Quality of Nursing Education in the Philippines: The Impact of Nursing Programme Profile


 Background: The production of nursing professionals who are capable of delivering quality health care services hinges on the quality of nursing education programme. Nevertheless, quality of nursing education programme has always been judged from the point of licensure exams results and calibre of faculty members. Objectives: To Investigate the impact of profile of nursing education programme such as years of establishment, kind of accreditation agency and level of accreditation on the quality of nursing education programme in the Philippines. Design: A cross-sectional survey study design was employed in this study. Study settings and Participants: One hundred and eight-five (185) faculty members in fifteen (15) higher educational institutions in the Philippines were selected for the research using purposive-census sampling. The study was carried out from January 1 to June 30, 2017. Method: 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 Likert’s scale was used to interpret the extent of perceived quality of nursing education programme.Results: Nursing education programmes offered in the Philippines was found to be of good quality. Years of establishment of nursing education programme showed significant impact on the quality of curriculum and instruction (p-value=0.007), physical structure and equipment (p-value=0.001), student services (p-value=0.001) and admission of nursing students (p-value=0.003) while level of accreditation had significant effect on the quality of administration nursing programme (p-value=0.000), faculty development programme (p-value=0.001), physical structure and equipment (p-value=0.000), student services (p-value=0.001), admission of student (p-value=0.006) and quality assurance system (p-value=0.000) of nursing education programme. However, accreditation agency only had significant impact on quality of admission of students (p-value=0.047).Conclusion: Profile of nursing education programme had significant impact on some criteria pertaining to the quality of nursing education programme in the Philippines.


Background
The principal objective of nursing education programme is to produce nursing professionals who are capable of delivering quality health care to their patients 1 . This outstanding objective is the reason quality of nursing education programme is placed on top of discussions. Although the global demand for nurses has been very high, there have been a consistently low production of nursing professionals especially in the low-middle-income countries 2 . The call for increase of the labour force in the nursing profession should not be the reason for compromising on the quality of nursing education programme because it may be detrimental to the achievement of Sustainable Development Goals (MDGs) 3,4 .
The continuous improvement in the quality of nursing education programme is essential, especially in the Philippines where most of the healthcare providers in the nursing profession are exported to developed countries such as the United States of America and Germany 5,6 . Nonetheless, most studies conducted to assess the quality of nursing education programme in Philippines and most parts of the world had been based on results of licensure examinations 7,8 , where nursing students passing rates of 70% and above classi es the nursing education programme of good quality. This had always provided a one-sided way of assessing and improving the quality of nursing education programme. However, very few studies had looked at the impact of pro les of faculty and higher educational institutions on the quality of nursing education programme as a measure of the quality of nursing education programme 9,10 . Additionally, limited studies have also considered factors such as practical exposure of students, programme accreditation and calibre of faculty as measure of quality of a nursing education programme 11 .
Building on previous studies 7-10 , this research investigated the effect of pro le of the nursing education programme on the quality of the nursing education programme. The pro le of nursing education programme may include how long the nursing education programme has been in existence, agency that offers accreditation for nursing education programme and the level of accreditation status attained by the nursing education programme. This work speci cally studied how pro le of nursing education programmes operated in higher educational institutions in the Philippines can affect the quality of the nursing education programme.
Ultimately, this research will strengthen quality assurance of nursing education programme and ensures that nursing professionals trained in Philippines and beyond meets the market demand of nurses without compromising on the quality 5,6,11,12 . Therefore, the study used quantitative methods to measure the quality of nursing education programme. And also assessed how the quality of nursing education programme can be in uenced by the pro le of these nursing education programmes 13 . This was grounded on the null hypothesis (Ho), there is no impact of pro le of nursing education programme on the quality of nursing education programme.

Study Design
The study employed a cross-sectional design. A purposive-census sampling method was employed to recruit one hundred and eighty-ve (185) faculty members in fteen (15) tertiary institutions in achieving this study plan. These two sampling methods complimented each other in the recruitment of study area and participants. Study questionnaire that captured the aim and objectives of the research was used for the research work. A duration of six months, January 1-June 30, 2017 was used to gather data to carry out the study.

Study Area
The research took place in fteen (15) private-owned higher educational institutions in the central government seat, National Capital Region of the Philippines. Two-thirds of these higher educational institutions had been in existence for the more than forty-ve (45) years while the rest had been in operation for less than 45 years. Though seven (7) of these higher educational institutions were under the monitoring of Commission on Higher Education of the Philippines (CHED), eight (8) were accorded an autonomous status by this same regulatory body. One-fth of the higher educational institutions were properties of non-sectarian private organizations whereas the others were owned by sectarian private organizations. Although this research concentrated on undergraduate nursing education programme, most of the institutions were offering other health-related programmes.

Sampling procedure
The survey considered twenty-two (22) accredited higher educational institutions at the early stage of the sampling; however, fteen (15) of these institutions approved and allowed their faculty members to take part in the research. Additionally, one hundred and eight-ve (185) faculty members including deans, program coordinators and faculty members gave their consent and took part in the survey out of the initial two-hundred and twenty (220) study participants targeted. This re ected study participants' response rate of 84.1%.

Inclusion criteria
All faculty members who had spent at least a year in their educational institutions were recruited to partake in the study.

Exclusion criteria
All other instructors who had not completed an academic year in their educational institutions were excluded from the study.

Tool for Data Collection
A close-ended questionnaire was developed to undertake this survey on quality of nursing education programme. Three (3) areas were taken into consideration in the design of the questionnaire. These were; 1) aim and objectives of 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. All questions regarding the quality of nursing education programme were measured on a four (4) Likert scale. The 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 were considered in the assessment of the quality of nursing education programme. A pilot study was conducted among nineteen (19) respondents to measure the reliability of the questionnaire before it was employed for the study. Also, the questionnaire was put to Cronbach's alpha reliability test to determine its consistency and validity. The nal result showed .989 given an indication of high consistency and reliability.

Data Analysis
All information in completed questionnaire was entered into Microsoft Excel and later imported into SPSS statistical software version 22 for editing, cleaning and analysis. Frequency and percentage were employed to summarize the pro le of faculty members whereas weighted means based on a four-Likert scale was used as an interpretation to the extent of perceived quality of nursing education programme as among faculty members. The following scales were used for assessment of the quality of nursing education programme; 1.00-1.49, 1.50-2.49, 2.50-3.49 and 3.50-4.00 were 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 pro le of nursing education programme. A p-value of less than 0.05 was considered signi cant in this study.

Pro le of Study Participants in Higher Educational Institutions (HEIs)
Most, 121 (65.0%) of the one hundred and eighty-ve (185) study participants that were recruited into the study were classi ed as classroom-clinical faculty members while just 8 (4.0%) were deans of their departments. Also, majority, 73 (39.0%) of study participants had 1-5 years of clinical experience and few, 15 (8.0%) had 16-20 years of clinical experience. Additionally, almost half, 85 (46.0%) of faculty had 6-10 years of teaching experience and about 14 (8.0%) had taught for 16-20 years. (Table 1)

Quality of Nursing Education Programme as assessed by study participants
The assessment of the nursing education programme by study participants found an average of the grand weighted mean of 3.84, which indicates participants strongly agreed that nursing programme is of good quality. Nevertheless, administrators who were faculty members rated the quality of nursing education programme higher with a mean of 3.88 compared to a mean of 3.81 by faculty who were just instructors. The quality of the mission/vision/goals/objectives of the nursing education programme was appraised highest with a mean of 3.91 while the least rated was the admission of students with a mean of 3.76. (Table 3) Signi cant differences existed in the quality of curriculum and instruction (p-value=0.007), physical development and equipment (p-value=0.001), student services (p-value=0.001), and admission of students (p-value=0.003) in relation to years of establishment of nursing education programme. Also, signi cant differences existed in the quality of administration of nursing programme (p-value=0.000), faculty development programme (p-value=0.001), physical structure and equipment (p-value=0.000), student services (p=0.001), admission of students (p=0.006) and quality assurance system (p-value=0.000) with respect to level of accreditation of nursing education programme. In contrast, only the quality of admission of students differed signi cantly (p=0.047) with regards to the type of accreditation agency. (Table 3)

Discussion
Many studies have measured the quality of nursing education programme and related nursing education colleges and universities on the yardstick of licensure examination and calibre of nursing education instructors 11,14 . A study published recently have also looked at the impact of faculty members' pro le including job category, years of clinical and teaching experience on the quality of nursing education programme 9 . The results of this present study uncover the impact of pro le of nursing education programme on its quality in terms 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.
This study found that majority of nursing education programmes were over forty-ve years since its creation and operation in the Philippines. Additionally, all nursing education programmes have been certi ed by one accreditation agency or the other. Moreover, most of these programmes were within an intermediate level of accreditation. All these factors may have contributed to the high-rate quality of nursing education programme with over 80% average score. On the contrary, this nding was not in coherent with a study done in Indonesia that found nursing education excellence achievement percentage below fty 15 . This difference in quality in these two countries may be due to the difference in criteria used in measuring the excellence of nursing education programme.
Again, this study found that there was signi cant effect on the quality of curriculum and instruction, physical development and equipment, student services and admission of students of nursing education programme with regards to years of establishment of nursing education programme. This evidence suggests that there may be improvement in quality of curriculum and instruction of nursing education programme after some years of creating the programme because the programme might have gone through various phases of syllabus and teaching development. Also, many tertiary institutions are mostly established without enough infrastructure; however, more facilities are put in place to address and cater for the needs and requirement of the programme with time. The signi cance of improvement in curriculum and its assessment as well as provision of conducive learning culture and environment including supporting physical infrastructure and equipment are areas mentioned in the recent United Kingdom Nursing and Midwifery Council standards to assess nursing and nursing associate education programmes 16 . So, quality in curriculum and instruction, and infrastructure development are expected after many years of establishment of a nursing education programme.
Additionally, student services, admission of students and any interactions related to students are usually made better upon yearly quality assurance methods to receive feedback from students on the nursing education programme. This nding echoes studies that found that personal commitment and support for students accounts for the reason why students stay in the nursing and midwifery education programme to achieved their long life ambition and goals 16,17 . Therefore, offering a nursing education programme for more than forty-ve may bring signi cant impact on the quality of curriculum and instruction, physical development and equipment, student services and admission of students.
Although accreditation in the Philippines is voluntary, many institutions avail themselves for accreditation since it forms part of the framework of measuring quality of higher education programme 18 . Therefore, it is was expected as the ndings of this study revealed that level of accreditation of nursing education programme has signi cant in uence on the criteria used in the measurement of quality of administration of nursing programme, faculty development programme, student services, physical structure and equipment, admission of students, quality assurance system of nursing education programme. These quality forms the basis of accreditation institutions in the Philippines and other countries 16,18,19 . Most accreditation agencies are concern with majority of the quality criteria found to have signi cant impact on the quality of nursing education programme especially, administration of programmes, faculty development programmes and student services and quality assurance system.
Another result in this study is that the type of accreditation agency had signi cant impact on the quality of admission of students of nursing education programme. In this current generation, most prospective students sought out for the accreditation status of schools as well as names of institutions accrediting those college or University. This may be a possible reason for the in uence of accrediting agency on the quality of admission of students into nursing education programme 20 . Also, funding opportunities are mostly available in institutions that are highly accredited to offer speci c programmes including nursing education programme. These accredited institutions usually receive regular funding from some federal agencies to fund student's education so prospective students may prefer to go to such institutions to offer nursing education programme.

Conclusion
Nursing education programmes offered in the Philippines was found to be of good quality. Many of the nursing education programmes offered in the Philippines have been in existence for huge number of years and are all accredited by one of the accreditation agencies within Philippines. Most of these institutions had also achieved the minimum standards of accreditation to run nursing education programmes. Pro le of nursing education programme such as years of establishment, kind of accreditation agency and level of accreditation had signi cant impact on the quality of nursing education programme offered in the Philippines.

Recommendation
The study re-emphasizes the need of accreditation for all nursing education programme for the reason that it has signi cant in uences on most of the quality criteria for nursing education programme. It is also important to encourage all nursing education programmes in related institutions to obtain minimum accreditation standard since it ensures quality of the nursing education programme and continuous funding to such colleges and universities for student and faculty development.

Limitation
The use of Likert scale was employed by the study to answer questions pertaining to measurement of quality of nursing education programme; however, study participants may have exercised some form of bias in avoiding extreme answers or intermediate answers, which may not have re ected the situation on the ground. This may be as a result of recall bias or an intentional motive of answering questions.

Declarations
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 corresponding author and can be made available on reasonable 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.