NURSES’ LEVEL OF SATISFACTION AND COMPETENCY IN THE

DELIVERY OF TELEHEALTH IN TERMS OF TEACHING-COACHING

AND HELPING ROLE FUNCTION

Submitted By:

Acuzar, Riegne Chiara Fay

Dumarpa, Jauhariyyah A.

Ingayan, Carmen A.

Lipapac, Honey P.

Luzon, Clarisse E.

Laracas, Lezel

Malacas, Shiera Mae B.

Mendoza, Clarisse B.

Mendoza, Maria Alyzza Yanee G.

Mendoza, Vhey ia M.

Muhi, Marivel M.

Ramirez, Sunshai M.

MAY 2024
 CHAPTER 1

INTRODUCTION

The healthcare system struggles to meet the ever-changing demands of its aging population
that has become more prosperous and aware of its human rights (Chongsuvivatwong et al, 2011).
Healthcare is of utmost importance in ensuring individuals’ overall well-being because this allows
for the maintenance of health, prevention and reduction of diseases and unnecessary casualties, as
well as achieving health equity for the overall public (Haslam et al, 2020). Moreover, the healthcare
industry is the source of any improvement in the quality of services and quality of life, but also a
steady challenge to existing health care providers and systems.

Progress in medicine requires new technologies (e.g., drugs, implants and devices),
procedures (e.g., new surgical techniques) or forms of organization (e.g., palliative medicine as an
innovative form of care). The tremendous increase of the quality of life and the length of life over
the last 100 years can be attributed to innovations in health care or related fields, such as hygiene
and nutrition. Innovation is constantly improving prevention (Aichinger, 2021). In accordance with
all the innovative measures in healthcare, telemedicine was issued in order to solve the
maldistribution and scarcity of equipment and basic healthcare facilities in various countries as an
alternative method (Hossain, 2019).

Telehealth is the remote delivery of health-related services through telecommunication

technology to clients for diagnoses, treatment, and prevention of disease and injuries, research and
evaluation, and continuing education for health care providers (Koivunen & Saranto 2018).
Furthermore, telehealth is the delivery of health-related services and information via electronic
communication. The terms telehealth and telemedicine can be used interchangeably, but they have
different definitions. Telemedicine refers specifically to the remote delivery of healthcare services
and clinical information using telecommunications technology, such as internet, wireless, satellite
and telephones. Telehealth is defined as the use of electronic communications to share medical
information from one place to another with the intention of improving a patient’s health.
 According to Bagchi et al., 2018, there are many different identified categories of telehealth,
including but not limited to telecardiology, telemedicine, and telerehabilitation. Telehealth is often
referred to as telemedicine, which is defined as using real-time audio-video communication
between health care providers and patients, storing data for later interpretation, and using remote
patient monitoring tools, such as home blood pressure monitors (Balestra, 2018).

Kane and Gillis (2020) explained how telemedicine services have grown over the past five
years by its array of applications in radiology, psychiatry, pathology, emergency medicine, and
different internal medicine subspecialties such as cardiology and neurology. Telehealth is the result
of the entry of advanced technology into the health industry. With the upgrade and fusion of these
technologies, the potential of telehealth as an ecosystem within the larger global healthcare sphere
is eminent. (Macariola et al, 2021).

The “Nurses' Level of Satisfaction and Competency in the Delivery of Telehealth in terms
of Teaching-coaching and Helping Role Function” is critical concern in contemporary healthcare.
Telehealth has become an increasingly integral part of healthcare delivery and nurses play a pivotal
role in patient care, education, and support. However, assessing the satisfaction of nurses with the
implementation of telehealth in these roles is essential for optimizing its effectiveness and ensuring
quality patient care.
In the contemporary healthcare landscape, the integration of telehealth services has emerged
as a transformative force, offering innovative solutions to bridge geographical distances and
enhance patient access to healthcare resources. These telehealth programs have created fresh
opportunities for patients to receive medical guidance, monitoring, and assistance from a distance.
Nurses are crucial in making sure these initiatives thrive, and Luna Goco Medical Center
has adopted this technological transformation by providing a strong telehealth program that
emphasizes the educational-coaching, and helping roles of its nursing staff.
Luna Goco Medical Center, Oriental Mindoro Provincial Hospital and Ma. Estrella General
Hospital, Inc. are notable institutions in this rapidly evolving field, that has implemented a robust
telehealth program to cater to the healthcare needs of its clientele. At the core of this telehealth
paradigm lies the multifaceted role of nurses, who not only provide medical expertise but also
assume teaching, coaching, and helping roles in guiding patients through their healthcare journeys.
 The central objective of this research is to gauge the effectiveness of these nursing functions
in terms of enhancing the overall client experience and satisfaction within telehealth services in
Calapan City. It seeks to investigate whether the teaching and coaching components of nursing care,
when delivered through telehealth channels, empower clients to take charge of their health and
well-being effectively. Moreover, it aims to assess the impact of the nursing staff's supportive and
helping roles in addressing the diverse needs and expectations of clients seeking healthcare in a
remote and often unfamiliar virtual environment.

The implications of this study extend far beyond the confines of Luna Goco Medical Center,
Oriental Mindoro Provincial Hospital, and Ma. Estrella General Hospital, Inc. offering insights that
resonate with the broader healthcare community. By examining the intricate interplay between
telehealth, nursing, and nurses’ satisfaction, this research contributes to the ongoing discourse on
optimizing telehealth practices. It informs strategies for delivering high-quality, patient-centered
care remotely, thus influencing the trajectory of healthcare delivery in an era defined by
technological advancements and evolving patient preferences. Ultimately, this study underscores
the critical importance of nursing care in shaping positive healthcare experiences within the
telehealth landscape, reaffirming the commitment to enhancing the well-being of patients in a
digitally connected healthcare world.

STATEMENT OF THE PROBLEM

This study aims to explore the relationship between the Nurses' Level of Satisfaction and
Competency in the Delivery of Telehealth in terms of Teaching-coaching and Helping Role
Function in Calapan City.

Primarily, it seeks to answer the following questions:

1. What is the demographic profile of respondents in terms of:

1.1 Age
1.2 Gender
1.3 Educational attainment
1.4 Years of experience
 2. What is the level of competency of nurses in telehealth service in terms of:
2.1 Technological Proficiency in Telehealth Implementation
2.2 Teaching-coaching
2.3 Helping role

3. What is the level of satisfaction of nurses in the telehealth delivery?

4. Is there a significant relationship between nurses’ satisfaction and nurse competency in
telehealth service?

SIGNIFICANCE OF THE STUDY

This study hopes to establish an understanding on the importance in recognizing the

Nurses' Level of Satisfaction and Competency in the Delivery of Telehealth in terms of
Teaching-coaching and Helping Role Function namely in:

Nursing Practice
Understanding the different effects of telehealth with the patients, especially regarding
nursing practice along with the tools that will directly impact patient care. The findings of this
study will furtherly help improve nursing practice in terms of gaining a different perspective in
terms of how telehealth is utilized in the hospital setting.

Nursing Admin
This research can be further utilized by the core practitioners of the hospital in terms of
integrating the possible revisions that can be done with their health care providers that would be
evidenced by the tools that would show them the different roles of the nurses and its feedback
with the patient.

Nursing Research

Understanding nurse satisfaction today can inform the future adoption of telehealth
technologies. Positive experiences can lead to greater acceptance and integration of telehealth
into nursing practice. Moreover, through the results of this study, the possibility of adapting and
the innovation of the hospital care setting in connection to telehealth services will also help the
future researchers, as they will understand better what are the sides of the respondents chosen in
this nursing research.

SCOPE AND LIMITATION

The scope of this study is that it focuses on investigating the Nurses' Level of Satisfaction
and Competency in the Delivery of Telehealth in terms of Teaching-coaching and Helping Role
Function within the hospital in the vicinity of Calapan City.

The subject is only limited to the clients, nurses who have knowledge and/or first-hand
experience of giving telehealth service to patient outside hospital settings. Other health-allied
professionals such as radiologic technology, medical technology, midwifery, etc are excluded in
the study.

THEORETICAL FRAMEWORK

The “Technological Competency as Caring in Nursing (TCCN)” theory by Dr, Rozanno

Locsin offers a guide to research on the perception of technological competency and care of
internal medicine patients by nurses when using the electronic nursing record system.

It suggests that technology can bring the patient closer to the nurse by enhancing the
nurse’s ability to know more about the person. However, there is also the possibility that the
focus of treatment moves from the patient and patient care to the technology itself. The use of
technology can also increase the gap in the interpersonal relationship between the nurse and the
patient, as exhibited by the conscious disregard of the patient as a ‘person’ and ignorance of the
nursing imperative to know the patient as a ‘person’

The implementation of Locsin’s theory can further develop the electronic nursing record
system (ENRS), which is a part of the health information system. Theory-based ENRS could
utilize the language of caring human dimensions of nursing practice, and not only physical needs
and medical conditions.

Caring is a fundamental concept of nursing that manifests itself as the genuine,

intentional presence of a nurse with the person cared for. Holistic care is needed, and the
competent use of technology could support patient care

STATEMENT OF THE HYPOTHESIS

There is no significant relationship between the Nurses' Level of Satisfaction and

Competency in the Delivery of Telehealth in terms of Teaching-coaching and Helping Role
Function.

CONCEPTUAL PARADIGM

IV DV

Nurses’ Competency in the Delivery of

Telehealth in terms of the ff:
Nurses Level of
 Technological Proficiency in Satisfaction in the
Telehealth Implementation Delivery of Telehealth
 Teaching-Coaching
 Helping role function

Figure 1. The conceptual paradigm of Nurses' Level of Satisfaction and Competency in the
Delivery of Telehealth in terms of Teaching-coaching and Helping Role Function.

The conceptual framework of this study is composed of two main variables. The
independent variable (IV), and dependent variable (DV).

The independent variable (IV) represents the nurses’ competency in the delivery of
telehealth in terms of the following category which are technological proficiency in telehealth
implementation, teaching-coaching, and the nurses helping role function.
 On the other hand, the dependent variable (DV) shows the Nurses Level of Satisfaction in
the Delivery of Telehealth.

DEFINITION OF TERMS

Telehealth
Telehealth is a broad term that refers to the use of telecommunications technology to
provide healthcare services remotely. It encompasses a range of services, including
consultations, monitoring, and education delivered through videoconferencing, telephone, mobile
apps, and other digital communication platforms.

Teaching-Coaching Role Function of the Nurse

The teaching-coaching role function of the nurse involves the nurse's capacity to educate
and inform clients about their medical conditions, treatment plans, preventive measures, and
health-related knowledge through telehealth services.

Nurses Satisfaction
Nurses’ satisfaction refers to the degree of contentment, comfort, and positive experience
perceived by nurses of the Luna Goco Medical Center, Oriental Mindoro Provincial Hospital,
and Ma. Estrella General Hospital, Inc. in telehealth program in relation to the healthcare
services provided.

Helping Role Function of the Nurse

The helping role function of the nurse signifies the nurse's role in assisting clients with
emotional support, addressing their concerns, and connecting them to necessary resources and
services through telehealth channels.
 CHAPTER II

REVIEW OF RELATED LITERATURE

Telehealth in a Hospital Setting

There are various methods and technologies available to deliver medical care to patients.
This can occur through synchronous means, involving live interactions, or asynchronously,
enabling patients to record messages for healthcare providers to review at a later time.
Furthermore, according to Bashur (2019), remote patient monitoring plays a role in continuously
tracking patients' clinical measurements from a distance and transmitting this data to healthcare
providers for assessment. In addition to telemedicine that has been practiced since at least the
1960s, and many of the issues that today confront providers, researchers, and policymakers
previously have been addressed at length. The earliest telemedicine programs were
demonstration projects funded by various government agencies. The objective of many of these
programs was to establish the feasibility of using interactive telecommunications for diagnosis
and treatment of patients at remote sites. Almost none of these programs was self-supporting,
and most folded when funding was withdrawn. The one long-standing program in North America
is that at the Memorial University of Newfoundland.

Moreover, telemedicine is a complex term that entails many different aspects making it
hard for any one definition to capture its meaning completely. Shannon (2020) defined
telemedicine as “the use of modern information technology, especially two-way interactive
audio/video communications, computers, and telemetry, to deliver health services to remote
patients and to facilitate information exchange between primary care 2 physicians and specialists
at some distance from each other”. A simpler definition of telemedicine was proposed by
Wootton who defined it as simply: “health care carried out at a distance” According to Field
(2022), there are several different components of telemedicine of which only some apply
depending on the organization implementing it. Therefore, there is no one concrete definition of
telemedicine, but there are rather variations depending on which aspects of it apply to those
using it. First, some feel that mentioning video conferencing or other specific means of
telecommunications is pertinent in describing the concept. Even though this electronic mode of
sending and receiving patient information from a distance is a key aspect of telemedicine, it only
constitutes a small portion of it. Other acts such as analyzing and controlling information are also
equally or sometimes even more important. This patient information may include details about
the patient’s previous procedures, residence, prescribed medications, and hospital admissions.
Second, telemedicine can apply to clinical along with non-clinical aspects of healthcare,
depending on what is trying to be accomplished. Clinically, telemedicine can be used in the
interaction between the physician and patient to allow for a comprehensive consultation and
possible diagnosis. Other times, it can be used non-clinically to advise patients about their health
such as in the form of electronically posting any pertinent information patients may need.
Finally, an aspect of telemedicine that is almost always used in defining it is the fact that it is
occurring over a distance. Connecting patients and their 3 healthcare providers by overcoming
geographic barriers is the most important advantage of telemedicine and thus undoubtedly worth
noting in its definition.

Moreover, according to Darkins and Cary (2019), the focused concept of telemedicine
pertains to actual medical care including preventative health or curative procedures carried out
by physicians themselves. On the other hand, the broader concept of telehealth includes
telemedicine along with other healthcare services that consist of communication between the
patient and any healthcare employee ranging from a nurse to a consultant. This may include
services such as electronic medical records, electronic information and transmission of patient
information. Physicians, however, are increasingly losing their autonomy and are collaborating
more with other subspecialties including nurses, social workers and physician assistants.
Therefore, it is not practical to use a term that solely focuses on only the physician’s part in the
care of patients while ignoring all the others in an era of medicine that is increasingly becoming
interdisciplinary. In addition, the curative aspect of medicine is expanding to now include giving
information to patients and providing healthcare to those who are homebound. Ultimately, the
combination of all of these factors is causing healthcare providers to slowly replace the term
“telemedicine” with “telehealth” to include services that overlap with both concepts. Since most
of the studies reviewed in this thesis pertain to direct consultations between the physician and
patient, the term “telemedicine” will be used.
Patient Satisfaction

With the growing popularity of telemedicine, measuring patient satisfaction is critical in

identifying its effectiveness. Darkins and Cary (2018) propose that there are a variety of ways in
which patient satisfaction can be measured in a clinical setting. The 6 most expedient way is
through the use of questionnaires since they are inexpensive and can be easily arranged. In
addition to simple questionnaires, in-depth interviews are also a common form of evaluation of
patient satisfaction. This allows for a more expanded and subjective interpretation of what the
patients’ experience with telemedicine was like. It is critical for the researchers to use the same
kinds of questions when administering surveys or asking interview questions to the population
sample. Only then will the responses be consistent, allowing for any kind of meaningful
comparative analysis surrounding telemedicine to be made.

Before examining this issue, it is first important to define what satisfaction is, since this
concept is subjective. Whitten and Love (2019) defined satisfaction as when “an individual’s
expectations of treatment and care are met.” Most studies have shown that high patient
satisfaction with telemedicine seems to be consistent with a particular demographic, specifically
rural patients. In addition, telemedicine implemented in certain fields of medicine tends to bring
about higher patient satisfaction than in others. More than any other patient population, patients
who live in rural areas show the highest satisfaction with using telemedicine.

In addition, Nesbitt et al. (2020) showed this by examining the use of telemedicine in
northern California by comparing the effectiveness, need and level of acceptance of telemedicine
in remote and municipal healthcare settings. A total of 657 rural and urban patients were studied
and were asked whether they would prefer seeing a specialist via telemedicine or by a face-to-
face consultation. Those patients who chose telemedicine were transferred to a clinic in which
the 7 patient’s physicians provided the medical information to the corresponding clinician who
carried out the teleconsultation. The patients were then asked to complete a questionnaire asking
about their level of satisfaction by rating it 1-5, with 5 being the best, for statements related to
their ability to communicate with the physician, readiness to have a teleconsultation again, and
impression of how trained the employees were in using the equipment. Results showed that the
majority of the patients from rural areas were very eager to have a teleconsultation again and
would do so over the traditional face-to-face method. They also found high patient satisfaction in
rural patients. They showed that patients from rural areas repeatedly preferred telemedicine since
they were able to avoid resorting to driving many miles in order to see their physician. The
patients also agreed that this saved travel time compensated for having to give up the face-to-
face interaction they would otherwise have had with their physician

In response, many have proposed using telemedicine by visually and audibly interacting
between the pediatric patients and psychiatrists. To understand the effectiveness of telemedicine
in the field of psychiatry, Blackmon (2020) of the University of Kentucky performed a study in
which patients from Appalachian rural areas would have consultations with a psychiatrist using
telemedicine. A total of 43 pediatric patients were studied and were transferred to an institution
by their primary care physician. In addition, two psychiatrists volunteered to participate in this
telemedicine study and received the necessary patient information from each patient’s
corresponding healthcare provider. Each session was 60 minutes long in which the psychiatrist
interviewed the family and discussed any issues with the family’s primary provider who was also
present Following the consultation, the subjects completed a questionnaire about how they felt
using the equipment and their level of comfort with communicating with the physician through
video as compared to a face-to-face consultation. Finally, the subjects were asked if they would
choose face-to-face contact instead of communicating with their physician through video. Since
some of the patients were under-aged and incapable of completing the questionnaire, the data
collected consisted of a mix of responses from both the parents and the patients. The results
showed that all the subjects expressed high levels of satisfaction with having the teleconsultation.
More specifically, 96% of the respondents expressed that they were very comfortable during the
consultation and could say anything they felt necessary to the physicians. The respondents also
expressed that they had an overall satisfaction with telemedicine and did not prefer the traditional
face-to-face consultation.

In addition, Sangelaji et al (2018), studied the patient satisfaction of telehealth services

that were delivered through videoconferencing, asynchronous telehealth websites with videos,
and telephone communication. All four of the analyzed studies included videoconferencing. The
findings of this review revealed that there is high patient satisfaction with telehealth services for
occupational therapy, physical therapy or physiotherapy, and speech-language therapy. Most of
the participants in all studies reported satisfaction with telehealth or indicated that they would
utilize services again. A few participants across all studies reported dissatisfaction due to poor
technological quality or other program difficulties (Hall et al., 2019). The four studies all
differed in types of rehabilitation services provided via telehealth, and therefore further studies
are necessary for more in-depth reviews of specific telehealth services. These findings contribute
to the benefits of the expansion of telehealth as a service delivery model in rural settings.
Because of the high satisfaction ratings related to ease of travel, quality of care, safety, and
reduced costs, telehealth services should be utilized to deliver therapy to clients in rural settings
that have difficulty accessing healthcare services (Hall et al., 2019). Additionally, most
participants across two studies preferred telehealth over standard in-person therapy. According to
Hung & Fong,2019 the other systematic review on the effects of telehealth in occupational
therapy practice found that telehealth can be used as an alternative service delivery model. Hung
and Fong (2019) only evaluated the effectiveness of rehabilitation for occupational therapy
delivered via telehealth and did not use patient satisfaction as the main outcome measure. They
also did not find sufficient evidence that telehealth was more effective than standard in-person
services. Another systematic review on synchronous telehealth for musculoskeletal conditions
found that telehealth was an effective service delivery model and found it to be comparable to
standard practices.

In conclusion, according to Kruse et al. (2017), it has been found that patient satisfaction
can be associated with the modality of telehealth but factors of effectiveness and efficacy are
mixed. Patient’s expectations are also met when providers deliver healthcare via videoconference
and other telehealth methods. In addition, telehealth is a feasible option for providers who want
to expand their practices to remote areas without having to relocate. And as telehealth continues
to develop, special care should be given to incorporate features that enable acceptance and
reimbursement of this modality.

Barriers and Facilitators

 Health care providers are adopting information and communication technologies (ICTs)
to enhance their services. Telemedicine is one of the services that rely heavily on ICTs to enable
remote patients to communicate with health care professionals; in this case, the patient
communicates with the health care professional for a follow-up or for a consultation about his or
her health condition. This communication process is referred to as an e-consultation. In this
paper, telemedicine services refer to health care services that use ICTs, which enable patients to
share, transfer, and communicate data or information in real time (i.e., synchronous) from their
home with a care provider-normally a physician-at a clinical site. However, the use of e-
consultation services can be positively or negatively influenced by external or internal factors.
External factors refer to the environment surrounding the system as well as the system itself,
while internal factors refer to user behavior and motivation.

This review aims to investigate the barriers and the facilitators that influence the use of
home consultation systems in the health care context. This review also aims to identify the
effectiveness of Home Online Health Consultation (HOHC) systems in improving patients'
health as well as their satisfaction with the systems.

Almathami et al. (2020) conducted a systematic literature review to search for articles-
empirical studies-about online health consultation in four digital libraries: Scopus, Association
for Computing Machinery, PubMed, and Web of Science. The database search yielded 2518
articles; after applying the inclusion and exclusion criteria, the number of included articles for
the final review was 45. A qualitative content analysis was performed to identify barriers and
facilitators to HOHC systems, their effectiveness, and patients' satisfaction with them.

The systematic literature review identified several external and internal facilitators and
barriers to HOHC systems that were used in the creation of a HOHC framework. The framework
consists of four requirements; the framework also consists of 17 facilitators and eight barriers,
which were further categorized as internal and external influencers on HOHC.

In the final analysis, according to Almathami et al. (2020), patients from different age
groups and with different health conditions benefited from remote health services. HOHC via
video conferencing was effective in delivering online treatment and was well-accepted by
patients, as it simulated in-person, face-to-face consultation. Acceptance by patients increased as
a result of online consultation facilitators that promoted effective and convenient remote
treatment. However, some patients preferred face-to-face consultation and showed resistance to
online consultation. Resistance to online consultation was influenced by some of the identified
barriers. Overall, the framework identified the facilitators and barriers that positively and
negatively influenced the uptake of HOHC systems, respectively.

Quality Care

Telemedicine offers great potential for promoting the quadruple aim in health care
delivery: patient experience, clinician experience, cost, and quality. Studies on patient experience
have shown high satisfaction with telemedicine, citing convenience, higher levels of comfort,
and decreased costs. Studies on clinician experience have shown improved intra-office
effectiveness, patient-clinician communication, and improved outcomes (notably in medication
adherence). Regarding health care costs, telemedicine has been shown to favorably affect office
management costs, revenue (by decreased staffing requirements and extending office hours), and
no-show rates. Telemedicine has also shown potential for improving clinical outcomes,
especially in managing chronic diseases like diabetes and hypertension, reducing diagnostic
times, and reducing infection risk. Certainly, telemedicine has its limitations, notably in the
heterogeneous evidence surrounding its long-term. cost-effectiveness, the known variability in
telemedicine’s quality of care, and its association with follow-up care (Baughman et al. 2022).

Moreover, telemedicine technology holds great promise for patients in remote areas. The
most significant effect is provided in various countries where healthcare facilities are both scarce
and unavailable. To ensure an accurate medical history, all patients and doctors must have
sufficient hardware and software security in place. Some clinics can provide virtual
appointments with a doctor through online video conferencing. When an in-person visit is not
required or necessary, these appointments enable them to continue receiving treatment from a
usual doctor. Web-based visits with a doctor or nurse practitioner are another form of interactive
appointment. As part of their health care offerings, several major corporations have access to
automated doctor's offices. On the other hand, a nursing call center is staffed by nurses who use a
question-and-answer format to offer advice for at-home treatment. This technology allows
people to take blood pressure medicine, refill medications, and recall their appointments. In
addition, patients can describe their symptoms to doctors by email, take a series of self-tests, and
enroll in step-by-step training services tailored to their specific condition. For all scenarios,
electronic health technology makes chronic illness control easier by simply placing care
monitoring apps and smartphones in the hands of patients (Zwisler, 2019).

Telemedicine according to Kohnke et al. (2018), caters to a distant patient, and employs a
range of electronic communications media, ranging from teleconferencing to image-sharing to
remote patient surveillance. Doctors may also use automation to offer quality treatment to their
patients. They need to develop better IT support systems and learn a new way of file
management. For example, a virtual appointment encourages primary care physicians to receive
advice from experts when they have concerns about the illness or treatment. Exam reports,
history, medical findings, X-rays, or other images are sent to the expert for examination to the
doctor. The specialist can answer electronically, setting up a virtual meeting with the doctor.
These virtual consultations can eliminate the need for unnecessary in-person referrals to
specialists, reduce wait times for specialist feedback, and eliminate the need for unnecessary
travel. Telemedicine strategies are more useful where a doctor can see the patient, identify a
disease, and chart the experience.

Synthesis:
Telehealth, which includes telemedicine and other remote healthcare services, uses
different technologies for long-distance medical care. It can be live or recorded, making it easier
for patients to see a doctor without going in person. Even though people define it in various
ways, it usually involves modern tech helping with healthcare from far away. Patient satisfaction
is a big deal in telemedicine, especially among rural patients who find it convenient. Despite
some tech problems, studies show most people are happy with services like therapy done
remotely. But sometimes patients prefer seeing a doctor face-to-face and can run into problems
with using telemedicine. Overall, telemedicine aims to make healthcare better for everyone, from
patients to doctors, by saving time and money and improving care quality. It's especially helpful
in areas where getting to a doctor is hard.
 CHAPTER III

METHODOLOGY AND RESEARCH DESIGN

This chapter deals with the methods research applied in this study which includes the
research design used, the target population/study subjects, the sampling technique, the data
gathering instrument, and the gathering procedure and the statistical treatment used for the
analysis and interpretation of data.

RESEARCH DESIGN
This quantitative study will utilize descriptive, correlational study design with purposive
sampling. According to Creswell (2018), quantitative research is “a means for testing objective
theories by examining the relationship among variables. These variables, in turn, can be
measured, typically on instruments, so that numbered data can be analyzed using statistical
procedures''. It often involves structured data collection methods, such as surveys, experiments,
or existing databases, and employs statistical analysis to draw conclusions.

This descriptive study can analyze the relationship between the Nurses' Level of
Satisfaction and Competency in the Delivery of Telehealth in terms of Teaching-coaching and
Helping Role Function.

Correlational research can be used to determine prevalence and relationships among

variables, and to forecast events from current data and knowledge (Curtis et al., 2016).

RESEARCH POPULATION AND SAMPLING

The researcher will utilize purposive sampling. According to Heath (2023), Purposive
sampling is used in research studies to select a specific group of individuals or units for analysis.
This method is appropriate when the researcher has a clear idea of the characteristics or
attributes, they are interested in studying and wants to select a sample representative of those
characteristics.
In conclusion, the respondents will be selected based on the inclusion criteria set by the
researcher, the participants who will be included to participate the study are the followings: (1)
nursing staffs of Luna Goco Medical Center, Oriental Mindoro Provincial Hospital, and Ma.
Estrella General Hospital, Inc. who gave nursing services using telehealth (2) willing to
participate and, (3) willing to sign an informed consent.

RESEARCH LOCALE
The study will be conducted in three (3) hospital in the vicinity of Calapan City Oriental
Mindoro once given the permission or approved the letter for conducting this research. These
hospitals are Luna Goco Medical Center (LGMC), Oriental Mindoro Provincial Hospital
(OMPH) and Ma. Estrella General Hospital, Inc.
Luna Goco Medical Center (LGMC) is a private hospital where there are numerous
individuals working such as doctors, nurses, medical technologists, and radiologic technologists.
Luna Goco Medical Center, situated in J.P. Rizal St., Lalud, Calapan, 5200 Oriental Mindoro,
exemplifies a harmonious blend of advanced medical technologies and compassionate patient
care. Offering a comprehensive suite of services encompassing primary care, specialized
treatments, surgical interventions, diagnostics, and laboratory services, the center stands as a
cornerstone of healthcare excellence in the community. With a dedicated team of healthcare
professionals at its helm, Luna Goco Medical Center prioritizes patient well-being and ensures
each individual receives personalized care tailored to their unique needs. Patients can confidently
place their trust in Luna Goco Medical Center, knowing they will receive exceptional medical
care delivered with expertise and compassion. The nursing staffs who have knowledge and/or
first-hand experience in using telehealth service to provide care for patients outside the hospital
settings are the respondents of this study.
Oriental Mindoro Provincial Hospital (OMPH), located in Barangay Santa Isabel,
Calapan City, is a trusted public healthcare facility dedicated to serving the community with
compassion and expertise. Offering a wide range of medical services, from primary care to
specialized treatments, surgeries, diagnostics, and laboratory services, the hospital is committed
to providing accessible and high-quality healthcare to all residents. With a caring team of
healthcare professionals, Oriental Mindoro Provincial Hospital prioritizes patient well-being,
ensuring that every individual receives personalized care tailored to their needs. Patients can rely
on Oriental Mindoro Provincial Hospital for exceptional medical care delivered with compassion
and dedication. The nursing staffs who have knowledge and/or first-hand experience in using
telehealth service to provide care for patients outside the hospital settings are the respondents of
this study.

Ma. Estrella General Hospital, Inc. located in Tawiran, Calapan, Oriental Mindoro serves
as a vital healthcare hub for the local community. Offering a range of medical services from
routine check-ups to specialized treatments and diagnostic procedures, the center is dedicated to
meeting the diverse healthcare needs of its residents. With a caring and dedicated team of
healthcare professionals, Ma. Estrella General Hospital, Inc. prioritizes patient well-being,
ensuring each individual receives personalized care tailored to their requirements. Patients can
rely on Ma. Estrella General Hospital, Inc. for compassionate and accessible healthcare services
delivered with professionalism and empathy. The nursing staffs who have knowledge and/or
first-hand experience in using telehealth service to provide care for patients outside the hospital
settings are the respondents of this study.

RESEARCH INSTRUMENT
This study will use a questionnaire which will be the main instrument to determine the
Nurses' Level of Satisfaction and Competency in the Delivery of Telehealth in terms of
Teaching-coaching and Helping Role Function. This questionnaire will be based on the one
category which is:

Nurse's Satisfaction of Telehealth:

In measuring the nurses’ telehealth competency the researchers have made use of
the 2019 survey questionnaire that Mr. Cornelis T.M. van Houwelingen, PhD, RN have
formulated in his research study entitled “Hospital Nurses' Self-Reported Confidence in Their
Telehealth Competencies”. This survey began with socio demographic questions: gender, age,
educational degree, experience with telehealth, and daily use of digital technology (van
Houwelingen, 2016). For each item, participants will be asked to rate their confidence in
possessing that KSA (e.g., “I can communicate the benefits of telehealth technologies to
patients”) on a 5-point Likert scale, where 1 = totally disagree, 2 = disagree, 3 = neither agree
nor disagree, 4 = agree, 5 = totally agree.
In addition, the questions asked in this questionnaire are as follows; 1.
Technological Proficiency in Implementation of Telehealth: 1.1 I have confidence that telehealth
technology is not difficult to use. 1.2. I know the limitations of telehealth in providing health
care. 1.3. I know what to do if the technology does not work. 1.4. I am able to use electronic
health records. 1.5. I have basic information technology (IT) skills, such as the use of internet
and personal computer. 2. Teaching-Coaching: 2.1 I know how to collect health-related data for
monitoring patients' health, 2.2 I am able to recognize (at a distance) the needs of the patient and
determine the care situation, 2.3 I can communicate clearly in videoconferencing and have
knowledge of the key points (e.g., use of voice, light, background), 2.4 I know what to do in case
of an emergency during the use of telehealth, 2.5 I can assess the reliability of health information
on the Internet, websites, and mobile applications and advise patients about these apps and sites.
I can also advise patients on how to use medical record portals in a safe way. 3. Helping Role
Function: 3.1 I can train the patient using IT equipment, 3.2 I can combine my nursing
knowledge and experience effectively when using telehealth technology and decision making,
3.3 I can assess whether telehealth technology is convenient for the patient (e.g., based on their
cognitive ability, technological skills), 3.4 I can protect the privacy of self and the patient by
taking into account ethical, legal, and regulatory considerations, 3.5 I am able to create a
confidential environment and a pleasant atmosphere in videoconferencing. 4. Nurses
Satisfaction: 4.1 I can convey empathy through videoconferencing by facial expression and
verbal communication, 4.2 I can put patients at ease when they feel insecure about using
technology, 4.3 I am able to create a confidential environment and a pleasant atmosphere in
videoconferencing, 4.4 I am able to assess the needs and preferences of the patient with respect
to telehealth, 4.5 I encourage the use of electronic measurement devices for the collection of
detailed patient information.

Application:
 This questionnaire will be given to the participants of this study. Researchers will analyze
the data based on the answers of the participants that will help determine Nurses' Level of
Satisfaction and Competency in the Delivery of Telehealth in terms of Teaching-coaching and
Helping Role Function.

DATA COLLECTION PROCEDURE

Securing of Approval
A written approval for this study will be given and secured to be approved before
conducting this research study at the hospitals in Calapan City including Luna Goco Medical
Center (LGMC), Oriental Mindoro Provincial Hospital (OMPH), and Ma. Estrella General
Hospital, Inc. After the approval was given, we will be conducting the actual study that aims to
determine the Nurses' Level of Satisfaction and Competency in the Delivery of Telehealth in
terms of Teaching-coaching and Helping Role Function.

Selecting Participants
Choosing participants for the research study during the data gathering procedure is
essential to ensure a representative sample. This selection is crucial as it directly impacts the
study's validity and the generalizability of its findings. We will give the consent letter for the
respondents and we will explain our objective, the significance and purpose of this study.
The researcher will send consent approval to the participants, especially to the nurses and
discharged patients available to answer the questionnaire and be part of this study through the
simple random sampling applied.

Data Collection
For data collection, a comprehensive approach will be employed to gather relevant
information for this research study. The primary method involves selecting a sample of
participants based on predefined criteria, and each participant will be provided with a structured
questionnaire. The questionnaire includes closed-ended questions using Likert scales to gauge
participant opinions. Data will be collected over a specified period, ensuring consistency and
minimizing potential biases. Confidentiality and ethical considerations will be strictly adhered to
throughout the data collection process. The gathered data will serve as the foundation for robust
analysis, contributing to the study's objectives and the generation of meaningful insights.

Statistical Treatment
To assess the level of satisfaction in the use of the telehealth program and its correlation
with the teaching-coaching and helping role function of nurses in hospitals in Calapan City, a
mixed-methods statistical approach will be applied. Descriptive statistics, such as frequencies
and percentages, will be used to summarize and present the general satisfaction levels among
nurses participating in the telehealth program. Likert scales will be employed to measure the
nurses' satisfaction, and mean scores will be computed to determine the overall satisfaction level.

Furthermore, inferential statistics, such as correlation analysis, will be conducted to

explore the relationship between nurses' satisfaction with the telehealth program and their

technological proficiency in implementation of telehealth, teaching-coaching and helping role

function. This analysis aims to identify potential associations and trends between these variables.

Additionally, spearman - rho may be employed to examine the predictive value of satisfaction

with the telehealth program on the teaching-coaching and helping role function of nurses.

The statistical treatment will be guided by a significance level (e.g., p < 0.05), providing

a basis for determining the statistical significance of observed relationships. The findings will

contribute valuable insights into the satisfaction of nurses with the telehealth program and its

potential impact on their teaching-coaching and helping role.

ETHICAL CONSIDERATION

In conducting research on the “Nurses' Level of Satisfaction and Competency in the

Delivery of Telehealth in terms of Teaching-coaching and Helping Role Function” several
ethical considerations must guide the study.

Social value
 Values including honesty, accuracy, efficiency, fairness, objectivity, reliability,
accountability, transparency, personal integrity, and knowledge of current best practices
(National ethical guidelines for biomedical and health research involving human participants,
2017) should be reflected in the procedure of the study.

In this study, nursing students can understand the actual meaning of professional identity
and reflect their self-concept based on the findings of this study. Nursing administrators and
nursing researchers will understand what the current situation of professional identity are, as well
as what the main perceived influencing factors of professional identity under the pandemic are.
So, nursing administrators can use the nursing internship guidelines as the administration
strategies for internships or new hired nurses, meanwhile, nursing researchers can cite this article
as reference to investigate some related topics and explore the advanced knowledge related to
maternal and child nursing area identity.

Informed consent

Informed consent protects the individual’s autonomy to freely choose whether or not to
participate in the research (National ethical guidelines for biomedical and health research
involving human participants, 2017). Informed consent should be informed before the study and
consisted of the whole study procedure. Respect principle is assumed to be upheld through the
informed consent process, where researchers should repeat and explain the purpose and contents
of the study, answering participant’s questions to ensure that every individual understands each
procedure, besides, researchers will obtain the agreements of participants.

This questionnaire is conducted optionally, and all of the information and data provided
are served for research only. You can participate this study voluntarily. Please answer all of the
questions carefully, objectively as well as truthfully. And there is no right or wrong, good or bad
answer, and we do not analyze individual answers but analyze all of the data. All of the data will
be confidential.

Risks, Benefits, and Safety

Benefits to the individual, community or society refer to any sort of favorable outcome of
the research, whether direct or indirect. The social and scientific value of research should justify
the risk, which is the probability of causing discomfort or harm anticipated as physical,
psychological, social, economic or legal (National ethical guidelines for biomedical and health
research involving human participants, 2017).

For the risk, the items may negatively affect emotion of respondents, so the researcher
will explain the purpose and procedure of the study. For the benefits, the respondents fill in this
questionnaire and they will reflect the professional identity as to professional self-image, benefit
of retention and risk of turnover, social comparison and self-reflection, independence of career
choice and social modeling. For the safety, the

Privacy and confidentiality are paramount in this research, given the sensitive nature of
healthcare information. Strict measures must be in place to safeguard participants' privacy,
outlining how their data will be stored, shared, and anonymized. The principle of beneficence is
crucial, necessitating that the telehealth program and coaching methods contribute positively to
participants' well-being while minimizing any potential harm.

Privacy and Confidentiality of Information

Privacy is the right of an individual to control or influence the information that can be
collected and stored and by whom and to whom that information may be disclosed or shared
(National ethical guidelines for biomedical and health research involving human participants,
2017).
Confidentiality is the obligation of the researchers to the participant to safeguard the
entrusted information. It includes the obligation to protect information from unauthorized access,
use, disclosure, modification, loss or theft (National ethical guidelines for biomedical and health
research involving human participants, 2017).

Justice
Efforts must be made to ensure that individuals or communities invited for research are
selected in such a way that the benefits and burdens of research are equitably distributed.
Vulnerable individuals should not be included in research to solely benefit others who are better-
off than themselves. Research should not lead to social, racial or ethnic inequalities. Plans for
direct or indirect benefit sharing in all types of research with participants should be included in
the study, which should be decided a priori in consultation with the stakeholders (National
ethical guidelines for biomedical and health research involving human participants, 2017).
Researchers should choose to sample equally and be without prejudice of social status,
economic status, gender, race or belief of the participants. Researchers should care and respect
participants.

CHAPTER IV

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter contains information about the results of the study and the analysis and
interpretation of data gathered with the use of the adapted statistical measures. The presentation
includes a narrative discussion of the results and implications of the data gathered which are
illustrated in tables.

Problem No. 1. What is the demographic profile of respondents in terms of:

1.1 Age
1.2 Gender
1.3 Educational attainment
1.4 Years of experience

1.1 Age
Table 1
Frequency and Percentage Distribution Table in Terms of Age

Years Frequency Percentage

30 and below 12 30.00
31 – 40 21 52.50
41 – 50 5 12.50
51 and above 2 5.00
Total 40 100.00%

Table 1 illustrates the demographic distribution of the study participants in terms of age. It
reveals that the majority of respondents fall within the age range of 31 to 40, constituting 52.5%
of the total sample size. Additionally, individuals aged 30 and below comprise a significant
portion, accounting for 30% of the participants. In contrast, the older age groups, namely 41 to
50 and 51 and above, represent smaller percentages, with 12.5% and 5% respectively. This
breakdown highlights that our study group mainly consists of middle-aged individuals which
could potentially influence the interpretation and generalization of research findings, particularly
in relation to age-related variables and outcomes.

1.2 Gender
Table 2
Frequency and Percentage Distribution Table in Terms of Gender

Gender Frequency Percentage

Female 35 87.50
Male 5 12.50
Total 40 100.00%

Table 2 presents the gender distribution among our study participants. It indicates that the
majority of respondents are female, constituting 87.50% of the total sample, while male
participants represent 12.50%. This breakdown highlights a notable gender imbalance within our
study, which warrants consideration when interpreting our research findings, especially
concerning gender-related variables and outcomes.

1.3 Educational Attainment

Table 3
Frequency and Percentage Distribution Table in terms of Educational Attainment

Educational Attainment Frequency Percentage

College Graduate 40 100%

Table 3 illustrates the educational attainment of our respondents. It reveals that all 40
individuals in our study are college graduates, representing 100% of the total sample. This data
highlights the uniformity in educational background within our participant group, which may
impact the interpretation and applicability of our research findings, especially concerning
educational variables and outcomes.

1.4 Years of experience

Table 4
Frequency and Percentage Distribution Table in Terms of Length of Service

Years Frequency Percentage

10 and below 27 67.50
11 – 20 11 27.50
21 – 30 1 2.50
31 and above 1 2.50
Total 40 100.00%
 Table 4 illustrates the distribution of respondents based on their length of service. It
reveals that the majority of respondents, constituting 67.50% of the total sample, have a length of
service of 10 years or below. Additionally, 27.50% of respondents have served between 11 and
20 years, while only 2.50% each have served between 21 and 30 years, and 31 years and above,
respectively. This breakdown emphasizes the majority of our respondents have 10 years below
experience, which may influence the interpretation of our research findings, particularly in
relation to years of experience-related variables and outcomes.

Problem No. 2. What is the level of competency of nurses in telehealth service in terms of:
2.1 Technological Proficiency in Telehealth Implementation
2.2 Teaching-coaching
2.3 Helping role

2.1 Technological Proficiency in Telehealth Implementation

Table 5
Mean Perception Profile of the Respondents in Terms of Technological Proficiency

Item Mean Rank Description

1. I have confidence that telehealth technology is not 4.05 4 Agree
difficult to use.
2. I know the limitations of telehealth in providing 4.28 1 Agree
health care.
3. I know what to do if the technology does not work. 3.85 5 Agree
4. I am able to use electronic health records. 4.08 3 Agree
5. I have basic information technology (IT) skills, 4.13 2 Agree
such as the use of internet and personal computer.
Overall Mean 4.08 Agree

Table 5 outlines the mean perception profile of respondents regarding their technological
proficiency and comfort level with telehealth technology. The respondents were asked to rate
their agreement with statements related to their confidence in using telehealth technology,
understanding its limitations, troubleshooting technical issues, proficiency in using electronic
health records (EHR), and possessing basic information technology (IT) skills.

The highest-ranked item was “I know the limitations of telehealth in providing health
care”, with a mean score of 4.28, indicates that respondents possess a robust understanding of the
limitations of telehealth in providing healthcare. This suggests that they are well-informed about
the constraints and challenges associated with delivering care remotely, a critical awareness for
effectively utilizing telehealth services.
 The second-ranked item, with a mean score of 4.13 was “I have basic information
technology (IT) skills, such as the use of internet and personal computer,” suggests that
respondents possess basic information technology (IT) skills, such as using the internet and
personal computers. This foundational knowledge is important for effectively engaging with
telehealth technologies and platforms.

The third-ranked item, with a mean score of 4.08 was “I am able to use electronic health
records,” reveals that respondents feel capable of using electronic health records (EHR). This
indicates their proficiency in navigating digital platforms for accessing and managing patient
health information, an essential skill for telehealth practice.

The fourth-ranked item, with a mean score of 4.05 was “I have confidence that telehealth
technology is not difficult to use”, indicates that respondents have confidence in the ease of use
of telehealth technology. This suggests that they perceive telehealth tools as accessible and user-
friendly, which likely contributes to their willingness to embrace and utilize such technology in
their practice.

The fifth-ranked item, with a mean score of 3.85 was “I know what to do if the
technology does not work,” indicates that respondents are somewhat confident in their ability to
troubleshoot technical issues if the technology does not work. While this score is lower
compared to others, it still reflects a moderate level of proficiency in addressing technical
challenges that may arise during telehealth sessions.

Overall, the respondents demonstrate a high level of technological proficiency, as

indicated by the overall mean score of 4.08, with the majority agreeing with the statements
presented in the table. This suggests that they feel confident in their ability to effectively use
telehealth technology and overcome any technical obstacles that may occur during virtual
healthcare interactions. This alignment with their perception of technological competence
resonates with previous research highlighting the pivotal role of technological proficiency in
shaping professional identity (Smith & Johnson, 2022). However, alternative perspectives exist,
suggesting potential variations in how individuals perceive their technological proficiency within
the context of their professional roles.

A positive self-perception of competence is associated with behavioral change (Bandura,

1977). This also applies to the context of nursing telehealth; more confidence in telehealth
competence is positively associated with nurses' willingness to use telehealth services (Lam
M.K., et. al, 2014).

2.2 Teaching-coaching
Table 6
Mean Perception Profile of the Respondents in Terms of Teaching Coaching
 Item Mean Rank Description
1. I know how to collect health-related data for 4.35 1 Agree
monitoring patients' health.
2. I am able to recognize (at a distance) the needs of 3.85 5 Agree
the patient and determine the care situation.
3. I can communicate the clearly in 4.03 3 Agree
videoconferencing and have knowledge of the key
points (e.g., use of voice, light, background).
4. I know what to do in case of an emergency during
the use of telehealth. 3.93 4 Agree
5. I can assess the reliability of health information on
the Internet, websites, and mobile applications and 4.05 2 Agree
advise patients about these apps and sites. I can also
advise patients on how to use medical record portals
in a safe way.
Overall Mean 4.04 Agree

Table 6 presents the mean perception profile of respondents regarding the nurses
teaching-coaching abilities in the context of telehealth. Respondents were asked to rate their
agreement with statements related to their proficiency in collecting health-related data,
recognizing patient needs, communicating effectively via videoconferencing, handling
emergencies during telehealth sessions, and evaluating the reliability of health information
online.

The highest-ranked item “I know how to collect health-related data for monitoring
patients' health”, with a mean score of 4.35, indicates that respondents feel confident in their
ability to collect health-related data for monitoring patients' health. This suggests a high level of
competence in gathering and utilizing pertinent health information to assess and monitor patient
well-being remotely.

The second-ranked item was “I can assess the reliability of health information on the
Internet, websites, and mobile applications and advise patients about these apps and sites. I can
also advise patients on how to use medical record portals in a safe way,” with a mean score of
4.05, indicates that respondents feel adept at assessing the reliability of health information on the
internet, websites, and mobile applications. This suggests their ability to critically evaluate
online health resources and provide informed guidance to patients regarding their use.

The third-ranked item was “I can communicate the clearly in videoconferencing and have
knowledge of the key points (e.g., use of voice, light, background),” with a mean score of 4.03,
highlights that respondents feel confident in their ability to communicate clearly via
videoconferencing and possess knowledge of key points such as voice modulation, lighting, and
background. Effective communication skills are essential for facilitating meaningful interactions
and ensuring patient understanding during telehealth consultations.

The fourth-ranked item was “I know what to do in case of an emergency during the use
of telehealth,” with a mean score of 3.93, suggests that respondents feel capable of handling
emergencies during telehealth sessions. While this score is slightly lower compared to other
items, it still indicates a moderate level of preparedness to address urgent situations that may
arise during virtual patient encounters.

The fifth-ranked item was “I am able to recognize (at a distance) the needs of the patient
and determine the care situation,” with a mean score of 3.85, suggests that respondents feel
somewhat confident in their ability to recognize patient needs and determine the care situation
from a distance. While this score is lower compared to other items, it still indicates a moderate
level of proficiency in assessing patient needs remotely.

Overall, the respondents demonstrate a positive perception of their teaching and coaching
abilities in the context of telehealth, as indicated by the overall mean score of 4.04. The majority
agree with the statements presented in the table, reflecting their confidence in their capacity to
effectively educate and support patients in a virtual healthcare setting. These findings resonate
with existing literature emphasizing the importance of technological competence and
communication skills in the delivery of telehealth services (Wang et al., 2021). However, it's
worth noting that while respondents generally agree with their proficiency in these areas, there
may still be room for further improvement and training to enhance their effectiveness in
delivering telehealth care.

2.3 Helping role

Table 7
Mean Perception Profile of the Respondents in Terms of Helping Role Function

Item Mean Rank Description

1. I can train the patient using IT equipment 3.93 5 Agree
2. I can combine my nursing knowledge and 4.25 2 Agree
experience effectively when using telehealth
technology and decision making.
3. I can tell whether telehealth technology is 4.15 3 Agree
convenient for the patient (e.g., based on their
cognitive ability, technological skills).
4. I can protect the privacy of myself and the patient 4.35 1 Agree
by taking into account ethical, legal, and regulatory
considerations.
5. I am able to create a confidential environment and 4.10 4 Agree
a pleasant atmosphere in videoconferencing.
 Overall Mean 4.16 Agree

Table 7 presents the mean perception profile of respondents concerning nurses helping
role function within the context of utilizing telehealth technology. Each item reflects a specific
aspect of this role, and respondents rated their agreement with each statement on a scale.

The highest-ranked item was “I can protect the privacy of myself and the patient by
taking into account ethical, legal, and regulatory considerations,” with a mean score of 4.35,
suggests that respondents exhibit a strong consensus in their ability to safeguard privacy and
uphold ethical, legal, and regulatory standards while using telehealth technology. This
underscores a high level of competence in maintaining confidentiality and adhering to
professional standards, contributing to the trust and integrity of telehealth interactions.

The second-ranked item was “I can combine my nursing knowledge and experience
effectively when using telehealth technology and decision making,” with a mean score of 4.25,
suggests that respondents strongly agree that they can integrate their nursing expertise with
telehealth technology effectively. This suggests a high level of confidence in their ability to
make informed decisions and provide quality care remotely, showcasing the fusion of nursing
skills with technological advancements in healthcare.

The third-ranked item was “I can tell whether telehealth technology is convenient for the
patient (e.g., based on their cognitive ability, technological skills),” garnered a mean score of
4.15, indicating that respondents feel capable of assessing the suitability and convenience of
telehealth for patients. This implies a proficiency in considering various factors, such as
cognitive ability and technological skills, to determine the appropriateness of telehealth
interventions for individual patients, thereby optimizing their healthcare experience.

The fourth-ranked item was “I am able to create a confidential environment and a

pleasant atmosphere in videoconferencing,” with a mean score of 4.10, respondents generally
agree that they can establish a confidential and welcoming atmosphere during videoconferencing
sessions. This suggests proficiency in fostering a positive patient-provider relationship remotely,
although there may be areas for further enhancement in creating a truly immersive and engaging
telehealth environment.

The fifth-ranked item was “I can train the patient using IT equipment,” received a mean
score of 3.93, indicating that respondents feel reasonably confident in their ability to train
patients in the use of IT equipment for telehealth purposes. This suggests a level of competence
in guiding patients through technological aspects of their healthcare, has a room for potential
improvement or further training to enhance effectiveness in this area.

Overall, respondents demonstrate a strong perception of their competence in fulfilling the

helping role function in telehealth scenarios, with a mean perception score of 4.16, reflecting
their ability to integrate telehealth technology into nursing practice while prioritizing patient
comfort, privacy, and convenience.

Problem No. 3. What is the level of satisfaction of nurses in the telehealth delivery?

Table 8
Mean Perception Profile of the Respondents in Terms of Satisfaction

Item Mean Rank Description

1. I can convey empathy through videoconferencing 4.33 1 Agree
by facial expression and verbal communication.
2. I can put patients at ease when they feel insecure 4.28 2 Agree
about using technology.
3. I am able to create a confidential environment and 4.13 4 Agree
a pleasant atmosphere in videoconferencing.
4. I am able to assess the needs and preferences of the 4.15 3 Agree
patient with respect to telehealth.
5. I encourage the use of electronic measurement 4.05 5 Agree
devices for the collection of detailed patient
information.
Overall Mean 4.19 Agree

The table presents the mean perception profile of respondents regarding their satisfaction
with various aspects of telehealth interactions. The respondents were asked to rate their
agreement with statements related to their ability to effectively communicate, establish rapport,
ensure confidentiality, assess patient needs, and encourage the use of electronic measurement
devices during videoconferencing sessions.

The highest-ranked item, with a mean score of 4.33, indicates that respondents feel
confident in conveying empathy through videoconferencing via both facial expressions and
verbal communication. This suggests that they believe they can effectively convey warmth and
understanding despite the virtual medium.

Following closely behind is the item ranked second, with a mean score of 4.28, which
indicates that respondents feel capable of putting patients at ease when they may feel insecure
about using technology. This highlights the importance of the healthcare provider's role in
alleviating any technological anxieties patients may have, fostering a more comfortable and
productive telehealth experience.
 The fourth-ranked item, with a mean score of 4.15, reveals that respondents feel adept at
assessing the needs and preferences of patients concerning telehealth. This indicates their
confidence in tailoring their approach to meet individual patient requirements effectively.

The fifth-ranked item, with a mean score of 4.05, suggests that respondents generally
encourage the use of electronic measurement devices for collecting detailed patient information
during telehealth sessions. This reflects their recognition of the benefits and importance of
utilizing technology to gather comprehensive data remotely.

Overall, the respondents exhibit a high level of satisfaction, as indicated by the overall
mean score of 4.19, with the majority agreeing with the statements presented in the table. This
suggests a positive perception of their abilities to effectively utilize telehealth technologies and
practices to facilitate meaningful patient interactions and provide quality care.

Problem No. 5. Is there a significant relationship between nurses’ satisfaction and nurse
competency in telehealth service?

Table 8
Correlations of Variables

Table 8 shows the correlations of the dependent variables such as technological proficiency in
implementation of telehealth, teaching-coaching, and helping role function and their relationship
to the independent variable which is the nurses satisfaction.

Table 9
Summary of r and r2
DV: Satisfaction in the Delivery of Telehealth

Independent Variable r r2 Interpretation

Technological Proficiency 0.29 0.0852 Not Significant
Teaching Coaching 0.55 0.3073 Significant
Helping Role Function 0.54 0.2884 Significant
 Table 9 provides a summary of the correlation coefficients (r) and coefficients of
determination (r2) for various independent variables in relation to the dependent variable (DV)
of Satisfaction in the Delivery of Telehealth.

The independent variable of Technological Proficiency shows a correlation coefficient (r)

of 0.29, indicating a weak positive correlation with Satisfaction in the Delivery of Telehealth.
The coefficient of determination (r2) of 0.0852 suggests that only about 8.52% of the variability
in telehealth satisfaction can be explained by technological proficiency. Additionally, this
correlation is deemed not significant, suggesting that the level of technological proficiency does
not strongly influence overall satisfaction with telehealth delivery.

Conversely, the independent variable of Teaching Coaching demonstrates a higher

correlation coefficient (r) of 0.55, indicating a moderate positive correlation with Satisfaction in
the Delivery of Telehealth. The coefficient of determination (r2) of 0.3073 suggests that
approximately 30.73% of the variability in telehealth satisfaction can be attributed to teaching
coaching. This correlation is deemed significant, highlighting that the presence of teaching
coaching significantly impacts satisfaction with telehealth delivery.

Similarly, the independent variable of Helping Role Function exhibits a correlation

coefficient (r) of 0.54, indicating a moderate positive correlation with Satisfaction in the
Delivery of Telehealth. The coefficient of determination (r2) of 0.2884 suggests that around
28.84% of the variability in telehealth satisfaction can be accounted for by the helping role
function. Like teaching coaching, this correlation is deemed significant, underscoring the
considerable influence of the helping role function on satisfaction with telehealth delivery.

In summary, while technological proficiency shows a weak and insignificant correlation

with telehealth satisfaction, teaching coaching and the helping role function both demonstrate
moderate and significant correlations. This implies that the presence of teaching coaching and
the effectiveness of the helping role function play pivotal roles in determining satisfaction levels
with telehealth delivery, highlighting the importance of supportive coaching and effective
assistance in enhancing the telehealth experience for users.
 Chapter V
SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS

This chapter presents the summary of findings, conclusions, and recommendations based
from the results of the study.

Summary of Findings:

Among the important findings of this research were:

1. The study revealed the demographic profile of respondents, indicating variations in age,
gender distribution, educational attainment, and years of experience among nurses
participating in telehealth services in Calapan City.

2. Nurses exhibited varying levels of competency in telehealth service, with notable

proficiency in technological implementation, teaching-coaching, and helping roles.

3. Overall, nurses expressed moderate to high levels of satisfaction with telehealth delivery,
indicating a positive perception of their roles and effectiveness in providing care
remotely.

4. A significant relationship was found between nurses' satisfaction and competency in

telehealth service, emphasizing the importance of addressing both aspects to optimize
patient care outcomes.

Conclusion:

Based on the findings, it can be concluded that nurses play a critical role in telehealth delivery,
showcasing competency and satisfaction in their teaching-coaching and helping functions. The
study highlights the importance of recognizing nurses' satisfaction and competency in telehealth,
as they directly impact patient care quality and overall healthcare outcomes.

Recommendations:

1. Nursing Practice: Hospital administrations should provide ongoing training and support
to enhance nurses' competency in telehealth delivery, focusing on technological
proficiency and the development of teaching-coaching skills.

2. Nursing Administration: Hospital management should prioritize nurses' satisfaction

with telehealth services by addressing any concerns or challenges they face in their roles.
Implement feedback mechanisms to continuously improve telehealth programs and
support nursing staff.

3. Nursing Research: Future research should explore additional factors influencing nurses'
satisfaction and competency in telehealth delivery, considering variables such as
workload, communication tools, and patient outcomes. Use findings to inform policy
changes and best practices in telehealth implementation.
REFERENCES

Aichinger, W. (2021). Progress in medicine: Innovations, challenges, and the role of telehealth.
Journal of Medical Innovation, 1(1), 15-26.

Almathami, H. K., et.al. (2020). Barriers and facilitators that influence telemedicine-based, real-
time, online consultation at patients’ homes: Systematic literature review. Journal of
Medical Internet Research, 22(2), e16407.

Bagchi, S. et.al. (2018). Telehealth: The bridge across health disparity. Journal of Family
Medicine and Primary Care, 7(5), 885-888.

Balestra, M. (2018). Telehealth and telemedicine: A practical guide for dermatologists. Journal
of Clinical and Aesthetic Dermatology, 11(8), 43-47.

Bandura A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological

Review, 84, 191–215.10.1037/0033-295X.84.2.191

Bashur, R. L. (2019). Telemedicine and the integration of healthcare. In Integrating

Telemedicine into the Health Care System: Meeting the Needs of Older Adults (pp. 11-
22). Springer.

Baughman, A. W., et.al. (2022). Telemedicine: Current state, historical perspective, and future
implications. South Dakota Medicine, 75(1), 17-21.

Chongsuvivatwong, V. et.al. (2011). Health and health-care systems in Southeast Asia: Diversity
and transitions. The Lancet, 377(9763), 429-437.
Creswell, J. W. (2018). Research design: Qualitative, quantitative, and mixed methods
approaches (5th ed.). Sage Publications.

Curtis, E., Comiskey, C., & Dempsey, O. (2016). Importance of research design for
epidemiological studies. In Epidemiology - Current Perspectives on Research and
Practice (pp. 57-72). InTech.

Darkins, A., & Cary, M. A. (2018). Patient satisfaction with teledermatology. Journal of
Telemedicine and Telecare, 24(3), 169-178.

Field, M. J. (2022). Telemedicine: A guide to assessing telecommunications in healthcare.

National Academies Press.

Haslam, C., et.al. (2020). The importance of social groups for retirement adjustment: Evidence,
application, and policy implications of the social identity model of identity change. Social
Issues and Policy Review, 14(1), 7-34.

Hossain, I. (2019). Telemedicine: The new future of healthcare. Journal of Health and Medical
Sciences, 2(2), 1-4.

Hung, Y., & Fong, K. N. K. (2019). Effects of telehealth on functional outcomes in patients with
heart failure: A meta-analysis of randomized controlled trials. Telemedicine and e-
Health, 25(8), 684-692.

Kane, C. K., & Gillis, K. (2020). Telehealth expansion during the COVID-19 pandemic.
American Medical Association. Retrieved from https://www.ama-assn.org/delivering-
care/public-health/telehealth-expansion-during-covid-19-pandemic

Koivunen, M., & Saranto, K. (2018). Nursing professionals’ experiences of the facilitators and
barriers to the use of telehealth applications: A systematic review of qualitative studies.
Scandanavian Journal of Caring Sciences, 32(1), 24-44.

Kohnke, A. M., & Goh, G. (2018). Telemedicine in the rural community. In Rural Medicine (pp.
133-148). Springer.
Kruse, C. S., et.al. (2017). Telehealth and patient satisfaction: A systematic review and narrative
analysis. BMJ Open, 7(8), e016242.

Lam M.K., et.al, (2014). “I can do it”: Does confidence and perceived ability in learning new
ICT skills predict pre-service health professionals' attitude towards engaging in e-
healthcare? Studies in Health Technology and Informatics, 204, 60–66.

Macariola, R., et.al. (2021). Harnessing technology for better health: The rise of telehealth in the
Philippines. Acta Medica Philippina, 55(1), 83-87.

Mathur, R., & Swaminathan, S. (2018). National Ethical Guidelines for Biomedical and Health
Research Involving Human Participants, 2017: A commentary. Indian Journal of Medical
Ethics/Indian Journal of Medical Ethics (Online), 3(3).
https://doi.org/10.20529/ijme.2018.065

Nesbitt, T. S., et.al. (2020). Development of a telemedicine program: A review of 1,000

videoconferencing consultations. Western Journal of Medicine, 160(2), 156.
Parmanto, B., Lewis, A. E., Graham, K. M., & Bertolet, M. (2016). Development of the

Telehealth Usability Questionnaire (TUQ). International Journal of Telerehabilitation,

8(1), 3–10. https://doi.org/10.5195/ijt.2016.6196

Smith, J., & Johnson, A. (2022). The Role of Technological Proficiency in Shaping Professional

Identity: A Study on Healthcare Professionals. Journal of Technology in Healthcare,

10(3), 123-135.

Shannon, G. W. (2020). Telemedicine in the United States: Regulation and innovation. In

Telemedicine (pp. 37-53). Springer.

Thomas, L. (2020). Sampling. In The Encyclopedia of Clinical Psychology (pp. 1-4). American
Cancer Society.

van Houwelingen, C. T. M, et.al. (2019). Hospital Nurses' Self-Reported Confidence in Their

Telehealth Competencies. The Journal of Continuing Education in Nursing, 50(1), 26–34.
https://doi.org/10.3928/00220124-20190102-07
Wang, L., Smith, K., & Chen, J. (2021). Telehealth in the era of COVID-19: A study on
healthcare professionals' perspectives and practices. Journal of Telemedicine and
Telecare, 27(3), 123-135.

Whitten, P., & Love, B. (2019). Patient and provider satisfaction with the use of telemedicine:
Overview and rationale for cautious enthusiasm. Journal of Postgraduate Medicine,
65(1), 29.

Wootton, R. (2019). Twenty years of telemedicine in chronic disease management—an evidence

synthesis. Journal of Telemedicine and Telecare, 25(3), 139-143.

Zwisler, J. (2019). Telemedicine. In Innovations in Global Health Professions Education (pp.

247-255). Springer.