Factors that Hinder the Implementation of Nursing Process




Background of the Study

Demand for “quality” in all areas seems to be a rallying point for today’s society. It has become a major concern in the agenda of service delivery. It is virtually impossible to be part of today’s health care system and not appreciate the quality revolution that is taking place (Adigwe, 2004). In addition to the demand for quality, the public wants health care delivered at a lower cost, with greater accessibility, accountability, efficiency and effectiveness.

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Quality can be defined as a continuous striving for excellence and a conformance to specifications of guidelines (Adigwe 2004).  Operationally, quality of care could be defined as the ability of the nurse to provide care that meets patients’ needs based on professionally agreed standard. The process of health care includes two major components, technical interventions and interpersonal relationships between practitioners and clients. Both are important in providing quality care and both can be evaluated (Okoronkwo, 2005). Traditional approaches to quality have included a focus on assessing or measuring performance, assuring performance conforms to standards and providing appropriate modification if those standards are not met. The Nursing profession must meet these challenges by implementing a process that addresses the multifaceted issues in providing quality health care. For the nurse to actually attain to the improved quality of service, she should be conversant with the application of Nursing process, which is basically a systematic, patient-centred and scientific method of problem- solving for structuring the nursing care in order to achieve a maximum level of change towards the expected outcome (Kozier et al, 2008). Hence, Nursing process demonstrates Nursing function through the use of science, humanities, arts and skill, a combination that is unique and un-replicated. (Nwonu, 2002).

The Nursing profession like other health care professions in Nigeria and beyond have recognized and accepted that quality care in health is necessary in the professional practice of the disciplines responsible for the delivery of health. The delivery of quality health care in health sector is linked with problem identification, resolution, prevention and drive for efficiency, effectiveness and maintenance of very high and sustainable standard of care (Adigwe, 2004). This unique professional goal is to offer good care.

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The quest for quality care is as old as Nursing itself. Florence Nightingale first initiated quality Nursing care by the use of morbidity and mortality rates as a measure of quality during the Crimean war (Bassey, 2006). In addition, the author stated that this brought about reforms in the British health care system based on her reputation on the cycle of standard setting, observation, review and improvement in Nursing. Joint commission on accreditation of hospitals in North America was a corner stone in the work towards the setting of standard of nursing care. Moreso, in 1978, the Royal College of Nursing (RCN) commissioned a committee on the standard of Nursing care which recommended that nurses should imbibe to use the framework of the nursing process as a generic process of patients’ care.

A lot of improvements have been recorded in advanced countries, all geared towards meeting the satisfaction of consumers of Nursing service and health care. Programmes like Nursing audit, quality assurance and a review of nurses’ practice act all aimed at the improvement and sustenance of quality of nursing care. The need for this care was prompted due to recent great scientific and technological advances which brought about radical changes in the society and consequently, in the delivery of health care services in general and nursing practice in particular. Their efforts were channeled towards:

  • Providing appropriate health teaching to patients and significant others in the areas of maintenance of wellness and rehabilitation.
  • Utilizing the principles of Nursing process in meeting the specific needs of all ages in the areas of hygiene, safety, medication, etc.

In this part of the world, the effect is not much, despite numerous attempt that have been made to improve the quality of Nursing care, much have not been achieved. Several attempts have been made to improve the quality of Nursing service like the workshops organized by the west African college of Nursing in Accra with the theme. Quality Nursing care through Nursing process in 2003. Ghanian, Gambian, Nigerian nurses etc all participated in the sub-regional workshop. In Nigeria, committed efforts have been made to improve the quality of nursing care through the utilization of nursing process.

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The Nursing and Midwifery Council of Nigeria in 1982 in order to bring the quality of nursing care to an enviable position reviewed Nursing education curriculum and fully integrated the Nursing process concept to ensure that newly qualified nurses will be able to utilize the nursing process  in patient care.

Much concerted efforts have been put in place in areas like initial and continuing education through seminars, workshops and symposium with the upper-most view of improving the quality of nursing care and build capacity of professional nurses to adopt and use the nursing process programme in organizing, directing and implementing care. Examples of such hospitals include Ebonyi State University Teaching Abakaliki, Presbyterian joint Hospital Uburu and Mater Misericordiae Hospital [MMH], Afikpo.

Statement of Problem

Mater Misericordiae Hospital [MMH], Afikpo is a mission hospital in Afikpo and also a training institution for student Nurses since 1952. Nursing students and the professional nurses do not integrate the concept of Nursing process in directing patients’ care despite the concerted efforts of the ministry of health and Nursing profession to do so. As highlighted previously, nursing process is the major way to render quality nursing care to patients. It is hence, on the basis of giving undiluted, standard and quality nursing care that the researcher is motivated to identify factors hindering the implementation of Nursing process in Mater Misericordiae Hospital Afikpo, Ebonyi State.

Purpose/Objectives of the Study.

The purpose of this study is to identify the factors militating against Nursing process implementation and utilization in directing patient care in Mater Misericordiae Hospital, Afikpo, Ebonyi  State.

The objectives of the study specifically are to:-

  1. identify the Nurses’ factors that are responsible for the non- implementation of the Nursing process in Mater Misericordae Hospital, Afikpo, Ebonyi State.
  2. determine the administrative factors that hinder the Nursing process implementation in the hospital.
  3. elicit strategies to ensure Nursing process implementation and sustenance.


Significance of the Study

The researcher is optimistic that the findings of this study will be of great benefits to the Government/management of health care in general and Nursing service in particular to formulate policies, implement, direct, organize and evaluate the effectiveness and efficiency of care provided to patients in  Mater Misericordae Hospital Afikpo, Ebonyi State.

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To the nurse: The paper provides a bench mark upon which individual or collective nurses will re-appraise their achievement/productivity over time mostly in areas of competence and uniqueness in job specialization.

To the patients/clients: It will help to enhance their health status tremendously.

Finally, this quality Nursing care will serve/form a basis for further research either to confirm or refute findings.


  1. Are nurses knowledgeable on Nursing process (N.P)?
  2. What nurses’ factors are responsible for non-implementation of  Nursing process?
  3. What administrative factors hinder the implementation of N.P?
  4. What strategies ensure N.P implementation and sustenance?

Scope (Delimitation) of Study

The study is delimited to Mater Misericordae Hospital, Afikpo, Ebonyi State, one of the mission hospitals in the state. The study is confined to all cadres of nurses in the hospital. It is only investigating lack of adequate knowledge, skill and attitudinal factors that hinder Nursing process implementation in Mater Misericordae Hospital Afikpo, Ebonyi State.

Operational definition of terms

  • Process:- on-going event
  • Administrative factors:- Hospital issues/authority including policy , manpower development, material resources, stationery, and facilities, etc that hinder the implementation of Nursing process.
  • Nursing factors:- Nursing/ Nurses’ issues e.g educational status, attitude or lack of adequate knowledge of the total work environment hindering Nursing process’ implementation .


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