Challenges to the implementation of the nursing process among nurses in public hospitals of Addis Ababa, Ethiopia: A qualitative study

The nursing process is a structured framework that guides healthcare professionals in delivering personalized, goal-oriented patient care. However, the implementation of the nursing process in Ethiopia remains suboptimal, particularly in public hospital settings. Therefore, this study aims to explore the challenges associated with the implementation of the nursing process among nurses working in public hospitals in Addis Ababa, Ethiopia, in 2024. An exploratory descriptive qualitative study was conducted between February 1 and March 15, 2024, among nurses working in three hospitals in Addis Ababa, Ethiopia. The study included 15 nurses from the three hospitals, as well as three key informants from the nursing management teams. Participants were selected using purposive sampling, and data were collected through individual in-depth interviews guided by a semi-structured interview guide. Data collection continued until data saturation was achieved, defined as the point at which no new codes, themes, or insights emerged from subsequent interviews and repetitive information was consistently observed. The analysis of data was done simultaneously with data collection in thematic analysis approach. The findings revealed four overarching themes: management inefficiencies, logistical constraints, nurse-related factors, and patient-related factors. Participants reported that nursing management teams were often unsupportive, frequently imposing additional burdens on staff and exacerbating workplace challenges due to a lack of understanding of nurses’ needs and working conditions. Logistical constraints were also identified as significant challenges, including shortages of essential medical supplies, overcrowded patient rooms lacking privacy screens, and inadequate staffing levels. These factors collectively hindered the delivery of quality nursing care and contributed to increased workload and job-related stress among nurses. The study identified management inefficiencies, logistical constraints, nurse-related factors, and patient-related factors as key challenges affecting nursing care. Furthermore, the role of quality improvement and audit teams, along with the appropriateness of assessment tools within the local context, warrants further evaluation to enhance the quality of nursing services.