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

Wubet Alebachew Bayih; Metadel Yibeltal Ayalew; Demeke Mesfin Belay; Abebaw Yeshambel Alemu; Binyam Minuye Birihane; Sintayehu Asnakew; Aklilu Endalamaw; Asmamaw Demis; Solomon Demis Kebede; Biruk Beletew Abate; Shegaw Zeleke Baih; Dejen Getaneh Feleke; Demewoz Kefale Mekonen; Yared Asmare Aynalem; Tigabu Munye Aytenew; Ermias Sisay Chanie

doi:10.1016/j.heliyon.2021.e06933

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

Heliyon. 2021 May 1;7(5):e06933. doi: 10.1016/j.heliyon.2021.e06933. eCollection 2021 May.

Authors

Wubet Alebachew Bayih¹, Metadel Yibeltal Ayalew², Demeke Mesfin Belay³, Abebaw Yeshambel Alemu³, Binyam Minuye Birihane¹, Sintayehu Asnakew⁴, Aklilu Endalamaw^{5

6}, Asmamaw Demis⁷, Solomon Demis Kebede¹, Biruk Beletew Abate⁷, Shegaw Zeleke Baih⁸, Dejen Getaneh Feleke³, Demewoz Kefale Mekonen³, Yared Asmare Aynalem⁹, Tigabu Munye Aytenew⁸, Ermias Sisay Chanie³

Affiliations

¹ Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
² Department of Nursing, Pediatrics Ward, Tibebe Ghion Specialized Hospital, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 196, Bahir Dar, Ethiopia.
³ Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
⁴ Department of Psychiatry, School of Medicine College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia.
⁵ Department of Pediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 196, Bahir Dar, Ethiopia.
⁶ School of Public Health, The University of Queensland, Brisbane, Australia.
⁷ Department of Nursing, Woldia University, Woldia, Ethiopia.
⁸ Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
⁹ Department of Pediatrics and Child Health Nursing, Debre Berhan University, Debre Berhan, Ethiopia.

Abstract

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.

Keywords: Ethiopia; Nursing process; Patient care; Systematic review.