Effect of Implementing Nursing Process on the Quality of Patient Care in Surgical Wards

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Vol-7, Special Issue4-May, 2016, pp327-332 http://www.bipublication.com

Research Article

Effect of Implementing Nursing Process on the Quality

of Patient Care in Surgical Wards

Mohammad Latif Rastian1, Fatemeh Sadeghi2 and Nahid Sadeghi3

1

MSc in Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Yasuj University of Medical Sciences, Yasuj, Iran

2

BSc in Software Technology, Education Department of Yasuj, Iran 3

MSc in Animal Physiology, Education Department of Yasuj, Iran

*Corresponding author: Mohammad Latif Rastian.Email:R115_rastian@yahoo.com

ABSTRACT

Nursing process is a deliberate problem solving approach for meeting people's health care and it helps to improve the quality of patient care.This study aims to determine the effect of implementing nursing process on the quality of patients care in surgical wards. Present study is quasi-experimental with pretest-posttest design. The samples consisted of 48 nurses that were selected by using purposive sampling (2012-2013). The nursing care quality was evaluated by using the quality patient care scale (QUALPAC). Initially the nursing care quality was evaluated then nurses participated in an educational program on nursing process and its implementation. After one month the quality of nursing care was assessed again. Data were analyzed by using SPSS16 software and using paired t-test.

This study showed a significant difference between the quality of nursing care in meeting psychosocial needs (p=0.031), communication needs (p=0.012), physical aspect (p=0.047) and the overall quality of nursing care (p=0.001) before and after implementation of nursing process. The results of this study showed that nursing process implementation can improve the quality of nursing care of patients in surgical wards.

Keywords: Nursing Process, Quality of PatientCare, Nursing Care

INTRODUCTION

Quality of health care means the level of

achieving the most desirable health

outcomes(Marquis and Huston,2003)in the other words the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are

accordance with current professional

knowledge (Grant et al, 2004). Since nurses constitute a large group in a health system and their activities are highly significant in terms of health care outcomes, ensuring the quality of provided services has always attractedthe attention of health system authorities (Zagheri Tafreshi et al. 2012).

Nurses are legally and ethically responsible for the quality of patient care, and patients have the

right to enjoy good and quality nursing care (Mohammadnia et al. 2010). In today’s world, nursing care quality is facing many challenges. A study in the hospitals of New York showed that one individual out of 25 is hurt by the provided care and 13.6% of these cases leads to death (Overtveit, 2001).

According to reports and research conducted in Iran on nursing care quality and patients’ viewpoint about it, it can be said that in most cases, the quality of nursing care provision is unfavorable (Ahmadi et al. 2011, Adib Hajbaqheri et al. 2006, Akbari Kaji & Farmahini Farahani, 2009).

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risk, and pain in patients (Zolfaghari, 2009). The first step to improve quality is to use care standards (Shamaa, et al., 2011). Care standards can increase care quality, improve patient outcomes, and reduce costs (Zerwekh and Claborn, 2006). One of these standards is using nursing process, (Tylor, 2011).

Nursing process is a deliberate problem solving approach for meeting people’s health care needs (Brunner, et al., 2010). Using nursing process enables nurses to use critical thinking for their clinical judgments and care activities (Potter & Perry, 2009). On the other hand, nursing process is a systematic approach, patient-oriented and purposeful, which provides a framework for nursing practice (Tylor, 2011). Although most nursing experts emphasize the importance of using nursing process in patient care, some researchers are not quite agreeable to nursing process and believe that it might limit nurses’ abilities (Mason, 1999, Alfaro-Lefevre, 2005). In other words, some believe that nursing process can limit critical thinking, and some believe that it can increase decision-making in different clinical situations (Wilkinson, 2011).

A study by Akbari & Shams (2010) in Iran, showed that to the majority of nurses, lack of complete information about the concept of nursing process and learning it insufficiently were the major barriers for nursing process implementation ((Akbari and Shams, 2010). In fact, there is a huge gap between theory and practice in nursing, and nurses pay more attention to its practical and technical aspect rather than nurses’ art and science (Mrayyan, 2006). Because nurses are the only large group that have the most frequent contact with patients (Kurtzman et al. 2008). And most important factor in improving the quality of care is to measure it, and the most valuable way to measure the quality of care is to evaluate nurses’ performance in nursing care provision (Lee et al. 2007). Therefore, the present study aims to determine the effect of implementing nursing process on the quality of patients care in surgical wards at Shahid Beheshty Hospital in YASUJ.

MATERIALS AND METHODS

Present study is semi-experimental in nature. Authors started data gathering process after getting permission from ethic committee of Shahid Beheshti University of Medical Sciences. All participants provided written informed consent. The research environment included general surgery, orthopedic, urology and neurosurgical wards at Shahid Beheshti hospital. The inclusion criteria were as follows: 1) Bachelor of nursing or higher degrees. 2) Doing practical work in one of the surgery wards at Yasuj Shahid Beheshti hospital during the study. In this study, 48 nurses who met the inclusion criteria were identified by purposive selection. Data collection was performed by using the Quality Patient Care Scale (QUALPAC). This scale has been used to evaluate care process and quality of nursing care since 1975 in the U.S., England and Nigeria (Dabirian et al, 2009). The first part of the scale is related to the demographic characteristics of nurses including 11 questions which were filled out by the participants. The second part consisted of three aspectual quality patient care scale; Psychosocial (20 Questions), Physical(16Questions) and communicational (11Questions)respectively were assessed using three-Point Likert Scale (rarely, sometimes, and often) each question is given 1-3 scores. In this study, the Numeric Rating Scale completed by co-researcher before and after intervention. The opinions were divided into 3 groups of unfavorable (less than 1.5), somewhat favorable (1.5-2.49), and favorable (2.5-3) by calculating the mean Rating Scale score for each nurse (Neishabory et al, 2010).

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educational program, the (QUALPAC) Scale was filled out by the co-researcher and the resulting changes were analyzed by using the SPSS16 software as well as the descriptive statistics and the statistical tests including paired t-test.

FINDINGS

In this study, 79% of the participants were female and 21% male. With mean age of 28.10 years. The majority of subjects were married (58.3%) and 97.9% had a bachelor’s degree. History of clinical work was 1-3 years for 58.3% of the samples, and 87.5% of them worked on rotating shifts.

Table 1 presents scores of nursing care quality in terms of physical dimension before and after intervention in surgical wards. The table shows that before intervention, the mean score was 31.21, which reached 34.02 after intervention. The paired t-test showed a significant difference in nursing care quality in terms of physical dimension (p = 0.047).

Table 2 presents the scores of nursing care quality in terms of psychosocial dimension before and after intervention in surgical wards. The tables shows that before intervention, the mean score was 39.23, which reached 42.08 after intervention. The paired t-test showed a significant difference in nursing care quality in terms of psychosocial dimension (p = 0.031). Table 3 presents the scores of nursing care quality in terms of communicational dimension before and after intervention in surgical wards. The tables shows that before intervention, the

mean score was 20.35, which reached 22.92 after intervention. The paired t-test showed a significant difference in nursing care quality in terms of communicational dimension (p = 0.012). Table 4 show the comparison of overall nursing care quality before and after intervention in nurses of surgical wards. The findings show that before intervention, the mean score was 90.79, which reached 99.02 after intervention. There was a significant statistical difference between before and after intervention in terms of the overall nursing care quality. Moreover, there was a significant

relationship between nursing care

implementation and care quality (p = 0.001).

DISCUSSION AND CONCLUSION

The findings of this study showed that nursing process implementation can improve the quality of nursing care. These findings are consistent with the results of the studies by Akbari Kaji & Farmahini Farahani (2009) and Rastian et al (2015a) that found the implementation of nursing process enhanced quality of care.

In the study of Hasson & Arentz (2009) showed that educational interventions can improve nursing care quality for older patients, which is consistent with the results of our study.

The results of Emamzadeh Ghasemi et al (2004) showed that after the intervention, the quality of nursing care and training patients significantly increased in the experimental group, which is in accordance with the results of our study (Emamzadeh Ghasemi et al. 2004).

Table 1: Scores of nursing care quality in physical dimension before and after intervention in surgical wards

Group Scores

Before Intervention After Intervention

Number Percentage Number Percentage

Unfavorable 10 20.8 8 16.7

Somewhat Favorable 34 70.8 28 58.3

Favorable 4 8.3 12 25.0

Total 48 100 48 100

Mean Scores 31.21 34.02

Standard Deviation 6.869 7.318

p-value (CI 95%) 0.047

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Table 2: Scores of nursing care quality in psychosocial dimension before and after intervention in surgical wards

Table 3: Scores of nursing care quality in communicational dimension before and after intervention in surgical wards

Table 4: Comparison of overall nursing care quality before and after intervention in nurses of surgical wards

Group

Nursing Care Quality

Unfavorable 2 4.2 0 0

Favorable 0 0 1 2.1

Total 48 100 48 100

p-value (CI 95%) 0.001

Df 47

t -3.511

Optimal implementation of nursing process requires determining nursing care standards such as nurse-to-patient ratio, how to divide tasks based on nursing duties, changing the method of care provision to case method or team work, and necessity of an accurate system to evaluate qualitative and quantitative performance. Lack of attention to increased workload, increased number of patients compared to nurses, and assigning non-nursing tasks to nurses can decrease both the time nurses allocate to patients and the quality of

nursing care (Atashzadeh Shoorideh and Ashktorab, 2011). As respects, nursing job requires a lot of tolerance in dealing with patients, hospitals Managers should provide with nurses working shifts, recreational and educational programs, and pay attention to the natural happiness nurses (Rastian et al 2015b). Nursing process is a global standard to improve the quality of nursing care, which can be implemented in Iran, too (Akbari Kaji & Farmahini Farahani, 2009, Rastian et al (2015a). It is to be hoped that health authorities

Favorable 6 12.5 4 8.3

Total 48 100 48 100

p-value (CI 95%) 0.031

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T -2.218

Favorable 2 4.2 9 18.8

Total 48 100 48 100

p-value (CI 95%) 0.012

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and those in charge in Iran can prepare the ground for implementing such programs in all hospitals, and consequently improve the quality of nursing care as well as nurses’ job satisfaction.

ACKNOWLEDGEMENTS

The authors thank all the participants for their contributions to this study. We would hereby like to thank the research deputy of Shahid Beheshti Universityof Medical Sciences who financially supported this study.The authors have no conflicts of interest to declare.

REFERENCES

1. Adib Hajbaghery M, Salsali M and Ahmadi F (2006) [Empowerment model of nursing]. Edition. Tehran, Boshra (Persian)

2. Ahmadi F, Nobahar M, Alhani F and Falahi Khoshknab M (2011) [Perspectives of retired nurses on factors that affect quality of nursing care]. Hayat. 17 (1) 24-34. 3. Akbari Kaji M and Farmahini Farahani B

(2009). [The effect of nursing process education to nurses on quality of

schizophrenic patients] (MSc

Thesis).Tehran: Islamic Azad University. 4. Akbari M and Shams A (2010) A Survey on

Nursing Process Barriers from the

Perspective of Nurses in Intensive Care Units in Hospitals of Tehran. Iranian Journal of Critical Care Nursing. 4 (3); 181-6. 5. Alfaro-LeFevre R (2005) Applying nursing

process: the foundation for clinical reasoning. 7th ed. edition. Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins.

6. Atashzadeh Shoorideh F and Ashktorab T (2011) [Factors influencing implementation of nursing process by nurses: A qualitative study]. Knowledge & Health. 6 (3); 16-23. 7. Brunner L S, Suddarth D S and Boyer M J

(2010) Study guide for Brunner and Suddarth's textbook of medical-surgical nursing. 12th edition. Philadelphia, Wolters Kluwer.

8. Dabirian A, Zolfaghary H, Abed Saidi JH, Alavi Majd H (2009) Views of AIDS

patients regarding nursing care quality in health care centers affiliated to Shaheed Beheshti and Tehran Universitis of Medical

Sciences. Journal of Nursing and

Midwifery. 18(61);40-45.

9. Emamzadeh Ghasemi H, Vanaki Z and Memarian R (2004) [The Effect of Using “Applied In-Service Education Model” on Quality of Nursing Care in Surgery Unit]. Iranian Journal of Medical Education. 4 (2); 13-21.

10.Grant S M, Wild L, Vincent J (2004). Process and outcome measures using nursing sensitive indicators.Nurse leader.2 (2); 46-49.

11.Hasson H and Arnetz J E (2009) The impact of an educational intervention on nursing staff ratings of quality of older people care: a prospective, controlled intervention study. Int J Nurs Stud. 46 (4); 470-8.

12.Kurtzman E T, Dawson E M and Johnson J E (2008) The current state of nursing performance measurement, public reporting, and value-based purchasing. Policy, politics & nursing practice. 9 (3); 181-91.

13.Lee L-L, Hsu N and Chang S-C (2007) An evaluation of the quality of nursing care in orthopaedic units. Journal of Orthopaedic Nursing. 11 (3–4); 160-168.

14.Marquis B L , Huston C J (2003) Leadership roles and management functions in nursing: theory and application. 4th ed. edition. Philadelphia, Pa. ; London, Lippincott Williams & Wilkins.

15.Mason C (1999) Guide to practice or 'load of rubbish'? The influence of care plans on nursing practice in five clinical areas in Northern Ireland. J Adv Nurs. 29 (2); 380-7. 16.Mohammadnia M, Delgoshaei B, Tofighi S, Riahi L and Omrani A (2010) Survey on Nursing Service Quality by SERVQUAL at Tehran Social Security Organization Hospitals. Hospital. 8 (3); 68-73.

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18.Neishabory M, Raeisdana N, Ghorbani R and Sadeghi T (2010) Nurses' and patients' viewpoints regarding quality of nursing care in the teaching hospitals of Semnan University of Medical Sciences, 2009. Koomesh. 12 (2); Pe134-Pe143, En19. 19.Ovretveit J (2001) Quality evaluation and

indicator comparison in health care. The International journal of health planning and management. 16 (3) 229-41.

20.Potter P A and Perry A G (2009) Fundamentals of nursing. 7th ed. edition. St. Louis, Mo., Mosby/Elsevier.

21.Rastian M, Borzabady Farahani Z, Rasouli M. et al (2015a)The effect of nursing process implementation on nursing care quality of patients hospitalized in surgical wards. Journal of Nursing and Midwifery. 24(87); 29-36.

22.Rastian M, Hassan-nia S, Sadeghi N, Sadeghi F(2015b) A Comparative Study of Happiness in Male and Female Nurses. International Journal of Review in Life Sciences. 5(2); 1001-1004.

23.Shamaa E T E-, Mostafa F, Mohamed M A and Attia M (2011) Effect Of Implementing Nursing Care Standards For Nurses Caring For Patients With Cardiac Arrhythmia. Journal of Medicine and Biomedical Sciences. 2 (1); 13-23.

24.-Tylor C (2011) Fundamental of Nursing the Art and Science of Nursing Care. Seventh edition. Philadelphia: Lippincot Williams and Wilkins.

25.Wilkinson J M (2011) Nursing process & critical thinking. Fifth edition. Edition. Boston, Pearson.

26.Zagheri Tafreshi M, Atashzadeh Shorideh F, Pazargadi M, Barbaz A (2012) Quality of Nursing Care: Nurses, Physicians, Patients and Patients familys Perspectives: A Qualitative study. Journal of Urmia Nursing and Midwifery Urmia University of Medical Sciences .10(5); 648-65.

27.Zerwekh J G and Claborn J C (2006) Nursing today: transition and trends. 5th edition. St. Louis, Mo., Saunders/Elsevier.

28.Zolfaghaeri H (2009). [Nursing Care Quality from the Perspective of AIDS Patients in health care centers affiliated to shahid Beheshti and Tehran Universities of Medical Sciences] (MSc Thesis). Tehran:

Shahid Beheshti University of