VOLUME  1 | ISSUE 6 | MAY 2025

Beyond the Bedside: Cultivating Research Skills in Philippine Nursing

Allan Paul A. Caabay, RN, MSN

While compassionate care is the heart of nursing, its progress relies on inquiry and evidence. In the Philippines, there is growing recognition of the vital role research competence plays in empowering nurses to enhance their practice and contribute meaningfully to national health. It’s about equipping nurses not just to deliver care today, but to help shape a healthier tomorrow through knowledge and discovery.

The 2012 National Nursing Core Competency Standards (NNCCS) (Professional Regulation Commission, 2012) for the Philippines lays the foundation for this. Under the "Research" domain, it outlines expectations for nurses at all career stages. Even beginners are expected to "participate in data collection for research studies," acknowledging that every nurse is a potential contributor to evidence-based practice. As nurses gain experience, they are encouraged to develop more advanced research skills—formulating questions, analyzing literature, and eventually leading investigations.

However, bridging these standards with real-world engagement remains a work in progress. Though research principles are introduced during nursing education, their practical application is often shaped by multiple factors—availability of mentors, access to research resources, and a workplace culture that supports inquiry. Without these, enthusiasm for research can quickly wane.

Encouragingly, there are ongoing efforts across the country to nurture research capacity among nurses. Professional nursing organizations regularly conduct workshops and training focused on research methods, scientific writing, and evidence-based practice. Collaborations between universities and hospitals also open doors for nurses to participate in active research, learning alongside experienced investigators.

One of the strongest motivators is the increasing emphasis on evidence-based practice (EBP). When nurses are empowered to critically assess and apply evidence in clinical decisions, they begin to appreciate the value of research. This practical exposure often sparks a deeper curiosity—encouraging them not only to consume knowledge but to generate it.

A research-competent nursing community in the Philippines holds transformative potential. It can lead to the creation of culturally relevant interventions tailored to the diverse needs of Filipino communities. It strengthens the voice of Filipino nurses in shaping health policies and ensures that practice is anchored in sound, locally relevant evidence. On an individual level, engaging in research can enrich a nurse’s career—promoting critical thinking, continuous learning, and opportunities for professional growth.

To truly foster a culture of research in Philippine nursing, a multi-faceted approach is essential. This includes integrating strong research training in nursing curricula, expanding access to mentorship and development programs, cultivating supportive work environments, and recognizing nurses who engage in scholarly work. By strengthening research competence, the Philippines invests not only in its nurses but in a future where nursing practice is informed, empowered, and committed to improving the health of every Filipino.

Reference

Professional Regulation Commission. (2012). 2012 National Nursing Core Competency Standards. Professional Regulatory Board of Nursing. Task Force on Nursing Core Competency Revisiting Project. Retrieved from https://www.prc.gov.ph/uploaded/documents/Nursing%20Core%20Competency%20Standards%202012.pdf

Revolutionizing Nursing Education through Jean Watson’s Caring Science: A Case Study Approach to a Real-Life Brain-Dead Patient in End-of-Life Care 

By: Angeline P. Piñera, RN

(Dedication Note: This article is dedicated in loving memory to the author’s deceased mother.)

I. Introduction

Jean Watson’s Theory of Caring provides a comprehensive framework that integrates the emotional, spiritual, and physical dimensions of human interaction. It emphasizes the importance of connection, compassion, and the sacredness of life. Jean Watson highlighted in the webinar entitled, “Redefining Nursing Education Through Discipline of Caring Science,” that historically, the concept of healing was primarily associated with medical practice rather than nursing. However, with the inclusion of caring in the Nursing Meta-paradigm by the American Nurses Association (ANA), nurses now play a crucial role in promoting healing. Through transpersonal caring, nurses can foster healing in a holistic manner that addresses the physical, emotional, spiritual, and overall well-being of the patients.

During the webinar, several key principles of caring were highlighted such as Ethics of Belonging- this principle suggests that we all belong to an infinite field of universal cosmic love, forming a sacred circle of life and death. It emphasizes the inter-connectedness of humanity through the energy of cosmic love, where healing occurs through right relationships with love. This sense of belonging helps us evolve together within the sacred circle of life. Next, Ethics of Face- this principle underscores the importance of face-to-face connections in sustaining our humanity. It asserts that every individual needs to be seen, heard, and honored. By facing our own humanity, we also acknowledge the humanity of others, fostering a deep sense of connection and respect. Third, Ethics of Hand- this principle highlights the significance of physical touch, both literal and metaphorical. Holding another person’s hand symbolizes compassion and support, with hands being connected to the heart. This touch can profoundly impact the lives of others, often in ways we may not fully visualize. Last, Heart-Brain Communication- this principle focuses on the inter-connectedness of the heart, brain, and spirit. It emphasizes that caring and compassion originate from the heart, reflecting our inner truth and beauty. This connection is existential, involving an energetic spirit-to-spirit field that fosters relational connections. When this connection occurs, a transpersonal caring moment is created. The key takeaway from the webinar is the equation “nurse’s presence + patient’s presence = transpersonal moment” which shows the significance of each interaction. Every moment shared with a patient is unique, highlighting the value of being fully present and engaged in the care-giving process. A transpersonal caring moment happens when the presence of the nurse and the patient come together in a meaningful way that creates a moment of deep connection and healing. In real-life scenarios, every moment is different and every moment we spend with someone is significant. 

The author has incorporated Jean Watson's Caring Science Theory to the recent passing of her mother as an application and a reflection on how the family dealt with her end-of-life stage as a patient, with the family as care-provider and doctors, along with staff nurses and the the medical team as the primary health care providers.

II. Case Presentation

Table 1. Summary of Case &Treatments

Demographic data

63 years old, Female, Christian

Medical Condition

Nasopharyngeal Carcinoma Stage IV, battling with cancer for 8 years, on Gastrostomy tube for feeding, Covid-19 confirmed (RAT) Critical SGA Grade 6

Discharge Diagnosis

Acute Respiratory Failure Type 1 secondary to Bilateral Pleural Effusion

Details

Rushed to ER on October 31, 2024 at 9am due to unresponsiveness (semi-conscious state) and Pulse Oximeter Oxygen level of 40. Upon admission, Oxygen level rose to 70 after providing Oxygen. Patient was diagnosed with Pneumonia and was later revealed to be Covid-19 positive. At 5pm, the patient was transferred to the Isolation room and was advised to be intubated for mechanical ventilator. Patient declined and refused to be intubated. Patient was responsive to pain until 9pm. In critical condition, November 01- 6am, unresponsive (brain-dead)

November 01, 2024 – past 12nn declared “expired”

Order:

DNR (Do-Not-Resuscitate), continuous medication and food feeding

III. Case Analysis: Discussion, Interpretation, Application

Applying Jean Watson’s Theory of Human Caring to brain-dead or comatose patients involves focusing on the holistic and humanistic aspects of care, even when the patient cannot actively participate: 

1. Creating a Healing Environment- Even though brain-dead or comatose patients are not conscious, the environment around them can still be made peaceful and respectful. This includes maintaining a calm, quiet, and clean space, which can also provide comfort to the family members (Subsequently, the patient was transferred to Isolation room wherein she could get an individualized care)

2. Transpersonal Caring Relationships-Watson’s theory emphasizes the importance of deep connections between caregivers and patients. For brain-dead or comatose patients, this can mean being present, speaking to them, and involving their loved ones in care decisions. This presence can be comforting to families and can help maintain the dignity of the patient. (The doctor solicited the family's decision regarding intubation, prompting a family discussion. However, it was recalled that the patient had previously expressed her wishes to her husband in the Emergency Room, specifically directing him not to proceed with intubation.)

3. Respecting Human Dignity- Even in a state of unconsciousness, patients deserve to be treated with respect and dignity. This includes gentle handling, respectful communication, and honoring any known wishes or cultural practices of the patient. (Prior to falling into a coma, the patient explicitly communicated her wish to avoid intubation, which were her final verbal instructions. She had previously discussed her advance care preferences with her husband during a period of ambulation, giving him instruction to decline intubation if the situation were to arise. The family honored her wishes and respected her autonomy in that matter. Additionally, despite the DNR or Do Not Resuscitate order, continuous medication and food-feeding were carried on despite the brain-death condition which is an evidence that brain-dead or comatose patients are treated with dignity by providing continuous treatments)

4. Supporting Families- Families of brain-dead or comatose patients often experience significant emotional distress. Watson’s theory encourages caregivers to provide emotional support, listen to their concerns, and offer compassionate care to help them cope with the situation (During the time of bereavement, the medical team demonstrated exceptional compassion and understanding. Specifically, the doctor acknowledged their concerns and accommodated  the author’s request to take a final photograph of her mother, despite institutional restrictions. That gesture was particularly meaningful, as the author had not had the opportunity to communicate with her or hold her hand prior to her passing. Notably, other siblings had briefly interacted with her in earlier hours, with one brother eliciting a response from her despite her critical condition. Similarly, her husband had attempted to engage her in a simple task, which, although unsuccessful, provided a moment of connection. Following her passing on November 1, the family appreciated the hospital's continued support. Although COVID-19 protocols for confirmed patients restricted viewing of the deceased, the staff made an exception for the eldest daughter who had been unable to see her mother before her passing. The family were granted the request for final viewing of the cadever. That thoughtful accommodation allowed the eldest daughter to bid a final farewell, and they were grateful for the hospital's empathetic response to their needs during that difficult time.)

5. Human-to-human Interaction- The human to human interaction took place when other family members had a direct communication with the patient and the rest were through honoring her requests as a dying patient and honoring the family’s concerns by the medical staff and the rest of the hospital management, as representative of the brain-dead patient for decision-making.

IV. Conclusion

In conclusion, by integrating Jean Watson’s Caring Science principles, caregivers and healthcare providers can ensure that brain-dead or comatose patients receive compassionate and dignified care, in patient’s end-stage of life situation while also supporting the emotional needs of the patient’s family and loved ones. 

V. Recommendations

Other Principles of Caring derived from the webinar that can be used in real-life situations especially in clinical practice are Jean Watson’s Ten Caritas Processes summarized as follows: 

1. Embracing: encouraging love and compassion.

2. Inspiring enabling faith and hope: fostering sense of hope and faith in others.

3. Trusting: being sensitive to self and others, strengthening (EI) Emotional Intelligence

4. Nurturing: develop trusting relationship.

5. Forgiving: expression of positive and negative feelings, listen to someone’s story.

6. Deepening: creative problem-solving, solution-seeking

7. Balancing: relational teaching, nurse-coaching

8. Co -creating: creating healing environment, being-becoming, transpersonal caritas field

9. Ministering: assistance in basic needs with dignity; sacred act of helping

10. Opening: allowing for mystery and miracles; sacred circle of life and death beyond existential-spiritual unknown.

Reference

Watson, Jean. "Redefining Nursing Education Through Discipline of Caring Science," St. Bernadette of Lourdes College, 19 Oct. 2024, Zoom webinar, Meeting ID: 956 1408 5750, Passcode: 879575.