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FACTORS AFFECTING THE USE OF NURSING PROCESS IN HEALTH

INSTITUTIONS IN OGBOMOSO TOWN, OYO STATE

Article · March 2013

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International Journal of Medicine and
Pharmaceutical Sciences (IJMPS)
ISSN 2250 - 0049
Vol. 3, Issue 1, Mar 2013, 91-98
© TJPRC Pvt. Ltd.

FACTORS AFFECTING THE USE OF NURSING PROCESS IN HEALTH INSTITUTIONS

IN OGBOMOSO TOWN, OYO STATE

FLORENCE. O. ADEYEMO1 & ADENIKE A A E OLAOGUN2

1
Department of Nursing, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso,
Oyo, Nigeria
2
Department of Nursing, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria

ABSTRACT

This study assessed the factors affecting the use of nursing process in Health institutions in Ogbomoso town in
South West Nigeria. The objective was to find out the relative contribution of knowledge factor, institutional issues,
Professional factors and Attitudinal factors in the prediction of the use of nursing process and to evaluate which of the
predictor variables is the most potent predictor of the use of nursing process.

A survey design was adopted and questionnaires were distributed to 95 correspondents. Simple random sampling
technique was used to select forty five (45) subjects in Mission hospital, ten (10) subjects in Primary health care and forty
(40) subjects in government hospital, Ogbomoso. The instrument for collecting the data required for this study was a self -
structured questionnaire. The questionnaire was divided into five sections namely:- demographic data, knowledge,
institutional issues, professional factors and attitudinal factors. Likert rating scale was used.

Validity Test: The questionnaire was given to colleagues for peer review.

Reliability of the research instrument was done through test-retest method which gave 0.84 reliability co-efficient. The
statistics used for analysis of data were percentages, Anova and regression. The level of significance is P at<0.05 value.
The combination of these variables explained 76.5 percent of the variance in the use of nursing process. This indicates that
the multiple regression coefficient of 0.874 is not by chance.

Results: The relative contributions of the four predictor variables to the use of nursing process expressed as beta weights.
The partial correlation coefficients of all the predictor variables (knowledge factor, institutional factor, professional factor
and attitude factor) have positive values with criterion variable (the use of nursing process). Findings also revealed that
knowledge factor has the highest predictive value of 0.350 in the use of nursing process, followed by institutional factor (B
= 0.222) and professional factor (B = 0.063) the least is the attitude factor (B = 0.019). The result concluded that the
knowledge factor has the most important influence on the use of nursing process. It is recommended that the introduction
of educational programmes will enhance nurses’ ability to use nursing the process to improve the quality of patient’s care.
Secondly, motivation of nurses is very important in improving care planning systems that would further promote
consistency in the use nursing process.

KEYWORDS: Factors, Nursing Process, Nurses, Health Institutions

INTRODUCTION

Nursing process is described as a modified scientific method of clinical judgement used by nurses in clients’
care. It was developed by Ida Jean Orlando in the late 1950s with the observations of nurses in action. Doenges and
92 Florence. O. Adeyemo & Adenike A A E Olaogun

Moorhouse(2003) explained that nursing process has been in use for over 25 years as a systematic approach to nursing
practice. They further described nursing process as an efficient and effective method for organizing nursing knowledge and
clinical decision making in providing planned client care which has been undergoing constant re-evaluation and revision,
but the concepts within the process still remain central to nursing practice.

The nursing process was initially an adapted form of problem solving technique based on theory used by nurses
every day to help patients improve their health and assist doctors in treating patients. Its primary aim is to know the health
status and the problems of clients which may be actual or potential. It is made up of a series of stages that are used to
achieve the objective - the health improvement of the patient. The use of nursing process can stop at any stage as deemed
necessary or can be repeated as needed. This process is inclusive of physical health as well as the emotional aspects of
patient health. Nursing knowledge is used throughout the process to formulate changes in approach to the patient's
changing condition. During the process, nurses use this knowledge to identify problems and changes that are occurring to
the patient. Caring for a patient requires the nurse to communicate with the patient to determine how they are feeling and
gain the results of implemented care from the patient. Phases of the nursing process as identified by Kozier, Erb, Berman
& Snyder {2004} are (1)Assessment of the patient’s needs (2)Diagnosis of human response needs that nurses can dealt
with,(3)Planning of patient’s care, (4)Implementation of care, (5)Evaluation of the implemented care and these five phases
are not discrete entities but overlapping continuing sub processes. These five steps are the core of nursing actions in
which quality nursing care is delivered to patients [Quan,2007] .

Kozier et al {2004} stated that Nursing process gained legitimacy in 1973 and was included in the American
Nurses Association {ANA} standard of clinical nursing practice. In Australia, the use of nursing process commenced in
1974 as a result of the funding from Common Wealth Tertiary Education Commission (CWTEC), through Pat Slander.
Nursing Process was part of the new move to tertiary institution as a result of the establishment of degree programme for
nurses as recommended by Dr Sidney Sax in 1978.(Bowman, Thompson and Sulton 1983).

Nursing process is used in clinical practice worldwide to deliver quality individualized care to patients. This
process is supported by theories and philosophies as pointed out by Wikipedia [2009].The North American Nursing
Diagnosis Association [NANDA] explained that the nursing diagnosis is a clinical judgment about an individual, family or
community response to actual or potential health problems or life processes which provide nursing intervention and assist
nurses to achieve nursing outcome.

Nursing process started in Nigeria in the 1980s through the degree program in the universities but the
implementation in the clinical areas did not start until the 1990s. Wilkson[1999], explained that nurses use the nursing
process terms as separate progressive steps which in reality is progressive steps that form continuous circle of thought and
action. Wilkson further stated that nursing process is patient oriented, goal oriented, dynamic and cyclic, universally
applicable, problem oriented and cognitive processed. Berman, Synder, Kozier, and Erb [2008] stated that the nursing
process is continuous for every patient problem and care.

In Australia also, the nursing process has gone through the phases of resistance, acceptance and
institutionalization (Bowman, Thompson and Sulton 1983) The implementation of nursing process in both government and
private health institutions is one of the problems currently facing the nursing profession in Nigeria. The Nursing and
Midwifery council of Nigeria has fostered increased awareness in use of nursing process through seminars and workshops.
It seems that this innovation in our health institutions often meet with obstructions, and the motivations which might help
us to understand and overcome the implementation of the nursing process are lacking. The utilization of nursing process in
Factors Affecting the use of Nursing Process in Health Institutions in Ogbomoso Town, Oyo State 93

health institutions in Ogbomoso is a big problem. There seem to be factors causing the proper implementation of nursing
process, thus preventing quality care despite the fact that many nurses have acquired more knowledge about it. Ogbomoso
being a university town with a department of nursing, implementation of nursing process should not pose a problem but it
seems the reverse is the case. Thus, prompting the study of factors that affect the use of nursing process some health
institutions in Ogbomoso.

STATEMENT OF PROBLEM

In Nigeria, there are rigorous pursuits of the use of nursing process. The nursing care plans provides quality
delivery of nursing care through assessment, planning and implementation of care. Many of our health institutions have the
knowledge but they are not putting nursing process to practice. Many nurses complained of shortage of manpower when
interviewed. Other nurses felt it is cumbersome while others felt that the nursing process booklets are meant to teach
students. Ogbuokuri(2011) believed that “most nurses are resistant to change, professional development and advancement.
Some nurses tend to hold onto previous knowledge and skills without making efforts to improve and maintain new skills.
Many nurses are not willing to accept the challenges of staying abreast with education and development of new skills in
nursing practice.” The findings in this study is expected to profer solutions to health institutions in Ogbomoso on the use
of nursing process which will improve quality care giving to patients. Therefore this study sought to address the factors
that affect the use of nursing process some health institutions in Ogbomoso.

OBJECTIVES

The objectives of this study are:

• To determine what proportion of variance in the use of nursing process is accounted for by the linear
combinations of predictor variables (knowledge factor, institutional factor, professional factor and attitude
factor)?

• To assess the relative contribution of knowledge factor, institutional factor, professional factor and attitude factor
in the prediction of the use of nursing process.

• To evaluate which of the predictor variables is the most potent predictor of the use of nursing process?

MATERIALS AND METHOD

Research Setting
The setting of the study was Mission hospital, General hospital and Primary health centre located in the heart of
Ogbomoso town. Ogbomosho is constituted into five local government councils which include Ogbomoso north,
Ogbomoso south, Surulere, Orire and Ogo-oluwa . Ogbomoso is the second largest city in Oyo state after Ibadan lying on
the North-South trade root of the state. Ogbomoso is linked to the Northern and Eastern part of Nigeria by road and the city
has a University and two major teaching hospitals. This study is conducted in Ogbomosho north local government.

The Mission Hospital is a 182 bedded hospital founded 1907. The hospital is accredited total number of nurses
working there are ninety seven. It has facilities such as medical, surgical, paediatric and maternity wards, eye clinic, dental
clinic, intensive care unit, outpatient department, theatre, accident and emergency unit etc. Laboratory services such as X-
ray, ultra sonography, medical microbiology lab etc are also available. IT serves Ogbomoso, Oyo, Igbetti, Iwo and it’s
environment.
94 Florence. O. Adeyemo & Adenike A A E Olaogun

Primary Health Centre is situated in Arowomole area of Ogbomoso. The total no of nurses working there is
fifteen. The services rendered include infant welfare clinic, ante natal clinic, growth monitoring, nutrition demonstration,
immunizations and treatment of minor ailment.

Goverment Hospital 60 is a bedded hospital founded in 1957 by the then Premier of Western region. The
number of nurses working in this hospital is fifty five. It has facilities such as medical, surgical, paediatric and maternity
wards, theatre, ophthalmic, dental, outpatient department physiotherapy dept., Laboratory services such as X- ray, medical
microbiology lab, etc IT serves Ogbomoso, and it’s environment.

Study Design: Descriptive survey which examined factors that affect the use of nursing process in a mission,
general and primary health institutions in Ogbomoso.

Subjects: The subjects selected for this study are nurses drawn from Mission hospital, Government hospital and
Primary health centre all in Ogbomoso, Oyo state of Nigeria.

Sampling Technique: Simple random sampling in which ninety-five subjects was adopted. This include three
wards in the Mission hospital, i.e the male, female and children’s wards, Primary health centre and three wards in the
Government hospital, i.e maternity ward, male and female wards through fish bowl method. A total number of forty five
subjects from Mission hospital, ten subjects from Primary health centre and forty subjects from Government hospital
participated in the study.

Instrument: The instrument for collecting the data required for this study was a self- structured questionnaire.
The questionnaire was divided into five sections namely:- demographic data, knowledge factor[understanding of skills],
institutional issues[manpower, stationaries, continue education], professional factors[standard practice, promoting the use,
significance] and attitudinal factors[cumbersome, time consuming, difficult, not understood].The instrument consists of 34
items :12 items on knowledge,6 items on institutional factors. 7 items on professional issue and 9 items on attitudinal
factor.

Likert rating scale was used. The statistics used for data analysis include percentages, Anova and multiple
regressions.

Validity Test:-.The questionnaire was given to colleagues for review.

Reliability of the research instrument was done through test-retest method which gave 0.84 reliability co-efficient

Procedure for Data Collection:- The questionnaire was administered and data was collected from respondents

Ethical Consideration

Permission was sought from the heads of the nursing division in the selected hospitals, also a brief letter of
introduction appealing to respondents to participate in the study and informing them about the confidentiality of
information was given along with the questionnaires.

RESULTS

The demographic characteristics of the subjects in this study are presented as follows: the age range are (20-35yr)s
46.3%, (31-40yrs) 37.5% (41-51yrs) 11.3% and (51-60yrs) 5% . 82.5% of the subjects are female and 17.5% are male,
53.3% are married and 43.2% are singles. Subjects are 92% Yoruba, 5% igbos 2.6% other tribes. The professional
qualifications of subjects include RN 48.8%, RN/RM43.3%, BNSc 3.8%, RN/HED 1.3% RPHN 1.3% RN/A&E1.3% . The
current position of subjects are Nursing Officer 11 55%, Nursing Officer 1 2.1%, Senior Nursing Officer, 11.3%,
Factors Affecting the use of Nursing Process in Health Institutions in Ogbomoso Town, Oyo State 95

Principal Nursing Officer 13.8%, Acting Chief Nursing Officer 8.8% and Chief Nursing Officer 6.3%. Lastly, the years
of experience of subjects are 5yrs or 42.5%, 6-10yrs 18.8%, 11- 15yrs 20%, 16-20 5%, 21yrs and above 11.3%.

Table 1(a): Composite Contribution of the Knowledge Factor, Institutional Factor, Professional Factor and
Attitude Factor to Nursing Process

R R Square Adjusted R Square Std. Error of the Estimate

0.874 0.765 0.752 1.04066

Table 1(b): Analysis of Variance

Source of Variation Sum of Squares Df Mean Square F Sig.

Regression 263.965 4 65.991 60.936 0.000*
Residual 81.223 75 1.083
Total 345.188 79
* Significant at P<0.05

Results in Table 1(a) showed that the combination of all the predictor variables: knowledge factor, institutional
factor, professional factor and attitude factor have a multiple correlation of 0.874 with the use of nursing process.
However, the combination of these variables explained 76.5 percent of the variance in the use of nursing process as shown
by the coefficient of determination (R2adj = 0.765). The F(4;79) = 60.936 P < 0.05 Table 1(b) indicates that the multiple
regression coefficient of 0.874 is not by chance.

Table 2: Parameter Estimate of the Contribution of Knowledge Factor, Institutional Factor, Professional Factor
and Attitude Factor in the Prediction of the use of Nursing Process

VARIABLE B SEB Beta Rank T–Value Sig

(Constant) 3.029 1.303 2.324 .023
Knowledge factor .350 .027 .797 1st 12.771 .000
Institutional factor .222 .044 .289 2nd 5.082 .000
Professional factor .063 .060 .066 3rd 1.054 .295
Attitude factor .019 .027 .043 4th .720 .474

Table 2 reveals the relative contributions of the four predictor variables to the use of nursing process expressed as
beta weights. The partial correlation coefficients of all the predictor variables (knowledge factor, institutional factor,
professional factor and attitude factor) have positive values with criterion variable (the use of nursing process). This means
that the more nurses are knowledgeable, the more their use of nursing process. Similarly, the higher the institutional factors
in reducing the problem associated with medical issues in the clinics, the higher the use of nursing process. Also, the
higher the nurses are professionally (registered nurses) the higher the nursing process they practiced. Lastly, the higher the
attitude of nurses, the better their practice of nursing process.

The significant contributions of each of the predictor variables to the criterion variable was estimated and two
(knowledge and institutional factors) out of the four variables were significant. The remaining two variables were not
significant.

The independent variables that is the most potent predictor of the use of nursing process.

Using the value of partial correlation coefficient to determine the relative positions of the independent variables in
the prediction of the dependent variable, Table 2 reveals that knowledge factor has the highest predictive value of 0.350 of
the use of nursing process, followed by institutional factor (B = 0.222 and professional factor (B = 0.063) the least is the
attitude factor (B = 0.019).
96 Florence. O. Adeyemo & Adenike A A E Olaogun

DISCUSSIONS

This study showed that the combination of all the predictor variables which include knowledge factor,
institutional factor, professional factor and attitude factor have a positive influence on the use of nursing process.
Knowledge factor has the highest predictive value of 0.350 of the use of nursing process. This study agrees with the studies
of Martin el (1994) who noted that participants were knowledgeable of the nursing process, although the influence as
revealed by this study is not by chance. However, it is interesting to note that the knowledge factor influenced the use of
nursing process more than other variables. It is assumed that the subjects are only knowledgeable about nursing process
and all other factor are of less significance and this maybe the reason why the use of nursing process is not well
established in the health institutions under study.

Institutional factor (B = 0.222 ) ranked the second highest predictive value in the use of nursing process. This
study explained that institutional factor does not pose a barrier to the use of nursing process which is with the study of
Olaogun, Oginni, Oyedeji Nnahiwe and Olatubi (2011) which indicated that the hospital management made nursing
process booklets available for the use of nurses in caring for their patients. This present study does not agree with other
studies such as Brown, Wickline, Eccof and Glaser(2009) in their study discovered that organizational barriers { lack of
time and lack of nursing autonomy} were top barriers to the use of evidenced base practice while knowledge factor is a
facilitator. Munroe, Duffy and Fisher (2010) also identified lack of administrative support(institutional factor) as one factor
affecting the use of research findings, while Pokorski, Moraes. Chiarell,’ Costanzi and Rabelo (2009) focuses on
institutional variables as exerting more control over the use of the nursing process than the personal characteristics of
individual nurses. Lee [2005] further stated that many health institutions faces the challenges of helping professional
nursing staff refine their understanding of nursing diagnoses and charting skills, to identify patient problems and propose
appropriate care plans.

Professional factors (B = 0.063) ranked the third highest predictive value in the use of nursing process, which
means the professional factors are negligible. This may result from inadequate motivation by the professional associations
in promoting the use of nursing process. Carpento- Moyet in Olaogun, Oginni, Oyedeji Nnahiwe and Olatubi (2011) stated
that nurses preferred the use of medical model of care than embracing the care model exclusive to professional nursing
which is misunderstood by other health professionals, patients and their families. It is expected that ordinarily the
professional influence should outweigh other variables since the factors that make up a profession include education, with
extensive knowledge and skills which will distinguish nursing from other profession code of ethics, research, and
autonomy amongst other requirements. Although there is a standard of practice documented by the federal government,
but this standard is yet to be reviewed by the nurses association after the initial production. Many of the nurses have never
set their eyes on the standard of practice document in Nigeria as a result, affect the use of nursing process in promoting
quality care.

Attitudinal factor(B = 0.019)ranked the lowest predictive value in the use of nursing process, this is in contrast
with Martin el (1994) findings which revealed that participants held a relatively positive attitude toward the nursing
process and nursing diagnosis. They further explained that higher nursing degrees were associated with more positive
attitudes, but only 3.8% of the respondents of this study had degree which may account for the negative attitude . Their
study concluded that the most common barrier to the use of the nursing process was insufficient time and this portrays a
negative attitude. Bowman et al (1983) lamented that in Australia, the nursing process has gone through the phases of
negative attitude. Shabel (2009) in her studies explained that attitude is 20% of variance in the utilization of nursing
Factors Affecting the use of Nursing Process in Health Institutions in Ogbomoso Town, Oyo State 97

process. In the study of O’Connell (1998) some nurses displayed negative attitude towards the use of nursing process by
stating that it is incongruent with nursing practice.

CONCLUSIONS

This study showed that knowledge factor influence the use of nursing process more than other variables .One of
the biggest problems currently facing the nursing profession is that of implementing the nursing process as lamented by
Milne (1985) which the reporter believed that it can be influenced by the variables such as knowledge, profession, attitude,
institution. Institutional factor ranks the second highest predictive value in the use of nursing process but currently, many
institutions do not use nursing process for the care of their clients. The professional factor which ranked the third highest
need to be addressed because innovations in health care systems often elicit obstructions or faced with challenges resulting
in lack of motivation in implementation which may be responsible for the negative attitude of nurses which is the least
ranked in the use of nursing process.

Relevance to Clinical Nursing Practice

This study will give management of health institutions an overview of determinants for possible quality
improvements in nursing process documentation that needs to be undertaken in clinical practice, since the trend in health
care is to provide quality of care. It will also orientate the nurses to see the need for applying for in-service training
programmes through their institutions to replace the traditional method of care with a standardized care planning system,
thus helping nurses through this transition process.

RECOMMENDATIONS

• Introduction of educational programmes will enhance nurses' ability to use nursing the process to improve the
quality of patient’s care.

• Motivation of nurses is very important in improving care planning systems that would further promote
consistency in the process.

• Programs to train, improve and update the nurses working in health institutions with current innovations in the
nursing process should be implement

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