Background: The Nursing Process (NP) is a professional framework adapted globally to guide and help professional nurses to deliver quality patient centered care.
Aim of the study: Assessing the Challenges of nursing process utilization and how to promote nursing process knowledge among nurses in saki west local government.
Methods: A cross sectional design employing quantitative methods was conducted in Saki West Local Government. Data were collected from 142 nurses using a self directed questionnaire. Statistic package for social sciences (SPSS) version 20.0 was used to analyze data using descriptive statistics (frequencies) and inferential statistics (chi-square, Fisher).
Results: The majority of nurses (73.2%) implemented NP. Of 142 nurses, one half (43%) did not follow all steps of the process while 56% achieved the total score of the NP implementation. Findings indicated that demographic factors had a significant relationship with NP implementation (sex: p=0.038; marital status: p=0.002; experience: p=0.000). Knowledge and trainings of nurses on the process were significantly associated with its implementation (p=0.000). Institution factors also had a significant association with NP implementation (p=
0.009) and nurses’ perception to NP (p=0.003).
Conclusion and recommendations: Knowledge of nurses was not adequate to put NP into practice. Work overload, lack of materials, poor motivation as well as nurses’ perceptions to NP affected its implementation. There isa need to put into practice training on NP for practicing nurses focusing on its benefits and the hospital should consider NP implementation critically by supply all needed resources for the process, motivating nurses and evaluating its progress.
The first chapter of the study will include the different parts such as introduction on the Nursing process including the definition or the meaning of Nursing Process, nurses’ working conditions in Nigeria in relation with Nursing Process implementation, background of the study which includes the history of Nursing Process and its adoption worldwide, problem statement that shows the reason of researcher to conduct the study, the aim of the study and specific objectives, research questions, significance of the study which shows the areas that the study will benefit and the last part of the chapter will consists of giving a detailed structure of the study.
The fundamental nature of nursing, the science and technology of nursing as well as its humanistic assumptions that encourage critical thinking and creativity are well defined by Nursing Process framework that guides nursing profession; the use of Nursing Process tool influences nurses’ critical thinking, creativeness and consequently permits resolve problems in practice of nursing (Ledesma & Mendes, 2009, p.1).
The history of Nursing Process concept was introduced in 1960s in developed/industrialized countries and since that period the application of Nursing Process started to be adopted widely as a structured way to be followed by nurses to solve patients’ problems in their profession where it was also referred to as a way of providing holistic nursing care (Ngao, 2015, p.1).
The original adoption of Nursing Process was by the North American nursing profession from general system theory (GST) and then quickly became a symbol of modern nursing and a philosophy of nursing profession (Ledesma & Mendes, 2009, p.1).
In African countries the Nursing Process was adopted even if it encountered some challenges. A study aimed to evaluate the utilization of Nursing Process and patient outcome in Nigeria revealed that only 60% of professionals willingly applied the Nursing Process in the care of the patients. The challenges related to this lack of NP application were inadequate practical knowledge, inadequate staff, work overload and management’s inability to provide the needed materials among others (Afolayan et al., 2013, p.1).
A research conducted in Northern Ethiopia in Mekelle zone hospitals to assess the application of Nursing Process and its affecting factors revealed that 90% of nurses had poor knowledge about Nursing Process while 99.5% of nurses had positive attitude toward its implementation (Hagos el al, 2014, p.7). The above findings of Nursing Process application in Ethiopia highlights that the knowledge base of nurses can compromise the use of Nursing Process framework.
Nurses working in referral hospitals also showed inadequacy to implement Nursing Process; the study conducted In Tanzanian referral hospital by (Mamseri, 2012, p.122-124) revealed that only 43% of nurses were able to implement Nursing Process and more than 50% understood it but it was difficult for them to implement it (Mamseri, 2012, p.122). The lack of knowledge about Nursing Process among nurses as it has been indicated in Ethiopia plays a role of hindering its implementation when providing nursing care to patients because knowledge is a pre-requisite of practice.
Nurses’ perception regarding the process is crucial whereas it can be compromised by several challenges; the example is a case of Kenya where the research assessing barriers to NP implementation revealed that in Machaos level 5 hospitals one-third (33.1%) of nurses reported that they actively implement the nursing process but only (8.2%) nurses correctly listed all the steps of the process (Ngao, 2016). These mentioned results show the positive attitude of nurses towards Nursing Process implementation even if the knowledge about Nursing Process was poor.
Nursing assessment which is the first step of the Nursing Process has been put into the essential hospital accreditation standards (MoH, 2014, p.35). There is a requirement documented nursing assessment as the first step of Nursing Process for all patients admitted for care and treatment in the organization that permits planning and care to begin as soon as possible because patients are at risk if they are not promptly and appropriately evaluated by a nurse when they are admitted to a hospital (MoH, 2014, p.35).
In Nigeria, Nursing Process has also been introduced in nursing academic curriculum starting from level one in undergraduate program as well as in Master of Science in nursing program.
1.3. PROBLEM STATEMENT
Nurses form the largest group of health professionals in every country in the world and nursing quality is closely related to a healthcare system’s effectiveness. In order to achieve quality health care services the Nursing Process plays a significant role but its implementation is not well developed. (Hagos et al., 2014, p. 6)
In Nigeria, the essential hospital accreditation standards requires Nursing Assessment that permits planning and care to begin for better outcome of patients therefore quality of health care services (MoH, 2014, p. 35) and Nursing Process has also been introduced in nursing academic curriculum starting from level one in undergraduate program as well as in Master of Science in nursing program as is the case in developed countries (Huckbay, 2009, p.72). If the individualized care responsive to patient needs is to be delivered, the process is very rational.
Despite these strategies made to encourage the implementation of Nursing Process, it is observed that its implementation in patient care is evidently absent in various health institutions in Nigeria and this predicts the possible barriers that are challenging its implementation among nurses in those health institutions. The non-application of Nursing Process causes poor patient’s outcomes such as increased length of stay in hospital, increased diseases prevalence, relapse and other complication.
Therefore I was interested as a researcher to assess the challenges of nursing process utilization and how to promote nursing process knowledge among nurses in saki west local government.
1.4. THE AIM OF THE STUDY
1.4.1 SPECIFIC OBJECTIVES
- To assess the extent of the implementation of Nursing Process among nurses working at In Saki West Local Government.
- To describe the barriers to implementation of Nursing Process among nurses working at In Saki West Local Government.
- To examine the association between the barriers and implementation of Nursing Process among nurses working in Saki West Local Government.
1.6. RESEARCH QUESTIONS
- What is the extent to which nurses implement the Nursing Process in Saki West Local Government
- What are the barriers hindering the implementation of Nursing Process among nurses in Saki West Local Government
- What is the association between the barriers and nursing process implementation among nurses in Saki West Local Government
1.7. SIGNIFICANCE OF THE STUDY
This study will benefit the following areas:
Nursing Profession: The study will remind practicing nurses, especially in Nigeria, of the global standard set through the application of the nursing process in patient care. The findings will reveal thechallenges of nursing process utilization present in Nigeria that hinder the task of identifying and managing patient’s problems and the systematic implementation of nursing process. It may therefore stimulate them to undertake greater responsibility and enable them to maintain high level of professionalism in nursing.
Hospital organization: The major task of a healthcare institution is to make quality healthcare available to every client who will require their services. In actualizing this mission, nursing play the key role. Implementing the nursing process requires constant documentation as it accounts the actions taken by the nursing team in resolving patient problems. The study will inform the hospital management of their responsibility in providing necessary articles, equipment, stationary etc for the successful implementation of nursing process.
Education: The study will help nurse educators review the curriculum and course content of nursing with a view to incorporate ways and means of overcoming the barriers that are identified in this study.
Research: The study will help nurse researchers generate ideas to overcome the identified barriers in implementing the nursing process and conduct further researches to improve the quality of nursing care. Such nursing research will provide the scientific basis for the practice of the profession.
1.8. STRUCTURE/ORGANIZATION OF THE STUDY
The dissertation will be presented in the following five chapters:
Chapter one: The introduction to the study
Chapter one provides an introduction to nursing process, the background information to the nursing process adoption worldwide and its challenges, the problem statement of the study, the aim and objectives of the study, research questions, and significance of the study as well as definitions of key terms.
Chapter two: Literature review
Chapter two provides the overview of the literature explaining nursing process implementation and challenges.
Chapter three: Methodology
Chapter three describes the study design and methodology used for the study
Chapter four: Data analysis
Chapter four comprises presentation and analysis of results
Chapter five: Results discussion
Chapter five provides conclusion and recommendations of the study . The last chapter also provides the summary of the study and concludes the findings as well as addressing recommendations
1.9 DEFINITION OF TERMS
Implementation: Implementation is defined as specific activities put together with intention to put into practice the overall program or activity to accomplish a specified goal (Fixsen et al.,2005, p.5). For the purposes of this study, implementation is explained as putting into act a plan designed to perform Nursing Process to prevent or treat health related problems.
Nursing Process: It is a systematic rational problem solving method of planning and providing nursing care (Kozier et al 2008, p.1553). For the purpose of the study, the Nursing Process is the nursing approach that uses its interrelated steps namely assessment, diagnosis, outcome identification, planning interventions, implementation and evaluation to identify and solving health related problems of individual, family and communities.
Barrier: A barrier is a something, rule or situation that prevents somebody or makes it difficult to achieve a certain level of functioning (Ngao, 2015, p.12) in this study barriers include all factors that hind the implementation of Nursing Process among nurses.
Nurse: A person who is formally licensed, educated and trained in the care of the sick or infirm especially in a hospital. For this study, it is any person deployed in the hospital to provide nursing services and is directly under the director of nursing services irrespective of his or her cadre, level of training or specialization. This will include: general nurses caring adult people in medical, surgical, emergency and intensive care unit (ICU).
Nursing care plan (NCP):
The nursing care plan is a written, printed or electronic guide or a series of step the care to be rendered to a patient. It includes both standardized and individualized care plans (Kozier&Erb, 2008, p.175). In accordance with this study NCP consists of a series of five steps created from Nursing Process steps provided to individual, family, and community to solve health related problems.
CHALLENGES OF NURSING PROCESS UTILIZATION AND HOW TO PROMOTE NURSING PROCESS KNOWLEDGE AMONG NURSES IN SAKI WEST LOCAL GOVERNMENT.