NEKEMTE HEALTH SCIENCES COLLEGE, DEPARTMENT OF BSC

NURSING

RESEARCH PROPOSAL ON IMPLEMENTATION OF NURSING

PROCESS AND ASSOCIATED FACTOR AMONG NURSES WORKING
AT NEKEMTE COMPREHENSIVE SPECIALIZED HOSPITAL,
NEKEMTE, ETHIOPIA 2025.

NAME OF RESEARCH MEMBER

1. Sisay alemayehu------------------041
2. Hawwii kenenisa----------------025
3. muktar Mohamed---------------036
4. Nurii hasen----------------------039
5. Gamula waaqbulchoo-----------018

A PROPOSAL SUBMITTED TO NEKEMTE HEALTH SCIENCES

COLLEGE, DEPARTMENT OF BSC NURSING FOR PARTIAL
FULFILLMENT OF THE REQUIREMENTS FOR THE BACHLOR
DEGREE IN NURSING

MARCH 2025 NEKEMTE ,ETHIOPIA

March , 2025.

Nekemte,
Ethiopia

i
Table of content.................................................................................................................ii
Summary----------------------------------------------------------------------------------------------iv

List of figure......................................................................................................................v
Acknowledgement..............................................................................................................vi

List of acronyms and abbreviation.....................................................................................vii

1. Introduction...................................................................................................................8
1.1. Background.............................................................................................................8
1.2. Statement of the Problem........................................................................................9
1.3. Justification of the Study.......................................................................................11
2. Literature Review........................................................................................................12
2.1. Overview of nursing process implementation.......................................................12
2.2. Factors affecting nursing process..........................................................................12
3. Objective......................................................................................................................16
3.1. General objective..................................................................................................16
3.2. Specific objective..................................................................................................16
4. Method and Materials..................................................................................................18
4.1. Study Design.........................................................................................................18
4.2. Study Area............................................................................................................18
4.3. Population.............................................................................................................18
4.3.1. source of population...........................................................................................18

4.3.2. study population ................................................................................................18

4.3.3. study unit............................................................................................................18

4.3.4. Eligibility of criteria ..........................................................................................18

4.4. Sampling Technique..............................................................................................19
4.4.1. sample size determination ...............................................................................19

4.4.2. sample procedure.............................................................................................20

4. 5. Variable of the Study............................................................................................20

4.5.1. Dependent Variable........................................................................................20
4.5.2. Independent Variable......................................................................................20

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 4.6. Operational Definition..........................................................................................20
4.7. Data Collection Tools and procedure ...................................................................21
4.8. Data quality management......................................................................................21
4.9. Data Processing and Analysis...............................................................................21
4.10. Ethical Consideration..........................................................................................21
4.11. Dissemination of Results.....................................................................................22
5. Work Plan....................................................................................................................22
6. Budget Break Down.....................................................................................................23
Annex-I. Conceptual Frame Work...................................................................................24
Annex II. Questionnaire...................................................................................................25
Annex III. Declaration.....................................................................................................31
Annex IV. Assurance of Investigators..............................................................................32
References.......................................................................................................................33

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 Proposal Summary
BACK GROUND: - Nursing is the use of clinical judgments in the provision of
care to enable people to improve, maintain, or recover health, to cope with health
problems, and to achieve the best possible quality of life, whatever their disease
or disability, until death. While, nursing process is a systematic method of
assessing, diagnosing, planning, intervening and evaluating individualized care
for clients in any state of health or illness. Based on the scientific problem-solving
method, it constitutes the foundation for nursing practice.

OBJECTIVE: - To assess the implementation of nursing process and associated

factors among nurses working in Nekemte Comprehensive Specialized Hospital,
2025 GC.

METHOD: - A quantitative facility based cross-sectional study will be conducted

among Nurses on Nekemte Comprehensive Specialized Hospital, Oromia ,
Ethiopia. These Hospital is purposively selected based on the general service they
have been provided and their number of nurses for study area. The total number of
staff nurses in the hospitals are two hundred and one (201). Convenience
sampling method will be used to select participant Nurses. All staff nurses will be
the study participant. Data will be collected by using standardized self-
administered questionnaire.

iv
 i. List of Figures and Tables
Figures
I. Conceptual Frame Work-----------------------------------------------------24
II. English Version Questionnaire -------------------------------------------25
III. . Declaration of the Study --------------------------------------------------31
IV. Assurance of Investigators’ ----------------------------------------------32

TABLES
1. Work plan------------------------------------------------------------------------22
2. Budget plan-----------------------------------------------------------------------23

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 Acknowledgments
First and for most, we would like to thank Nekemte Health Science College and
Department of Nursing staffs for their high cooperation, initiation and drive to
prepare this proposal.

Secondly, we would like to express our deepest gratitude and special thanks to our
advisor, Mr.Tariku Olana (RN,BSC,MSC) for his willingness and commitments to
support, comment, suggest and to give clear directions for the success of this
work.

Lastly, it is also our pleasure to thank Nekemte Comprehensive Specialized

Hospital, Nurse, administrative and technical staffs for their extending support,
collaboration and spending their precious time for us whenever it was needed.

vi
 List of acronyms and Abbreviations
ANA- American Nursing Association
CEO- Chief Executive Officer
DX- Diagnosis
ICU- Intensive Care Unit
MHSC- Medicine and Health Sciences
NANDA- North America Nursing Diagnosis Association
NANDA- I- North America Nursing Diagnosis Association International
NCP- Nursing Care Plan
NIC- Classification of Nursing Intervention
NP- Nursing Process
RN- Registered Nurses
SNCPs- Standardized Nursing Care Plans
USA- United State of America
WHO- World Health Organization
NHSC- Nekemte Health Science College
NCSH- Nekemte Comprehensive Specialized Hospital

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1.Introduction
1.1. Background
In the eighties, the nursing process was introduced as a systematic method of planning nursing
care internationally. The nursing process was described as a relational and problem solving
process. Patient problems for which nurses provide interventions were called “nursing
problems”. These problems were worded in freestyle and nursing goals and interventions were
chosen according to these patient problems. Even though investigations indicated that the
nursing process was well adopted the so called nursing problems were often not accurately
formulated.(1)
Nursing care, at its best, is designed and implemented in a thorough manner, using an organized
series of steps, to ensure quality and consistency of care. The nursing process, a proven form of
problem solving based on the scientific method, serves as the basis for assessing, making a
nursing diagnosis, planning, organizing, and evaluating care. That the nursing process is
applicable to all health care settings, from the prenatal clinic to the pediatric intensive care unit,
is proof that the method is broad enough to serve as the basis for all nursing care.(2)

The nursing process is central to all nursing actions and applicable to all settings and methods of
client care. Because the nursing process is flexible, it adapts readily too many variables and any
conceptual framework one may use in clinical practice. (3)

Nursing process is a systematic method of planning, delivering, and evaluating individualized

care for clients in any state of health or illness. Based on the scientific problem-solving method,
it constitutes the foundation for nursing practice. The first step is assessment. It is appropriate for
use with individual clients, families, groups, or communities. It is the organized and systematic
process of collecting information from a variety of sources in order to evaluate the health status
of the client. Through assessment the nurse develops a data base regarding the client’s level of
wellness, past illnesses and experiences, health practices, and health care goals.(4)

The second step is nursing diagnosis. It is a clinical judgment about individual, family, or
community responses to actual or potential health problems/life processes. It focuses on human

8
responses and alterations in the client’s ability to function as an independent human being. It is
holistic, encompassing all aspects of the human being. The third step is planning. It helps to
solve, lessen, or minimize the effects of the identified problems, or to prevent potential problems.
It has four essential steps; prioritizing the identified nursing diagnoses, developing
goals/outcome statements, Planning nursing actions and Documentation-the Nursing Care Plan.
(4)

The fourth step is nursing interventions it is a nursing treatments, based on clinical judgment and
knowledge, which are implemented by nurses to improve patient outcomes. At the University of
Iowa, a classification of nursing interventions (NIC) was developed. The results of linear
regression models that included intervention scores and nursing diagnoses as predictor variables
explained 53.2% of the variance in total number of interventions and 58.9% of the variance in
intervention time.(1)

The fifth step is evaluation. It is judging and out comes in relation to the desired outcomes of
care, measuring the effectiveness of planned nursing interventions, further assessment and
planning if an expected out comes has not been achieved and critically analyzing the steps of the
process and making any adjustments necessary. (5)

1.2. Statement of the problem

The nursing process has been used for over 27 years as a systematic approach to nursing
practice. The process is an efficient and effective method for organizing nursing knowledge and
clinical decision making in providing planned client care. Although it has been undergoing
constant re-evaluation and revision, the concepts within the process still remain central to
nursing practice. It is an interactive method of practicing nursing, with the components fitting
together in a continuous cycle of thought and action. (6)
The nurse’s carries personal responsibility and accountability for nursing practice, and for
maintain competence by continual learning. Theoretically, if nurses fail to carry out necessary
nursing care, then the effectiveness of patient surveillance may be compromised and lead to
preventable adverse patient event. In Addis Ababa selected governmental hospitals among 192
participated nurses, 52.1% of them implemented nursing process while 47.9 % of them did not
implement nursing process. (7) Consistent adherence to the components of the nursing process
9
tends to reduce the possibility of omitting an important finding in the overall condition of the
client.

There are no studies conducted on the factors affecting the implementation of nursing process
among nurses who works at Nekemte Comprehensive Specialized Hospital. Therefore, this study
is designed to investigate the factors affecting the implementation of nursing process among
Nurses who works at Nekemte Comprehensive Specialized Hospital.

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 1.3. Significances of the study

Poor quality of implementing nursing process leads to unsatisfying delivery of nursing care.
Quality of nursing care could be improved, if the factors affecting the implementation of nursing
process are studied. The study tries to explore the factors affecting the implementation of nursing
process among nurses who work at Nekemte Comprehensive Specialized Hospital. These factors,
if identified, might lead to recommendations regarding the implementation of nursing process
and served as a baseline for a future study. Patients and society will potentially benefit from the
knowledge derived from the study.

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2.Literature Review

2.1. Overview of nursing process implementation

The nursing process is dynamic and requires creativity for its application. The steps remain the
same, but the application and results will be different in each client situation. The nursing
process is designed to be used with clients throughout the life span and in any setting in which a
nurse provides care for clients. (8)
The nurse has to always be thinking and recognizing what step in the nursing process is being
utilized. They must incorporate knowledge from many areas in order to deliver holistic care, that
is, to meet the total needs of the client. They can utilize the nursing process with clients of any
age and with any developmental level. (4)

Some scholars have recently shown the investments made to use the nursing process in care
practice, providing information on what nurses know, believe and adopt in various situation and
difficulties encountered in hospitals. These studies indicate the potential of investments in its
practice by approaching nursing practice and health care, education and research.(9)

Based on the above, we confirm the researchers’ view that the nursing process is an action full of
meaning that can be used by nurses in practice. As a method for care delivery, this represents
challenges in education and practice. The nursing process needs to be depended in the hospital
context, based on the perception of nurses working there, highlighting their doubts, uncertainties
and questions about how to put in to operation. (10)

A study conducted on Assessment of utilization of nursing process in a District Hospital in

Ghana, 2015 showed that the nursing process implementation was 77.13 %( 11)

As study conducted on The Implementation of Nursing Process and Associated Factors among
Nurses Working in Debremarkos and Finoteselam Hospitals, Northwest Ethiopia, 2013, revealed
that out of 124 respondents, only 37.1% of nurses were implementing nursing process very much
and the rest 62.9% not practicing (12)

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A study conducted in Mekele Region, in Mekele Zone hospitals in 2014 showed that out of 200
nurses involved in a study, almost all, 180(90%) have poor knowledge to implement NP. This
shows that implementation of nursing process was almost null (13)

A study conducted in selected hospitals of Addis Ababa in 2014 showed that out of 202 study
participants almost half of them, 100 (52.1%), nurses were implemented nursing process where
as 92(47.9%) of them were not implemented nursing process(14)

A study conducted in selected hospitals of Central and Northwest zones of Tigray Region 2015
showed that out of 200 participants enrolled in a study, only Seventy (35%) of participants have
implemented nursing process. Most of the nurses (65%) were not did so (15)

A study conducted in Arbaminch University, Ethiopia, 2015 on Determinants towards

Implementation of Nursing Process showed that out of 105 respondents, only 43 (43.87%) of the
nurses made visible their nursing related activities (16)

A study conducted in Public Hospitals of Harari People National Regional State in 2017, Showed
that from a total of 174 nurses who were included in the study, almost half of the respondents 85
(48.9%) were practiced nursing process, but 89(51.1%) were not.(17)

2.2. Factors affecting nursing process

2.2.1. Nurse’s related factors
A study conducted on Challenges Faced by Nurses on Implementation of Nursing Process in
Special Units at Teaching Hospital, Jaffna; The Open University of Sri Lanka in 2018 showed
that majority of the nurses (73%) lack theoretical knowledge of nursing process. Out of 10
respondents included in a study, 52% of participants strongly agreed that positive attitude of
nurses help the practice of nursing process (18)

A study conducted on the barriers and facilitators for execution of nursing process from nurses'
perspective in Egypt, 2014 showed that 68.2% of nurses agreed there is lack of time to
implement nursing process as it is time consuming and criticized by many nurse. The study also
identifies nurse’s opinions on the documentation of NP. As it involves a series of stages which
include writing down of nursing activities by hand makes nurses feel they have no time for.
Lack of knowledge to perform the process is the major factor leading nurses to avoid
implementing nursing process in their daily activities (5).

A study conducted on Implementation of the Nursing Process in Naivasha District Hospital,

13
Kenya, 2016 showed that Forthy- three (51.8%) participants strongly agreed that the nursing
process facilitates total patient care while 32.7% (n=27) agreed. Thirty-six participants (43.4%)
strongly disagreed that nursing care plans are a waste of. Majority of the participants (60.2%)
strongly disagreed that nursing care plans are a mere academic exercise while 87.7% strongly
agreed that care plans facilitate establishment of priorities of care. Overall, majority of the
nurses’ attitude towards the nursing process was positive (19).

A study conducted on the assessment of knowledge and practice of nursing process among
nurses in university of Calabar Teaching Hospital, Cross River State, Nigeria, in 2016 showed
that out of 200 study participants, 37(30.8%) strongly agreed, that adequate knowledge of nurses
on nursing process will improve the practice of nursing process. Nursing process should only be
taught in school due no time for nurses so not applied in the clinical setting. 34(28.3%) strongly
agreed while 23(19.2%) strongly disagreed, 27(22.5%) strongly agreed that workload does not
allow nurses to practice the nursing process, 50 (41.7%) agreed, 22(18.3%) disagreed while 21
(17.5%) strongly disagreed (6).

A study conducted on Nurses’ Knowledge, Perspectives and Practice of the nursing Process in
Two Public Hospitals in Kenya, 2017,showed that majority of nurses have highly agreed that the
application of nursing process is cumbersome(56.2%). Applying nursing process is not
mandatory to draw nursing care plan (44.8%), nursing care plan should only be drawn for the
very sick patients (64.8%) and that writing of a care plan is a burden to nurses (40%) (20)

A study conducted on Factors Affecting Implementation of Nursing Process: Nurses'

Perspective, Mansoura University, Egypt, 2017 showed that the majority of the respondents
(99.0%) give correct answer about assessment but only 9% of them give correct answer
regarding diagnosis. The study also showed that, participants with the age of (35-39 years
47.7%) had average knowledge score. A significant association between knowledge score and
age group observed .The work experience between 5-9 years was (75%) good knowledge score
than other age groups. A significant association between knowledge score and Years of
experience observed. All studied nurses 100.0% have no sufficient interest in using the nursing
process, (10)

A study conducted Assessing Barriers To Implementation Of Nursing Process Among

Nurses Working At A Tertiary Hospital in Kenya in 2018 showed that nurses who have trained
on nursing process were more likely to implement the nursing process 41 (37.6%) compared to
those who had not trained 3 (12%). Nurses, who had trained in the nursing process, competently
practice the nursing process (21).

As study conducted on The Implementation of Nursing Process and Associated Factors among

14
Nurses Working in Debremarkos and Finoteselam Hospitals, Northwest Ethiopia, 2013 ,revealed
that out of 124 respondents, 46 (37.1%) practice NP very much, 62 (50%) practiced somewhat
and the rest 16 (12.9%) not at all . The study showed that knowledgeable nurse was more likely
to implement nursing process. Working experience of more than 4 years was almost double
more likely to implement nursing process than working experience of less than or equal to 4
years (17)

As study conducted on Application of Nursing Process and Its Affecting Factors among
Nurses Working in Mekele Zone Hospitals, Northern Ethiopia , 2014,showed that out of the
study participants, 181 (90.5%) reported that they have heard about nursing process, but 61
(30.5%) failed to mention the steps of nursing process effectively. From nurse 71 (35.5%), 67
(33.5%), and 55 (27.5%), respectively, failed to mention evaluation, implementation, and the
nursing diagnosis steps. Only 5 respondents (% 2.5%) were mentioned the number of nursing
diagnoses, five, and the rest 94 (47%) failed to respond to the question. Nurses have no
knowledge on the nursing diagnosis; 60 (30%) of respondents mentioned actual nursing
diagnosis; 48 (24%) of respondents mentioned risk nursing diagnosis; and 4 (2%) of respondents
mentioned possible nursing diagnosis. Regarding the overall knowledge of nurses on nursing
process, the majority, and 180 (90%), of them has poor knowledge while only 20 (10%) of them
has fair knowledge. From the in-depth interview, it was found that nurses have no adequate
knowledge to implement nursing process. For instance, one of the key informants said “I do not
believe that nurses have enough knowledge about the nursing process.” From the educational
level point of view, the key informants made it known that BSc nurses may have better
knowledge to apply the nursing process. One key informant said “I think BSc nurses have better
knowledge than diploma nurses to apply the nursing process.” The other key informant said “I
think BSc nurses have better knowledge in nursing process than diploma nurses because the
nursing process is included in the curriculum of BSc nursing.” (11).

A study conducted in selected hospitals of Central and Northwest zones of Tigray

Region, Ethiopia, 2015 shows that knowledge and skill of nurses to implement the nursing
process; out of 200 respondents,79 (39.5%) of the nurses had low knowledge of the nursing
process while 92 (46%) nurses were moderately skilled in the activity of nursing care. Nurses
with degree holder (BSc) in their educational level are 6.972 times more likely to implement the
nursing process than diploma-educated nurses. Highly knowledgeable nurses were 15.09 times
more likely to implement the nursing process than low knowledgeable nurses by adjusting all
other factors (8)

A study conducted on Assessment of Nurses’ Perceptions and Barriers on Evidence Based

15
Practice in Tikur Anbessa Specialized Hospital Addis Ababa Ethiopia in 2015 reviled that out of
the respondents 155 (73.8%) have positive attitude. Only 55 (26.2%) have negative attitude and
belief towards implementation of (22).

Another study conducted on The Practice of Nursing Process and Associated Factors Among
Nurses Working in Public Hospitals of Harari People National Regional State, Eastern Ethiopia
in 2017,showed that nurses’ attitude towards the nursing process 92 (52.9%) were favorable
attitude and 82 (47.1%) were unfavorable attitude. Regarding the practice of nursing process
question assessment was performed in greater than two third 144 (82.8%) of cases; diagnosis
was made in two third 136 (78.2%) of cases; planning was made in 130 (74.7%) of cases;
implementation was made greater than half 107 (61.5%) of cases and evaluation was made
almost half 85 (48.9%). The study also showed that nurses who have less knowledge of nursing
process were 96% less likely to practice nursing process as compared to their counterparts (4)

1.2.2. institution Related Factors Affecting Implementation of Nursing Process

A study conducted on Challenges Faced by Nurses for Implementation of Nursing Process in

Special Units at Teaching Hospital Jaffna, Sri Lanka in 2018, showed that 88% of nurses have
no enough time to implement nursing process and 69.8% have workload for implementing
nursing process. The study also showed that 48% unavailability of materials for documentation
and 42 % shortages of nursing staff are most common barriers for application of nursing process
(18).

A study conducted on the assessment of barriers and facilitators for execution of nursing process
from nurses' perspective in Cairo University: Egypt in 2014, showed that most frequently nurses
have encountered 81% of inadequate staff in the unit and workload as the most commonly
barriers. Lack of specified nursing care document and education budget, insufficient equipment
and absence of supplies and materials and that lack of time due to high patient flow are
challenges for the execution of nursing process(5).

A study conducted on the assessment of knowledge and practice of nursing process among
nurses in university of Calabar teaching hospital, Cross River State, Nigeria ,2016, showed that
from 200 study participants, 48 (24%) of the nurses have a great strain due to a symptomatic
manager. One hundred fifty seven (78%) of the nurses were dissatisfied with their job; out of
which 66 (42%) were dissatisfied due to the patient workload .The study showed that 131
(83.4%) nurses reported that dissatisfied had affected the implementation of nursing process (6)

16
A study conducted on the application of nursing process in pediatric care and the factors
associated with its implementation at Korle-Bu Teaching Hospital and princess Marie Louis
Hospital in Accra, Ghana,2017, showed that nurse to patient ratio, workload, availability of
materials for documentation and lack of time were high challenges that impede the effective
implementation of NP by 202(94%),204 (94.9%), 191(88.8%) and 194(90.2%) respectively
(13).

A study conducted on factors affecting implementation of nursing process nurses' perspective

Mansoura University, Egypt, 2017 showed shortage of nursing staff, lack format for writing
nursing process, lack of follow up by the management body, inadequate time lack of attention by
authorized body about the importance of nursing process and lack of clear instruction for the
implementation of nursing process by the authorities were the challenges faced by nurse in the
application of nursing process (10).

A study conducted on Nurses knowledge, Perspectives and Practice of the nursing Process in
Two Public Hospitals in Kenya, 2017 showed that lack of resources and increased workload
were the major inhibitors of the nursing process utilization (12).

A study conducted on the assessment of factors affecting implementation of NP in selected

governmental hospitals, Addis Ababa, Ethiopia,2011 showed that out of the study participants,
one hundred five (54.7%) of the respondents have had anxiety from nurse to patient ratio and
54(28.1%) nurses faced equal burden from rude physician and unsympathetic manager with.
From the total respondents 104 (54.2%) of them said the dissatisfying aspect of their job was
caring for so many patients followed by rules being made up without staff or residents in mind
79(41.1%) and useless paper work 40 (20.8%) and new reporting system 31(16.1%). From those
dissatisfied 95 (49.5%) due to their profession. One hundred forty (72.9%) were working in a
stressful working environment, 31(16.1%) were working in a disorganized working environment
the rest 21(10.9%) respondents explained their work place is negligent at a time. (7)

As study conducted on The Implementation of Nursing Process and Associated Factors among
Nurses Working in Debremarkos and Finoteselam Hospitals, Northwest Ethiopia, 2013 showed
that availability of necessary equipment for patient care were three times more likely to
implement nursing process than inadequate one. Nurse who have orientated upon joining the
respective hospitals were more likely to implement nursing process (17).

A study conducted in selected hospitals of Central and Northwest zones of Tigray Region,
Ethiopia, 2015 showed that nurses who had consistent material supply were 95.1% more likely
to implement the nursing process than those nurses with no consistent material supply were.

17
Nurses who worked in a very good atmosphere were 99% more likely to implement nursing
process than those who worked in a stressful work place when adjusting for all other factors.
Nurses who did not have high patient load were 98.7% more likely to implement the nursing
process than nurses who had a high patient load when adjusting for all other factors. There was
105(76.5%) nurse turnover in the hospital. Out the turnover, 32.7% leaving to work for higher
paying non-governmental organizations which is a leading reason for the nurse turnover and
75.2% nurses responded that nurse turnover had affected their nursing process implementation
(8)

A study conducted on The Practice of Nursing Process and Associated Factors among Nurses
Working in Public Hospitals of Harari People National Regional State, Eastern Ethiopia, 2017
showed that nurses who were working in favorable working environment were 70% more likely
to practice nursing process than those were in negligent working environment (4)

1.2.3. Nurses Perception on Patient Related factors

A study conducted on the assessment on factors affecting implementation of NP in selected

governmental hospitals, Addis Ababa, Ethiopia, 2011showed that out of the study participants
ninety four (49%) of them responded that patients were discharged before they receive full care
due to long time required to get the service. Ninety-two (47.9%) of the respondents informed
that patients were discharged early before they get relief from their problem due to poor
economical income. Thirty seven 37(19.3%) of respondents have informed that patients were
discharged early before they were receive the appropriate management by assuming that they
were not cured of their illness (7).

A study conducted on The Implementation of Nursing Process and Associated Factors among
Nurses Working in Debremarkos and Finoteselam Hospitals, Northwest Ethiopia, 2013 showed
that cooperative patients were three times more likely to get nursing process than those who
were not. Patients with no complication were about six times more likely to get nursing process
than those who were complicated (17).

A study conducted in Arbaminch University, Ethiopia, in 2015, on determinants towards

Implementation of Nursing Process showed that early discharge and due to lack of cooperation
and economic status of patient to buy material for nursing care, were negatively associated with
implementation of nursing process (16)

A study conducted on The Practice of Nursing Process and Associated Factors Among Nurses
Working in Public Hospitals of Harari People National Regional State, Eastern Ethiopia:2017
showed that long waiting time to get the service, lower economic status of patients poor

18
understanding of modern medicine and the principle of nursing process and discrimination of a
patient had influenced the practice of nursing process .In patients who didn’t discharged before
completing planned intervention nursing process was practiced 3 times more likely as compared
to patients discharged early(4)

19
 Nurses perception on patient related factors

 Economic status
 Miss-understanding of modern medicine

Individual nurse’s related

factors Socio-demographic factors:

 Knowledge of Implementation of  Sex

nurses nursing process  Age
 Attitude of nurses  Marital status
 Religion
 Monthly income
 Years of
experience
 Level education
Institution related factors

 Work load
 Working hours
 Nurses’ turnover
 Shortage of nurses
 Luck of training
 Availability of materials for nursing
process
 Job dissatisfaction
 supervision of NP implementation
 Training on NP
 Type of hospital
 Ward/Unit

Figure ---: A conceptual framework showing the factors affecting implementation of

nursing process in Nekemte comprehensive specialized hospital, 2025(5,6, 13-33)

20
3.Objectives
3.1 General objective

 To assess the implementation of nursing process and associated factors among

nurses working in Nekemte Comprehensive Specialized Hospital, 2025.

3.2 Specific objectives

1. To assess the implementation of nursing process in Nekemte Comprehensive

Specialized Hospital, Nekemte , Ethiopia, 2025.

2. To assess factors affecting the implementation of nursing process among nurses

working in Nekemte Comprehensive Specialized Hospital,Nekemte, Ethiopia,
2025.

21
4. Methods and Materials

4.1. Study Design

Institutional based cross-sectional study design will be conducted to assess implementation of
nursing process and associated factors among nurses working in Nekemte Comprehensive
Specialized Hospital, Nekemte, Ethiopia, 2025 by using quantitative method.

4.2. Study area and period

The study will be conducted from February 2025 to May 2025.
4.3 population
All staff nurses who have been working in Nekemte Comprehensive Specialized Hospital.

4.3.1 Source population

 Nurses who are working at Nekemte Comprehensive Specialized Hospital
4.3.2 Study population
All staff nurses who have been working in Nekemte Comprehensive Specialized Hospital and
were available during the study period.
4.3.3 Study unit
 Nurses who are working at Nekemte Comprehensive Specialized Hospital available
during the study period and willing to participate in the study.
4.3.4 Eligibility criteria
Inclusive Criteria
 Nurses who are working at Nekemte Comprehensive Specialized Hospital
available during the study period and willing to participate in the study.

Exclusive Criteria
 Nurses who will not be available due to sick leave, temporary reassignment, annual
leave; free service workers and those who decided to exercise their right not to
participate in the study.
4.4. Sample Technique

22
A sample size is calculated by using single population proportion formula by taking these
assumptions into account: The proportion of nurses implemented nursing process at selected
hospitals of Addis Ababa was 52.1%(14). Hence, prevalence (p) considered 0.521, with a 95%
level of confidence and a 5% margin of error. Sample size without correction equals ___, Since
the source population is less than 10,000, using correction formula it equals ___, by including a
10% non-response rate, the final sample size was __..

4.4.1. Sample size determination

n=¿ ¿ n= (1.96)2 0.521(1-0.521) =201 professional nurses
(0.05)2
n= number of minimum sample required
p= population proportion(50%) = 0.521
d= margin of error = 0.05
N= source population= 201
p(1 - p) = 0.5 ⋅ 0.5 = 0.25
d² = 0.05² = 0.0025
n = 201 * 0.25 / 0.0025 ⋅ 200 + 0.25
n = 50.25 / 0.5 + 0.25 = 50.25 / 0.75 ≈ 67

Finite population correction formula (FPC) =N-n/N-1

n =Minimum sample size = 67
N =source of population = 201
201 - 67 / 201 -1 = 134 / 200 = 0.67
FPC n 67 * 0.67 = 44.89 ≈ 45

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4.4.2. Sampling procedure
Based on the general service they have been provided and their number of nurses for study area.
Convenience method will be used to select participant Nurse from all wards.
4.5. Study Variables
4.5.1. Dependent variable
 Implementation of nursing process.
4.5.2. Independent/ explanatory variables
 Year of experience.
 Knowledge of nurses.
 Nurses demographics.
 Nurses skill.
 Hospital organizational structures.
 Patient’s income.
 Patient’s turnover

4.6. Operational definitions

Nursing Process: systematic ways of problem-solving include assessment, diagnosis,
planning, implementation and evaluation practiced by licensed nurses. (7)

Skill:-daily nurses practice performed for participant. Those respondents who have scored > 26
are highly skill full; 18-25 are moderately skill full, and < 17 are low skill full group out of 30.
(7)

KnowledgeableNurses:-Nurses awareness about nursing process. Highly knowledgeable nurses

are those 80% of the questions, moderately knowledgeable nurses are those answered in between
55-79.9%, and low knowledgeable nurses those scored < 55 %.( 7)

Organizational Structure: - The hierarchical level of a hospital in health care delivery. (7)

Year of Experience: - Number of year nurses has worked in nursing. (7)

24
Patient Turnover: - A patient was visiting hospital for getting health care and leaves before full
provision of care. (7)

4.7. Data collection tools and procedures

Data will be collected by using structured self- administered questionnaire. Structured English
version questionnaire which is adapted from previous study. It includes five main parts about
nurses’ socio demographics, knowledge of nursing process, work load, organizational structure
and facilities, patient turnover and patient’s income.

Data will be collected by self-administered questionnaire. The data collection process will be
supervised by the principal investigators from march-april-may/2025. Before the actual data
collection we will have a pre-test and half day orientation about the aim of the study and the
content of the instrument for our volunteer data collectors. Therefore, the data collectors became
familiar about each. It is also a mechanism of minimizing biases during the process of data
collection. Questionnaires are filled by nurses in their work place.

4.8. Data quality management

During data collection, both principal investigators and data collectors themselves will check the
data for its completeness and missing information at each point. Furthermore data will be
checked during entry and compilation before analysis.

4.9. Data processing and analysis

The collected data will be cleaned, coded and entered. Descriptive statistics like frequency and
percentage will be used to summarize the collected data.

4.10. Ethical considerations

Ethical clearance will be getting from Nekemte Health Sciences College, Department of nursing
before the beginning of data collection permission letter will be provided to the hospital for
proceeding data collection. After that participants will be oriented about the purpose and
procedure of data collection, and that confidentiality and privacy is ensured. It is also cleared that
participation is fully based on the willingness of participants using written consent

25
4.11. Dissemination of results
The findings of this study will be communicated through Nekemte Health Sciences
College website, Nekemte health Science College library, the NCSH which are the study
will done.

26
 5 .Work Plan
Table 1. Work Plan of to assess the implementation of nursing process and associated factors
among nurses working in Nekemte Comprehensive Specialized Hospital,Nekemte , West
Oromia , Ethiopia, 2025.

Dec. Jan. Feb. March April May June

Weeks Weeks Weeks weeks Weeks weeks weeks

Activities to be Responsi
performed ble 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
phase

bodies
1 Title selection Research
team
Proposal Research
writing team
Questionnaire >>
2 development
Ethical DMU,M
clearance HSC
Personnel Research
orientation team
Data collection >>

Data coding, >>

entry, and
analysis
3 Thesis writing >>

Submission of >>
final thesis
report

Preparation for >>

Public defenses
4 Public defenses >>

27
 6. Budget Break Down
Table 2.Budget breakdown to assess the implementation of nursing process and associated
factors among nurses working in Nekemte Comprehensive Specialized Hospital , West Oromia
Ethiopia, 2025.
NO BUDGET CATEGORY
No of Duration of
1 Personal Cost Unit cost persons work Total cost Remark
Investigators 150.00 birr 05 05 days 2,750.00 birr
Data collectors 100.00 birr 05 05 days 2,500.00 birr
Subtotal-1 5,250.00 birr
Equipment & Supplies Unit quantity Unit cost
Pen Number 10 20.00 birr 200.00 birr
Pencil Number 03 20.00 birr 60.00 birr
Note book Number 5 100.00 birr 500.00 birr
2 Questionnary paper Number 100 45.00 4500 birr
Printing Page 70 5.00 birr 350.00 birr
Copy Page 70 5.00 350.00 birr
Stapler Number 01 250.00 birr 250.00 birr
Staples Packet 02 100.00 birr 200.00 birr
Binder Number 05 30.00 birr 150.00 birr
Subtotal-2 6560.00 birr
Cell-phone card Card 5 50.00 birr 250.00 birr
Subtotal-3 250.00 birr
4 Grand total - - - 12,060.00 birr

28
Annex II. Questionnaire

NEKEMTE HEALTH SCIENCE COLLEGE , DEPARTMENT OF NURSING

Confidentiality and Verbal Consent Form:-This questionnaire is adapted from a research
conducted in Nekemte health science college to assess the implementation of nursing process
and associated factors in Nekemte Comprehensive Specialized Hospital . The questionnaire
contains both closed ended and open ended questions and will be provided in self-administered
form. You are therefore kindly requested to provide genuine answers to the questions. The
information you provide is confidential and is used only for the purpose of this study. If you have
any question, don’t hesitate to ask the data collector. Your cooperation and participation until the
compilation of the questionnaire is very necessary for the successful compilation of the
assessment. We therefore ask your genuine willingness. However, you have the right to turn
down if you are not voluntary to participate so that fills ‘NO’ in the box below.

If you are voluntary or not mark ‘x’ on your opinion YES NO

THANK YOU IN ADVANCE FOR YOUR COOPERATION

Participant’s signature ______________________Date_____________________
Data collectors sign ________________________Date_____________________
Cell phone =

29
PART. I Socio Demographic Questions
Circle your response from the given option/fill the blank space/
S/No Items Responses Remark
1. Sex 1.male 2.female
2. How old are you? _________(in year)
What is your ethnicity? 1.Amhara 2.Tigraye
3. 3.oromo 4.others(specify)--------------
4. What is your current marital 1.single 2.married 3.widowed
status? 4.divorced 5.separated

PART- II. Organizational and Nurses Related Questions:

ITEM Responses
5. When do you graduated for nursing? ______________________ in E.C.
6. How many years you did work in clinical area? __________________________
7. On average how many hours do you work per day? ______________________________
8. How many patients do you care per day? ------------------------------------------------
9. Do you have all equipment in your organization to 1. Yes 2. No
do nursing care?
10 Have you worked over time? 1. Yes 2. NO If ‘no’ skip Q.NO. 13
11 If your answer ‘yes’, is that with payment? 1. Yes 2. NO If ‘no’ skip Q.NO. 13

12 If your answer ‘yes’, is the payment enough? 1. Yes 2. NO

13 Have you ever had misbehavior record in your 1. Yes 2. NO
personal file?
The greatest strain for you during in your working 1.Rude physicians
14 time is/are? 2.harassing coworker
3.unsympatic manager
4.When coworkers doesn’t do their task.
5. others (specify)-------------------------
15 Is there any dissatisfying aspect of your job? 1. Yes 2. No. If ‘no’ skip Q. 18.
1.Having care for so many patients
16 What is/are the dissatisfying aspects of your job? 2.the new report system
3. Useless paper work.
4. Rules being made up without staff
5. others (specify)------------------------

30
 If you are dissatisfied with the above any reason
17 from Q.NO.16, is it due to your profession? 1.Yes 2.NO
18 How would you describe the atmosphere of your 1.stressful at times
Work place? 2.Negligent at times
3.disorganized
4. very well 5. others (specify)--------
19 Did you get satisfying orientation while you joined 1.Yes 2.NO
this organization?
1.recording every activities what you
perform
20 What do you use to make your work visible? 2.using nursing process
3.reporting to supervisors
4.working on the patient problems &
seeing the outcome
5. Nothing used 6. others (specify)-----
21 Have you committed clinical errors 1. Yes 2.NO. If ‘no’ skip Q.NO 23.

1.Slip/slap
22 If you do, what kind of error you perform? 2.knowledge error
3. Excusive error 4 others (specify) ----
1.decreasing productivity
23 How high rate of staff nurses turnover affect once 2.disorganized service delivery
society health? 3.lossing sharing of organizational
knowledge
4. others (specify)--------------------------
1.job&employee skill mismatch
24 What do you think the causes of employee turnover? 2.due to NGO’s attractive payment
3.low access of short/long training
4.less/no recognition for the work done
5. others (specify)--------------------------
1. miss-understanding of the modern
25 What do you think the major reason of patient medicines
turnover? 2. due to poor economic status
3. due to long time waiting time to get
the service
4. others (specify)-----------------
1.patient discharge before completing
26 According to Q.NO.25 how it influence your the planned interventions
nursing process? 2.patients are not cooperative for the
care you provide
3.inability to collect the required

31
 material for care
4.present with complicated problems
that is challenging to manage
5. others (specify)--------------------------

PART- III. Knowledge Assessment

1.collecting subjective & objective data
2.evaluating what has been done for the patient
27. The first step on your nursing 3.indicating the activities to be done
process is? 4.directly intervening the problem
1.focuses on ethical principles
28. The primary aim of Gordon 2.focuses on patients responses towards their illness
approach is? 3. Focuses on the disease process/medical diagnosis
4. focuses on patient’s attendant interest
1.assassment
2.implementation
29. Select from the given option that is 3.planning
not a component of nursing process. 4.evaluation
5.evidenced based practice
6.nursing diagnosis
30. Your appropriate nursing diagnosis 1.potential nursing diagnosis
for a patient with Hypertension to 2.actual nursing diagnosis
prevent future complication is? 3.medical diagnosis
4.laboratory investigation
5. others (specify)--------------------------
1.nursing dx focuses on the diseases than other
patient’s response
31. What makes nursing process 2.nursing dx focuses on patient’s response than
different from medical diagnosis? patient’s response
3.both focuses on patient’s responses
4.both have similar procedure to resolve a patient’s
5. others (specify)--------------------------
32. In your organization who is 1. Physician 2. Patient’s family 3.nurses
mandatory for the better 4. Patients 5.no one should excluded
accomplishment of nursing process?

33. What are your activities During your 1. Assigning priorities

planning phase? 2. Specifying expected out comes
3.recording the data of the patient

32
 4.specifying goals
5.identifying interdependent interventions
6. others (specify)--------------------------
34. Select your role during 1.propose the interventions
implementation phase of your 2.implementing the proposed interventions
nursing process? 3.performing the planned interventions by excluding
Activity of daily living
4. Stop the phase if the initial implementations fail to
Change patients’ problem.
35. Select that may be not a guide for 1.the nursing diagnosis
your nursing process evaluation? 2.collaborative problems
3.priorities and nursing interventions
4.expected out comes
5.all could be guide lines
36. Fluid volume deficits related to 1.fluid volume deficit
unresolved vomiting & diarrhea as 2.unresolved vomiting and diarrhea
evidenced by dry oral mucosa and 3.dry oral mucosa and sunken eyes
sunken eyes. From the given nursing 4.dehydration
diagnosis select the etiology from
the given options?

PART IV: Skill Assessment

Score the following activities according to the frequency you perform. Mark by using ‘x’ on your
choice. 1. not at all 2.not really 3.undecided 4.somewhat 5.verymuch
ACTIVITIES 1 2 3 4 5

33
37 Ability to apply theories of nursing practice
38 Ability to maintain patient dignity, privacy and confidentiality(using
nursing skills)
39 Ability to practice principles of health and safety, including morning and
handling, and infection control; essential first aid and emergency
procedures
40 Ability to safely administer medicine and other therapies; (using nursing
skills, Interventions/ activities to provide optimum care)
Ability to consider emotional, physical, and personal care, including
41 meeting the need for comfort, nutrition, personal hygiene and enabling the
person to maintain the activities necessary for daily life; (using nursing
skills, Interventions/ activities to provide optimum care)
41 Respond to patient needs by planning delivering and evaluating
appropriate and individualized programs of care working in partnership
with the patient, their care givers, family and other health workers.

THANKS AGAIN FOR YOUR PARTICIPATION!!!!!!!!

Annex III. Declaration

34
We, the undersigned, BSC nurse students declare that this senior essay proposal is our original
works in these Hospital in partial fulfillment of the requirement of Bachelor of degree in nursing.

NAME OF INVESTIGATORS SIGNATURE

1. SISAY ALEMAYEHU _____________________________
2. HAWWII KENENISA ________________________________
3. MUKTAR MOHAMED ________________________________
4. NURI HASSAN ______________________________
5. GAMULA WAQBULCHOO ________________________________

Place of submission Nekemte Health Sciences College Department of Nursing

Date of submission _____________________________ and the thesis will be submitted for
examination with the approval of advisors.

ADVISORS’ NAME SIGNATURE

1. Mr.TARIKU OLANA ( RN,BSC, MSC) _________________

Annex IV. Assurance of Investigators

35
We the under signed agrees to accepts the responsibility for the scientific, ethical and technical
conduct of the research project and for provision of required progress reports as pre-terms and
conditions of the research and publication committee of Nekemte Health Science College
Department of Nursing.

Name of Investigators Signature Date

1. Sisay Alemayehu

2. Hawwii Qenenisa

3. Muktar Mohammed

4. Nurii Hasan

5. Gamula Waaqbulcho

Advisors Approval
Advisors’ Name Signature Date
1.Mr.TARIKU ( BSc, MSc)_________________ __________

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