Barriers and facilitators in the meticulous compilation and adaptation of standardised nursing care plans in a public hospital of the Eden district, South Africa : a nursing perspective

Thesis (MNur)--Stellenbosch University, 2018.ENGLISH SUMMARY : Background: South African Nursing Council Regulation, No. R.2598 (as amended) requires that registered nurses (RNs) develop, implement and evaluate nursing care plans as part of their legal scope of practice. Keeping meticulous records forms an indispensable part of nursing care in order to provide continuity and quality patient care. Risks associated with poor care planning can include non-attainment of patient goals, patient dissatisfaction with care received, inferior quality of nursing care and lengthened hospitalisation. Document audits conducted in the study hospital provided evidence that standard care plans were often incomplete, inaccurate and not relevant to the patient’s condition. However, these audits cannot provide insights into why this poor practice occurs. The aim of this study was to describe the particular barriers and facilitators RNs experienced in the meticulous compilation and adaptation of standardised nursing care plans as part of their patient care activities in order to inform strategies that may be developed to promote meticulous practice in this aspect of care planning by RNs. Four study objectives were formulated, namely: to describe (i) barriers and (ii) facilitators influencing RNs in the meticulous compilation and adaptation of standardised nursing care plans, (iii) to determine if associations exist between demographic data and the most reported barriers and facilitators, and (iv) to identify strategies suggested by RNs to reinforce facilitators or minimise barriers. Methods: A quantitative approach with a descriptive design was used to meet the stated objectives. A 41-item structured questionnaire which was developed by the researcher, consisting of three sections, was used as the data collection tool. It was available in Afrikaans and English. Data were collected from RNs working in medical and surgical units of a public hospital in the Eden District. Of the 43 possible respondents, 29 respondents completed the questionnaire, with a response rate of 67% (n=29). A descriptive analysis of each of the scale items was conducted. Hypothesis tests between each of the five demographic variables and all the scale items were performed to identify trends showing associations between these variables and scale items by using the non-parametric Kruskal-Wallis and Mann-Whitney U tests. Results: The most prominent barriers reported included lack of multidisciplinary collaboration, failure to update objectives and plans daily, a lack of plans for every type of diagnosis, lack of involvement in the development of plans, and workload. Facilitators included ease of identifying priorities of care, compiling individual care plans when necessary, adequate knowledge, and predominantly positive attitudes towards the application of standardised nursing care plans. Significant associations were found between age and availability of a policy as well as the availability of plans for every diagnosis, and also between gender and completion of plans being a waste of time. Furthermore, type of basic qualification showed significant associations with validation of plans, minimising unnecessary documentation, careful use, aiding in the provision of high-quality care, and continuity of care. The type of qualification, specifically the 4-year diploma, impacts on how RNs view and experience the use of standardised nursing care plans. Meliorating strategies included the use of individual care plans or a combination of standardised and individual care plans, regular refresher training, as well as more audits – specifically aimed at the content of the standardised nursing care plans. Conclusion: Study results confirmed that RNs experience various barriers and facilitators in the meticulous compilation and adaptation of standardised nursing care plans, and associations exist between demographic variables and the identified barriers and facilitators. RNs offered meliorating strategies regarding the most reported barriers that were incorporated into the study recommendations.AFRIKAANSE OPSOMMING : Agtergrond: Regulasie R.2598 (soos gewysig) van die Suid-Afrikaanse Raad op Verpleging vereis dat geregistreerde verpleegkundiges (GVs) as deel van hulle wetlik voorgeskrewe praktykbestek verpleegsorgplanne opstel, implementeer en evalueer. Nougesette rekordhouding is ’n onmisbare deel van verpleging om kontinuïteit te verseker en pasiëntsorg van gehalte te voorsien. Die gevare verbonde aan swak sorgbeplanning sluit in die nieverwesenliking van pasiëntdoelwitte, pasiënt-ontevredenheid met die sorg wat hulle ontvang, verpleegsorg van ’n swak gehalte, sowel as verlengde hospitalisasie. Dokumentoudits in die studiehospitaal het bewys dat standaardsorgplanne dikwels nie volledig, akkuraat óf relevant is vir die pasiënt se toestand nie. Tog kon die oudits nie insig bied in die redes vir hierdie swak praktyk nie. Die doel van hierdie studie was dus om te beskryf watter spesifieke hindernisse en katalisators GVs in die nougesette opstelling en aanpassing van gestandaardiseerde verpleegsorgplanne as deel van hulle pasiëntsorgaktiwiteite ervaar. Op grond daarvan kan moontlike strategieë ontwikkel word om nougesette praktyk in hierdie faset van GVs se sorgbeplanning te bevorder. Vier studiedoelwitte is geformuleer. Dit was (i) om hindernisse en (ii) katalisators te beskryf wat die nougesette opstelling en aanpassing van gestandaardiseerde verpleegsorgplanne deur GVs beïnvloed, (iii) om enige verwantskappe tussen demografiese data en die belangrikste hindernisse en katalisators te bepaal, en (iv) om te identifiseer watter strategieë GVs self voorstel om katalisators te versterk of hindernisse te beperk. Metodes: ’n Kwantitatiewe benadering met ’n deskriptiewe ontwerp is gebruik om dié doelwitte te bereik. Die navorser het ’n gestruktureerde vraelys met 41 items en drie afdelings opgestel om as datainsamelingsinstrument te dien. Die vraelys is deur die navorser opgestel en was in Afrikaans en Engels beskikbaar. Data is ingesamel onder GVs wat in die mediese en chirurgiese eenhede van ’n openbare hospitaal in die Eden-distrik werk. Van die 43 moontlike deelnemers het 29 die vraelys voltooi, met ’n responssyfer van 67% (n=29). ’n Deskriptiewe ontleding is van elke skaalitem onderneem. Hipotesetoetse is op elk van die vyf demografiese veranderlikes en alle skaalitems uitgevoer om tendense te identifiseer wat op verwantskappe tussen hierdie veranderlikes en die skaalitems dui. Hiervoor is die nie-parametriese Kruskal-Wallis- en Mann-Whitney-U-toetse gebruik. Resultate: Die vernaamste hindernisse wat aangemeld is, sluit in ’n tekort aan multidissiplinêre samewerking, versuim om oogmerke en planne daagliks by te werk, ’n gebrek aan planne vir elke tipe diagnose, gebrekkige betrokkenheid by die ontwikkeling van planne, en werklas. Katalisators sluit in die gemak waarmee sorgprioriteite geïdentifiseer kan word, die opstelling van individuele sorgplanne waar dit nodig is, voldoende kennis, sowel as ’n oorwegend positiewe ingesteldheid jeens die gebruik van gestandaardiseerde verpleegsorgplanne. Beduidende verwantskappe is opgemerk tussen ouderdom en die beskikbaarheid van ’n beleid sowel as die beskikbaarheid van planne vir elke diagnose, en ook tussen geslag en die beskouing dat dit ’n verkwisting van tyd is om planne op te stel. Daarbenewens was daar ’n sterk verwantskap tussen die tipe basiese kwalifikasie en die stawing van planne, die beperking van onnodige papierwerk, sorgvuldige gebruik, die ondersteuning van sorg van gehalte en sorgkontinuïteit. Die tipe kwalifikasie, in die besonder die vierjaardiploma, beïnvloed hoe GVs die gebruik van gestandaardiseerde verpleegsorgplanne beskou en beleef. Voorgestelde verbeteringstrategieë sluit in die gebruik van individuele sorgplanne of ’n kombinasie van gestandaardiseerde en individuele sorgplanne, gereelde opknappingskursusse, sowel as meer oudits wat spesifiek op die inhoud van die gestandaardiseerde verpleegsorgplanne konsentreer. Gevolgtrekking: Die studieresultate bevestig dat GVs verskeie hindernisse en katalisators in die nougesette opstelling en aanpassing van gestandaardiseerde verpleegsorgplanne ervaar. Die resultate bring ook duidelike verwantskappe tussen demografiese veranderlikes en die geïdentifiseerde hindernisse en katalisators aan die lig. GVs het verbeteringstrategieë vir die meeste van die aangemelde hindernisse aan die hand gedoen, wat in die studieaanbevelings vervat is