ASSESSMENTS 0F THE APPLICATION OF NURSING PROCESS IN SURGICAL WARDS

The nursing process is a problem-solving framework that enables the nursing staff to plan their care for a patents and clients as an individual or group basis . This requires nurses to be accountable for the care that they prescribe with care deliver and to keep clear and accurate records of the discussions .Today, one’s ability to use the nursing process is governed by the standards for pre-registration for any nursing education as outline. The present study aimed at utilize the nursing process in Mosul teaching hospitals The initial sample consisted of (42) nurses whose were selected randomly from surgical and emergency units at Mosul teaching Hospitals . the period of data collection for this study was carried out from 20-1-2019 until 20-2-2019 . in Ibn-Sina and AL-Jamhuori teaching hospitals. The results shows a highly significant of all assessment for applications of nursing process at p. value (0.05) In conclusions of this study The nursing process it's very important to enhancing the quality of care especially at surgical field and The highly significant number for all elements of nursing process. Furthermore, the nursing staff cant not be able to make any management without nursing process. Thus the researcher put some recommendations for the current study such as ;the nursing process case sheet should be putting in patient case folder , to evaluate the patient and his health status systematically, the nursing staff and health care team must be educating to how could they using nursing process and updating, surgical wards should be formulate a time table for all clients to guide them about their care as a schedules .The head of nursing staff as a adviser must be enrolled with conferences and educations centers to discuss the implementation of nursing process .


Introduction:
The nursing process is a problem-solving framework that enables the nursing staff to planning their care for a clients on an individual or group basis .This requires nurses to be accountable for the care that they prescribe with care deliver and to keep clear and accurate records of the discussions (NMC, 2008).
Today, one's ability to use the nursing process is governed by the standards for preregistration for any nursing education as outline.(NMC, 2010) The nursing care plan should be covering all aspects for the patient needs like physical , emotional, social ,spiritual and cultural these demands leading to improvement the ability to make a systematic framework (DoH, 2000) and (NMC, 2010).
In addition the nursing records were of poor quality and showed little understanding of the nursing process (Darzi, 2008).Failure to keep a record of nursing care or to use the nursing process can lead to a breakdown in the quality of care that is provided.
The Delivering of standerd quality care to patients based on patients' needs.the importance of appled and using a systematic plan like nursing process to the provision of nursing care which are can be estimatting with in care time (Miller and Sanderson, 2000).

Flaxabilty
There has been some debate within the profession over the number of stages needed in the nursing process, some suggesting four and others five.With a four-stage approach, the nurse does not have time to reflect on the assessment data that have been collected and instead moves from assessment to planning (

Adoma et al 2005) .
The nursing process make the nursing staff responsible to formulate the care plan dibanding on the patient needs and nursing diagnosis.(NMC, 2008).
This is important to remember in an effort to counteract any criticism surrounding who is ultimately responsible under a system of collective responsibility (Borgelt 2003 ).
the critical thinking of any care plan make the nursing staff a Flexibility to modify and updata the patient management , care and intervention ( Groen 1995) .
the experienced nurses could link patient problems and interventions to gether so that problems can be resolved more efficiently (Grobe, Drew, and Fonteyn1991).
The nursing process in intensive care units (ICU) is increasingly characterized by a heavy reliance on medical equipment.The variety of equipment is large and innovations appear on the market continuously.
Due to these technological developments, the profession of intensive care nursing has changed.Nurses are increasingly required to conduct complex therapeutic and diagnostic procedures using the equipment's (Effken, 1997).
Despite this increased functionality The task of selecting and integrating the vast amount of data into diagnostic information is still the responsibility of the nurse Deciding which actions should be taken is often done under time-critical circumstances.There is a high work pace, and the cumulative work pressure combined with working in shifts results in fatigue (Groen 1995).
On top of this, there is an increasing demand on medical and nursing staff should be a higher efficiency.(Kohn et al 2000).
To minimize inexperience, training is crucial.
However, there is a lack of general training for nursing staff in the use of technology as well as adequate, task-specific training (Bogner, 1994).
Especially The core system of the patient follows its own logic, clinicians have to play two roles.
Assuming the role of collaborator with processes tending towards homeostasis, and saboteur of processes tending away from homeostasis (Miller 2000).
Another important factor in the use of nursing process related to the intended tasks is that the nurses are responsible not only for the device operation, but also for the larger performance goals of the overall system.As a result, the system of people and artifacts evolve over time to produce generally successful performance, even if the usability of that system is poor (Moorhead et al 2004).
Utilization of the nursing process shall be evident in review of the completed Community Health and Safety assessment for all admissions, transfers, long term care stays, and significant changes in condition (Obradovich and Woods 1996).
The shorter Nursing assessment form shall be utilized by the nurse to document body checks, minor injuries, or returns from short hospitalizations with minor changes in condition.The short nursing assessment form has an area to document a focus nursing note data (Miller et al 2003)

Aim of The Study:
The present study aimed at utilized the nursing process in Mosul teaching hospitals

Methodology Ethical consecrations
The first official permission was obtained from clinical science department director ( research councilor) , depending on that permission the researchers team has a second official permission from the Nineveh health office to conduct the present study in Ibn-Sina and AL-Jamhuori teaching hospitals .

Design of the study:
The descriptive study design was applied for the period from 20-1-2019 until 20-2-2019.

Setting of Study:
The current study was carried out in Iben Sina and Al-Jamhori teaching hospitals and Emergency care Unit at Mosul The patient come to this hospital who is suffering from general diseases and surgical problems The number of client for both hospital was is Approximately more than (150) patient per day.

Sample of Study:
The sample was (42) they are selected randomly of the first time for all nurses who are workers at surgical ward and Emergency departments The percentage between male and female was different according to level of the education of the of nursing graduate ,Bachelors e and diploma of nursing .The researchers put some criteria for the selection of the sample according to how application of the nursing process in surgical wards.

Study Tool:
In the present study ,the following steps ware applied in accordance to the a quantitative nursing research .table (2) indicates that the same highly significant results for assessment statement at ( P 0.05).

Table (3) shows Statement Diagnosis
Table (3).indicates that the same highly significant results for diagnosis statement at ( P 0.05).

Discussion
The nursing process as a model its very important for any healthcare program .theapplication of any care plan or management should be formulate depending on systematic nursing process .In this study the researchers try to investigate the ability of nursing staff towered implementation of nursing process and their concept about this approach (Dochterman and Bulechek 2004).
Table (1) simply show the main points about demographical data .The age was 40% belong 18-27 and 28-37 years , this indicate the majority of the sample at mid age and they don't has experience .The male number was higher than female which was about 36 nurse The work setting higher percentage was in intensive care units 14 nurse 42% however 23% working in medical wards and 42% in surgical units .
With regard working time about 28 participants was night shifting 66% however 42% morning duty.
When the researcher talking about nursing process, must be starting with nursing assessment as the first step and last with nursing evaluation or expected out com.

Nursing Assessment:
Table ( 2 ) The nurses answer 55% of the questions related to taking the history of the disease ,which shows that the process of assessment and diagnosis of the patient is entirely based on the doctor , and also confirmed by 40% of nurses that they only collect general data from the patient (Lin 2002 ) The main target of all health care plane is to arranged the steps and process for any care or management time table , the quality should be interact with this process it lead to reflect to health care system as a positive factors .

Nursing diagnosis :
The conclusions of this study include the following: 1.The Variation in the percentage of the sample with regards their variables was not influencing on their knowledge.
2. The nursing process its very important to enhancing the quality of care especially at surgical field 3. The highly significant number for all elements of nursing process .
4. The nursing staff cant not be able to make any management with out nursing process .

Recommendations:
Depending on the aims and objectives of this study, the researchers expecting the following recommendations: 1.The nursing process case sheet should be putting in patient case folder , to evaluate the patient and his health status systematically .
2. The nursing staff and health care team must be educating to how could they using nursing process .
3. The surgical wards should be formulate a l time table for all clients to guide them about their care as a schedules .
4. The head of nursing staff as a adviser must be enrolled at every health center in particular to discuss the implementation of nursing process 5. Assessment from time to time the positive and negative factors which was influencing on expected out come during evaluation care .

1 - 3 - 1 . 2 . frequency and percentage 3 .
The literature review was searched and seek by research plain through using the following key word (emergency word ,surgical word , nursing process , assessment ,diagnoses, planning , intervention and evaluation or expected out com ).2-formalate the questioner survey based on the (application of nursing process).Explore the initial draft to the experts to have a validity of tools.4-the reliability of instrument was getting by doing assessment ,diagnosis, planning, Implementation and evaluation of nursing process and the sample was about (10 nurses pre-post test ) Testing the reliability and validity of the tool:-The validity term refers to be measured and to degrees to which an instrument measures what it is supposed to be measuring.the researchers were had the face validity by experts However the Reliability refers to the degree of consistency or accuracy with an instrument measure an attribute.the higher reliability of an instrument.the lower the amount of error present in the obtained scores.several empirical methods assess various aspects of an instrument reliability(pilot and hunger 1999) Statistical analysis Percentage are used to the description of the sample.SPSS version 17.
85%.With regard training program for nursing process the half of sample non enrolled with any educational or training program 20 nurse 50%.The same results for services duration 50% has less than 5 years, however just 6 nurse has more than 10 years .The educational level about 42% come from university education ( Nursing college ) 1 nurse postgraduate and 30 % from Institute .

Table ( 1
) demographic characteristics of the sample.

Table ( 2
) reveals the statement of assessment .

Table ( 4
) demonstrate the Statement Planning.

Table ( 4
) appears the same highly significant results for planning statement at ( P 0.05).

Table ( 6
) demonstrate the Statement Evaluation.

Table ( 5
) appears the Statement Intervention.