Testing of a New Nursing Process Software in Selected Low Resource Nigerian Hospitals: A Multicentre Pre-Post Study

Abstract

Background: There is a lack of electronic nursing process solutions tailored for low resource hospitals in Nigeria where paper-aided documentation is cumbersome and internet services are limited. The locally developed nursing process software (named ENPF) with incorporated 235 nursing diagnosis taxonomy codes was recently published, and this study tested the ENPF in seven public hospitals in Nigeria.

Methods: A multicentre pre-post intervention design was applied. A random sample of 872 clinical nurses was examined by three purposively selected nursing professors. The participants documented their daily nursing activities with pen and paper at baseline for seven days and used the ENPF for another seven days. A random selection of 872 paper and ENPF-aided nursing process records made by the nurses were paired and assessed for completeness, accuracy, timeliness, and perceived usability. The tool for data collection was an assembled questionnaire including free versions of standardized tools (Documentation Audit Checklist, Quality of Nursing Diagnosis-Intervention-and-Outcomes Scale, and Perceived Usability Scale). Data analysis was done with descriptive and inferential statistics at p < 0.05. The study was independently approved by three relevant Institutional Review Boards in Nigeria.

Results: The ENPF-aided documentation was significantly better than paper in terms of completeness (75.2% vs. 49.2%, p = < 0.001), timeliness (39.75 vs. 78.87 seconds, p = <0.001), and accuracy (nursing diagnoses: mean 2.96 vs. 1.02, p = <0.001; interventions: 2.52 vs. 1.42, p = <0.001; outcome: 2.63 vs. 1.11, p = 0.006; Criterion mean 3.00).  The ENPF was perceived to have better usability (3.25 vs. 2.98, p = < 0.001) than paper-based documentation.

Conclusions: Electronic solutions tailored for low resource nursing settings for ease in usability can improve the completeness, accuracy, and timeliness of nursing documentation. Hospital administrators should consider deploying electronic solutions to improve nursing documentation quality.