ADVANCES IN MEDICAL AND BIOLOGICAL SCIENCE RESEARCH (AMBSR) VOL. 2(4), pp. 93-100, DECEMBER 2014 REF NUMBER: 0920141105 ONLINE: http://www.projournals.org/AMBSR

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Full Length Research Paper

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EVALUATION OF THE CHALLENGES OF NURSING PROCESS PRACTICE AT THE UNIVERSITY OF ABUJA TEACHING HOSPITAL, NIGERIA. Aiyedun J.I., Chukwu L.N., & Musa R.H. Aiyedun J.I. (RN, RM, DIP IN OPH, BNSC) A.D.N.S. U.A.T.H. ABUJA Chukwu L.N. (RN, RM, DIPN, NN, BNSC) Musa R.H. (RN, RM, BNSC) Accepted: 10 DECEMBER, 2014.

------------------------------------------------------------------------------------------------------------------------------ABSTRACT

T

he study was designed to examine the perception of nursing process implementation among the practicing nurses in the University of Abuja Teaching Hospital, Gwagwalada, of the Federal Capital Territory (F.C.T) Abuja, Nigeria in June, 2014 as well as the problems and challenges militating against its effective implementation. The study aims at evaluating the problems challenging nurses in the implementation of nursing process in the hospital, assess the utilization level of nursing process in the care of patient by nurses in UATH, Abuja and identify factors that can enhance effective utilization of nursing process. The descriptive survey research design was used. Two hundred and forty (240) respondents comprising of six (6) cadres of nurses, cutting across all ages and sex were randomly selected. Questionnaire was used as instrument and was distributed to the respondents. Data obtained were analyzed using frequency distribution table and percentile method. The results show that 45% of respondents indicated that shortage of manpower is a major challenge to the practice of nursing process in the hospital. 33% of respondents agreed that poor attitude of nurses towards documentation constitutes a major hindrance while 22% of respondents said it is time constraints.

KEYWORDS:

challenges, practice, Nurses, nursing process

-------------------------------------------------------------------------------------------------------------------------------------------*Corresponding Author. Email: [email protected], [email protected]

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EVALUATION OF THE CHALLENGES OF NURSING PROCESS PRACTICE AT THE UNIVERSITY OF ABUJA TEACHING HOSPITAL, NIGERIA.

0920141105

INTRODUCTION The old concept of nursing changes for new concept with time as health care reforms in which all professionals are complying to enhance their skill and output; nursing profession is also part of this change. This change for new concept of patient care is referred to as Nursing Process and it poses a challenge in recent times to modern nursing. In the past, nursing has been defined as a unique function in assisting the individual sick or well in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge [1] Similarly, [2] in his view defined nursing as “an encounter with a client and his family in which the nurse observes, supports, communicates, ministers, teaches and contribute to the maintenance of optimum health, and provides care during illness until the client is able to assume responsibility for fulfillment of his own basic human needs when necessary and provides compassionate assistance for the dying”. Nursing process is a scientific method widely accepted and judge capable to guide procedures, as well as the frame of reference for nursing practice [3] Nursing all over the world has changed its focus from a physical approach to a patient centered approach which came to the front care of clients in 1960’s. Nursing care provides care that has been designed methodically based on, sound rationale and is individualized to meet the needs of each health consumer because of new technological innovation in health care delivery. Nursing has metamorphosed from preoccupation illness disease process to scientific approach completely in 1970. Webster [4] defined process as an action, moving forward, progressing from one point towards a goal, the movement being continuous through development stages. Nursing process therefore is a dynamic, systemic and scientific problem-solving approach to nursing which seeks to individualize nursing care. It is characterized to be planned, client centered, problem oriented, goal directive and realistic. It comprises of all nursing activities and thoughts put into actions which are followed in continuously from admission to discharge, the rationale for each step found in nursing process serves as organizational frame work for the practice of nursing. Nursing process uses clinical judgment to strike balance of epistemology between personal interpretation and research evidence in which critical thinking may play a part to categorize the client issues and course action which provides a frame work of nursing care. For effective use of nursing process, there is need to apply concepts and nursing theories from nursing, biological, physical, behavioral sciences and humanities in order to provide a rationale for clinical judgment. It involves six major steps namely Assessment, Nursing Diagnosis, Outcome Identification, Planning, Implementation and Evaluation. The term nursing diagnosis was first used by Freg in 1953, after the first meeting of the group now called the North American Nursing Diagnosis Association (NANDA). However, despite the breakthrough in client care with the use of nursing process, there is resistance and refusal to change by nurses in UATH, Abuja. The challenges of implementation of nursing process in University of Abuja Teaching Hospital (UATH) need to be studied so as to find way to remedy it.

RESEARCH OBJECTIVES The objective of the study is to  Evaluate the problems/challenges in the implementation of nursing process in UATH, F.C. T. Abuja.  Assess the utilization level of nursing process in the care of patient by nurses in UATH, Abuja.  Identify factors that can enhance effective utilization of nursing process.

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Advances in Medical and Biological Science Research (AMBSR)

EVALUATION OF THE CHALLENGES OF NURSING PROCESS PRACTICE AT THE UNIVERSITY OF ABUJA TEACHING HOSPITAL, NIGERIA.

0920141105

METHODOLOGY The study was undertaken using descriptive survey design and was carried out at the University of Abuja Teaching Hospital (UATH), Gwagwalada, F.C.T, Abuja. A tertiary health institution that is involved in training midwives, nursing students, medical students and other paramedical. The target population of the study was nurses with various fields of specialty; that cut across all ages, and sex. Six (6) cadres; Nursing Officer II (NO II) to Chief Nursing Officer (CNO) consisting of 240 nurses were selected using simple random sampling method. A structural questionnaire was developed and shared to 240 nurses. The questionnaire consisted of 12 items. The perception of nursing process, experiences and ways of overcoming the hindrances militating against the acceptance/effective use of nursing process in UATH Gwagwalada, Abuja. The 240 copies of questionnaires administered were retrieved back. Formal permission letters and research protocol were submitted to the management of the UATH, and an approval was secured before data collection began. The objective of the study was explained to the respondents and they voluntarily consented to be involved for the study, and confidentiality was adhered to.

RESULT The data collected were analyzed and presented in frequency distribution tables with the percentages, using descriptive statistics

Table I: Sex of Respondents.

Sex Male Female

Frequency 80 160

Percentage 33% 67%

Total

240

100%

Table II: Respondents Age Range

Age Range

Frequency

Percentage (%)

20-25years 26-35years 36 and Above

60 80 100

25 33 42

Total

240

100

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Advances in Medical and Biological Science Research (AMBSR)

EVALUATION OF THE CHALLENGES OF NURSING PROCESS PRACTICE AT THE UNIVERSITY OF ABUJA TEACHING HOSPITAL, NIGERIA.

0920141105

Table III: Respondents Qualification

Qualification RN RM RNM RN + Specialty RM + Specialty RNM + BNSC RNM + other degrees BNSC + MCS

Frequency 20 25 40 25 20 20 90 Nil

Percentage (%) 8 10 17 10 8 8 8 Nil

Total

240

100

Table IV: Respondents Year Of Qualification

Years of Experience 1-5years 6-10years 11-15years 16-25years 26-35years

Frequency 20 30 50 60 80

Percentage 8% 13% 21% 25% 33%

Total

240

100%

Table V: Cadres of Respondents

Cadres Nursing Officer II Nursing Officer I Senior Nursing Officer Principal Nursing Officer Assistant Chief Nursing Officer Chief Nursing Officer

No of Respondents 40 40 40 40 40 40

Percentage 16.6% 16.6% 16.6% 16.6% 16.6% 16.6%

Table VI: Nursing process a tool for quality care?

Nursing process a quality care Yes No

tool

for

Frequency

Percentage

105 15

87.5 12.5

Page 4 PRO JOURNALS [IJMPHSR] - EVALUATION OF THE CHALLENGES OF NURSING PROCESS PRACTICE AT THE UNIVERSITY OF ABUJA TEACHING HOSPITAL, NIGERIA. By Aiyedun J.I., Chukwu L.N., & Musa R.H.

Advances in Medical and Biological Science Research (AMBSR)

EVALUATION OF THE CHALLENGES OF NURSING PROCESS PRACTICE AT THE UNIVERSITY OF ABUJA TEACHING HOSPITAL, NIGERIA.

Total

120

0920141105

100%

Table VII: Does use of Nursing Process Reduce Morbidity/Mortality Rate

Use of nursing process reduce morbidity/mortality rate Agreed Dis-agreed

Frequency

Percentage

100 20

83 17

Total

120

100%

Table VIII: Hindrances to Implementation of Nursing Process

Hindrance Lack of Manpower Poor attitude of nurses towards documentation Resistance to new innovation (change) Time Constraints

Frequency 108 80 30 22

Percentage 45% 33% 13% 9%

Total

240

100%

Table IX: Ways forward to implementation of nursing process

Suggested Way Forward NANNM should ensure implementation of nursing process in all health institutions. The ratio of nurses to patient should be improved Organization of workshops/seminars for nurses on the importance of documentation and its legal implication. Enforcement of cubicle nursing care to enhance proper planning/time management Constant practice of nursing process will lead to perfection and reduce the fear experienced by nurses.

Frequency 50

Percentage 21%

120 27

50% 11%

20

8%

23

10%

Total

240

100%

The socio-demographic finding of this study showed that 67% (160) female respondents formed the largest study group while 33% (80) were male; showing that there are more female nurses in nursing profession than male. 42% (100) of the respondents are within the age range of 36years and above while 33% (80) falls within the range of 26 – 35years; 25% (60) being the least falls between 20-25years of age. The result confirms that nurses from various specialties are involved in the use of nursing process. RNM + specialist 90respondents (39%) was the highest, followed by RNM 40 (17%), RM and RN+ specialist formed 10% (25) while RN, RM+ specialist and RMN+BNSC were 8%(20) formed the least respondents.

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Advances in Medical and Biological Science Research (AMBSR)

EVALUATION OF THE CHALLENGES OF NURSING PROCESS PRACTICE AT THE UNIVERSITY OF ABUJA TEACHING HOSPITAL, NIGERIA.

0920141105

The year of working experience revealed that 33% (80) of respondents are in the range of 26 – 35years which is the highest closely followed by 25% (60) which are within the range of 16-25years, 11 – 15years formed 21% (50) of respondents while 1-10 when merged is 21% (50) of the population. Cadres of the respondents were chosen equally (40 respondents from each cadre) and questionnaires were also shared equally. The result showed 40 respondents from NO II – CNO with 16% each to all cadres. In Table III, the perception of respondents as indicated in “yes or no” and “true or false” showed that 29% (70) of respondents indicated yes while 20% (48) accepted no. 30% (72 respondents) being the highest indicated true while 21% (50) accepted false to the questionnaire. In Table IV, the identified challenges such as lack of man power showed 45% (108 respondents) as the highest hindrance, poor attitude of nurses towards documentation followed with 33% (80 respondents), resistance to new innovation (change) showed 13% (30 respondents) while the least was time constraints with 9% (22 respondents). The study found out the way forward to implementation of nursing process as the ratio of nurses to patient should be increased 50% (120 respondents) being the highest submission of respondents, 21% (50respondents) suggested that NANNM should ensure implementation of nursing process in all health institutions, 11% (27respondents) suggested that conferences/seminars for nurses on documentation and it’s legal implication should be held. 10% (23 respondents) suggested that constant practice of nursing process will enhance perfection and reduce fear experienced by nurses, while 8% (20 respondents) suggested that enforcement of cubicle nursing care to ensure proper planning, time management and accountability should be put in place.

DISCUSSION From the research questions used in collecting and analyzing data, it was identified that nursing process is the only tool that can be used to assess and evaluate quality care rendered to patient in U.A.T.H. Gwagwalada, Abuja. The use of nursing process is a challenge of our time and the problems hindering its embracement need to be addressed. Nursing in the past during the pre-world war II era was based on helping the sick to get well and return to their homes and family with little emphasis on education. Then nurses were considered as helpers or assistant to doctors and the relationship between the two disciplines was that of master-servant relationship. But now, nursing practice has metamorphosed into scientific evidence based profession where quality care can be measured by a standardized tool. This statement was justified in table III where 88% of respondent agreed that nursing process is the only tool to measure patient quality care. One of the problems hindering the embracement has been due to refusal of the older nurses to change because of the fact that ‘old ideas die hard’. The hypothesis on the relationship between the nurse’s years of practice and utilization of nursing process in client care was tested and the finding revealed that there is a significant relationship between the years of practice and utilization of nursing process. But now a lot of changes have occurred in nursing profession and nurses are more concerned about creating dynamic actions and ability to cope with patient demand and problems. The research work also revealed that 78% of the respondents agreed that nursing has changed from just an art to a science oriented profession since the advent of nursing process, unlike before when nursing practice was regarded as an art and you have to carry out orders only. Now nurses can identify patients problems and address them accordingly; this is because nurses know what action to take and the extent to which the action affect patient, the significance of decisions and judgment to the present and future welfare of the clients. Page 6 PRO JOURNALS [IJMPHSR] - EVALUATION OF THE CHALLENGES OF NURSING PROCESS PRACTICE AT THE UNIVERSITY OF ABUJA TEACHING HOSPITAL, NIGERIA. By Aiyedun J.I., Chukwu L.N., & Musa R.H.

Advances in Medical and Biological Science Research (AMBSR)

EVALUATION OF THE CHALLENGES OF NURSING PROCESS PRACTICE AT THE UNIVERSITY OF ABUJA TEACHING HOSPITAL, NIGERIA.

0920141105

In table III, 83% of respondents submitted that implementation of nursing process will reduce mobility/mortality rate in UATH, Abuja. This is achievable as a result of professionalism in nursing practice that enhances quality client care because nursing profession believe in excellence which is achieved through continuous review, auditing, evaluation and modification of care through goal setting and several measures. The use of nursing process enhances client confidence due to scientific, systematic and dynamic approach to their problems as 95% of respondents agreed to this. In confirmation, nurses should know that illness threatens both the health and personality of the clients, therefore nurse’s responsibility is to help clients identify themselves and promote their self-respect, personal integrity that is achieved through maintenance of privacy during care, encouragement for adaptation. Orlando [6] published the dynamic nurse relationship and indicated that interpersonal relationship is important, she was concerned with clients need and emphasized that clients look upon their health care providers for the outcome of their problems and so the reaction of nurses will make patient know whether or not they will overcome their problems. This is why holistic approach is very useful in the total person of the client physical, psychological, emotional etc. should be considered while caring for the clients and this can only be achieved through nursing process. This was confirmed where 69% of respondents are of the opinion that quality nursing care can only be achieved through nursing process. The cost of getting care and clients stay in the hospital is considerably reduced. Care given to the clients is quality care through nursing process in which a care plan is always drawn, providing detailed guide for the clients care, individualizing clients care, providing information and communication link, guaranteeing continuity of clients care and assisting the nurse in meeting clients psychological need. It also encourages clients and family participation in nursing programs. It develops clients care activities based on scientific principles and systemic problem- solving approach. It prevents trial and errors in client care; it coordinates the efforts of all nursing and other team members.

CONCLUSION This study examined the challenges hindering the implementation of nursing process as encountered by the nurses of UATH Abuja. The perceived problems were shortage of man power, time constraints, resistance to new innovation (change) and finally poor attitude towards documentation. The way forward was also outlined. The study concluded that with co-operation in all nursing cadres, determination and commitment the challenges will be overcome. With the provision of NANDA-1, NIC, NOC in all units of UATH Abuja; every practicing nurse will get used to the standardized nursing language (SNL) thereby enhancing scientific nursing care and professionalism.

REFRENCES [1] Henderson, V. (1966). The nature of nursing. New York, NY: Macmillan. [2] Yura. H. (1973) (Eds.). The nursing process: Assessing, planning, implementing, and evaluating (5thEd.). East Norwalk, CT: Appleton and Lange. [3] Nwonu, E.E (2002). Nursing process concept and practice. Enugu Snaap Press Ltd. [4] Webster’s New World Dictionary. (1996). http://www.merriam-webster.com

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Advances in Medical and Biological Science Research (AMBSR)

EVALUATION OF THE CHALLENGES OF NURSING PROCESS PRACTICE AT THE UNIVERSITY OF ABUJA TEACHING HOSPITAL, NIGERIA.

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[5] Herdman, T. H., (Ed.) (2009). Nursing diagnoses: definitions and classification 2009 - 2011. WileyBlackwell: Singapore -- Nursing Diagnosis [6] Orlando J. (1960). http://nursingtheories.weebly.com/ida-jean-orlando.html [7] Wokili, D. (2010) A Symposium on Need For Continuing Education for Nurses UATH, Abuja F.C.T.

Gwagwalada,

[8] Ofi, B., Kujore, O. O., K.S Olubiyi, K. S. (2004) Nature of Nursing. 1st Edition. Lagos. National Open University of Nigeria. [10] Goshit, J.B. (2001) Lecture Notes On Nursing Process. Gwagwalada, Abuja. [11] Monika Habermann, L.R. (2006) Nursing Process A Global Concept And Literature On Innovation In Nursing. [12] Timber, B.K. Fundamental Skills and Concepts in Patient Care. 7th Edition, LWW, N. [13] George B., And Julia, N. Nursing Theories: The Basis for Professional Nursing Practice. 3rd Edition, Norwalk, Appleton & Lange. [14] Funnell, R., Koutoukidis, G. & Lawrence, K. (2009) Tabbner’s Nursing Care 5th Edition, Australia. Elsevier Pub. Page 72 [15] Bradshaw, J. & Lowestein (2010) Innovative Teaching Strategies in Nursing and Related Health Profession.

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Advances in Medical and Biological Science Research (AMBSR)