Study design and setting
The cross-sectional study design was conducted in Woldia referral hospital in Northern Ethiopia. Woldia is a hill market town and the capital town of the North Wollo zone. It is about 521 Km from Addis Ababa and 360 km from Bahirdar. The town has a total population of 75,496 of whom 37279 are females and 38,167 are males. The hospital contains 17 specialists, 45 general practitioners, 172 nurses (94 BSc and 78), and 66 midwives. The study was conducted from April to May 2020.
Inclusion and exclusion criteria
All nurses who were working in Woldia referral hospital were considered as the study population. Nurses who had at least 6 months of work experience were included in the study and nurses who were critically ill were excluded from the study. Furthermore, those nurses who were on annual and maternal leave, and those who were in short-term and long-term training during the study period were excluded from the study.
Sample size determination
The sample size was calculated based on a single population proportion formula designated as (n= (Zα/2)2p(1-p)/d2)); where n=the required minimum and feasible sample size, Za/2(1.96): significance level at α=0.05 with 95% confidence interval, p: the proportion of implementation of the nursing process from a previous study (0.37) (15), and d: margin of error (5%).then, the final sample size calculated was 113 after considering 10% non-response rate.
Sampling technique and sampling procedure
Woldia Referral Hospital has seven departments. From these departments, the total sample size was allocated to each department in proportion to the number of nurses. Then, from each department, study subjects were selected by a computer-generated simple random sampling method
Method of data collection
The data were collected using pretested, structured, adopted self-administered questionnaires prepared in English. The questionnaires include information on socio-demographic characteristics, organizational and nurse’s related questions, knowledge, and practice assessment questions. The questionnaires were pretested on 5% of the sample size at Dessie Referral hospital and the necessary correction was made based on the strength and weakness of the questionnaires. Furthermore, an amendment was done regarding the questionnaire format after the pretest. The data were collected by two BSc nurses and supervised by one MSc nurse. The data collectors were trained before actual data collection and the supervisors supervised the data collector closely. The nurses who scored mean and above the mean of knowledge-related questions were considered knowledgeable, whereas those who were scored below the mean were considered as not knowledgeable. Similarly, nurses who practiced the nursing process daily were considered as good practice, whereas those who were not practicing the nursing process at least once a day were considered under poor practice.
Data processing and analysis
After the data collection, the data template format was prepared, coded, and entered into Epidata version 4.2. Then the data were exported to SPSS version 24 for analysis. The descriptive and analytic analysis was employed to describe the percentages and distributions of the respondents for socio-demographic characteristics, organization, and nursing-related characteristics, and the factors that influence the implementation of the nursing process. Bivariate and multivariate analysis was conducted for the association of the independent variables with the dependent variable. Crude and adjusted odds ratios with the corresponding 95% confidence intervals were also computed. P-value <0.05 was considered statistically significant in this study. The results were presented in the form of texts and tables (10).
Data quality control
The quality of the data was assured by using; structured and validated questionnaires pretest on 5% of study subjects at Dessie referral hospital and modification and adjustment of the data collection instruments after the pretest finding, training of data collectors and supervisors for one day on the data collection instrument and data collection procedure. Furthermore, the data collectors were supervised closely by the supervisors and investigators, and the completeness of each questioner was checked by the principal investigator.
Ethics approval and consent to participate
Ethical clearance was obtained from the institutional review board of Woldia University. An official letter from the College of Health Science was written to the Woldia City Administration Health Bureau and Woldia Referral Hospital. Permission was obtained from the Woldia city administration health bureau and an official letter was given to Woldia referral hospital. Informed written consent was also obtained from all nurses. The confidentiality of the information was reassured that they were anonymous. All methods were carried out following relevant guidelines and regulations (8).
Funding source
The funding organization is Woldia University. There is no role in the development of the paper except the logistics one.