1.1 Introduction
The nursing process is a systematic, patient-centered approach used by nurses to ensure comprehensive and individualized care. It consists of five interrelated steps: assessment, diagnosis, planning, implementation, and evaluation. This process helps nurses deliver effective care by continuously assessing and addressing the changing needs of patients (Potter et al., 2016). The nursing process, a systematic method used by nurses to ensure quality patient care. This structured approach is integral to nursing practice, aiming to promote health, prevent illness, and provide holistic care to patients. However, the effective implementation of the nursing process can be influenced by a myriad of factors that span organizational, educational, and environmental domains.
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.
1.2 Background of Study
The nursing process, a cornerstone of modern nursing practice, was developed to provide a structured, systematic approach to patient care. This methodology comprises five interrelated steps: assessment, diagnosis, planning, implementation, and evaluation. Each step builds upon the previous one, ensuring that patient care is comprehensive, individualized, and continuously improved based on outcomes. The consistent application of the nursing process is crucial for delivering high-quality patient care, promoting positive health outcomes, and ensuring patient safety.
In the 1970s, the nursing process gained widespread recognition and was incorporated into nursing education curricula. The American Nurses Association (ANA) officially endorsed the nursing process in 1973, further solidifying its role in professional nursing practice (American Nurses Association, 1973). This endorsement highlighted the importance of using a standardized approach to ensure consistency and quality in patient care. The nursing process, which consists of assessment, diagnosis, planning, implementation, and evaluation, has a rich history rooted in the evolution of modern nursing. Its development can be traced back to the mid-20th century, a period marked by significant advancements in nursing education and practice.
Despite its importance, the implementation of the nursing process faces various challenges in real-world clinical settings. Historical context reveals that the nursing process was introduced in the 1950s and 1960s, with the aim of standardizing nursing care and elevating the professional status of nurses. Over time, it has been integrated into nursing curricula worldwide, emphasizing its theoretical and practical significance in nursing education and practice (Yura & Walsh, 1973). In contemporary healthcare environments, several factors have been identified as influential in the implementation of the nursing process. Organizational factors such as staffing levels, administrative support, and resource availability play a significant role. Studies have shown that high patient-to-nurse ratios and limited resources can impede nurses' ability to perform thorough assessments and develop effective care plans (Aiken et al., 2012). Moreover, the organizational culture and leadership style within healthcare institutions can either facilitate or hinder the adoption of the nursing process (Huber, 2018).
Educational factors are also critical. The quality of nursing education, including both initial training and ongoing professional development, affects nurses' proficiency and confidence in utilizing the nursing process. Research indicates that nurses who receive continuous education and training are more likely to effectively implement the nursing process and adapt to evolving clinical guidelines (Furukawa, 2016). Personal factors, such as individual attitudes, beliefs, and levels of motivation, significantly impact the use of the nursing process. Nurses who are committed to lifelong learning and exhibit a patient-centered approach are more likely to adhere to the steps of the nursing process. Conversely, factors such as job dissatisfaction and burnout can negatively affect implementation (Miller & Apker, 2017). Additionally, environmental factors, including the physical work environment and availability of medical equipment, are crucial. A supportive environment that provides the necessary tools and fosters teamwork and collaboration among healthcare professionals can enhance the effective implementation of the nursing process (Huber, 2018).
The nursing care plan serves as a roadmap for the team's junior members as well as a means of imparting specialized skills necessary for carrying out a singular, professional role and foreseeing future issues. Care plans are a special kind of action that combines thinking and doing. Nursing practice requires the effective use of the nursing process, per current practice standards. Therefore, in Nigeria where the research was carried out, the activities that was conducted is to assess the Factors Influencing the Implementation of Nursing Process in the Care of Patient.
1.3 Statement of Problems
Investigation revealed that One of the most significant barriers to the implementation of the nursing process is inadequate staffing. High patient-to-nurse ratios lead to increased workloads, which in turn limit the time nurses can dedicate to each step of the nursing process, from thorough assessments to detailed care planning and evaluation (Aiken et al., 2012). This problem is compounded by budget constraints and a global nursing shortage, making it challenging for healthcare institutions to maintain optimal staffing levels.
Additionally, the level of education and ongoing training that nurses receive is crucial for the effective use of the nursing process. However, many nurses report gaps in their education, particularly in areas such as nursing diagnosis and care planning. Without sufficient training, nurses may struggle to apply theoretical knowledge in practical settings, leading to inconsistent or suboptimal patient care (Furukawa, 2016). Additionally, limited opportunities for continuing education and professional development exacerbate this issue.
Furthermore, Nurses' personal attitudes and levels of motivation significantly impact their use of the nursing process. Negative attitudes towards the nursing process, often stemming from a lack of understanding or perceived complexity, can hinder its application. Furthermore, burnout a prevalent issue in nursing due to high stress and demanding work conditions reduces job satisfaction and motivation, further obstructing the effective implementation of the nursing process (Miller & Apker, 2017).
The implementation of the nursing process is vital for delivering high-quality patient care, but it faces several significant challenges. Addressing these issues requires a multifaceted approach, including improving staffing levels, enhancing nursing education and training, fostering positive attitudes, providing strong organizational support, and creating a conducive work environment. By tackling these problems, healthcare institutions can better support nurses in the effective application of the nursing process, ultimately leading to improved patient outcomes.
1.4 Aim and Objectives of Study
The aim of the study is to identify the Factors Influencing the Implementation of Nursing Process in the Care of Patient. In achieving this aim, the following specific objectives were laid out as follows:
- To explore the availability and effectiveness of continuing education and professional development programs related to the nursing process;
- To assess the impact of staffing levels, nurse-to-patient ratios, and resource availability on the implementation of the nursing process;
- To examine the role of healthcare management and leadership in supporting the nursing process;
- To investigate the adequacy of initial nursing education in preparing nurses for the practical application of the nursing process; and
- To provide evidence-based recommendations for healthcare institutions to address the identified barriers to implementing the nursing process.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the impact of staffing levels, nurse-to-patient ratios, and resource availability on the implementation of the nursing process?
- What is the role of healthcare management and leadership in supporting the nursing process?
- How adequate is nursing education in preparing nurses for the practical application of the nursing process?
- What is the availability and effectiveness of continuing education and professional development programs related to the nursing process?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: Organizational factors, such as staffing levels, nurse-to-patient ratios, and resource availability, do not significantly influence the implementation of the nursing process in patient care
- H1: Organizational factors, such as staffing levels, nurse-to-patient ratios, and resource availability, significantly influence the implementation of the nursing process in patient care
Hypothesis Two
- H0: There are no significant factors that influence the implementation of the nursing care plans in patient management
- H1: There are significant factors that influence the implementation of the nursing care plans in patient management
Hypothesis Three
- H0: The level of nursing education and availability of continuing professional development programs do not significantly influence the implementation of the nursing process
- H1: The level of nursing education and availability of continuing professional development programs significantly influence the implementation of the nursing process
1.7 Significance of Study
The relevance of this study will help nurses utilizing nursing care plans to communicate the patient's condition and also to other members of the health team in a clear and concise manner. Nurse satisfaction and the patient's perception of the plan of care's value are enhanced when the population-level patient care plan is integrated into the workflow documentation rather than existing as a stand-alone document or task.
Specifically, this research will be significant to the listed stakeholders in the following ways:
- The Client (Patients): increased client participation, tailored care, avoidance of duplication and omission, and continuity of care.
- The Nurses: Standards of practice, staffing assignments, ongoing education, boosted self-esteem, and work satisfaction.
Furthermore, the study underscores the importance of continuous professional development in nursing. Identifying the role of ongoing education and training in the implementation of the nursing process can encourage healthcare institutions to invest in continuous learning opportunities for their nursing staff (Huber, 2018). Such investments not only improve individual nurse performance but also elevate the overall standard of care within the institution.
Finally, this study will contribute to the body of knowledge in nursing research by providing empirical data on the factors influencing the nursing process. This can serve as a foundation for further studies and stimulate ongoing research in this area, ultimately leading to continuous improvement in nursing practice and education.
1.8 Scope of Study
The scope of the research is focused on the Factors Influencing the Implementation of Nursing Process in the Care of Patient using General Hospital Calabar in Cross River State as a case study.
1.9 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this research work. There were lots of information needed from the staffs of this establishment to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.10 Operational Definition of Terms
Nursing Process:
The nursing process is a systematic, patient-centered approach used by nurses to ensure comprehensive and individualized care (Potter et al., 2016).
Implementation:
Implementation refers to the execution of the nursing care plan developed during the planning phase of the nursing process. It involves carrying out specific interventions to meet the patient’s health needs and achieving the desired outcomes (Huber, 2018).
Organizational Factors:
Organizational factors include the structural and administrative aspects of healthcare institutions that influence nursing practice. These factors encompass staffing levels, nurse-to-patient ratios, availability of resources, management support, and the overall organizational culture (Aiken et al., 2012).
Educational Factors:
Educational factors pertain to the initial and ongoing training and education that nurses receive. This includes the quality of nursing education programs, the adequacy of training in applying the nursing process, and opportunities for continuing professional development (Furukawa, 2016).
