Assessment of documentation practice and associated factors among nurses working in jimma university medical center, jimma town, south west Ethiopia

Abstract

Background: Nursing documentation is an essential component of nursing practice that has a potential to improve patient care outcome. Poor documentation of nursing care activities among nurses has been shown to have negative impacts on the health care quality. However, little has been explored about nursing documentation practice in the study area. Objective: The aim of this study was to assess documentation practice and associated factors among nurses working in Jimma university medical center. Method: Institutional based cross sectional study design was employed. The study was conducted from March l3 to April 6/2018 among 391 nurses. Data was collected using a structured self- administered questionnaire. Simple random sampling was used to select the study participants. Pre-taste was done among 39 (10%) of sampled nurses working in shenen gibe Hospital and Cronbach’s alpha was calculated. Nursing care standard checklist was used to review documents from major wards. Data was entered into Epidata version 3.1 and then exported to SPSS version 21for analysis. Descriptive statistics, Binary logistic regression and multivariate logistic regression was used to describe, identify candidate variable for multivariate logistic regression and identify factors associated with documentation practice. P-value of less than0.05 was used to declare statistical significance in multivariate logistic regression. Result: Among the participants good nursing documentation was practiced by 48.6%. Adequacy of documenting formats, motivation from supervisors, in-service training and familiarity with operational standard of nursing documentation were significantly associated with practice of nursing care documentation [AOR=0.357, AOR =4.237, AOR =0.462,AOR=2.165, respectively. Conclusion: Nursing documentation practice was poor among nurses under the study. Adequacy of documenting formats, availability of motivation, familiarity with operational standard of nursing documentation and in-service training were significantly associated with practice of nursing care documentation. Recommendation: Nursing leaders should motivate the employees to enhance the practice of documentation, avail the necessary documenting materials besides adequate staffing which may be related to time shortage. Researchers also need to carry out large scale studies in order to address the problem.