Training Engagement and Performance Feedback as Predictors of Staff Nurses’ Compliance with Nursing Protocols: An Explanatory Sequential Mixed Methods Study

Abstract

Patient safety and the quality of treatment are significantly influenced by staff nurses' adherence to established clinical guidelines. In a secondary-level Department of Health (DOH)-retained public hospital in Zamboanga del Sur, Philippines, this explanatory sequential mixed-methods study examined training engagement and performance feedback as determinants of staff nurses' adherence to nursing protocols. The study used a sample of 229 eligible staff nurses using a descriptive-correlational and predictive design; 149 of them took part in the quantitative phase (65% response rate). After eight interviews, qualitative data saturation was reached, and two further interviews verified this. Jamovi software was used to analyze quantitative data in order to calculate multiple linear regression with bootstrapping, Spearman's rank correlation, and descriptive statistics. Using semi-structured in-depth interviews and a qualitative inquiry informed by the Appreciative Inquiry (AI) 4D Framework (Discover, Dream, Design, and Destiny), the next qualitative phase investigated nurses' peak operational practices and success-oriented behaviors. All subcategories had strong baseline levels of protocol compliance, performance feedback, and training engagement, according to quantitative studies. According to multiple linear regression, typical supervisory feedback channels need a deliberate structural makeover, even though training engagement serves as a main positive predictor of protocol compliance. Five key compliance facilitators were identified using qualitative theme analysis: (a) experiential and simulation-based learning; (b) peer collaboration and mentorship; (c) constructive and reflective feedback; (d) the methodical application of procedural checklists; and (e) supportive leadership. According to integrated findings, protocol compliance is an intricate operational procedure. Healthcare organizations need to shift from high-volume, punitive performance audits to focused, reflective developmental coaching in order to optimize frontline autonomy and self-efficacy. The study comes to the conclusion that, in settings with limited resources, maintaining a culture of patient safety and promoting compliance habits require ongoing training involvement and developmental feedback.