1.1 INTRODUCTION

Background of the Study

Evaluating the implementation of nursing process for improved

clients care is quite significant very necessary and important.

Evaluation measures the effectiveness of an action carried out. It

promotes and questions goal achievement of a planned action.

Evaluation is defined as the judgement of the effectiveness of nursing

care to meet client’s goal based on the client’s behavioural response

(Adejumo and Olaogun 2009)

This implies that evaluation in nursing practice has to do with judging

the effectiveness of the nursing action carried out on the client and to

decide the improvement of the client health status following the care

rendered. Evaluation of care is one of the advantages of nursing

process.

Implementation is the practical way of putting plan either

verbal or documented into actions. However most of the care

rendered to client must be put into practical action in order to be able

to evaluate its implementation properly. Frankly speaking

implementation is the action phase of nursing process in which the

nurse carries out the plan of care (Brunner and Suddert 2004).

Critical thinking problem solving and decision - making skills are

essential for implementing the nursing plan as well as ability to

perform psychomotor skills. During implementation the nurse

continually assesses the client’s response and movement towards

goals and obtains data for use in evaluating the effectiveness of

nursing intervention and need for alternative actions.

The nursing process is a problem-solving approach that enables

the nurse to provide care in an organised scientific manner. The goal

is to alleviate minimize or prevent actual or potential health

problems. Nursing process is very significant when evaluating

problem in any health setting in accordance with quality assurance

(QA) and improved care of clients which is linked with quality

improvement (QI). The nursing process can be applied in any

interaction that involves a nurse and a client. The process can take

place in a variety of setting private home or long term care facilities.

Initially the steps are followed in sequence after the process has

begun; it becomes a cycle (Garba 2009). However the nursing

process provides an exiting arena for nurses to claim their role as

carers. The basic principles of this holistic approach that are

interwoven through the nursing process are consistent with the views

of health and healing globally (Adejumo and Olaogun 2009).

‘‘Improved clients care ’’ as a concept of this research work has

to do with better care/nursing actions rendered to the client to achieve

a better qualitative and positive result than the initial one. The

essence of improved clients care lies on the great benefits to the

client the nurses and the nursing profession. However skills that are

required in nursing process are necessary for the clinical application

of knowledge and theory in nursing practice. Moreover nursing

process has become an internationally accepted concept for providing

qualitative and interactive client care. Presently there are six phases

of the process which are assessment diagnosis outcome

identification planning implementation and evaluation (Adejumo and

Olaogun 2009).

1.2 Rational/Theoretical Framework

Many theories exist for better understanding of nursing

assessment of client’s needs. Each of these theories focuses on the

client/patient as an individual with nursing needs. The purpose of a

theory in nursing is to achieve the desired outcome of nursing. A

theory is a scientifically supported statement that describes explains

or predicts the interrelationship among concepts. According to

Rotimi (2006) different types of nursing model/theories are used to

gather necessary and relevant information from the client in order to

effectively deliver quality nursing care and to enhance quality

control/assurance.

Abraham Manslow Hierarchy of needs assist the nurse to

determine the ranking of the problems encountered by the clients.

Abraham Manslow Hierarchy of needs is a theory that views man as

an integrated whole that is influenced by internal and external needs.

In this theory the needs of man are arranged into categories with the

most basic need at the base of the pyramid. Manslow stated that the

higher needs only emerge after the lower ones have been gratified.

This was illustrated in a pyramid of human needs:

● Physiological needs which include food air water rest

elimination sexual gratification etc.

● Safely and security needs. This includes worthiness trust etc.

● Love and belonging needs. Includes affection approval.

● Esteem and recognition. Includes respect beauty physical

appearance knowledge etc.

● Self actualization respect fulfilment in life.

This theory of Abraham Manslow Hierarchical needs is applied in

assessment phase and in setting goal during planning phase.

Also Gordon Majory’s Eleven Functional Pattern Theory states

that all human responses fall within the eleven Functional pattern

which includes:

● Health perception

● Nutritional/ metabolic pattern

● Elimination pattern

● Activity/Exercise pattern

● Sleep and rest pattern

● Self perception- concept pattern

● Cognitive – Perception/Relationship pattern

● Sexuality – reproductive pattern

● Coping – stress tolerance pattern

● Value- belief pattern

This theory is usually adequately applied in the first phase

(assessment) in nursing process and it is best used in data

organization from which nursing diagnosis of client is deduced.

Furthermore Virginia Henderson (1968) stated that the unique

function of the nurse is to assist the individual sick or well in the

performances of those activities of daily living which he/she would

normally perform unaided if he/she had the necessary will

knowledge strength etc and to do it as quickly as possible to aid

recovery restore health or a peaceful death.

Virginia Henderson postulated fourteen activities of daily living

(ADL) which helps individual to carry on in life autonomously. She

expressed that the view that the nurse is and should be legally an

independent practitioner once she is not diagnosing treating a

disease or making a prognosis as this falls within the physicians’

responsibilities. Therefore the nurse has authority to nursing care

using the following activities of daily living:

● Breathing normally

● Eating and drinking adequately

● Elimination of the body wastes

● Movement and maintenance of desirable postures

● Sleep rest or play

● Maintenance of body temperature

● Grooming of body and protecting the integument (skin)

● Avoidance of changes in the environment and injuries to others

● Clothing

● Communication

● Working/learning/Discovery

● Worship

● Reproduction/Sexuality

● Death.

It is important to note that a theory or combination of theories/models

serve as the frame work/guidelines on which nursing care is planned

organised and implemented for improved clients care and to ensure

quality assurance in nursing practice.

1.3 Statement of Problem

Nursing process is very important to the nursing profession

hence evaluating its implementation is very necessary. It has been

observed that nurses are yet to live up to expectation as far as nursing

process is concerned particularly in Ahamadu Bello University

Teaching Hospital. It was also discovered that nurses in this hospital

have ready made answers for not wanting to implement the nursing

process and if they have to do it student nurses are instructed to

perform this function with little or no close supervision by the

registered nurses. Several efforts have been made to find out the

reasons for this poor attitude as regards the implementation of nursing

process in Ahamadu Bello University Teaching Hospital Zaria. It is in

view of this that this research will be embarked upon in order to

unveil the factors that affect the implementation of nursing in the

management of the clients. This evaluative study will reveal current

position and provides the way forward towards the implementation of

nursing process for improved clients care.

1.4 Purpose of the Study

This study will be guided by the following specific objectives:

● To determine nurses knowledge and attitude about nursing

process.

● To examine the utilization of nursing process in solving clients

needs

● To examine the factors that affects the implementation of

nursing process.

● To determine the effect of the use of nursing process in

Ahamadu Bello University Teaching Hospital Zaria.

1.5 Research Question and/or Hypothesis

The following research questions were raised for the study:

● What is the nurses’ knowledge and attitude towards nursing

process?

● Do nurses actually apply this knowledge of nursing process in

clients’ management?

● What are the factors that may affect the implementation o the

nursing process?

● Is the nursing process effectively used for client care in

ABUTH?

1.6 Significance of the Study

The study is deemed necessary because such study i.e.

“Evaluating the Implementation of Nursing Process for Improved

Client Care” in a Nigeria teaching hospital will be beneficial to

individuals groups community and institutions.

The study will assist the nurse to be able to evaluate the

implementation of nursing process in her hospital the factors

affecting the implementation as well as how to improve on these

factors or the way forward. Secondly the study will proclaim

nursing profession by making it more scientific and researchable. It is

obvious that implementation of nursing process in the Nigerian

hospital is a problem. As such data can be collected to find out why it

is a problem. Thirdly government and non governmental

organisations will definitely benefit from this research work as it will

assist them in formulating health policies that will be of benefit to the

people.

Furthermore the study will assist in improving the quality of

care given to the public and clients. In fact the health of individuals

families and the society at large will be improved.

Also the Nursing and Midwifery Council of Nigeria (NMCN) will be

of benefit because the study will assist her (NMCN) in maintaining

standards in the nursing profession by determining what knowledge

and skills are to be attained by individuals seeking to be members of

the nursing profession. The study will also benefit the institutions of

learning by formulating comprehensive clinical procedures and

development of curriculum for training of student nurses. Lastly the

study will also provide a framework for the evaluation of client’s

health condition.

1.7 Limitations of the Study

The limitation of study is strongly related to time factor as well

as financial implications which have to do with feeding and

accommodation expenses.

1.8 Scope/Delimitations of Study

The study will be carried out at Ahamadu Bello University

Teaching Hospital Zaria Kaduna state and the study is targeted at 160

out of the nurses working in the permanent site and Tudun Wada

hospital.

1.9 Operational Definition of Terms

● Evaluation: This means assessing the success of any action

carried out on the client with the hope of determining the

benefits.

● Implementation: It is a practical way of putting verbal/written

professional (nursing) plans into action.

● Nursing: It is the art of giving practical and verbal advices

correction lectures actions and care to both sick and healthy

people in order to promote their health status.

● Nursing process: This is current way of rendering a

comprehensive client care which involves the client’s relations

in which the nurses now enjoys professional autonomy.

● Client’s care: This is the nursing actions carried out on clients

to improve his/her health status.

● Improve: Means a better result/status than the initial time.

● Care: This means what can be said /done to someone else to

improve his/her health status.

● Process: This is a step by step of how things are done to

achieve best result.