Factors Influencing The Utilization Of Nursing Care Plans In Patients Care By Nurses At Nyamira District Hospital

Content

ABBREVIATIONS

ABSTARCT

CHAPTER ONE
1.1. BACKGROUND INFORMATION
1.2 PROBLEM STATEMENT
1.3 RESEARCH QUESTIONS
1.4 STUDY OBJECTIVES
1.4.1 Broad Objectives
1.4.2 Specific objectives
1.5 SIGNIFICANCE OF THE STUDY

CHAPTER TWO LITERATURE REVIEW
2.1 Introduction
2.2 Use ofthe nursing care plan.
2.3 Factors that hinder the utilization of the nursing process.
2.4 Factors that promote the utilization of the nursing process in patient
2.5 Strategies that promote theutilization of the nursing process.

CHAPTER THREE Research Methodology
3.1 study area
3.2 Topography and Climate
3.3 Study population
3.4 Research Design
3.5 Inclusion and Exclusion criteria
3.5.1 Inclusion criteria
3.5.2 Exclusive criteria
3.6
3.7 Sampling Technique
3.8 Study variables
3.8.1 Independent variables
3.8.2 Independent variables
3.9 Data Collection
3.9.1 Study Tools
3.9.2 Pretesting
3.9.3 Data Collection Process
3.10 Data management and Analysis
3.10.1 Ethical Considerations

CHAPTER FOUR DATA ANALYSIS AND PRESENTATION OF FINDINGS

CHAPTER FIVE DISCUSSION OF THE FINDINGS

CHAPTER SIX CONCLUSION

REFERENCES

APPENDICES
Appendix 1 Questionnaire
APPENDIX II :PROPOSAL BUDGET
APPENDIX III:WORK PLAN

DEDICATION

This dissertation is dedicated to our dear parents and guardians for their continued love and support in our academics.

ACKNOWLEDGEMENT

I express my sincere appreciation and gratitude to my supervisor, Mr. Johnson Omare and our research teacher Mr. Peterson Ongeri for their valuable guidance, patience and devotion from inception all through to finalization of this research proposal. Finally thanks to my parents for financial and moral support they offered.

But above all I thank the Almighty God for the gift of life and for guiding throughout the whole process.

OPERATONAL DEFINATIONS

Nursing process-provision of individualized nursing care to the patient

Nursing care plan- standardized frame work for implementing the nursing process

Utilization – the act of using

A factor- an element contributing to a particular result or situation

Influencing – to produce an effect either positively or negatively

A variable –something that can be changed

ABBREVIATIONS

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ABSTARCT

The main purpose of this study was to find out the factors that influence the use of the nursing process in patient care by nurses at Nyamira level five hospital. Both the factors that promote the nursing proves and also the factors that hinder he using of nursing hugely affect the outcome of nursing care that the patient receives either positively or negatively. The literature review provide the background information about th etopic under investigation. A descriptive survey method was used for the study. Data was collected using a questionnaire . stratified random sampling was used to select a sample size of 108 respondents from the target population . analysis of data rely heavily on statistical tools which enable one to come up with better presentation of the findings using pie charts and tables.

CHAPTER ONE

1.1. BACKGROUND INFORMATION

The Americannurses associationhas defined the nursing process assolving systematic rational approachthat ensuresconsistentcontinuous quality care . the steps of nursing process are assessment, nursing diagnosis ,planning , intervation and evaluaton. The nurse requirescognitive skills , technicalskills, interpersonal skillsand legalskills in orderto implement the nursing process.

Before the nursing process evolved the nurse provided care based on the orders that were given by the physician .carewas basedon the care giver’s instinctto nurture. There were no clearlydefined boundariesfornursing practice. Moorhouse(2003) explained that the nursing processhas been used over 25 yearss a systematic approachin nursing practice. In 1955 the term nursingprocess was fierst used by Lydia hall. Dorothy Johnson (1959), Ida Orlando (1961) and Ernestine Wiendenbach 91963) introduceda three stepnursing processmodel. In 1967Yuli and W alsh published the first comprehensivebook onthe nursing process in whichthey describedthefoursteps. Theyviewedthe element of nursing diagnosisasthe logical conclusionof theassessmentphasewhereas Gabbie and Lavin (1974) made nursing diagnosis as a separatestep in the nursing process. In 1973theAmerican associationlegitimized the nursing process when the standardof practiceto guide were developed (kozier et al 1995).

The utilization of the nursing processin patient carehad been veryminimal . in Australia the nursing processhas undergonethroughresistance , acceptance and institutional (Bowmanet al 1983). Studies have revealeddifficultiesin establishingthe use of the nursing processwithin institutions for examplea studycarried out in Brazil showed there were difficultiesin developingthe nursing process at all stages and that there was no needfor changesto speedup thework process (Lima Afc et al 2006).

1.2 PROBLEM STATEMENT

The nursing process is oneof the most misunderstoodnursing theories and yet one of the most effective as well as practical. Many studentsstruggle with this theory . it takes for students and new nursesto get the hung of this process, and many fightit every stepof the way , until oneday a lightbulb begins to burnbrightly(Revisalid et al 2002).

Learning the step of the processdoes not necessarilyequipa nurse to operationalize the process. Nursing requiresa strong cognitiveprocess as well as developedskills. Most of the times nurses are not working what they have gotfrom the class (Global healthcouncil et al 2010).

In kenya , thereare rigorouspursuits of the use of nursing process. The nursing care plans providesquality delivery of nursing care throughassessment, planning and implementationof care. Many of our health institutionshave knowledgebut they are not putting nursing processto practice. Many nurses complained of the shortage of manpowerwhen interviewed. Other nurses felt it iscumbersome whileothers felt thatnursing processbooklets aremeant to teach the students. In Kenyanurses make up5105% of all health workersin kentia public hospitals. (National Report on healthworkforce 2010). This impliesthat nursing service contributea large percentagetowardsoverall health care. Therefore the kind of care provided shouldbe of high quality hence the nursing processshould be applicablein all clinical settingto provide high quality patient care. Fortunatelytrainingcurriculumfor all cadreof nurseshas incorporated the nursing processas a frame work forproviding quality care(the nursing council of Kenya standards of nusing education). Even with these attempts the nursing process has not been adequately utilized in the Kenyan public hospitals.

1.3 RESEARCH QUESTIONS

The study will answer the following questions.

1. Do nurses in Nyamira Levelfive Hospital utilizethe nursing process?
2. What factorspromote the use of the nursing process in patientcare at Nyamira level five hospital?
3. What factors hinder the use of nursing process in patient care at Nyamiralevel five hospital?
4. What are the strategies that have ben put in place to promotethe use of nursing process?

1.4 STUDY OBJECTIVES

1.4.1 Broad Objectives

To establish the factors influencing the utilizationof the nursing process

1.4.2 Specific objectives

- To establishwhether the nurses use the nursing processin patient care
- To establishfactorsthat promotethe use of the nursing process
- To establishthe factorsthat hinderthe use of the nursing process in the patient care
- To establishthestrategiesthat have been put in place to promote the use of nursing process.

1.5 SIGNIFICANCE OF THE STUDY

The proposed study will be beneficial to stake holders such as the nursing council of Kenya as it will enable them to ascertain whether nurses in Nyamira level five hospitals use the nursing process. The ministry of medical services will use the information to justify whether to introduce the educational programs on the nursing process at Nyamira Level five hospital. Nurse mangers at the hospital will use the information from this study to promote the use of the nursing process among the nurses in their wards. The study will also serve as a reference material for future scholars who want to venture in to this area for a deep research.

CHAPTER TWO LITERATURE REVIEW

2.1 Introduction

This chapter examines the literature on the factors that affect the utilization of the nursing process (NP). It also tries to blend the previous studies from other world religions which faced similar situations, together with the Kenyan situation in an attempt to view the problem in various dimensions in order to understand the problem better and also with a view of identifying existing gaps in implementation of the nursing process. There are comprehensive and extensively written materials on factors that affect the utilization of the nursing process in patient care. This study will review literature based on the objectives of the study.

2.2 Use ofthe nursing care plan.

The daily application of the nursing process is characterized by the scientific background of the professional involved since it requires knowledge and provides individualized human assistance. Nursing involves assisting others with basic human needs using a holistic approach, and the patient is defined as someone who needs care.in theory, the majority of nurses have knowledge of the nursing process, but they do not apply it in practice.(Freites et al).

The nursing process is an approach and tool todetermine the needs of its consumers. It uses clinical judgment to strike a balance of epistemology evidence where critical thinking plays a part in categorizing client issues and the course of action. (Altamier et al). The nursing process is a problem solving framework that forms the basis on which the patient is determined delivered and communicated. Although it’s mainly used in educational purpose in the clinical stings it’s used at a low level (O’ Connell et al 1997). In order for a nurse to deliver quality care she or he has to have the knowledge of the nursing process (kozier et al2008). Florence Nightingale first initiated quality nursing care by use of mortality and morbidity rates as a measure of quality during the Crimean war (Bassey et al 2006). According to the standard ofpractice nursing demands the efficient use of the nursing process (Bartholomew et al 2007). This implies the nursing process is still developing and more needs to be done in order to fully

Incorporate the nursing process in to the standard of care. According to the committee of standard of nursing care at the royal college of nursing, nurse should incorporate the nursing process as a generic process of patient care (Moreso et al 1978). The use of nursing process is believed to have started in the 1960 and has been in use for over 30 years in countries like United States of America and Britain (Bartholomew et al 2010).according to carpetino (2008) an optimal care management system should include the nursing process (a general action formulated according to the nursing process). The plan should include an individualized approach. Study carried out to establish the useof the nursing process in gynecological wards in Namibia that revealed that the nursing process had been utilized efficiently. The finding indicated that registered nurses belief systems should be framed and that they should approach the nursing process differently and that thenursing process was a prerequisite for effective nursing care.(Africa journal of nursing and midwifery vol2 2010). The study furtherconcludes that optimal utilization of the nursing process is determined by cognitive impediments. A study carried out in Spain to determine the use of nursing process at public and private centers revealed that 43% ofhealthcenters apply the nursing process. The study noted that the use of nursing process was more wide spread at public than in private centers. This is because the public health system in Spain has received more human and financial support than the private system.

A study conducted in the United Kingdom to assess whether data obtained from nursing record could reliably use to identify interventions for patients with acute myocardial infarctions that the analyzed records did not provide an adequate picture of the needs or nursing interventions (Hornby et al 2008). A study conducted in Europe to test the establishment of validated model of nursing records aimed to promote individualized carerevealed that there are limitations ofthe nursing process conducted according to the model, particularly in the identification of the problems presented by the patients and consequently diagnosis and the possible intervention process. The daily application of nursing process is characterized by the scientific background of the professional involved since it requires knowledge and provides individualized human assistance. Nursing involves assisting others with basic needs using a holistic approach, and the patient is defined as someone as someone who needs care. In theory, the majority of nurses have knowledge of the nursing process, but they do not apply it in practice. (Freites et al 2007).

Studies thathave been carriedout have shown that the introduction of educational program has enhanced the ability of the nurse nursing process to improve the quality of patient care (Florence Adeyemi et al 2011).

2.3 Factors that hinder the utilization of the nursing process.

According to a study carried out in Nigeria at Mater Miseridordiae hospital on factors that hinder the nursing process , both the nurse and the patient have agreat deal on influence on the outcome of the nursing process. The study identified the following nurse factors to be major hindrance to the nursing process; lack of practical skills in data collection ,writing the nursing diagnosis and objective, nurses’ attitude towards the nursing process, lack of personnel and equipment, inadequate/lack of a conducive working environment and frustrations among nurses on the non-implementation of the nursing process. The patient factors were ; long patient stay in the hospital coupled with huge hospital bills make the patient to leave the hospital against medical advice and also the reluctance of patient to respond to questions siting too much questioning during the assessment stage of nursing process.

Mariner (2008) commented that some nurses’ attitude towards the nursing process was bad and he gave reasons for their actions such as the nursing process is a time consuming , a nurse cannot see any purpose for writing care plan and nurses lack the ability to recognize the independence of nursing functions and make their own judgments.

Emeh (2007) identified factors which he called the impediments to the implementation of the nursing process, such as ; lack of nursing process materials. Insufficient supply of nursing process materials, bad attitude by the nurses, non-cooperation among nurses, lack of supervision by the head nurses and lack of universal format for writing the nursing process. In a study published in 2008 that investigated whether the phases of the nursing process were fully utilized in patient care in hospital in Brazil, the author discovered the presence of failure in formulation of the nursing diagnosis (Hornby et al 2008).

The findings of the study carried out at the University of Nigeria to determine the factors that mutilate against the use of nursing process that 41% of the respondents have knowledge on the nursing process while 59% do not know the nursing process. 84% of the respondents saidthat a negative attitude towards the nursing process affected its use while 16% disagree with the opinion. Majority of the respondents that is 70% accepted that there is a relationship betweenthe nursingprocess and patient care while 30% opposed to that view (Momoh et al 2010).

A study conducted in Colombia to establish the factors that determine the application of the nursing process revealed that lack of time during the shift and having more than 4 years of professional experience, are decisive factors not to apply the nursing process

2.4 Factors that promote the utilization of the nursing process in patient

Foroozan (2011) commented that in order to promote the implementation of the nursing process nurse manager and educators should remove the barriers that impede the nursing process and also provide the facilities for implementation of the nursing process. Evidence of acute staff shortage in hospital in the USA has been surfacing since 2000. There has been a staff attrition rate of over 60% among the nursing staff this has led to poor implementation of the nursing process as the claim that they have inadequate time to implement the nursing process. Adequate number of staff promotes the utilization of the nursing process as every care given to the patient is individualized and there is time toadequately fulfill allthe care hence promoting high quality of care.

Murugan (2011) recommended that nursing managers should provide adequate environment and facilities for implementation of the nursing process. These include adequate nursing staff, adequate medical facilities and proper motivation of nurse so as to create morale to use of the nursing process.

2.5 Strategies that promote theutilization of the nursing process.

There have been numerous efforts to promote the use of nursing process in advanced countries. Programmers like nursing audit, quality assurance and review of nurses’practice act have improved the quality of nursing care. There is provision of health teaching to patients and also utilization of the nursing process in meeting the needs of all ages in hygiene, safety and medication.

A study carried out in Nigeria suggested that the following strategies for effective implementation of the nursing process; regular supply of nursing process materials, motivating the nurses, employing nurses, encouraging cooperation among nurses and regular supervision of the staff in implementation of the nursing process( Chudi Chukwuka et al 2013).

A Canadian retrospective study recommended that hospital administration should provide maximum support for the implementation of the nursing process. This can come in the form of financial or human support which is the key factors in the development of a successful system for providing quality care to the clients.

Adeyemi (2011) in her study recommended that there should be introduction of educational programmes to the nurse to enhance the use of the nursing process. She concluded that motivation of the nurse is key in improving care planning system that would promote consistency in the process

CHAPTER THREE Research Methodology

3.1 study area

The area studied was at Nyamira Level five Hospital. The hospital is situated in Nyamira Town in Nyamira County. The hospital has a bed capacity of 180. Hospital provides various services such as ; Antenatal ,laboratory, basic emergency and obstetric care, cesarean section, comprehensive emergency , curative inpatient and outpatient services, family planning , growth monitoring , integrated maternal and child health services , home based care and immunization.

3.2 Topography and Climate

The climate of Nyamira County is of a highland equatorial type with temperature which range from a mean annual minimal of 10.1c to a maximum of 20.8c with rainfall amount between 600mm and 2300mm per annum. It lies between latitude 0 and 45 south, the longitude 34,45 and 30,00 East. Long rain season occurs betweenMarch andJune whileshort rains occur from October to December. The main economic activities are tea, coffee,daily and farming and bananas plantation. Agricultural products are maize, bananas, beans, finger millet.

3.3 Study population

The study population were nurses working in all the departments such as casualty, medical wards, surgical ward, gynecological ward, pediatric ward. Therefore the study population of 70 nurses

The figure below shows the distribution of nurses in each ward

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3.4 Research Design

The design adopted fo rthis study was descriptive survey design this because the study was trying to find out what the nurse perceive to be factors that influence utilization of the nursing care plan in patient care.

3.5 Inclusion and Exclusion criteria

3.5.1 Inclusion criteria

Participants were included in this study if they meet the following criteria

- Staff nurses who have been practicingnursingfor a minimum of 3 months
- Willing to voluntarily participate in the study

3.5.2 Exclusive criteria

Participants were not included in this study if they meet the following criteria

Nursing staffs who have not qualified to practice such as student nurses and intern nurses.

3.6

Fishers’ formula will be used to calculate the minimum sample size

Formula:

N=desired sample size (target pop ≥500

Z=standard normal deviant at the required confidence level (1.96)

P= the proportion in the target population estimated to have particular characteristics being measured 50%

Q=1-p

d=precision level set at 0.05

p=50%

z=1.96

d=0.05

n=(1.96)2(0.05)(0.05)

(0.05)2

N=384.14

nf=desired sample size when the population size is less than 500

n= desired sample size when the population size is than 500

n=estimated of the population size 70

nf=384/70(1+384/70)

nf=35.578776

nf=36 therefore 36 nurses will be sampled.

3.7 Sampling Technique

A subset of the entire population was used for the study. Stratified was used in that the specific ward represent the strata for example the casualty ward , medical or surgical ward was the strata from which random sampling was done. In order to get the proportionate allocation of each allocation of each ward the following formula was used.

Total population in the strata / total population multiplied by sample size

For casualty =13/70×36=7 nurses

The same formula was used for all the remaining wards. The table below shows respondents from each ward.

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3.8 Study variables

3.8.1 Independent variables

Utilization of nursing care plan

3.8.2 Independent variables

Use of the nursing care plan

Factors that influence use of the nursing care plan

- Staff education
- Staff motivation
- Resources
- Attitude
- Knowledge
- Administrative factors
- Professional factors

3.9 Data Collection

3.9.1 Study Tools

The study instruments were structured questionnaire, because;

- It permits greater depth of response
- It is economical in terms of timeand money
- It is easy to analyze
- Open ended questions are easier to formulate.

3.9.2 Pretesting

The study pretesting was tested at Nyamira Level Hospital. The pretest was used to refine the study instrument for clarity and to ensure validity of the study findings is maintained.

3.9.3 Data Collection Process

Data was collected through self-administered questionnaires designed by the researcher that was distributed to all nurses willing to be sampled. It consisted of the following items to gather data; use of the nursing process, factors hindering the use of nursing process, factors promoting the use of nursing process bout the study to get an informed consent.

3.10 Data management and Analysis

All questionnaire completed were entered into an MS Excel database created by the researcher. Data wias then be analyzed for descriptive and inferential statistics. Qualitative data was coded for themes and analyzed for patterns, similarities and contrasts. Descriptive statistics was presented to describe the essential characteristics of the interviewed panel.

3.10.1 Ethical Considerations

Ethical approval to conduct this study was sought from Department of Nursing Kenya Medical Training College Nyamira campus. Permission to carry out the study at Nyamira level five hospital was also sought from hospital administration. Confidentiality was ensured by not inserting names of the participants on the questionnaires. All participants involved in the study were asked to give an informed consent before providing any information to the researcher. In addition the assessment did not involve confidential patient information.

CHAPTER FOUR DATA ANALYSIS AND PRESENTATION OF FINDINGS

The study was carried out at Nyamira District Hospital.It had one part of questionnaire which was filled by qualified nurses.

Question 1

Table 1:Age of the respondents.

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1.The table shows majority of the respondents (42%)were between age of 30-40 years.The lowest percentage 14 were above 50 years.26%were between age 25-30 years and 18% were ages 40-50 years.

Question 2.

Table 2:Gender

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2.The table shows majority of the respondents(79%)were female and lowest percentage 21 were males.

Question 3:EDUCATION LEVEL

Table 3:Showin the education level of respondents.

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3.The table shows that most respondents (61%)had their level of education at Kenya Registered Community Health Nursing,the lowest percentage 5% had their education level up to master of science.7%had their education in enrolled nursing ,16%had their education up to bachelorof science in nursing.

Question 4:

Figure 1: A pie chart showing use of nursing process in patient care.

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4.The pie chart above shows that most respondents(90%) do not use nursing process in patient care while 10% use nursing process.

Question 5:

Pie chart showing relationships between nursing process and the care the patient recievies.

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5.The pie chart above shows most respondents (95%)agreee that there is a relationship between nursing process and the care the patient receives while 5% disagree.

Question 6:

A bar chart showing if there are any guidelines in the ward on use of nursing process.

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6.From the pie chart above 20%shows availability of guidelines on use of nursing process in the wards while 80%shows lack of guidelines.

Question 7

A pie chat showing if guidelines influence utilzation of nursing process in patient care.

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7.The pie chart above shows that 10%of respondents agrees that guidelines influence utilisation of nursing process in patient care while 90%disagree.

Question 8

A bar graph showing the strategies put in place in the wards to promote utilization rate of the nursing process.

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8.The bar graph above shows majority of respondents 80% of strategies put in place in the wards to promote utilization rate of nursing process,and lowest percentage (20%) shows strategieswhich have not been put in place.

Question 9

The bar graph shows strategies are effective in promoting use of nursing process.

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9Majority of respondents(60%) shows that strategies used in promoting the effectivess of nursing process while (20%) shows the strategies in promoting use of nursing process was not effective.

CHAPTER FIVE DISCUSSION OF THE FINDINGS

The study was based on utilization of nursing care plan in patient care by nurses at Nyamira District Hospital.

According to the study,most of respondents were aged between 30-40 years with a percentage of 42.The respondents with least percentage were aged above 50 years.

Question 2.According to the study most of respondents were females with a percentage of 79 while male present with the least percentage of 21.

From the study the highest level of education of respondents was 61 who had their education up to Kenya Registered Community Health Nursing,master of science giving a percentage of 5,those who went up to bachelor of science in nursing 16% and those with Enrolled Nursing accounts to 18%.

Majority of respondents do not use nursing process in patient care hence patient’s needs are not met fully leading to long hospitalisation.

From the study it shows that a big relationship between nursing process and the care that the patient receives accounts to 95% while 5%disagree the relationship between the nursing process and the care that the patient receives.

The respondents who shows that there are no guidelines in their wards and the use of nursing process is represented by 80% and 20%shows there are guidelines in the wards on use of nursing process.

Majority of respondents shows that guidelines are not influenced how they utilize the nursing process in patient care which accounts to 90% but 10% shows how influence on utilisation of nursing process.

The respondents who agree that the strategies were put in place in their ward to promote utilisation rate of the nursing process represents 80% and the least percentage which is 20 % shows no strategies were put in place in their ward to promote utilisation of nursing process in patient care.

Majority of respondents agree that strategies put in place are effective in promoting the use of nursing process is represented by 60%

CHAPTER SIX CONCLUSION

The study was carried out to determine factors influencing utilisation of nursing care plans in patient care by nurse at Nyamira County And Referral Hospital.From the analysis majority of the respondents were aged between 30-40 years.This shows that most nurses know that nursing care plan is important in nursing care but due to shortage of nurses patient’s needs are not met.

RECOMMENDATION

The purpose of the study carried out was to ensure that health status of the patient in the hospital has been improved this can be done through ;

1.increasing number of staffs in the ward
2.providing guidelines in the wards on the use of nursing care plans.
3.educating staffs on the use of nursing process in patient’s care

LIMITATIONS

1.It is expensive as a lot of money is required for purchasing ,binding and typing materials
2.The research is time consuming as it requires perseverence and devotion.

REFERENCES

1. American Nurses Association (2000). Nursing A Social Policy Statement. Kansas. Berman Publications.
2. Ann Z.Kruszewski, Janice B. Linderberg And Mary Love Hunter (1998); Introduction Of Nursing ; Concepts , Issues And Opportunities . 2nd Edition. Philadenlphia. Lippincott.
3. Ballack C AndPoldosky T (2008). Discharge ofTheWard. London. Blackwell Scientific Publications
4. Barbara Cherry , Susan R. Jacob (2011) Contemporaly Nursing , Trends And Management . Memhis . Elsevier Mosby.
5. Barbara Hazard (2001). Statistical ,Methods For Health Care Research . 4th Edition .UsaLippointt.
6. Bartholomew C /(2010) . Aguide To The Nursing Process. London .Klinman Publications
7. Bland M (2001); An Introduction To Medical Statisticals, 3rd Edition . London .Oxford University Press.
8. Carol Taylor (2006); Fundermentals Of Nursing ; The Art And Science Of Nursing Care. Philadelphia Lippincott Williams.
9. Chitty Black , Kay Kitrel (2007). Professional Nursing 5thEdition . Saunders Inc
10. ChistensenKackrow (2011) Foundation Of Nursing 6th Edition . USA. Mosby Elsevier Inc
11 KozierErb (2004), Berman A And Snyder S (2004).Fundermentals Of Nursing ; Concepts Process And Practice, New Jersey . Pearson Education Inc.
12. Lee T Chang (2004), Standard CarePlans;Experiences Of Nurses, Taiwan. J Elin.
13 world Health Organization Report (2010).

APPENDICES

Appendix 1 Questionnaire

SECTION A:BIOGRAPHY

1. What is your age?

A 25-30 years ( )

B 30-40 year ( )

C 40-50 years ( )

D above 50 years ( )

2. What is your gender?

A. Male

B. Female

3. What is your highest level of education

A. Registered nurse

B. Kenya community health registered nurse

C. Bachelor of science in nursing

D. Master of science in nursing

SECTION B USE OF THE NURSING PROCESS

4. Do you use the nursing process in patient care

Yes ( )

No ( )

5. Do you thinkthere is a relationship between the nursing process and the carethe patient receives?

Yes ( )

No ( )

Give your reason…

6. Arethere any guidelines in yourward on the use of the nursing process?

7. Have these guidelines influenced how you utilizethe nursing process in patient care?

Yes ()

No ()

Factors influencing the use of nursing process

8. Which factors do you think promotethe use of nursing process in patient care?

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9. Which factors do youthink inhibit the use of nursing process in patient care?

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Strategies that promote the use of nursing process

10. Are there any strategies put in place in your ward to promotethe utilization rate of the nursing process?

No ()

11. Do you think these strategies are effective in promoting the use of the nursing process/

Yes ()

No ()

12. What do you think should be done to further promote the use ofnursing process in your ward?...

APPENDIX II :PROPOSAL BUDGET

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APPENDIX III:WORK PLAN

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