INTRODUCTION

Background of the Study

Nursing is viewed as a helping profession that assists individuals

families and communities to effectively meet their health needs. Virginia

Henderson a nurse theorist gave her first definition of nursing in 1955

as; Nursing is primarily assisting the individual (sick or well) in

performance of those activities contributing to health or its recovery (or

peaceful death) that he would perform unaided if he had the necessary

strength will or knowledge and to do so in such a way as to help him

gain independence as rapidly as possible (Bassavanthappa 2007).

The challenge for developing a scientific base for nursing process in

order to improve the practice of its members in rendering services to its

clients/patients has been the basis for evolving a knowledge which is

uniquely nursing.

Process according to Horby (2005) is a series of things done in order to

achieve a particular result; it is a series of actions directed to some end.

Nursing process in the light of the aforementioned definitions is a series

of nursing actions directed towards an end or goal.

Shore (1988) Inyamel (2005) described the nursing process as

“combining the most desirable element of the art of nursing with the

most relevant elements of systems theory using the scientific method.

Nursing process is a process by which Nurses deliver care to patients

supported by nursing models or philosophies originally adopted form of

problem solving and is classified as a deductive theory

(en.wikipedia.org/wiki/Np.2011)

The North American Nursing Diagnosis Association (NANDA 1999)

defined the nursing process as a deliberate step by step series of

intellectual and scientific based skills used by a professional nurse to

assess client/patient problem plan objectives put the plan into action

and evaluate the extent to which the set goals have been achieved.

The nursing process was produced by the contribution of many

individual nurses in early 1960s Chambers and Komonta wrote some of

the first articles on nursing diagnoses in American Journal of Nursing

other contributors include Yura Walsh Carpanito Kim McFarland M.C.

Lane Gordon and Campbell. Each of which published textbooks of

nursing diagnoses (Ojo (2005) in Habila (2010)).

The leading force in reviewing and developing nursing diagnosis is

NANDA whose membership includes experts from various nursing

disciplines. These meet yearly to review refine and develop new

nursing diagnoses.

Adejumo (2008) in Garba (2008) reported that before the widespread

use of the concept of nursing process nurses were providing care to

clients/patients through the use of loosely structured framework based

on the medical model care was largely intuitive; relying on experience

feelings and observation rather than on facts base on research and

scientific evidence. There was little or no utilization of systematic

problem-solving skills and tools for individual and family patient

assessment as a result the data collected was haphazard and

inadequate for planning care leading to inconsistent nursing

interventions that could not be systematically evaluated.

Identifying the nursing process as the most suitable tool Adejumo

(2008) stated that the scientific tool that provides the nurse with the

unique role of work in collaboration with the client family and other

health care providers to carry out logical data collection analysis

appropriate intervention of client needs/problems as well as effective

evaluation of care is the nursing process.

The introduction of the nursing process as a systematic and scientific

approach to patient care started in the 1960s and has brought

tremendous improvement in the quality of nursing care rendered to all

categories of patients. As good as the concept of nursing process is its

implementation in health institutions across the globe has not been free

of set-backs and teething problems. For example Anyebe (1998)

asserted that the implementation of the nursing process in health

institutions have been rather slow and its acceptance by nurse

practitioners is resisted at worst and haphazardly implemented at best.

in the same vein Walsh (2002) observed that the nursing process

developed as a tool for teaching care planning and was then

implemented across the whole of nursing but unfortunately with little

research to support such a major step the result has been much

criticism and a sense among many nurse that it is time consuming

furthermore the idea that this all has to be written down is a task which

the nurses feel they have not got time for.

The nursing process is a deliberate intellectual activity whereby the

practice of nursing is approached in an orderly systematic manner; it is a

movement away from the traditional ritualistic task-oriented approach.

Nursing had to change to be able to satisfy the consumers of nursing

services as nursing then became concerned with clients total needs and

made concrete effort to develop a more systematic and rational pattern

for practice (Yamel 2005).

Nursing process is an effective tool for providing comprehensive patient

care that ensures patient satisfaction with nursing care and it

encompasses all the significant action taken by registered nurses. It is

the foundation of professional nursing practice and a strong foundation

for decision making process in nursing care. It is core and essence of

nursing and it is central to all nursing actions and can be used in all

nursing fields (Hirnle & Carven 2000).

Nurses maintain that care is at the core of nursing practice (Walsh

2007) the nursing process helps the nurses to achieve this goal it is an

adaptable tool which allows only the nurse to respond to the challenges

and changing needs of patients by following less on medical emphasis of

disease cure and more on holistic patient health promotion maintenance

and restoration.

In 1980 the American Nurses Association (ANA) developed the first

Social Policy Statement defining nursing as “the diagnosis and

treatment of human responses to actual or potential health problems:

Along with this definition came the need to explain the method used to

provide nursing care. Thus in the 1950s nursing leaders developed a

problem-solving process consisting of three steps – Assessment

Planning and Evaluation – patterned after the scientific method of

observing measuring gathering data and analysing findings. This

method was called the nursing process (Doegenes Moorhouse & Mur

2006).

Over time the nursing process expanded to five steps and has gained

wide spread acceptance as the basis for providing effective nursing care.

According to Hinrle and Carven (2001) the newest development in

nursing process is the six-step nursing process model introduced by ANA

in its standards of Clinical Nursing Practice (1991). In this six-step

model the ANA distinguished outcome identification as the third step of

the nursing practice. In emphasizing the importance and unique

position of the nursing process in nursing practice Doegenes et al

(2006) asserted that nursing process is now included in the conceptual

framework of all nursing curricula is accepted in the legal definition of

nursing in the Nurse Practice Act of most states and it is included in the

ANA Standards of Clinical Nursing Practice.

The five steps of the nursing process according to Kozier & Erb (2002)

are Assessing Diagnosing Planning Implementing and Evaluating.

Statement of the Problem

Ogoja Urban Hospitals (General Hospital Ogoja and Catholic Maternity

Hospital) are the two largest health facilities in Ogoja local government

area. These provide health care to a vast number of clients within the

area and neighboring local government area. The nursing process has

been accepted as the most effective professional tool for nursing

practice worldwide since the first national conference that herald its

official inception in 1990 at University College Hospital Ibadan by the

Nursing and Midwifery Council of Nigeria. Issues of implementation

have become a regular topic in research. However no attempts have

been made to determine the implementation of the nursing process sin

Ogoja Urban Hospital. This study is therefore aimed at determining the

implementation of the nursing process in Ogoja Uran Hospitals in Cross

River State.

Purpose of the Study

The purpose of this study is to determine the implementation of nursing

process in Ogoja Urban Hospitals. Specifically the objective of the study

is to:

1. Determine the adequacy of resources for the effective

implementation of the nursing process in Ogoja Urban Hospitals.

2. Ascertain the correct methods of administration of the nursing

process in Ogoja Urban Hospitals.

3. Determine the problems encountered by nurses in the

implementation of the nursing process in Ogoja Urban Hospitals.

Significance of the Study

The beneficiaries of the outcome of this study will be primarily:

The client/patients

The urban hospital management

Other state and private health facilities

The government of Cross River State

Nurses

Student nurses

The society

The clients/patients will benefit by receiving quality nursing care

patterned to meet their holistic needs as individuals and/or families.

Their rate of hospital visits and admissions will be reduced as a result of

improved care through the evidence based approach of nursing process

morbidity and mortality rate will also be reduced.

The nurses themselves will benefit by implementing the nursing process

and perfecting their skills on the job improvement of their

clients/patients conditions brings about job satisfaction and increased

knowledge base. Nurses and nursing will be appreciated in the society.

The hospital management will benefit from increase patronage of

clients/patients through increased revenue and partnership from

non-governmental organisations and government parastatals.

The government of Nigeria and especially that of Cross River state will

benefit from increased revenue from the hospitals and increased

productivity from reduced illness-related inefficiencies by employees.

Student nurse and midwives will benefit from the study as they will use

it to enhance academic performance and proficiency in clinical practice.

It will also act as secondary source for their literature review during

research studies.

Lastly the society in general will enjoy good health improved life

expectancy improved and efficient work force improved economy and

better standards of living.

Research Questions

The study will attempt to answer the following questions:

1. How adequate are the resources needed for the effective

implementation of the nursing process in Ogoja Urban Hospitals?

2. What are the correct methods of administration of the nursing

process?

3. What are the problems encountered by nurses in the implementing

the nursing process?

Scope of the Study

Issues on the implementation of the nursing process are vast and varied.

This study is restricted to determining the adequacy of resources

(human and material) needed for the implementation of the nursing

process ascertaining the correct methods of implementing the nursing

process and determining the problems encountered by nurses during

implementation of the nursing process in the two major urban hospital

in Ogoja local government area of Cross River state.