Assessing the Effectiveness of the Nursing Process Among Nurses in Central Hospital, Warri, Delta State
Chapter One
Objectives of the Study
The primary objective of this study is to assess the effectiveness of the nursing process among nurses at Central Hospital Warri. Specifically, the study aims to:
- Evaluate the level of understanding and knowledge of the nursing process among nurses at Central Hospital Warri.
- Examine the extent to which the nursing process is being implemented in patient care at the hospital.
- Identify the challenges faced by nurses in effectively applying the nursing process and suggest strategies for overcoming these challenges.
CHAPTER TWO
LITERATURE REVIEW
Conceptual Framework
Nursing Process
The nursing process is a systematic, patient-centred approach employed by nurses to deliver individualised care. It involves five critical stages: assessment, diagnosis, planning, implementation, and evaluation. Each stage plays a vital role in ensuring that nursing care is structured, evidence-based, and tailored to the unique needs of each patient. According to Alfaro-LeFevre (2023), the nursing process helps nurses to systematically collect data, identify patient problems, formulate care plans, execute interventions, and evaluate outcomes, making it a foundational tool in nursing practice. The process ensures that nurses are providing high-quality, coordinated care to achieve optimal patient outcomes (Vaismoradi et al., 2020).
Alfaro-LeFevre (2023) emphasises that the nursing process is designed to enhance patient safety and clinical outcomes. The first step, assessment, involves gathering comprehensive data about the patient’s health status, including physical, emotional, and social factors. This data is then analysed to make a diagnosis, which forms the basis for individualised care plans. In the planning phase, specific, measurable, and achievable goals are established, with interventions chosen based on the patient’s needs. During implementation, interventions are carried out, and continuous monitoring ensures that the care plan is being followed. Finally, in the evaluation phase, the effectiveness of the interventions is assessed to determine whether patient goals were met, and adjustments are made accordingly (Godsey, Houghton, & Hayes, 2020).
However, the application of the nursing process can be inconsistent due to various challenges. As noted by Koy et al. (2023), differences in training, experience, and institutional support often affect how well nurses can apply the nursing process in practice. For example, inadequate training in the nursing process can lead to poor assessment and diagnosis, which in turn affects the care plan. Moreover, organisational constraints, such as a lack of resources or insufficient staffing, can hinder the implementation of the nursing process, leading to suboptimal care (Fukada, 2018). These factors suggest that while the nursing process is theoretically sound, its practical application may face significant barriers.
The nursing process is fundamental in improving patient outcomes, especially in complex healthcare environments like Central Hospital Warri. The proper use of the nursing process allows nurses to deliver coordinated, effective, and patient-centered care, contributing to improved clinical outcomes (Egert, Lee, & Gill, 2023). Therefore, understanding the effectiveness of its application is crucial for ensuring that nursing practices align with established standards and meet the needs of patients in this setting (Koy et al., 2023).
CHAPTER THREE
METHODOLOGY
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Design
The research design employed in this study was a cross-sectional and quantitative survey research design, which was selected due to its ability to systematically collect and analyse numerical data from a large sample of participants. This approach allowed for the objective assessment of relationships between variables, such as nurses’ competencies in applying the nursing process and the factors influencing their clinical practice. Quantitative designs are particularly suitable for measuring the prevalence of particular attributes or behaviours within a population, offering statistical power and generalizability (Creswell & Creswell, 2018). This design facilitates the collection of data that can be analysed using statistical methods to draw valid conclusions.
Setting
The study was conducted at Central Hospital, Warri, located in Delta State, Nigeria. This hospital serves as a major public healthcare facility in the South-South region of the country and plays a crucial role in providing medical services to a diverse population. Warri is a commercial and urban centre in Delta State, with a growing population and a variety of healthcare needs. Central Hospital, Warri, is known for its wide range of medical services and serves patients from both urban and surrounding semi-urban and rural areas. This makes it an ideal setting for assessing the effectiveness of the nursing process, as it offers a mix of cases that reflect the real-world challenges faced by nurses in public healthcare institutions.
Healthcare delivery in Central Hospital is characterised by high patient turnover, limited resources, and staffing challenges typical of many government-owned health facilities in Nigeria. These conditions impact the implementation of the nursing process and highlight the practical difficulties nurses encounter in delivering holistic and patient-centred care. Conducting the study in this environment provides valuable insights into how the nursing process is applied in practice and the factors that influence its effectiveness in a high-demand healthcare setting.
Target Population
The target population for this study comprised registered nurses working at Central Hospital, Warri, in Delta State, Nigeria. An estimated 200 nurses across various units and departments within the hospital were identified as potential participants. Nurses were selected as the focus of the study because they play a central role in patient care and are directly responsible for implementing the nursing process in clinical practice. Their firsthand experiences, professional insights, and perceptions are vital to evaluating the effectiveness of the nursing process, as well as identifying the practical challenges and enabling factors that influence its successful application in a public healthcare environment like Central Hospital.
CHAPTER FOUR
RESULTS
Data Presentation
Demographic Distribution of Respondents
CHAPTER FIVE
DISCUSSION OF FINDINGS
Findings
The findings from the study on the evaluation of the nursing process at Central Hospital Warri, as shown through various tables in the results section, provide a comprehensive view of nurses’ understanding, implementation, and challenges regarding the nursing process. These findings are aligned with several relevant studies that emphasize nursing competence, adherence to the nursing process, and the barriers faced in its effective application.
The results indicate that a significant number of nurses at Central Hospital Warri have a strong understanding of the nursing process, with 69% either strongly agreeing or agreeing that they have a strong understanding of it. This is consistent with the findings from Vaismoradi et al. (2020), who reviewed nurses’ adherence to patient safety principles and found that adequate understanding of the nursing process is integral to improving patient safety and care quality. Their research also stresses that a lack of understanding of these principles can compromise patient safety, which directly relates to the nurses’ confidence in their knowledge as demonstrated in the findings of this study.
The perception of having a strong understanding of the nursing process correlates with Fukada’s (2018) definition of nursing competency, where competency is not only defined by knowledge but also by the ability to apply that knowledge in practice. Nurses’ responses in the current study reflect that a majority feel confident in their understanding, but the need for continuous education and training is evident, as highlighted by Koy et al. (2023), who assert that nursing competencies must be constantly assessed and updated to align with evolving healthcare needs.
Regarding the implementation of the nursing process, the majority of respondents (72%) agreed that the nursing process is consistently applied in daily patient care, which reflects a high level of adherence to the process. This finding aligns with the work of Koy et al. (2023), who explored the application of the nursing process in patient safety. The study found that nurses’ consistent use of the nursing process improves patient outcomes and ensures higher standards of care. Similarly, Peters (2023) discusses how nursing shortages impact the consistency of care, suggesting that while nurses may understand the process, insufficient staffing can hinder its proper implementation. This can explain the variation in responses where some nurses reported uncertainty or disagreement about the consistency of application.
The findings in this study also support the view of Hagos et al. (2024), who observed in their Ethiopian study that when nursing staff consistently follow the nursing process, patient care quality improves significantly. Despite the positive response to implementation, this study also acknowledges the need for better training and support, especially given the challenges nurses face in real-world settings, such as the availability of resources.
The study revealed several barriers to the effective implementation of the nursing process, including time constraints, limited resources, lack of adequate training, and insufficient support from hospital management. These findings resonate with the research by Saiga et al. (2024), who found that work environment factors such as staffing shortages and time constraints significantly affect nurses’ ability to implement care plans effectively. Similarly, Godsey et al. (2020) discuss how external factors, including institutional support, influence nurses’ perceptions of their profession and the challenges they face. The lack of support from hospital management and inadequate resources further exacerbate the difficulties faced by nurses, as reflected in the responses from Central Hospital Warri.
A key challenge identified in this study is the lack of adequate training on the nursing process, with 78% of respondents agreeing or strongly agreeing that this is a significant barrier. This aligns with the findings of Koy et al. (2023), who emphasized that effective training is critical to ensure that nurses develop the necessary competencies to carry out the nursing process competently. The study also echoes Al-Ghwary et al. (2024), who reported that continuous professional development and training are essential for maintaining and improving nursing skills, especially in areas such as patient assessment, care planning, and implementation.
Work Environment and Communication Barriers
The study highlights communication issues between nursing staff and other healthcare professionals as a significant barrier. Boudreau and Rhéaume (2024) discuss how poor communication within healthcare teams can negatively affect the implementation of patient care protocols, including the nursing process. The importance of inter-professional collaboration is also emphasized by Alfaro-LeFevre (2023), who suggests that effective communication among healthcare providers leads to more cohesive patient care and better clinical outcomes.
Additionally, Numminen et al. (2022) highlight the importance of a supportive practice environment in promoting professional competence. Nurses who work in a positive and well-supported environment are more likely to adhere to patient safety principles and provide high-quality care. The lack of support from hospital management, as indicated in this study, points to a broader issue of organizational culture, which, as Amarneh et al. (2021) noted, can affect turnover intention and job satisfaction, thus impacting the overall quality of care.
Implication of Findings
The findings from the study on the evaluation of the nursing process at Central Hospital Warri have significant implications for the nursing profession, particularly in nursing education, practice, policy, and healthcare management. The study reveals that while nurses generally possess a good understanding of the nursing process, they face considerable challenges when it comes to consistently applying it in their daily work. This highlights a gap between theoretical knowledge and practical application. Although nursing education provides a solid foundation in the theoretical aspects of the nursing process, the ability to translate this into effective practice remains a significant challenge. Nurses reported that time constraints and limited resources were major barriers to the consistent application of the nursing process, further emphasizing the need for systemic changes to overcome these issues.
These findings align with research by Vaismoradi et al. (2020), who stress that adherence to structured care processes and safety principles directly impacts patient outcomes. Therefore, nursing education must not only focus on theoretical knowledge but should also place a greater emphasis on practical skills and clinical decision-making. Incorporating more experiential learning opportunities into nursing programs could help bridge the gap between theory and practice, better preparing nurses to handle the complexities of patient care. As the healthcare environment evolves, continuous professional development is essential to maintaining nursing competency, ensuring that nurses remain well-versed in new technologies and evidence-based practices.
The study also highlights the impact of systemic issues, such as time constraints and high patient-to-nurse ratios, which hinder the effective implementation of the nursing process. These challenges are consistent with findings from Peters (2023), who identifies nurse shortages and excessive workloads as major contributors to burnout, which can negatively affect patient care. Addressing these challenges requires healthcare organizations to provide a supportive work environment with adequate staffing levels, balanced workloads, and resources to reduce stress and prevent burnout. Furthermore, reducing non-clinical responsibilities, such as administrative tasks, would enable nurses to focus more on direct patient care, which is essential for the thorough application of the nursing process.
From a policy perspective, the study underscores the need for healthcare administrators to create environments that support nurses’ ability to implement the nursing process effectively. The lack of institutional support for nurses, as identified in this study, suggests that healthcare policies should prioritize creating organizational structures that enable nurses to apply best practices in patient care. Policies should focus on ensuring sufficient nurse staffing, resource allocation, and ongoing professional development. Additionally, healthcare managers must cultivate a culture of collaboration between nurses, interdisciplinary teams, and management to improve the efficiency and effectiveness of care delivery.
The findings also emphasize the need for clearer competency frameworks in nursing, a concept that Koy et al. (2023) discuss in their research on nursing competencies and patient safety. The nursing process involves critical thinking, patient assessment, care planning, and evaluation. This study indicates that nurses may not always feel confident in their ability to apply these steps consistently, pointing to the necessity for structured competency frameworks. Such frameworks can guide nursing practice and serve as a benchmark for evaluating and improving clinical performance. Regular competency assessments, mentorship programs, and skill-building initiatives are essential to ensure nurses are equipped to provide high-quality care.
Furthermore, the importance of nursing leadership cannot be overstated. As Fukada (2018) suggests, strong leadership plays a crucial role in creating a conducive work environment for nurses and ensuring the effective application of the nursing process. Nurse leaders can advocate for necessary policy changes, secure adequate resources, and provide the necessary training and support to help nurses perform their duties effectively. Empowering nurses to make decisions and implement the nursing process with confidence is also a key responsibility of nurse leaders. The development of nurse leadership skills is therefore vital for improving patient care and nursing practice.
Lastly, the findings underscore the need for healthcare institutions to address the root causes of barriers to the nursing process, such as time constraints and inadequate resources. These challenges, though common in many healthcare settings, significantly affect patient care and nurse performance. Institutions must ensure that nurses are given the tools, time, and support needed to provide optimal care, including adequate time to assess and plan for patient needs effectively. Additionally, fostering a positive work environment where nurses feel valued and supported can lead to greater job satisfaction and retention, ultimately benefiting patient care.
Limitations of the Study
One limitation of this study is the reliance on self-reported data from nurses, which may introduce response bias, as participants could have overestimated or underestimated their knowledge and practices related to the nursing process. Additionally, the study was conducted at a single hospital, Central Hospital Warri, which may limit the generalizability of the findings to other healthcare settings with different organizational structures, resources, and staff dynamics. The sample size, while substantial, may still not fully represent the diversity of nursing professionals across all departments, which could affect the comprehensiveness of the results. Furthermore, the study did not consider other potential factors that could influence the implementation of the nursing process, such as personal attitudes, cultural influences, or external healthcare policies, which might have provided a broader understanding of the challenges faced by nurses. Lastly, the cross-sectional nature of the study limits the ability to draw conclusions about the long-term effects of the challenges identified on the nursing process or the healthcare system.
Summary
This study aimed to evaluate the understanding, implementation, and challenges associated with the nursing process at Central Hospital Warri. The findings provide valuable insights into the current state of nursing practices at the hospital and contribute to the broader understanding of how the nursing process is utilized within healthcare settings. The study found that the majority of nurses at Central Hospital Warri have a strong understanding of the nursing process and are confident in their knowledge of its steps. The respondents also reported that they were generally well-trained in applying the nursing process to patient care. However, despite these positive results, there were some discrepancies in the extent to which the nursing process was consistently applied in daily patient care. Some nurses indicated uncertainty or disagreement about the thoroughness of its application, particularly in terms of following all the steps from assessment to evaluation.
Moreover, the study revealed that various challenges hindered the full implementation of the nursing process at the hospital. Time constraints emerged as a significant barrier, with many nurses agreeing that limited time often interfered with their ability to apply the nursing process effectively. Additionally, the study identified insufficient resources and lack of adequate training as key factors that contributed to difficulties in the implementation of the nursing process. These challenges were further compounded by communication issues between nursing staff and other healthcare professionals, which impacted the collaborative efforts required for effective patient care.
The study also explored the extent to which the nursing process was regularly monitored and evaluated to ensure its proper implementation. While many nurses believed that the nursing process was a priority in patient care, the findings highlighted that ongoing education and monitoring mechanisms were not consistently applied, suggesting room for improvement in the hospital’s quality control and training programs. These results align with literature that emphasizes the importance of continuous education and systematic evaluation in ensuring the success of the nursing process. Studies have consistently found that regular training and feedback contribute to improved adherence to the nursing process and enhance patient safety outcomes.
In terms of practical implications, the findings underscore the need for the hospital to address the identified challenges to better support nurses in the application of the nursing process. Addressing time constraints, providing adequate resources, and enhancing communication among healthcare teams are critical steps to improving the overall quality of care. Furthermore, the study suggests that providing more focused and continuous education on the nursing process could help nurses feel more confident in its application and ensure that the process is followed more consistently in daily practice. This aligns with prior research that stresses the need for a comprehensive approach to nursing education and the provision of necessary tools and resources to nurses.
The study’s findings also have broader implications for the nursing profession. They highlight the critical role that the nursing process plays in enhancing patient care and safety, and they point to the importance of creating supportive work environments that empower nurses to effectively apply the process. As nursing continues to evolve with advancements in healthcare technology and patient care models, the nursing process remains a cornerstone of nursing practice. Ensuring that nurses have the necessary knowledge, training, and support to implement the process is essential for improving patient outcomes and maintaining high standards of care. This study contributes to the growing body of literature on nursing process implementation and offers valuable insights for healthcare organizations aiming to improve nursing practices.
Overall, while the findings of this study are promising in terms of the nurses’ understanding and application of the nursing process, they also reveal several areas that require attention and improvement. The study’s limitations, such as its reliance on self-reported data and its focus on a single hospital, suggest that further research is needed to explore the challenges faced by nurses in different healthcare settings and to evaluate the long-term effectiveness of interventions aimed at addressing these challenges. Future studies could benefit from a more diverse sample, a longitudinal design, and a broader exploration of factors affecting the implementation of the nursing process. The implications of this research are significant for the nursing profession, as they provide a clearer picture of the factors that support or hinder the effective application of the nursing process, offering a foundation for improving nursing practice and patient care in various healthcare contexts.
Conclusion
In conclusion, this study highlights both the strengths and challenges of implementing the nursing process at Central Hospital Warri. The findings suggest that nurses possess a solid understanding of the nursing process and are generally well-equipped with the knowledge necessary for its application. However, inconsistencies were observed in the daily application of the nursing process, particularly due to barriers such as time constraints, limited resources, and insufficient training. These challenges indicate a need for improved support mechanisms, including more structured training programs and better communication among healthcare professionals, to ensure the full implementation of the nursing process.
The study also points to the importance of continuous education and evaluation in enhancing nursing competencies and ensuring that patient care remains optimal. Although nurses at the hospital are generally aware of the nursing process’s significance, the study emphasizes that addressing these identified challenges is crucial for improving its consistent application. Ultimately, the findings underscore the need for healthcare institutions to invest in providing nurses with the necessary resources and training to fully integrate the nursing process into daily patient care. By addressing these challenges, hospitals can enhance the quality of care, improve patient outcomes, and foster a more effective nursing workforce.
Recommendations
The following recommendations were proposed based on the findings of this study:
- Increase Training and Education Programs: To enhance the understanding and application of the nursing process, it is recommended that Central Hospital Warri invest in continuous professional development programs for nurses. These programs should focus on improving competency in applying the nursing process from assessment to evaluation. Regular workshops, seminars, and refresher courses can be implemented to ensure that nurses remain updated on best practices.
- Address Time Constraints: Time constraints emerged as a significant barrier to the effective implementation of the nursing process. It is recommended that the hospital management review staffing levels and workloads to ensure that nurses have sufficient time to implement the nursing process thoroughly. This could include optimizing shift schedules, improving task allocation, and increasing the nursing workforce to reduce workload pressures.
- Provide Adequate Resources: Limited resources were identified as a challenge to the full implementation of the nursing process. It is crucial for hospital management to allocate more resources, including medical equipment, technology, and support staff, to ensure that nurses can efficiently carry out their roles. Resource planning should prioritize essential tools that enhance the nursing process, ultimately improving patient care.
- Improve Communication Among Healthcare Professionals: Effective communication between nursing staff and other healthcare professionals is vital for the successful application of the nursing process. It is recommended that the hospital foster a more collaborative work environment through regular interprofessional meetings and the use of communication technologies. This would help ensure better coordination of care, reduce misunderstandings, and enhance the overall quality of patient care.
- Strengthen Management Support: The study revealed a lack of sufficient support from hospital management for the implementation of the nursing process. It is recommended that hospital leadership provide more robust support by ensuring that the necessary infrastructure, policies, and incentives are in place to encourage the consistent application of the nursing process. Management should actively involve nursing staff in decision-making processes and demonstrate a commitment to enhancing patient care standards.
Suggestion for Further Studies
Given the findings from this study, further research is needed to explore the specific strategies that can effectively bridge the gap between theoretical knowledge of the nursing process and its practical application. A comprehensive investigation into how nursing education can better integrate experiential learning and clinical decision-making into the curriculum would be valuable. Researchers could also examine the impact of various educational methods, such as simulation-based learning or mentorship programs, on nurses’ ability to apply the nursing process consistently in real-world settings. Additionally, exploring how different teaching modalities can enhance nurses’ critical thinking and problem-solving skills would contribute to improving their competency in patient care. Such studies would provide valuable insights into how to refine nursing education programs to better prepare nurses for the challenges they face in clinical practice.
Moreover, future research should investigate the effects of organizational and systemic factors, such as nurse staffing levels, workload distribution, and resource availability, on the implementation of the nursing process. Studies could focus on identifying best practices for optimizing the nursing work environment, including how to balance non-clinical duties with direct patient care responsibilities. Investigating the role of leadership in fostering supportive environments for nurses would also be beneficial. Researchers could explore how effective nurse leadership influences nurses’ ability to apply the nursing process and improve patient outcomes. By addressing these organizational and leadership factors, further studies could provide evidence-based recommendations for healthcare managers and policymakers to improve nursing practice and patient care quality.
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