Nursing Process Implementation and Associated Factors in Tertiary Hospitals in Oromia Regional State, Ethiopia.

Abstract

Background: -Nursing process is described as a modified scientific method of clinical judgment used by nurses in clients‟ care. Nursing process is dynamic and it is used in clinical practice worldwide to deliver quality-individualized care to patients and lack of its application can affect the quality of nursing care in health institutions. Despite comprehensive training was given by different stake holders; evaluation reports of these hospitals shows low evidence of nursing process implementation. It has five steps which include assessment, diagnosis, nursing care plan, implementation and evaluation. Objective:- To assess implementation status of nursing process and associated factors among nurses working in tertiary Hospitals in Oromia regional state, Ethiopia. Methods and Materials:-Institution based cross-sectional study was conducted in tertiary hospitals of Oromia regional state, Ethiopia from February-March, 2017. All the nurses (396) from the four hospitals were included in the study. One month record review was systematically selected during the same study period. Data were collected using pre-tested self administered questionnaire and checklists prepared for medical record review and in-depth interview. Qualitative data were coded through content analysis according to the different themes identified. Data was coded, entered into Epidata 3.1 and exported to SPSS version 21 for analysis. Result: -Out of 396 respondents 381 agreed to participate in the study and the response rate was 96.2%. With respect to overall performance of nursing process, 152(40%) of respondents were applied nursing process. From the total of 358 medical records reviewed only 38.5% had completed nursing process. Among the reviewed medical records majority 220(61%) had not performed evaluation of nursing process. Regarding the knowledge status of the respondents, two hundred fifty one (65.9%) of respondents were knowledgeable. Slightly 197(51.7%) of respondents had unfavorable attitude toward nursing process implementation. From multivariate logistic regression model analysis knowledgeable nurses were 1.8 times more likely to implement nursing process than non knowledgeable nurses (AOR=1.766, 95% CI (1.101-2.834), P=0.02). Majority of the key informants mentioned that the most challenging factors that obstacles implementation of nursing process are lack of training, high patient load, knowledge gap, lack of nurse human power, negligence and work load. Conclusion and Recommendation: - The overall nursing process implementation was found low. Knowledge of nurses was predictor of implementation of nursing process. The regional health bureau, hospitals as well as the nurses should seek means to upgrade their knowledge on the nursing process implementation was recommended in this study.