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.

LITERATURE REVIEW

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

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

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

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

IMPLEMENTATION

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

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

– 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.

2.10 Summary of Reviewed Literature

Among these theories are’ theory of Virginia Handerson, theory of Jean Orlando and Becks theory, the aim of each theory is to focus on the patients as an individual with nursing needs not just medical needs (Hornby and Podosky 2007).

According to authors cited in this work and the research they have done on nursing process, it has been observed that not all nurses in different hospitals studies, effectively implemented nursing process in patient care some nurses use it (Nursing Process), but do not effectively evaluate it in patient care.

Effective implementation of nursing process leads to improved quality of care, and stimulate the construction of theoretical and scientific knowledge based on the best clinical practice to improve nursing care.

CHAPTER THREE

RESEARCH METHODOLOGY

This chapter discussed the method use by the researcher in order to achieved the objective of the study which was geared towards ascertaining the factors affecting the implementation of nursing process among nurses working federal teaching hospital Abakaliki II. it covered:

 Design

 Setting

 Target population

 Sample and sampling technique

 Instrument for data collection

 Validity of the instrument

 Method of data collection

 Method of data analysis

 Ethical consideration

Design, setting/ location of study, target population, sample and sample ling techniques, instrument for data collection, validity and reliability of instrument, method of data collection, method of data analysis and ethical consideration.

3.1 Design

design adopted for this study was descriptive method

Description method used for this study involves description of event, situation and phenomena.

A body of data were collected, recorded, analyzed and described the behaviour of a subject without influencing it in any way (Becks, 2007). Descriptive design is used since the purpose was to gather and analyzed data.

It is also considered appropriate, because the researcher used only questionnaire for data collection.

3.2 Setting/Area of Study

The research study was conducted in Federal Teaching Hospital II, Abakaliki located along Enugu Abakaliki express way in Abakaliki Local Government Area of Ebonyi State.

The topography is actually a plain leveled land made up of rocky soil.

The hospital site covered area of about 2500 acres, while the entire parcel of about 306 hectares (747acres) (Wikipedia, 2006). The hospital is arranges in wards and clinic with different offices. The words are mainly made bed of three cubicles with an average of about 24 beds per wards and average patients of about 24 patients per ward.

The old wards which were built during the military era of leadership are equally still in use.

Some wards were relocated to the new ward complex situated within the Federal Teaching Hospital II, Abakaliki environment.

3.3 Target Population

The target population used for this study is all the nurses working in the major wards of Federal Teaching Hospital Abakaliki II (four in number)

The total number is 439 nurses. (From deputy director of nursing services records book, 2011).

Table 3.1: Respondents’ wards and population

Respondents’ wards Respondents population

Medical wards (male and female) 90

Surgical wards (male and female) 100

Pediatric wards (male and female) 150

Accidents and emergency wards 99

Total 439

Source: administrative department

This respondents’ (group of nurses) were selected for the study as they were selected to be in better position to give accurate and reliable information required for the study regarding patient care in the wards. Age sex educational qualification, professional status (Cadre) were also relevant criteria for the study.

3.4 Sample and Sampling Techniques

A subset of the entire (target) population of 439 was used for the study. A sample of 109 subjects which was 25% of the population chosen for the study. According to Nwanna (2005), if a population is a few hundreds, 40% or more is a enough, but if many hundreds, 25% sample size is sufficient but if a few thousands, 10% sample size will be all right.

As stated above, 25% of the target population of 439 was used for the study

That is: 25 x 439 = 109.8 subject

100 1

 

Proportionate stratified and purposive sampling technique was used. When the sample is proportionately allocated, it will ensure equal and adequate representation of the target population.

To get the proportionate allocation of each ward (stratum), the formula show below was used to calculate the number

That is: Total population in stratum x sample size

Total population 1

 

For medical wards (both male and female), the population was calculated as shown below.

= 90 x 109 = 22.3 subjects

439 1

Same procedure was used to work out the proportionate sample for the rest of the remaining three other strata (ward) Use the above table 3.2 here above

Table 3.2: Respondent’s different strata (ward) and their proportionate allocation

S/No Name of wards No of Selected Respondents’

1 Medical wards (male and female) 22.3

2 Surgical wards (male and female) 24.8

3 Paediatric ward 37.2

4 Accidents and emergency ward 24.6

Total 109

The selection of subject used as sample in each stratum was by convenience

3.5 Instrument for Data Collection

The main instrument used for data collection is structured questionnaire. The questionnaire was developed by the researcher after review of relevant literature.

The questionnaire is made into two section, A and B section A contained age range, set, highest education qualification, cadre nursing activities years in services (Table 4.1-4.5). Where as section B contained four questions on respondents’ specific knowledge on the evaluation of implementation of nursing process based on the objectives of the study ( table 4.6-4.8) and figure 1).

3.6 Validity and reliability of the instrument

3.61 validity of the instrument.

The researcher gave the questionnaire to the supervisor for its face and content validity to assess whether it was capable of collecting the required data. Equally, the structured questionnaire was given to four jurors of health promoting experts for the same purpose. All their corrections were adequately effected in restructuring the instrument before usage.

3.6.2 Reliability of the instrument.

Reliability of the instrument was established by exposing the structured questionnaire to a pilot study group of twenty nurses randornly drawn form different teaching hospital (Abia state university teaching hospital ABSUTH as the shared the same characteristic with the study group and twenty nurses of the same study group , two weeks after the first study group, to assess the suitability of the questionnaire to rule out ambiquity.

Ambiguous and difficult question were identified, clarified and restated. Their responses (ABSUTH and study group) were correlated.

3.7 Method of Data Collection

An introductory letter from the head of department nursing was submitted to the chief medical director (CMD) through the director of Nursing service (DNS), TETHA II for their permission same was granted.

Consequently the researcher administer 109 reliable and valid copies of the questionnaire personally, on face to face basis to the 109 respondents’ in the four major wards of FETHA II(medial, surgical) pediatric and accident and emergency wards on the same day . He made use of four research assistants (nurse one in each ward) after educating them and the respondents what the research was al about sorting out their difficulties about the questionnaire.

All the 109 questionnaires were retrieved by hand on the same day of administration giving rise to a return-rate of 100%

3.8 Method of data analysis

The responses of the structured questionnaire were rallied and coded manually after data collection by the researcher

Data were organized and analyzed using relevant frequency distribution tables x and percentages.

3. 8 Ethical Consideration

A letter of permission from the Head of department nursing was submitted to chief medical director through the director of nursing services for their permission which was granted.

The researcher applied the principles of confidentially, voluntary participation and anonymity in the conduct of the research.

The principle of confidentiality means that the respondents were assured that the information will not be disclosed to anyone who is not directly invoiced in the study.

The principle of voluntary participation entail that the respondents were fully informed and volunteered to participate in the study after explaining the purpose of the study – for academic purpose only. .

The principle of anonymity means that the respondents were promised that they will remain anonymous throughout the study (their names/address were not written on the questionnaire also).

The researcher carried the study within his personal and professional limitations.

Presentation and Analysis of Data

This chapter deals with the analysis of data and the discussion of the findings of the study findings are presented under two sections A and B

Section A presets the demographic data (table 4.1- 4.5) where as section B deals respondents specific Knowledge on the evaluation of implication of nursing process. (Table 4.6 – 4.8 and figure 1)

Section A: Demographic data (personal data)

1. Which age range do you belong to

(a) 23-30yrs

(b) 31-38

(c) 39-40

(d) above 48

2. What is your sex?

(a) Male

(b) Female

3. What is your highest educational qualification in nursing?

(a) RN/RM

(b) Post basic diploma

(c) BSC/BNSC

(d) PhD

What is your cadre in Nursing?

(a) Nursing sister (NO)

(b) Senior nursing office (SNO)

(c) Principal nursing officer (PNO)

(d) Assistant director of nursing (ADON)

5. How many years have you been in active service?

(a) 2-5 years

(b) 6-10 years

(c) 11-15years

(d) 16-20

(e) above 20yrs

 

Table: 4.1: Frequency of distribution of respondents’ age range

Respondents’ Age range (years) Frequency Percentage (%)

20-30 years 73 68.81%

31-40 17 15.60%

41-50 12 11.01%

450 and above 7 4.59%

Total 109 100%

 

Table 4.1 above revels frequency distribution of respondents’’ age range

From the table above 73(68.8%) of the respondents were within the age range of 20-30years, 17 (5.6%) were within the age range of 31-40years 12 (11.01%) were within the age range of 40-50 years while 7(45%) of the respondent were within the age range of 50 years and above

Table 4.2: frequency distribution of respondents’ sex.

Respondents Sex Frequency Percentage (%)

Male 31 28.44%

Female 77 71.56%

Total 109 100%

Table 4.2 above reveals frequency distribution of respondents’ sex. 31(28.44%) respondents were males while

From the table above 77 (71.56%) of the respondents were female, while 31 (28.44%) of the respondents were males.

Table 4. 3: Frequency distribution of respondents’ educational qualification

Respondents’ Educational Qualification Frequency Percentage (%)

RN/RM 61 55.10%

Post basic diploma 6 3.67%

BSC 41 39.45%

PhD 1 0.925%

Total 109 100%

 

Table 4.3 above reveals frequency distribution of respondents’ educational qualification.

From the table, 61 (56.10%) of the respondents had RN/RM as their qualification, 6(3.67%) had post basic diploma 43(39.45%) had BSC, 6(3.6) had post basic diploma, while 1(0.92%) had PhD as his educational qualification.

Table 4.4: frequency distribution respondents’ cadre in nursing.

Respondents Cadre Frequency Percentage (%)

Nursing sister (NO) 58 53.21%

Senior nursing officer (SNO) 29 27%

Principal nursing officer(chief Nursing officers (PNO/CNO) 10 7.34%%

Assistant chief nursing

Officer (ADON) 6 5.50%

Chief nursing officer 6 7.34%

Assistant director of nursing 0 _

Total 109 100%

Table 4.4: frequency distribution respondents’ cadre in nursing cadre

From the table 58(53.21%) of the respondent were nursing sisters, 29(27%) were senior nursing officer 10(7.34%) were principal nursing officer and. Chief nursing officer 6(5.50%) were assistant chief nursing officer, while non of the respondent were assistant director of nursing.

Table 4.5: frequency distribution respondents’ years in active e service

Respondents years in active services Frequency Percentage (%)

2-5 years 70 64.22%

6-10 years 19 17.43%

11-15 years 8 9.17%

16-20years 8 5.66%

21 years and above 4 3.67%

Total 109 100%

 

Table 4.5 above reveals frequency distribution respondents’ years in active service.

From the table 70(64.22%) respondent were 2-5year in active service 19 (17.43%) were 6-10 years 8(9.1%) were 11-15 years, 8(5.66%) were 16-20 years, while 4(3.6%) were 21 year and above in active service

 

Section B: RESPONDENTS’ SPECIFIC KNOWLEDGE ON THE FACTORS EFFECTING IMPLEMENTATION OF NURSING PROCESS

Question 6 How is nursing process implemented in your ward?

Table 4.6 frequency distribution respondents’ knowledge on the implementation nursing process.

Respondents knowledge on the implementation nursing process Frequency Percentage (%)

Often 70 64.22%

Not always 30 27.52%

Never 9 8%

Total 109 100

 

Table 4.6 above reveals frequency distribution respondents’ knowledge about the implementation of nursing process.

From the table, 70(64.22%) respondent often implemented nursing process, (nursing process) 27.52% did not always implement 30(27.52%) while 9(8%) never implemented nursing process.

Figure 1: Pie chart showing respondent response on how nursing process is been implemented.

 

Table of extent at which nursing process is been implement responded response on the extent at which nursing process is implemented.

Question 7 what is the extent of nursing process implementation in your ward

Table 4.7 frequency distribution respondents’ opinion on the extent of nursing process implementation in their wards.

 

Respondents opinion the nursing process implementation in their ward Frequency Percentage (%)

Level of assessment 44 40.37%

Level of nursing diagnosis 5 13.76%

Nursing care plan 47 43.12%

Evaluation 3 2.75%

Total 109 100%

 

Extent of nursing process implementation

Figure 1 above reveals frequency distribution respondents’ opinion on the extent of nursing process implementation.

From the figure, 44 (40.37%) respondents implemented nursing process at the assessment level only, 5(13%) respondent implemented nursing process at the nursing diagnosis a level, 47(43.12%) implemented nursing process at the level of nursing care plan and finally 3(2.75%) respondents’ implemented nursing process at the level of evaluation.

Question 8. What factors that affect the implementation of nursing process in your ward?

Table 4.7 frequency distribution of respondents’ opinion on the factors that affect the nursing process implementation.

Respondents ‘ opinion on the factors that affect nursing process implementation Frequency Percentage (%)

No regular supply of nursing process materials 36 32.70%

No supply of nursing process material 34 29.00%

Lack of interest by nurses 14 10.63%

Shortage of nursing staff 16 12.5%

Lack of cooperation among nurses 4 2.5%

Lack of supervisor of nurses 4 2.5%

No format for writing nursing process 1 0.1.1%

Total 109 100%

 

Table 4.7 above reveals frequency distribution of respondents’ opinion on the factors that affect nursing process implementation. It their wards

From the table 36(32.7%) respondents’ indicated to regular supply of nursing process materials 34(29.00%) said no supply of nursing process materials was a factor, 14(12.5%) stated that lack of interest by nursing was a factor 16(14.5%) affirmed that shortage of nursing staff was a factor 4(2.5%) was of the view that lack of cooperation among nurses was a factors 4(2.5%) saw lack of supervision of nurses by head nurses as a factors lastly 1(0.0%) indicated that no format for writing nursing process affecting nursing process implementation.

Question 9 what are the suggested strategies the implementation of nursing process

Table 4.8: Frequency distribution of respondents’ suggested strategies for promoting the implementation of nursing process.

Respondents suggested strategies for promoting the implementation of nursing process. Frequency Percentage (%)

Regular supply of nursing process material 20 40.37%

Motivating nurses 10 40.37%

Employing more nurses 20 30.28%

Encouraging cooperation among nurses 10 20.18%

Regular supervision 20 37.61%

Creating standard format 5 13.76%

Handing over nursing process 20 29.36%

Continuous retraining of nursing 4 24.77%

Total 109 100%_

 

Table 4.8: Reveals frequency distribution of respondents suggested strategies for promoting the implementation of nursing process.

From the table 20 (40.37%) respondents’ indicated that regular supply of nursing process materials promoted nursing implementation 10(20.37%) indicated motivating nurses 20 (40.37 %) indicted employing more nurses 10(20.37%) indicated encourage cooperation among nurses 20 (40.37%) indicated regular supervision of the nurse and the process by the head of nurses 5 (10.75%) indicated creating standard format 20 (40.36%) affirmed that continuous retraining of nursing staff (moves) promoted nursing process implementation.

SUMMARY, CONCLUSION AND RECOMMENDATIONS

In this chapter the major findings, it summary and the conclusion of the study are presented. The implications of the study are highlight and recommendations made based on the findings of the result suggestions for further studies and limitation of the study are also pointed out.

DISCUSSION OF MAJOR FINDINGS

This chapter presents the detailed discussion of findings made in course the study. The discussion is done under the following headings.

Highlight of finding, relationship with other studies, implication to nursing, summary of the study, conclusion, recommendation and suggest for further studies.

DISCUSSION OF MAJOR FINDINGS

The study was carried out to ascertain factors affecting the implementation of nursing process among nurses working in Federal Teaching Hospital Abakaliki II. The study showed that 68.31% of the respondent were within the age range of 41-50 years, 15.60% were within the age of 31-40years, 11.01% were within the age range of 39-40 years, while 4.59% were within the age range of 50 years and above. (Table 4.1)

Table 4.2: Reveals that 71.56% of the respondents were females while 28.44% were males. Table 3: showed that educational qualification of respondents’ were RN/RM 56.10%, were BSC, (39.45%) post basic diploma, 3. 67% while Ph. D holders (0.925%)

Research question 1: what factors affect the implementation of nurses in FETHA II

The analysis of data on table 4.7 revel shed that 59.63% respondents’ lack of interest by nurses affected nursing process implementation most, this is followed by 36(32.70%) of respondents who said that irregular supply of nursing process materials affected nursing process implementation. Other respondents identified the following factors affecting nursing process implementation as shortage of nursing staff 16(14.5%) lack of supervision nurses by head nurse 4 (2.5%) lack of cooperation among nurses 4(2.5%) low format for writing 1(1.1%).

Emeh (2007) equally identified these factors which the author rightly called impediments to effective implementation of nursing process

The researcher is in support of the aforementioned factors but advise that all kind sundry should make frantic efforts to avert all these in order to render patients quality care.

Equally figure 1 (Barchart’s analysis) reveals that 64.22% of the respondents stated that nursing process is often implement in their ward, 27.52% revealed that nursing process is never been implemented in the ward.

The study revealed that 43.12% of the respondents implement nursing process at the level of nursing care plan, 40.37% of the respondents were at the level of nursing process after nursing assessment, 13. 76% of respondents were at the level of nursing diagnosis while 2.75% of respondents were at the level of evaluation.

Research question 1: what factors affects implementation of nursing process. Though no reviewed related literature disclosed the stage nursing process is been practice the researcher as a potential nurse knows that some people practice nursing process at one or more levels.

While others do not but he encourage every nurse to implement nursing process at all its five levels in other to render holistic nursing care to patient which will also boost the image of the profession.

Research question 3: what strategies promote affective implementation of nursing process on patients care in FETHA II

On the strategies promoting the implementation of nursing process the analyze data of table 4.8 reveal that 40.37% of the respondents’ suggested the strategies to promoting the implementation of nursing process , the study revealed that 20(40.37%) of the respondents suggested regular supply of nursing process materials and motivating nurses to have interest in writing and implementing nursing process, (37.6%) suggested regular supervision of nurses by the head nurse, 20 (40.61%) suggested handling over nursing process at each shift 20(40.77% ) suggested continuous retraining of nurses on nursing process in the continue education,4(4.77%) of the respondents suggested encouraging cooperation among nurses.

 

5.1 Relationship with Other Studies

The research work showed that 64.22% of respondents often implement nursing process, 27.52% were not always while 8.26% were never implementing it.

This corresponds with the finding of university of Brazil (2005). Reported that 54.61% of the respondents often implement nursing process, while 45.39% were of the respondents were not always implementing nursing process.

Also in the study carried out by Beck in United Kingdom (2006), which showed that there was a limitation in the number of nurses working in the hospital, but there was a regular supply of nursing process material to ensure increase in the level of compliance on the part of nurses.

 

5.2 Implication for Nursing

This is the era of tremendous scientific and technological in the society, in nursing practice specifically and in the delivery of health of care service in genera. Nursing process is the framework be fully implemented by every nurse in order to renders holistic, effective, evidence based and quality nursing care to patients client in order to make them happier and more satisfied.

Equally, nursing process make the profession autonomous and independent (self-regulatory). Also when, nursing process is utilized implemented by e very nurse of, it boost the image of nursing as it promoting clients’ satisfaction because personalized (individualize) nursing care is rendered to each client/patient.

5.3 SUMMARY OF THE STUDY

This study was aimed at ascertaining factors affecting the implementation of nursing process among nurses working in Federal Teaching Hospital Abakaliki II in line with the objectives of the study three questions guided the study. Related literature were reviewed and the summarized.

A descriptive research designed was adopted for the study.

The target population for the study consisted of all nurses working before major ward FETHA II. The sample of the study comprise of 109 nurses from medical, surgical, pediatric, accidents and emergency ward of FETHA II. Proportionate stratified, purposive and convenience sample in drawing 109 respondents’ for the study. The main instrument for data collection was structured questionnaire. Validity and reliability of the instrument were ensured. Data collected analyzed by using descriptive statistics of frequency distribution tables, figure (Barchart and the percentages)

 

5.4 CONCLUSION

Base on the analysis of data, the following conclusions were drawn.

1. Ten tables (two in chapter three and eight in chapter four) and one figure were used for the study.

2. The tables in chapter two ere presented under two section, A and B.

The study comprehensively specified factors influencing the implementation of nursing process among nurses working in Federal Hospital II, Abakaliki.

The major constraints identified to have affected the implementation of nursing process are lack of interest by nurses and no regular supply of nursing process materials. Another constraint identified was shortage of nursing staff to implement nursing process. Suggested strategies were motivating nurses to have interest in writing and implementing nursing process.

Adequate supply of nursing process materials should be given a priority attention.

5.5 Limitation of the Study

The researcher have limited time to carry but the research work

The researcher has to combine his light academic work with running round to collect data for the project

Some nurses were relevant to accept and fill the questionnaire except with persuasions finance in for adequate computer search, type-setting and photocopying needed materials for the study.

The researcher concentrated on the selected nurses working at different department in Federal Teaching Hospital II, Abakaliki.

It is equally delimited to 439 nurses working in Federal Teaching Hospital II, Abakaliki.

5.6 RECOMMENDATION

The following recommendation were made base on the findings

1. There should be regular supervision of nurse by the head nurse.

2. Nurses should be motivated in writing and implementing nursing process by organizing workshop from time to time for them improve in their skills. More nursing should be regular supply of nursing process materials.

3. More nurses should be employed so as to effectively implementing nursing process in course of nurses caring for patients.

4. There should be mandatory adequate funding of the department in readiness for the supply of needed materials.

5.7 Suggestion for Further Studies

1. The researcher suggested that study should be conducted in other University Teaching Hospitals so that more generalization would be made.

2. Effect of non implementation of nursing process on patient care

3. Factors hindering the implementation of nursing process

 

4. Government should assist by enacting some laws on the use of nursing process among nurses working in tertiary institution to ensure evidence-based practice in health care delivery system.

 

5. Government should assist in the provision of required materials to ensure effective implementation.

REFERENCES

Altamier P. (2010). Evaluation of implementation of nursing process among

nurses working in Abakaliki metropolis, Abakaliki: West African

Anichebe, P. N (2010) perception, attitude and practice of nursing process

among nurses in Enugu: journal of college of nursing 5 (2): 78-80.

Anonymous (2005) available at Milton: file://c: / document and stetting

/users / my document/ Dr Kalu .mht.

Beck J.(2006). The nursing process context of community health nursing

London: Longman publishers.

Barthlomew, A. I (2010). A guide to Nursing process,

Owerri: Klinmann

Ballack, C and Poldosky J. (2008) discharge of the ward,

London: black well scientific publication

Ehemere, I.A (2006) A guide to nursing process

Enugu. Klinsmann publisher.

Emeh, A.N. (2007). Issues on the foundation of nursing process

Owerri Lord dubem publisher

Hornby, E. (2008) nursing process concept and practice

Enugu, SNAAP press Ltd

Health care workers (2007).

London: Bailliere Tindall

Hornby, A.S (2009), oxford advance leaner dictionary of current English

U .S.A oxford university press

Imagins (2008) available at http:// www.imagins.com/nursing process practice

imagins (2008) available at http://www.imagins.com/health/clinical trials

Nwangbada, J.(2006) basic facts in nursing process,

Enugu, SNAAP press Ltd

Onyekwere, E (2009), implementation of nursing process in health institutions

U.S.A ASP loius mosby

Porter and perry (2005) concept of nursing process in nursing

Enugu Macmillan press

Okoronkwo, Anarado and Ehimere in chi; KO (2006). A study of peoples

Knowledge, attitude, and practice nursing process

http:www.koreamed org/ search basic phd.

World health organists report (2001) Gneral who

www.En.M.wilipedia org/wiki Evaluation 2008.

Walsh, m (2002) nations –clinical nursing and relating hella B.f (2005) Bailliere Nurses dictionary twenty third education, Bailliere tribal

Zacheous, B.I. (2008) evidence based assessment method no more pride or

prejudice. AACN clinical issues 20009:15(4):501-505

APPENDIX II

QUESTIONNAIRE

 

Department of Nursing Science,

Faculty of Health Science and Technology,

Ebonyi State University,

Abakaliki

20th august, 2012

 

RESEARCH QUESTION ON THE FACTORS AFFECTING THE IMPLEMENTATION OF NURSING PROCESS AMONG NURSES WORKING IN FETHA II.

Dear Respondents’

The researcher is final year undergraduate student of the above mentioned institution conducting the above study in fulfillment for the award of registered nurse (RN) diploma. All information given will be highly confidential.

Thanks for your cooperation.

 

Yours faithfully,

Obiora Benard C.

1. Instructions

2. Do not write your name

3. They are section A and B

4. Tick (√ ) the correct respondents as appropriate and the give necessary comment

Section A: Demographic data (personal data)

1. Which age range do you belong to

(a) 23-30yrs

(b) 31-38

(c) 39-40

(d) above 48

2. What is your sex?

(a) Male

(b) Female

3. What is your highest educational qualification in nursing?

(a) RN/RM

(b) Post basic diploma

(c) BSC/BNSC

(d) PhD

What is your cadre in Nursing?

(e) Nursing sister (NO)

(f) Senior nursing office (SNO)

(g) Principal nursing officer (PNO)

(h) Assistant director of nursing (ADON)

5. How many years have you been in active service?

(a) 2-5 years

(b) 6-10 years

(c) 11-15years

(d) 16-20

(e) above 20yrs

 

Section B

Evaluation of implementation of nursing process

6. How is nursing process been implemented in your ward?

(a) Often

(b) not always

(c) never

7. To what extent is nursing process been implemented in your ward in course of patient care?

(a) To the level of assessment

(b) After each nursing diagnosis

(c ) After each nursing care plan

(d) After each successful evaluation

8. Which of these factors affects the implementation of nursing process?

(a) No regular supply of nursing process materials

(b) No supply of nursing process materials

(c ) Lack of interest by the nurses

(d) Shortage of nursing staff to implement it.

(e) Nursing process is time consuming

(f) Lack of cooperation among nurses

(g) Lack of supervision of nurses by the head nurse

(h) No format for writing nursing process

(9) What are the suggested strategies for promoting the implementation of nursing process?

(a) Regular supply of nursing process materials

(b) Motivating nurses to have interest in writing and implementing nursing process.

(c) Employing more nursing staffs

(d) Encouraging nurses to cooperate among each other when writing nursing process.

(e) Regular supervision of nurses by head nursing services

(f) Creating a standardized format for writing nursing process

(g) Handing over nursing process at the end of each shift

Nursing Process Among Nurses – Factors Affecting The Implementation

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