International Journal of Science and Healthcare Research Vol.3; Issue: 1; Jan.-March 2018 Website: www.ijshr.com Original Research Article ISSN: 2455-7587

Challenges Faced by Nurses for Implementation of Process in Special Units at Teaching Hospital Jaffna

Thuvaraka S1, Vijayanathan S2, Pakeerathy M3, Subathra R4, Laavanya M5, Priyanthi WN6

1,2,3,4 Teaching Hospital, Jaffna 5,6 The Open University of Sri Lanka

Corresponding Author: Priyanthi WN ______

ABSTRACT INTRODUCTION The nursing process is a systematic The nursing process is a systematic problem- problem-solving approach used to identify, solving approach used to identify, prevent and prevent and treat actual or potential health treat actual or potential health problems and problems and promote wellness. The promote wellness. Implementation of nursing nursing process is widely accepted method process will improve the patient care and decreases morbidity rate and hospital stay. In and has been suggested as a scientific method to guide procedures and quality Teaching Hospital Jaffna, rate of morbidity and [1] hospital stay are increased because of less nursing care. It has five steps: consideration on application of nursing process. assessment, diagnosis, planning, Therefore it was decided to conduct a study to implementation and evaluation. Nursing assess the nurses’ knowledge on nursing process process is an essential part of the nursing and to identify the factors impact on care plan. International Council of Nursing implementation of nursing process in special (ICN) and the American Joint Commission units at Teaching Hospital, Jaffna. Descriptive on Accreditation of Hospital Nursing cross-sectional study was conducted among 100 Service Standards highly recommended that nurses working in special units at Teaching nursing process should be used in nursing Hospital, Jaffna. Convenient sampling method documentation and promoted the use of the was used. Data were collected by using [2] structured self-administrated questionnaire. Data nursing process in nursing care. Nursing were analyzed in descriptive statistical method. involves assisting others with basic human Among the participants 63% were females; 60% needs using a holistic approach and the were less than 30 years; 76% were Tamils; 64% patient is defined as someone who needs were Hindus, 46% nurses had 3-6 years working care. The majority of nurses have experience; 31% of participants from Medical knowledge on nursing process but they Intensive Care Unit (MICU). Results show that don’t apply in practice. [3] It is difficult to 17% of nurses had enough knowledge about bring significant improvement in nursing nursing process. 88% and 69.8% of nurses care if nurses do not use nursing process to reported that less time and workload are the assess, plan, implement and evaluate major personnel barriers for implementing nursing process respectively. Institutional clinical condition of the client. More ever, factors took the greatest part for lack of malpractice of nursing process will affect implementation of nursing process. Government quality of nursing care as a result of [4] must reemphasize on the provision of adequate different factors. Implementation of the resources to improve the practice of nursing nursing process leads to improved quality of process. care and stimulates the construction of theoretical and scientific knowledge based Key words: Challenges, Factors, Nurses, on the best clinical practice. [5] Due to this, Nursing process, Teaching Hospital. quality of care will improve and decreases morbidity rate and hospital stay.

International Journal of Science and Healthcare Research (www.ijshr.com) 61 Vol.3; Issue: 1; January-March 2018 Thuvaraka S et al. Challenges Faced by Nurses for Implementation of Nursing Process in Special Units at Teaching Hospital Jaffna

Furthermore, nurse’s positive attitude, lack engines. Reliability and readability of of sufficient time, lack of authority support, questionnaire was assured by a pre-test. disorganized working environment, and Ethical clearance was obtained from Ethics harassing co-workers were the challenges in Review Committee of Faculty of Medicine, developing countries. [6] In Teaching Jaffna. Pilot study was carried out among 5 Hospital, Jaffna morbidity rate and hospital nurses from Base Hospital, Tellipalai. stay were increased. Therefore it was Permission to conduct this study was decided to conduct a study to assess the obtained from obtained from , Base nurses’ knowledge on nursing process and Hospital, Thellipalai and from Director, to identify the factors impact on Teaching Hospital, Jaffna. Director, implementation of nursing process in Teaching Hospital, Jaffna through Matron. special units at Teaching Hospital, Jaffna. Data were analyzed by using SPSS19 statistical software in descriptive statistical METHODOLOGY method to assess the knowledge regarding Descriptive cross-sectional study nursing process and to identify the factors was conducted among 100 nurses working impact on practicing nursing process. in special units at Teaching Hospital, Jaffna. Convenient sampling method was used. RESULTS Nurses who were willing to participate and Among the participants 63% were available during the study period were females; 60% were under the age group of included as respondents and who were on less than 30 years; 76% were Tamils; 64% leave were excluded from the study. Data were Hindus, 46% nurses had 3-6 years were collected by using structured self- working experience; 31% of participants administrated questionnaire which included from MICU. Figure 1 describes the questions regarding socio-demographic knowledge and awareness regarding nursing details, nurses’ knowledge on nursing process. This finding indicates that only process, personal factors & institutional 17% of nurses had enough knowledge about factors that influence to implement the nursing process. Only 7% of nurses were nursing process. The questionnaire was aware about the first step in nursing process. generated by conceptual frame works that 27% and 35% of nurses understood results from review of literatures, experts’ activities during planning phases and opinions and personal observations. The nurses’ role during implementation phase in content validity of questionnaire was nursing process respectively. Only 3% of assured by referring to subject experts, nurses know about nurse’s performance for relevant books and by searching web evaluation in nursing process.

nursing performance

implementing process

planning phase

diff.betwewn med.diag and nur.dig

know.of 1st step of nur.process

know.of nursing procees

No.of nursing officers 0 5 10 15 20 25 30 35 Figure 1: Knowledge and awareness regarding nursing process

International Journal of Science and Healthcare Research (www.ijshr.com) 62 Vol.3; Issue: 1; January-March 2018 Thuvaraka S et al. Challenges Faced by Nurses for Implementation of Nursing Process in Special Units at Teaching Hospital Jaffna

While considering the personal nursing process, similar findings available factors influencing in application of nursing in a study, done in bad zone hospitals of process 52% of participants strongly agreed South East Ethiopia. [7-8] All participants in that positive attitude is important for the current study reported that they were practice of nursing process. 58% of nurses suffering from physical and mental stress, strongly agreed that adequate working which are influencing in practicing nursing experience also influencing the process. Similar findings are available in a implementation of nursing process. 88%, study, done in Ethiopia. [1] 69.8% nurses reported that not enough time In Teaching Hospital, Jaffna most of and workload are the barriers for the nurses have lack of theoretical implementing nursing process respectively. knowledge regarding nursing process. According to the current findings all Meanwhile shortage of nursing staff, participants reported that they were unavailability of materials for suffering from physical and mental stress, documentation; Similarly a study done in such as back pain, work load and time Brazil showed that lack of time, high patient management problems which are turnover and lack of administrative support influencing in practicing nursing process. were the factors limited the ability of nurses In Teaching Hospital, Jaffna most of to implement the nursing process in their the nurses have lack of theoretical daily practice. [9] knowledge regarding nursing process. Shortages of nursing staff, unavailability of CONCLUSION materials for documentation are most delivery system of Sri common barriers for application of nursing Lanka is aiming to offer the highest possible process. 73%, 42%, 48% of participants quality of health care services to many reported that nurses’ involvement is needed, people. Nurses should use nursing process superiors supports is need and ward to make their work visible and valuable to managers’ need to have positive concept improve the quality of care. Hence, about nursing process for the application of implementation of nursing process is nursing process respectively affected by various factors, if nurses have adequate knowledge about implementation DISCUSSION of nursing process, they can apply easily. Findings of this study indicate that Institutional factors took the greatest part for only 17% of nurses had enough knowledge lack of implementation of nursing process. about nursing process. Similar results were Alleviating the barriers based on the found in another study. [1] Only 7% of personal and institutional factors can nurses aware about the first step in nursing increase the application of nursing process process. Contrast finding was there in in health care service. From the findings of another study, [5] 27% and 35% of nurses this study it is recommended that nurses and understood activities during planning phases nurse educators should update their and nurses’ role during implementation knowledge on nursing process in theoretical phase in nursing process respectively. aspect as well as practical aspects. Similar results were found in another study. Government must reemphasize on the [6] provision of adequate resources such as 52% of participants strongly agreed materials, and nursing staff to health that positive attitude is an important institutions. personal factor for the practice of nursing process. Similar findings are available in a REFERENCES study which was done in Ethiopia. [1] Many 1. Hagos F, Alemseged F, Balcha F, et al. nurses reported that not enough time and Application of Nursing Process and Its workload are the barriers for implementing Affecting Factors among Nurses Working in Mekelle Zone Hospitals,

International Journal of Science and Healthcare Research (www.ijshr.com) 63 Vol.3; Issue: 1; January-March 2018 Thuvaraka S et al. Challenges Faced by Nurses for Implementation of Nursing Process in Special Units at Teaching Hospital Jaffna

Northern Ethiopia. Associated Factors among Nurses and Practice. 2014. Retrieved from: Working in Debremarkos and http://dx.doi.org/10.1155/2014/675212. Finoteselam Hospitals, Northwest 2. Björvell C, Wredling R, Ekstrand T. Ethiopia. J Nurs Care.2013; (3):149. Long-term increase in quality of nursing 7. Mahmoud MH, Bayoumy HM. Barriers documentation: effects of a and facilitators for execution of nursing comprehensive intervention. process from nurses’ perspective in Scandinavian Journal of Caring Najran General Hospital and King Sciences 2002;16(1):34–42. Khalid Hospital in Saudi Arabia. 3. Doublegist M. Nursing process among International Journal of Advanced Nurses- Factors Affecting Nursing Research .2014; 2(2):300-315. Process at Federal teaching hospital ll, 8. Siemuri KE, Oladayo OF, Ugochukwu Abakaliki, Ebong state Nigeria. NC. Factors influencing the utilization (2013).Retrieved from: of the nursing process in Ogun State, www.doublegist.com Nigeria. International Journal of 4. Shewangiza Z, Mersha A. Factors General Medicine and Pharmacy. 2013; affecting implementation of nursing 3(2): 57-64. process among nurses in Arbaminch 9. Adeyemo FO, Olaogun AAAE. Factors General Hospital, Ethiopia. American affecting to the Use of Nursing Process Journal of Nursing Science. 2015;4(3) in Health Institutions in Ogbomoso :45-49. Town, Oyo State, IJMPS.2013; 3(1):91- 5. Aseratie M ,Murugan R, Molla M. 98. Assessment of Factors Affecting Implementation of Nursing Process How to cite this article: Thuvaraka S, Among Nurses in Selected Vijayanathan S, Pakeerathy M et al. Challenges Governmental Hospitals, Addis Ababa, faced by nurses for implementation of nursing Ethiopia; Cross Sectional Study, J Nurs process in special units at teaching hospital Care. 2011; (3):170. Jaffna. International Journal of Science & 6. Abebe N, Abera H, Ayana M. The Healthcare Research. 2018; 3(1): 61-64. Implementation of Nursing Process and

******

International Journal of Science and Healthcare Research (www.ijshr.com) 64 Vol.3; Issue: 1; January-March 2018