AcknowledgmentFirst and for most, we would like to thank Debre

Markos University, Medicine and Health Sciences

College, Department of Nursing staffs for their high

cooperation, initiation and drive to prepare this

proposal.

Secondly, we would like to express our deepest

gratitude and special thanks to our advisors, Habtamu

Abera (RN, BSC, and MSC) & Mulatu Ayana (BSC, MPH) for

their willingness and commitments to support, comment,

suggest and to give clear directions for the success of

this work.

Lastly, it is also our pleasure to thank Debre Markos

Referral Hospitaland Finote Selam District Hospital

administrative and technical staffs for their extending

support, collaboration and spending their precious time

to us whenever it was needed.

i

Table of content

Contents pagesAcknowledgment............................................i

Table of content.........................................ii

Acronyms.................................................iv

List of Annex.............................................v

Summary..................................................vi

1. Introduction...........................................1

1.1. Background..........................................1

1.2. Statement of the Problem............................3

1.3. Justification of the Study..........................4

2. Literature Review.....................................5

2.1. Overview of nursing process implementation..........5

2.2. Factors affecting nursing process...................5

ii

3. Objective.............................................10

3.1. General objective..................................10

3.2. Specific objective.................................10

4. Method and Materials..................................11

4.1. Study Design.......................................11

4.2 Study period........................................11

4.3. Study Area.........................................11

4.4. Source Population..................................12

4.5. Inclusion and Exclusion Criteria...................12

4.5.1. Inclusive Criteria.............................12

4.5.2. Exclusive Criteria.............................12

4.6. Sampling Technique.................................12

4. 7. Variable of the Study.............................13

4.7.1. Dependent Variable.............................13

4.7.2. Independent Variable...........................13

4.8. Operational Definition.............................13

4.9. Data Collection Tools..............................14

4.10. Method of Data Collection.........................14

4.11. Data Quality Assurance............................14

4.12. Data Processing and Analysis......................14

4.13. Ethical Consideration.............................15

4.14. Dissemination of Results..........................15

5. Work Plan.............................................16

iii

6. Budget Break Down.....................................17

Annex-I. Conceptual Frame Work...........................18

Annex II. Questionnaire..................................19

Annex III. Declaration...................................26

Annex IV. Assurance of Investigators.....................27

References...............................................28

Acronyms

ANA-American Nursing Association

CEO- Chief Executive Officer

DX- Diagnosis

ICU- Intensive Care Unitiv

MHSC- Medicine and Health Sciences

NANDA- North America Nursing Diagnosis Association

NANDA- I- North America Nursing Diagnosis Association

International

NCP- Nursing Care Plan

NIC-Classification of Nursing Intervention

NP- Nursing Process

RN- Registered Nurses

SNCPs-Standardized Nursing Care Plans

USA-United State of America

WHO-World Health Organization

List of AnnexPage

Annex I. Conceptual Frame

Work---------------------------------------------------

v

--18

Annex II. English Version Questionnaire

-------------------------------------------19

Annex III. Declaration of the Study

--------------------------------------------------26

Annex IV. Assurance of Investigators’

----------------------------------------------27

vi

Summary

BACK GROUND: - Nursing is the use of clinical judgments

in the provision of care to enable people to improve,

maintain, or recover health, to cope with health

problems, and to achieve the best possible quality of

life, whatever their disease or disability, until

death. Whereas, nursing process is a systematic method

of assessing, diagnosing, planning, intervening and

evaluating individualized care for clients in any state

of health or illness. Based on the scientific problem-

solving method, it constitutes the foundation for

nursing practice.

OBJECTIVE: - To assess the implementation of nursing

process and its’determinant factors in Debre Markos

Referral Hospital &Finote Selam District Hospital,

North West Ethiopia, 2013.

METHOD: - Institutional based cross-sectional study

will be conducted on Debre Markos referral Hospital

&Finote Selam district Hospital, North West

Ethiopia.Quantitative method will be used. These

Hospitals are purposively selected based on the general

service they have been provided and their number ofvii

nurses for study area. The total number of staff nurses

in both hospitals is 139. Convenience sampling method

will be used to select participant Nurses. All staff

nurses will be the study participant. Data will be

collected by using standardized self-administered

questionnaire.

BUDGET: - A total of Birr 3,645.00 is required to

conduct this study.

viii

1. Introduction

1.1. BackgroundIn the eighties, the nursing process was introduced

as a systematic method of planning nursing care

internationally. The nursing process was described as

a relational and problem solving process. Patient

problems for which nurses provide interventions were

called “nursing problems”. These problems were worded

in freestyle and nursing goals and interventions were

chosen according to these patient problems. Even though

investigations indicated that the nursing process was

well adopted the so called nursing problems were often

not accurately formulated.(1)

Nursing care, at its best, is designed and implemented

in a thorough manner, using an organized series of

steps, to ensure quality and consistency of care. The

nursing process, a proven form of problem solving based

on the scientific method, serves as the basis for

assessing, making a nursing diagnosis, planning,

organizing, and evaluating care. That the nursing

process is applicable to all health care settings, from

the prenatal clinic to the pediatric intensive care

unit, is proof that the method is broad enough to serve

as the basis for all nursing care.(2)

1

The nursing process is central to all nursing actions

and applicable to all settings and methods of client

care. Because the nursing process is flexible, it

adapts readily too many variables and any conceptual

framework one may use in clinical practice. (3)

Nursing process is a systematic method of planning,

delivering, and evaluating individualized care for

clients in any state of health or illness. Based on the

scientific problem-solving method, it constitutes the

foundation for nursing practice. The first step is

assessment. It is appropriate for use with individual

clients, families, groups, or communities. It is the

organized and systematic process of collecting

information from a variety of sources in order to

evaluate the health status of the client. Through

assessment the nurse develops a data base regarding the

client’s level of wellness, past illnesses and

experiences, health practices, and health care goals.

(4)

The second step is nursing diagnosis. It is a clinical

judgment about individual, family, or community

responses to actual or potential health problems/life

processes. It focuses on human responses and

alterations in the client’s ability to function as an

2

independent human being. It is holistic, encompassing

all aspects of the human being. The third step is

planning. It helps to solve, lessen, or minimize the

effects of the identified problems, or to prevent

potential problems. It has four essential steps;

prioritizing the identified nursing diagnoses,

developing goals/outcome statements, Planning nursing

actions and Documentation-the Nursing Care Plan. (4)

The fourth step is nursing interventions it is a

nursing treatments, based on clinical judgment and

knowledge, which are implemented by nurses to improve

patient outcomes. At the University of Iowa, a

classification of nursing interventions (NIC) was

developed. The results of linear regression models that

included intervention scores and nursing diagnoses as

predictor variables explained 53.2% of the variance in

total number of interventions and 58.9% of the variance

in intervention time.(1)

The fifth step is evaluation. It is judging and out

comes in relation to the desired outcomes of care,

measuring the effectiveness of planned nursing

interventions, further assessment and planning if an

expected out comes has not been achieved and critically

analyzing the steps of the process and making any

adjustments necessary. (5)

3

1.2. Statement of the ProblemThe nursing process has been used for over 25 years as

a systematic approach to nursing practice. The process

is an efficient and effective method for organizing

nursing knowledge and clinical decision making in

providing planned client care. Although it has been

undergoing constant re-evaluation and revision, the

concepts within the process still remain central to

nursing practice. It is an interactive method of

practicing nursing, with the components fitting

together in a continuous cycle of thought and action.

(6)

The nurse’s carries personal responsibility and

accountability for nursing practice, and for maintain

competence by continual learning. Theoretically, if

nurses fail to carry out necessary nursing care, then

the effectiveness of patient surveillance may be

compromised and lead to preventable adverse patient

event. In Addis Ababa selected governmental hospitals

among 192 participated nurses, 52.1% of them

4

implemented nursing process while 47.9 % of them did

not implement nursing process. (7) Consistent adherence

to the components of the nursing process tends to

reduce the possibility of omitting an important finding

in the overall condition of the client.

There are no studies conducted on the factors affecting

the implementation of nursing process among nurses who

works at Debre Markos referral Hospital and Finote

Selam District Hospital. Therefore, this study is

designed to investigate the factors affecting the

implementation of nursing process among nurses who

works at Debre Markos referral Hospital and Finote

Selam District Hospital.

1.3. Justification of the Study

Poor quality of implementing nursing process leads poor

delivery of nursing care. Quality of nursing care could

5

be improved, if the factors affecting the

implementation of nursing process are investigated. The

study tries to investigate the factors affecting the

implementation of nursing process among nurses who

works at Debre Markos referral Hospital and Finote

Selam District Hospital. These factors, if identified,

might lead to recommendations regarding the

implementation of nursing process and served as a

baseline for a future study. Patients and society will

potentially benefit from the knowledge derived from the

study.

6

2. Literature Review

2.1. Overview of nursing process implementationThe nursing process is dynamic and requires creativity

for its application. The steps remain the same, but the

application and results will be different in each

client situation. The nursing process is designed to be

used with clients throughout the life span and in any

setting in which a nurse provides care for clients. (8)

The nurse has to always be thinking and recognizing

what step in the nursing process is being utilized.

They must incorporate knowledge from many areas in

order to deliver holistic care, that is, to meet the

total needs of the client. They can utilize the nursing

process with clients of any age and with any

developmental level. (4)

Some scholars have recently shown the investments made

to use the nursing process in care practice, providing

information on what nurses know, believe and adopt in

various situation and difficulties encountered in

hospitals. These studies indicate the potential of

investments in its practice by approaching nursing

practice and health care, education and research.(9)

Based on the above, we reaffirm the researchers’ view

that the nursing process is an action full of meaning

that can be used by nurses in practice. As a method for7

care delivery, this represents challenges in education

and practice. The nursing process needs to be depended

in the hospital context, based on the perception of

nurses working there, highlighting their doubts,

uncertainties and questions about how to put in to

operation. (10)

2.2. Factors affecting nursing processYet hospitals confront challenges with regards to

nursing involvement, including scarcity of nursing

resources; difficulty engaging nurses at all levels

from bed side to management; growing demands to

participate in more, often duplicative, and quality

improvement activates. (11)

Because nurses are the key caregivers in hospitals,

they can significantly influence the quality of care

provided and, ultimately, treatment and patient

outcomes. Consequently, hospitals’ pursuit of high-

quality of patient care is dependent, at least in part,

on their ability to engage and use nursing resources

effectively. This will likely become more challenging

as these resources become increasingly limited. (9)

Nurses are “the largest deliverer of health care in the

U.S.A”, according to a representative of an accrediting

organization, and as hospital participation in quality

improvement activities increases, so does the role of8

nursing universally, respondents described how vital

nurses are to hospitals; that nursing care is a major

reason why people need to come to a hospital. As one

hospital, CEO said of nurses, they are the “heart and

soul of the hospitals” (10).

The scarcity of nurses is a major challenge for

hospitals because it impact to not only their ability

to provide nursing coverage for patient care, but also

to provide adequate nursing resources for other key

activities, such as quality improvement. Nurses usually

have a multiple patients and meeting all of their

physical and emotional needs is challenging, if not

impossible. Consequently, nurses continually evaluate

what needs to be done, reprioritizing their tasks to

meet patients’ changing needs (11).

The planning phase also involves identifying the

specific actions one must perform to administer the

medication safely and appropriately. Evaluations

involve criteria used to determine if the goals were

met. Specific, measurable, clearly stated goals make it

simple to determine whether the intended outcomes have

been achieved and to what degree. Evaluation involves

the review of several areas, including compliance,

client learning/understanding, therapeutic drug

response, and evidence of side effects. The evaluation

9

phase permits the provider to determine if, in fact,

goals were met, and also measures the effectiveness of

nursing care (12).

However, a study that investigated the meaning of

nursing process among nurses in an intensive care unit

(ICU) showed that their experiences were contradictory:

although the nursing process was seen as a form of

professional recognition with regard to its role in

society. Something that allows nurses to have

authenticity and freedom of action in their practice,

it was also viewed with feelings of anger,

dissatisfaction and frustration (13).

Today, there is a lack of knowledge about how to

successfully implement standardized nursing care plans

(SNCPs) in various settings in general and hospital

wards in particular. There are few previous studies of

SNCPs, and those identified focused on effect and

utilization as opposed to implementation. Registered

Nurses represent a patient surveillance system and are

essential to the prevention and early detection of

adverse patient events. Adverse events occur in an

estimated 2.9 to 3.7 percent of acute care

hospitalizations in the United States of America

(U.S.A.), and it is estimated that between 44,000 and

98,000 patients die in hospitals each year as a result,

10

with nearly half due to errors in the delivery of care.

A recent systematic review of eight studies conducted

in the U.S.A., Australia, United Kingdom (U.K.), and

Canada revealed that the median overall incidence of

in-hospital adverse events was 9.2%. From those 43.5%

of the incidents did preventable and 7.2% leading to

death. According to Swedish surveys, the SNCP is used

as clinical guidelines, although there is lack of

research behind it. In Sweden university hospitals and

rural hospitals among 131 participated nurses only 21%

of nurses stated that the SNCPs had been evaluated, of

whom a majority (73%) of them stated that SNCPs was

successful. While 27% of them considered it

unsuccessful. (7)

Despite their knowledge of the nursing process, certain

factors limited the ability of nurses to implement it

in their daily practice, including lack of time, high

patient volume, and high patient turnover. Despite

these hurdles, the daily application of the nursing

process is characterized by the scientific background

of the professionals involved since it requires

Knowledge and provides individualized human assistance

(14).One of the barriers to the development of nursing

process is the implementation of the nursing diagnosis.

However, studies have shown that the implementation of

the nursing diagnosis is a challenge for nurses (15). 11

An evaluation of the implementation of the nursing

diagnosis highlighted the importance of the survey of

needs, and of the mobilization of resources to meet

these needs. These included the technical resources

required to provide structural resources and the time

required to participate in ethics and policy training,

which promote enhanced knowledge and creative

potential. Taken together, these factors support

positive assessment and allow its continuity (16).

It is reasonable to conclude that the nursing process

is important for the practice of nursing; however, its

use is not an easy task. Therefore, a continuous

evaluation of how the nursing process is executed with

in the health services is required (17).

A majority of the studies on nursing work load and

patient safety used nurse-patient ratio as the measure

of nursing work load. According to research on work

load in human factors engineering it is well known that

work load is a complex construct, more complex than the

measure of nurse- patient ratio. It is unlikely that

the multidimensional, multifaceted structure of work

load can be captured by one unique, representative

measure. Therefore, the belief is that researchers who

use the nurse- Patient ratio as a measure of work load

offer a limited contribution to understanding the

12

impact of nursing workload and designing solutions for

reducing or mitigating nursing work load (18).

Nursing work load affects the time that a nurse can

allot to various tasks. Under a heavy work load, nurses

may not have sufficient time to perform tasks that can

have a direct effect on patient safety. In Addis Ababa

selected governmental Hospitals among 192 participated

nurses 72.9% of them working in a stressful working

environment where as 16.1% were working in a

disorganized working environment the remaining 10.9%

were working in a negligent work place at a time. In

Addis Ababa selected governmental Hospital nurses from

those dissatisfied with any reason 95 (49.5%) of the

total respondents were dissatisfied due to their

profession. Job dissatisfaction of nurses can lead

potentially threaten patient care quality and

organizational effectiveness. These problems are

manageable if a nurse can properly implement nursing

process; thus, this study show factors affecting

implementation of nursing process performed by nurses

on the nursing practice in Debre Markos referral

Hospital and Finote Selam District Hospital and the

results of the study will be used as base line

information to design appropriate intervention

strategies for the factors that can influence nurses’

13

capacity to conduct nursing process for their patients.

(7, 19)

A study conducted in Europe to test the establishment

of a validated model of nursing records aimed to

promote individual care. The results showed limitations

of the nursing process conducted according to the

model, particularly in the identification of problems

presented by the patients and, consequently, diagnosis

and the possible information producers. A study

conducted in the United Kingdom to assess whether data

obtained from nursing records could be reliably used to

identify interventions for patients who had suffered

acute myocardial infarction or a fracture of the head

of the femur, showed that the analyzed nursing records

did not provide an adequate picture of patients’ needs

for nursing intervention (20).

An investigation of the steps of the nursing process

actually implemented in the routine of a university

hospital showed that all phases were performed

however; problems were identified in the nursing

process, involving recording the history and

implementing nursing perception. The evaluation of

expected results, in particular, was not adequately

recorded (21).

14

Specially seeking to investigate the phases of the

nursing process performed in the care practice of a

university hospital in Brazil, the authors identified

the implementation of all stages. However, the

existence of failure was shown among the nursing

diagnoses in the patients’ history, as well as the

implementation of nursing prescriptions without

recording the evaluation of the expected results (18).

Similar results were also shown in a study conducted in

2006 during the implementation of the nursing

diagnosis, in which the research subjects indicated

difficulties in developing the nursing process at all

stages, and the need for changes to speed up the work

process and optimize the quality of action in care and

education (22).

3. Objective

3.1. General objective

To assess the implementation of nursing

process and its determinant factors in Debre

Markos Referral Hospital &Finote Selam

District Hospital, North West Ethiopia, 2013.

15

3.2. Specific objective

1. To assess the implementation of nursing

process in Debre Markos Referral Hospital

&Finote Selam District Hospital, North West

Ethiopia, 2013.

2. To assess the determinant factorsaffecting

the implementation of nursing process among

nurses in Debre Markos Referral Hospital

&Finote Selam District Hospital, North West

Ethiopia, 2013.

16

4. Method and Materials

4.1. Study Design

Institutional based cross-sectional study design will

be conducted to assess implementation of nursing

process and its’determinant factors in Debre Markos

Referral Hospital &Finote Selam District Hospital,North

West Ethiopia by using quantitative method.

4.2 Study periodThe study will be conducted from December 2012

to May 2013.

4.3. Study AreaThe study will be conducted in Debre Markos referral

hospital of Debre markos ,East Gojjam Zone ,Amhara

Regional State of Ethiopia .Debre markos is the

administrative town of East Gojjam Zone and it is found

in the North West part of the country bounded by

Gozamen woreda in the North,South,and East ,and Aneded

woreda in the West. located on the main road of Addis

Ababa-Bahir-Dar and 300 km away from Addis Ababa and

265 km from Bahir-Dar. It has 01 referral hospital ,03

governmental health center ,07 health post ,16 private

pharmacy ,22 private clinic ,02 diagnostic laboratory

and 12 traditional healer service provider up to 2004

E.c. And Finote Selam is the administrative town of

17

West Gojjam Zone and it is found in the North West part

of the country bounded by Sekela woreda to the North,

Bureworeda to the West ,Dembechaworeda to South-East

and East ,and Kuaritworeda to the North-East. It is

Located on the main road of Addis Ababa-Bahir-Dar and

387 km away from Addis Ababa and 178 km from Bahir-Dar.

It has 01 District hospital, 01 governmental health

center, 02 health post, 06 private pharmacy, 08 private

clinics, and 05 traditional healer service provider up

to 2004 E.C.

4.4. Source Population All staff nurses who have been working in Debre

Markos Referral Hospital &Finote Selam District

Hospital, North West Ethiopia.

4.5. Inclusion and Exclusion Criteria

4.5.1. Inclusive Criteria

Nurses who are working at Debre Markos

Referral Hospital & Finote Selam District

Hospital available during the study period and

willing to participate in the study.

18

4.5.2. Exclusive Criteria

Nurses who will not be available due to sick

leave, temporary reassignment, annual leave;

free service workers and those who decided to

exercise their right not to participate in the

study.

4.6. Sampling TechniqueDebre Markos Referral Hospitaland Finote Selam District

Hospital are purposively selected based on the general

service they have been provided and their number of

nurses for study area. Convenience method will be used

to select participant Nurses. According to the data we

obtained from these Hospitals, there are 108 and 31

nurses in Debre Markos referral Hospital and Finote

Selam District Hospital respectively. All staff nurses

will be the study participant.

19

4. 7. Variable of the Study

4.7.1. Dependent Variable

Implementation of nursing process.

4.7.2. Independent Variable

Year of experience.

Knowledge of nurses.

Nurses demographics.

Nurses skill.

Hospitals organizational structures.

Patient’s income.

Patient’s turnover

4.8. Operational DefinitionNursing Process: systematic ways of problem-solving

include assessment, diagnosis, planning,

implementation and evaluation practiced by licensed

nurses. (7)

Skill:-daily nurses practice performed for participant.

Those respondents who have scored > 26 are highly skill

full; 18-25 are moderately skill full, and < 17 are low

skill full group out of 30. (7)

KnowledgeableNurses:-Nurses awareness about nursing

process. Highly knowledgeable nurses are those 80% of

the questions, moderately knowledgeable nurses are

20

those answered in between 55-79.9%, and low

knowledgeable nurses those scored < 55 %.( 7)

Organizational Structure: - The hierarchical level of a

hospital in health care delivery. (7)

Year of Experience: - Number of year nurses has worked

in nursing. (7)

Patient Turnover: - A patient was visiting hospitals

for getting health care and leaves before full

provision of care. (7)

4.9. Data Collection ToolsData will be collected by using structured self-

administered questionnaire. Structured English version

questionnaire which is adapted from previous study. It

includes five main parts about nurses’ socio

demographics, knowledge of nursing process, work load,

organizational structure and facilities, patient

turnover and patient’s income.

4.10. Method of Data CollectionData will be collected by self-administered

questionnaire. The data collection process will be

supervised by the principal investigators from April-

May/2013. Before the actual data collection we will

have a pre-test and half day orientation about the aim

of the study and the content of the instrument for our

21

volunteer data collectors. Therefore, the data

collectors became familiar about each. It is also a

mechanism of minimizing biases during the process of

data collection. Questionnaires are filled by nurses in

their work place.

4.11. Data Quality Assurance

During data collection, both principal investigators

and data collectors themselves will checkthedata for

its completeness and missing information at each point.

Furthermore data will be checked during entry and

compilation before analysis.

4.12. Data Processing and Analysis

The collected data will be cleaned, coded and entered.

Descriptive statistics like frequency and percentage

will be used to summarize the collected data.

4.13. Ethical ConsiderationEthical clearance will be getting from Debre Markos

University Medicine and Health Sciences College,

Department of nursing before the beginning of data

collection permission letter will be provided to the22

two hospitals for proceeding data collection. After

that participants will be oriented about the purpose

and procedure of data collection, and that

confidentiality and privacy is ensured. It is also

cleared that participation is fully based on the

willingness of participants using written consent.

4.14. Dissemination of ResultsThe findings of this study will be communicated through

Debre Markos University Medicine and Health Sciences

College website, Debre Markos University library, the

two hospitals which are included in the study, East and

West Gojjam zone’s health office, and Amhara regional

state health bureau.

23

5. Work PlanTable 1. Work Plan of to assess the implementation of

nursing process and its determinant factors in Debre

Markos Referral Hospital &Finote Selam District

Hospital, North West Ethiopia, 2013.

Dec. Jan. Feb. March April May June

phas

e

Activitiesto beperformed

Responsiblebodies

Weeks Weeks Weeks weeks Weeks weeks weeks

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

1 Titleselection

Researchteam

2

Proposalwriting

Researchteam

Questionnairedevelopment

>>

Ethicalclearance

DMU,MHSC

Personnelorientation

Researchteam

Datacollection

>>

Datacoding,entry, and

>>

24

3 analysisThesiswriting

>>

Submissionof finalthesisreport

>>

Preparation forPublicdefenses

>>

4 Publicdefenses

>>

6. Budget Break DownTable 2.Budget breakdown to assess the implementation

of nursing process and its’determinant factors in Debre

Markos Referral Hospital &Finote Selam District

Hospital, North West Ethiopia, 2013.NO BUDGET CATEGORY

1 Personal Cost Unit

cost

No of

person

s

Duratio

n of

work

Total

cost

Remar

kInvestigators 70.00

birr

02 05 days 700.00

birrData collectors 50.00 05 06 days 1,500.00

25

birr birrSubtotal-1 2,200.00

birr

2

Equipment & Supplies Unit quanti

ty

Unit

costPen Number 10 3.00

birr

30.00

birrPencil Number 08 2.00

birr

16.00

birrNote book Number 06 8.00

birr

48.00

birrCD-RW Number 01 30.00

birr

30.00

birrPrinting Page 70 4.00

birr

280.00

birrDuplication Page 1,500 0.30

cent

450,00

birrStapler Number 01 40.00

birr

40.00

birrStaples Packet 02 15.00

birr

30.00

birrBinder Number 05 30.00

birr

150.00

birrSubtotal-2 1,074.00

birr3 Transport &

CommunicationCell-phone card Card 10 25.00 birr 250.00

birr

26

Transportation

Trip 01 100.00 birr 100.00

birr

Finot

e

selam07 3.00 birr 21.00

birr

Taxi

Subtotal-3 371.00

birr4 Grand total - - - 3,645.00

birr

Annex-I. Conceptual Frame Work

27

IMPLEMENTATION

OF NURSING

PROCESS

KNOWLEDGE OF NURSING

PROCESS

NURSES SKILL

ORGANIZATIONAL

STURACTURES AND

FACILITIES

PATIENT’S INCOME

NURSES

DEMOGRAPHICSPATIENT

TURNOVERYEAR OF

Figure .1 conceptual frame works that shows factors

affecting implementation of nursing process. (7)

Annex II. QuestionnaireDEBRE MARKOS UNIVERSITY

MEDICINE AND HEALTH SCIENCES COLLEGE, DEPARTMENT OF

NURSING

Confidentiality and Verbal Consent Form:-This

questionnaire is adapted from a research conducted in

Addis Ababa selected governmental hospitals to assess

theimplementation of nursing process and

its’determinant factors in Debre Markos Referral

Hospital &Finote Selam District Hospital, North West

Ethiopia. The questionnaire contains both closed ended

and open ended questions and will be provided in self-

administered form. You are therefore kindly requested

to provide genuine answers to the questions. The28

information you provide is confidential and is used

only for the purpose of this study. If you have any

question, don’t hesitate to ask the data collector.

Your cooperation and participation until the

compilation of the questionnaire is very necessary for

the successful compilation of the assessment. We

therefore ask your genuine willingness. However, you

have the right to turn down if you are not voluntary to

participate so that fills ‘NO’ in the box below.

If you are voluntary or not mark ‘x’ on

your opinion YES NO

THANK YOU IN ADVANCE FOR

YOUR COOPERATION

Participant’s signature

______________________Date_____________________

Data collectors sign

________________________Date_____________________

Cell phone = +251 913-27-52-59

29

PART. I Socio Demographic Questions

Circle your response from the given option/fill the

blank space/

S/

No

Items Responses Remark

1. Sex 1.male

2.female2. How old are you? _________(in

year)

3.What is your

ethnicity?

1.Amhara

2.Tigraye

3.oromo

4.others(specify)-------------- 4. What is your current

marital status?

1.single 2.married 3.widowed

4.divorced

5.separated

PART- II. Organizational and Nurses Related Questions:

ITEM Responses 5. When do you graduated for nursing? ______________________ in

E.C.6. How many years you did work in

clinical area?

__________________________

7. On average how many hours do you ___________________________

30

work per day? ___8. How many patients do you care per

day?

---------------------------

---------------------9. Do you have all equipment in your

organization to do nursing care?

1. Yes 2. No

10 Have you worked over time? 1. Yes 2. NO If

‘no’ skip Q.NO. 1311 If your answer ‘yes’, is that with

payment?

1. Yes 2. NO If

‘no’ skip Q.NO. 13 12 If your answer ‘yes’, is the

payment enough?

1. Yes 2. NO

13 Have you ever had misbehavior

record in your personal file?

1. Yes 2. NO

14The greatest strain for you during

in your working time is/are?

1.Rude physicians

2.harassing coworker

3.unsympatic manager

4.When coworkers doesn’t do

their task.

5. others

(specify)------------------

------- 1

5

Is there any dissatisfying aspect

of your job?

1. Yes 2. No.

If ‘no’ skip Q. 18.

16 What is/are the dissatisfying

aspects of your job?

1.Having care for so many

patients

2.the new report system

31

3. Useless paper work.

4. Rules being made up

without staff

5. others

(specify)------------------

------

17If you are dissatisfied with the

above any reason from Q.NO.16, is

it due to your profession?

1.Yes 2.NO

18 How would you describe the

atmosphere of your

Work place?

1.stressful at times

2.Negligent at times

3.disorganized

4. very well 5. others

(specify)--------19 Did you get satisfying orientation

while you joined this organization?

1.Yes 2.NO

20 What do you use to make your work

visible?

1.recording every

activities what you perform

2.using nursing process

3.reporting to supervisors

4.working on the patient

problems & seeing the

outcome

5. Nothing used 6.

others (specify)-----21 Have you committed clinical errors 1. Yes 2.NO. If ‘no’

32

skip Q.NO 23.

22 If you do, what kind of error you

perform?

1.Slip/slap

2.knowledge error

3. Excusive error 4

others (specify) ----

23 How high rate of staff nurses

turnover affect once society

health?

1.decreasing productivity

2.disorganized service

delivery

3.lossing sharing of

organizational knowledge

4. others

(specify)------------------

--------

24 What do you think the causes of

employee turnover?

1.job&employee skill

mismatch

2.due to NGO’s attractive

payment

3.low access of short/long

training

4.less/no recognition for

the work done

5. others

(specify)------------------

--------

25 What do you think the major reason1. miss-understanding of

the modern medicines

33

of patient turnover? 2. due to poor economic

status

3. due to long time waiting

time to get the service

4. others

(specify)---------------

--

26 According to Q.NO.25 how it

influence your nursing process?

1.patient discharge before

completing

the planned

interventions

2.patients are not

cooperative for the care

you provide

3.inability to collect the

required material for care

4.present with complicated

problems that is

challenging to manage

5. others

(specify)------------------

--------

34

PART- III. Knowledge Assessment

27

.

The first step on your

nursing process is?

1.collecting subjective & objective

data

2.evaluating what has been done for

the patient

3.indicating the activities to be

done

4.directly intervening the problem

28

.

The primary aim of

Gordon approach is?

1.focuses on ethical principles

2.focuses on patients responses

towards their illness

3. Focuses on the disease

process/medical diagnosis

4. focuses on patient’s attendant

interest

29

.

Select from the given

option that is not a

1.assassment

2.implementation

3.planning

35

component of nursing

process.

4.evaluation

5.evidenced based practice

6.nursing diagnosis30

.

Your appropriate nursing

diagnosis for a patient

with Hypertension to

prevent future

complication is?

1.potential nursing diagnosis

2.actual nursing diagnosis

3.medical diagnosis

4.laboratory investigation

5. others

(specify)--------------------------

31

.

What makes nursing

process different from

medical diagnosis?

1.nursing dx focuses on the diseases

than other

patient’s response

2.nursing dx focuses on patient’s

response than

patient’s response

3.both focuses on patient’s responses

4.both have similar procedure to

resolve a patient’s

5. others

(specify)--------------------------32

.

In your organization who

is mandatory for the

better accomplishment of

nursing process?

1. Physician 2. Patient’s family

3.nurses

4. Patients 5.no one should

excluded

33 What are your activities 1. Assigning priorities

36

. During your planning

phase?

2. Specifying expected out comes

3.recording the data of the patient

4.specifying goals

5.identifying interdependent

interventions

6. others

(specify)--------------------------34

.

Select your role during

implementation phase of

your nursing process?

1.propose the interventions

2.implementing the proposed

interventions

3.performing the planned

interventions by excluding

Activity of daily living

4. Stop the phase if the initial

implementations fail to Change

patients’ problem. 35

.

Select that may be not a

guide for your nursing

process evaluation?

1.the nursing diagnosis

2.collaborative problems

3.priorities and nursing

interventions

4.expected out comes

5.all could be guide lines36

.

Fluid volume deficits

related to unresolved

vomiting & diarrhea as

evidenced by dry oral

1.fluid volume deficit

2.unresolved vomiting and diarrhea

3.dry oral mucosa and sunken eyes

4.dehydration

37

mucosa and sunken eyes.

From the given nursing

diagnosis select the

etiology from the given

options?

PART IV: Skill Assessment

Score the following activities according to the

frequency you perform. Mark by using ‘x’ on your

choice. 1. not at all 2.not really

3.undecided 4.somewhat 5.verymuch

ACTIVITIES 1 2 3 4 537 Ability to apply theories of nursing practice38 Ability to maintain patient dignity, privacy and

confidentiality(using nursing skills)39 Ability to practice principles of health and

safety, including morning and handling, and

infection control; essential first aid and

38

emergency procedures 40 Ability to safely administer medicine and other

therapies; (using nursing skills, Interventions/

activities to provide optimum care)

41Ability to consider emotional, physical, and

personal care, including meeting the need for

comfort, nutrition, personal hygiene and enabling

the person to maintain the activities necessary

for daily life; (using nursing skills,

Interventions/ activities to provide optimum care)41 Respond to patient needs by planning delivering

and evaluating appropriate and individualized

programs of care working in partnership with the

patient, their care givers, family and other

health workers.

THANKS AGAIN FOR YOUR PARTICIPATION!!!!!!!!

Annex III. Declaration

39

We, the undersigned, BSC nurse students declare that

this senior essay proposal is our original works in

these Hospitals in partial fulfillment of the

requirement of Bachelor of degree in nursing.

NAME OF INVESTIGATORS

SIGNATURE

1. ABAYNEW ASSEMU _____________________________

2. KALKIDAN YIBELTAL

________________________________

3. G/TSADIK ENDESHAW

________________________________

4. AYALEW KASSIE______________________________

5. ASNAKU ALEMU

________________________________

Place of submission Debre Markos University, College of

Medicine and Health Sciences Department of Nursing

Date of submission _____________________________ and

the thesis will be submitted for examination with the

approval of advisors.

40

ADVISORS’ NAME

SIGNATURE

1. HABTAMU Abera (RN, BSC, MSC)

_________________

2. MULATU Ayana (BSC, MPH)

___________________

Annex IV. Assurance of Investigators

We the under signed agrees to accepts the

responsibility for the scientific, ethical and

technical conduct of the research project and for

provision of required progress reports as pre-terms and

conditions of the research and publication committee of

Debre Markos University, College of Medicine and Health

Sciences Department of Nursing.

Name of Investigators Signature

Date

1. AbaynewAssemu ____________________

______________

41

2. KalkidanYibeltal___________________

_____________

3. G/TsadikEndeshaw __________________

____________

4. AyalewKassie _____________________

______________

5. AsnakuAlemu _____________________

________________

Advisors Approval

Advisors’ Name

Signature Date

1. Habtamu Abera (RN, BSc, MSc)_________________

__________

2. Mulatu Ayana (BSc, Mph) _____________________

___________

42

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