ABSTRACT
The
nursing process is a scientific and systematic method of solving the numerous
patient’s problems, which promotes problem solving in professional practice,
and is useful because it promotes congruency and uniformity in practice.
This study
was carried out evaluate the impact of a training programme on utilisation of nursing
process among community health nurses in primary health care centres in
Ijebu-Ode LGA. A thorough review of
literature was done on the subject under study. The study design was a quasi-experimental
study and a total of 32 female participants took part in this study.
They were purposively assigned into the two treatment groups – intervention
group (participants who were trained on the use of nursing process) and the
placebo control group (participants who were not trained) using the relevant
inclusion and exclusion criteria. The intervention group had 18 (56.3%)
participants while the control group had 14 (43.7%) participants. Data was
collected using close-ended structured questionnaires and performance
observation check-lists. A statistical package for social sciences (SPSS 24.0)
was used to analyse data, descriptive statistics was used to present data, and
inferential statistics such as chi-square test was used to test the
relationship between different variables of the study at 0.05 significant
levels.
The results of analysed data showed that participants
had fair knowledge towards the utilization of nursing process, participants
also showed negative attitude towards the utilization of nursing process for
health care delivery. Further findings revealed low level of practice of
nursing process among community health nurses in primary health care centres in
the study area. The results of t-test statistic showed that the
post-implementation impact of the training programme was significant on the
knowledge of community health nurses (t= -1.565; p < .05), attitude of
community health nurses (t= -3.699; p < .05), and on the performance of
community health nurses (t= - 16.194; p <.05) in primary health care
centres. The univariate test of effect showed that there was a significant
effect of the training programme on participants’
post-test performance (F = 267.628; p < 0.05) with Least Square Difference
(LSD) comparisons indicate that the post implementation performance of participants
who were not trained and those who were exposed to training programme were
statistically different (MD =
-19.158; Std error = 1.171; p < 0.05). Years of experience of the
participants were not significantly associated with the assimilation of the training
programme, χ2(12) = 12.125.
The study concluded that the
intervention group exerted a greater effect over the control group, with
overall improvement in their knowledge, attitude and practice of the nursing
process. It is recommended that community health nurses should attend periodic
workshops to enhance their ability to use nursing process to improve the
quality of patient’s care. Nurse educators should also constantly reflect on
the nursing curricula to strengthen the role of registered nurses on the
utilisation of the nursing process when implementing elements of PHC in their
daily practice.
CHAPTER
ONE
INTRODUCTION
1.1.Background to the Study
Primary Health Care (PHC) describes
the basic tenets and values that guide professional nurses as the continuous
practice of health promotion, illness prevention, prompt diagnosis/care of
ailments and restoration of sick people to their pre-illness state (Iita, Small
and Van, 2011). According to WHO (2010), the utmost priority and
objective of primary health care is to ensure improved health for everyone. The
organisation has identified five basic principles for this as reducing
segregation and inequalities in social health (global coverage); designing
health care services around people's health needs and aspirations (service
delivery); integrating health into all sectors (public policy); the pursuing
collaborative ideals of policy dialogue (leadership); and the increasing
stakeholders’ involvement. In other words, PHC
focuses on a strategy that surpasses the orthodox health care
arrangement which stresses on health uniformity-yielding social policy;
but rather includes all aspects that directly influence health. This include;
prompt and timely access to health services, suitable environment and
lifestyle. Hence, primary healthcare and public health strategies may
together be considered as the fundamentals of universal health system (Daisy,
2009).
In
order to achieve these goals, the core attributes of primary health care which
are first contact (accessibility), longitudinality (person focused preventive
and curative care overtime), patient-oriented comprehensiveness and
coordination (including navigation towards secondary and tertiary care) are
factors that should be put in place and to also enhance effective health care
delivery (WHO, 2008). Besides taking care of the needs of the individuals,
primary health care teams also look at the community, especially when
addressing social determinants of health. This is achievable through a
community oriented primary care (COPC) experience which integrates public
health focus and primary health care. The interaction of the primary health
care team with different networks (education, work, economy, and housing) are
also important. By using all these methods, the primary health care team
promote health equity, increase social cohesion and empowerment through its
contribution (Daisy, 2009).
According
to Chukwu and Momoh (2010), the nursing process which is a universal phenomenon
is fundamental for making nursing a unique profession. Consequently, the
process of implementation of the components and attributes of primary health
care can be best achieved through the use of this process, being a broadly
acceptable, systematic
method of planning and delivering individualized care for clients in any state
of health or illness; and a scientific means
of solving the numerous and dynamic nursing problems (Chiarelli, Costanzi, Moraes,
Pokorski, and Rabelo, 2009). The nursing
process is made up of a global standard through which nursing problems
are identified and solved (Elder and Paul, 2005). It is also a method of
thinking critically to solve patient problems within the professional
practice. The nursing process is a series of steps taken to fulfil the goals
and objectives of nursing practice” (Walsh and Yura 1983). The nursing process
is a dynamic and an organised pattern for rendering nursing care through six
interrelated and overlapping phases of assessing, diagnosing, identifying
outcome, planning, implementing and evaluating nursing actions. It is an actual
task adopted by professional nurses to identify/ solve patient’s problems and
deliver a top quality levels of care among families, groups and communities
(American Nurses Association, 2009). At the assessment phase, a thorough
exploration of the needs of the individual, family, group or community that are
of importance to them are made by the nurse in order to arrive at a diagnosis
from the numerous data collected.
At
the planning phase, nurses’ judgment of the individual, family, or community’s
responses to the important life’s activities; or to specific or potential
health needs are identified and planned for. This also provide a basis for the
choice of appropriate nursing actions (North American Nursing Diagnosis
Association, 2007). The implementation phase addresses the problems identified
using the most relevant nursing actions and finally assessed for effectiveness
at the evaluation phase (Alfaro-LeFerve, 2004).
However,
the Implementation of the nursing process in the community and primary health
care settings can be achieved through the principles of action research which
requires knowledge and understanding of the major aspects of the nursing
process, and the platform through which this knowledge can be applied in
practical settings (Good and Savett, 2005). If this is implemented, it will
amount to good quality of care that enhances the development of scientific cum
theoretical knowledge that rests on a quality clinical nursing care, (Almeida,
Barra, Debétio, Marinho, Paese, Rios, and Sasso, 2013). Also, to promote and
enhance the worth of nursing practice, the use of nursing process is advocated,
because it advances, patterns and designs, in addition to promoting the
continuous use of information. This gives nursing staff the opportunities to
evaluate their work output/productivity as well as revamp the rate at which
they perform their job in relation to their consumers’ responses to care (Dal
Sasso, et al., 2013).This research
implemented a training programme for community health nurses on the utilisation
of nursing process, in primary health care in selected primary health care
centres in Ijebu-Ode Local Government Area.
1.2. Statement of the Problem
Nursing
process is a universal phenomenon that is foundational to nursing as a
profession. If correctly and effectively utilised, it will promote the quality
of health care; and improve the worth of nursing care at all levels of health
care including the primary, secondary and tertiary levels (Chukwu & Momoh
2010). However, despite this universal identification and acceptance of nursing
process as the major tool for delivering quality health care services, its
utilisation in the primary health care centres is still underrated, with the
major obstacles being related to the management processes in health services,
the resistance of nurses to change, shortage of manpower,
administrative/political matters that antagonise the practice of nursing, the
administrative design and programme of healthcare institutions, the lack of
autonomy of the professional nurse, centralisation of power in institutions;
and lack of willingness on the part of nurses to accept and face the tasks of modelling
themselves to acquiring new skills and education in nursing practice
(Alemseged, Aregay, Balcha, Berhe &
Hages, 2013).
The World Health
Organisation (2008) has registered this as a concern; and submits that since
health is a fundamental human right, the community has a role to play in
contributing to the health of its members and divers groups in the community.
Most communities today have at least one health care facility located as close
as possible to where they live or work, in all the districts or local
government areas of many of the states in Nigeria. Nonetheless, it has been
discovered that the establishment of these health care facilities has not in
any way led to its utilisation; with the record that one of the major
contributory factors to high mortality rate in Nigeria is lack of access to;
and non-utilisation of health care services due to unfair treatment of patients
and their relatives by the nurses and lack of competencies in providing quality
nursing care (Achi, Amos & Olayinka, 2014).
The researcher has noted from
clinical practice that most members of the communities where primary health
care centres are located, bypass these health centres to seek for health care
in secondary or tertiary institutions, when there are primary health care
centres in their neighbourhoods which are meant to serve their health needs.
Also, when patients are referred from Primary Health Care centres to secondary
or tertiary institutions for better and continued health management, they often
report at these institutions with more grievous complications than they were
originally before they sought care in these Primary Health Centres; with
reasons ranging from inhumane and rigid attitude of the community health nurses
to lack of competencies in providing quality care, mismanagement of the
conditions by care providers, exorbitant prices charged on services when they
felt primary health care should be relatively cheap and affordable among other
reasons. These has often led to increase mortality, morbidity and irreversible
damages on the patients’ lives. Chianca, Miranda, Silveira & Vaz, (2013)
support this evidence and affirm that a mismanaged patient in a primary health
care or faith-based organisation is often a reason for opening a death record
in either a secondary or tertiary health institution.
1.3. Research
Objectives
The
main objectives of the study isto evaluate the impact of a training programme
on utilization of nursing process among community health nurses in primary
health care centres in Ijebu-Ode LGA and the specific objectives of the study
are to:
- conduct
a need assessment on knowledge, practice and attitude of community health
nurses towards the utilization of Nursing Process.
- design
and Implement a training programme on the utilisation of nursing process
in primary health care delivery and
- measure
the post implementation impact of the training programme on the
participants.
- determine
the relationship between the years of experience of the participants and
assimilation of the nursing process training programme
1.4. Research Questions
- What
are the required needs of community health nurses on knowledge, attitude
and practice towards the utilisation of nursing process?
- What
is the post implementation impact of the training programme on the
community health nurses towards the utilisation of Nursing Process?
1.5. Research
Hypothesis
Ho1.
There is no significant effect of training programme on the utilization of
nursing process among community health nurses in primary health care centres in
Ijebu-Ode LGA
Ho2.
There is no relationship between the years of experience of the participants
and the assimilation of the training programme.
1.6. Significance of
the Study
This
study would help to stimulate the interest of community health nurses to
utilise the nursing process in delivering quality-individualised care to
patients and members of the community. It would also promote professionalism
and autonomy in work place; thereby making their work more visible and highly
valued by the broader society. It is expected to contribute to minimising
healthcare costs by less delays, reducing the length of hospital stay, task
duplication and promote the implementation of evidence-based practice; to drive
the use of information that supports the continuous practice of quality and
safe care. As part of the importance of the nursing process, it would support
collaboration on decision making among health care providers based on
contributory knowledge from them as led by nurses who are the primary care givers
in any clinic or community setting.
Since the development of nurse leadership is
considered as one of the key stones for enforcing the retainership and
productivity improvement at the primary health care level,
the study may contribute some importance for stakeholders and policy makers in
the primary health care board to provide an atmosphere for nursing care
practice template on scientific grounds, which stem from the pattern of the
service delivery framework, and the inclusion of nursing care into every
institution’s goals and mission
statements. This enhancement geared towards the implementation of
organisational-oriented techniques which seek to tailor the practice framework,
offer nurse professionals a concrete platform which promote the intense
commitment their involvement in the correct application of the nursing process
in various settings.
1.7. Operational
Definition of Terms
Outcome:
Information, event, object or state of being produced as a result or
consequence of a plan, process, accident, effort or other similar action or
occurrence (Oxford English Dictionary).
Training:
The activity of imparting and acquiring skills or the action of teaching a
person or animal a particular skill or type of behaviour (Oxford English
Dictionary).
Community:
A group of people or a social unit living in the same place or having a
particular characteristic in common and sharing certain attitudes such as
norms, values and identity (Merriam Webster Online Dictionary).
Community health nurse:
Community health nurses are the primary care providers in most communities,
home care and public health services working in an expanded nursing role with
other health care professionals to provide community health promotion services
which include prevention of disease, maintenance of health and the overall
wellbeing of the community in a designated region in accordance with the
philosophy and objectives of the authority (Northwest Territories).
Nursing Process:
It is a series of organised steps designed for nurses to provide excellent
care, offer framework for thinking through problems and provide some
organisation to a nurse’s critical thinking skills (American Nurses’
Association, 2005).
Selected Primary Health Care Centres: These are the basic
structural and functional units of the public health services in the community
who provide accessible, affordable and available primary health care to people
and have met the inclusion criteria for the research study from among several
options. ================================================================
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