CHAPTER ONE

INTRODUCTION TO THE STUDY

1.1. Background

Nursing care plan is a set of actions the nurses use to implement, resolve patients needs and demands, at its best, is designed and implemented in a thorough manner, using an organized series of steps, to ensure quality and consistency of care (Laryea, 2004). Importance of nursing care plan is to minimize patient stay in hospital and in turn will reduce health care cost since patients will get better faster and go home, shortening the length of hospital stay. Care plans will also help the nurses from duplication of task while working to the same patients; this enhances the quality of patient care and helps to implement the evidence-based care practice.  The nursing care planning process is an important aid in the treatment of patients as it creates a systematic care plan approach that includes other health care professionals to attend to the patient needs and facilitates faster healing. (Hunter and Segret, 2006).

Nurses lack practical skills in data collection, writing nursing diagnosis and objective as found out in Ghana by Larynea (2004)  Ezel, (2004) discovered that knowledge was lacking although nurses had correct information on nursing process. Block, (2009) discovered that nursing process was not done accordingly, mainly due to the fact that some nurses have lower ability to process information based on intellectual, interpersonal and technical skills. Globally, the (WHO) estimates a shortage of almost 4.3 million nurses, physicians and other health human resources worldwide, nursing shortages have been linked to the following effects, Increased nurses patient workloads, Increased risk for error, thereby compromising patient care. Quality of patient care as well as adverse nurse outcomes is directly affected by nurses workload (Aiken,Clarke &Sloan,2002) (Howe 2005) is of the opinion that out of stock syndrome  is among the  factors that work against nursing process implementation.

The older or earlier graduate nurses never did nursing process in their days at college, but did medical practice was taught and practiced and they were not trained to give care through application of  nursing process model or use nursing care plans. Another fact is that newer nurses who are graduating now view nursing care plans more of student learning tool, which existed only during those days they were being examined in the ward. Carlton, (2007) based on these fact, these study therefore seek to establish factors hindering utilization of nursing care plan in Coast Provincial General Referral Hospital with view of examining nurses related factors and institution related factors.

                                            1.2 Problem Statement

CPGH is government hospital and a training institution for student nurses and doctor interns, those nurses do not integrate the concept of nursing care plan in directing patient care despite concerted efforts by Ministry of Health and nursing professionals to do so. The central figure in the health services is the patient whose needs vary depending on their problems, this can be achieved by the use of nursing care plan process a tool that captures the patients problems and outlines the plan on how to solve them.

Despite the fact that this tool is important in the nursing care of patients and clients, many nurses in Coast provincial General Hospital do not apply it in their practice, while taking care of patients in their respective wards. Therefore, researcher had observed with great concern that most of patients did not have nursing care plan, has it is required, by nursing council of Kenya. Which help the nurse to prioritize the patients needs and this has led to reducing quality of nursing care in Coast Provincial General Hospital? For instance, month of July and August 2014 out of four hundred and fifty patients admitted in postnatal, medical, and surgical wards in CPGH only 4% had a complete nursing care plan and 29% had a incomplete care plan has tabulated in the table.

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Table 1.1: Records of patients and number of patients using care plan developed in July and August 2015

Month

Ward

Patients admitted in that month

Patients with incomplete care plans

Patients with complete nursing care plan within first 24hours of admission

Patients with complete nursing care plan  24 hours to discharge

Percentage of pts with care plan

July

Medical ward

40

5

1

2

5%

August

medical ward

60

3

2

3

5%

July

Postnatal ward

50

6

0

1

2%

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