Technological Competence and Compassion Among Filipino Nurses in a Private Hospital
Chasty Kate S. Paras ● Jasmine Audri S. Bagunas
Kyle Angelo C. Capindit ● Erika Monette A. Dativo
Richelle Mae P. Engada ● Cheryl F. Gasis
Ryalyn L. Larroza ● Meiryl Teza G. Prado
Jose Emamuel Galecia ● Gelbert Jan S. Porque
Iloilo Doctors’ College
ABSTRACT
This descriptive-correlational study involving 113 nurses in a private hospital in Iloilo, Philippines, investigated the relationship between technological competence and compassion in nursing. Validated questionnaires assessed nurses’ technological competence and compassionate care, acknowledging technology's growing role in healthcare quality. Most nurses exhibited high technological competence, though improvements were needed in emergency equipment use and troubleshooting. They also showed satisfactory compassion levels, but needed support for patient visitors' accommodation and financial issues. A positive correlation was found between technological competence and compassion, with higher technological competence linked to increased compassion in patient care. The study highlights that despite its technological focus, healthcare modernization does not lessen the importance of compassionate care. Both technological competence and compassion are crucial for delivering high-quality patient care. The findings suggest a need for continuous training to enhance both aspects among nursing functions.
keywords: technological competence, compassion, nurse
INTRODUCTION
The rapid growth of technology in healthcare has increased the demand for technologically competent nurses (Barakat et al., 2013; World Health Organization, 2018). Studies indicate varying levels of competence and challenges in integrating technology with compassionate care. While some nurses demonstrate proficiency, others, particularly novice nurses, struggle to balance technological skills with compassion (Kato et al., 2017; Kleib & Nagle, 2018). Lack of training and resources for advanced technologies can also overwhelm nurses (Gupta et al., 2021).
Locsin’s Technological Competency as Caring in Nursing Theory (2005) postulates that technology can bring the patient closer to the nurse by enhancing the nurse’s ability to know more about the person. However, some studies suggest that relying solely on technology can widen the interpersonal gap between nurses and patients, potentially lessening nurses' caring competency (Krel et al., 2021). While some literature examines technology's role in healthcare in terms of cost-effectiveness and patient acceptance (Sharma & Clarke, 2014), issues remain regarding telehealth in nursing care, practice, and education. Technology may also have limitations, such as recording errors or providing inadequate information (Aldakheel et al., 2021), thus not entirely replacing human interaction and potentially restricting patient autonomy when solely used for decision-making.
While Philippine studies suggest technological competency does not ensure high-level clinical decision-making due to various internal and external factors (Rizani et al., 2018; Martinez, 2020), today's fast-paced healthcare nurses often rely on technology for tasks like managing electronic health records and administering medications. Over-reliance, however, can negatively impact critical thinking, empathy, and bedside manner. An assisted and supported approach allows nurses to benefit from technology while retaining essential skills.
This study explored the relationship between technological competence and compassion among nurses in one private hospital in Iloilo City to better understand the role of advanced digital health management in nursing practice and the importance of its application and skills, along with transparent and quality nursing care.
METHODS
Design. This is a descriptive-correlational study using a one-shot survey design.
Respondents. Respondents of this study are staff nurses working in a selected private hospital in Iloilo City. Studying nurses in private hospitals can help explore how technological competence interacts with and supports compassionate care delivery.
The participants were chosen using the following inclusion criteria: (1) must be a Philippine Registered Nurse, (2) an employee of the mentioned private hospital, and (3) have at least six months of experience in the chosen hospital. The following were excluded: (1) nurses who are on leave, and (2) nurses who did not give consent to participate.
The primary respondents of the researchers consist of all nurses working in one private hospital in Iloilo City. The total number of nurses is 113 who responded in the study. The researchers preferred to use purposive sampling techniques to select and gather all respondents in the private hospital. It did not discriminate against any specific group of nurses in the population as long as they were within the inclusion criteria, which makes the technique effective. Researchers personally gathered the information to ensure the quality of data and observed ethical considerations during data gathering.
Study Setting. The study is conducted in a private secondary hospital in Iloilo City.
This study setting is a hospital that employs an adequate number of nurses using more advanced healthcare technologies, which can be a good fit for the study in achieving its objectives.
Research Questionnaire. The researchers used questionnaires as the main instrument to obtain the necessary data for the study, which was divided into three (3) parts.
Part 1 asked for the demographic profile of the respondents, which includes the name (optional), age, assigned department, length of service, and type of employment.
Part 2 was for the level of Technological Competence of the private hospital nurses with 10 items of researcher-made questions that are answerable by a 4-point Likert Scale: (4) Always, (3) Frequently, (2) Sometimes, and (1) Never. This was categorized as follows: High Technological Competence if the score is 31-40 (3.00 - 4.00), Moderate Technological Competence if the score is 21-30 (2.00 - 2.99), and Low Technological Competence if the score is 10-20 (1.00 - 1.99). This categorization was based on the study of Pimentel (2010), which calculates the interval of the Likert questionnaire.
Part 3 was for the level of Compassion among nurses working in a private hospital. This consisted of 28 adopted questions from (Rakhshan et al., 2020) specifically answerable by a 5-point Likert Scale: (5) Always, (4) Often, (3) Sometimes, (2) Rarely, and (1) Never. Questions were also divided into 4 areas: (a) professional performance, (b) continuous follow-ups, (c) patient-centered performance, and (d) empathic communications. This was categorized as follows: Satisfactory level of Compassion if the score is 104-140 (1.00 - 2.32), average level of Compassion if the score is 66-103 (2.33 - 3.65), and poor level of Compassion if the score is 28-65 (3.66 - 5.00).
Validity of the Instrument. Part two (2) utilized a researcher-made questionnaire on technological competence, and part three (3) adopted the Compassionate Care Questionnaire for Nurses (Rakhshan et al., 2020), from whose authors have granted the researcher access. The researchers conducted a validity test on these questionnaires using Good and Scates' (1972) instrument evaluation form for further cultural applicability. This form was given to three (3) experts holding Master’s Degrees in Nursing and with experience in research on the subject matter. Following a review of the validators’ evaluations, one expert’s average score showed 5.00, indicating excellent validity of the research instrument for this study. The two validators provided the same average score of 4.54, further supporting the instrument’s very good level of validity.
Reliability of the Instruments. Pilot testing was done to determine the instruments' validity. Cronbach's Alpha coefficient was used to obtain the reliability coefficient of the questionnaire. The Technological Competence Questionnaire had a Cronbach’s alpha value of .864, indicating good reliability. In contrast, the twenty-eight-item Compassionate Care Questionnaire for Nurses (Rakhshan et al., 2020) had a Cronbach’s alpha value of .820, indicating good reliability. This interpretation was based on Habidin et al. (2015).
Data-Gathering Procedure. The researchers secured requisite approvals from the Dean, the institutional ethics review board, and the participating hospital. During data collection, subjects received comprehensive briefings regarding the study's aims, potential risks and benefits, and their rights, subsequently providing written informed consent. Data were gathered via in-person questionnaires encompassing sociodemographic variables and Likert scales assessing knowledge and proficiency in technologically integrated and compassionate care. Following completion, questionnaires underwent review, and data were entered into SPSS for analysis. All research materials were securely stored with restricted access post-analysis to ensure confidentiality.
Data Analysis Procedure. In this research, data analysis was carried out per the established research goals, utilizing descriptive and inferential statistical methods. Descriptive statistics, such as frequencies, percentages, means, and standard deviations, were applied to illustrate and assess demographic information, including age, department, length of employment, and employment type of nurses in private hospitals. Inferential statistics were implemented to investigate variations and relationships in technological competency and compassion levels among nurses correlated with these demographic factors, including the Kruskal-Wallis test, Mann-Whitney U test, and Spearman’s rank correlation coefficient. An alpha level of 0.05 was set for significance in all analyses, which were executed using SPSS software.
Ethical Consideration. The University of Cebu Academe Research Ethics Committee (UCAREC) approved this study for Ethical Clearance (EXT (5)-2024-02-008).
RESULTS
Descriptive Analysis
Extent of Technological Competence. Mean responses from each indicator of the technological competence questionnaire were used further to assess nurses' extent of technological competence. The higher the mean, the more competent the skill. Overall, a mean of 3.34 out of 4 shows that, in general, most respondents agree that they are highly qualified in using technology in the hospital. The highest indicator shows they can assess their patients effectively using technology such as vital signs equipment, pulse oximeter, cardiac monitor (x=3.61). The next prominent indicator indicates that they can use basic machines in the hospital, such as oxygen administration devices, glucometers, infusion pumps, and/or cardiac monitors without supervision (x=3.58). And the third highest indicator shows that they effectively use computers as a nurse (x=3.55). Their clinical competence is highly noted due to their workplace expertise in using technologies, machines, and computers.
The following indicators have the lowest mean. However, it shows that the mean level is still high, meaning they agree to possess this technological competence. The topmost lowest indicator shows they are not familiar with troubleshooting and resolving simple technical issues with their computer/software without assistance (x=3.00). Next to this was the indicator stating they can operate emergency equipment (laryngoscope, ECG machine, and/or defibrillator) without supervision (x=3.05). Another lowest indicator shows that they are not adequately knowledgeable when a problem arises with the equipment used (x=3.18). It shows they are still competent in using these technologies, but the lowest indicators mean they are not as efficient as the highest indicators mentioned. Table 1 shows the data.
Table 1
Mean responses on the Technological Competence among Nurses, (n=113)
The majority of respondents (77.9%) demonstrated a high level of technological competence, while a significant proportion (22.1%) reported a moderate level. Additionally, there is a category for the low level of technological competence, but no respondents are classified into this category. Table 2 shows the data.
Table 2
Distribution of respondents according to the extent of Technological Competence (n=113)
Extent of Compassion. Compassion is essential in nursing, as it allows nurses to connect with patients emotionally while addressing their physical needs. The mean responses to each item on a compassion questionnaire were analyzed to understand the level of compassion among nurses.
The mean responses from each indicator of the compassion questionnaire were utilized to evaluate the extent of compassion among nurses. A higher mean value suggests that a nurse is more compassionate. The overall mean of 4.47 out of 5 indicates that respondents have responded “often” in showing compassion in caring for their patients. Examining the individual indicators provides a more nuanced understanding of how compassion manifests. The highest indication of compassion (x = 4.76) shows that they largely concur that they provided care for their patients, regardless of the economic, social, religious, and cultural circumstances. This highlights a fundamental aspect of compassionate care – treating all patients with dignity and respect irrespective of their circumstances. Another significant factor (x = 4.73) reveals that nursing respondents engage in clinical interventions while prioritizing patient privacy, resulting in the second-highest mean.
This suggests recognizing the importance of maintaining a patient's dignity and autonomy during medical procedures. And the third highest indicator shows that when it comes to providing nursing care, the mean value of (x = 4.71) suggests that nurses highly value and honor the patient's beliefs. It demonstrates that nurses can enhance their empathy by providing attentive care to their patients, regardless of economic, social, religious, and cultural factors, while valuing patient privacy and honoring their beliefs. These top indicators collectively illustrate that nurses frequently demonstrate empathy by providing attentive, inclusive care, respecting privacy, and respecting individual beliefs.
The indicators listed below have the lowest mean, yet they still exhibit a high mean level, indicating that nurses frequently demonstrate compassion in patient care. The top-lowest indicator (x = 3.99) reveals that nurses often lack the time to make routine family visits. This finding suggests that time constraints significantly impact this aspect of compassionate care. The data (x = 4.05) indicates that respondents typically do not recommend social support institutions for patients facing financial difficulties. Table 3 shows the data.
Table 3
Mean responses on the Compassion among Nurses, (n=113)
The Likert scale within the compassionate care questionnaire for nurses was further used to assess the respondents' level of compassion in patient care. Categorization into different levels revealed that 92% of participants demonstrated satisfactory compassion, while 8% exhibited an average level. Notably, while the poor level of compassion was included as a response option, no participants selected this category, further supporting the overall positive trend in compassionate care. This data suggests that most of the respondents from the private hospital possess a satisfactory level of compassionate care. However, for the 8% exhibiting an average level of compassion, further development of these skills is recommended to ensure optimal patient care delivery. Table 4 shows the data.
Table 4
Distribution of respondents according to the extent of Compassion among Nurses (n=113)
Legend: Poor (1.00 - 2.32), Average (2.33 - 3.65), Satisfactory (3.66 - 5.00)
Inferential Analysis
The researcher used the Kolmogorov-Smirnov test (Faizi & Alvi, 2023) to test the normality of data and the specific inferential statistical tool utilized. The test shows that data in Technological Competence (p=.433) and Compassion (p=.000) violate the normality distribution, and nonparametric tests can ideally be applied. Thus, the researcher applied Spearman's rho correlation.
Relationship between the Level of Technological Competence and Compassion among Nurses. Using Spearman rho to test for relationships between variables showed that Technological competence and compassion have a significant relationship (p-.000), therefore rejecting the null hypothesis. The extent of the direction of their relationship was based on Vargas's (2016) interpretation, showing a moderate correlation (r=.433). It further reflected that whenever a nurse possesses a higher technological competence, this can also moderately increase their compassion level. Table 5 shows the data.
Table 5
Relationship between the Level of Technological Competence and Compassion among Nurses
DISCUSSION
The study provides significant insights into the levels of technological competence and compassion nurses exhibit in a private hospital. The study's results on technological competence align with some existing literature while also highlighting nuanced aspects. The overall high level of technological competence observed is consistent with the increasing technology integration in healthcare settings and reflects the training provided within the private hospital. However, identifying lower competence in troubleshooting and operating emergency equipment resonates with findings suggesting a need for ongoing education and practical experience in these areas. The study by Goe et al. (2024) in China, which indicates a moderate level of informatics competency among nurses, provides a point of comparison. While not directly measuring the exact scope of technological competence, it suggests that technology proficiency can vary across different healthcare systems and contexts. The absence of respondents in the "low level of technological competence" category could be due to the scale’s imbalance, as having positive than negative options can lead to an underrepresentation of responses in the lowest category (Choi & Pak, 2004). Conclusively, these results suggest that, in general, respondents from private hospitals possess modernized knowledge and technological efficiency. Thus, improving the foundation of technological competency can be achieved through training programs that promote a culture of innovation in healthcare.
Regarding compassion, the consistently high levels reported in this study are encouraging and align with the core values of the nursing profession. The strong endorsement of providing care regardless of background, respecting privacy, and valuing beliefs reflects widely accepted principles of compassionate care embedded in nursing education and standards (American Nurses Association, 2021). However, the lower scores in areas such as time for family visits, suggesting social support institutions, and accurate diagnosis highlight practical challenges that can impede the full expression of compassion. These findings are congruent with studies that identify workload, time constraints (Carayon & Gurses, 2008), and lack of awareness or training in social support referrals (Tajvar et al., 2018) as barriers to certain aspects of compassionate care. The observation that nurses might not perceive referring patients for financial help as their primary role, especially in private hospitals with dedicated social work departments, is also reflected in the literature (Tajvar et al., 2018). Furthermore, the suggestion that limited autonomy in clinical decision-making in private settings (Benner, 1984) could impact diagnostic confidence aligns with broader discussions on the scope of nursing practice. While this study emphasizes the high overall level of compassion, the lower scores in specific areas underscore the persistent systemic and practical challenges nurses face in fully enacting their compassionate intentions. To improve, nurses must focus on addressing these issues, like time and resource allocation, providing targeted training and communication and diagnostic support, and highlighting best practices to help overcome these challenges.
The study's most significant contribution is the observed positive relationship between technological competence and compassion among the nurses in this private hospital. This finding suggests that the increasing levels of technological competence are associated with moderately increasing levels of compassion in this population. These findings agree with the theory of Rozanno Locsin’s Technological Competency as Caring in Nursing Theory (2005), wherein it states that there is an importance of technological competence as a means of expressing care and creating a supportive environment for patients. Additionally, it shows that there is a correlation between compassion and technological competence when handling patients. This observed correlation is a key insight, indicating that technology, in this context, may not be a barrier to compassionate care but could potentially facilitate it. It just shows that this could be a basis for the maintenance of compassion of nurses that will deviate from the idea that nurses are irreplaceable by machines.
CONCLUSIONS
In today’s rapidly evolving healthcare environment, nurses face many challenges adapting to advanced technologies while maintaining compassionate care amidst increased workloads, staff shortages, and emotional strain. These ongoing issues highlight the importance of balancing technological skills with empathy in patient care. The study's findings demonstrate that most nurses generally have a high level of technological competence, but those at a moderate level still have room for improvement. Training and workshops can help nurses maximize their use of technology, especially in operating emergency equipment (laryngoscope, ECG machine, and/or defibrillator) and how to troubleshoot and resolve simple technical issues using their computers/software. Whereas, having a high level of compassionate care only reflects the normality of their profession. This emphasis on compassion likely translates into improved patient outcomes and experiences, potentially fostering a more empathetic health care system overall. Significantly, an increase in technological competence also moderately increases compassion in nursing care. These results show that technology can aid patient care, and the compassion of nurses is keeping up with this innovation trend that reflects how indispensable the touch of nurses' care is. In conclusion, the study's key finding is a positive correlation between technological competence and compassion among nurses in this private hospital. This suggests technology may facilitate, not hinder, compassionate care in this setting. While this study shows a relationship, further research is needed to understand how technological competence influences compassion and if this finding holds in other contexts. This counters the idea that technology necessarily depersonalizes care.
RECOMMENDATIONS
Hospital administrators should implement surveys assessing nurses' technological competence, compassionate care delivery, workload management in technology and bedside duties, and patient satisfaction to ensure that effective technology integration enhances high-quality care. Simultaneously, nurses should actively participate in specialized empathy-building, communication, and technology training, prioritizing self-care to mitigate burnout and compassion fatigue. Nursing schools should enrich their educational materials with high-fidelity simulations and modern technological skills training carefully integrated with cultivating compassionate care. Although this study demonstrates a relationship, understanding the underlying mechanisms through which technological competence might influence compassion requires further exploration. Future researchers could explore diverse demographic profiles and public or district hospital settings to broaden the understanding of factors influencing compassion, and incorporate patient perspectives to identify additional elements impacting their care experiences with technologically competent nurses.
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