CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
The term “professional qualification” can be used to refer to higher-level vocational qualifications in “professional” roles. Subscribing to the fact that nursing is an action oriented profession and that nurses learn by doing, means the mastery of clinical skills must be a key component of courses leading to registration of nurses (Chan, 2001a, 2001b).
In the intensive care environment, the quality of nursing care and patient safety depends not only on the qualification of professionals, but also on the appropriate number of human resources available. However, health services still face extreme difficulty in matching the number of professionals with the demand, generally due to financial issues. The numerical and qualitative mismatch between human resources and the care required by patients in intensive care can lead to work overload and failures in the process of care (Magalhães Riboldi and Agnol, 2015).
Nursing workload can be defined as “work process elements that interact dynamically with each other and with the body of the worker, generating a process of adaptation which leads to wear” (Laurell and Noriega, 1989). Acknowledging this load in the workplace is essential, since it is subject to control and reduction of undesirable effects (Kirchhof, Lacerda, Sarquis, Magnago and Gomes, 2011). However, ignoring the importance of its measurement may cause a negative impact on the quality and safety of care to patients, due to the greater likelihood of adverse events.
Therefore, the assessment of nursing workload is a subject of great relevance, insofar as an oversized team implies higher costs. On the other hand, it is known that a reduced team can cause a drop in effectiveness and/or quality of care, extending the length of hospital stay and generating greater costs of treatment, in addition to exposing patients, staff, and the institution itself to the risk of not having safe care (Tanos Massarollo and Gaidzinski, 2015; Queijo & Padilha, 2015).
Studies show that an increase in hours of nursing care provided to patients is associated with a decrease in the occurrence of adverse events (AE), such as: urinary tract infection; pressure ulcers; hospital-acquired pneumonia; wound infections; complications in central venous access; shock; thrombosis; medication errors; and postoperative complications (Needleman Buerhaus Matte Stewart and Zelevinsky, 2002; Aiken Clarke Cheung Sloane and Silber, 2013). Another publication shows that the nursing workload is a risk factor for death in the intensive care unit (ICU) (Kiekkas, Sakellaropoulos, Brokalaki, Manolis, Adamantios and Skartsani, 2008). However, no systematic reviews were identified from the literature showing a possible relationship between workload and AE in the scope of nursing.
1.2 Statement of Problem
Inadequate nurse staffing and nursing workloads are intrinsically linked. When there are not enough nurses, the workload of each nurse is increased. This means less time to attend to routine observations, hygiene, wound care, nutrition, patient education, paperwork, counseling, and taking rest and/or meal breaks.
Inadequate staffing and overwhelming workloads not only reduce nurses’ ability to deliver qualify necessary care, but it also predisposes nurses to increased fatigue Brunt and increases the risk of errors. In considering the contribution of workload to patient outcomes, it is important to think not only of the work that nurses do that contributes to patient outcomes, but also the care they do not do, when rushing between too many patients prevents them from providing optimum nursing interventions.
Over 160 million people in Nigeria with much needed access to healthcare resources raise two questions; (1) is the current nursing workforce enough to provide the needed care? (2) Can the already burdened healthcare system provide good, safe, quality care for patients and supportive, healthy work environments for nurses? (3) What role has professional qualification and workload? A research conducted by Aiken et al. (2013) has demonstrated that increased morbidity and mortality for patients in acute care settings can be attributed to inadequate numbers of caregivers at the bedside. This lead to work overload. According to Aiken et al. (2013), the effects of increased workload, may lead to low job satisfaction, and work-related stress on nurses can negatively effect on patient care. Therefore, it is important to determine the role the nursing professional qualification and work overload quality and nursing care or services and the job outcomes of nurses to ensure that they are optimally utilized.
1.3 Objectives of the Study
The objectives of the study is to assess the impact of professional qualification and workload on quality nursing practice.
1.3.1 Specific Objectives of the Study
The specific objective of the study includes;
- To determine the impact of nursing professional qualification has on quality nursing care
- To determine how workload of nurse affect the quality of nursing practice.
1.4 Research Questions
The questions are as follows;
- What impact does nursing professional qualification has on quality nursing care?
- How does the workload of nursing practice affect quality nursing?
1.5 Significance of Study
This study is significant as it will enable the researcher to know the impact nursing professional qualification has on nursing care. To know how this qualification can help reduce the workload in the hospital and improved on quality care services by the proferssional, it will also be an eye opener to the government to improve on the training and retraining of the nursing staff for optimal performance in the hospital.
1.6 Scope of the Study
This research work was carried out in Irrua Specialist teaching hospital, Irrua, the administrative headquarters of Esan Central Local Government Area of Edo-state, Nigeria. Irrua shares boundaries with Uromi, Ewu, Ekpoma and Ugbegun. Irrua has a population of 89,628 and 127,718 at the 1991 and 2006 population census respectively, majority of which are health workers, civil servants, traders, businessmen/women, transporters, farmers and teachers by occupation.
1.7 Research Hypothesis
There is no significant relationship on professional qualifications and the impact on the workload towards quality nursing care.
1.8 Operational Definition of Terms
Profession: a paid occupation, especially one that involves prolonged training and a formal qualification.
Professional: relating to or belonging to a profession.
Qualification: a pass of an examination or an official completion of a course, especially one conferring status as a recognized practitioner of a profession or activity.
Workload: the amount of work to be done by someone or something.
Quality: the standard of something as measured against other things of a similar kind; the degree of excellence of something.
Nursing: is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life.
Care: suffering of mind, grief, a disquieted state of mixed uncertainty, apprehension, and responsibility.
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