The nursing process is a structured and systematic process of providing goal-oriented and humanistic nursing care that is both efficient and effective (1). It is a standard for the provision of individualized, ongoing nursing care through standardized nursing language. It helps improve the relationship of nurses with patients, uses available resources for patient care, and creates good communication between practicing nurses and nursing practice requires an efficient use of the nursing process and engages nurses in activities that enhance knowledge of the nursing process. Effective implementation of the nursing process improves quality of care and promotes the development of knowledge based on clinical practice (2–4).
The nursing process is coherent with the perspective of measuring results by benchmarking and prototyping, and encourages uniformity in practice (5). Implementing the nursing process is key to the core of professional nursing practice and allows nurses to deliver quality nursing care within a systematic goal-directed framework (6, 7).
There is a demand to implement the nursing process in practical care in every health institution, in hospitals as well as in the community as a whole, but the perception remains that it is time-consuming and impractical. If the nursing process is not valued and not used, nurses may continue to intervene on the basis of a medical diagnosis rather than on the basis of a rational nursing assessment, planning, evaluation, record keeping and feedback. In any of the steps, oversight or omission can result in less than optimal nursing care. If the nursing process is not used, the question could be asked how nurses assume responsibility and accountability for the patient and how to assess the quality of nursing care? (3, 8–10).
The nursing process is generally accepted in most countries but it is not implemented consistently. A study at the Brazilian teaching hospital revealed that all steps had been used, but not consistently carried out; in Taiwan, nurses followed the nursing process sequences and documentation; in Brazil, 98.7 percent of cases, assessment was done; in 90 percent of cases, diagnosis was made; and in 74 percent of cases, planning was carried out; in Mexico, there were problems with the implementations of the nursing process (3, 8, 11, 12).
Most countries in Africa had adopted the nursing process: however, problems were found in its implementation in clinical setting. Nurses generally agreed on the benefits of the nursing process in a study conducted in four African countries: however, they did not use it commonly in practice (13). A research in Nigeria showed 40.37 percent performed assessment, 13.7 percent performed diagnosis, 43.1 percent performed nursing plan and 2.7 percent performed assessment. While in Kenya, nurses were having trouble doing all the steps of the nursing process. Ethiopia's government has focused on the quality of health services, and nursing process quality. However, the implementation of the nursing process remains constrained (14). The nursing process was not introduced at all in Mekele, Ethiopia, in Addis Ababa hospitals, 52.1 percent of nurses implemented the nursing process, in Tigray region Ethiopia, 35 percent of nurses implemented the nursing process, in Debrmarkos and Finote-selam hospitals, Ethiopia, 37.1 percent of nurses implemented the nursing process, 32.7% in Arba-Minch Ethiopia, 42.1% nurses were implementing nursing process in Afar region (2, 15–21).
The implementation of the nursing process is hindered by several factors. Health care facility associated factors like organizational structures and facilities the environment of work place, non-proportional nurse to patient ratio, lack of training and motivating factors like salary high patient flow and scarcity of resources. The other is nurse related factor such as level of education, knowledge and skills of nurses, experience and ability to gather needed materials. Other factors hindering the implementation of the nursing process were the severity of cases and the patient cooperation (15, 16, 18, 19).
Nurses are the main health-care force in Ethiopia, and majority work in public health-care institutions and health-care services has been limited, quality of service has been poor, nurses face problems where their work has been underrepresented. They assume roles in various tasks, such as laboratory personnel, dentists, counselors and social workers, to cover the shortage of professionals in the field (15, 22, 23).
Although the implementation of the nursing process has been well investigated in many developed countries, it has only rarely been investigated in developing countries, including Ethiopia (3); this study therefore evaluated the implementation and factors affecting the nursing process and could provide information to researchers, program managers and nursing stakeholders.