Factors Influencing Effective Utilization Of Nursing Process In Emergency Unit

INTRODUCTION
1.1 Background of the Study
In making decisions regarding patient care, the advancement of the nursing profession requires the application of a logical and rational approach to problem-solving. Utilizing information from nursing practice, nursing theories, and other sciences, nurses acquire and apply knowledge to specific individual situations (Aliyedun & Chukwu, 2018). The nursing process, according to the World Health Organization (WHO, 2015), is an organized sequence of problem-solving stages used to identify and manage patients’ health problems. It is a method that employs scientific reasoning, problem-solving, and critical thinking to guide nurses in providing effective patient care. The nursing process also establishes an auditable global standard for nursing care and reduces patient anxiety. (Carole, et al., 2015; Harcourt, et. al., 2017).
In addition, a nurse is expected to consider critically and creatively when resolving patient issues. (Haapoja, 2019; Harcourt, et al., 2017; Kozier, et. al., 2018). Consequently, the expansion of nursing as a profession has necessitated the application of a logical and rational approach to problem-solving when making decisions regarding patient care, as opposed to relying on unsystematic and intuitive processes. A previous study conducted in Kenya indicates that the quality of nursing care in hospitals reduces the number of hospitalizations when improved nursing care is implemented. (Carole, et al., 2015). A study on the implementation of the nursing process in Mekelle zone hospitals in northern Ethiopia revealed that 100 percent of nurses did not use the nursing process when caring for patients throughout the entire duration of the study. (Hagos, et. al., 2016). In addition, according to the study, 75% of nurses did not follow the nursing process due to the nurse-to-patient ratio (overcrowding). (Hagos, et. al., 2016). In Abuja Teaching Hospital in Nigeria, a deficit of personnel was the greatest obstacle, followed by a negative attitude of nurses toward documentation and a lack of time. (Adeyemo & Olaogun, 2015; Akbari & Shamsi, 2018). The utilization of the nursing process in three Ibadan hospitals was associated with difficulties in recording the patient’s medical history, formulating nursing diagnoses, and issuing nursing orders. The majority of nurses opposed the use of authorized abbreviations and symbols. However, the study concluded that the majority of nurses knew and understood the significance of documentation and that nurses require continuing education, practice, and oversight. (Hagos, et al., 2016; Ofi & Sowumi, 2019).
Utilizing nursing processes improves patient care and outcomes for both the patient and the patient’s family. It is an organizational framework for the practice of nursing that includes all stages the nurse takes to care for a patient: assessment, nursing diagnoses, planning (with objectives and outcome criteria), implementation of the plan (with patient education), and evaluation. (Mahmoud & Bayoumy, 2020; Shewangizaw & Mersha, 2015). The provision of quality care is contingent upon the availability of functional human and non-human resources to provide care and treatment. (Ministry of Health Community Development Gender Elderly and Children, 2010). In addition, there is a lack of documentation of the nursing procedure, which results in insufficient nursing care. (Mamseri, 2017). In response to the present state of nursing in Nigeria, the Nigeria Nurses and Midwifery Council developed a plan to ensure that the nursing process is implemented in all health care facilities. The Nursing Services Unit of the Ministry of Health developed the Nigerian Nursing Practice Model as a result of this strategy. (Ministry of Health and Social Welfare, 2015). Therefore, the primary purpose of the nursing process is to comprehend the actual or potential health status and problems of clients and to logically address these issues. (Adeyemo & Olaogun, 2015).
Improving the quality of nursing care is a crucial strategy for enhancing patient outcomes. Since the formulation of the Nursing Practice Model by the Nursing Services Unit of the Nigerian Ministry of Health and Social Welfare in 2002, little is known about its current standing. The current investigation was justified as a status check on the nursing procedure implementation. Consequently, the purpose of this study was to evaluate the knowledge and application of the nursing process among nurses employed at the Paediatric New Complex (PNC) Muhimbili National Hospital in Dar es Salaam, Tanzania.

1.2 Statement of the problem
According to the Ministry of Health (2015), patients in Nigerian public hospitals are dissatisfied with nursing care. To enhance the efficacy of healthcare as a whole, nursing services must be enhanced. Inadequate use of NP for patient management can result in substandard care, prolonged hospital length of stay, and an increase in death rate and disability due to actual and potential risks that could be avoided if all nurses use nursing care plans as required. (Bastable, 2018). The nursing practice has been incorporated into the curriculum for all levels of Nigerian nursing education. However, a study conducted by Nyatichi (2021) on the factors influencing the implementation of the NP in public hospitals in Nigeria revealed that nurses face obstacles in their daily implementation of the NP in health institutions, which contributes to the poor quality of health care in public hospitals in Nigeria, as only 15.7% to 30.1% of the nurses utilized some of the NP’s components. This is likely due to substandard quality health care (QHC) in Kenyan government hospitals.A random examination of 125 patients’ medical files in the seven departments of Narok County Referral Hospital in March 2018 revealed a 0% utilization of NCP in patient care at the time of the visit, as none of the randomly selected patients’ medical files contained a Nursing care plan. The number of examined files per ward was as follows: Paediatric (35), Male Medical (22), Male Surgical (15), Female Medical (20), Female Surgical (15), Obstetrics and Gynecology (8), and Maternity (8). (10). In addition, the majority of patients, regardless of their initial medical diagnoses, remained in the hospital for at least 10 days on average, as revealed by their medical records. This gap in NP implementation necessitated this study in order to assess potential barriers to the use of the aforementioned scientific process in this hospital, as it likely led to a longer average length of stay for patients, higher morbidity and mortality rates, substandard patient care, and poor patient outcomes.

1.3 Objectives Of The Study
The main aim of the study is to examine the factors influencing effective utilization of nursing process in Emergency Unit Of General Hospital Ilorin. Other aims of this study are:
1. Ascertain the level of nurses knowledge on the uses of nursing process among nurses in Emergency Unit Of General Hospital Ilorin.
2. Identify the need for the use of nursing process in the care of patents in Emergency Unit Of General Hospital Ilorin
3. Find out the factors influencing the use of nursing process among nurses in Emergency Unit Of General Hospital Ilorin.
 
1.4 Research Questions
The following research questions will be answered in this study:
a. What is the level of nurses knowledge on the use of nursing process among nurses in Emergency Unit Of General Hospital Ilorin?
b. What are the need for the use of nursing process in the care of patents by nurses?
c. What are the factors influencing the use of nursing process among nurses in Emergency Unit Of General Hospital Ilorin?

1.5 Research Hypotheses
Ho: There are no factors influencing the use of nursing process among nurses in Emergency Unit Of General Hospital Ilorin.
Ha: There are are factors influencing the use of nursing process among nurses in Emergency Unit Of General Hospital Ilorin.

1.6 Significance Of The Study
The study will help to throw more light in the factors influencing effective utilization of nursing process in Emergency Unit Of General Hospital Ilorin. And it will help improve quality of individualized care given to patients.
The findings of this study will equip nurses with information on possible hindrances towards utilization of NP and the methods of curbing these shortcomings. It will also inform in-service training coordinators in all health institutions in Kenya on the significance of updating the nurses’ know-how on the said field, useful to policy makers and health care planners in up scaling NP utilization n service delivery. It can also benefit the patients through improving the standards of care, reduce the burden of prolonged length of stay in hospitals, promote positive patient outcome, reduce mortality and morbidity as well as increase patient’s satisfaction towards nursing care. It can also promote professional responsibility and accountability of nurse practitioners. The finding of this study can also act as a basis for future studies.

1.7 Scope Of The Study
The study generally focuses on the factors influencing effective utilization of nursing process in Emergency Unit Of General Hospital Ilorin. By extension the study will the level of nurses knowledge on the uses of nursing process among nurses, the need for the use of nursing process in the care of patents by nurses, and the factor militating against implementation of nursing process among nurses. However, the respondent for this study will be obtained from selected nurses in Emergency Unit Of General Hospital Ilorin.

1.8 Limitation Of The Study
Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.
Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.
 
1.9 Definition of Terms
Nursing process: A systematic approach which is scientific in nature involving use of nursing process in patient management and that forms a basis for nursing care towards patient management among NCRH nurses.
Implementation of nursing process: Implementation means utilizing all the NP steps in patient care by nurses in NCRH. It was used interchangeably with utilization in this study.
Quality nursing care: This refers to best practices channeled towards patient care by attending to patients individually and holistically by applying NP steps correctly in patient management in NCRH.

1.10 Organization Of The Studies
The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.