KNOWLEDGE AND ATTITUDE OF NURSES TOWARDS UTILIZING NURSING CARE PLANS IN PATIENT MANAGEMENT

1.1 Introduction

Nursing care has evolved, moving from the era of the disease model to the modern, scientifically grounded, and holistic approaches. in the past, patients' medical care was mostly focused on treating their physical illness, with little consideration given to the psychological and social aspects of their condition. Nursing process application, which combines the science and art of nursing, has shown to be a priceless tool that has transformed nursing practice and patient outcomes globally. As a result, nurse practitioners must remain current on the most recent scientific findings pertaining to all of their completed tasks (American Nurses Association, 2009). The use of the nursing process in clinical settings promotes patient health, upholds the scientific discipline of the nursing profession, and offers high-quality nursing care (Habermann et al., 2006).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.

1.2 Background of Study

In practical application, the Nursing Care Plan (NCP) serves as a methodical and scientific approach to problem-solving when assessing an individual's care needs. Nursing care documentation is an essential and effective tool in health care systems that guarantee communication and continuity of care among medical professionals for improved patient outcomes (Mangare et al., 2016). Implementation of the Nursing care process has economic benefits to a country as it leads to increase in patients’ working time and decrease in the cost of health care as a result of patients’ reduced hospital stay which is a result of quality health care from nurses (Miskir et al., 2018). The process for nursing was created with registered nurses in mind. All licensed nurses have a common way of thinking thanks to the application of the nursing process. There are five main steps involved in this process: assessment, nursing diagnosis, planning, execution/intervention, and evaluation (RCN, 2004).

Effective use of the nursing process and engagement in activities aimed at enhancing nursing process knowledge are essential components of nursing practice. According to Pokorski et al. (2009), the effective implementation of the nursing process enhances the standard of care and fosters the growth of clinical practice-based expertise.

In clinical practice, the appropriate implementation of nursing processes fosters critical thinking, creativity, problem solving, and decision-making abilities. Improvements in healthcare quality could lead to shorter hospital stays, longer patient stays, and lower medical costs, all of which could boost a nation's economy (Ardic, 2011).

The Nursing care process is regarded as the gold standard for nursing practice in the majority of developed nations' healthcare systems. The nursing profession is promoted as a scientific discipline and patient outcomes are enhanced through the efficient and effective application of the nursing process in clinical practice. The nursing process helps each patient become healthier by identifying, preventing, and treating current and potential health issues. Based on the methodical approach to problem-solving, it establishes the foundation for nursing practice. It consists of five interconnected steps that, when properly executed, allow for the planning and delivery of high-quality, all-encompassing nursing care (Catherine et al., 2019; Semachew, 2017; Thuvaraka et al., 2018; Abdelkader et al., 2017).

Nursing care plans are created exclusively for the critically ill and recently admitted patients; they are not usually followed strictly. Patients who are critically ill are not given any nursing care plans. Because nursing care plans are not consistently used from the time of admission to the time of discharge, this has an impact on how well patient health outcomes are monitored. But when a nursing care plan is effectively implemented, it guarantees the promotion of health and the avoidance of disease because nurses spend a considerable amount of time with their patients, offering continuous care throughout the course of treatment and then evaluating that care.

The nursing care plan serves as a roadmap for the team's junior members as well as a means of imparting specialized skills necessary for carrying out a singular, professional role and foreseeing future issues. Care plans are a special kind of action that combines thinking and doing. Nursing practice requires the effective use of the nursing process, per current practice standards. Therefore, in Nigeria where the research was carried out, the activities that was conducted is to assess the Knowledge and Attitude of Nurses towards Utilizing Nursing Care Plans in Patient Management.

1.3 Statement of Problems

Studies have shown that, despite the use of nurse practitioners as a framework for nursing care in training programmes for nurses and midwives, nurses still find it difficult to practise nursing practices, which may contribute to the low quality of patient care in Nigeria (Mangare et al., 2016). Hospitals also face challenges like a lack of supplies and an overwhelming amount of work for nurses, which prevent the nursing process from being fully implemented.

The primary obstacles to putting the nursing care plan process into practice, including a shortage of time, money, materials, manpower, and motivation, must be addressed. Nurse workflow should be aligned with integrated systems to promote a high-performing healthcare system. This will free up front-line nursing staff members to focus on planning and communicating care for individual patient issues.

Many African nations have embraced the nursing process approach to patient care; however, its application in clinical settings presents a challenge. Many African nations, including Nigeria, have not done a thorough investigation or documentation of the extent of its application in clinical settings.

1.4 Aim and Objectives of Study

The aim of the study is to examine the Knowledge and Attitude of Nurses towards Utilizing Nursing Care Plans in Patient Management. In achieving this aim, the following specific objectives were laid out as follows:

1. To identify the factors that may influence the implementation of the nursing care plans in patient management;
2. To examine the attitude and practice of nurses towards the use of Nursing care plans in patient management;
3. To determine Nurses understanding of the relevance of patient management to Nursing care delivery; and
4. To assess knowledge, attitude, practice and associated factors towards nursing care documentation among nurses.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• What are the factors that may influence the implementation of the nursing care plans in patient management?
• What are the Nurses understanding of the relevance of patient management to Nursing care delivery?
• What are the attitude and practice of nurses towards the use of Nursing care plans in patient management?
• What is the knowledge, attitude, practice and associated factors towards nursing care documentation among nurses?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There is significant attitude and practice of nurses that negatively impact the use of Nursing care plans in patient management
• H1: There is significant attitude and practice of nurses that positively impact the use of Nursing care plans in patient management

Hypothesis Two

• H0: There are no significant factors that influence the implementation of the nursing care plans in patient management
• H1: There are significant factors that influence the implementation of the nursing care plans in patient management

Hypothesis Three

• H0: There is no significant relationship between knowledge of nursing care plan and practice of nursing care plan among nurses in the study area
• H1: There is significant relationship between knowledge of nursing care plan and practice of nursing care plan among nurses in the study area

1.7 Significance of Study

The relevance of this study will help nurses utilizing nursing care plans to communicate the patient's condition and also to other members of the health team in a clear and concise manner. Nurse satisfaction and the patient's perception of the plan of care's value are enhanced when the population-level patient care plan is integrated into the workflow documentation rather than existing as a stand-alone document or task.

Specifically, this research will be significant to the listed stakeholders in the following ways:

1. The Client (Patients): Increased client participation, tailored care, avoidance of duplication and omission, and continuity of care.
2. The Nurses: Standards of practice, staffing assignments, ongoing education, boosted self-esteem, and work satisfaction.

Finally, this study will be extremely helpful to other researchers who wish to learn more about it. Non-researchers can also use it to expand on their own research projects. This research adds to the body of knowledge and may help direct future investigations.

1.8 Scope of Study

The scope of the research is focused on the Knowledge and Attitude of Nurses towards Utilizing Nursing Care Plans in Patient Management using Enugu State University Teaching Hospital (ESUTH) as a case study.

1.9 Limitations of the Study

During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:

1. Time Constraint:The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Establishment Policies:Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this research work. There were lots of information needed from the staffs of this establishment to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
3. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
4. Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.

1.10 Operational Definition of Terms

NCP:

It is an acronym for Nursing Care Plan.

Nursing Care Plan:

It is a medical plan that is used in practice to determine each person's unique care needs through a methodical, scientific approach to problem-solving.

Health:

It is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.