TABLE OF CONTENTS
Contents Page
Title Page i
Letter of
Certification ii
Dedication iii
Acknowledgement iv
Abstract vi
Table of
Contents viii
Appendices ix
List of Tables x
List of Figures xi
CHAPTER ONE: INTRODUCTION
- Background to the Study 1
- Statement of the Problem 3
- Objective of the Study 4
- Research Questions 4
- Hypotheses 4
- Significance of the Study 5
- Operational Definition of Terms 5
CHAPTER TWO: REVIEW
OF LITERATURE
2.1. Theoretical Framework 8
2.2. The Concept and Strategies of Primary Health Care 12
2.2.1. Definitions of Primary Health Care 13
2.2.2. Strategies of primary Health Care 14
2.3.
Nursing Process 17
2.3.1. The Phases of the Nursing Process 20
2.3.2. Assessment 21
2.3.3. Diagnosis or problem identification 22
2.3.4. Planning 24
2.3.5: Implementation 25
2.3.6: Step 5: Evaluation 26
2.4. Critical Thinking and Nursing Process 27
2.4.1. Introduction 27
2.4.2. Definitions of Critical Thinking 28
2.4.3.
The relevance of Critical Thinking in Nursing Process 28
2.4.4. Critical Thinking Skills needed in Nursing Process 30
2.5. Barriers to the successful implementation of Nursing
Process 31
CHAPTER
THREE: METHODOLOGY
3.0. Introduction 33
3.1.
Research Design 33
3.2. Population 33
3.3. Sample and Sampling Technique 34
3.3.1. Inclusion and Exclusion Criteria 35
3.4. Instrumentation 35
3.4.1. Validity of Instrument 36
3.4.2. Reliability of Instrument 36
3.5. The Training Module 36
3.6. Data Collection Procedure 37
3.6.1. Selection of Research Assistant 37
3.6.2. Design of Intervention. 38
3.7. Method of Data Analysis 38
3.8. Ethical Consideration 39
3.8.1. Post Research Benefits 39
CHAPTER FOURDATA ANALYSIS, RESULTS AND
DISCUSSION OF FINDINGS
4.0. Introduction 41
4.1. Data Presentation 41
4.1.1. Demogrgraphic characteristics 41
4.2. Analysis of Research Questions 42
4.2.1. Research Question One 43
4.2.2. Research Question Two 45
4.3. Testing of Hypotheses 50
4.3.1. Hypotheses One 51
4.3.2. Hypothesis Two 54
4.4. Summary of Findings 55
4.5. Discussion
of Findings 56
4.5.1. The demographic presentation of the participants 56
4.5.2.1.Research objective one(Knowledge
needs of participants) 57
4.5.2.2. Attitude of the Community Health Nurses 58
4.5.2.3. The performance (practice) of community health nurses 58
4.5.3.
Discussion on research objective
two: 59
4.5.4. Discussion on research objective three 60
4.5.5. Discussion on Hypothesis one 60
4.5.6. Discussion on Hypothesis two 62
CHAPTER FIVESUMMARY, CONCLUSION AND RECOMMENDATIONS
5.0. Introduction 63
5.1. Summary 63
5.2.
Conclusion 64
5.3. Recommendations 65
5.4. Suggestions for further studies 66
REFERENCES 67
APPENDICES 73
LIST OF APPENDICES
Appendix Page
1. The research questionnaire 73
II. Pre and Post Performance Check-list 75
III. Informed Consent Form 77
IV. Letter
of Introduction
V. Ethical
Clearance Certificate
VI. Pictures of events
LIST OF TABLES
Tables Page
3.1. The distribution of the community health
nurses in the study area 34
3.2. Timeline of Activities 35
3.3. Outline of Intervention 38
4.1. Age Distribution of Respondents 41
4.2a. Assessment of
Knowledge Needs of Participants on nursing process 43
4.2b. Assessment of the
participants’ attitude towards nursing process 44
4.2c. Assessment
of Participants’ Level of Practice of Nursing Process 45
4.3a. Summary
of Descriptive and inferential statistics of pre-test knowledge of Community Health Nurses on Nursing Process 45
4.3b. Summary of Descriptive and inferential statistics of post-test knowledge of Community Health Nurses on Nursing Process 46
4.3c. Summary of Descriptive and inferential statistics of pre-test Attitude of Community Health Nurses towards utilization of Nursing Process 47
4.3d. Summary
of Descriptive and inferential statistics of post-test Attitude of Community Health Nurses towards utilisation of Nursing Process 47
4.3e. Descriptive and inferential statistics of pre-intervention
performance(practice) of community health nurses in the control and experimental groups 48
4.3f. Descriptive and inferential statistics of post-intervention performance of community health nurses in control and experimental groups 49
4.4. Descriptive statistics of pre and post-intervention performance scores of participants 40
4.5. ANCOVA summary showing the effect of programme on the utilisation of nursing process 51
4.6. Estimates of control and intervention treatments 51
4.7. Univariate test of the effects of control
and intervention training on participants’ post-test scores 52
4.8. Pairwise comparison of treatments on
participants’ implementation of nursing process 52
4.9. Cross tabulation of years of experience and performance rating 54
4.10. Chi-square test showing relationship between
experience and assimilation of training programme 54
4.11. Adjusted
and Unadjusted Treatment Means and Variability for Post Implementation Performance of Nursing Process with Pre-test as a Covariate 56
LIST OF FIGURES
Figures Page
1. Nursing Process Model 8
2. Pre and post knowledge of the
participant on the use of nursing process 46
3. Pre and post attitude of the
participant on the utilisation of nursing process 48
4. Pre and post implementation practice of
nursing process by participants 49
5. Estimated marginal means of
post-performance scores 53
CHAPTER
ONE
INTRODUCTION
Primary Health Care (PHC) describes
the basic tenets and values that guide professional nurses as the continuous
practice of health promotion, illness prevention, prompt diagnosis/care of
ailments and restoration of sick people to their pre-illness state (Iita, Small
and Van, 2011). According to WHO (2010), the utmost priority and
objective of primary health care is to ensure improved health for everyone. The
organisation has identified five basic principles for this as reducing
segregation and inequalities in social health (global coverage); designing
health care services around people’s health needs and aspirations (service
delivery); integrating health into all sectors (public policy); the pursuing
collaborative ideals of policy dialogue (leadership); and the increasing
stakeholders’ involvement. In other words, PHC
focuses on a strategy that surpasses the orthodox health care
arrangement which stresses on health uniformity-yielding social policy;
but rather includes all aspects that directly influence health. This include;
prompt and timely access to health services, suitable environment and
lifestyle. Hence, primary healthcare and public health strategies may
together be considered as the fundamentals of universal health system (Daisy,
2009).
In
order to achieve these goals, the core attributes of primary health care which
are first contact (accessibility), longitudinality (person focused preventive
and curative care overtime), patient-oriented comprehensiveness and
coordination (including navigation towards secondary and tertiary care) are
factors that should be put in place and to also enhance effective health care
delivery (WHO, 2008). Besides taking care of the needs of the individuals,
primary health care teams also look at the community, especially when
addressing social determinants of health. This is achievable through a
community oriented primary care (COPC) experience which integrates public
health focus and primary health care. The interaction of the primary health
care team with different networks (education, work, economy, and housing) are
also important. By using all these methods, the primary health care team
promote health equity, increase social cohesion and empowerment through its
contribution (Daisy, 2009).
According
to Chukwu and Momoh (2010), the nursing process which is a universal phenomenon
is fundamental for making nursing a unique profession. Consequently, the
process of implementation of the components and attributes of primary health
care can be best achieved through the use of this process, being a broadly
acceptable, systematic
method of planning and delivering individualized care for clients in any state
of health or illness; and a scientific means
of solving the numerous and dynamic nursing problems (Chiarelli, Costanzi,
Moraes, Pokorski, and Rabelo, 2009). The nursing process is made up of a global standard through which
nursing problems are identified and solved (Elder and Paul, 2005). It is also a
method of thinking critically to solve patient problems within the
professional practice. The nursing process is a series of steps taken to
fulfil the goals and objectives of nursing practice” (Walsh and Yura 1983). The
nursing process is a dynamic and an organised pattern for rendering nursing
care through six interrelated and overlapping phases of assessing, diagnosing,
identifying outcome, planning, implementing and evaluating nursing actions. It
is an actual task adopted by professional nurses to identify/ solve patient’s
problems and deliver a top quality levels of care among families, groups and
communities (American Nurses Association, 2009). At the assessment phase, a
thorough exploration of the needs of the individual, family, group or community
that are of importance to them are made by the nurse in order to arrive at a
diagnosis from the numerous data collected.
At
the planning phase, nurses’ judgment of the individual, family, or community’s
responses to the important life’s activities; or to specific or potential
health needs are identified and planned for. This also provide a basis for the
choice of appropriate nursing actions (North American Nursing Diagnosis
Association, 2007). The implementation phase addresses the problems identified
using the most relevant nursing actions and finally assessed for effectiveness
at the evaluation phase (Alfaro-LeFerve, 2004).
However,
the Implementation of the nursing process in the community and primary health
care settings can be achieved through the principles of action research which
requires knowledge and understanding of the major aspects of the nursing
process, and the platform through which this knowledge can be applied in
practical settings (Good and Savett, 2005). If this is implemented, it will
amount to good quality of care that enhances the development of scientific cum
theoretical knowledge that rests on a quality clinical nursing care, (Almeida,
Barra, Debétio, Marinho, Paese, Rios, and Sasso, 2013). Also, to promote and
enhance the worth
