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
References1. Maria Muller Staub. Evaluation of the
implementation of nursing diagnostics.
International Journal of nursing terminologies and
classifications 2007; 18(1), 5-17.
2. Maternal and Child Health Nursing: Practice a
Framework for Maternal and Child Health Nursing,
Unit One, p. 5.
3. Delmar: Nursing Process and Considerations for Drug
Therapy: Cengage Learning, 2010, page 1-5.
4. Carpenito-Moyet, L.J. Nursing diagnosis:
application to clinical practice 10th Ed.
Philadelphia, 2004
5. Kate Barrett, Jim Richardson. The nursing process
and documentation. Learning material on nursing:
Denmark, 1996: P (19)
6. Marilynn E. Doenges. Application of Nursing Process
and Nursing Diagnosis an Interactive Text for
Diagnostic Reasoning 4th edit, 2003.
7. MulugetaAsratie: Assessment on factors affecting
implementation of nursing process among nurses in
selected governmental hospitals( MSc thesis), Addis
Ababa, Ethiopia, June 2011
8. Sue C. DeLaune, Patricia K. Ladne. Fundamentals of
nursing: Standards & practice. 2nd ed. 2002,
chap.5, p.79-89.
43
9. Revisalid A. Applying Nursing Process collaborative
care, 5th Ed. New York, 2002, p. 4-32.
10. Rev Latino-am Enfermagem. The nursing process
presented as routine care action: Building its
meaning in clinical nurses’ perspective.
(www.eerp.usp.)
11. M. H. Baena, R. Higa, Et’al, Evaluation of the
Nursing Process Used at a Brazilian teaching
Hospital. International Journal of Nursing
Terminologies and Classifications, 2010, Volume 21,
Issue 3, pages 116–123
12. ML. Calladine, Goal Oriented Nursing Record.
( www.jstor .)
13. Alvez, A. R., Lopes, C. H. A. F., & Jorge, M. S.
B. The meaning of the nursing Process for nursing
of intensive therapy units: An integrationist
approach 2008 42(4), 649–655.
14. Clarke SP. Aiken LH. Failure to rescue: American
Journal of Nursing. 2003; 103(1):42–47
15. Lee, T. T. Nursing diagnoses: Factors affecting
their use in charting standardized Care plans.
Journal of Clinical Nursing, 2005, vol. 14, 640–
647.
16. Lima, A. F. C., & Kurcgant, P. The nursing
diagnosis implementation process at the university
44
hospital of the University of São Paulo, 2006,
40(1), 111–116.
17. J Schaefer. Nursing Process and its determinant
factors. (www.jstor.)
18. Carayon P, Gurses A. Nursing workload and patient
safety in intensive care units: a Human factors
engineering evaluation of the literature. Intensive
Crit Care Nurse, 2005, 21:284-301.
19. IngerJansion, chrstelBahtsevani, Ewagilhammar-
Andersson and Anna Forsberg. Factors and conditions
that influence the implementation of standardized
nursing Care plans .The Open nursing journal 2010,
vol.4: P (25-34).
20. Hale CA, Thomas LH, Bond S, Todd C. The nursing
record as a research tool to identify Nursing
interventions. J ClinNurs 1997; 6:207-14.
21. Reppetto, M. A., & Souza, M. F. Evaluation of
nursing care systematization Through the phases of
nursing process performance and registration in a
teaching Hospital, 2005, 58(3), 325–329.
22. Lima, A. F. C., & Kurcgant, P. Meaning of the
nursing diagnosis Implementation process for nurses
at a university hospital, 2006, 14(5), 666–673.
45
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