ASSOCIATION BETWEEN TRAINING AND IMPLEMENTATION OF NURSING PROCESS
Table shows associations between training on nursing process and implementation of nursing process in
practice. Nurses who reported ever having trained in nursing process were also 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, were also similarly likely to report that the training had enabled them to competently practice
the nursing process (p = 0.002).
Table 7: Training and implementation of nursing process
Nursing plan implementation
Yes No Chi square P value
Self-rated understanding of NP
Very good 12(52.2) 11(47.8) 8.8 0.068
Good 21(36.2) 37(63.8)
Average 11(23.4) 35(74.5)
Poor 0(0.0) 5(100.0)
Very poor 0(0.0) 1(100.0)
Ever trained on NP
Yes 41(37.6) 67(61.5) 6.2 0.013*
No 3(12.0) 22(88.0)
NP training has enabled
competent practice of NP
Yes 36(46.8) 40(51.9) 9.6 0.002*
No 5(15.6) 27(84.4)
3.2.1 INSTITUTIONAL FACTORS AND THE ASSOCIATION WITH IMPLEMENTATION OF NURSING
PROCESS
Table 8 presents the associations between nursing process implementation and institutional factors. Among
the factors examined only a single factor, namely institutional supply of relevant tools required for nursing
process implementation was related to the implementation of nursing process (p = 0.048). Out of the nurses
who reported that the institution supplied the relevant tools 38 (37.6%) implemented the nursing process
compared to 6 (18.2%) of nurses who indicated that the institution did not provide the relevant tools for
implementation
of nursing process. Other variables which included supervision (p = 0.404), performance appraisals (p =
0.131) and staff motivation (p=0.751) were not significantly associated with the implementation of nursing
process.
Table 8: Institutional factors and the association with implementation of nursing process
Nursing plan implementation
Yes No Chi square P value
Hospital administration recognizes NP as
a framework of care delivery
Yes 33(31.4) 71(67.6) 0.6 0.452
No 11(39.3) 17(60.7)
Hospital administration support
implementation of NP
Yes 20(29.9) 46(68.7) 0.5 0.499
No 24(35.8) 43(64.2)
Management monitors NP implementation
Yes 12(28.6) 30(71.4) 0.7 0.404
No 32(35.6) 57(63.3)
Management recognizes staff for applying
NP
Yes 6(30.0) 14(70.0) 0.1 0.751
No 38(33.3) 75(65.8)
NP implementation forms part of
annual performance appraisal
objectives
Yes 15(31.9) 32(68.1) 4.1 0.131
No 27(32.1) 56(66.7)
Institution supplies relevant tools required
for NP implementation
Yes 38(37.6) 63(62.4) 3.9 0.048*
No 6(18.2) 26(78.8)
4. DISCUSSION
The study assessed barriers to implementation of nursing process among nurses working at Machakos Level 5
Hospital. This study objectively assessed nurse demographic factors, institutional factors, social and cultural
factors which were hindering implementation of nursing process in clinical setting.
The findings of this study showed that there was a significant association between nursing process
implementation with the nurses’ age and experience. The younger nurses were more likely to practice nursing
process compared to elderly nurses. Recently qualified nurses with experience less than 5 years and
experience between 5 and 10 years were more likely to implement nursing process respectively compared to
the nurses who have more years of experience. These findings could be attributed to positive shift of attitude
towards nursing process by the young nurses, the current mode of nursing upgrading system which is
enhancing upward mobility of nursing education and more so the push for patient centered care in our current
society. This is in agreement with the findings of Manal & Hala, (2014) that demographic characteristics of
nurses like age and years of work experience have significant impact on nursing process implementation.
Although academic qualifications has been found to have a direct statistical significance and a relationship
with nursing process knowledge and implementation in a study by Manal & Hala, (2014), the results of this
study indicate that academic qualification (p=0.141) was not significantly associated with nursing process
implementation though again this study results revealed that nurses with bachelors degree in nursing were
more likely to implement nursing process as compared to nurses with diploma and certificate in nursing. This
study finding could be attributed to lack of nursing process implementation emphasis by the current training
curriculum, lack of enabling or facilitating factors in the institution of this study like facilitative supervision
by manager, lack of enough resources, poor staffing levels and lack of guided practice.
The results of this study revealed that nurses who reported to have ever trained on nursing process were more
likely to implement nursing process compared to those who had not trained, similarly they were more likely
to report that the training had enabled them to competently implement nursing process (p = 0.002). However,
among the sample population (n=134) only 44(33.1%) were actively implementing nursing process by
formulating nursing care plans. Among the implementing nurse, 11(8.2%) could list all the steps of nursing
process correctly. Majority of the trained nurses not implementing nursing process could be attributed to
knowledge gap on nursing process, increased workload, lack of updates on nursing process, inconsistence in
facilitative supervision and low motivation among nurses working at Machakos level 5 Hospital. These
findings are in line with Delgado & Mendes, (2009) who noted that what is taught in school could be different
from what is actually being done in practice.
The study revealed that over more than half of the nurses rated their understanding of nursing process as very
good and good, however the study results shows no significant association between understanding and
implementation of nursing process. The statistical insignificance of the finding could be as a result of
inconsistence in nursing process practice, negative attitude, poor staffing ratios and lack of relevant resources
to implement nursing process. This finding varies with several studies. A study by Florance and Adenike,
(2013) reports that the more nurses are knowledgeable, the more they are likely to implement nursing process
The result of this study also varies with a study results in Ethiopia by Fisseha Hagos, et al., (2014) that
knowledge is one of the most key determinant factors for application of nursing process in clinical setting.
Another study by Fisseha Hagos, et al., (2014) found out that highly knowledgeable nurses were 8.78 times
more likely to implement nursing process than nurses who were not knowledgeable.
Among the institutional factors examined in this study, supply of relevant tools required for nursing process
implementation by the institution was significantly associated with the implementation of nursing process.
This is in agreement with the findings of Abebe, Abera and Ayana, (2014) in Northern Ethiopia which
revealed that nurses who reported availability of necessary resources and equipment for patient care in the
hospital were three times more likely to implement nursing process than those who reported inadequate
resources and equipment
for patient care. Out of the nurses who reported that the institution supplied the
relevant tools, 38 (37.6%) implemented the nursing process compared to 6
(18.2%) of nurses who indicated that the institution did not provide the relevant
tools.
Another institutional factor in this study was nurse workload. Results indicated
that nurse to patient ratio was high at Machakos Level 5 Hospital and this could
be one of the barriers hindered nursing staff from applying nursing process. This
agrees with a study by Clarke and Aiken, (2003) that revealed certain factors
limiting the ability of nurses to implement nursing process in their daily practice
as lack of time and high numbers of patient. Lukes, (2010) also noted that most
nurses find it easily to use the nursing process when caring for special patients
individually but with increase in the number of patients, this process becomes
impossible be used.
5. CONCLUSION
Nursing process implementation in Machakos Level 5 Hospital is below par
(33.1%) and is significantly affected by the nurses demographic factors
including age and experience, lack of continuous nursing process update
trainings, poor staffing ratios and inadequate resources to enable nurses
implement nursing process effectively. There is need to strengthen national
policy frameworks and interventions aimed at improving nursing process
training and implementation at clinical setting in Kenya.
ACKNOWLEDGEMENT
We wish to express our appreciation to the respondents who participated in this study for their
cooperation and sacrificing their precious time. Our gratitude also goes to the Machakos County
administration and Machakos Level 5 Hospital management for their support and assistance.
COMPETING INTERESTS
The authors declare that they have no competing interests.
