ASSESSMENTS 0F THE APPLICATION OF NURSING PROCESS IN SURGICAL WARDS

ASSESSMENTS 0F THE APPLICATION OF NURSING PROCESS IN SURGICAL WARDS

Munther Natheer AL-Fattah / MSc Science in Nursing ( adult nursing ) / Assistant lecturer / College of Nursing/ University of mosul

E-mail: [email protected]

 Abstract

The nursing process is a  problem-solving framework that enables the nursing staff to plan their care for a patents and clients as an individual  or  group basis . This requires nurses to be accountable for the care that they prescribe with care deliver and to keep clear and accurate records of the discussions .Today, one’s ability to use the nursing process is governed by the standards for pre-registration  for any nursing education as outline.

The present study aimed at utilize the nursing process in Mosul teaching hospitals

The initial sample consisted of  (42) nurses  whose were   selected randomly  from surgical and emergency  units at Mosul teaching Hospitals .

the period of data collection for this  study was carried out  from 20-1-2019 until  20-2-2019 . in Ibn-Sina and AL-Jamhuori teaching hospitals.

The results shows a highly significant of all assessment for applications of nursing process at p. value (0.05) 

In conclusions of this study The nursing process it's very important to enhancing the quality of care especially at surgical field and The highly significant number for all elements of nursing process. Furthermore, the nursing staff cant not be able to make any management without nursing process.

Thus the researcher put some recommendations for the current study such as ;the nursing process case sheet should be putting in patient case folder  , to evaluate the patient and his health status systematically, the nursing staff  and health care team  must be educating to how could they using  nursing process and updating, surgical wards should be formulate a time table for all clients to guide them about their care as a schedules .The head of nursing staff  as a adviser must be enrolled with conferences and educations centers to discuss the implementation of nursing process .

Keywords: nursing care plan, recommender system, data mining.

      The nursing process is a  problem-solving framework that enables the nursing staff to planning  their care for a clients on an individual  or  group basis . This requires nurses to be accountable for the care that they prescribe with care deliver and to keep clear and accurate records of the discussions  (NMC, 2008).

Today, one’s ability to use the nursing process is governed by the standards for pre-registration  for any nursing education as outline. (NMC, 2010)

The nursing care plan should be covering all aspects for the patient needs like physical , emotional, social ,spiritual and cultural these demands leading to improvement the ability to make a systematic framework  (DoH, 2000) and  (NMC, 2010).

In addition the nursing records were of poor quality and showed little understanding of the nursing process (Darzi, 2008). Failure to keep a record of nursing care or to use the nursing process can lead to a breakdown in the quality of care that is provided.

The Delivering of standerd quality care to patients based on patients’ needs.  the importance of appled  and using a systematic plan like nursing process  to the provision of nursing care which are can be estimatting with in care time (Miller and Sanderson, 2000). Flaxabilty

There has been some debate within the profession over the number of stages needed in the nursing process, some suggesting four and others five. With a four-stage approach, the nurse does not have time to reflect on the assessment data that have been collected and instead moves from assessment to planning ( Adoma et al 2005) .

The nursing process make the nursing staff responsible to formulate the care plan dibanding on the patient needs and nursing diagnosis. (NMC, 2008).

This is important to remember in an effort to counteract any criticism surrounding who is ultimately responsible under a system of collective responsibility  (Borgelt 2003 ).

the critical thinking of any care plan make the nursing staff a Flexibility to modify and updata the patient management , care and intervention ( Groen  1995) .

the experienced nurses could link patient problems and interventions to gether so that problems can be resolved more efficiently  (Grobe, Drew, and Fonteyn1991).

The nursing process in intensive care units (ICU) is increasingly characterized by a heavy reliance on medical equipment. The variety of equipment is large and innovations appear on the market continuously.

Due to these technological developments, the profession of intensive care nursing has changed. Nurses are increasingly required to conduct complex therapeutic and diagnostic procedures using the equipment's(Effken, 1997).

Despite this increased functionality The task of selecting and integrating the vast amount of data into diagnostic information is still the responsibility of the nurse  Deciding which actions should be taken is often done under time-critical circumstances. There is a high work pace, and the cumulative work pressure combined with working in shifts results in fatigue (Groen 1995). 

On top of this, there is an increasing demand on medical and nursing staff should be  a higher efficiency. (Kohn et al  2000).

To minimize inexperience, training is crucial. However, there is a lack of general training for nursing staff in the use of technology as well as adequate, task-specific training (Bogner, 1994).

Especially older nurses will suffer from this lack of focus on device usage. Furthermore, these products should be able to provide adaptive embedded support to users when appropriate. Several researchers claim that a successful application of modem nursing care to a large extent on its ability to function as a "team player" with human practitioners (Sarter and Woods,2000).

In other words, to collaborate with the user (We will need to know which technological innovations can be sensibly applied and how this should be done. The main goal of an intensive care nurse is returning the patient to as healthy a state as possible, by bringing the patient in a state of homeostasis and subsequently maintaining this state. Homeostasis is defined as an internal state of dynamic balance. It is reached when all physiological variables are operating within their normal bounds. This embedded nature of control influences the relation between nurse and patients(Han and Kamber 2006).

The core system of the patient follows its own logic, clinicians have to play two roles. Assuming the role of collaborator with processes tending towards homeostasis, and saboteur of processes tending away from homeostasis (Miller 2000).

Another important factor in the use of nursing process related to the intended tasks is that the nurses are responsible not only for the device operation, but also for the larger performance goals of the overall

system. As a result, the system of people and artifacts evolve  over time to produce generally successful performance, even if the usability of that system is poor(Moorhead et al 2004).

Utilization of the nursing process shall be evident in review of the completed Community Health and Safety assessment for all admissions, transfers, long term care stays, and significant changes in condition  (Obradovich and Woods 1996).

The shorter Nursing assessment form shall be utilized by the nurse to document body checks, minor injuries, or returns from short hospitalizations with minor changes in condition. The short nursing assessment form has an area to document a focus nursing note data (Miller et al 2003)

Aim of The Study:

The present study aimed at utilized the nursing process in Mosul teaching hospitals

Methodology

Ethical consecrations

The first official permission was obtained from clinical science department  director ( research councilor) , depending on that permission  the researchers team  has a second official permission from the Nineveh health office to conduct the present study in Ibn-Sina and AL-Jamhuori  teaching hospitals .

Design of the study:

The descriptive  study   design was applied for  the period from 20-1-2019 until  20-2-2019.

Setting of Study:

The current study was carried out in Iben Sina and Al-Jamhori teaching  hospitals and Emergency care Unit  at Mosul

The patient come to this hospital who is suffering from general diseases and surgical problems

The number of client for both hospital was  is Approximately more than (150) patient per day.

Sample of Study:

The sample was (42) they are  selected randomly of the first time for all nurses who are workers at surgical ward and   Emergency departments

The percentage between male and female was  different according to level of the education of the of nursing graduate  ,Bachelors e and diploma of nursing .The researchers put some criteria for the selection of the sample according to how application of the nursing process in surgical wards.

Study Tool:

In the present study ,the following steps ware applied in accordance to  the a quantitative nursing research .

1-The literature review was searched and seek  by research plain through  using the following key word (emergency word ,surgical word , nursing process , assessment ,diagnoses,  planning , intervention and evaluation or expected out com  ).

2-formalate the questioner survey based on the (application of nursing process).

 3- Explore the initial draft to the experts  to have a validity of tools.

4-the reliability of instrument was getting by doing assessment ,diagnosis, planning, Implementation and evaluation of nursing process and the sample was about (10 nurses pre-post test )

Testing the reliability and validity of the tool:-

The validity term refers to be measured and to degrees to which an instrument measures what it is supposed to be measuring. the researchers were had the face validity by experts However the  Reliability refers to the degree of consistency or accuracy with an instrument measure an attribute. the higher reliability of an instrument. the lower  the amount of error present in the obtained scores. several empirical methods assess various aspects of an instrument reliability(pilot and hunger 1999)

Statistical analysis

1. Percentage are used to the description of the sample.
2. frequency and percentage  
3. SPSS version 17. 

Distribution of the study samples according to demographic data

Table (1) demographic characteristics of the sample.

 Table (1)  shows  66.7 work at night shafting, 42,9 working in surgical wards . however 23,8 in medical wards 45,2 university education , 52,4 have experience less than five years

 Table (2) reveals the statement of assessment .

  table (2) indicates that the same highly significant results for assessment statement at ( P 0.05).

 Table (3) shows Statement Diagnosis

  Table (3). indicates that the same highly significant results for diagnosis  statement at ( P 0.05).

Table (4) demonstrate  the Statement Planning.

 Table (4) appears the same highly significant results for planning statement at ( P 0.05).

Table (5) appears the Statement Intervention.

 This table (5) the same highly significant results for intervention  statement at ( P 0.05).

 Table (6) demonstrate  the Statement Evaluation.

Table (6)  the same highly significant results for evaluation statement at ( P 0.05)

The  nursing process as a model its very important for any healthcare program .the application of any care plan or management should be formulate depending on systematic nursing process .In this study the researchers try to investigate the ability of nursing staff towered implementation of nursing process and their concept about this approach (Dochterman and Bulechek 2004).

Table (1) simply show the main points about demographical data . The age was 40% belong  18- 27 and 28-37 years , this indicate the majority of the sample at mid age and they don’t has experience . The male number was higher than female which was about 36 nurse 85%.

With regard training program for nursing process the half of sample non enrolled with any educational or training program 20 nurse 50%. The same results for services  duration 50% has less than 5 years, however just 6 nurse has more than 10 years .The educational level  about 42% come from  university education  ( Nursing college )  1 nurse  postgraduate  and 30 % from Institute .

The work setting higher percentage was in intensive care units 14 nurse 42% however 23% working in medical wards and 42% in surgical units .

With regard working time about 28 participants was night shifting 66% however 42% morning duty.

When the researcher talking about nursing process, must be starting with nursing assessment as the first step and last with nursing evaluation or expected out com.

Nursing Assessment:

Table ( 2 ) The nurses answer 55% of the questions related to taking the history of the disease ,which shows that the process of assessment and diagnosis of the patient is entirely based on the doctor , and also confirmed by 40% of  nurses that they only collect general data from the patient  (Lin 2002 )

Nursing diagnosis :    

Table (3) shows Statement Diagnosis the  second question was  (I diagnosed the signs and symptoms ) about 40% answer sometimes this is another sings for lack of knowledge  about nursing diagnosis and how to be getting  it, and the sample answer some times  52 % for serious question which was (N about ursing diagnosis it s the same of medical diagnosis). Based on signs and symptoms the nursing diagnosis should be belt ,however the sample answer for that question was sometimes  50% (NANDA 2005)

Nursing planning :       

Table (4) demonstrate  the Statement Planning. it’s a good news for when we found about  69% from sample answer always about second question (I make the nursing care plain ) but unfortunately  76% was answer always too for the forth question which was (I depending on the physician care plain)  this result indicate there is no clear nursing care plan at our wards (Keenan 2006 ) accepting with us .

Nursing intervention:

Table (5) appears the Statement Intervention. In this table we have a two questions each one is opposite of other . the first one was  (The intervention depending on assessment  diagnosis and planning  process ) the percentage of that was 61%  for always answer this is very good and its evidence for critical thinking during formulate nursing care schedule and time table . However other question was (I make just physician orders for patent care )the same answer was always and the percentage is 78%  its similar of ( DoH 1994) for some his results .

Nursing evaluation :

Table (6) demonstrate  the Statement Evaluation. All the question and answers in this table was high percentage in always suction . if the nursing care plan was intensive and contain  a faxable time  with ability to updating from time to time to reducing the negative factor and increasing a positive  factors .the highly number was 71% for fourth question which was (I evaluate my experience for nursing care ) and highest percentage was 88% other question was (I observing the patient health improvement  (Billsus 2002) disagree with this interpretations 

Conclusions And Recommendations

Conclusions:

The main target  of all health care plane is to arranged the steps and process for any care or management time table , the quality should be interact with this process it lead to reflect to health  care system as a positive factors .

 The conclusions of this study include the following:

1. The Variation in the percentage of the sample with regards their variables was not influencing on their knowledge.
2. The nursing process its very important to enhancing the quality of care especially at surgical field
3. The highly significant number for all elements of nursing process  .
4. The nursing staff cant not be able to make any management with out nursing process .

Recommendations:

        Depending on the aims and objectives of this study, the researchers expecting  the following recommendations:

 The nursing process case sheet should be putting in patient case folder  , to evaluate the patient and his health status systematically .

1. The nursing staff  and health care team  must be educating to how could they using  nursing process .
2. The surgical wards should be formulate a l time table for all clients to guide them about their care as a schedules .
3. The head of nursing staff  as a adviser must be enrolled at every health center in particular to discuss the implementation of nursing process 
4. Assessment from time to time the positive and negative factors which was influencing on expected out come during evaluation care .

 Reference

 Pilot DF, Hunguler ,Bp (1999) , Nursing research principle and method , (6^th ed  lippin cott) p 713-717.  

 Darzi, Lord A. (2008) High Quality Care for All (Cm. 7432, 2008) [Internet], Departmentof Health, London. http://www.dh.gov.uk/en/Publications and statistics Policy And Guidance/DH _085825(accessed 29 June 2014).

DoH (Department of Health) (1994) The Allitt Inquiry: Independent Inquiry Relating to Deaths and Injuries on the Children’s Ward at Grantham and Kesteven Hospital during the

 DoH (Department of Health) (2000) Nurses, Midwives and Health Visitors (Training)

 NMC (Nursing and Midwifery Council) (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. NMC, London.www.nmc-uk.org

 NMC (Nursing and Midwifery Council) (2010) Standards for pre-registration nursing education. NMC. London. http://standards.nmc-uk.org/Pages/Downloads.aspx (accessed 6 November 2014)

 Grobe, S., Drew, J. & Fonteyn, M. (1991). A descriptive analysis of experienced nurses' reasoning during a planning task. Research in Nursing and Health, 14, 305-314.

 Bogner, M.S. (1994). Human Error in Medicine, Lawrence Erlbaum Associates, New Jersey.

 Effken, J.A., Kim, N.-G. and Shaw, R.E. (1997). Making the constraints visible: testing the ecological approach to interface design. Ergonomics (40)1:1-27.

 Groen, M. (1995). Technology, Work and Organisation. A study of the nursing process in intensive care units, PhD thesis, Maastricht Universitaire  Pers, Maastricht, the Netherlands.

 Miller, A., Sanderson, P. (2000). Modeling "deranged" physiological systems for ICU information system design. Proceedings of the IEA 2000/HFES 2000 Congress:245-248.

 Obradovich, J.H. and Woods, D.D. (1996). Users as designers: How People Cope with Poor HCl Design in Computer-Based Medical Devices. Human Factors (38)4:574-592.

 Sarter, N.B. and Woods, D.D. (2000) Team Play with a Powerful and Independent Agent: A Full-Mission Simulation Study. Human Factors (42)3:390-402.

 Adoma vicius, G., Sankarana rayanan, R., Sen, S., and Tuzhilin, A., 2005. “Incorporating contextual information in recommender systems using a multidimensional approach,” ACM Trans. Information Systems 23(1), 103-145.

 Billsus, D., Brunk, C. A., Evans, C., Gladish, B., and Pazzani, M., 2002. “Adaptive interfaces for ubiquitous web access,” Commun. ACM 45(5), 34-38.

 Borgelt, C., 2003. “Efficient implementations of Apriori and Elcat,” Proc. Workshop on Frequent Item Set Mining Implementations, Melbourne, FL, USA.

 Dochterman, J., Bulechek, G.: Nursing Interventions Classification (NIC), 4th ed. St. Louis, MO: Mosby, 2004.

 Han, J., and Kamber, M., 2006. “Data Mining: Concepts and Techniques,” 2nd ed, Morgan Kaufmann.

  Keenan, G. M., Yakel, E., and Marriott, D., 2006. “HANDS: A revitalized technology supported care planning method to improve nursing handoffs,” Proc. 9th Int. Congress on Nursing Informatics, Seoul, South Korea, June 11-14, 2006.

 Kohn, L., Corrigan, J., and Donaldson, M., 2000, “To error is human: Building a safer health system,” Washington, DC: National Academy Press.

 Lin, W., Alvarez, S. A., and Ruiz, C., 2002. “Efficient adaptive-support association rule mining for recommender systems,” Data Mining and Knowledge Discovery 6(1), 83-105.

 Miller, B. N., Albert, I., Lam, S. K., Konstan, J. A., and Riedl, J., 2003. “Movie Lens unplugged: Experiences with an occasionally connected recommender system,” In Proc. 8th International Conference on Intelligent User Interfaces, Miami, Florida, USA, January 12 - 15, 2003. ACM, New York, NY, 263-266.

 Moorhead S, Johnson M, Maas M: Nursing Outcomes Classification (NOC), 3rd ed. St. Louis, MO: Mosby, 2004.

 NANDA: Nursing Diagnoses: Definition & Classification. Philadelphia, PA: NANDA International, 2005.