American Journal of Nursing Science

2015; 4(3): 45-49

Published online April 14, 2015 (http://www.sciencepublishinggroup.com/j/ajns)
doi: 10.11648/j.ajns.20150403.11
ISSN: 2328-5745 (Print); ISSN: 2328-5753 (Online)

Determinants towards Implementation of Nursing Process

Zewdu Shewangizaw*, Abera Mersha
College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia

Email address
Mershaabera@gmail.com (Abera M.), WERET83Z@outlook.Com (Zewdu S.)

To cite this article:

Zewdu Shewangizaw, Abera Mersha. Determinants towards Implementation of Nursing Process. American Journal of Nursing Science. Vol.
4, No. 3, 2015, pp. 45-49. doi: 10.11648/j.ajns.20150403.11

Abstract: Nursing Process is a systematic method which utilizes scientific reasoning, problem solving and critical thinking to
direct nurses in caring for patients effectively however, little is known about factors affecting the implementation of nursing
process. The study intended to assess factors affecting implementation of nursing process among nurses in Arbaminch General
Hospital, Ethiopia. Institutional based cross-sectional study with quantitative data collection through Self-administered pre-tested
Semi Structured questionnaire and observational checklist used among randomly selected 105 nurses. Data analysis was done by
SPSS version 15 for its objectives. Out of 105 studies 98 were participated in the study with 93.3% response rate. Forty two
(42.85%) of the total respondents were working in a stressful working environmental. Thirty five (35.7%) of respondents were
challenged to provide their nursing care due to patients inability to collect the required material for care provision. Factor affecting
implementation of nursing process were working in a stressful environment were 0.23 times less likely to implement nursing
process than those working in organized environment (OR: 0.23, [95% CI: (0.07-0.78)], highly knowledgeable nurses were 8.78
times more likely to implementation of nursing process than nurses who were not knowledgeable (OR: 8.78, [95%CI: (2.97-
77.48)] and economic status of patient to collect material for nursing care were negatively associated with implementation of
nursing process(OR: 0.07, [95%CI: (0.02-0.31)]. The study has identified lack of facility from organizational factors, economic
status of the patient to collect material for nursing care, early discharge, lack of cooperation and complicated problems from
patient related factors and level of knowledge were among those factors highly affecting nursing process implementation. Nearly,
one third of respondents have consistent with the implementation of nursing process in the clinical setting. This factors cause poor
quality of nursing care disorganized caring system, conflicting role, medication error and re-admission with similar problems,
dissatisfaction with the care patients have received, and increased mortality. Recommendation: The essence of nursing process for
client lies on the great benefits to the client, nurses and nursing profession as a whole. So, to provide quality of nursing care the
management body of the hospital should flow and supervise the implementation of nursing process in the hospital, the health
professional should train periodically and Information should be disseminated regarding nursing process.

Keywords: Nursing Process, Satisfaction, Knowledge

1. Background
Nursing Process is a systematic method which utilizes Nursing process is a cycle that never ends, roadmap that
scientific reasoning, problem solving and critical thinking to ensures good nursing care and improves patient outcomes (5,
direct nurses in caring for patients effectively (1). Nursing 6). As patient needs change, the nursing process allows the
process as problem solving approach and evidence based nurse to change the patient‘s plan of care to ensure that care is
method which involves different steps and it is a goal tailored to the patient‘s present needs. Nursing process allows
oriented method of caring for patients (2). health care team to observe and interact with the patient, and
The nursing process is widely accepted method and has not just become the task they are performing (5, 6).
been suggested as a scientific method to guide procedures According to current American and Canadian standards,
and quality nursing care. More recently, the process has been nursing practice demands the efficient use of the nursing
defined as a systematic and dynamic way to deliver nursing process and professional participation in activities that
care, operating through five interrelated steps: assessment, contributes to the permanent development of knowledge
diagnosis, planning, implementation and evaluation (3, 4). about this methodology(4).
46 Zewdu Shewangizaw and Abera Mersha: Determinants towards Implementation of Nursing Process

Different health care organization such as world health 2. Methods

organization (WHO), International Council of Nursing and
the American Joint Commission on Accreditation of Hospital Institutional based cross-sectional study with quantitative
Nursing Service Standards highly recommended that nursing data collection through Self-administered pre-tested Semi
process should be used in nursing documentation and Structured questionnaire and observational checklist used
promoted the use of the nursing process in nursing care (7). among randomly selected 105 nurses at Arbaminch General
The nursing process should be established in care practice Hospital. Study make eligible all nurses available during the
at all health care institutions, with in hospitals as well as in study period at Arbaminch Hospital.
the community as a whole (4, 8). Sample size were calculated by using single population
Nursing process is a cycle that never ends, roadmap that proportion formula with level of significance of 95%,
ensures good nursing care and improves patient outcomes (9, marginal error 5%, with 10 % non-respondents rate. The
10). As patient needs change, the nursing process allows the study tool also pretested for consistency on 10% of study
nurse to change the patient‘s plan of care to ensure that care is subjects at Chencha district hospital.
tailored to the patient‘s present needs. Nursing process allows According to the study nursing process were
health care team to observe and interact with the patient, and operationalized as a process in which nurses are used to solve
not just become the task they are performing (9, 10). patient’s problems by using the five steps i.e. Assessment,
Research evidence showed positive relationship between Nursing Diagnoses, Planning, Implementation and
practicing nursing process and decreased hospital stay, and Evaluation and patient hospital stay: A patient who is staying
increased satisfaction (11). An intervention study on the in hospital for getting nursing care.
effect of training nurses on nursing process implementation Data analysis were done by SPSS Version 15 software to
showed that the practice resulted in decreased hospital stay identify factors in multivariate bivariate analysis. Other
from 6.44 to 5.37, increased mean quality of discharge variables were measured by frequency and percentage. The
education practice from 2.24 to 12.2, increased mean quality confidentiality of the study participant were kept entire the
of documentation by staff from 2 to 23.4, increasing quality study process and informed consent also gotten from the
of care, increasing level of nurses' satisfaction, changing participant. Moreover, ethical clearance were gotten from
nurse's attitude regarding nursing care, decreasing energy Arbaminch Hospital.
consumed during care and increasing the ability of patients
for self-care (12). 3. Result
Results of previous studies indicated that patients who
received care according to nursing process were more 3.1. Socio Demographic Characteristics
satisfied than patients who received usual nursing care, as a Out of 105 study participant, 98 were participated in the
result of nurses spend more time with patient and patient had study with 93.3% response rate. About the sex distribution 46
more participation in their care (11). of them were males and 52 were females. Related to the
Nursing involves assisting others with basic human needs religion 46(46.9%) of the respondents were orthodox and
using a holistic approach, and the patient is defined as 1(1.02%) were catholic. The mean age of the study
someone who needs care. The majority of nurses have participant was 37.4 years old. Due to marital status
knowledge of the nursing process, but they do not apply it in 60(61.22%) of the respondents were married, 29(29.6%)
practice. Due to this, there are problems which are, decrease were single. (See table 1 below).
quality of care and ineffectiveness of the service (13).
Similarly, it is difficult to bring significant improvement in Table 1. Selected socio demographic characteristics of study participant in
nursing care if nurses don’t use nursing process to assess, Arbaminch General Hospital, 2014
plan, implement, and evaluate clinical conditions of the client. Characteristics Frequency Percentage
Moreover, malpractice of nursing process will affect quality Male 46 46.9
of nursing care as a result of different factors. (14). Sex
Female 52 53.1
According to study done at Addis Ababa indicate that, Orthodox 46 46.9
working overtime (81.8%), working without payment (12%), Protestant 44 44.8
Religion
misconduct (10.9%), high flow of patient, knowledge error, Islam 3 3.06
conflicting roles, high employee turnover and for 35.4% less Catholic 1 1.02
recognition, unsympathetic manager, 16.1% in a disorganized <24 6 6.12
organizational structure, early discharge and poor Age
25-44 70 71.4
participation of patients associated with professional, 45-54 13 13.26
organizational and patient related factors in implementation 55-64 9 9.18
of nursing process (15). < 5 years 26 26.53
Assessing the determinant factors which affect the 5-10years 40 40.81
Work
10-15 years 6 6.12
implementation, nursing process have vital role in the proper experience
15-20 years 16 16.32
implementation of the nursing process in Arbaminch Hospital.
20-25 years 4 4.08
 American Journal of Nursing Science 2015; 4(3): 45-49 47

3.2. Professionals Related Factors Affecting Nursing

Process

Seventy six (77.55%) of the respondents had no

misbehavior record on their personal file while 11(11.22%)
had misbehavior record and remaining 11(11.22%) did not
know misconduct record on the personal file. Regarding
orientation forty one (41.83%) of the total respondents have
got satisfying orientation while they join their organization
whereas 50 (51.02%) of respondents did not get satisfying
orientation. Figure 1. Selected patient related factors in implementation of nursing
Regarding on method of making implementation of process in Arbaminch general hospital, 2014
nursing 43 (43.87%) make visible their nursing related
activities. In this study, forty seven (47.97%) of respondents
were committed error on implementation of nursing process. 4. Nursing Process Implementation and
Among those twelve (25.5%), 13(27.7%), 22(46.8%) had Its Correlates
committed slap, executive, and knowledge errors respectively.
Characteristics such as, work place, nurses who were
3.3. Organizational Related Factors Affecting working in a stressful environment were 0.23times less likely
Implementation of Nursing Process to implement nursing process than those working in an
organized environment (OR: 0.23, [95% CI: (0.07-0.78)].
According to the current study, 42(42.85%) of respondents
Neglecting working environment had no association with
were anxious in working time due to high patient flow,
implementation of nursing process. Working in a hospital
9(9.18%) were from due misconception of physicians,
with high facility were 5.50 times more likely to implement
3(3.06%) were from harassing co-workers, 2(2.02%) were
nursing process than those working in lack of facility (OR:
from demanding patients, and 11(11.22%) were from
5.50, [95%CI: (2.18-13.74)].
unsympathetic managers.
Highly knowledgeable nurses were 8.78 times more likely
At the same time the study shows that, the misconception
to implementation of nursing process than nurses who were
of less important of nursing process 9(9.18%) and new
no knowledgeable (OR: 8.78, [95%CI: (2.97-77.48)].
reporting system 9(9.18%) affect the implementation of
Moderately knowledgeable nurses were positively associated
nursing process. Among the respondent, 35 (35.7%) of them
with implementation of nursing process (OR: 3.49, [ 95%CI:
believe that there working environment is stress full. (See
(1.03-11.82)].
table 2 below).
From patient related factors economic status of patient to
Table 2. Selected organizational factors affecting implementation of nursing collect material for nursing care were negatively associated
process among nurse at Arbaminch General Hospital, 2014 with implementation of nursing process (OR:0.07,
[95%CI:(0.02-0.31)] and (OR: 0.04, [95%CI, ( 0.01-0.21)],
Character Frequency Percent (%)
(OR: 0.19,[ 95%CI, ( 0.05-0.73)] were early discharge and
Availability of Available 38 38.8 due to lack of cooperation.(See table 3 below).
equipment Not available 60 61.2
Table 3. Relationship of implementation of nursing process by selected
with payment 50 51.02 variables in Arbaminch General Hospital,2014
Yes
Overtime work without payment 7 7.14
Nursing process
No 41 41.8 Characteristics Implemented AOR(95%CI)
Satisfied with Yes 1 2.0 Yes No
payment Male 14(14.3) 32(32.7) 0.83(0.36-1.92)
No 49 98.0 Sex
Female 18(18.4) 34(34.7) 1.0
Oriented while Yes 41 41.8 Stressful 7(7.1) 28(28.6) 0.23(0.07-0.78)*
joining the current Work place Negligent 15(15.3) 29(29.6) 0.47(0.16-1.36)
organization No 57 58.2
Organized 10(10.2) 9(9.2) 1.0
Available 21(21.4) 17(17.3) 5.50(2.18-13.74)*
3.4. Patient related Factors Affecting the Implementation of Facility
Lack of facility 11(11.2) 49(50) 1.0
Nursing Process Highly
13(13.3) 10(10.2) 8.78(2.97-77.48)*
knowledgeable
Poor understanding of the principle of nursing process, Knowledge
Moderately
15(15.3) 29(29.6) 3.49(1.03-11.82)*
poor patient economic status to implement designed nursing knowledgeable
Not
care plan, it need hospital stay and need of follow up and are 4(4.1) 27(27.5) 1.0
knowledgeable
patent related factors in implementation of nursing process Economic status 5(5.1) 22(22.4) 0.07(0.02-0.31)*
(See figure1 ). Patient
Early discharge 3(3.1) 23(23.4) 0.04(0.01-0.21)*
related
Not cooperative 11(11.2) 17(17.3) 0.19(0.05-0.73)*
factors
Cooperative 13(13.3) 4(4.1) 1.0
48 Zewdu Shewangizaw and Abera Mersha: Determinants towards Implementation of Nursing Process

5. Discussion were working in a stressful environment were 0.23 times less

likely to implement nursing process than those working in a
This study was tried to assess factors affecting organized environment (OR: 0.23, [95% CI: (0.07-0.78)].
implementation of nursing process among nurses in Neglecting working environment had no association with
Arbaminch General Hospital. Among nurses in Arbaminch implementation of nursing process. Working in a hospital
General Hospital .32(32.7%) were implemented nursing with high facility were 5.50 times more likely to implement
process while 66(67.3%) of them were not implemented nursing process than those working in lack of facility (OR:
nursing process. 5.50, [95%CI: (2.18-13.74)].
From the total respondents 50(51.02%) of them said the Highly knowledgeable nurses were 8.78 times more likely
dissatisfying aspect of their job was caring for so many to implementation of nursing process than nurses who were
patients followed by rules being made up without staff or no knowledgeable (OR: 8.78, [95%CI,(2.97-77.48)].
respondents in mind 28(28.57%) and useless paper work Moderately knowledgeable nurses were positively associated
9(9.18%) and new reporting system 9(9.18%). In research with implementation of nursing process (OR: 3.49, [95%CI:
conducted about nurse to physician communication, nursing (1.03-11.82)]. It shows knowledge is the most important to
workload definitely affects the time that a nurse can allow to implement nursing process.
various tasks. Under a heavy workload, nurses may not have In this study economic status patient to collect the material
sufficient time to perform tasks that can have a direct effect for nursing care were negatively associated with
on patient safety. It shows that when nurses become implementation of nursing process (OR: 0.07, [95%CI,(0.02-
dissatisfied about their job the nursing care to be provided 0.31)] and (OR: 0.04, [95%CI, ( 0.01-0.21)], (OR: 0.19,
will not have systemic approach. In other words nursing [95%CI,( 0.05-0.73)] were early discharge and due to lack of
process may not be implemented in hospital with high patient cooperation.
flow beyond the capacity of nurses.
In this study 37(37.75%) of nurses have cared for more
than 16 patients per day, 28(28.57%) were cared for 10-15 6. Conclusion
patients while 36(36.73%) were cared for 5-10 patients and The study identified that lack of facility from
1(1.02%) were cared for less than five patients. This shows organizational factors, economic status of the patient, early
that there significant difference between researches discharge, level of knowledge and lack of were among those
conducted in USA and this study due to the average nurse to factors affecting nursing process implementation.
patient ratio in high income countries is almost eight times Lack of equipment supply in hospitals for giving nursing
greater than in low income countries. care was highly affecting implementation of nursing process.
Sixty six (36.7%) believe that the cause was less or no
appreciation for work done. But research conducted in
selected hospitals in Addis Ababa most study participants
responded that the main cause for employment turnover were
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