Application of Nursing Process and Its Affecting Factors among Nurses Working in Mekelle Zone Hospitals, Northern Ethiopia

Translation, cross-cultural adaptation and evaluation of the Iranian Persian version of student survey on writing nursing care plan

AIM

The objective of this study was to validate the Iranian translation and cross-cultural adaptation of the Student Survey on Writing Nursing Care Plan (SSW-NCP).

BACKGROUND

To provide supporting evidence about the nursing students' skill in planning and documenting nursing care plans based on nursing process, Salvador et al. developed the SSW-NCP to measure the extent to which nursing students are qualified in writing nursing care plans. However, an Iranian version of the SSW-NCP is presently not available.

METHOD

The cross-cultural adaptation and linguistic translation of the SSW-NCP adhered to World Health Organization (WHO) guidelines. The reliability and validity process followed the COSMIN checklist.

RESULTS

The survey was well translated to Persian language and culturally adapted through confirming the relevancy, appropriateness and logical representation of all aspects on nursing process by bilingual experts and pre-tested on Persian-speaking nursing students. The Cronbach's Alpha coefficient (α) and test-retest stability assessing affirmed the reliability, and convergent validity of the adapted survey was confirmed through comparison to Influencing Factors of Nursing Students' Clinical Judgment (IFNSCJ). The adaptation process of the SSW-NCP resulted in a conceptually equivalent translated version, which is comparable to the original version and is acceptably valid and reliable.

IMPLICATIONS FOR NURSING MANAGEMENT

Knowing the proficiency of nursing students as future nurses in writing nursing care plans can provide accurate professional information for better educational and practical level programming and management that can enhance nursing practice.

PATIENT OR PUBLIC CONTRIBUTION

The target group of survey was nursing students who contributed and participated in the current study.

Nursing process application in Nepal teaching hospital

Relevance. Nursing process is a scientific method of organizing and providing nursing care. Due to imbalance of nurse patient ratio, application of nursing process in actual clinical setting is very limited which reduces the quality nursing care. Despite the importance of application of nursing process, there is no standard nursing process protocol available in the hospital where study was carried out. The governments set a standard nurse patient ratio in Nepal, UK and USA is 1:10, 1:8, and 1:5 respectively. However, global statistic has been revealed due to improper nurse patient ratio which cannot implement the nursing process for patient caring which are being for leading cause of mortality of patient in hospitals. Aim of the study. The study was conducted to assess the application of the nursing process among nurses working in teaching hospital. Additionally, this study explores the association between status of application of nursing process and selected variables. Materials and Methods. Based on a descriptive cross-sectional study design. A simple random sampling technique was applied for nurses working in tertiary hospital of Chitwan, Nepal. The data was collected using structured questionnaire among 182 nurses. The statistical analysis tool chi-square was used to find out the association and logistic bivariate to find out the odds ratio. Results and Discussion. The result indicates that only 23,1 % of nurses have moderate level of application of nursing process. Majority of nurses did not follow standard ways of nursing process. This study also explored the infl ncing variable for barriers related to nurses and profession. Age (p=0.001), professional qualification (p=0.001) and learning approach (p=0.022) were the significant influencing variable for barriers related to nurses whereas practical skill (p= 0.001), cooperation among nurses (p=0.008) and diffi in diagnosis characteristic (p=0.010) were the barrier related to profession. Conclusion. It was concluded that the majority of nurses working in teaching hospital of Nepal did not follow the standard ways of nursing process so that barriers for the application of nursing process are identifi The overall ratio of nurses to patients in the teaching hospital is 1:16, that is in the lower range than the standards set by the government. Therefore, special attention must be paid to adherence to a standardized nursing process protocol for quality medical care.

Nursing process application in Nepal teaching hospital

Relevance. Nursing process is a scientific method of organizing and providing nursing care. Due to imbalance of nurse patient ratio, application of nursing process in actual clinical setting is very limited which reduces the quality nursing care. Despite the importance of application of nursing process, there is no standard nursing process protocol available in the hospital where study was carried out. The governments set a standard nurse patient ratio in Nepal, UK and USA is 1:10, 1:8, and 1:5 respectively. However, global statistic has been revealed due to improper nurse patient ratio which cannot implement the nursing process for patient caring which are being for leading cause of mortality of patient in hospitals. Aim of the study. The study was conducted to assess the application of the nursing process among nurses working in teaching hospital. Additionally, this study explores the association between status of application of nursing process and selected variables. Materials and Methods. Based on a descriptive cross-sectional study design. A simple random sampling technique was applied for nurses working in tertiary hospital of Chitwan, Nepal. The data was collected using structured questionnaire among 182 nurses. The statistical analysis tool chi-square was used to find out the association and logistic bivariate to find out the odds ratio. Results and Discussion. The result indicates that only 23.1 % of nurses have moderate level of application of nursing process. Majority of nurses did not follow standard ways of nursing process. This study also explored the influencing variable for barriers related to nurses and profession. Age (p=0.001), professional qualification (p=0.001) and learning approach (p=0.022) were the significant influencing variable for barriers related to nurses whereas practical skill (p= 0.001), cooperation among nurses (p=0.008) and difficulty in diagnosis characteristic (p=0.010) were the barrier related to profession. Conclusion. It was concluded that the majority of nurses working in teaching hospital of Nepal did not follow the standard ways of nursing process so that barriers for the application of nursing process are identified. The overall ratio of nurses to patients in the teaching hospital is 1:16, that is in the lower range than the standards set by the government. Therefore, special attention must be paid to adherence to a standardized nursing process protocol for quality medical care.

Interviews with Community Healthcare Registered Nurses in Norway: Examination Practices and Clinical Evaluation Processes

Aim

This study describes the examination practices and clinical evaluation processes that Registered Nurses in Norway perform in the community healthcare sector.

Design

A qualitative exploratory design.

Methods

Twenty interviews were conducted with Registered Nurses employed in the community healthcare sector in Norway. The data were analysed using a thematic analysis.

Results

We found four major themes: (1) evaluations are embedded in nurses’ daily work, (2) significance of a Registered Nurse's clinical competency, (3) different tasks require various roles and (4) access to resources and equipment. Registered Nurses possess several skills in a range of different examination techniques and clinical evaluation processes in the community healthcare sector. They perform complex assessments in their daily work and must rely on other healthcare professionals, facilities and equipment to provide high‐quality care. Ongoing education and training will enable Registered Nurses to complete accurate assessments in their community healthcare practice.

Qualitative exploration of the challenges and the benefits of the nursing process in clinical practice: A study among registered nurses in a municipal hospital in Ghana

AIM

This study aims to explore the challenges and benefits of using the nursing process in a Ghanaian Hospital.

DESIGN

The study employed a qualitative descriptive design to explore the challenges and the benefits of the utilization of the nursing process.

METHODS

Twelve (12) Registered Nurses were recruited for the study using purposive sampling. Recorded in-depth interviews were conducted and data were analysed using thematic analysis.

RESULTS

The study found a low nurse-to-patient ratio, inadequate knowledge, apathy, inadequate logistics, poor supervision as challenges. However, quality and cost-effective care improved nurse-patient relationships, and job satisfaction was found to be the benefits of nursing process use. Interventions to improve its utilization should be targeted towards improving the nurse-to-patient ratio, provision of adequate resources and inclusion of the nursing care plan in patient folders.

Translation and psychometric properties of the Persian version of the position on nursing diagnosis scale

AIM

To validate the Positions on Nursing Diagnosis scale developed by Lunney and Krenz (1992) in Persian language.

DESIGN

Cross-sectional survey.

METHODS

A methodological study conducted in two stages of translation (by applying the forward and back-translation method) and psychometric assessment was conducted in a western area of Iran. The scale was completed by 600 nurses selected by quota method from different wards of four provinces. Date of data collection is 1-April-2019 to 1-Dec-2019.

RESULTS

The Positions on Nursing Diagnosis scale showed acceptable content validity with index of 0.97. The 20 items of the Positions on Nursing Diagnosis scale load on four factors. The confirmatory factor analysis demonstrated the good fit of the model's indicators. Cronbach's alpha coefficient for the whole instrument was 0.85. The intraclass correlation coefficient was 0.86.

Evaluation of Nurses' Perceptions of Nursing Diagnoses and Their Opinions Regarding the Application of Nursing Process

AIM

This study aimed to evaluate nurses’ perception of nursing diagnoses and their opinions regarding the application of nursing process and to determine the factors affecting them.

METHOD

This was a descriptive cross-sectional study. The sample consisted of 320 nurses who worked at a foundation university hospital between October and December 2017. The Nurse’s Information Form and Nursing Diagnoses Perception Scale were used to collect the research data. The scale included expressions reflecting nurses’ perceptions about the use, usefulness, aims, results, objectives, and limitations of nursing diagnoses.

RESULTS

A total of 51.2% of the nurses participating in the study had a bachelor’s degree, and the average age was 25.36 ± 4.83 years. More than half of the nurses (50.9%) stated that they had difficulty in the assessment stage of the nursing process and that they diagnosed the risk of infection most frequently (74.4%). The nurses’ mean total score on the survey was 2.68 ± 0.44 (2–4). There was a statistically significant relationship between the total mean score of the scale with the sex, education level, and the belief that the nursing process should be used (p < .001; p < .001; p < .05).

CONCLUSION

The nurses’ perception of nursing diagnoses was at a moderate level. Positive perception of nursing diagnoses could improve nursing quality by enabling nurses to focus on care.

The implementation of nursing process during patient care in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Nursing process (NP) is a standard method of ensuring individualized holistic care through systematic assessment, diagnosis, planning, intervention and evaluation of patients. Its standard implementation is mandatory to meet the health target of "ensuring universal quality health-care services" in the sustainable development goals (SDG) launched by World Health Organization (WHO) in 2015. Being a member state of WHO, Ethiopia endorsed the SDG agenda. Therefore, determining the recent pooled estimate and associated factors of NP implementation during patient care would be of greatest importance to improve the quality of nursing care in the country.

METHODS

Primary studies were systematically searched from PubMed, Scopus, Cochrane Library, Google Scholar, PsycINFO and CINAHL data bases using different search operators. Each selected primary study was critically appraised using the Joanna Briggs Institute (JBI) appraisal tool for prevalence studies. I2 and Q statistics were used to investigate heterogeneity. Given the substantial heterogeneity between the studies, random effects meta-analysis model was used to estimate the pooled magnitude of NP implementation. Subgroup analyses were performed for evidence of heterogeneity. Egger's test was considered to declare publication bias objectively. The PRISMA guideline was followed to report the results.

RESULTS

A total of 17 primary studies with a sample of 2,819 nurses were included in this meta-analysis. The pooled estimate of NP implementation in Ethiopia was 50.22% (95% CI: 43.39%, 57.06%) with severe statistical heterogeneity (I2 = 93.0%, P < 0.001) between the studies. From regional subgroup analysis, NP was least implemented in Tigray region 35.92% (95% CI: 30.86%-40.99%, I2 < 0.001%). Egger's test showed no statistical significance for the presence of publication bias (P = 0.23). Nurses' good knowledge of NP [(Adjusted Odds Ratio (AOR) = 13.16: 9.17-17.15], nurses' Bachelor of Science (BSC) and above level of education (AOR = 4.16; 2.32-5.99), working in a stressful environment (AOR = 0.10; -0.02-0.22), training access (AOR = 3.30; 1.79-4.82) and accessibility of facility required for NP (AOR = 6.05; 3.56-8.53) were significantly associated with NP implementation at 95 % CI.

CONCLUSIONS

It was found that only half of the nurses in Ethiopia implemented NP during patient care. Fortunately, its associated factors were modifiable. Therefore, the existing national efforts of increasing nurses' knowledge of NP and their level of education, availing facilities required for NP implementation, training access and ensuring non stressful working environment should be reinforced to meet the quality nursing care demand in Ethiopia.

PROSPERO ID

CRD42019138159.

Description and Validation of Nursing Diagnosis Using Electronic Documentation: Study Cases in Mother and Child Hospital Indonesia

Background:

A nursing diagnosis is a clinical judgment concerning a human response to a health condition, vulnerability for that response, by an individual, family, group, or community. For the determination of the right nursing diagnosis, a system that guides nurses in implementing care professionally is needed.

Objective:

To describe the nursing diagnosis in mother and child cases validated by using a management nursing information system.

Methods:

This case study used secondary data from 5.294 medical records. Medical records were retrieved from the server, analyzed, and validated by using the mapping model in accordance with the most frequent cases in mothers and children in the hospital. Approximately ten million (10.021) nursing diagnoses were performed by nurses and validated by using a mapping model of medical cases and nursing assessment. The selected medical cases were the five most frequent cases, namely normal delivery, cesarean delivery, healthy newborn, fever, and dengue in children.

Results:

This study yielded the five most frequent nursing diagnoses, namely risk for infection (20.1%), pain (13.37%), anxiety (9.37%), the risk for imbalanced fluid volume (9.36%), and risk for bleeding (9.27%).

Conclusion:

The electronic nursing documentation could help to determine a nursing diagnosis and had been validated for its appropriateness with assessment and the most common cases in mothers and children. Information and system training development are required to carry out the nursing process comprehensively.

Implementation and factors affecting the nursing process among nurses working in selected government hospitals in Southwest Ethiopia

BACKGROUND

The nursing process was initially adopted from the general system theory, and was developed and implemented in the field of education. There is a demand to implement the nursing process in practical care in every health institution, 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 Process steps. In any of the steps, oversight or omission can result in less than optimal nursing care. The purpose of this study was to assess implementation and factors affecting the nursing process among nurses working in selected government hospitals in Southwest Ethiopia.

METHODS

An institution-based cross-sectional descriptive study was conducted from March 10 to April 1, 2015 in three hospitals in southwest Ethiopia using self-administered questionnaires. This study included a total of 138 nurses using simple random sampling. Data were classified, coded and entered into epidemiological information version 3.5.3, and exported to the statistical package for social science version 20 for analysis, descriptive statistics were used to describe the variables, bivariable and multivariable logistic regression were used to see the effect of each variable on the dependent variable.

RESULT

The nursing process was found to be 73.9% implemented. Compared to a Bachelor of Science nurses', the likelihood of implementing the nursing process was less likely among diploma nurses. Nurses working in administratively supported hospitals implemented the nursing process more compared to those without administrative support. The nursing process had been implemented higher by trained nurses compared to untrained nurses.

CONCLUSION

The implementation of nursing process was good where; nearly seven in every ten nurses implemented the nursing process. Low educational qualification, lack of training, and non-supportive hospital administration were predictors of the nursing process implementation. The health service management, in collaboration with Ethiopian nursing/professional associations and international governmental and non-governmental organizations should give continuous on the job professional development education, and develop nursing practice guidelines.

The implementation of the nursing process in lower-income countries: An integrative review

Aims

This review study aimed to investigate the strategies for implementing the nursing process in the clinical practice and the assessment of the implementation rate of this process in clinical settings of lower-income countries.

Design

An integrative review.

Method

The search was conducted of EMBASE, MEDLINE, CINAHL, Scopus and ISI databases from 1975-July 2018. Following the formation of the research team, two researchers independently selected the eligible studies; finally, 39 articles were approved by the research team for this study.

Results

The researchers identified three themes: Effects of implementing the NP in clinical settings, Development and application of electronic software in the NP and Factors affecting the implementation of the NP. This review revealed that nurses and nursing managers in hospitals are interested in implementing the nursing process in the form of widely and continuously. But the necessary infrastructure, such as manpower, electronically or manually tools, has not yet been provided, and the implementation of the nursing process is done either imperfectly or not done.

Experiencias de los alumnos en el Aprendizaje del Proceso de atención de enfermería

Introducción: La utilización del Proceso de Atención de Enfermería (PAE) como metodología propia de la disciplina, resuelve los problemas de las competencias de enfermería, permite intervenciones reflexivas para la solución de problemas individuales y atención integral a la persona, mejora la comunicación, delimita el campo profesional en cuanto identifica los fenómenos de interés y fundamenta la investigación; por ello tiene un espacio destacado en la formación del pregrado de enfermería. Objetivos: a) Describir la experiencia de los alumnos de la licenciatura en enfermería en el aprendizaje y aplicación del PAE durante su formación académica, b) Identificar si el estudiante reconoce al proceso como la metodología propia de la disciplina para otorgar el cuidado. Metodología: Estudio con enfoque cualitativo-fenomenológico-descriptivo, los participantes fueron alumnos del tercero al séptimo semestre de un programa de licenciatura en enfermería, se realizaron entrevistas a profundidad sobre el saber qué y cómo aprende y aplica el PAE, se realiza análisis de discurso, con codificación y decodificación hasta la construcción de las categorías. Resultados: En el análisis emergieron tres categorías: a) Mundos diferentes, con tres subcategorías; darse cuenta, vinculación teoría-práctica e influencia del profesional de enfermería; b) Formación teórica con dos subcategorías; aprendizaje complejo y, salud y enfermedad, c) Ambivalencia en la enseñanza del PAE por el docente con dos subcategorías; heterogeneidad y desavenencia docente, y acompañamiento del profesor. Aquí se aborda la primera. Discusión y conclusión: Además de las diferencias entre la teoría y la práctica del PAE, la interacción del estudiante con personal de enfermería no favorece el desarrollo del aprendizaje y aplicación de este.

Patient satisfaction with nursing care in Ethiopia: a systematic review and meta-analysis

Background

Patient satisfaction with nursing care has been considered as the most important predictor of the overall patient satisfaction with hospital service and quality of health care service at large. However, the national level of patient satisfaction with nursing care remains unknown in Ethiopia. Hence, the objective of this systematic review and meta-analysis was to estimate the level of patient satisfaction with nursing care and its associated factors in Ethiopia.

Methods

Studies were accessed through an electronic web-based search strategy from PubMed, Cochrane Library, Google Scholar, Embase, PsycINFO, and CINAHL by using a combination of search terms. The quality of each included article was assessed using a modified version of the Newcastle-Ottawa Scale for cross-sectional studies. All statistical analyses were done using STATA version 14 software for windows, and meta-analysis was carried out using a random-effects method. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for reporting results.

Results

Of 1166 records screened, 15 studies with 6091 patients fulfilled the inclusion criteria and were included in the meta-analysis. The estimated pooled level of patient satisfaction with nursing care in Ethiopia was 55.15% (95% CI (47.35, 62.95)). Patients who have one nurse in charge (OR: 1.08, 95% CI: 0.45–2.62, I²: 77.7%), with no history of previous hospitalization (OR: 1.37, 95% CI: 0.82–2.31, I²: 91.3%), living in the urban area (OR: 1.07, 95% CI: 0.70–1.65, I²: 62.2%), and those who have no comorbid disease (OR: 1.08, 95% CI: 0.48–2.39, I²: 91.9%) were more likely to be satisfied with nursing care compared with their counterparts although it was not statistically significant.

Conclusion

About one in two patients were not satisfied with the nursing care provided in Ethiopia and may be attributed to several factors. Therefore, the Ministry of Health should give more emphasis to the quality of nursing care in order to increase patient satisfaction and improve the overall quality of healthcare service in Ethiopia.

Use of Electronic and Paper-based Standardized Nursing Care Plans to Improve Nurses' Documentation Quality in a Nigerian Teaching Hospital

PURPOSE

To evaluate the effect of electronic and paper-based standardized nursing care plans (SNCPs) use on quality of nurses' documentation.

METHODS

Using quasi-experimental design, two wards were grouped into electronic and paper-based wards. Nurses were trained to use electronic- and paper-based SNCPs for care-planning and documentation. Data was collected before, 3, and 6 months postintervention and analyzed with SPSS version 20.

FINDINGS

There was improvement in documentation quality in the two wards after introducing SNCPs with higher quality scores in the electronic ward postintervention.

CONCLUSION

Providing SNCPs in electronic and paper formats is critical to improving nursing documentation.

IMPLICATION FOR NURSING PRACTICE

Adequate training and support for nurses are needed for successful implementation of SNCPs in electronic health records (EHRs) in developing nations.

Determinants of Nursing Process Implementation in North East Ethiopia: Cross-Sectional Study

Nursing process is a framework used to provide an effective, coordinated, and organized quality care for patients. Effective implementation of this framework leads to improved quality of care and decreases potential complication, hospital length of stay, and the cost of care. To assess implementation of nursing process and its hindering factors, a quantitative cross-sectional study was conducted among nurses in Afar region hospitals from October 2016 to December 2016. The data were collected from 102 nurses using primary Brooking's ward nurses' self-report questionnaire and with some newly prepared questions. The collected data were entered using Epi-Data version 3.1 and analyzed by SPSS version 20 and then presented by tables, graphs, and figures. Forty-three (42.1%) nurses were implementing nursing process at the time of data collection. Assessment and diagnosis were carried out by 57 (56.9%) nurses, planning by 46% of nurses, implementation by 38.2% of nurses, and evaluation by 36.2% of nurses in Afar region. Among the hindering factors towards nursing process implementation, lack of preparedness or knowledge about the nursing process or some part of it (83.3%) and absence of in-service training pertinent to nursing process (75.5%) were the most mentioned ones. Generally, nursing process was poorly implemented in Afar region mainly due to lack of knowledge and absence of in service training. Therefore, giving emphasis for cognitive parts of students about nursing process during their school time and refreshing nurse staffs with continuous training will definitively improve level of nursing process implementation.

Implementation of nursing process in clinical settings: the case of three governmental hospitals in Ethiopia, 2017

Objective

The purpose of this survey was to evaluate the implementation of the nursing process at three randomly selected governmental hospitals found in Amhara Region North West Ethiopia.

Result

From the total 338 reviewed documents, 264 (78.1%) have a nursing process format attached with the patient’s profile/file, 107 (31.7%) had no nursing diagnosis, 185 (54.7%) of nurses stated their plan of care based on priority, 173 (51.2%) of nurses did not document their interventions based on plan and 179 (53.0%) of nurses did not evaluate their interventions. The overall implementation of nursing process among Felege Hiwot Referal hospital, Debretabor general hospital and Finoteselam general hospitals were 49.12, 68.18, and 69.42% respectively. Nursing professionals shall improve documentation required in implementing the nursing process. Nursing managers (matron, ward heads) shall supervise the overall implementation of nursing process. Hospital nursing services managers (matrons) shall arrange and facilitate case presentations by the nursing staffs which focus on documentation and updates on nursing process. Hospitals need to establish and support nursing process coordinating staff in their institution.

A cross sectional study on nursing process implementation and associated factors among nurses working in selected hospitals of Central and Northwest zones, Tigray Region, Ethiopia

BACKGROUND

The nursing process is a systematic method of planning, delivering, and evaluating individualized care for clients in any state of health or illness. Many countries have adopted the nursing process as the standard of care to guide nursing practice; however, the problem is its implementation. If nurses fail to carry out the necessary nursing care through the nursing process; the effectiveness of patient progress may be compromised and can lead to preventable adverse events. This study was aimed to assess the implementation of nursing process and associated factors among nurses working in selected hospitals of central and northwest zones of Tigray, Ethiopia, 2015.

METHOD

A cross sectional observational study design was utilized. Data was collected from 200 participants using structured self-administered questionnaire which was contextually adapted from standardized, reliable and validated measures. The data were entered using Epi Info version 7 and analyzed using SPSS version 20 software. Data were summarized and described using descriptive statistics and multivariate logistic regression was used to determine the relationship of independent and dependent variable. Then, finally, data were presented in tables, graphs, frequency percentage of different variables.

RESULT

Seventy (35%) of participants have implemented nursing process. Different factors showed significant association. Nurses who worked in a stressful atmosphere of the workplace were 99% less likely to implement the nursing process than nurses who worked at a very good atmosphere. The nurses with an educational level of BSc. Degree were 6.972 times more likely to implement the nursing process than those who were diploma qualified. Nurses with no consistent material supply to use the nursing process were 95.1% less likely to implement the nursing process than nurses with consistent material supply.

CONCLUSION

The majority of the participants were not implementing the nursing process properly. There are many factors that hinder them from applying the nursing process of which level of education, knowledge of nurses, skill of nurses, atmosphere of the work place, shortage of material supply to use the nursing process and high number of patient load were scientifically significant for the association test.

The Opinions of Nursing Students Regarding the Nursing Process and Their Levels of Proficiency in Turkey

Introduction: Nursing process, as a scientific method of nursing practice, is an important tool for putting nursing knowledge into practice which increases the quality of nursing care. The study was aimed to determine the opinions of nursing students regarding the nursing process and their levels of proficiency.

Methods: A total of 44 nursing students participated in this descriptive study. Data were collected by a three-part questionnaire including the opinion of students on nursing process, Gordon’s functional health patterns model and the NANDA diagnoses. Data were analyzed by SPSS software.

Results: Most of the students (65.9%) believed that the nursing process was necessary. half of the students explained the diagnosis, 58.3% explained the planning, 41.3% explained the implementation, and 43.6% explained the evaluation sufficiently.

Conclusion: It is suggested for instructors to use different teaching methods in order to develop critical thinking while teaching the nursing process.

Perception of primary healthcare management nurses on the nursing process

OBJECTIVE

this qualitative study aimed to analyze the perceptions of primary health care management nurses on the nursing process.

METHOD

data were collected through interviews and analyzed by the Content Analysis proposed by Bardin's theoretical framework.

RESULTS

managers recognize the importance of the nursing process, although its implementation was not a priority at the time of the interviews. A conceptual difficulty and a lack of understanding that the implementation of the care methodology should be a cross-departmental action in the local healthcare management were clearly observed.

CONCLUSION

managers should have their perspectives broadened concerning the relevance of the nursing process and the professional training. The active participation of legislative nursing bodies, local healthcare management and the federal government may open the way for the effective implementation of the nursing process.