PSYCHO-SOCIAL AND ECONOMIC FACTORS INFLUENCING NURSINGRESEARCH AMONG NURSES WORKING IN SPECIALIZED UNITS AT KENYATT A

NATIONAL AND AGA KHAN UNIVERSITY HOSPITALS IN KENYA

A THESIS PROPOSAL SUBMITTED TO THE UNIVERSITY OF NAIROBI FOR THEDEGREE OF DOCTOR OF PHILOSOPHY

BY

MUTISY A A. KY ALO(MScN, BScN, CEN)

FEBRUARY 2010

Declaration

I. Mutisya Albanus Kyalo declare that this thesis proposal titled "Psycho-social and economic

factors influencing nursing research among nurses working in the specialized units at

Kenyatta National and Aga Khan University Hospitals in Kenya" is completed as an

independent work. Icertify that all material in this thesis which is not my own work has been

identified and cited and that no material has previously been submitted and approved for the

award of a degree

by this or any other University.

Signature: . Date: .

II

Supervisors

This proposal is submitted for award of Doctor of Philosophy of the University of Nairobi with

our approval as university supervisors:

1. Prof Ann Karani (PhD, MA, BScN, DAN, KRN)

Associate professor, School of Nursing Sciences,

University of Nairobi,

P.O. BOX 19676 -00202

Nairobi -Kenya

Signature . Date .

2. Dr James Mwaura (PhD, MSc, BScN)

Lecturer, School of Nursing Sciences,

University of Nairobi,

P.O. BOX 19676 -00202

Nairobi -Kenya

Signature Date: .

iii

Table of Contents

ITEM PAGE

Title page .

Declaration......................................................................... 11

Supervisors... . . .. . . .. .. . . . . . .. . .. . . III

Dedication ,. IV

Table of contents. .. . . .. .. . . .. . .. . .. V

List of abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... V11

Operational definition of terms.......... .. . . . V11I

Executi ve summary. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IX

CHAPTER ONE: INTRODUCTION

Introduction......... . . . .. . . . . .. 1

Background information .

Statement of the problem .

Justification . 4

Significance .

Specific objectives .

5

6

6

7

Main objective .

Research questions .

Research hypothesis . 7

v

CHAPTER TWO: LITERATURE REVIEW

Introduction................................................................. 8

Nursing research............................................................ 8

Nursing research and Nursing practice........................... 9

Factors affecting nursing research.................. . . . .. . .. .. . 10

Nursing research and evidence based practice....................................... 13

CONCEPTUAL FRAMEWORK................................... 14

CHAPTER THREE: MATERIALS AND METHODS

Study design. .. . . . . . .. . .. . . . 20

Study area.. . . .. . .. . . . . . .. . .. . . .. 21

Study population..... . . .. . .. . .. . . 21

Sample size determination... .. . .. . . .. .. . . .. . .. . .. . .. .. .. 21

Sampling method............................................................ 23

Study instruments :................................................ 23

Selection and training of research assistants. . . . . . . . . . .. . . . . . 25

Pre-testing of the questionnaire. .. . . . .. . . .. . .. .. . . . . . . . . . . . . . . . 25

Validity and Reliability. .. . . . . . .. . .. 25

Data collection methods. . . .. .. .. . .. . .. . . . . . . . . 25

Data cleaning and entry... .. . .. . .. . . . . .. 26

Data analysis and presentation... . . 26

Ethical considerations...................................................... 27

Study Assumptions. . .. . . . 29

Study Limitations. . . .. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 29

Time frame 30

Budget estimates...... 31

References. . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 32

Appendices 1: Questionnaire for nurses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 38

vi

ACNO

AKU-H

CNO

CCUs

DCNO

EBNP

EBP

ECN

FGO

KAP

KNH

Kshs

KTA

MPH

MOHEST -

MTRH -

NCK

NO 1

NO 11

NO 111

OBS/GYNAE-

OMRU

.OR

PhO

SEN

SNO

UON

List of Abbreviations / Acronyms

Assistant Chief Nursing Officer

Aga Khan University Hospital

Chief Nursing officer

Critical Care Units

Deputy Chief Nursing Officer

Evidence Based Nursing Practice

Evidence Based Practice

Enrolled Community Nurse

Focus Group Discussion

Knowledge Attitude and Practice

Kenyatta National Hospital

Kenya shillings

Knowledge To Action process

Master of Public Health

Ministry of Higher Education, Science & Technology

Moi Teaching and Referral Hospital

Nursing Council of Kenya

Nursing Officer one

Nursing Officer two

Nursing Officer three

Obstetrics and Gynecology

Ottawa Model of Research Use

Operating Room

Doctor of Philosophy

Senior Enrolled Nurse

Senior Nursing Officer

University of Nairobi

vii

Operational Definition of terms

Evidence based nursing practice - Nursing care or practice that is not based on tradition but on

knowledge that has been thoroughly researched and found to be the appropriate practice

Evidence based practice - Practice that heavily relies on knowledge gained through research as

a basis for rationalization of the activities involved therein

Nursing research - The scientific process of collecting data, analyzing it and coming up with

findings that are significant to extent knowledge of solve identified problems. It is a systematic

enquiry that seeks to add new nursing knowledge to benefit patients, families and communities.

Participation in research - Involvement in either development of research proposal,

conducting research or utilization of research findings

Research utilization - undertaking of research and applying the findings to nursing practice

Specialized units - These refers to Critical Care Unit, Accident I Emergency Unit, Operating

Theatres, Burns Unit and Renal Unit

viii

Executive Summary

Introduction: In this era of evidence based practice and knowledge-driven health care, nurses

are constantly challenged to discover new and better ways of delivering care that is grounded in

new knowledge and evidence derived through research. Ndune (1995) as reported by Mukthar

(2006) asserts that very little scientific nursing research has been done in Kenya. The few that

have been conducted especially in specialized units are linked to academic requirements. There

is knowledge gap as to why the proportion of nurses who undertake nursing research is still

minimal and little is known as to how much nursing research is being used to impove nursing

practice.

Aim: The study will be undertaken to investigate the research activities and identify the psycho-

social and economic factors influencing the same among nurses working in the specialized units

of the two major referral hospitals in Kenya (i.e. KNH: Public and AKU-H: Private) for the

purpose of building and strengthening nursing research capacity and enhancing evidence based

nursing practice and also as part of nursing's quality improvement programme.

Materials and Methods: This will be a descriptive cross-sectional study that will utilize both

quantitative and qualitative methods to determine research activities and to identify and

determine the relationship between psycho-social and economic factors and the practice of

research among nurses in these two referral hospitals. It will be conducted in three phases. Phase

one will involve data collection and analysis to establish the factors influencing nursing research

and to identify needs. Phase two will involve development and implementation of training

modules based on the identified needs while phase three will be evaluation of the impact of the

training and determine factors that will need reinforcement for sustainability of nursing research

capacity.

Results: The study findings will help determine the knowledge, practices and barriers to nursing

research. The findings will be discussed alongside those from other studies to make comparisons.

Appropriate intervention measures will be instituted and their impact evaluated. This will help

improve research abilities of the nurses and in turn enhance evidence based nursing practice.

Conclusions will be drawn and appropriate recommendations made including nursing research

ix