A study of utilization of the Nursing Process in Kiambu County Referral Hospital.
Researcher: RONO RONALD NICKSON;
Department of Community and Reproductive Health, School of Nursing Sciences
DECLARATION
I Rono
Nickson declare that this is my original work and has not been submitted before in any institution of higher learning for any academic awards.
First, I would
like to express sincere gratitude to the Almighty for His continued grace.
Secondly, I extend my gratitude to my supervisor Dr. Grace Gachuiri for finding
time to guide me through the study and for believing in me. I would also like
to thank the hospital administration and nurses at Kiambu County Referral
Hospital for their support and cooperation during the study.
TABLE OF CONTENTS
2.2 Practice of the Nursing Process
2.3 Steps of the Nursing Process
2.4.1 Knowledge of the Nursing
Process
2.4.2 Nurses’ Perspectives of the
Nursing Process
2.5.1 Availability of Resources
3.3.1 Sample Size Determination
3.3 Inclusion and Exclusion Criteria
3.4.1 Data Collection Instruments
3.6 Assumptions and Limitations
4.1 Demographic Characteristics
4.2 Practice of the Steps of Nursing Process
4.3.1 Nurse’s Knowledge of The
Nursing Process
5.2 Discussion of Study Findings
5.3 Demographic Characteristics
5.4 Practice of The Steps of Nursing Process
5.4.1 Documentation of The Steps of The Nursing Process
5.5 Nurse Related Factors Influencing the Practice of
Nursing Process
5.5.1 Nurses’ knowledge of the nursing
process
CONCLUSIONS
AND RECOMMENDATIONS
Figure 0.1Conceptual Framework
Equation 1Confidence Interval Formula
NANDA- North American
Nursing Diagnosis Association
EBP-
Evidence-Based Practice
NP- Nursing Process
SMART- Specific, Measurable, Achievable, Realistic, and
Timely.
CME- Continuous
Medical Education.
Abstract
CHAPTER 1: INTRODUCTION
1.1
Background Information
Nursing
is a broad range yet an important profession in healthcare. As a practitioner,
one needs to take a holistic approach in care delivery to uphold the quality of
care in a hospital facility. According to Semachew (2018), the quality of
nursing care in a hospital mirrors the quality of their healthcare services.
From, the above, nurses play a critical role in healthcare. Nursing practice
spans from simple gestures of humanity such as helping with activities of daily
living to complex activities which are founded on Evidenced-Based Practice for
example case management. Such activities are too demanding for the nurse and
may negatively impact the quality of nursing services. This calls for the use
of a nursing framework.
According
to Toney-Butler & Thayer (2020), the nursing process is an important framework
that provides a strategic approach to care delivery. The framework provides an
orderly approach to care through critical thinking, a holistic approach to
treatment, goal-oriented activities, evidence-based practice (EBP), and instinctual
ability (Toney, Tammy & Thayer, 2020). These are possible through the five
chronological steps of the nursing process: assessment, diagnosis, planning,
implementation, and evaluation phases (Toney-Butler & Thayer 2019). The
nursing process is universally accepted for use in nursing care. Each nurse is
expected to utilize the nursing process in care provision regardless of their
level of training and patient needs.
Documentation
is critical for effective clinical communication. A nursing care plan is a tool
for documentation of the steps of the nursing process. Tuinman et al. (2017)
asserted that proper documentation provides an accurate account of nursing
assessments, patient’s progress, administering care, and any important
information to help the multidisciplinary team in quality care delivery.
Documentation is a great deal of nursing profession; such includes
documentation of Kardex and nursing care plan among other medical records.
These forms important references as evidence of care and in case of medical-legal
concerns of nursing practice. Other benefits of proper documentation include
enhanced creativity, problem-solving, enhanced decision-making, improved
quality of care, and enhanced communication between nurses regarding the
patient (Yilmaz et al. 2015). Thus, it reduces gaps such as medical errors in
nursing hence promoting highly effective nursing care. Mbithi, Mwenda &
Karonjo (2018), observed that lack of documentation in Kenyan Hospitals led to
medication errors such as repeated dosing of a given medication. Thus, a
nursing care plan is an important part of the nursing process as a tool for
communication and as evidence of care provided.
Each
step of the nursing process is equally important in nursing care. In the
assessment phase, nurses employ assessment skills to identify patient needs and
use their creativity to formulate a nursing diagnosis. The North American
Nursing Diagnosis Association (NANDA) outlines common nursing diagnoses which guide
nurses to identify or anticipate patients’ needs. The planning phase entails the
formulation of SMART goals or objectives and patient-specific interventions. This
leads to the implementation and evaluation phase where the nursing process is
actualized and outcomes evaluated according to the set goals and timeline. Therefore,
it is of great importance to ensure complete documentation of nursing care
plans.
Despite
the benefits of the use of the nursing process, it has not achieved its full
potential in many nations. According to Wagor & Rakuom (2015), the utilization
of the nursing process has encountered significant challenges in developing
countries. Studies of the acceptance and application of the nursing process have
shown a positive trend in developed countries more than low-income countries since
its inception 40 years ago (Lofti et al. 2020). The observed difference is
attributed to differential access to resources, training and research, and
legal regulations in healthcare organizations.
Proper
practice of the nursing process is evident from records of nursing care plans. Proper
documentation is indicated by various factors that include: the quality of the
assessment data; it can be objective or subjective. These data should explore
the functioning of all or selected body systems that form the basis of patient-centered
care (Toney-Butler & Unison-Pace 2020). Besides, good use of the nursing
process is seen in the planning phase: formulation of nursing diagnoses and
patient-specific interventions. Excellent use of NCP at this phase is
characterized by specificity in the formulation of priority nursing diagnoses
and interventions. This requires the use of creativity and incorporation of
theoretical knowledge such as the physiology of the body and basic nursing
skills among other funds of knowledge. Most importantly, proper use of NCP is
evidenced by the implementation of care and evaluation of the patient.
On the
contrary, poor practice is generally characterized by incomplete documentation
of nursing care plans. A study by Mbithi, Mwenda & Karonjo (2018), revealed
that 10% of nurse participants were able to sufficiently document the patient
assessment data which shows poor utilization of the nursing process. Besides,
poor use of the nursing process has been witnessed in Nigerian hospitals
whereby 71% of the nurses neither formulate the nursing interventions nor
document scientific rationale for the same (Afolayan et al. 2013). Also, poor
practice is characterized by irrelevant nursing diagnoses and interventions (Agyeman
& Korsah, 2018). These fall under the same category as nurses who fail to
provide a scientific rationale for their interventions. Failure to implement
interventions or a lack of documentation of evaluation amounts to poor use of
the nursing care plans (Mwangi,
Meng’anyi & Mbugua 2019).
Several
factors influence the observed trends in the practice of the nursing process. One
of the common causes is inadequate nurse staffing. This contradicts the high
patient volume which poses a challenge to the use of the nursing process. According
to Aseratie, Murugan & Molla
2014), any shortage of nursing staff as compared to the high patient
numbers would impair proper use of the nursing process. Besides, lack of
resources hinders the implementation phase of the nursing process in low-income
countries.
There
is also the issue of inadequate training; Agyeman, Korsah & Okrah (2017), observed
that many nurses were not taught well about the nursing process in their
training institutions hence lack of interest and motivation to implement the
nursing process. This category of nurses has a poor insight of the significance
of the nursing process hence revert to traditional nursing which does not
conform to patient-centered care.
Institutional
policies influence the utilization of the nursing process among nurses.
According to Wagoro & Rakuom (2015), strong institutional policies for
instance close supervision of nurses by nurse managers promoted proper
utilization of the nursing process. Also, failure to monitor nurses led to poor
utilization of the nursing process for instance incomplete documentation of
care in nursing care plan forms.
1.2
Problem Statement
The use
of the nursing process has not reached its full potential in many developing
countries. In Kenya, many nurses have difficulties completing all the phases of
the nursing process and has contributed to haphazard care provision in many
public hospitals (Mangare et al. 2016). In response to this problem, this study
aims to investigate the utilization of the nursing process among nurses working
in Kiambu County Referral Hospital through descriptive and retrospective
studies.
1.3
Research Questions
1. How is
the practice of the nursing process in Kiambu County Referral Hospital?
2. What
steps of the nursing process are mostly practiced in Kiambu County Referral
Hospital?
3. What nurse-related
factors influence the use of the nursing process?
4. What
facility-related factors influence the use of the nursing process?
1.4
Broad Objective
To describe
the practice of the nursing process among nurses in Kiambu County Referral
Hospital.
1.4.1 Specific
Objectives
1. To establish
the prevalence of use of the Nursing process in Kiambu County Referral Hospital.
2. To identify
the most practiced steps of the nursing process.
3. To identify
nurse-related factors that impact their practice of the nursing process.
4. To identify
facility-related factors that impact the practice of nursing process in Kiambu
County Referral Hospital.
1.5
Study Variables
1.5.1 Dependent
Variables
1. The
practice of nursing process in Kiambu County Referral Hospital. The practice of
the nursing process, in this case, refers to the provision of care to patients
using the steps of the nursing process. The practice is evident in the
documentation of nursing care plans.
1.5.2 Independent
Variables
1. Steps
of the nursing process: assessment, diagnosis, planning, implementation, and
evaluation.
2. Nurse-related
factors: knowledge, and attitude towards the use of the nursing process.
3. Facility-related
factors: availability of resources and managerial support of the nursing
process.
CHAPTER 2: LITERATURE REVIEW
2.1
Introduction
According
to Miskir & Emishaw (2018), nursing has undergone significant milestones
from the time of Florence Nightingale and has since developed into a recognized
profession. The profession has its conceptual and theoretical frameworks to
guide its practices; the nursing process (NP) is one of the critical frameworks.
On the same note, the nursing process is described as “an organized, dynamic
approach that allows nurses to meet patient’s needs through its five steps:
assessment, diagnosis, planning, implementation, and evaluation.” From a
relatively similar view, Moghadas & Sedaghati (2020), discoursed that the
nursing process consolidates cognitive, interpersonal, and ethical-legal skills
in the implementation of its standard steps. The steps are interconnected to
provide a systematic approach to nursing care service. These studies agree that
the nursing process leads to improved quality of care.
The
nursing process is a universally accepted framework. According to Moghadas
& Sedaghati (2020), the framework has continually replaced the traditional
nursing practices of little attention to patient needs. Today, nursing care is
patient-centered. The current practice of the nursing process recognizes
patients as individuals and not groups; each of them presents with unique
needs. Therefore, nurses ought to universally support the use of the nursing
process to reap the benefits of this framework.
2.2
Practice of the Nursing Process
The use
of the nursing process has evolved over the years. According to Huitzi, Elorza
& Asurabarrena (2017), at the time of its inception in nursing care; it began
with three phases, then four phases followed by the formulation of the NANDA
list of nursing diagnoses before settling on the present five steps of the
nursing process. On the same note, the nursing process took effect in Spanish
healthcare in response to calls to improve the delivery of nursing services.
From the comparative study by Huitzi, Elorza & Asurabarrena (2017), the teaching
of the nursing process began in nurse training institutions similar to Canada
and the United States before its adoption as part of nurse responsibilities in
hospital settings.
A study
in African countries by Osman, Ninnoni & Anim (2021), shows that the nursing
process has achieved widespread acceptance and use in hospitals; it is “a legal
and policy requirement in nurse-patient activities.” However, a study in Ghana
revealed half of the nurse participants demonstrated adequate knowledge and
skills of the nursing process while the other half lacked the same (Osman,
Ninnoni & Anim 2021).
On a
similar note, Agyeman, Korsah & Okrah (2017), found that nurses in Ghanaian
hospitals found it difficult to transition theoretical knowledge of the nursing
process into practice. New nurses in these hospitals reported a culture of poor
implementation of the nursing process in the ward which discouraged the acquisition
of practical skills through apprenticeship. Mutshatshi & Mothiba (2020),
observed that nurses in South Africa found it difficult to implement the
nursing process despite the integration of the same in the nurse’ training
curricula. A study in Ethiopia showed a comparatively higher utilization of the
nursing process more than in Kenyan hospitals (Shiferaw et al. 2020). However,
these results mark underutilization of the nursing process in both countries
which is below average score. Evidence from a study in Ethiopia showed poor
documentation of the nursing process, characterized by incompletely documented
care plans (Tasew, Mariye & Teklay 2019). Also, a cross-sectional study in
a Tanzanian hospital identified the poor practice of the nursing process; only
15.7% of the respondents demonstrated good knowledge and practice of the
nursing process (Obonyo et al. 2019). The study linked shortage of nurses and
inadequate motivation of staff to poor utilization of the nursing process.
Studies
on various Kenyan hospitals reported various findings on the practice of the nursing
process. Mwangi, Meng’anyi & Mbugua (2019), established that nurse respondents
cited poor staffing and shortage of supplies as the primary reasons for the inability
to implement the nursing process in five selected hospitals. Nurses in these
facilities haphazardly documented the steps of the nursing process. Similar
studies by Mbithi, Mwenda & Karonjo (2018), revealed that only 28% of the
respondents were able to conduct patient assessments and fully document the
nursing process and 4% were able to completely formulate nursing diagnoses. Lekenit, Gatere & Mutinda (2020),
established that 1% of the nurses in Narok, Kenya, correctly identified all the
steps of the nursing process; an indicator of the poor practice of the nursing
process. In line with these, Mangare et al (2016), observed that nurses in
Naivasha had skills in the nursing process but barely applied steps of the
nursing process to patient care. These findings further revealed a lack of
evaluation of the goals of treatment. Some of the patient files lacked
documentation of nursing care plans. Regarding the documentation of the steps
of the nursing process, a study by Githemo (2017), showed that 69.2% of the
nurses in Kiambu and Thika Hospitals agreed that nursing care plans should only
be drawn for the sickest patients. Besides, most of the nurses perceived the
use of nursing care plans as a cumbersome activity. Also, most of the
participants opposed the use of nursing care plans.
2.3 Steps of the Nursing Process
The
nursing process is a framework with a sequence of steps. ‘Assessment’ forms the
first step of the nursing process. In this phase, the nurse identifies cues or
pointers to an existing or impending heath need in a patient. Assessment may
include both objective and subjective data. For instance, it may include
findings from physical examination and verbal reports from the patient
respectively. Diagnosis forms the next step of NP; one formulates a nursing
diagnosis based on the assessment cues. A list of NANDA nursing diagnoses
provides standard nursing diagnosis which describes the patient's functions and
needs. A diagnosis should have a clinical issue or need, related factors, and
evidence of the health problem. The planning phase outlines the goals of
treatment, specific interventions, and a scientific rationale to justify the
interventions. The implementation phase involves the actualization of the
nursing interventions or the provision of treatment to meet the needs of the
patient. Lastly, in the evaluation phase, the nurse must reassess to ensure the
goals of treatment are met. The frequency of reassessment depends on the
overall condition of the patient (Toney-Butler & Thayer (2020).
2.4
Nurse Related Factors
Nurse-related
factors of important interest include knowledge of the steps of the nursing process
and nurses’ attitudes or perspectives of the nursing process.
2.4.1 Knowledge of
the Nursing Process
According
to Mbithi, Mwenda & Karonjo (2018), the nursing process is the epitome
foundation of the nursing profession which means nurses should have
prerequisite knowledge of various aspects of the framework. Knowledge, in this
case, refers to the steps of the nursing process namely: assessment, diagnosis,
planning, implementation, and evaluation. Ojewole & Samole (2017), asserted
that utilization of the nursing process relies on the nurses’ knowledge of the
framework, “awareness of the terminologies of nursing diagnoses, evidence-based
practice and capacity to evaluate patient responses to intervention.” Besides,
Mwangi, Meng’anyi & Mbugua (2019), acknowledged that the absence of primary
knowledge in the nursing process derails the acceptance of the framework and
transitioning of theoretical knowledge into practice in hospital settings.
Studies
conducted in Nigerian Port Harcourt Hospital showed that nurses' knowledge
influenced the implementation of the nursing process; among the selected 100
study participants, 41% of them demonstrated good knowledge of the nursing
process while the rest had insufficient knowledge of the framework (Afolayan et
al. 2013). Also, a study in selected Ethiopian hospitals showed similar
results; below-average knowledge and skills of the nursing process and
associated low implementation of the framework (Baraki et al. 2017). Similarly,
Hagos et al. (2014), observed that 90% of the nurses in Mekelle Zone Hospitals
in Ethiopia demonstrated unreliably low utilization of the nursing process. Out
of these participants, 90.5% only heard of the framework but a few were able to
apply theoretical knowledge into practice. In Kenya, the majority of the Nurses
participants (78.3%) in a study conducted at Thika Level 5 hospital reported
having a knowledge gap in the nursing process. Out of these participants, 48.3%
acknowledged their lack of knowledge in the formulation of nursing diagnoses
(Mwangi, Meng’anyi & Mbugua 2019).
2.4.2 Nurses’ Perspectives
of the Nursing Process
An
individual’s perspective determines their response to a subject. Negative
perspectives influence negative results and positive perspective often leads to
desirable outcomes. Regarding the nursing process, Mwangi, Meng’angyi, and
Mbugua (2019) observed that the majority, 81.25 percent of the nurses in Thika
felt that the nursing process is time-consuming while the remaining few held a
contrary opinion. On the same note, the nurse respondents held a majority
opinion that the nursing process should not adhered to every time and that it
is not always practical to consistently use the nursing process. However, the
same studies depicted that most of the nurses acknowledged the significance of
the nursing process as a framework that improves the health of the patients. Similarly,
studies by Githemo (2017), shared similar results that nurses in Kiambu and
Thika hospitals agreed that the nursing process is cumbersome. Besides, the majority
of the nurse respondents disapproved of the teaching of the nursing process. Out
of this study population, 50% strongly agreed that drawing of nursing care
plans should not be mandatory. Moreover, 69.2 percent agreed that nursing care
plans should be drawn for very sick patients only. These perspectives influence
the practice of the nursing process among nurses.
2.5
Hospital Related Factors
Institutional
or facility-related factors of key interest include the availability of
resources and managerial support in the practice of the nursing process.
2.5.1 Availability of
Resources
Physical
resources and human resources are critical in the utilization of the nursing
process. According to Adraro & Mengistu (2020), nurses in Ethiopia
attributed poor use of the nursing process to a lack of resources such as
hospital supplies. Also, the adequacy of human resources or staff determines
the prevalence of use of the nursing process. With adequate staffing, hospitals
achieve a balance of demand and supply forces. A study in selected African
countries identified major challenges from the shortage of staff; African
countries have high patient numbers as opposed to the low numbers of the
nursing workforce (Tadzong & Adelphine 2021). Besides, a rise in patient
numbers impedes continual implementation of the nursing process in case of low
staffing levels. The above study cited that the nursing process is laborious as
it involves a series of steps and it is even worse in non-computerized
environments. These studies concur with study reports from Kenyan nurses
working in Narok hospital that high patient numbers were the primary challenge
posing a below-average score in the use of the nursing process among nurses.
Nurses suffered the consequences of high patient turnout; they are overworked
and in the process experience burnout and subsequently poor use of the tedious
nursing process.
2.5.2 Managerial Support
Managerial
support denotes that which is directed to the nurses by the hospital
administration. The nursing process is a framework that requires baseline
support for it to bear fruits. The framework should be adopted and cultured
into the scope of practice of nursing by any serious hospital authorities.
Lakenit, Gatere & Mutinda (2020), acknowledged that 90.2% of respondents in
Narok, Kenya hospital reported a lack of support from the administration. All
the respondents reported the administration did not give them incentives. Among
these, 88% of them felt that nurse managers did not take the use of the nursing
process with great importance. Adraro & Mengistu (2020), shared a different
perspective of institutional support; those nurses who worked in
administratively supported hospitals consistently implemented the nursing
process unlike their counterparts with little support from the hospital
administration. Study findings from Agyeman, Korsah & Okrah (2017) revealed
that nurses who received moral support such as verbal recognition from nurse
managers motivated them to consistently implement the nursing process. The motivation
of nurses also came in form of consistent supervision, continuous medical
education, and evaluation of the use of the nursing process.
Figure 1. Conceptual Framework
CHAPTER 3: STUDY METHODOLOGY
3.1
Research Design
A
descriptive cross-sectional study design was used in the study. According to
Aggarwal & Ranganathan (2019), descriptive studies answer questions about the
‘how’, ‘when’, and ‘what’ of the population under study.
Study Area
The
study was conducted in Kiambu County Referral Hospital which is the main
referral hospital in Kiambu County. The facility is located in Kiambu town, a
distance of 15 kilometres from Kenyatta University, and an average travel time
of approximately 30 minutes via Eastern Bypass Road. Data will be collected
from In-patient departments that include the medical ward, surgical ward,
gynaecology, and paediatric units.
3.2
Target Population
The
study population included qualified nurses working in the in-patient
departments: medical ward, surgical ward, gynaecology ward, and paediatric
wards where patients are admitted for more than 24 hours. A total of 48 nurses
working at the inpatient departments consented to take part in the study, also
a total of 110 patient files found in the wards were audited for documentation
of nursing care plans.
3.3
Sampling
3.3.1 Sample Size
Determination
The
sample size was determined by using Andrew Fischer’s formula (Jung 2014) shown
below and adjusted using a formula by Taro Yamane as cited by Adam (2020).
d2
Where:
n=
required sample size (population is less than 10,000)
Z is the
confidence interval (i.e., 1.96 for 95% confidence);
d is the margin of
error (i.e., 0.05 = ± 5%) and p is the estimated value for the proportion of a
sample that has the characteristics of interest.
P= proportion of the target population projected to have
the characteristics of interest. The variability on the number of patient files
is unknown in the study area, hence the study will use the maximum variability
(0.5).
The sample size
for nurse population:
0.052 0.052
The sample size for patient files:
0.052
The population of in-patient nurses is 56, thus replacing
the values in the above gives a sample of 55 nurses. Similarly, the same calculation
applied to the number of patients discharged in the selected 3 months gives a
sample size of 153 patient files. However, the population of study in each case
is less than 10,000 thus the sample size will be adjusted using Yamane’s
formula:
Desired sample size (nf) =N/1+N (e)2)
Where: n is the sample size (55 and (153)
respectively.
N is the study population (56) and (252) respectively.
E is the margin error (0.05 in both cases).
Desired sample size of nurses;
nf = 55/ (1+55(0.05)2
= 48
Desired sample size for patient files;
nf = 252/ (1+153 (0.05) 2 =110
The sample size for patient files only serves the
purpose of inclusivity of the four wards. Otherwise, these files shall be
subjected to further scrutiny according to the inclusion criteria so as to
obtain a feasible sample.
3.3.2 Sampling Technique
The
study adopted both probability and non-probability sampling. To select the
nurses to be interviewed per ward/unit, the researcher utilized stratified sampling
to ensure an equal representation of nursing practice in each unit. The
selection of nurses per unit was done through convenient sampling.
Stratification at the unit level helped to ensure an equal representation of
the different specialized units. Convenient sampling of the nurses at the ward
level is owing to the nature of nursing duties that may limit availability of
some nurse doing odd duties and offs during the time of data collection.
Selection
of files was done using probability sampling. Initially the researcher
calculated the number of files from each unit to be scrutinized through
stratification. Units with more discharges received more files for the study. Selection
of the individual files was done using random sampling. The selected files were
scrutinized to ensure they met the criteria. Any file that was randomly
selected and failed to meet the criteria was replaced with an alternative.
3.3
Inclusion and Exclusion Criteria
Inclusion Criteria
The
researcher considered participants and samples based on the following:
1. Qualified in-nurses
working in Kiambu County Referral Hospital.
2. Nurses
who consented to take part in the
study.
3. All files of patients in the ward with chronic
conditions.
Exclusion Criteria
Besides,
the study excluded:
1. Nurses
who declined to participate.
2. Files of patients admitted secondary to
COVID-19 related infections.
3. Files
of patients with an hospital stay of less than 24 hours since the time of
admission in the ward.
3.4
Data Collection
3.4.1 Data Collection
Instruments
To
accomplish this, a data checklist
containing 5 items was used to retrospectively audit patient files. Items on
the checklist corresponds with the steps of the nursing process. The tool
collected was used to collect data on the documentation of nursing care plans
to discover the mostly practiced steps of the nursing process. The checklist was
adapted from COCHRANE; Li, Higgins & Deeks (2019), appraised the
significance of data checklists as a means of ensuring consistency in the
process of data extraction and for comparing duplicate data.
Also,
data collection utilized researcher-made questionnaires. The questionnaire consists of a
series of open-ended questions and closed-ended questions which investigated
the nurse-related factors and hospital related factors impacting the use of
nursing process in Kiambu County Referral Hospital. Ponto (2015) justified that;
questionnaires enable researchers to examine human behaviours of interest.
Questionnaires were printed and administered by the researcher with the help of
research assistants.
3.4.2 Research
Procedure
On the
days of data collection, the researcher together with research assistants selected
files of patients in the respective wards: medical ward, surgical, gynaecology,
and paediatric units. A total of 110 patient files were selected from all the
four wards as follows: 31 files in medical, 29 in the surgical ward, 27 in the
paediatric ward and 22 in the gynaecology wards. Further stratification of
files was done by putting it into clusters each containing 5 files. Clustered
files were scrutinized based on the inclusion criteria; those that failed to
meet the criteria were replaced to maintain the integrity of the target sample
size. For instance, while sorting the
files, only patients admitted with chronic conditions such as Diabetes, pneumonia,
hypertension, HIV related complications, post-operative patients among others were
selected; acute conditions were excluded in the sample. The resulting sample was
subjected to an observation checklist to investigate the documentation of the
five steps of the nursing process.
Besides,
the researcher firstly obtained an informed consent from nurses by clarifying
the purpose, benefits, and rights of nurse participants regarding the study. A
total of 48 nurses were selected from the four wards as follows: 15 in medical
ward, 15 in surgical, 10 in paediatric and 8 from gynaecology wards. Thereafter,
questionnaires with a series of open-ended and closed-ended questions were
administered to assess the practice of the nursing process among nurses. The
study was conducted during working days for 2 weeks.
3.4.3 Data Management
Data
cleaning of questionnaires was done by counterchecking to ensure the
completeness of responses. This was followed by the sorting of data and
analysis of distribution of the study variables through calculation of
percentages. The results were then represented in frequency distribution tables
since this makes it easy to summarize and interpret grouped data. Responses
from the questionnaires were analysed and compared for quality; compelling relationship
of variables from the responses were recorded.
3.5
Quality Control
3.5.1 Research
Assistants
Two
nurse interns at Kiambu County Referral Hospital were selected voluntarily to
help with the following activities: testing of the research tools, recruiting
study participants, data collection, and management. Thus, they were trained
for two days on the use of data checklists and administering of questionnaires.
3.5.2 Pre-testing of
Tools
A total
of 11 patient files which represent 10% of the sample size were selected from
the paediatric ward at Ruiru Hospital for testing of observation checklists. The
nursing process is practiced in Ruiru Hospital similar to the targeted study
area. Also, 5 nurses were selected for testing of questionnaires; this
represents 10% of the sample size. Pretesting of tools helps to identify and
correct errors on the tools of data collection and thus enhance reliability.
3.6
Assumptions and Limitations
In
conducting the study, the researcher assumes that:
1. The
respondents provided true and accurate information.
2. Completeness
of documentation of nursing care plans represents proper utilization of the
nursing process.
Therefore,
the study is subject to the following limitations in the research methodology:
1. Data
checklists fail to account for the quality of nursing diagnosis and nursing
interventions.
2. Data
collected shall only apply to Kiambu County Referral Hospital and may not be
used for generalization to other hospitals.
3. Some
wards may be underrepresented if there are no chronic conditions or if there
are less chronic cases or few nursing staff.
Therefore,
further studies should be conducted in the facility and other hospitals to gather
more reliable data.
3.7
Ethical Considerations
The proposal
was submitted to the Kenyatta University nursing department for approval. Then the approval was sent to the nursing service
manager in Kiambu Hospital to obtain permission to carry out the
study. The nurse managers of the medical and surgical departments were be
informed and various units nursing in-charges informed as well. Besides, consent
was sought from willing participants clearly stating the purpose and benefits
of the study. According to Page & Nyeboer (2017), these prerequisites are
important to “safeguard the welfare and safety of the human research
participants.”
CHAPTER 4: STUDY RESULTS
4.1
Demographic Characteristics
The
nurse participants working in the selected units in Kiambu are described in
Table 1 below. Most of the participants worked in Medical (15), surgical (15)
and pediatric (10) departments with the least at Gynaecology ward (8)
respectively. Female nurse participants accounted for three-quarters; 42 (75%),
of the study population and the male counterparts with a 25% (6) distribution
in the selected units. The distribution gives a male to female ratio of 1: 7.
Furthermore, the population consisted of 33 diploma holders marking
approximately two-thirds; 68.7% of the population and 15 (31.3%) degree
holders.
Table
1: Distribution of Nurse Participants by Gender, Level of Training and
Deployment in the Units
|
Characteristic |
Frequency (n) |
Distribution in Percentage (%) |
|
Gender |
|
|
|
Female |
42 |
75 |
|
Male |
6 |
25 |
|
Total |
48 |
100 |
|
Level of Training |
|
|
|
Diploma |
33 |
68.7 |
|
Degree |
15 |
31.3 |
|
Total |
48 |
100 |
|
Deployment in the Units |
|
|
|
Medical |
15 |
31.3 |
|
Surgical |
15 |
31.3 |
|
Paediatric |
10 |
20.8 |
|
Gynaecology |
8 |
16.7 |
|
Total |
48 |
100 |
4.2
Practice of the Steps of Nursing Process
Table 2
below shows the prevalence of the practice of the steps of the nursing process.
Results are obtained from the self-rated practice of the steps of the nursing
process and findings from the audit of nursing care plan forms in the wards.
Auditing of nursing care plans shows 31 (28.2%) care plans in the medical ward,
29 (26.4%) in the surgical ward, 27 (24.5%) in pediatrics, and 22 (20%) in the
Gynaecology ward had incomplete documentation. Out of the sampled files, only 1
(1%) of the nursing care plans from the surgical ward had complete
documentation.
Table
2: Completeness of Documentation of the Steps of Nursing Process
|
In-Patient Department/Ward |
Frequency (n) |
Distribution in Percentage (%) |
|
Medical Ward |
|
|
|
Complete (C) |
0 |
0 |
|
Incomplete (I) |
31 |
28.2 |
|
Surgical Ward |
|
|
|
Complete (C) |
1 |
0.9 |
|
Incomplete (I) |
29 |
26.4 |
|
Paediatric Ward |
|
|
|
Complete (C) |
0 |
|
|
Incomplete (I) |
27 |
24.5 |
|
Gynaecology Ward |
|
|
|
Complete (C) |
0 |
|
|
Incomplete (I) |
22 |
20 |
|
Total |
110 |
100 |
Table 3
below shows results from the self-rated practice of the steps of the nursing
process among nurses in Kiambu County Referral Hospital. Nurses who rated their
practice as “All the time” and “Most of the time” were considered similar
responses. On the other hand, nurses who rated their practice as “Never or Not
sure” were counted as similar responses. Results show that most of the nurse
respondents; 48 (100%) in total, conducted the assessment step of the nursing
process at all times. Similarly, a total of 26 (53.8%) performed the diagnosis
step of the nursing process all the time while 22 (46.2%) did it a few times. A
total of 26 (53.8%) performed the planning phase of the nursing process all the
time and a similar 26 (53.8%) performed the step only a few times. The
implementation step received 41 (84.6%) responses as ‘all the time’ while 7
(15.4%) participants practiced the step of the nursing process only a few
times. Most of the nurses; a total of 30 (61.5%), reported performing
evaluation steps all the time, 14 (30.7%) do it a few times and 3 (17.7%)
reported to have never performed the evaluation phase of the nursing process.
Table
3: Nurse self-reported practice of the steps of Nursing Process
|
Steps of Nursing Process |
Frequency (n) and rate (%) of Practice |
|||
|
All the time |
Few Times |
Never |
||
|
Assessment |
48; (100%) |
0 |
0 |
|
|
Diagnosis |
26; (53.8%) |
22; (46.2%) |
0 |
|
|
Planning |
26; (53.8%) |
26; (53.8%) |
0 |
|
|
Implementation |
41; (84.6%) |
7; (15.4%) |
0 |
|
|
Evaluation |
30; (61.5%) |
14; (30.7%) |
3; (17.7%) |
|
On a similar note, nurse participants rated the documentation
of the nursing care plans as shown in table 4 below. Results in figure 2
summarize the following characteristics of documentation: completeness,
self-rated competence, ease, and importance to patient care. Nurses who rated
their competence as “Excellent”, “Very Good” and “Good” were counted as similar
responses. Responses as “poor and very poor” are considered of equal ability.
Those who rated the ease of documentation as “Very Easy” and “Easy” were as
well considered similar responses and those who rated “Very Difficult”, “Fair”
and “Not sure” were considered equals. On the other hand, nurses who rated the
importance of documentation of nursing care plans as “Very Important”, and
“Important” were considered similar responses; any result under “Less
Important”, “Not Important” and “Not sure” are as well grouped as similar
outcomes as shown in table 4.
Table 4: Characteristic of Documentation
of Nursing Care Plans
|
Characteristic
|
Frequency
(n) |
Rate
in Percentage (%) |
|
Completeness
|
|
|
|
All steps completed |
18 |
38.5 |
|
1 step missing |
4 |
7.7 |
|
2 steps missing |
15 |
30.8 |
|
3 steps missing |
7 |
15.4 |
|
4 steps missing |
0 |
0 |
|
All 5 steps missing |
4 |
7.7 |
|
Total |
48 |
100 |
|
Competence
|
|
|
|
Excellent |
33 |
69.2 |
|
Average |
14 |
30.8 |
|
Poor |
1 |
2 |
|
Total |
48 |
100 |
|
Ease |
|
|
|
Easy |
18 |
38.5 |
|
Difficult |
30 |
61.5 |
|
Total |
48 |
100 |
|
Importance
to patient care |
|
|
|
Very Important |
40 |
84 |
|
Less Important |
8 |
16 |
In table 4 above, 18 (38.5%) nurses reported the
ability to document all the steps of the nursing process, 4 (7.75%) missed one
step, 15 (30.8%) missed documenting the utmost 2 steps, 7 (15.4%) missed three
steps and 4 (7.7%) reported to missing documentation of all the five steps on
nursing care plans. On a similar note, the majority; 33 (69.2%) nurses rated
their competence as excellent, 14 (30.8%) rated as average a while 1 (2%) rated
their competence as poor. The majority of the nurses; 30 (61.5%), found it
difficult to document the steps of the nursing process. On the other hand, a
total of 40 (84%) nurses regarded the nursing care plan as important to patient
care while 8 (16%) rated the nursing care plan as less important to patient
care.
Figure 2 below summarizes results from self-reports
of motivation to practice each step of the nursing process by nurses in Kiambu
County Referral Hospital.
4.3 Nurse Related
Factors that Influenced the Practice of Nursing Process
4.3.1 Nurse’s Knowledge
of The Nursing Process
In figure 3 below, 28
(58.3%) nurses who rated their knowledge as “Very Good” and “Good” are
considered equals, responses as “moderate” totaled up to 19 (39.6%) nurses
while only 1 (2.1%) nurses rated their knowledge as ‘poor.’
4.3.2
Challenges in The Use of The Nursing Process in Kiambu County Referral Hospital
Table 5 below summarizes responses from nurse
participants regarding the challenges encountered with the use of the nursing
process in Kiambu County Referral Hospital. The majority of the nurses; 30
(62.5%) reported shortage of staff as the challenge facing the use of the
nursing process. Besides, a total of 7 (14.6%) nurses and approximately 7
(14.6%) nurses reported lack of supervision, and poor knowledge respectively,
as the challenges in the use of the nursing process. Moreover, 4 (8.3%) nurses
reported a lack of medical supplies and commodities as a challenge in the use
of the nursing process.
Table 5: Major Challenges of the use of
nursing process
|
Challenges
|
Frequency
(n) |
The
rate in Percentage (%) |
|
Shortage of staff |
30 |
62.5 |
|
Lack of Medical Supplies and
commodities |
4 |
8.3 |
|
Lack of supervision |
7 |
14.6 |
|
Poor knowledge of the nursing
process |
7 |
14.6 |
|
Total |
48 |
100 |
4.4
Facility Related Factors
4.4.1 Institutional
Support
Table 6 below shows the level of support from the
administration regarding the use of the nursing process in Kiambu County
Referral Hospital. Results show that 18 (38.5%) nurses and a similar 18 (38.5%)
rated the level of institutional support as high and moderate respectively. The
rest 11 (23%) nurses report a low level of support from the institution.
Besides, 15 (30.8%) respondents and a similar 15 (30.8%) rated the
accessibility of stationery and other commodities as ‘very likely’ and
‘moderately likely’ respectively. Support from fellow nurses resonated as “Very
supportive” among 29 (61%) of the nurse participants while 19 (39%) nurses
rated nurse colleagues as “not supportive.” Among the participants, 4 (8%)
acknowledged having recently attended a continuous medical education (CME) on
the nursing process at the facility. Cumulatively, 44 (92%) nurses either
reported not having attended CME in the past or have never heard about CMEs on
the nursing process at the facility.
Table 6: Institutional Support of the
Nursing Process in Kiambu County Referral Hospital.
|
Level/Type
of support |
Frequency
(n) |
The
rate in percentage (%) |
|
Nurse
perspective of the level of support |
|
|
|
High |
18 |
38.5 |
|
Moderate |
18 |
38.5 |
|
Low |
11 |
23 |
|
Total |
48 |
100 |
|
Accessibility
of stationery and other commodities |
|
|
|
Very Likely |
15 |
30.8 |
|
Moderately |
15 |
30.8 |
|
Never |
18 |
38.4 |
|
Total |
48 |
100 |
|
Support
by nurse colleagues |
|
|
|
Very Supportive |
29 |
61 |
|
Not Supportive |
19 |
39 |
|
Total |
48 |
100 |
|
Attended
CMEs on the Nursing process |
|
|
|
Recently attended |
4 |
8 |
|
Never attended |
44 |
92 |
|
Total |
48 |
100 |
CHAPTER 5: DISCUSSION
5.1
Introduction
This chapter begins with a discussion of the study
results to describe the practice of the nursing process in Kiambu County
Referral Hospital. Each topic of discussion conforms with the study objectives
to discover the prevalence of the practice, the most commonly practiced steps
of the nursing process, nurse-related factors, and facility-related factors
influencing the practice of the nursing process. Firstly, it is important to
describe the nurse population utilizing the nursing process. Secondly, the
discussion shall set a foundation for the relationship between variables by
generally describing the practice of the nursing process as good or poor
practice. Thereafter, significant relationships identified among the study
variables shall be used to draw conclusions and recommendations.
5.2
Discussion of Study Findings
5.3
Demographic Characteristics
A picture of the study population is important as a
foundation to describe the practice of the nursing process. Study findings show
that three-quarter of the nurse population consists of female nurses with the
male counterparts scoring less than average in dominance. Besides, more nurses
were deployed to medical and surgical units than paediatric and gynaecology
wards respectively. The former distribution could be attributed to the high
workload in the medical and surgical wards. Kiambu County Referral hospital has
more than two-thirds of nurse diploma holders and a below-average distribution
of degree holders in the selected wards.
5.4
Practice of The Steps of Nursing Process
5.4.1
Documentation of The Steps of The Nursing Process
Trends of documentation rank the medical and
surgical wards with the highest number of incompletely documented nursing care
plans followed by pediatric and gynecology wards respectively. This could be
associated with the high workload in the former wards as compared to the
latter. A further result from the self-reported practice of the nursing process
shows that nurses in the facility are most likely to utilize the assessment and
the implementation phases of the nursing process. Each recorded a performance
index of 100% (48) and 84.6% (41) respectively. Nurses were moderately likely
to utilize the diagnosis and planning phases of the nursing process. While
there were no reports of nurses to skive these steps, the results depict
reluctance to formulate a diagnosis, goals of treatment, and interventions.
Similarly, nurses skipped the documentation of the evaluation phase than the
assessment, diagnosis, planning, and implementation phases collectively.
A self-rated assessment of the documentation showed
that a large number 38.5% (18) of the nurses completed all the five steps of
the nursing process. On the other hand, a significant 30.8% of the nurses
acknowledged skipping at least any two steps of the nursing process. However,
more than half of the nurses (69.2%) rated their competence as ‘excellent and
only 2% as poor. These contrasting characteristics could be attributed to a
lack of supervision of the process of documentation whereby nurses have the
skills but do fail to transition them into practice. These results are in
agreement with the findings of Asmirajanti et al (2016) that supervision
increased the utilization of the nursing process and the quality of nurse
services.
More than half (61.5%) nurses rated the process of
documentation as difficult yet 84% rated the nursing process as very important
for patient care. Also, from the study, more than average depicted as highly
motivated to practice the assessment and implementation phase of the nursing
process. The planning phase and evaluation phase recorded an increasingly high
number of nurses (30.7% and 23.1%) rating their level of motivation as ‘low’ as
compared to the assessment and implementation phases. This means that nurses
who found it difficult to perform particular steps of the nursing process were
less motivated to utilize the nursing process. Asmirajanti et al (2016) found
that nurse managers motivated nurses by consistently directing, controlling,
and evaluating the practice of the steps of the nursing process.
5.5
Nurse Related Factors Influencing the Practice of Nursing Process
5.5.1 Nurses’
knowledge of the nursing process
Assessment results showed that more than half of the
nurses (58.3%) have good knowledge of the nursing process. On the other hand,
39.6% rated their knowledge as moderate while 2.1% of the nurse population have
poor knowledge of the nursing process. Although nurses possessed knowledge,
there was a low practice of the nursing process among the nurse population.
These results agree with the findings of Agyeman, Korsah & Okrah (2017)
that nurses fail to transition theory into practice due to insufficient
training on the nursing process. The same findings could be attributed to a
lack of training such as CMEs on the nursing process at Kiambu County Referral
Hospital. Training is important to impart practical knowledge and enhance the
practice of the nursing process.
5.5.2
Challenges in the Use of Nursing Process
Findings from the study ranked shortage of staff and
corresponding lack of time as the major problem hindering the use of nursing
process among 62.5% of the nurses. This helps to explain the poor practice of
the steps of the nursing process.
Govasli & Solvo (2020) shared similar findings that nurses felt
uncomfortable spending time in proactive nurse activities at the expense of
more direct nurse actions. Thus, nurses utilized the assessment and
implementation phases since it involves active participation of the nurse in
the patient care as opposed to the diagnosis and planning phases which are
theoretical.
Besides, lack of supervision and poor knowledge
ranked second as the major challenges in the use of the nursing process among
14.6% of the nurses. Lack of medical supplies and commodities did not display
as a major challenge as it was significant to only 8.3% of the nurse
population. Thus, the poor practice of the nursing process at Kiambu County
Referral Hospital could be majorly attributed to shortage of staff and lack of
supervision. These resonated with the findings of Agyeman, Korsah & Okrah
(2017) that the shortage of staff limited documentation of nursing care plans.
5.6
Facility Related Factors
5.6.1 Institutional
Support
Institutional support is important in the use of the
nursing process. Various factors were assessed regarding the support from the
administration and nurse colleagues. Results show that many nurses perceived
the current level of support as high and an equal 38.5% of nurses rated the
support as moderate. On the other hand, 23% of nurse participants regarded the
level of support as low. Support also came from provision and accessibility of
stationery and other commodities whereby 18 (38.4%) nurses demonstrated lack of
access to resources as one of the major hindrances to the practice of the
nursing process as only a few nurses (30.8%) acknowledged a high likelihood to
access the resources in the ward.
Nurses (61%) highly rated the level of support by
colleagues in the practice of the nursing process. Thus, inadequate support by
nurse peers does not show much significance as a problem that hinders the
practice of the nursing process. However, lack of training at the hospital
seemed a major problem since the majority of the nurses (92%), reported to have
never attended CMEs on the nursing process in the past. Only 8% of the nurses
acknowledged having attended CMEs in the recent past. Thus, this could have
contributed to the observed trend of the poor practice of the nursing process
in Kiambu County Referral Hospital.
CONCLUSIONS AND RECOMMENDATIONS
Conclusion
1.
The population
of nurses using the nursing process is majorly made of female nurses and
diploma holders.
2.
There is low
utilization of the nursing process in Kiambu County Referral Hospital.
3.
Assessment and
Implementation phases are the most practiced steps of the nursing process while
diagnosis, planning and evaluation are the least practiced steps of NP.
4.
Poor staffing
and lack of supervision are major hinderances in the use of nursing process.
5.
Lack of
continuous medical education highly contributes to poor practice of NP.
Recommendations
1.
Continuous
training on nursing process should be instituted to enhance transition of
knowledge to practice among nurses in the facility.
2.
The study
recommends to increase supervision of the use of nursing process by nurse
managers.
3.
The hospital
institution to institute mechanisms to lower workload and increase utilization
of NP. Some options include hiring of more nurses and or nurse assistants.
4.
Further
interventional studies should be conducted to increase the utilization of the
NP among nurses in Kenyan hospitals.
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Appendices
APPENDIX 1: CONSENT FORM FOR RESEARCH PARTICIPANTS
Study: The practice of the Nursing Process in Kiambu County
Referral Hospital
Researcher:
Rono Nickson
School of Nursing Sciences
Kenyatta University
Email: kipngenorono@students.ku.ac.ke
Introduction: I am a
student at the school of Nursing Sciences at Kenyatta University pursuing a
Bachelor’s degree in Nursing and Public Health. I am undertaking a research
study ‘The practice of the Nursing Process. I am conducting the study at
Kiambu County Referral Hospital. The purpose of this information is to provide
you with details that will make you decide to willingly take part in the study.
You ate entitled to ask questions for clarifications regarding the study.
Thereafter, the researcher shall ask you to sign a consent form if you agree to
take part in the study.
Background information:
This study aims to collect data on the practice of the nursing process by
nurses in Kiambu hospital. This shall describe the practice in terms of the most
practiced steps of nursing process, nurse related factors and hospital related
factors.
Participation:
Participants shall fill the questionnaires with the guidance of the researcher.
You are encouraged to ask for clarifications where you do not understand the
questions.
Benefits: While there
is no direct benefit in participation, the provided information shall guide in
formulation of recommendations to solve the problems hindering the practice of
nursing process. The provided information shall be kept confidential and used
for research studies only.
Consent
If you agree with the
above provisions of the study please sign below:
I hereby consent to
take part in the study. I have been informed of the nature of the study; the
benefits and risks that may occur in the process. I acknowledge that by taking
part in the study I have voluntarily made decision by self without coercion
from anyone.
Participants
signature______________________ Date_______________
APPENDIX 11: DATA COLLECTION TOOL 1
Questionnaire
Code
_________________
Questionnaire on The Practice of Nursing Process
Purpose: To
describe the practice of nursing process in Kiambu County Referral Hospital.
Instructions:
1) DO NOT write your personal details such as names or contacts.
2) Attempt all questions by ticking the most appropriate
answer.
3) The collected data shall be used for research only and
will not be disclosed to unrelated persons.
DEMOGRAPHIC DATA
1.
Sex of the
participant
A. Male
B. Female
C. Other
2.
Level of training
of participant.
A. Diploma
B. Degree
C. Masters
D. Others
3.
Department the
participant works
A. Medical ward
B. Surgical ward
C. Pediatrics
D. Gynecology ward
PRACTICE OF NURSING PROCESS
4.
How often do you
use the nursing process in the ward?
A. All the time
B. Most of the times
C. Few times
D. Never
E. Not sure
5.
Which part of the
nursing process do you implement more frequently compared to the others? Rate
the frequency of implementation in the table below…
|
|
|
All the time |
Most of the time |
Few times |
Never |
Not sure |
|
a.
|
Assessment |
5 |
4 |
3 |
2 |
1 |
|
b.
|
Formulating Nursing diagnosis |
|
|
|
|
|
|
c.
|
Care Planning |
|
|
|
|
|
|
d.
|
Implementation of planned care |
|
|
|
|
|
|
e.
|
Evaluation of care outcome |
|
|
|
|
|
6.
What reasons
impact the implementation of the following steps of the nursing process as you
have rated them above. Tick all the reasons that apply for each.
|
Reasons |
Assessment |
Nursing diagnosis |
Care Planning |
Implementation of planned care |
Evaluating care outcomes |
|
I am not very competent in it |
|
|
|
|
|
|
Lack of sufficient knowledge |
|
|
|
|
|
|
Difficulty of implementation |
|
|
|
|
|
|
Time not adequate |
|
|
|
|
|
|
The workload is high |
|
|
|
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Lack of stationery |
|
|
|
|
|
|
Lack of close supervision |
|
|
|
|
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|
Nurses are few |
|
|
|
|
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I am not motivated |
|
|
|
|
|
|
|
|
|
|
|
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Any other reason, specify |
|
|
|
|
|
7.
How do you
describe the practice of the nursing process in the ward?
A. Excellent
B. Moderate
8.
In a scale of 1 to
10, how likely are you to conduct patient assessment when writing nursing care
plans?
A. 8-10
B. 5-7
C. 4-6
D. 1-3
9.
Do you use the
nursing process for all the patients in the ward?
A. Yes
B. No (explain)_________________________
10. Rate the process of documentation of nursing care
plans in the ward.
|
Characteristic |
|
|
|
|
|
|
|
1. Completeness |
All steps
completed |
1 step missing |
2 steps missing |
3 steps missing |
4 steps missing |
All 5 steps
missing |
|
2. Competence |
Excellent |
Very good |
Good |
Average |
Poor |
Very poor |
|
3. Ease |
Very Easy |
Easy |
Difficult |
Very Difficult |
Fair |
Not sure |
|
4. Importance to
patient care |
Very Important |
Important |
Less important |
Not important |
Not sure |
Other |
11. How motivated are you to follow each of the below
steps of the Nursing Process?
|
|
STEP |
Highly Motivated |
Moderately Motivated |
Less motivated |
Never |
Not sure |
|
1 |
Assessment |
|
|
|
|
|
|
2 |
Diagnosis |
|
|
|
|
|
|
3 |
Planning: (Goals &
Expected outcomes, Interventions & Rationale) |
|
|
|
|
|
|
4 |
Implementation |
|
|
|
|
|
|
5 |
Evaluation |
|
|
|
|
|
12. The use of nursing process has the following benefits. (You can choose more than
one).
A. Better decision making
B. Problem solving made easier
C. Patients are more satisfied
D. Improved quality of nursing care
E. It has promoted critical thinking
NURSE RELATED
FACTORS
13. Describe your knowledge of the nursing process.
A. Very good
B. Good
C. Moderate
D. Poor
14. Rate the level to which you consider the nursing
process relevant to patient care
A.
Very relevant
B.
Relevant
C.
Of little
relevance
D.
Not at all
relevant
15. Rate the ease of implementing the following steps of
the nursing process
|
|
Step |
Very easy |
Easy |
Average |
Difficult |
Very difficult |
|
a.
|
Assessment |
|
|
|
|
|
|
b.
|
Diagnosis |
|
|
|
|
|
|
c.
|
Planning |
|
|
|
|
|
|
d.
|
Implementation |
|
|
|
|
|
|
e.
|
Evaluation |
|
|
|
|
|
16. Indicate any major problems you encounter with the use
of the nursing process in the ward (Select all that apply).
A. Shortage of staff
B. Lack of medical supplies
and commodities
C. Lack of supervision
D. Poor knowledge of nursing process
FACILITY RELATED
FACTORS
17. Rate the level of support of the management towards
the use of nursing process?
A. High
B. Moderate
C. Low
18. How likely are you to find nursing care plan forms in
the ward?
A. Very likely
B. Moderately
C. Never
19. In your opinion, how would you rate the acceptability
of the nursing process by nurses in your unit.
A.
Highly accepted
B.
Fairy accepted
C.
Barely accepted
D.
Not accepted
20. In your opinion, rate the support your colleague
nurses give to the nursing process in the unit
A.
Very supportive
B.
Supportive
C.
Barely supportive
D.
Not at all
supportive
21. When did you attended a continuous medical education
on nursing process in the ward/hospital?
A. I Recently attended
B. I have never attended
C. I have never heard of any training on nursing process
in the facility
22. What actions has the hospital administration taken to
promote the use of nursing process? (List any two)
_____________________________________________________________________
23. Do you know of any policies in the facility regarding
the use of the nursing process?
A. Yes (mention)_____________________________________
B. No
C. Not sure
APPENDIX 3: DATA COLLECTION TOOL 2
Observation Checklist
Purpose: To describe the documentation of the steps of nursing process.
Ward: Medical/Surgical/Pediatrics/Gynaecology
|
Steps
of Nursing Process: (Tally any missing
Documentation) |
Documentation Status of Nursing Care Plan (Tally
file as complete or incomplete) |
||||||
|
Assessment |
Diagnosis |
Planning |
Implementation |
Evaluation |
Complete |
Incomplete |
|
|
Goals & Outcomes |
Interventions & Rationale |
||||||
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|
Purpose
NB:
1.
Tally
any missing documentation on the columns provided below each step of the
nursing process.
2.
In
the column written “Documentation Status
of Nursing Care Plan” tally a file as COMPLETE
when there are no missing steps of nursing process or INCOMPLETE when there is at least one missing step of the nursing
process.
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