Implementing the nursing process in a teaching hospital ward : an action research study
An innovative and complex action research study was carried out in a teaching hospital ward in order to implement the nursing process and to contribute to theory regarding the factors that facilitate or hinder this implementation. The findings from the baseline phase showed a very poor implementation of the nursing process on the ward. Nevertheless, the culture of the organisation was favourable towards the nursing process implementation. The five months implementation of change phase was led by a steering group composed of two nursing managers, two staff nurses and the researcher. They decided on the interventions needed which consisted in the clarification of nursing competencies and the nursing philosophy of the ward; the design and implementation of nursing documentation, and an education course on the nursing process. A formative evaluation took place immediately after phase 2 and identified improvements in the use of the nursing process on the ward. The findings from the study showed that action research was a useful and appropriate approach for implementing the nursing process. The flexible and context-based nature of this approach, the fact of providing a facilitator of change and finally the participative nature influenced positively the implementation of the nursing process. Among the factors that facilitated the implementation were the education programme on the nursing process with special attention to increasing knowledge, changing attitudes and developing skills; and to introduce nursing documentation facilitating the development of nurses skills, specially communication and problem-solving. Among the barriers found was the use of a medical model of care; nurses lack of preparation to lead their own changes and the lack of co-ordination with doctors and auxiliaries as well as excessive dedication to bureaucratic maters. Important recommendations have been made for nursing practice, education and research.