Nursing Process Among Nurses – Factors Affecting The Implementation

Nursing Process Among Nurses – Factors Affecting The Implementation

Nursing Process Among Nurses – Factors Affecting The Implementation

The basic idea of nursing process has been of great importance in course of nursing practice.

It is an orderly, systematic, manner of determining client’s problems, making plans to solve them, initiating the plans to implemented and evaluate the extent to which the plans were effective in resolving the problems identified (Kozier, 2010).

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Nursing is the treatment of human response to actual or potential health problems.

Nursing process is a cyclic process, purposeful activity and interactive in nature involving intellectual and physical activities.

It examines the personalized or individual care nurses give or deliver do their patients.

It is an evidenced –based approach to health care delivery system.

Nursing process is a systematic method which utilizes scientific reasoning, problem solving and critical thinking to direct nurses in caring for patients effectively (Altamier, 2010).

Where as Emeh (2007)

Conceptualized nursing process as a problem solving approach is evidence based method which involves different steps and it is a goal oriented method of caring for a patient.

Nursing process has both been developed as an approach and a tool to determine the needs of its consumers (Altamier, 2010).

The nursing process uses clinical judgment to strike balance of epistemological evidence in which critical thinking may play a part to categorize the client issues and the course of action (Altamier, 2010).

It is very important to determine how much it is used by nurses especially in Federal Teaching Hospital Abakaliki which is a tertiary institution, where many client and patients come for quality care.

Since early 1970s, nursing process has been in the curriculum for nursing education in Nigeria.

The implication is that many nurses posses the theoretical knowledge of nursing process.

According to American and Germany practice standards, nursing practice demands the efficient use of nursing practice, the efficient use of the nursing process and professional participation in activities that contribute to the permanent development of knowledge about this methodology (Barthlomew, 2007). It is of utmost importance to establish nursing process in practical care in every health institution, within hospitals as well as in the community as a whole (Barthlomew, 2010). Hence, this work which is to ascertain factors affecting the implementation of nursing process among nurses working in Federal Teaching Hospital Abakaliki II. Federal Teaching Hospital Abakaliki II is a University teaching hospital with centre of excellence in cardiothoracic surgery serving the south east. It has number of nurses, trained in various specialist fields.

Ebonyi State University has demonstrated high level of academic excellence in course of practice.

1.2 Statement of Problem

The problem is that, it is skill uncertain how far nurse have gone towards effective utilization and effective implementation of nursing process in nursing practice.

The essence of nursing process for client care lies on the great benefits to the client, nurses and nursing profession as a whole.

Against the background, the researcher therefore has undertaken to research on the factors affecting the implementation of nursing process among nurses working in Federal Teaching Hospital Abakaliki II. It is nursing process which gives the profession autonomy and quality nursing care to patient. To the grates dismay, many nurses lack interest in the implementation like table 417 with 509. 63% it is against this background in order to render quality nursing care to boost the image of nursing profession that motivate the researcher towards ascertain the factors affecting the implementation of nursing process. Among nurses working Federal Teaching Hospital Abakaliki II.

1.3 Purpose/Objectives of the Study

The main purpose of the study is to ascertain the factors affecting the implementation of nursing process among nurses working in Federal Teaching hospital Abakaliki II.

i. Determine the extent of implementation of nursing process in patient care among nurses working in Federal Teaching Hospital II Abakaliki.

ii. Identify factors affecting the implementation of nursing process.

iii. Elicit nurses opinion on strategies that will promote the effective implementation of nursing process for patient care.

iv. Elicit nurses opinion on factors militating against the effective implementation of nursing process for patient care.

v. Ascertain the basic ways through which nurses could be rewarded for effective implementation of nursing process in Ebonyi State University Teaching Hospital, Abakaliki.


1.4 Significance of the Study

The findings of this study, if published will serve as a reference for subsequent studies on related topics.

It will serve as body of knowledge to nursing department on how to effectively implement nursing process these among nurses if communicated to them. It will equally help to plan strategies on how to remedy the problems of non implementation of nursing process in order render quality patient care.



1.5 Research Questions

1. What factors affect the implementation of nursing process among nurses working in Federal Teaching Hospital Abakaliki II.

2. What stage of nursing process is implemented most in patient care among nurse working in Federal Teaching Hospital Abakaliki. II

3. What strategies promote the effective implementation of nursing process for patient care in Federal Teaching Hospital Abakaliki II.

1.6 Scope of Study

The study covered nurses working in Federal Teaching Hospital Abakaliki II, Ebonyi State.



1.7 Operational Definition of Terms

i. Nursing process: rendering personalize (individualize) Nursing care to patients.

ii. Implementation: performance of an obligation especially to care for a patient.

iii. A nurse: A person certified by the nursing and midwifery council of Nigeria to render care to patient/client.

iv. Evaluation: To form an idea of the amount, number or value of something

v. Factors: Things affecting the happenings of something

vi. Influencing: Control observed either positively or negatively.


Related literature from text books, Journals, magazine and periodicals were reviewed under the following sub-headings.

– Concept of evaluation

– Concept implementation,

– Concept Nursing process.

– Steps of nursing process

– Characteristics of nursing process

– Importance of nursing process

– Implementation of nursing process

– Factors affecting nursing process implementation

– Nursing process implementation

– Empeirical study of nursing process

– Theoretical frame work of nursing process

– Summary of literature review

2.1 Concept of Evaluation

According to Wikipedia (2008), evaluation is the systematic determination of merit, work and significance of something or some using criteria against a set of standards.

Evaluation is the comparison of actual impact against strategic plans. It works at original objectives, at what was accomplished and how it was accomplished. It can either be formative or summative. It can be formative; that is taking place during the life of a project or organization, with the intention of improving the strategy or way of functioning of the project.

It can also be summative drawing lesions from a complete project or an organization that is no longer functioning.

Evaluation is a theoretical based approach that would be tailored to the theory approach, needs purpose and methodology of the evaluation itself.

Evaluation has been defined as a systematic and meticulous application of scientific method to assess the design, implementation, improvement or outcome of a program (Wikipedia, 2008).

It is a resource intensive process, frequently requiring resources such as evaluator expertise Labour, time size and budget, (Henry, 2008). A study designed to assist some audience to assess an objects merit and worth (Henry, 2008). The author further stated that the main purpose of a programmed evaluation can determine the quality of a program by formulating a judgment.



2.2 Concept of Implementation

According to Wikipedia (2008), implementation is the realization of an application, standards, or policy. It is a referrer to a building process rather than the design process. In health, implementation involves carrying out a health policy.

The author further stated that implementation can be inform of “Direct change over” Direct change is one of the method to change from existing system to another all together this is a simple method it takes a lot of planning, secondly hot standby: otherwise called hot spare is used us a fail over mechanism to provide reliability in system adjustment.

Thirdly pilot introduction and lastly well-trade.

2.3 Concept of Nursing Process

The advent of nursing process which is now central to practice had its inception since 1960s and had been in use for over 30 years in countries like united state of America and Britain (Barthlomew, 2010).

It has undergone reviews, refining and revisions since its inception.

Nursing process had been described as systematic and individualized way of achieving nursing outcome.

Nursing process is an approach and a tool for nursing practice is noted for efficient and effective method of identifying and meeting the needs of the patients (Henry, 2008).

Potter and Perry (2005), defined nursing process as a systematic individualized care for all patient/ clients in all state of health and illness

Based on similar framework Ehimere, (2006) stated that nursing process is a systematic data collection process used for the identification of clients problems and for organizing and rendering individualized nursing care to client in a logical manner. Also whereas Nwangbada (2006), Opined that nursing process is a systematic and goal directed set of activities which are interrelated and dynamic, used by the nurses to determine, plan and implement individual nursing care, which is aimed at helping the patient to achieve integration of his whole being or optional level of wellness.

2.4. Steps of Nursing Process

Ehimere (2006), identify five steps of nursing process which includes:

i. Assessment

ii. Nursing diagnosis

iii. Planning

iv. Implementation

v. Evaluation


Assessment involves the process of identifying the unknown to analyze the patients problem.

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It is the first stage of nursing process which must be taken care of first before other steps could be well attained.

It begins with collection of data during which period the professional nurse utilizes all communication and interview skills in gathering data about client actual and potential health problems.

In collection of data, you must do the followings.

– Physical examination

– Ascertain result of laboratory and diagnostic tests.

– Information from patient relatives

– Review record

NURSING DIAGNOSIS: It is a statement that describes the clients actual or potential response to health problems for which the nurse is licensed and competent to practice. (Porter & Perry 2005). Nursing diagnosis comprises of both subjective (patients data from his/her point of view) and objectives data collection (other peoples’ view point)


Planning involves setting of goals achievable within specified time of nursing intervention. The period within which the planning should be achieved must be specified.


It is the doing phase which encompasses nursing intervention and the rationale for doing that effective implementation of nursing process leads to improved quality of care and stimulates the construction of theoretical and scientific based on the best clinical practice, aiming at collecting information to improve the nursing care currently provided.


Evaluation is the systematic and meticulous application of scientific method to assess the design, implementation, improvement or outcome of a programme (Wikipedia 2008). It entails assessing whether the set goals/objectives are achieved and client response to care rendered. If the goal is not met, the nurse need to go back to the drawing board to replan.

Beck (2006), has identified six steps in nursing outcome identification which are filled into a contusions cycle of thoughts and actions.

She carried out outcome identification (goal) as the third step from planning phase. He identified immediate nursing actions when a patient is in danger or emergency.

Nursing care is average in form of triage, so that more danger patient can be taken care of first before the less dangered ones.

Moor house (2006, addeds documentation as the sixth step in nursing process becks (2007) opinioned that documentation is imperative in clients Emergency care as such should be regarded as a step.

These six steps identified by Beck assist the nurse to ensure nothing is missing out while writing the care plan.

2.5 Characteristics of Nursing process

Emeh (2007), Identified this characteristics as follows:

– It is a systematic and a goal directed follow sequential directed approach to achieve some set goal it render individualize. That is care given to patient A is base on the clinical manifestation from him/her which is different from that given to patient B even if they are suffering from the same disease entity

– Activities are interrelated and dynamic.

– Importance of nursing process Nwonu (2002), identified four importance of nursing process as a vital tool for patient care as:

1. Nursing process is means of unifying nursing practice

2. It promote consumer satisfaction

3. It restores nursing to its primary commitment, that is, determining care to people one to one basis.

4. It provide the means of assessing nurses economic contribution to the totality of client care.

5. It enables the nurse to realize potentials as an independent decision maker

Factors hindering of the implementation of nursing process Emeh (2007), rightly identified factors which the author called impediment to effective implementation of nursing process. This factors includes:

1. Lack of nursing process materials

2. Insufficient supply of nursing process materials

3. Lack of interest by nurses

4. Lack of cooperation among nurses

5. Lack of supervision by the head nurses

6. Lack of format for writing nursing process

2.6 Implementation of nursing process

Effective implementation of nursing process has moved the health states of the populace from the valley stage to the top of the mountain stage in the world.

Effective implementation of the nursing process leads to improved quality of care and stimulate the construction of theoretical and scientific knowledge based on the best clinical practice, aiming at collecting information to improve the nursing care currently provided. According to Hornby and podosky (2007), the benefit of implementation nursing process in client care are an individualized approach to patient modification of care, writing permanent nursing records, evaluation of care, continuity of care. A tool for monitoring the quality of care a system method of determining patient need and problems, a systematic and property articulated client care and lasting, a record of information for other health care professional and research.

For effective implementation of nursing process and consequent documentation at care plan, the nurse must posses the following skills; cognitive skills, or intellectual skills to enable the nurse identify and differentiate actual and potential health needs.

The nurse must carefully handle patient and his equipment proficiently well.

2.7 Suggested strategies for the implementation of nursing process

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– Regular supply of nursing process material

– Motivating nurses

– Employing more nurses

– Encouraging cooperation

– Regular supervision

2.8 Empirical Study on nursing process

Ballack and Poldosky (2008) performed a cross-sectional retrospective study in a hospital in port allegre in Brazil. Medical records for adult patients admitted to a surgical, clinical or intensive care unit were reviewed to identify the nursing process steps accomplished during the first 48 hours after admission.

The form for data collection was structured according to other report 302 medical records were evaluated, nursing records and physical examination were in over 99% of them.

The research showed that nursing diagnosis was not found in any of the records.

Among the steps performed, prescription was the least frequent evaluation of the case was described in over 90% of the records that is, evaluation was the most frequent reported and recorded for statistics purposes.

A study conducted in America to test the establishment of a validated model of nursing records aimed at promoting individualized care, the research results showed a limitation in the nursing process. Conducted according to the model, particularly in the identification (nursing diagnosis) presented by the patient and consequently diagnosis are the possible intervention procedures.

A study conducted in United Kingdom to assess whether data obtained from nursing records could be reliably used to identify interventions for patient who had suffered acute myocardial infraction or a fracture of the head of the femur, showed that the analyzed nursing records did not provide an adequate picture needs or nursing interventions (Horby, 2008).

The evaluation of expected results were not adequately recorded.

The research to investigate the phases of nursing process, performed in the care practice of a university hospital in Brazil, the author identified the implementation of all stages. How ever, the existence of failure was shown among the nursing diagnosis in the patients history, as well as the implementation of nursing prescription without recording the evaluation of the expected results (Horby, 2008).

Similar results were also gotten in a study published in 2006, during the implementation of the nursing diagnosis, in which the research subject indicated difficulties in developing the nursing process at all stages, are the need for changes to speed up the work process and optimal the quality of actions in care and education (Hornby, 2009).

2.9 Theoretical Framework For Nursing Process

Theories are set of interrelated phenomena (an observable fact or events) that are explanatory and predictive in nature (Henry, 2008). According to Wikipedia (2010) theories are composed of concepts, definitions, models and are based on assumptions.

Nursing theory is an organized and systematic participation of set of statement related to questions in the discipline of nursing (Wikipedia 2010). Also, a nursing theory is a set of concepts related to questions, relationships and assumption or prepositions derived from nursing models.

The aim of theories is to focus on the patient as an individual with nursing needs not just medical needs (Whelamis, 2003) Virginia Handerson in 1964 stated that “the unique function of the nurse is to assist the individual sick or well in the performance of those activities contributing to health or its recovery or peaceful death which he or she would have performed unaided if he or she had the necessary strength, will or knowledge.

Handerson set the patients needs as the foundation for nursing care.

Based on Handerson theory, it made assumptions about a behaviour, health problem, target population or environment that are logical, consistent with everyday observation similar to those used in previous successful programs and supported by past research in the same area.

The nursing process is also based on a nursing theory developed by Jean Orlando. She developed this theory in the late 1950s, from observation she recorded between a nurse and a patient. Despite her efforts, she was only able to categorize the record as “good or bad” nursing. From these observatories she formulated the deliberative nursing process. “The role of the nurse it to find out and meet the patient immediate need for help” the patient presenting behavior may be a plea for help, however, the help needed may not be what it appears to be, so nurses need to use their perception, thought about feeling endangered from their thoughts to explore with patient the meaning of their behaviour.

Orlando identified four steps but through practice application over the past 50 years, one step evolved into two and now, there are five steps, assessment, nursing diagnoses, planning, implementation and evaluation.

Nursing Process Among Nurses – Factors Affecting The Implementation

To place an order for the Complete Project Material, pay N5,000 to

GTBank (Guaranty Trust Bank)
Account Name – Chudi-Oji Chukwuka
Account No – 0044157183

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