. The one hundred and eighty-five (185) faculty members recruited into the study consisted of deans, program coordinators, and faculty instructors on full and part time contracts.

Inclusion Criteria
All teaching and clinical instructors who have spent more than 1 year in their educational institution were recruited to partake in the study.

Exclusion Criteria
All other instructors who had not spent complete 12 months in their educational institutions were not allowed to be part of the study.

Tool For Data Collection
Three areas were considered in the design of the close-ended questionnaire used for study. These were; 1) aim and objectives of the study 2) policies, and standards of nursing schools in the Philippines and 3) World Health Organization (WHO) guidelines on quality assurance and accreditation of nursing and midwifery educational institutions in the South-East Asian countries. A four (4) liker scale with standard questions were used to evaluate the quality of nursing education programmes.
The criteria for the assessment of quality of nursing education programmes included mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system. Pretesting of questionnaire was done among respondents of related characteristics in the NCR to measure the reliability of the tool before it was employed for the study.

Data Analysis
Information from completed questionnaire were entered into Microsoft Excel and imported into SPSS statistical software version 22 for editing, cleaning and analysis. Frequency and Percentage were employed to analyse the profile of faculty members while weighted means from a four-liker scale was used to interpret the extent of perceived quality of nursing education programme as assessed by faculty members. The scales for assessing quality of nursing education programme; 1.00-1.49, 1.50-2.49, 2.50-3.49 and 3.50-4.00 was interpreted as strongly disagree, disagree, agree and strongly agree respectively. One-way ANOVA was used to test for the differences in quality of nursing education programme in the eight (8) thematic areas (mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system) in relation to the profile of faculty members.

Profile of Faculty Members in Higher Educational Institutions (HEIs)
Majority, 73 (39.0%) of the 185 participants that partake in the study had 1-5 years' clinical experience whilst few, 15 (8.0%) had 16-20 years of clinical experience. Almost half, 85 (46.0%) of respondents had taught for 6-10 years though a small number, 14 (8.0%) had 16-20 years teaching experience. A little below two-thirds, 121 (65.0%) were doing both clinical and classroom teaching whereas very few, 8 (4.0%) were deans of nursing department in their institutions. (Table 1)

Quality of Nursing Education Programme as Perceived by Faculty Members
At the end of the assessment of nursing education programme, an average of grand weighted mean of 3.84 resulted, which means participants strongly agreed that nursing programme is of good quality.
However, administrators who were faculty members rated quality of nursing education programme higher with a mean of 3.88 compared to mean of 3.81 by faculty who were only instructors. The quality of the mission/vision/goals/objectives of nursing education programme was appraised highest with a mean of 3.91 while the least valued was admission of students with a mean of 3.76. (Table 2) Difference in Quality of Nursing Education Programme according to Profile of Faculty Significant differences existed in the quality of mission/vision/goals/objectives (p-value = 0.008), curriculum and instruction (p-value = 0.038), administration of nursing programme (p-value = 0.025), faculty development programme (p-value = 0.003), physical structure and equipment (p-value = 0.016), student services (p-value = 0.017), admission of students (p-value = 0.010) and quality assurance system (p-value = 0.009) in relation to teaching experience of faculty members. On the contrary, the quality of mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system did not differ significantly with respect to clinical experience and job category of faculty instructors. (Table 3) The p-values denoted by '*' are significant at a level of p < 0.05, Ho -denotes null hypothesis.

Discussion
The excellence of nursing education programme and to a large extent nursing institutions, has often been linked to success in licensure exams undertaken by nursing students while other studies have associated it to the quality and shortage of nursing instructors (Cabanda, 2017;Ironside et al., 2014).
The findings of this study also sought to unravel another concept of whether the profile of faculty in terms of clinical experience, teaching experience and job category cause significant differences in the quality of nursing education programme in the areas of mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system.
According to this study, participants strongly agreed with a score of 3.84 out of 4.00 that quality of nursing education programmes offered by institutions in the Philippines is similar to ones run by other universities. This high grading of quality of nursing education programme may have resulted because of the majority, 39% and 46% of faculty members had 1-5 years' clinical experience and 6-10 years of teaching experience respectively. Also, this is consistent with the requirement that nursing instructors should have at least a year each of clinical and teaching experience (Commission on Higher Education of the Philippines, 2013; Venzon & Venzon, 2010). Again, clinical experience particularly is important to close the gap between classroom lessons and simulation classes and this in the long run improves the quality of nursing education programme (Lauder et al., 2004).
In addition, this study also found that about two-thirds, 65% of faculty members were both classroom and clinical instructors. This result has direct influence on the high grading of quality of nursing programme because is very suitable if instructors who taught particular group of students takes them through the practical component of the course. This leads to a better delivery of the curriculum of nursing education programme according to Chaatit et al., (2015), which consequently leads to high quality of nursing education programmes.
The World Health Organization emphasized on vision as a key requirement for quality of nursing education as part of the global standards for initial education of professional nurses and midwives (World Health Organization, 2009). In a study on quality assurance in higher education, mission/vision/goals/objectives were rated higher as the driving force for quality nursing education programme. This was also congruent with the finding of this study where mission/vision/goals/objective was rated highest, 3.91 out of 4.00 compared to the other quality matrix that was used in the assessment of nursing education programmes.
Even though, many studies have emphasized on the importance of clinical experience on the quality of nursing education programme (Lauder et al., 2004), clinical experience and type of faculty did not show a significant difference in the quality of nursing education programme in all the eight quality matrix in this study. This implies that quality of nursing education programmes will be the same throughout all the nursing colleges in Philippines with regards to clinical experience and job category of instructors.
Conversely, teaching experience of faculty revealed significant difference in the quality of nursing education programme in all the criteria used for monitoring the quality of nursing education programmes. This underlines the importance of teaching experience in the quality of nursing education (Fawaz, Hamdan-Mansour, & Tassi, 2018). Experienced faculty members are usually needed in the development of mission/vision/goals/objectives, curriculum and instruction of a nursing programme (Shanthi & Grace, 2015). They are also practically involved in the administration of nursing education programme and even report gaps in curriculum where and when is necessary (Landeen et al., 2016;Shanthi & Grace, 2015). The nursing lecturers who have enough teaching experience usually had undergone a series of faculty development programme and have the experience in advising management on the needed physical structure and equipment that are necessary for the running of quality nursing education programme (Benner, Tanner, & Chesla, 2009).
Also, these faculty members have the knowledge in the calibre of students to be admitted and the type of student services that should be provided to ensure the best of nursing education.

Conclusion
Faculty members strongly perceived nursing education programmes to be of good quality in this study. Majority of these nursing instructors had sufficient years of both clinical and teaching experience. No significant difference was found in all the quality criteria of nursing education programme with regards to the profile of instructors; clinical experience and job category. However, teaching experience revealed significant difference in the quality of nursing education programme in the area of mission/vision/goals/objectives, curriculum and instruction, administration of nursing education, faculty development programme, physical structure and equipment, student services, admission of students and quality assurance system.

Declarations
Ethical approval and consent to participate The Research Development and Innovation Centre of Our Lady of Fatima University reviewed and gave ethical clearance before the conduct of the study. Approval was also granted by the ethical review committees of the Higher Educational Institutions of study participants. Consent was also given by study respondents before asked to complete the study questionnaire.

Consent For Publication
The author declares her consent for the publication for the study.
Availability Of Data And Materials the study data and materials are in the custody of the author and will be provided upon request.

Competing Interest
The author declares no competing interest concerning the publication of the research.

Funding
The author self-sponsored the study Author's contribution The sole author conceptualized, designed, analysed and interpreted the study. The author also prepared the manuscript for publication of the study.