Nursing process : perceptions and experiences of nurses in a district public hospital in Lesotho

Abstract

Background: The nursing process is a widely accepted method and has been suggested as a scientific method to guide procedures and qualify nursing care. More recently, the process has been defined as a systematic and dynamic way to deliver nursing care. This process is performed through five interrelated steps, namely: assessment, diagnosis, planning, implementation and evaluation, with subsequent modifications used as feedback mechanisms that promote the resolution of the nursing diagnoses. The Lesotho Nursing Council (LNC) adopted the nursing process over a decade ago and the LNC mandated nurse training institutions and clinical settings to utilise this methodology. However, there is a reluctance to implement the nursing process despite its importance in nursing care (LNC, 2009:7). Purpose: The primary purpose of this research was to explore and describe the perceptions and experiences of nurses in implementing the nursing process in a district public hospital in Lesotho. On the grounds of these findings, the researcher ultimately makes recommendations for nursing education, nursing practice and nursing research. Methodology: To explore and describe the perceptions and experiences of nurses implementing the nursing process in a district public hospital in Lesotho, the researcher chose a qualitative, exploratory, descriptive and contextual research design. The researcher used voluntary purposive sampling to identify participants who complied with the set selection criteria. The sample comprised of professional nurses with varying years of working experience and qualifications. The data was collected by means of narratives and two focus group interviews; n=10 and n=6. The data was captured on a digital audio recorder and was transcribed verbatim. The researcher took field notes during each focus group. Both the researcher and independent co-coder analysed the narratives and transcribed data together, using narrative analysis and open coding (Creswell, 2009:185). Three main themes and nine subthemes emerged from the data collected from the narratives and focus groups. The researcher illustrated these themes through direct quotes by the participants. Each of these themes was discussed accompanied by relevant data obtained from literature, and reduced to conclusive statements, which serve as a basis for the derived recommendations to nursing education, nursing practice and nursing research. Trustworthiness was ensured in accordance with the principles of credibility, transferability, dependability and confirmability. Conclusions: The researcher reached a number of conclusions. The participants perceived several factors and experienced them as interfering with the efficient implementation of the nursing process. Operational difficulties experienced in the systematisation of nursing care in practice, are amongst others a lack of knowledge of the steps involved in the process, an excessive number of tasks assigned to the nursing team, the poor quality of professional education, insufficient reports on the physical examination related to the disease and difficulty to formulate the nursing diagnosis. The research report concluded with the researcher’s evaluation of the research and recommendations for nursing practice, nursing education and nursing research with the purpose of improving the implementation of the nursing process.