Barriers to the Implementation of Nursing Process From the Viewpoint of Faculty Members, Nursing Managers, Nurses, and Nursing Students

Abstract

The nursing process is defined as a standard of care; however, its implementation in actual clinical settings is very limited, which reduces the quality of care.Objective: To determine the barriers to the implementation of the nursing process from the viewpoint of the faculty members, nursing managers, nurses, and nursing students of the Mashhad University of Medical Sciences. Materials and Methods:This analytical cross-sectional study was carried out in 2014 on 90 nursing lecturers and students of the Mashhad Nursing and Midwifery Faculty, and 134 nurses and nursing managers of the educational hospitals of the Mashhad University of Medical Sciences. The participants were selected by the convenient sampling method using a research-oriented questionnaire (validity and reliability confirmed) to investigate the barriers to the implementation of the nursing process. The data was analyzed by using descriptive statistics (mean±SD, and absolute and relative frequencies), one-way ANOVA, and the Pearson correlation coefficient. Results:The most significant barrier to implementing the nursing process according to 90% of the lecturers was the lack of a checklist for recording the process in the medical records of the patients; according to 90% of the managers, it was the high number of patients under care of each nurse, and according to 90% of the nurses and 93.5% of the students, it was the lack of a principal training of the nursing process during their studentship. There was a significant difference in the views of the four groups (P=0.03). Conclusion:The health system authorities of the country should make changes in the clinical and educational areas, such as including a nursing process record sheet in the medical records of the patients, getting advice and assistance from the experts in the field of nursing education and technology, and facilitating the implementation of the nursing process in the clinical field.

The implementation of the nursing process in lower‐income countries: An integrative review

“…The implementation of this process increases patients' satisfaction due to an increase in patient–nurse communication, improves the quality of nursing care and documentation. If the nursing process is implemented electronically, it saves time and nursing errors are reduced (Ghafouri Fard et al, ; Rajabpoor et al, ; Semachew, ; Takahashi, Barros, Michel, & Souza, ). But, in lower‐income countries for three reasons, the NP is not conducted extensively and continuously at the hospitals or performed very poorly: low proficiency of faculty members from the concept of the NP, lack of necessary infrastructure and lack of supporting nursing institutions and managers (Rahmani et al, ; Rajabpoor et al, ; Semachew, ).…”

“…The lack of infrastructures such as lack of appropriate nursing documentation system manually, lack of software NP, poor HIS in hospitals, lack of standard tools for assessing nursing care based on NP and lack of tools supervising the implementation of the NP is the second reason that the nursing process is not implemented in these countries (Rahmani et al, ; Rajabpoor et al, ; Semachew, ).…”

“…Then, the final papers were extracted according to the inclusion and exclusion criteria of the study (Table ). The reasons for choosing low‐income countries including Iran, Brazil, Bolivia, Taiwan, Ethiopia, Mexico and Egypt in this study were that the challenges of nursing care in their clinical settings were similar (Fernández‐Sola et al, ; Ledesma‐Delgado & Mendes, ; Rajabpoor et al, ; Semachew, ; Yeh et al, ).…”

“…Following this, an iterative process was used to develop categories by combining codes. Descriptive themes were attached to each category and are discussed in data comparison (Dal Sasso et al, ; Frigstad, Nøst, & André, ; Ghafouri Fard et al, ; Ledesma‐Delgado & Mendes, ; Mazlom & Rajabpoor, ; Mohammadi, Ghafori Fard, & Esmaeilivand, ; Rahmani, Alijani, Dashtbozorge, & Haghighizadeh, ; Rajabpoor et al, ; Semachew, ; Zamanzadeh et al, ).…”

“…The main element of the NP is the nursing diagnosis that helps the nurses in guiding nursing care and in promoting the documentation process (Paans, Nieweg, van‐der‐Schans, & Sermeus, ). Despite the importance of this process for patients and nurses, the conditions for its implementation in low‐income countries (IPNA & Residents/nationals of these countries qualify for low‐income country rates, 2018) are unclear and dissatisfaction with nursing care has been widely reported in these countries (Ghafouri Fard, Haririan, Aghajanloo, Akbari, & Shirvani, ; Lotfi, Zamanzadeh, Valizadeh, & Khajehgoodari, ; Rajabpoor et al, ; Semachew, ).…”