Exploring Factors Influencing Implementation of Nursing Process in Mathari National Teaching and Referral Hospital.

Abstract

Background: Nursing Process is a decision-making approach that promotes critical thinking towards enhanced patient management and better health outcomes. Its implementation in most Kenyan hospitals still remain low especially in the mental health units. Inadequate knowledge, incompetence, high patient turnover, lack of resources, inadequate administrative support and negative attitude are some of the factors which undermine the NP implementation. Objective: To explore factors that influence the implementation of nursing process in Mathari National Teaching and Referral Hospital. Material and Methods: MNTRH was purposely selected for the study and mixed method research design was used. The sample size was 151 nurses selected by simple random sampling technique while purposive sampling was used to select respondents for the interviews. Data was collected using questionnaires, interview guides and an observation checklist and presented in tables, graphs, charts and narrations. The data was analyzed using thematic analysis and descriptive statistics. Chi-square test of significance was used to determine the relationships between factors which influence NP implementation (Level of significance was set at p<0.05). The data was collected for a period of 4 weeks and study conducted at an estimated cost of Ksh 85,112.50. Findings: The findings of the study revealed that majority of the respondents 104(93%) were affirmative on their awareness of NP. It was established that utilization of NP at MNTRH was yet to be successful with the respondents indicating 25-40% success levels. The main utilized phases of NP at MNTRH were; assessment, diagnosis, implementation/interventions, and documentation but significant gaps existed in all the phases. Both structural and process factors have positive and significant influence on NP implementation at MNTRH. The interviewees further indicated that major barriers affecting NP implementation to be poor nurse-patient ratio, lack of managerial support and lack of monitoring and follow ups on the NP implementations. Conclusion and Recommendations: NP has not yet been fully utilized in patient care at MNTRH. Structural and process factors significantly influenced the level and extent of implementation of NP at MNTRH. The management of MNTRH should highly prioritize implementation of NP in patient care, offer regular in-service training on NP and monitor its practice. The Ministry of Health, regional health bureau, and other Non-Governmental partners to ensure that the institution is empowered on importance of NP and equipped with adequate nursing staffs.