MBALIZI INSTITUTE OF HEALTH SCIENCES

RESEARCH PROPOSAL

TITLE
ASSESSMENT OF QUALITY NURSING CARE DERIVERED TO OUT PATIENT
ATTENDING MBALIZI DISTRICT HOSPITAL FROM DECEMBER 2022 TO
JANUARY 2023

STUDENT NAME: PILLY SELEMANI

CANDIDATE NUMBER: NS0905/0042/2007

PURPOSE: RESEARCH PROPOSAL SUBMITTED IN PARTIAL FULFILMENT FOR

DIPLOMA IN NURSING AND MIDWIFERY AT MBALIZI INSTITUTE OF HEALTH
SCIENCES

YEAR OF COMPLETION: 2023

 CERTIFICATION
The undersigned, certify that have read and here by recommend for acceptance by MBALIZI
INSTITUTE OF HEALTH SCIENCE entitled Assessment of the quality of nursing care
delivered to outpatients attending to Mbalizi hospital in fulfilment of the requirements for the
diploma of nursing and midwifery

Name of Supervisor; MR.EMMANUEL KIDUKO

Signature.............................................................
Date.....................................................................

DECLARATION

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I declare that this proposal is my original ideas, and that the proposed research has not and will
not be presented or conducted elsewhere in a similar manner for either award or as a research
project. I confirm that appropriate credit has been given where reference has been made to the
work of others.

NAME OF STUDENT SIGNATURE DATE

_________________ ____________ ______________

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 AKNOWLEDGEMENT
Firstly, I would like to pay thanks to Almighty GOD for keeping me healthy and strong from the
beginning up to the end of writing these research proposals.
Secondly I would like to pass my special appreciation to my supervisor Mr.emmanuel kiduko
who despite his busy schedule has taken time to continually review my work and advise me
accordingly and direct me in developing the research proposal
Lastly I would like to thank all class mates who in one way and another supported me including
giving their ideas.

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 Contents

COPYRIGHT STATEMENT...........................................................................................................i

CERTIFICATION...........................................................................................................................ii

DECLARATION............................................................................................................................iii

AKNOWLEDGEMENT...............................................................................................................iv

LIST OF ABBREVIATIONS........................................................................................................ix

LIST OF TABLES...........................................................................................................................x

CHAPTER ONE..............................................................................................................................1

INTRODUCTION...........................................................................................................................1

1.0 Introduction................................................................................................................................1

1.2 Background of the problem.......................................................................................................1

1.3 Statement of the research problem............................................................................................2

1.4 Research objectivess..................................................................................................................3

1.4.1 General objectives..................................................................................................................3

1.4.2 Specific objectives..................................................................................................................3

1.5 Research questions.....................................................................................................................3

1.6 Significance of the study...........................................................................................................3

1.7 Scope of the study......................................................................................................................4

CHAPTER TWO.............................................................................................................................5

LITERATURE REVIEW................................................................................................................5

2.1 Introduction................................................................................................................................5

2.2 Theoretical perspective..............................................................................................................5

2.2.1 Theory of Change...................................................................................................................5

2.2.2 Service quality theory.............................................................................................................6

2.3 Empirical Literature review.......................................................................................................6

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2.4 Research gap..............................................................................................................................8

2.5 Conceptual framework model....................................................................................................8

CHAPTER THREE.......................................................................................................................10

RESEARCH METHODOLOGY..................................................................................................10

3.0 Introduction..............................................................................................................................10

3.1 Research approach...................................................................................................................10

3.2 Research Design......................................................................................................................10

3.3 Description of the Study Area.................................................................................................10

3.4 Study Population......................................................................................................................10

3.5 Sample Size and Selection.......................................................................................................11

3.6 Sampling Techniques...............................................................................................................11

3.6.1 Purposive Sampling..............................................................................................................11

3.6.2 Random Sampling................................................................................................................12

3.7 Methods of Data Collection.....................................................................................................12

3.7.1 Primary Data.........................................................................................................................12

3.7.1.1 Questionnaire.....................................................................................................................12

3.7.2 Secondary Data.....................................................................................................................12

3.8 Reliability and Validity of instruments....................................................................................13

3.8.4 Reliability of instruments.....................................................................................................13

3.8.5 Validity instruments..............................................................................................................13

3.9 Data Analysis.........................................................................................................................13S

REFERENCES..............................................................................................................................25

APENDIX 1 : Questionnaire.........................................................................................................27

Appendix 2: Work plan.................................................................................................................30

Appendix 3: Financial arrangement...............................................................................................31

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Appendix 4 :Permit letter...............................................................................................................32

Appendix 5: Ethical clearance.......................................................................................................33

LIST OF ABBREVIATION

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AHRQ: Agency for Healthcare Research and Quality,
ED: Emergency department,
RNs: Registered nurses,
USA: United States of America,
ED Emergency depertmentss
IPC Infection Prevention Control

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 CHAPTER ONE
1.0 INTRODUCTION
1.1 Chapter overview
This chapter presents general information on the study, it has covered the background
information to the problem, statement of the research problem, research objectives, and research
questions, significance of the study and scope of the study

1.2 Background of the problem.

1.2.1 GLOBALLY.
Quality and safety in health care have been increasingly in focus in recent years. Within a variety
of health care (Sveriges Kommuner och Landsting; SKL, 2013), research (Agency for Healthcare
Research and Quality; AHRQ, 2013), and policy-making organizations (Ministry of Health and
Social Affairs, 2010) ways to measure quality of care and patient safety to improve
reimbursement systems and the health care system as a whole are perpetual topics for active
discussion. Defining and measuring quality and safety is, however, complicated (Loeb, 2004;
Pronovost et al., 2005). Agencies such as the World Health Organization (Sherman et al., 2009;
World Health Organization, 2008) and the AHRQ (Farquhar, 2008) both acknowledge that there
is a plethora of classifications and definitions of patient safety and quality of care. Definitions
vary by context and purpose and descriptions of the relationships between patient safety and
quality of care also vary.

1.2.2 SUB SAHARAN AFRICA

Africa It has been proved that the nursing work environment is related to adverse events for
patients in the hospital. The incidence of patient falls in hospitals that provide excellent good
care practices are 5% lower than in hospitals that do not provide this method (Bae 2011). A good
nursing practice environment can not only reduce patients’ adverse events (such as hospital
infections and medication errors), but also improve the overall quality of care (Grant 2009).
Research by Stalpers et al. found other characteristics of nurse staffing and work environment
(for example, partnership, experience, and education). The nursing practice environment has a
significant impact on falls, pain management, and pressure ulcers. Therefore, a more favorable
working environment can help improve the prognosis of patients (Stalpers et al. 2015). Health

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care is changing rapidly and the need to improve quality in its delivery is increasing. Patient
satisfaction is a central indicator for health care quality and reflects the ability of the provider to
meet the patients’ needs. Patient satisfaction is defined as the extent of the resemblance between
the expected quality of care and the actual received care. Patient satisfaction with nursing care is
of great importance to any health care agency because nurses comprise most health care
providers and they provide care for patients 24 hours a day. Patients are easier to serve if they
feel their needs are being met. Patient satisfaction has been used as an indicator of quality
services provided by health care personnel in tertiary hospitals. The most important predictor of
patient’s overall satisfaction with hospital care is particularly related to their satisfaction with
nursing care Studies of the quality of nursing care are increasing in importance as a component
of health care research

1.2.3 IN TANZANIA
In Tanzania, given the expansion of health services, quality of care has become a major concern
for many years. Some of the issues are low standards of hygiene and sanitation, insufficient
health infrastructure, poor healthcare will bete disposal, low motivation of health workers,
inadequate adherence to professional and ethical conduct, as well as a known-do gap amongst
health workers. (Ministry of Health and Social Welfare, 2013-2018). The Registered nurses
(RNs) hold a central position in inpatient hospital care. In addition to providing direct patient
care, RNs contribute to safe and high-quality patient care by supervising other nursing staff,
monitoring the health status of patients, coordinating and collaborating with multi-professional
health care teams, and providing education and support for both patients and patients’ families.
This allows RNs to have a unique perspective of the patient care experience, putting them at the
“sharp end” of patient safety (Hughes, 2008; Reason, 1995), and influencing their ability to make
well-informed assessments of care quality and patient safety in their workplace (Page, 2004)

1.2.4 IN LOCAL INFORMATION.

No research found about assessment of quality nursing care delivered to outpatient attending
mbalizi district hospital Therefore, the result from study will acts as baseline information for
other big interventions. This research will be conducted from January 2023 to march 2023.

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1.3 Statement of the research problem.

1.3.1 nature of problem.

The expansion of the role of the advanced practice nurse is very useful in providing holistic and
cost-effective care. usually, the definition of quality reflects the object of assessment and the
measurable attributes of health care associated with good quality and these vary with the level of
assessment (Donabedian 1988 & Gilson 1992). At general level one can look at health care
system as a whole in which resources, activities management and outcomes of health care are all
implicated. In this approach quality become the meant of excellence of the system in all aspects
(Donabedian, 1988)

1.3.2 nature of problem

Quality can be considered as one of the features of the health care, resources and activities. The
attributes of a given set of resources and attributes of a set of activities included in the program
affect the effectiveness with regard to the health problem being addressed. (Roemer & Mantoya,
1988) A study done by Kipp (2001) showed that
1.3.3 scope of problem.
Study will be seeking to assess to explore quality of nursing care delivered to outpatients by
nurses at Mbeya region, specifically Mbalizi Hospital, which involved only the selected health
activities. Cross sectional study design meet in assessment of the factors; quantitative techniques
will be meet to analyze data
.
1.3.4 Effect of problem.
Caring is a core characteristic of the profession of nursing. He describes the implementation of
performance and communication nursing caring standards in an emergency department (ED) to
improve patient satisfaction, a significant quality outcome measure for healthcare providers. ED
patient satisfaction with the "care and concern by nurses" increased 6.6% after the caring
standards were implemented

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1.3.5 Gaps and proposed solutions
Many studies conducted to on the responsibilities of nurses to the patients globally but failed to
show how in developing countries how the quality of services provided by nurses to the patients.
There for the study seek to explore the quality of nursing care delivered to patients by nurses at
Mbalizi Hospital.

1.4 Research objectives

1.4.1 Broad objectives

To assess quality of nursing care delivered to outpatients by nurses at Mbalizi Hospital

1.4.2 Specific objectives

i. To determine the efficiency of quality of nursing care delivered to outpatients by nurses.
ii. To identify the satisfaction of quality of nursing care delivered to outpatients by nurses
iii. To assess the improvement measure to develop the quality of nursing care delivered to
outpatients by nurses.
1.5 Research questions
i. What the efficiency is the quality of nursing care delivered to outpatients by nurses?
ii. What the satisfaction of quality of nursing care delivered to outpatients by nurses?
iii. What is the improvement measure to develop the quality of nursing care delivered to
outpatients by nurses?
1.6 Significance of the study
The study aimed at contributing to the growing body of research knowledge about associations
between the work/care environment and outcomes for patients. Efforts to improve patient
outcomes need to for the patient care environment where the quality service of nursing is a
central actor although not the only active professional. The use of best qualified nurses as
informants about the organization of patient care in hospitals can give me further clues as to what
in the work/care environment facilitates or hinders the provision of safe, high quality care. My
continued research will entail observations and interviews from “exceptionally positive
environments” and will be include involvement of patients and other health care professionals’
perspectives.

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1.7 Conceptual framework model
Conceptual frameworks, according to educational researcher Smyth (2004), are structured from a
set of broad ideas and theories that help a researcher to properly identify the problem they are
looking at, frame their questions and find suitable literature. Most academic research meets a
conceptual framework at the outset became it helps the researcher to clarify his research question
and aims. Conceptual frameworks (theoretical frameworks) are a type of intermediate theory that
attempt to connect to all aspects of inquiry (e.g., problem definition, purpose, literature review,
methodology, data collection and analysis). Conceptual frameworks can act like maps that give
coherence to empirical inquiry. Became conceptual frameworks are potentially so close to
empirical inquiry, they take different forms depending upon the research question or problem
(Botha, 1989). According to sociologists Haralambos and Holborn, a conceptual framework
enables the researcher to find links between the existing literature and his own research goals.
The measurable variables involved in the conceptual framework are: -
Independent variables, which are: - safety, Reliability, Responsiveness, Empathy, assurance,
effectiveness.
Dependent Variables is the quality of nursing care delivered to patients by nurses at the areas.

safety Expected quality

Reliability of nursing care

Responsiveness quality of
nursing care
Empathy
Perceived quality
Assurance
of nursing care
effectiveness

Since: Research study 2022

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 CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 Introduction
This chapter provides and covers literatures which seem to be relevant on the stated topic. It
consists of chapter overview, definition of terms, theoretical literature review, Empirical
literature review, research gap and conceptual framework of the research

2.2 Theoretical perspective

Theoretical literature review is an evaluation of selected information found in different literature
which relates to the study topic. It gives a theoretical base for the study and helps the researcher
to determine the problem (Mmari et al, 2000).

2.2.1 Theory of Change

This study is also guided by the theory of change reviewed by James’ (2011) on the meet of
theory of change highlights the presence of another influence, equally long-standing. Since the
1960s, empowerment approaches for social change and participatory approaches have advocated
a conscious reflection on different interpretations of development situations, especially the
perspectives of poor and marginalized people themselves. In these approaches, reflecting on
change is in itself an empowering process, building an awareness of how to influence change
(Freire, 2000).
Theory of change is an ongoing process of reflection to explore change and how it happens and
what that means for the part we play in a particular context, sector and group of people. Every
program is packed with belief, assumption and hypotheses about how change happens about the
way humans work, or organization, or political systems, or ecosystems. Theory of change is
about articulating assumptions these many underlying assumptions about how change will
happen in a program (Patricia R, 2012). Due to that this theory is supportive to this study when
the rules and regulations put forward to govern the quality of services provided by nurses to the
patients. The Theory of Change as a tool not only helps to clearly articulate and connect efforts
to bigger goal, and allows the researcher to spot potential risks in plan by sharing the underlying
assumptions in each step. Theory of change provides a working model to test hypothesis and
assumption about what action will best bring about the intended outcome.

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2.2.2 Service quality theory
The theory of service quality is based on product quality and costumer’s satisfaction literature
(Brady & Cronin, 2001a). In 1988, Zeithaml defined service quality as “an assessment of
metameres from the overall excellence of services”. Although researchers have general
agreement on the significant role of service quality on customers’ satisfaction and performance
of the firms, there is no unanimous notion on the model of service quality measurement. Service
quality is multidimensional (Brady & Cronin, 2001a; Parasuraman et al., 1988) and dimensions
can vary according to the different service deliveries (Pollack, 2009). Nevertheless, service
quality measurement enables managers to identify the problem in the service provided to the
customers to enhance the efficiency and quality for the purpose of customers’ satisfaction and
fulfilling desire. Service quality has been studied wildly from the early of 1980 when Gronroos
introduced the first model for measuring service quality called the Nordic model. He believes in
distinguishing technical qualities as an outcome for the service performance and functional
qualities as a subjective perception of the service provided. After that Parasuraman, Zeithaml,
and Berry introduced a new model called SERVQUAL in 1985 which is the most famous and
used model in service quality. At first, they suggested ten dimensions for their model but in the
new version of this model in 1988 they reduced the dimensions into five. The basis of this model
will be on measuring the differences between expectation and perception of the customers on the
service provided through five suggested dimensions. During these three decades, researchers
introduced other models and measurements for service quality and the majority of them will be
evaluated in the next part.
2.3 Empirical Literature review
Kipp (2001) done a study showed that Caring is a core characteristic of the profession of nursing.
He describes the implementation of performance and communication nursing caring standards in
an emergency department (ED) to improve patient satisfaction, a significant quality outcome
measure for healthcare providers. ED patient satisfaction with the "care and concern by nurses"
increased 6.6% after the caring standards were implemented. The development of concrete ED
customer service standards appears to be effective in improving caring behaviors by staff and
patient satisfaction.
Young et al, (1996) done a study in Chicago, MEA, investigated 2051 medical-surgical patients,
1264 staff members, and 97 nurse managers from 17 randomly selected hospitals. The

7
respondent participated in study activities related to selected aspects of patient care. Trained
interviewers surveyed patients by telephone within 26 days of discharge using a pretested
instrument. Staff members and managers completed a coordinated questionnaire. Descriptive and
correlation statistics were used in individual and unit-level analyses Staff members perceived
correctly that patients’ value had different various aspects of care but did not agree with their
managers on patients' value of aspects of care. Unit staff members' and managers' beliefs
regarding patients' care values did not match those of their patients.
Voutilainen P,etal (2004), done a study at Finland to gain information on the quality of nursing
care based on the comments in nursing records. The specific aims of the study were to find out if
the patients' (i) individual needs are assessed, the goals for nursing care are set, and the nursing
interventions are determined; (ii) if the patients' needs are met and (iii) if goal achievement is
regularly evaluated by including comments in nursing documents. In addition, the study aimed to
describe the up-to-datedness of nursing care plans as well as the frequency of making daily
notes. The data were collected on 36 wards of four residential homes. A 30% sample of the
nursing documents on each ward will be collected (n=332) using the Senior Monitor instrument.
The documents studied were mainly nursing care plans and daily note sheets. Seventy-three per
cent of the nursing home residents had an up-to-date nursing care plan at the time of data
collection. The main results demonstrated that a written statement on the patient's mental ability
will be lacking in every fourth document although 75% of the patients suffer from at least
moderate dementia in Finnish long-term care institutions. Development activities should also be
targeted to the documentation of clear and concrete means by which patients' independent
functioning is supported. In addition, evaluation will be the area that warranted attention and
development activities since only every fourth record included information on changes in the
patients' functional capability. Although a lot of in-service training has been focused on
improving the documentation practices, there is still a need for development. The means by
which knowledge is transferred to guide the practice should be carefully considered. Also, forms
should be developed to meet the special requirements for recording nursing care in long-term
care setting
Gilson L,etal,(1993)done a study on assessment of process quality care in Tanzania show that,
Process quality is the commonly used operational definition of health care quality. Its key
components are technical and inter-personal skills, but most assessments undertaken in

8
developing countries focus only on technical skills. This study from Tanzania used explicit
observation checklists to review the process of providing antenatal, curative and nursing care in
primary health units, assessing both technical and inter-personal skills. The study findings
emphasize the weaknesses in available care, particularly in the attitudes of health staff but also in
aspects of technical care.
2.4 Research gap
The studies revealed that in global context, in which science, technology and information lie
within many people's reach, the professions, and particularly nursing, are confronted with the
need to improve their work processes with a view to guaranteeing high-quality care provision to
the patients. The new health care technologies have increased the costs of the health sector and
the population's expectations with regard to the services offered. Nevertheless, studies indicate
flaws in the quality and safety of care, involving unwanted events that negatively affect the
health organizations' image
However, in different countries present problems in the quality and safety of hospital care,
efforts have been made to improve their efficiency and efficacy. That the World Health
Organization recommended managers to take into account the citizens' expectations in decision
making and, since then, various studies about patient satisfaction have been conducted. Patient
satisfaction is not only important by itself, it has also been suggested as a care quality indicator
in developed countries. Nursing is aware of its responsibility for the quality of its care provision
to the patients, the institution, ethics, laws and professional standards, as well as of how its
performance contributes to the valuation of care and the patients' satisfaction
Even though the study found the effort of many researchers towards the quality of service of
nurses to the patients but few of them have the assessment of quality that patient receives from
nurses as a strategy to obtain a set of perceptions related to the quality of the care received,
providing information that benefits the organization of these services. That the study will be set
to explore quality of nursing care delivered to patients by nurses at Mbalizi Hospital.

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 CHAPTER THREE
3.0 RESEARCH METHODOLOGY
3.1 Chapter overview
This chapter describes procedures and plan that employed in collecting data during the study. A
description of major methodological aspect of the study is highlighted.
3.2 Study Area
Creswell (2011) Comments that the researcher has to indicate the actual areas which can be
reached during field data collection as not all the areas can be reached due to various limitations.
The study will be conducted in Mbeya city in Mbalizi Hospital. The areas chosen because it is
the area where study conducted a field practical which likely to increase to collect the data easily
3.3 Research Design
Study will be seeking to assessment of quality of nursing care delivered to patients by nurses
Mbeya region. It is descriptive and exploitive convey on quantitative analysis using both primary
and secondary data where by primary data will be obtained through questionnaires and
secondary data obtained through document reviews. The use of this research design minimize
bias and maximize the reliability of data collected for analysis.

3.4 Study Population

The study population refers to entire set of individuals on which the researcher findings are made
(Fraenkel 2002). Population is the totality of any group of units which have one or more
characteristics in common that are of interest to the researcher (Omary, 2011). Also, population
can be defined as an aggregate of all that conform to a given specific condition. Population is an
entire group of individuals who have one or more events or objects having common
characteristics that are of interest to the researcher Best J. and Khan J. (2008). The research
target outpatients at Mbalizi hospital
3.5 Sample Size and Selection
A sample is a small proportion of population selected for observations and analysis (Omary,
2011). Addition to that a sample is defined as a small portion that presents a whole population,
Kothari (2009). Bailey (2008) define Sample is a group of hopefully representative of the
population intended to study and from which one derives generalization about the population A
sample should be a representative of a wider population implied.
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The study finds out about a sample that possible be true to a wider population, thus
generalization will be made from sample which is representing. This study covered a total of
groups of respondents located at all levels at Mbalizi hospital
3.6 Sampling Techniques.
Mugenda & Mugenda (2003) contented that sampling is a process of selecting a number of
individuals for a study in such a way that individual selected represent the large group from
where they are selected. Also, sampling is a procedure in which a researcher decides about the
technique to be used in selecting the items for the sample Kothari (2000). In conducting this
research two sampling techniques will be applied: purposive sampling and random sampling
which covered 100respondents.
Will be 100 patients; this is calculated from the following formula
N=z2 p(1-p)/E2 where by
N= is the estimated operation of characteristics in the population
Z=standard deviation which is 1.96
P= the prevalence is 0.9
E=estimated standard error of population which is 5%
N= (1.96x1.96) x0.9(1-0.9)/ (0.05x0.05)
N=100
Therefore, the expected sample size of the study will be 100 clients.

3.7 Methods of Data Collection

The decision regarding data collection method guided by two important factors namely: the
material under study and the type of information required (Yates, 2000). Cohen et all (2001)
posit that no single method can act as in isolation because it can bias or distort the whole picture
of reality that the research is investigating. The study involved collection of quantitative data
complemented. The researcher relayed on both primary and secondary data sources. Primary data
collected using questionnaires while secondary data collected by using documentary reviews.

3.8 Data collection instrument

I am expecting to collect research data by using the following data collection tools;
questionnaires, checklist and compilation sheets.

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3.9 Reliability and Validity of instruments.
3.9.1 Reliability of instruments.
Reliability is the instrument likely to give consistent results across time, place, similar
instrument, irrespective of whom is meting it, (Omary, 2011). If a test is highly reliable then a
greater weight can put on score of individual (Torrington, 2002) and highly reliable is valueless
unless the instrument has high validity. Data collected checked while still in the field to ensure
that all questions are answered. Results from tryout exercise enabled the study to make
modifications of instrument in order to make them appropriate for collecting valid and reliable
data.
3.9.2 Validity instruments.
Validity is the instrument capable of measuring what is supposed to measure accurately,
effectively and efficiently (Omari, 2011). This will be achieved through setting standards on
constructing questionnaires which related to the researcher’s objectives and questions.
3.10 Data Analysis
According to Kombo and Tromp (2006) Data analysis refers to examining what has been
collected in survey or experiment and making deductions and inferences. This implied
computation of certain measures along with searching for patterns of relationship that exists
among data groups (Chamwali, 2007). Whereas data processing consists of a number of closely
related operations: editing, classification, coding and tabulation. Data from the respondents will
be edited, coded, ordering and compiled so that they can enable analysis to take place. Data will
be analyzed meet the SSPS computer programs. The findings presented being frequencies, tables
and graphs. Descriptive statistics including frequency distribution milking d to make
comparisons.

3.11. Ethical considerations.

The ethical consideration based on obtaining permission from Mbalizi school of Nursing,
Mbalizi District hospital management and to the respondents. The letter will be written to the
medical officer in charge of Mbalizi District Hospital in Mbeya Region for permission. The

12
respondents will be assured of confidentiality in all data that were to be provided by them, and
that the information were to be need for academic purposes only.

3.12 Dissemination of study findings.

The copies of research report were disseminated to Mbalizi institute of health science in
department of nursing and other copies to researcher where it be accessible to the user and by
any means when researcher need to represent to increase knowledge of community

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 REFERENCES
Agency for Healthcare Research Quality (AHRQ) Quality & Patient Safety. 2013
De Andrade JS, Vieira MJ, Nursing care in practice: problems, perspectives, and need for
systematization, Rev Bras Enferm. 2005 May-Jun;58 3):261-5
Farquhar M. AHRQ quality indicators. In: Hughes RG, editor. Patient Safety and Quality: An
Evidence-based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research
and Quality; 2008.
Gilson L, Kitange H, Temecher T.(1993) Health Policy Unit, London School of Hygiene and
Tropical Medicine. 26(2): 119-39
Hughes RG. Chapter 2 – Nurses at the “sharp end” of patient care. In: Hughes RG, editor. Patient
Safety and Quality: An Evidence-based Handbook for Nurses. Rockville, MD: Agency
for Healthcare Research and Quality; 2008
Kipp KM, Implementing nursing caring standards in the emergency department,J Nurs Adm.
2001 Feb;31(2):85-90.
Kruk ME, Kelley E, Syed SB, Tarp F, Addison T, Akachi Y. Measuring quality of health-care
services: what is known and where are the gaps? Bull World Health Organ.
2017;95(6):389–A.
Loeb JM. The current state of performance measurement in health care. Int. J. Qual. Health Care.
2004;
Ministry of Health and Social Welfare. National Health and Social Welfare Quality
Improvement Strategic Plan 2013–2018. Dar es Salaam: Ministry of Health and Social Welfare,
United Republic of Tanzania; 2013.
Page A. Institute of Medicine Quality Chasm Series. Will behington, DC: The National
Academies Press; 2004. Keeping patients safe: transforming the work environment of nurses;
p. 488.
Polit,D.F and Hungler(1999):Nursing research Principles and methods.2nd edition
Polit,D.F and Beck,C.T(2004):Nursing research, Principles and methods.7 edition.
Polit,D.F and Hungler(1999):Nursing research Principles and methods.2nd edition.

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Pronovost PJ, Thompson DA, Holzmueller CG, Lubomski LH, Morlock LL. Defining and
measuring patient safety. Crit. Care Clin. 2005;
Reason J. Understanding adverse events: human factors. Qual. Health Care. 1995;4(2):80–89

APENDIX 1: Questionnaire
SOCIAL, DEMOGRAPHIC AND ECONOMIC DATA OF A CARE GIVER
For the following questions put tick in the box of a correct answer
1. Age range
a) 0-15 ( ) b) 16-30 ( ) c) 31-45 ( ) d) 46-60 ( ) e) 61-100 ( )

2. Gender
a) Male ( ) b) Female ( )

3. Occupation
a) Business ( ) b) Chefs ( ) c) Doctors( ) d)Drivers ( ) Dry cleaners ( )
f) Engineers ( ) g) Jobless ( ) h) Nurses ( ) i) Peasants ( ) j)Prisoners ( )
k) Social workers ( ) l) Students ( ) m)Teachers ( ) n)Waiters ( )

4. Education level
a) Variables ( ) b)Primary ( ) c) Secondary ( ) d) College ( )
e) University ( ) f) Others ( )

5. Living area
a) Songwe ( ) b) chunya( ) c) Mbalizi ( ) d) umalila ( )

6. Marital status
a) Single ( ) b) Married ( ) c) Cohabiting ( ) d)Separated ( )
e) Widowed ( )

Efficiency quality of nursing care delivered to patients by nurses

7. What the Quality level of nursing care to patients by nurses?

15
 a) High quality ( )
b) Medium quality ( )
c) Low quality ( )

8. How the Patients are safety by service from nurses is at this hospital?
Very good ( )
Good ( )
Medium ( )
Bad ( )
Very Bad ( )

9. What Professionalism level of nurses this hospital did you think?

a) Highly professional ( )
b) Medium professional ( )
c) Low professional ( )

The satisfaction of quality of nursing care delivered to patients by nurses

10. How the level Competence of nurses?
a) Highly competence ( )
b) Medium competence ( )
c) Low competence ( )
11. How the organization management in managing and directing all activities performed in this
hospital?
a) Very good ( )
b) Good ( )
c) Medium ( )
d) Bad ( )
e) Very Bad ( )

The improvement measure to develop the quality of nursing care delivered to patients by
nurses

16
12. There is a need of Training of personnel to improve measure to develop the quality of
nursing care delivered to patients by nurses?
a) Yes ( )
b) No ( )
13. Communication skills development to improve measure to develop the quality of nursing
care delivered to patients by nurses?
a) Yes ( )
b) No ( )
14. Administration management development to improve measure to develop the quality of
nursing care delivered to patients by nurses?
a) Yes ( )
b) No ( )

DATA ZA KIJAMII, KIDEMOGRAFIA NA KIUCHUMI ZAA MTOA HUDUMA

Kwa maswali yafuatayo weka tiki kwenye kisanduku cha jibu sahihi
1. Umri wako miaka mingapi?
a) 0-15 ( )
b) 16-30 ( )
c) 31-45 ( )
d) 46-60 ( )
e) 61-100 ( )

2. Jinsia yako ni?

a) Mwanaume ( )
b) Mwanamke ( )

3. Kazi ni
a) Biashara ( )
b) Wapishi ( )
c) Madaktari( )
d)Madereva ( )

17
Wasafishaji kavu ( )
f) Wahandisi ( ) g) Wasio na kazi ( ) h) Wauguzi ( ) i) Wakulima ( ) j)Wafungwa ( )
k) Wafanyakazi wa kijamii ( ) l) Wanafunzi ( ) m)Walimu ( ) n)Wahudumu ( )

4. Kiwango cha elimu

a) Vigezo ( ) b)Msingi ( ) c) Sekondari ( ) d) Chuo ( )
e) Chuo Kikuu ( ) f) Nyingine ( )

5. Eneo la kuishi
a) Songwe ( ) b) chunya( ) c) Mbalizi ( ) d) umalila ( )

6. Hali ya ndoa
a) Mseja ( ) b) Kuolewa ( ) c) Kuishi pamoja ( ) d)Kutengana ( )
e) Mjane ( )

UBORA WA UFANISI WA HUDUMA YA UUGUZI INAYOTOLEWA KWA WAGONJWA

NA WAUGUZI

7. Ni kiwango gani cha Ubora cha huduma ya uuguzi kwa wagonjwa na wauguzi?
a) ubora wa juu ()
b) Ubora wa kati ( )
c) Ubora wa chini ( )

8. Je, Wagonjwa wako salama kwa huduma kutoka kwa wauguzi katika hospitali hii?
Vizuri sana ( )
Nzuri ()
Kati ( )
Mbaya ()
Mbaya sana ( )

18
9. Je, ni wauguzi wa kiwango gani cha Taaluma katika hospitali hii?
a) Mtaalamu wa hali ya juu ()
b) Mtaalamu wa kati ( )
c) Mtaalamu mdogo ( )

Kuridhika kwa ubora wa huduma ya uuguzi inayotolewa kwa wagonjwa na wauguzi

10. Jinsi kiwango cha Uwezo wa wauguzi?
a) Uwezo wa hali ya juu ()
b) Uwezo wa wastani ( )
c) Uwezo mdogo ()

11. Jinsi gani shirika linasimamia katika kusimamia na kuelekeza shughuli zote zinazofanywa
katika hospitali hii?
a) Nzuri sana ()
b) Nzuri ()
c) Kati ( )
d) mbaya ()
e) Mbaya sana ( )

Hatua ya uboreshaji wa kukuza ubora wa huduma ya uuguzi inayotolewa kwa wagonjwa na

wauguzi
12. Je, kuna haja ya Mafunzo ya wafanyakazi ili kuboresha kipimo ili kuendeleza ubora wa
huduma ya uuguzi inayotolewa kwa wagonjwa na wauguzi?
a) Ndio ()
b) Hapana ()

13. Ukuzaji wa ujuzi wa mawasiliano ili kuboresha kipimo cha kuendeleza ubora wa huduma ya
uuguzi inayotolewa kwa wagonjwa na wauguzi?
a) Ndio ()
b) Hapana ()

19
14. Maendeleo ya usimamizi wa utawala ili kuboresha hatua ya kuendeleza ubora wa huduma ya
uuguzi inayotolewa kwa wagonjwa na wauguzi?
a) Ndio ()
b) Hapana ()

CHAPTER FOUR; WORK PLAN AND BUDGET

WORK PLAN FROM THIRD WEEK OF DECEMBER 2022 TO FEBRUARY 2023
ACTIVITY 1st 2rd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd
wee wee
wee Wee Wee Wee Wee wee wee wee Wee
k k
k k k k k k k k k
Survey and
problem
identificatio
n
Extensive
literature
review
Writing
research
proposal
Submit
sresearch
proposal
Data
collection

Data
analysis
Data
interpretatio
n
Report
writing
Report

20
printing and
binding
Submitting
report

RESEARCH BUDGET

Activities Research Quantity of Cost per each Total cost

Research

Secretarial 1)Research @36 pages x 1 100 for 1 page 3600

services proposal and copy

report

2) Binding 2 copies 2000 6000

9600

Stationary and 1.Questionnaire 2 page 50 copies 4000

photocopy

2.Ream paper 1 ream paper 13000 13000

3.writting pens 40 pens @ 3000 12000

29000

21
 Data entry and 50000 88600

clearance,

miscellaneome

and contingency

Appendix II
CONTACT INFORMATION: INFORMED CONSENT FORM

FORM NO________.
MBALIZI INSTITUTE OF HEALTH SCIENCES
DIRECTORATE OF RESEARCH AND PUBLICATIONS, MIHS
Consent to participate in a research study

PURPOSE: to assess the quality nursing care delivered to outpatient attending at Mbalizi
Hospital.
PRINCIPLE INVESTIGATOR: PILLY SELEMAN.

PROCEDURES: No invasive procedures will be done.

RISKS: The study will not harm you in any way.

BENEFITS: the study will help to assess the quality nursing care delivered to outpatient
attending at Mbalizi Hospital, Mbeya region.

THE RIGHT TO PARTICIPATE

Participation in this study is voluntarily, you have right to refuse or to agree to participate in this study,
also you are allowed to withdraw from filling the questionnaire even if you have signed the consent
form no adverse outcome by doing so.

22
Appendix D; FOMU YA RIDHAA YA KMEHIRIKI KATIKA UTAFITI.

NAMBA YA FOMU:

IDARA YA UTAFITI NA MACHAPISHO, CHUO CHA AFYA YA SAYANSI

MBALIZI.
Utayari wa kukubali kushiriki katika utafiti huu

LENGO: Malengo ya utafiti huu ni kuchunguza wagonjwa nje kama wanaridhika na huduma
inayotolewa na wauuguzi na wakunga katika hospitali teule ya wilaya ya Mbalizi.

MTAFITI: PILLY SELEMAN

NAMNA YA KUFANYA: Utafiti huu hautakua na madhara ndani au nje ya mwili wa mshiriki
yeyote.

FAIDA: Utafiti huu utasaidia kuweza kufahamu kama wagonjwa wanaridhika na huduma inayotolewa
nawauuguzi katika hospitali teule ya mbalizi

USIRI: Hakuna jina la mshiriki litakaloandikwa katika karatasi hii, wala picha ya mshiriki yeyote
itakayochukuliwa.

HAKI YA KUSHIRIKI AU KUTOSHIRIKI: Mama anayo haki ya kushiriki au kutoshiriki katika

utafiti. Hakuna kitu kibaya kinachoweza kusababishwa na kushiriki au kutoshiriki.

23
PERMISSION LETTER FROM MBALIZI INSTITUTE OF HEALTH SCIENCES

MBALIZI INSTITUTE OF HEALTH SCIENCES,

P.O.BOX 6117,
MBEYA.
25THJAN 2023.
MEDICAL OFFICER INCHARGE,
MBALIZI HOSPITAL,
P.O.BOX 6117,
MBEYA.
U.F.S
PRINCIPAL,
MBALIZI INSTITUTE OF HEALTH SCIENCES,
P.O.BOX 6117,
MBEYA.
Dear, Sir/Madam.
REF: APPLICATION FOR PERMISION TO CONDUCT RESEARCH AT MBALIZI
HOSPITAL

24
 Refers to the heading above. I Pilly Seleman a third-year student at Mbalizi Institute of
Health Sciences Department of Nursing and Midwifery. I’m requesting to be permitted to
conduct a research study in you Hospital. My research title is assessment of the quality nursing
care delivered to outpatient at Mbalizi hospital. I hope my request will be considered in advance.
Your faithful,

………………………..

PILLY SELEMAN

25