Journal of Nursing Education

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Current Status of Nursing Process in ADN Programs

Margaret A Justus, RN, MSN; Joyce A Montgomery, RN, MS

Abstract

A survey of Associate Degree (AD) nursing schools was conducted to gather data about the effectiveness and efficiency of teaching the Nursing Process. Information about the Nursing Process was obtained related to teaching methods, current trends in terminology, placement in the curriculum, time frame, and faculty feelings about how well students have learned the Nursing Process.

Teaching of the Nursing Process is very significant. It is a time-consuming activity for nursing faculties. Hours are spent in the classroom teaching the Nursing Process. This information is then reinforced and applied in the clinical setting. The faculty has a responsibility to comment on students' written and verbal feedback about the Nursing Process. So, hours are spent grading written Nursing Process papers.

Furthermore, students spend many hours learning the Nursing Process. The lecture material must be learned prior to testing. Then they must learn to apply the Nursing Process in the care of their patients. This leads to many hours of writing Nursing Process papers which may be required each week or only one time during the school term.

The literature reveals that all levels of nurses are expected to have some knowledge of the Nursing Process. The National League for Nursing (NLN) expects all nursing graduates to use the Nursing Process as a basis for their decisions and practice (NLN Task Force, 1983). Of course, the extent to which the Nursing Process is used depends upon the level of education of the nurse (NLN Task Force, 1978).

Little research was found in the literature related to methods of teaching the Nursing Process. However, there is some literature concerning what the Nursing Process is (Marriner, 1983; Mayers, 1978), its value (Atkinson & Murray, 1983), and placement in the curriculum (Kozier & Erb, 1983) of nursing schools.

Many nurses have written about the components of the Nursing Process. Assessment, planning, implementation and evaluation are the four steps of the Nursing Process which NLN suggests for use in all nursing schools (NLN Task Force, 1983). Other authors use five steps and different terminology for the steps (Billings & Stokes, 1982; Kozier & Erb, 1983).

The significance of this study is further supported by the results of an earlier pilot study (Justus, 1982). The results of which revealed that AD and BSN nursing educators at two separate colleges had a disparity of definitions and feelings about scientific nursing intervention, the action step in the Nursing Process.

Purpose of Study

The purpose of this study was to determine the current status of the Nursing Process in AD programs. The writers designed questions concerning the Nursing Process to reveal when, where, and how it is taught as well as exactly what is taught. Faculty feelings concerning the use of the Nursing Process were surveyed also.

Methodology

This research is a descriptive study about teaching the Nursing Process in AD nursing programs. It is a study of the components of the Nursing Process which are taught, the methods of teaching, the satisfaction from teaching, and brief information about the person who answered the questionnaire (respondent). Our sample was 143 AD programs in the United States which were randomly selected. Every fourth school listed in State-Approved Schools of Nursing RN (1983) was invited to participate.

The selected schools were sent a letter of invitation to participate, a questionnaire, and a stamped, self-addressed envelope. Completed questionnaires were returned by 119 of the schools. The questionnaire was answered by nursing faculty. No control was placed on faculty expertise for answering the questionnaire. Anonymity of the respondent was safeguarded.

The questionnaire was written by the authors. It contained 25 items, most being designed…

A survey of Associate Degree (AD) nursing schools was conducted to gather data about the effectiveness and efficiency of teaching the Nursing Process. Information about the Nursing Process was obtained related to teaching methods, current trends in terminology, placement in the curriculum, time frame, and faculty feelings about how well students have learned the Nursing Process.

Teaching of the Nursing Process is very significant. It is a time-consuming activity for nursing faculties. Hours are spent in the classroom teaching the Nursing Process. This information is then reinforced and applied in the clinical setting. The faculty has a responsibility to comment on students' written and verbal feedback about the Nursing Process. So, hours are spent grading written Nursing Process papers.

Furthermore, students spend many hours learning the Nursing Process. The lecture material must be learned prior to testing. Then they must learn to apply the Nursing Process in the care of their patients. This leads to many hours of writing Nursing Process papers which may be required each week or only one time during the school term.

The literature reveals that all levels of nurses are expected to have some knowledge of the Nursing Process. The National League for Nursing (NLN) expects all nursing graduates to use the Nursing Process as a basis for their decisions and practice (NLN Task Force, 1983). Of course, the extent to which the Nursing Process is used depends upon the level of education of the nurse (NLN Task Force, 1978).

Little research was found in the literature related to methods of teaching the Nursing Process. However, there is some literature concerning what the Nursing Process is (Marriner, 1983; Mayers, 1978), its value (Atkinson & Murray, 1983), and placement in the curriculum (Kozier & Erb, 1983) of nursing schools.

Many nurses have written about the components of the Nursing Process. Assessment, planning, implementation and evaluation are the four steps of the Nursing Process which NLN suggests for use in all nursing schools (NLN Task Force, 1983). Other authors use five steps and different terminology for the steps (Billings & Stokes, 1982; Kozier & Erb, 1983).

The significance of this study is further supported by the results of an earlier pilot study (Justus, 1982). The results of which revealed that AD and BSN nursing educators at two separate colleges had a disparity of definitions and feelings about scientific nursing intervention, the action step in the Nursing Process.

Purpose of Study

The purpose of this study was to determine the current status of the Nursing Process in AD programs. The writers designed questions concerning the Nursing Process to reveal when, where, and how it is taught as well as exactly what is taught. Faculty feelings concerning the use of the Nursing Process were surveyed also.

Methodology

This research is a descriptive study about teaching the Nursing Process in AD nursing programs. It is a study of the components of the Nursing Process which are taught, the methods of teaching, the satisfaction from teaching, and brief information about the person who answered the questionnaire (respondent). Our sample was 143 AD programs in the United States which were randomly selected. Every fourth school listed in State-Approved Schools of Nursing RN (1983) was invited to participate.

The selected schools were sent a letter of invitation to participate, a questionnaire, and a stamped, self-addressed envelope. Completed questionnaires were returned by 119 of the schools. The questionnaire was answered by nursing faculty. No control was placed on faculty expertise for answering the questionnaire. Anonymity of the respondent was safeguarded.

The questionnaire was written by the authors. It contained 25 items, most being designed to be answered objectively. Some choices were numbers, some were "yes" or "no," and some were Likert-type scales with six possible answers (Polit & Hungler, 1978). In addition, one item also asked for comments. Only six of the items called for affective knowledge. The remainder were designed to elicit facts.

The questionnaire was examined by two faculty authorities for content and clarity Based upon their review and the writer's scrutiny, the instrument has content validity and face validity.

Most of the collected data were nominal in level. However, a few items yielded ordinal level data. For this reason, descriptive statistics were used to interpret the findings.

Results

All the AD programs which were surveyed include the Nursing Process in their curricula. They spend from O to over 8 hours lecturing on the process. (The program that spends O hours of lecture teaches it using modules. ) The same percentages of programs spend 9 or more hours (50%) in lecture as spend less time (50%) in lecture.

The Nursing Process is initially introduced in the first year of almost all the programs (99%). The only respondent who introduces the Nursing Process later marked "other" and indicated that her program is a "1 + 1" program.

The responses were varied as to the depth in which the Nursing Process is first taught. Some marked more than one answer. "Brief was marked by some of the respondents (28%); an "historical overview" was indicated by only a few (8%); a "detailed overview" was indicated by about half (57%); and a few (12%) indicated "other." So, the majority does give a detailed description the first time the Nursing Process is taught.

Another question measured the frequency with which steps of the Nursing Process were taught. All but one school (99%) teach assessment. Most of the schools (83%) teach nursing diagnosis. Some of these teach nursing diagnosis as a step and others teach it as part of the assessment. The least taught step is goals (79%). Almost all teach planning (96%), implementation (99%), and evaluation (100%). Some of the schools (29%) teach nursing problems and/ or patient problems. A few schools (8%) indicated that they teach steps other than those listed above and on the questionnaire.

Most schools (88%) require students to write rationale for each or for groups of plans of actions. Many (81%) require rationale for each plan of action. A few (7%) write rationale only for groups of plans of actions. Even fewer schools (12%) do not require any written rationale. (Two respondents omitted this question.)

Respondents were asked about the size of the class at the time the Nursing Process is taught. The size of the classes varies from under 20 to over 100. The results were almost equally divided at the class size of 40. Forty-eight percent of the schools teach groups with 40 or fewer students and 52% teach groups with more than 40 students.

Methods of teaching differ from school to school. Yet, almost all the schools (98% ) use lectures and very few (5%) use self-paced instruction. The ranking of methods of teaching from most- frequently-used to least-used are (1) lecture, (2) study guides, (3) films, (4) other, (5) teacher-prepared programmed instruction, and (6 ) self-paced programmed instruction. Comments from the respondents indicated that "other" includes seminars, role playing, case studies, small group discussions, overheads, filmstrips, and computers.

All of the responding schools require students to write Nursing Processes on their patients. No school allowed students to write Nursing Processes on simulated patients only. However, some of the schools (39%) do have students to write Nursing Processes on both patients from clinical settings and from simulated experiences.

Most schools (97%) have their students begin writing the Nursing Process in the first term of the program. In a few of the schools (21%), students begin writing the Nursing Process later in the first year. Very few schools (3%) wait until the second year to have students start writing the Nursing Process. (One respondent marked "other" as the choice for this question.)

Assessment is required by most schools (94%) when students first write the Nursing Process. The number of schools requiring each additional step when the Nursing Process is first written is smaller. The findings showed that a majority used nursing diagnosis (62%), goals (57%), implementation (66%), and evaluation (61%). Some (25%) require nursing problems or patient problems. Very few of the schools (2%) require steps other than those listed above.

Respondents were asked to evaluate students' ability to write the Nursing Process. Very few (6%) indicated that their students can write the Nursing Process without assistance. Most others (76%) indicated their students can with a minimum of assistance. Some (18%) said their students can with much assistance. None answered that their students cannot write the process. Additional comments were given. One said that second-year students can write the Nursing Process without assistance and six said with a minimum of assistance. Seven schools said the first-year students can write the Nursing Process with much assistance.

Clinical agencies may or may not use the same Nursing Process format as do the schools. The format used by clinical agencies is the same as that taught in about half (47%) of the schools. Many schools (43%) answered that the clinical agencies do not use the same Nursing Process format that their schools use although a few (9%) use a similar format. (Two schools omitted this question. )

The questionnaire contained five statements about faculty members' feelings concerning the Nursing Process. The possible responses ranged from agree-strongly to disagree-strongly. No one disagreedstrongly about any of the statements. The range of responses was small. For each statement a majority of the respondents selected one choice. This choice was always either agree-strongly or agree.

The majority of the respondents (55%) agreed that their faculty members as a whole seem satisfied with the results of the teaching methods used to teach the Nursing Process. Some (3%) even agreedstrongly with this statement. Very few agreed-slightly (9%), disagreed-slightly (4%), or disagreed (2%).

Almost all respondents (93%) agreed to some extent that their faculty members seem satisfied with the first -year students' skills in writing the Nursing Process Paper/Nursing Care Plan. Of these, the majority (62%) agreed while a few agreedstrongly (17%) or agreed-slightly (14%). Very few disagreed-slightly (4%) or disagreed (3%).

The responses to the statement about satisfaction with the second-year students' skills in writing the Nursing Process Paper/Nursing Care Plan were similar to responses to the first -year students' skills. Most (90%) chose some form of agreement. The majority (57%) agreed. Some (21%) agreed-strongly and a few (12%) agreedslightly. Very few disagreed-slightly (8%) or disagreed (2%).

Two statements about faculty members' feelings concerning the Nursing Process related to the value of the Nursing Process. All respondents except four chose agreestrongly or agree. The overwhelming majority of choices were agree-strongly. One of these statements was "Faculty as a whole feel the Nursing Process is a valuable tool that determines nursing actions which form the basis of 'good' patient care in the clinical area." Agree-strongly was chosen by 79% of the respondents, agree by 20% and agree-slightly by 1%. The other value statement was "Faculty as a whole feel the Nursing Process is beneficial to student learning." Agree-strongly was chosen by 73% of the respondents, agree by 25%, and agree-slightly by 2%.

These questionnaires were answered by administrators and faculty. Chairpersons were the leading group (76 respondents). Faculty who taught the Nursing Process comprised the second largest group (40 respondents). In addition, there was one respondent who was a faculty member, but who does not teach the Nursing Process, and one person who was assistant chairperson. There was one omission.

The respondents were asked to indicate their highest degree earned in nursing. They are as follows: 18 baccalaureates, 85 master's, and 12 doctorates. Also, two respondents were candidates for the master's degree, six had a master's degree in another field, and one had a doctorate in another field.

The majority of the responding schools (59%) is accredited by the NLN. A few schools did indicate that they are in the process of applying for accreditation.

Discussion

The survey results demonstrated that the Nursing Process core (assessment, planning, implementation, and evaluation) is consistently used in all of the responding AD programs. Educators perceive it as being a valuable learning tool, regardless of whether or not their school was accredited by the NLN. Most of the respondents valued the Nursing Process enough that they requested the results of this study.

The most obvious inconsistency concerning the teaching of the Nursing Process was in the amounts of time and teaching methods utilized. The Nursing Process is still a young concept, but recent government regulations should spur nursing to make a concentrated effort toward refinement of the concept as an avenue for growth and cohesiveness. This can best be accomplished through faculty research on the Nursing Process. The research should be designed to determine effective and necessary content to be taught, as well as, student-faculty feelings and behaviors concerning the methods of teaching the Nursing Process.

Opportunities for increased utilization of the Nursing Process in practice settings were uncovered by this study. Faculty members should research their local practice settings to determine if the setting would benefit from nursing students' documentation of the Nursing Process. This provides the possibility of twofold benefits. First, faculty and students will have the opportunity to fuse education into actual practice. Secondly, practicing nurses will have increased awareness of the usefulness of the Nursing Process.

The respondents indicated that nursing faculties agree that the Nursing Process forms a basis for "good patient care." Therefore, as needed, nursing faculty should present workshops on the Nursing Process to practicing nurses. These workshops could present new knowledge, reinforce existing knowledge, and acquaint the practice setting with existing methods utilized in nursing education.

The survey lends support to the idea that the Nursing Process is valuable to the identity of nursing as a profession. Also, the highly reported use of nursing diagnosis as part of the Nursing Process provides another boost to professional identity.

In conclusion, nursing educators should continue to carefully plan and study the utilization of the Nursing Process as a learning tool. The current status of the teaching of the Nursing Process (as revealed in this study) is expected to have long range effects on nursing practice and should be the subject of future nursing research.

References

  • Atkinson, L.D. & Murray, M.E.cute;1983K Understanding the nursing process (2nd ed.). New York: MacMillan Publishing Co., Inc.
  • Billings, D.M. & Stokes, L.G. (1982). Medicalsurgical nursing. St. Louis: The C.V. Mosby Co.
  • Kozier, B. & Erb, G. (1983). fundamentals of nursing (2nd ed.). Menlo Park: Addi son -WesJey Publishing Co.
  • Justus, M.A. (1982). Role of nursing process in determining nursing actions directed toward patient care. Unpublished master's thesis, University of Tennessee Center for the Health Sciences. Memphis.
  • Marriner, A. (1983). The nursing process (3rd ed ). St. Louis: The C.V. Mosby Co.
  • Mayers, M. G. (1978). A systematic approach to the nursing care plan (2nd ed.). New York: Appleton -Century-Crofts.
  • National League for Nursing (1983). Stateapproved Schools ofNursing/R.N. New York: Author.
  • NLN Task Force (1978). Competencies of associate degree nurse on entry into practice. New York: National League of Nursing.
  • NLN Task Force (1983X Competencies of graduates of nursing programs. (Pub. No. 14-1905). New York: National League for Nursing.
  • Polit, D. F. & Hungler, B. P. (1978). Nursing research: Principles and methods. Philadelphia: JB. Lippincott Co.

10.3928/0148-4834-19860301-08

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