Factors Affecting the Implementation of the Nursing Process in Tertiary Hospitals: A Cross-Sectional Study
Keywords:
Factors, implementation, nursing process, patients, Saudi ArabiaAbstract
OBJECTIVE: To identify and examine the factors that hinder the effective implementation of the nursing process in tertiary health care settings in Saudi Arabia.
METHODOLOGY: A descriptive cross-sectional study was conducted among 182 registered nurses with at least one year of experience in tertiary hospitals in Makkah, Saudi Arabia, recruited through hospital administration using a systematic random sampling technique A structured questionnaire, adapted from Owusu-Ansah YA and Agyeman-Yeboah J, was used to collect data on demographic characteristics and factors at the knowledge, individual, and health system levels that affect the implementation of the nursing process. Data were analyzed using descriptive statistics, and chi-square tests were performed to assess associations and predictors of barriers to the implementation of the nursing process (p < 0.001).
RESULTS: Knowledge of the nursing process varied, with gaps in understanding its structured framework and care plan, while most nurses recognized its continuity, patient involvement, and role in quality care. Certain aspects of knowledge were significantly associated with academic qualification and clinical experience, whereas professional rank had minimal influence. Individual-level factors showed limited associations with qualification, rank, or experience, and health system factors were largely un-associated with nurse characteristics, except that participation in training and workshops was significantly associated with qualification and experience.
CONCLUSION: The study reveals a diverse spectrum of knowledge among nurses regarding the nursing process and its components. Addressing context-specific factors that may facilitate or hinder the implementation of the nursing process is essential for effective patient care and patient safety.
References
REFERENCES
Pentecost, C., et al., Patients' and nurses' experiences of fundamental nursing care: A systematic review and qualitative synthesis. J Clin Nurs, 2020. 29(11-12): p. 1858-1882.
Kieft, R.A., et al., How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC Health Ser Res, 2014. 14(1): p. 249.
Šip, M., et al., Human Dignity in Inpatient Care: Fragments of Religious and Social Grounds. Religions, 2023. 14(6): p. 757.
Zamanzadeh, V., et al., Challenges associated with the implementation of the nursing process: A systematic review. Iran J Nurs Midwifery Res, 2015. 20(4): p. 411-9.
Mariano, C., Nursing Emergency: ANA, Nursing: Scope and Standards of Practice. 2021: American Nurses Association.
Lotfi, M., et al., Nursing process from theory to practice: Evidence from the implementation of "Coming back to existence caring model" in burn wards. Nurs Open, 2021. 8: 2794-2800.
Asmirajanti, M., A.Y.S. Hamid, and R.T.S. Hariyati, Nursing care activities based on documentation. BMC Nurs, 2019. 18(1): p. 32.
Mohanna, K., et al. Teaching made easy: a manual for health professionals. 2004: CRC Press.
Mousavinasab, E.S., et al., Nursing process education: A review of methods and characteristics. Nurse Edu Pract, 2020. 48: p. 102886.
Semachew, A., Implementation of nursing process in clinical settings: the case of three governmental hospitals in Ethiopia, 2017. BMC Res Notes, 2018. 11(1): p. 173.
Shahzeydi, A., Jazi, Z.H., and Babaei, S. Exploring the perceptions of nursing internship students and their faculty mentors regarding the complexities and hindrances associated with implementing the nursing process within the clinical setting: An in-depth qualitative investigation. Heliyon, 2024. 10: p. e31715.
Alsadaan, N., et al., Challenges Facing the Nursing Profession in Saudi Arabia: An Integrative Review. Nurs Rep, 2021. 11: p. 395-403.
Zeleke, S., D. Kefale, and W. Necho, Barriers to implementation of nursing process in South Gondar Zone Governmental hospitals, Ethiopia. Heliyon, 2021. 7(3): p. e06341.
Adraro, Z. and D. Mengistu, Implementation and factors affecting the nursing process among nurses working in selected government hospitals in Southwest Ethiopia. BMC Nurs, 2020. 19(1): p. 105.
Tadzong-Awasum, G. and A. Dufashwenayesu, Implementation of the nursing process in Sub-Saharan Africa: An integrative review of literature. Int J Africa Nurs Sci, 2021. 14: p. 100283.
Asrate, M., Murugan, R., and Molla M., Assessment of factors affecting implementation of nursing process among nurses in selected governmental hospitals, Addis Ababa, Ethiopia; Cross Sectional study. J Nurs Care, 2014. 3(3): p. 2.
Hagos, F., et al., Application of Nursing Process and Its Affecting Factors among Nurses Working in Mekelle Zone Hospitals, Northern Ethiopia. Nurs Res Pract, 2014. 2014: p. 675212.
Baraki, Z., et al., A cross sectional study on nursing process implementation and associated factors among nurses working in selected hospitals of Central and Northwest zones, Tigray Region, Ethiopia. BMC Nurs, 2017. 16(1): p. 54.
Alhamed, A., et al., Perspectives of Executive Nurse Leaders on Advanced Practice Nursing in Saudi Arabia: Challenges to be Overcome and Opportunities to be Seized. J Nurs Manag, 2023. 2023: p. 6620806.
Alshammari, M., J. Duff, and M. Guilhermino, Barriers to nurse–patient communication in Saudi Arabia: an integrative review. BMC Nurs, 2019. 18(1): p. 61.
Alqahtani, J.M.,et al., Barriers to Implementing Evidence-Based Practice among Primary Healthcare Nurses in Saudi Arabia: A Cross-Sectional Study. Nurs Rep, 2022. 12: p. 313-323.
Yamane, T., Statistics: An introductory analysis. 2nd ed. 1967, New York, USA: Harper and Row.
Owusu-Ansah, Y.A. and J. Agyeman-Yeboah, Barriers to effective implementation of the nursing process among emergency ward nurses at a tertiary hospital, Accra; a cross sectional survey. Int J Africa Nurs Sci, 2022. 16: p. 100425.
Munro, N., Evidence-based assessment: no more pride or prejudice. AACN Clin Issues, 2004. 15(4): p. 501-5.
Pokorski, S., et al., Nursing process: from literature to practice. What are we actually doing? Rev Lat Am Enfermagem, 2009. 17(3): p. 302-7.
Ahtisham, Y. and Jacoline, S., Integrating nursing theory and process into practice; Virginia's Henderson Need Theory. Int J Caring Sci, 2015. 8(2).
Jamal, Z., et al., Nurses knowledge regarding nursing process and barriers in its application: Nurses' knowledge regarding nursing process. Pak J Health Sci, 2023. 4(07): p. 52-56.
Mahmoud, M.H., and Bayoumy, H.M., Barriers and facilitators for execution of nursing process from nurses’ perspective. Int J Adv Res, 2014. 2: p. 300-315.
Bassah, N., Epie, N.N.E., and Ngunde, P.J., Nurses' knowledge and use of the nursing process in two major hospitals in Fako, Cameroon. Nursing Practice Today, 2023. 10(1): p. 53-61.
Tadzong-Awasum, G., et al., Nurses’ experiences with the adoption and use of the nursing process in four urban hospitals. Int J Africa Nursing Sci, 2022. 16: p. 100411.
Miskir, Y. and S. Emishaw, Determinants of Nursing Process Implementation in North East Ethiopia: Cross-Sectional Study. Nurs Res Pract, 2018. 2018: p. 7940854.
Obonyo, H., et al., A cross-sectional study on knowledge and implementation of the nursing process among nurses at Muhimbili National Hospital-Tanzania. Tanzania J Health Res, 2019. 21(2): p. 1-9.
Alshammari, M.H., et al., Evaluation of the utilization of nursing process and quality of patient care in Ha’il city, Saudi Arabia. Int J Adv Appl Sci, 2020. 8: p. 67-74
Afolayan, J.A., et al., Evaluation of the utilization of nursing process and patient outcome in psychiatric nursing: Case study of psychiatric Hospital Rumuigbo, Port Harcourt. Adv Appl Sci Res, 2013. 4(5): p. 34-43.
Adeyemo, F.O. and A. Olaogun, Factors affecting the use of nursing process in health institutions in Ogbomoso Town, Oyo State. Int J Med Pharmaceut Sci, 2013. 3(1): p. 91-98.
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