MILLENNIUM COLLEGE OF MEDICINE ASOSSA CAMPUS

IMPLEMENTATION AND FACTORS AFFECTING THE NURSING

PROCESS AMONG NURSES WORKING AT ASOSSA GENERAL
HOSPITAL, BENISHANGUL GUMUZ REGION WESTERN ETHIOPIA, AN
INSTITUTIONAL-BASED CROSS-SECTIONAL STUDY, 2023.

A RESEARCH PROPOSAL TO BE SUBMITTED TO MILLINIUM

COLLEGE OF MEDICINE ,DEPARTMENT OF NURSING ,IN PARTIAL
FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF
BACHELOR IN NURSING.

ADVISOR; GIRMA CHERINET (BSC, M.Sc.)

BY

1. TIBEBU ABEBE---------MCM/033/12
2. TIGIST ABEBE-----------MCM/034/12
3. TIRUSEW ASSAYE------MCM/035/12
4. TESGANESH TESO-------MCM/114/12
5. ZEKARIAS HABTAMU- - -MCM/116/12

ASOSSA/ETHIOPIA

March/2023

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Table of content---List of Table

Table 1. Work Plan of to assess the implementation of nursing process and its
associated factors in Assosa General Hospital, North Western Ethiopia, 2015.

Table 2. Budget breakdown to assess the implementation of nursing process and

its‘ associated factors in Assosa General Hospital, B/G Region Western Ethiopia,
2015.

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List of Annex
Annex I. Conceptual Frame Work 18
Annex II. English Version Questionnaire-------------------------------------------19

Annex III. Declaration of the Study 26

Annex IV. Assurance of Investigators‘----------------------------------------------27

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Acronyms
ANA-American Nursing Association

CEO- Chief Executive Officer

DX- Diagnosis

ICU- Intensive Care Unit

MCM- Millennium College of Medicine

NANDA- North America Nursing Diagnosis Association

NANDA- I- North America Nursing Diagnosis Association International

NCP- Nursing Care Plan

NIC-Classification of Nursing Intervention

NP- Nursing Process

RN- Registered Nurses

SNCPs-Standardized Nursing Care Plans

USA-United State of America

WHO-World Health Organization

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Acknowledgment
First and for most, we would like to thank GOD, Secondly we would like to thank
Millennium College of Medicine, Department of Nursing staffs for their high
cooperation, initiation and drive to prepare this proposal.

Thirdly, we would like to express our deepest gratitude and special thanks to our
advisors, Girma Chirnet (BSC, MSc) his willingness and commitments to support,
comment, suggest and to give clear directions for the success of this work.

Lastly, it is also our pleasure to thank Asossa General Hospital and administrative
and technical staffs for their extending support, collaboration and spending their
precious time to us whenever it was needed.

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TABLE OF CONTENTS

Table of Contents pages

List of Annex.....................................................................................................................ii
Acronyms..........................................................................................................................iii
Acknowledgment..............................................................................................................iv
TABLE OF CONTENTS...................................................................................................v
Summary..........................................................................................................................vii
BACK GROUND.........................................................................................................vii
1. Introduction...................................................................................................................1
1.1. Background.............................................................................................................1
1.2. Statement of the Problem........................................................................................2
1.3. Justification of the Study.........................................................................................3
2. LITERATURE REVIEW..............................................................................................4
2.1. Overview of nursing process implementation.........................................................4
2.2. Factors affecting nursing process............................................................................5
2.3 Conceptual Frame Work........................................................................................10
3. OBJECTIVES..............................................................................................................11
3.1. General objective..................................................................................................11
 To assess the implementation of nursing process and its associated factors in Assosa
General Hospital, B/G Region Western Ethiopia, 2015...................................................11
3.2. Specific objective..................................................................................................11
4. Method and Materials..................................................................................................12
4.1. Study Area............................................................................................................12
4.2 Study period...........................................................................................................12
4.3. Study Design.........................................................................................................12
4.4. Source Population.................................................................................................12
4.5. Inclusion and Exclusion Criteria...........................................................................12
4.5.1. Inclusive Criteria............................................................................................12
4.5.2. Exclusive Criteria...........................................................................................12
4.6. Sampling Technique.............................................................................................12
4. 7. Variable of the Study...........................................................................................13

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 4.7.1. Dependent Variable........................................................................................13
4.7.2. Independent Variables....................................................................................13
4.8. Operational Definition..........................................................................................13
4.9. Data Collection Tools...........................................................................................14
4.10. Method of Data Collection..................................................................................14
4.11. Data Quality Assurance......................................................................................14
4.12. Data Processing and Analysis.............................................................................15
4.13. Ethical Consideration..........................................................................................15
4.14. Dissemination of Results.....................................................................................15
5. Work plan....................................................................................................................16
6. Budget Break Down.....................................................................................................17
Annex I. Questionnaire....................................................................................................18
Annex II. Declaration.......................................................................................................34
Annex IV. Assurance of Investigators.............................................................................35
References.......................................................................................................................36

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Summary
BACK GROUND: - Nursing is the use of clinical judgments in the
provision of care to enable people to improve, maintain, or recover
health, to cope with health problems, and to achieve the best possible
quality of life, whatever their disease or disability, until death.
Whereas, nursing process is a systematic method of assessing,
diagnosing, planning, intervening and evaluating individualized care
for clients in any state of health or illness. Based on the scientific
problem-solving method, it constitutes the foundation for nursing
practice.

OBJECTIVE: - To assess the implementation of nursing process and

its‘ associated factors in Asossa General Hospital, B/G Region
Western Ethiopia, 2015.

METHOD: - Institutional based cross-sectional study will be

conducted on Asossa General Hospital; Western Ethiopia.
Quantitative method will be used. These Hospital is purposively
selected based on the general service the Hospital has been provided
and the number of nurses for study area. The total number of staff
nurses in the hospital is 101. Convenience sampling method will be
used to select participant Nurses. All staff nurses will be the study
participant. Data will be collected by using standardized self-
administered questionnaire.

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1. Introduction
1.1. Background
In the eighties, the nursing process was introduced as a systematic method of
planning nursing care internationally. The nursing process was described as a
relational and problem solving process. Patient problems for which nurses provide
interventions were called ―nursing problems‖. These problems were worded
in freestyle and nursing goals and interventions were chosen according to these patient
problems. Even though investigations indicated that the nursing process was well
adopted the so called nursing problems were often not accurately formulated.(1)
Nursing care, at its best, is designed and implemented in a thorough manner, using an
organized series of steps, to ensure quality and consistency of care. The nursing
process, a proven form of problem solving based on the scientific method, serves as the
basis for assessing, making a nursing diagnosis, planning, organizing, and evaluating
care. That the nursing process is applicable to all health care settings, from the prenatal
clinic to the pediatric intensive care unit, is proof that the method is broad enough to
serve as the basis for all nursing care.(2)

The nursing process is central to all nursing actions and applicable to all settings and
methods of client care. Because the nursing process is flexible, it adapts readily too
many variables and any conceptual framework one may use in clinical practice. (3)

Nursing process is a systematic method of planning, delivering, and evaluating

individualized care for clients in any state of health or illness. Based on the scientific
problem-solving method, it constitutes the foundation for nursing practice. The first
step is assessment. It is appropriate for use with individual clients, families, groups, or
communities. It is the organized and systematic process of collecting information from
a variety of sources in order to evaluate the health status of the client. Through

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assessment the nurse develops a data base regarding the client‘s level of wellness, past
illnesses and experiences, health practices, and health care goals.(4)

The second step is nursing diagnosis. It is a clinical judgment about individual, family,
or community responses to actual or potential health problems/life processes. It focuses
on human responses and alterations in the client‘s ability to function as an independent
human being. It is holistic, encompassing all aspects of the human being. The third step
is planning. It helps to solve , lessen, or minimize the effects of the identified problems,
or to prevent potential problems. It has four essential steps; prioritizing the identified
nursing diagnoses, developing goals/outcome statements, Planning nursing actions and
Documentation-the Nursing Care Plan. (4)

The fourth step is nursing interventions it is a nursing treatments, based on clinical

judgment and knowledge, which are implemented by nurses to improve patient
outcomes. At the University of Iowa, a classification of nursing interventions (NIC)
was developed. The results of linear regression models that included intervention
scores and nursing diagnoses as predictor variables explained 53.2% of the variance in
total number of interventions and 58.9% of the variance in intervention time.(1)

The fifth step is evaluation. It is judging and out comes in relation to the desired
outcomes of care, measuring the effectiveness of planned nursing interventions, further
assessment and planning if an expected out comes has not been achieved and critically
analyzing the steps of the process and making any adjustments necessary. (5)

1.2. Statement of the Problem

The nursing process has been used for over 25 years as a systematic approach to nursing practice. The
process is an efficient and effective method for organizing nursing knowledge and clinical decision
making in providing planned client care. Although it has been undergoing constant re-evaluation and
revision, the concepts within the process still remain central to nursing practice. It is an interactive
method of practicing nursing, with the components fitting together in a continuous cycle of thought and
action. (6)

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The nurse’s carries personal responsibility and accountability for nursing practice, and for maintain
competence by continual learning. Theoretically, if nurses fail to carry out necessary nursing care, then
the effectiveness of patient surveillance may be compromised and lead to preventable adverse patient
event. In Addis Ababa selected governmental hospitals among 192 participated nurses, 52.1% of them
implemented nursing process while 47.9 % of them did not implement nursing process. (7) Consistent
adherence to the components of the nursing process tends to reduce the possibility of omitting an
important finding in the overall condition of the client.

There are no studies conducted on the implementation of nursing process and its associated factors
among nurses who works at Asossa General Hospital. Therefore, this study is designed to investigate the
implementation of nursing process and its associated factors among nurses who works at Asossa
General Hospital.

1.3. Justification of the Study

Poor quality of implementing nursing process leads poor delivery of nursing care. Quality of nursing
care could be improved, if the factors affecting the implementation of nursing process are investigated.
The study tries to investigate the implementation of nursing process and its associated factors among
nurses who works at Asossa General Hospital. These factors, if identified, might lead to
recommendations regarding the implementation of nursing process and served as a baseline for a future
study. Patients and society will potentially benefit from the knowledge derived from the study.

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2. LITERATURE REVIEW
2.1. Overview of nursing process implementation
The nursing process is dynamic and requires creativity for its application. The steps remain the same,
but the application and results will be different in each client situation. The nursing process is
designed to be used with clients throughout the life span and in any setting in which a nurse provides
care for clients. (8)
The nurse has to always be thinking and recognizing what step in the nursing process is being
utilized. They must incorporate knowledge from many areas in order to deliver holistic care, that is,
to meet the total needs of the client. They can utilize the nursing process with clients of any age and
with any developmental level. (4)

Some scholars have recently shown the investments made to use the nursing process in care practice,
providing information on what nurses know, believe and adopt in various situation and difficulties
encountered in hospitals. These studies indicate the potential of investments in its practice by
approaching nursing practice and health care, education and research. (9)

Based on the above, we reaffirm the researchers‘ view that the nursing process is an action full of
meaning that can be used by nurses in practice. As a method for care delivery, this represents
challenges in education and practice. The nursing process needs to be depended in the hospital
context, based on the perception of nurses working there, highlighting their doubts, uncertainties and
questions about how to put in to operation. (10)

Some scholars have recently shown the investments made to use the nursing process in care practice,
providing information on what nurses know, believe and adopt in various situation and difficulties
encountered in hospitals. These studies indicate the potential of investments in its practice by
approaching nursing practice and health care, education and research.(9)

Based on the above, we reaffirm the researchers‘ view that the nursing process is an action full of
meaning that can be used by nurses in practice. As a method for care delivery, this represents
challenges in education and practice. The nursing process needs to be depended in the hospital
context, based on the perception of nurses working there, highlighting their doubts, uncertainties and
questions about how to put in to operation. (10)

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2.2. Factors affecting nursing process
Yet hospitals confront challenges with regards to nursing involvement, including
scarcity of nursing resources; difficulty engaging nurses at all levels from bed side to
management; growing demands to participate in more, often duplicative, and quality
improvement activates. (11)

Because nurses are the key caregivers in hospitals, they can significantly influence the
quality of care provided and, ultimately, treatment and patient outcomes.
Consequently, hospitals‘ pursuit of high-quality of patient care is dependent, at least in
part, on their ability to engage and use nursing resources effectively. This will likely
become more challenging as these resources become increasingly limited. (9)

Nurses are ―the largest deliverer of health care in the U.S.A‖, according to a
representative of an accrediting organization, and as hospital participation in quality
improvement activities increases, so does the role of nursing universally, respondents
described how vital nurses are to hospitals; that nursing care is a major reason why
people need to come to a hospital. As one hospital, CEO said of nurses, they are the
―heart and soul of the hospitals‖ (10).

The scarcity of nurses is a major challenge for hospitals because it impact to not only
their ability to provide nursing coverage for patient care, but also to provide adequate
nursing resources for other key activities, such as quality improvement. Nurses usually
have a multiple patients and meeting all of their physical and emotional needs is
challenging, if not impossible. Consequently, nurses continually evaluate what needs to
be done, reprioritizing their tasks to meet patients‘ changing needs (11).

The planning phase also involves identifying the specific actions one must perform to
administer the medication safely and appropriately. Evaluations involve criteria used to
determine if the goals were met. Specific, measurable, clearly stated goals make it
simple to determine whether the intended outcomes have been achieved and to what

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degree. Evaluation involves the review of several areas, including compliance, client
learning/understanding, therapeutic drug response, and evidence of side effects. The
evaluation phase permits the provider to determine if, in fact, goals were met, and also
measures the effectiveness of nursing care (12).

However, a study that investigated the meaning of nursing process among nurses in an
intensive care unit (ICU) showed that their experiences were contradictory: although
the nursing process was seen as a form of professional recognition with regard to its
role in society. Something that allows nurses to have authenticity and freedom of
action in their practice, it was also viewed with feelings of anger, dissatisfaction and
frustration (13).

Today, there is a lack of knowledge about how to successfully implement standardized

nursing care plans (SNCPs) in various settings in general and hospital wards in
particular. There are few previous studies of SNCPs, and those identified focused on
effect and utilization as opposed to implementation. Registered Nurses represent a
patient surveillance system and are essential to the prevention and early detection of
adverse patient events. Adverse events occur in an estimated 2.9 to 3.7 percent of acute
care hospitalizations in the United States of America (U.S.A.), and it is estimated that
between 44,000 and 98,000 patients die in hospitals each year as a result, with nearly
half due to errors in the delivery of care. A recent systematic review of eight studies
conducted in the U.S.A., Australia, United Kingdom (U.K.), and Canada revealed that
the median overall incidence of in-hospital adverse events was 9.2%. From those
43.5% of the incidents did preventable and 7.2% leading to death. According to
Swedish surveys, the SNCP is used as clinical guidelines, although there is lack of
research behind it. In Sweden university hospitals and rural hospitals among 131
participated nurses only 21% of nurses stated that the SNCPs had been evaluated, of
whom a majority (73%) of them stated that SNCPs was successful. While 27% of them
considered it unsuccessful. (7)

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Despite their knowledge of the nursing process, certain factors limited the ability of
nurses to implement it in their daily practice, including lack of time, high patient
volume, and high patient turnover. Despite these hurdles, the daily application of the
nursing process is characterized by the scientific background of the professionals
involved since it requires Knowledge and provides individualized human assistance
(14).One of the barriers to the development of nursing process is the implementation of
the nursing diagnosis. However, studies have shown that the implementation of the
nursing diagnosis is a challenge for nurses (15).

An evaluation of the implementation of the nursing diagnosis highlighted the

importance of the survey of needs, and of the mobilization of resources to meet these
needs. These included the technical resources required to provide structural resources
and the time required to participate in ethics and policy training, which promote
enhanced knowledge and creative potential. Taken together, these factors support
positive assessment and allow its continuity (16).

It is reasonable to conclude that the nursing process is important for the practice of
nursing; however, its use is not an easy task. Therefore, a continuous evaluation of how
the nursing process is executed with in the health services is required (17).

A majority of the studies on nursing work load and patient safety used nurse-patient
ratio as the measure of nursing work load. According to research on work load in
human factors engineering it is well known that work load is a complex construct,
more complex than the measure of nurse- patient ratio. It is unlikely that the
multidimensional, multifaceted structure of work load can be captured by one unique,
representative measure. Therefore, the belief is that researchers who use the nurse-
Patient ratio as a measure of work load offer a limited contribution to understanding

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the impact of nursing workload and designing solutions for reducing or mitigating
nursing work load (18).

Nursing work load affects the time that a nurse can allot to various tasks. Under a
heavy work load, nurses may not have sufficient time to perform tasks that can have a
direct effect on patient safety. In Addis Ababa selected governmental Hospitals among
192 participated nurses 72.9% of them working in a stressful working environment
where as 16.1% were working in a disorganized working environment the remaining
10.9% were working in a negligent work place at a time. In Addis Ababa selected
governmental Hospital nurses from those dissatisfied with any reason 95 (49.5%) of
the total respondents were dissatisfied due to their profession. Job dissatisfaction of
nurses can lead potentially threaten patient care quality and organizational
effectiveness. These problems are manageable if a nurse can properly implement
nursing process; thus, this study show the implementation of nursing process and its
associated factors performed by nurses on the nursing practice in Asossa General
Hospital, the results of the study will be used as base line information to design
appropriate intervention strategies for the factors that can influence nurses‘ capacity to
conduct nursing process for their patients. (7, 19)

A study conducted in Europe to test the establishment of a validated model of nursing

records aimed to promote individual care. The results showed limitations of the nursing
process conducted according to the model, particularly in the identification of
problems presented by the patients and, consequently, diagnosis and the possible
information producers. A study conducted in the United Kingdom to assess whether
data obtained from nursing records could be reliably used to identify interventions for
patients who had suffered acute myocardial infarction or a fracture of the head of the

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femur, showed that the analyzed nursing records did not provide an adequate picture of
patients‘ needs for nursing intervention (20).

An investigation of the steps of the nursing process actually implemented in the routine
of a university hospital showed that all phases were performed however; problems
were identified in the nursing process, involving recording the history and
implementing nursing perception. The evaluation of expected results, in particular, was
not adequately recorded (21).

Specially seeking to investigate the phases of the nursing process performed in the care
practice of a university hospital in Brazil, the authors identified the implementation of
all stages. However, the existence of failure was shown among the nursing diagnoses
in the patients‘ history, as well as the implementation of nursing prescriptions without
recording the evaluation of the expected results (18). Similar results were also shown
in a study conducted in 2006 during the implementation of the nursing diagnosis, in
which the research subjects indicated difficulties in developing the nursing process at
all stages, and the need for changes to speed up the work process and optimize the
quality of action in care and education (22).

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2.3 Conceptual Frame Work

Figure .1 conceptual frame works that shows factors affecting implementation of

nursing process. (7)

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3. OBJECTIVES
3.1. General objective

 To assess the implementation of nursing process and its associated factors in

Assosa General Hospital, B/G Region Western Ethiopia, 2015.
3.2. Specific objective

1. To assess the implementation of nursing process in Assosa General Hospital,

B/G Region Western Ethiopia, 2015.

2. To assess factors affecting the implementation of nursing process among nurses

working in Assosa General Hospital, B/G Region Western Ethiopia, 2015.

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4. Method and Materials
4.1. Study Area
The study will be conducted in Asossa General Hospital, western Ethiopia, and Benishangule Gumuz
Regional State of Ethiopia. Asossa is the administrative town of western Benishangul Gumuz Region
and it is found in the Western part of the country. 660 km away from Addis Ababa. It has 06 General
hospital, 70 governmental health center, 380 health posts, 148 drug store 11 private pharmacies, 104
primary clinic, 46 medium clinic, 01 diagnostic laboratory and 33 traditional healer service provider
up to 2015 E.c.

4.2 Study period

The study will be conducted from February – May, 2015 E.

4.3. Study Design

Institutional based cross-sectional study design will be conducted to assess

implementation of nursing process and its‘asocciated factors in Assosa General
Hospital, B/G Region Western Ethiopia by using quantitative method.
4.4. Source Population
All staff nurses who have been working in Assosa General Hospital, B/G Region
Western Ethiopia.

4.5. Inclusion and Exclusion Criteria

4.5.1. Inclusive Criteria
 Nurses who are working at Asossa General Hospital available during
the study period and willing to participate in the study.
4.5.2. Exclusive Criteria
 Nurses who will not be available due to sick leave, temporary
reassignment, annual leave; free service workers and those who
decided to exercise their right not to participate in the study.
4.6. Sampling Technique

Asossa General Hospital is purposively selected based on the general service that
have been provided and number of nurses for study area. Convenience method will be
used to select participant Nurses. According to the data we obtained from these

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Hospitals,

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there are 100 nurses in Asossa General Hospital. All staff
nurses will be the study participant.

n= (zα/2)2 p (1−P)/d2

Where;

 n is the minimum sample size,

 z is the normal standard distribution (z = 1,96) at a confidence level of 95% and
α = 0,05,
 P is the prevalence / population proportion and d is the tolerable margin of error.

Please calculate/determine the sample size

4. 7. Variable of the Study

4.7.1. Dependent Variable
 Implementation of nursing process.

4.7.2. Independent Variables

 Nurses skill.
 Hospitals organizational structures.
 Patient‘s income.
 Patient‘s turnover
 Year of experience.
 Knowledge of nurses.
 Nurses demographics.
4.8. Operational Definition
Nursing Process: systematic ways of problem-solving include assessment, diagnosis,
planning, implementation and evaluation practiced by licensed nurses. (7)

Skill:-daily nurses practice performed for participant. Those respondents who have
scored > 26 are highly skill full; 18-25 are moderately skill full, and < 17 are low skill
full group out of 30. (7)

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Knowledgeable Nurses:-Nurses awareness about nursing process. Highly
knowledgeable nurses are those 80% of the questions, moderately knowledgeable
nurses are those answered in between 55-79.9%, and low knowledgeable nurses those
scored < 55 %.( 7)

Organizational Structure: - The hierarchical level of a hospital in health care

delivery. (7)

Year of Experience: - Number of year nurses has worked in nursing. (7)

Patient Turnover: - A patient was visiting hospitals for getting health care and leaves
before full provision of care. (7)

4.9. Data Collection Tools

Data will be collected by using structured self- administered questionnaire. Structured
English version questionnaire which is adapted from previous study. It includes five
main parts about nurses‘ socio demographics, knowledge of nursing process, work
load, organizational structure and facilities, patient turnover and patient‘s income.

4.10. Method of Data Collection

Data will be collected by self-administered questionnaire. The data collection process
will be supervised by the principal investigators from April-May/2015. Before the
actual data collection we will have a pre-test and half day orientation about the aim of
the study and the content of the instrument for our volunteer data collectors. Therefore,
the data collectors became familiar about each. It is also a mechanism of minimizing
biases during the process of data collection. Questionnaires are filled by nurses in their
work place.

4.11. Data Quality Assurance

During data collection, both principal investigators and data collectors themselves will
check the data for its completeness and missing information at each point. Furthermore
data will be checked during entry and compilation before analysis.

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4.12. Data Processing and Analysis
The collected data will be cleaned, coded and entered by SPSS?? data analysis.
Descriptive statistics like frequency and percentage will be used to summarize the
collected data.

4.13. Ethical Consideration

Ethical clearance will be getting obtained from Millennium college of Medicine,
Department of BSC nursing before the beginning of data collection permission letter
will be provided to the hospital for proceeding data collection. After that participants
will be oriented about the purpose and procedure of data collection, and that
confidentiality and privacy is ensured. It is also cleared that participation is fully based
on the willingness of participants using written consent.

4.14. Dissemination of Results

The findings of this study will be disseminated to Millennium College of Medicine
Millennium College of Medicine library, to Assosa hospital which included in the
study, Asossa town health office, and B/G regional state health bureau.

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 5. Work plan
Table 1. Work Plan of to assess the implementation of nursing process and its
associated factors in Asossa General Hospital, North Western Ethiopia, 2015.

Feb. Mar. April. May

Weeks Weeks Weeks weeks

Activities to be Responsible bodies
phase

performed 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
1 Title selection Research team

Proposal Research team

writing
Questionnaire >>
2 development
Ethical MCM
clearance
Personnel Research team
orientation
Data collection >>

Data coding, >>

entry, and
analysis
Thesis writing >>
3
Submission of >>
final thesis
report

Preparation for >>

Public defenses
4 Public defenses >>

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 6. Budget Break Down
Table 2. Budget breakdown to assess the implementation of nursing process and its‘
associated factors in Asossa General Hospital, Western Ethiopia, 2015.
NO BUDGET CATEGORY
No of Duration of
1 Personal Cost Unit cost persons work Total cost Remark
Investigators 70.00 birr 02 05 days 700.00 birr
Data collectors 50.00 birr 05 06 days 1,500.00 birr
Subtotal-1 2,200.00 birr
Equipment & Supplies Unit quantity Unit cost
Pen Number 05 20 birr 100 birr
Pencil Number 05 05 birr 25 birr
Printing Page 70 5.00 birr 350 birr
2 Duplication Page 1,500 5.00 birr 7,500 birr
Subtotal-2 11,125 birr
Transport & Communication
3 Cell-phone card Card 05 10 birr 50 birr
Trip 01 40 birr 200 birr Asossa
Transportation Hospital
10 birr 70 birr Bajaj
07
Subtotal-3 320 birr
4 Grand total - - - 11,445 birr

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Annex I. Questionnaire
MILLINNEUM COLLEGE OF MEDICINEA ASSOSA CAMPUSE ,
DEPARTMENT OF BSC NURSING.

Confidentiality and Verbal Consent Form:-This questionnaire is adapted from a

research conducted in Debre Markos Referral Hospital and Finote Selam District
Hospital, to assess the implementation of nursing process and associated factors in
Assosa General Hospital B/G Region Western Ethiopia. The questionnaire contains
both closed ended and open ended questions and will be provided in self-administered
form. You are therefore kindly requested to provide genuine answers to the questions.
The information you provide is confidential and is used only for the purpose of this
study. If you have any question, don‘t hesitate to ask the data collector. Your
cooperation and participation until the compilation of the questionnaire is very
necessary for the successful compilation of the assessment. We therefore ask your
genuine willingness. However, you have the right to turn down if you are not voluntary
to participate so that fills ‘NO’ in the box below.

If you are voluntary or not mark ‘x’ on your opinion YES NO

THANK YOU IN ADVANCE FOR YOUR COOPERATION!!!

Participant‘s signature Date

Data collectors sign Date

Cell phone = +251 900-60-12-25

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PART. I Socio Demographic Questions

Circle your response from the given option/fill the blank space/

S/No Items Responses Remark

1. Sex 1.male 2.female
2. How old are you? (in year)
What is your ethnicity? 1.Amhara 2.Tigraye
3. 3.oromo 4.others(specify)--------------
4. What is your current marital 1.single 2.married 3.widowed
status? 4.divorced 5.separated

PART- II. Organizational and Nurses Related Questions:

ITEM Responses
5. When do you graduated for nursing? in E.C.
6. How many years you did work in clinical area?
7. On average how many hours do you work per day?
8. How many patients do you care per day? --------------------------------------
9. Do you have all equipment in your organization to 1. Yes 2. No
do nursing care?
10 Have you worked over time? 1. Yes 2. NO If ‗no‘ skip Q.NO. 13
11 If your answer ‗yes‘, is that with payment? 1. Yes 2. NO If ‗no‘ skip Q.NO. 13

12 If your answer ‗yes‘, is the payment enough? 1. Yes 2. NO

13 Have you ever had misbehavior record in your 1. Yes 2. NO
personal file?
The greatest strain for you during in your working 1.Rude physicians
14 time is/are? 2.harassing coworker
3.unsympatic manager
4. When coworkers doesn‘t do their task.
5. others (specify)

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15 Is there any dissatisfying aspect of your job? 1. Yes 2. No. If ‗no‘ skip Q. 18.
1.Having care for so many patients
16 What is/are the dissatisfying aspects of your job? 2.the new report system
3. Useless paper work.
4. Rules being made up without staff
5. others (specify)
If you are dissatisfied with the above any reason
17 from Q.NO.16, is it due to your profession? 1.Yes 2.NO
18 How would you describe the atmosphere of your 1.stressful at times
Work place? 2.Negligent at times
3.disorganized
4. very well 5. others (specify)--------
19 Did you get satisfying orientation while you joined 1.Yes 2.NO
this organization?
1. recording every activities what you
perform
20 What do you use to make your work visible? 2. using nursing process
3.reporting to supervisors
4. working on the patient problems &
seeing the outcome
5. Nothing used 6. others (specify)-----
21 Have you committed clinical errors 1. Yes 2.NO. If ‗no‘ skip Q.NO 23.

1.Slip/slap
22 If you do, what kind of error you perform? 2.knowledge error
3. Excusive error 4 others (specify) ----
1.decreasing productivity
23 How high rate of staff nurses turnover affect once 2.disorganized service delivery
society health? 3.lossing sharing of organizational
knowledge
4. others (specify)

v
 1.job&employee skill mismatch
24 What do you think the causes of employee turnover? 2.due to NGO‘s attractive payment
3.low access of short/long training
4. less/no recognition for the work done
5. others (specify)
1. miss-understanding of the modern
medicines
25 What do you think the major reason of patient
2. due to poor economic status
turnover? 3. due to long time waiting time to get
the service
4. others (specify)-----------------

1. patient discharge before completing

26 According to Q.NO.25 how it influence your the planned interventions
nursing process? 2. patients are not cooperative for the
care you provide
3. inability to collect the required
material for care
4. present with complicated problems
that is challenging to manage
5. others (specify)

v
PART- III. Knowledge Assessment

1.collecting subjective & objective data

2.evaluating what has been done for the patient
27. The first step on your nursing 3.indicating the activities to be done
process is? 4.directly intervening the problem
1. focuses on ethical principles
28. The primary aim of Gordon 2. focuses on patients responses towards their illness
approach is? 3. Focuses on the disease process/medical diagnosis
4. focuses on patient‘s attendant interest
1.assassment
2.implementation
29. Select from the given option that is 3.planning
not a component of nursing process. 4.evaluation
5. evidenced based practice
6. nursing diagnosis
30. Your appropriate nursing diagnosis 1.potential nursing diagnosis
for a patient with Hypertension to 2.actual nursing diagnosis
prevent future complication is? 3.medical diagnosis
4.laboratory investigation
5. others (specify)
1. nursing dx focuses on the diseases than other
patient‘s response
31. What makes nursing process 2. nursing dx focuses on patient‘s response
different from medical diagnosis? than patient‘s response
3. both focuses on patient‘s responses
4. both have similar procedure to resolve a patient‘s
5. others (specify)
32. In your organization who is 1. Physician 2. Patient‘s family 3.nurses
mandatory for the better 4. Patients 5.no one should excluded
accomplishment of nursing process?

v
33. What are your activities During your 1. Assigning priorities
planning phase? 2. Specifying expected out comes
3.recording the data of the patient
4.specifying goals
5. identifying interdependent interventions
6. others (specify)
34. Select your role during 1.propose the interventions
implementation phase of your 2.implementing the proposed
nursing process? interventions
3. performing the planned interventions by
excluding Activity of daily living
4. Stop the phase if the initial implementations fail to
Change patients‘ problem.
35. Select that may be not a guide for 1.the nursing diagnosis
your nursing process evaluation? 2.collaborative problems
3.priorities and nursing interventions
4.expected out comes
5.all could be guide lines
36. Fluid volume deficits related to 1. fluid volume deficit
unresolved vomiting & diarrhea as 2. unresolved vomiting and
evidenced by dry oral mucosa and diarrhea 3.dry oral mucosa and
sunken eyes. From the given nursing sunken eyes 4.dehydration
diagnosis select the etiology from
the given options?

v
PART IV: Skill Assessment

Score the following activities according to the frequency you perform. Mark by using
‗x‘ on your choice. 1. not at all 2.not really 3.undecided 4.somewhat
5.verymuch

ACTIVITIES 1 2 3 4 5
37 Ability to apply theories of nursing practice
38 Ability to maintain patient dignity, privacy and confidentiality(using
nursing skills)
39 Ability to practice principles of health and safety, including morning and
handling, and infection control; essential first aid and emergency
procedures
40 Ability to safely administer medicine and other therapies; (using nursing
skills, Interventions/ activities to provide optimum care)
Ability to consider emotional, physical, and personal care, including
41 meeting the need for comfort, nutrition, personal hygiene and enabling the
person to maintain the activities necessary for daily life; (using nursing
skills, Interventions/ activities to provide optimum care)
41 Respond to patient needs by planning delivering and evaluating
appropriate and individualized programs of care working in partnership
with the patient, their care givers, family and other health workers.

THANKS AGAIN FOR YOUR PARTICIPATION!!!!

v
አባሪ II. መጠይቅ
ሚሊንዩም ኮሌጅ

ሚሚሊንየም ኮሌጅ ኦፍ ሜዲሲን አሶሳ ካምፓስ፣ የቢኤስሲ ነርሲንግ ዲፓርትመንት

ምስጢራዊነት እና የቃል ስምምነት ቅጽ፡- ይህ መጠይቅ የተወሰደው በሰሜን ምዕራብ ኢትዮጵያ በደብረ

ማርቆስ ሪፈራል ሆስፒታል እና ፍኖተ ሰላም ዲስትሪክት ሆስፒታል በተደረገ ጥናት ነው። የመንግስት

ሆስፒታል በሰሜን ምዕራብ ኢትዮጵያ በአሶሳ አጠቃላይ ሆስፒታል የነርሲንግ ሂደት አፈፃፀምን እና

ተያያዥ ምክንያቶችን ለመገምገም። መጠይቁ የተዘጉ እና የተጠናቀቁ ጥያቄዎችን ያካተተ ሲሆን በራስ

በሚተዳደር ቅጽ ይቀርባል። ስለዚህ ለጥያቄዎቹ እውነተኛ መልስ እንድትሰጡ በትህትና ተጠይቀዋል።

ያቀረቡት መረጃ ሚስጥራዊ ነው እና ለዚህ ጥናት ዓላማ ብቻ ጥቅም ላይ ይውላል። ማንኛውም ጥያቄ

ካለዎት መረጃ ሰብሳቢውን ከመጠየቅ አያመንቱ። መጠይቁ እስኪዘጋጅ ድረስ ትብብርዎ እና ተሳትፎዎ

ለግምገማው ስኬታማነት በጣም አስፈላጊ ነው። ስለዚህ እውነተኛ ፍቃዳችሁን እንጠይቃለን። ነገር

ግን፣ ለመሳተፍ ፈቃደኛ ካልሆንክ/ሽ እምቢ ማለት መብት አለህ/ሽ ስለዚህ ከዚህ በታች ባለው ሳጥን

ውስጥ ‗አይ‘ ይሞላል። አይም

በጎ ፈቃደኞች ከሆኑ ወይም በእርስዎ አስተያየት 'x' ምልክት ካላደረጉ አዎ ሆ

ስለ ት ብርዎ አስቀድመን እናመሰግናለን!!!!!

የተሳታፊ ፊርማ ቀን
የመረጃ ሰብሳቢዎች ፊርማ ቀን
ሞባይል ስልክ = +251 900-60-12-25

ክፍል. I. የሶሺዮ ስነ-ሕዝብ ጥያቄዎች

ከተሰጠው አማራጭ ምላሽዎን ያክብቡ/ባዶውን ቦታ ይሙሉ/

v
ተ.ቁ ዝርዝር
ምላሾች

v
 አስተያየት
1. ፆታ 1.ወንድ 2.ሴት
2.
ስንት አመህ/ሽ ነው? (በዓመት)

ብሄርህ/ሽ ምንድን ነው?

1.አማራ 2.ትግሬ
3.
3.ኦሮሞ 4.ሌሎች (ይግለጹ) -----

4.
አሁን ያለህ/ሽበት የትዳር ሁኔታ 1.ነጠላ 2.ያገባ 3.ባልቴት

ምን አይነት ነው? 4.የተፋታ 5.የተለያየ

ክፍል- II. ድርጅታዊ እና ነርሶች ተዛማጅ ጥያቄዎች፡-

ምላሾች
5. አ.ም
በነርስነት የተመረቁት መቼ ነው?

6.
በክሊኒካዊ አካባቢ ስንት ዓመት ሰርተዋል?

7.
በአማካይ በቀን ስንት ሰዓት ይሰራሉ?

8. ----------------------------------------------
በቀን ምን ያህል ታካሚዎችን ይንከባከባሉ?

9.
በድርጅትዎ ውስጥ የነርስ እንክብካቤን ለመስራት 1. አዎ 2. አይደለም

ሁሉም መሳሪያዎች አሉዎት?

10
በጊዜ ሂደት ሰርተሃል? 1. አዎ

2. አይ 'አይ' ከዘለሉ ጥ.ቁ. 13

v
11
መልስዎ 'አዎ' ከሆነ፣ ያ ከክፍያ ጋር ነው? 1.
አዎ
'አይ' ከዘለሉ ጥ.ቁ. 13
2. አይ
12
መልስዎ 'አዎ' ከሆነ ክፍያው በቂ ነው? 1. አዎ 2. አይ

13 1. አዎ 2. አይ
በግል መዝገብህ ውስጥ የተዛባ ባህሪ መዝገብ

አጋጥሞህ ያውቃል?

በስራ ጊዜዎ ውስጥ ለእርስዎ ትልቁ ጫና ነው/ነው? 1. ባለጌ ሐኪሞች

14
2.የሥራ ባልደረባን ማስጨነቅ

3. የማይራራ አስተዳዳሪ

4. የስራ ባልደረቦች

ተግባራቸውን በማይፈጽሙበት

ጊዜ.

5. ሌሎች (ይግለጹ) -------------

15
በስራዎ ውስጥ ምንም የማይረካ ገጽታ አለ? 1. አዎ

2. አይ. ‗አይ‘ ከሆነ ከዘለለ ጥ.ቁ 18.

1. ለብዙ ታካሚዎች እንክብካቤ ማድረግ

16
የሥራዎ እርካታ የሌላቸው ገጽታዎች ምንድን ናቸው?
2. አዲሱ ሪፖርት ሥርዓት

3. የማይጠቅም የወረቀት ስራ.

4. ያለ ሰራተኞች የሚዘጋጁ ደንቦች

5. ሌሎች (ይግለጹ) -----

ከላይ በተገለጸው ምክንያት ካልተደሰቱ ከቁ.16፣ በሙያዎ

v
17
ምክንያት ነው? 1.አዎ 2.አይ

18
የእርስዎን ድባብ እንዴት 1.አንዳንዴ አስጨናቂ

ይገልጹታል? የስራ ቦታ? 2. አንዳንድ ጊዜ ቸልተኛ

3.የተደራጀ

4. በጣም ጥሩ

5. ሌሎች (ይግለጹ)------

19
ይህን ድርጅት ሲቀላቀሉ የሚያረካ አቅጣጫ አግኝተዋል? 1.አዎ 2.አይ

1.የምታከናውናቸውን ተግባራት ሁሉ

20 መመዝገብ
ስራዎ እንዲታይ ለማድረግ ምን ይጠቀማሉ?
2.የነርስ ሂደትን መጠቀም

3. ለተቆጣጣሪዎች ሪፖርት ማድረግ

4. በታካሚው ችግሮች ላይ መስራት

እና ውጤቱን ማየት

5. ምንም ጥቅም ላይ አልዋለም

6. ሌሎች (ይግለጹ)-------------

21
ክሊኒካዊ ስህተቶችን ፈጽመዋል 1. አዎ

2.አይ. ‗አይ‘ ከሆነ ጥ.ቁ 23 ን ይዝለሉ።

1. ተንሸራታች / በጥፊ
22
ካደረግክ ምን አይነት ስህተት ነው የምትሰራው?
2.የእውቀት ስህተት

3. ሰበብ ስህተት

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 4. ሌሎች (ይግለጹ) --------------------

1.የምርታማነት መቀነስ
23
ከፍተኛ የሰራተኞች ነርሶች ዝውውር አንዴ የህብረተሰብ
2.የተደራጀ አገልግሎት አሰጣጥ
ጤና ምን ያህል ይነካል?
3.የድርጅታዊ እውቀት መጋራት ማጣት

4. ሌሎች (ይግለጹ) ----------------------

1.የስራ እና የሰራተኛ ክህሎት

24
የሰራተኛ ለውጥ ምክንያቶች ምን ይመስላችኋል?
አለመመጣጠን

2. መንግስታዊ ባልሆኑ ድርጅቶች ማራኪ

ክፍያ ምክንያት

3.የአጭር/ረጅም ስልጠና ዝቅተኛ ተደራሽነት

4.ለተሰራው ስራ ያነሰ/ እውቅና የለም

5. ሌሎች (ይግለጹ) ----------------------

የታካሚው ሽግግር ዋና ምክንያት ምን ይመስልዎታል? 1. የዘመናዊ መድሃኒቶችን አለመግባባት

25
2. በደካማ የኢኮኖሚ ሁኔታ ምክንያት

3. አገልግሎቱን ለማግኘት ረጅም ጊዜ

በመጠባበቅ ምክንያት

4.ሌሎች (ይግለጹ)--------

1.የታካሚ ፈሳሽ ከመጠናቀቁ በፊት

26 በተ.ቁ.25 መሰረት በእርስዎ የነርሲንግ ሂደት ላይ እንዴት
የታቀዱት ጣልቃገብነቶች
ተጽእኖ ይኖረዋል?
2.ታካሚዎች ለሚሰጡት እንክብካቤ ተባባሪ

አይደሉም

v
 ለእንክብካቤ አስፈላጊውን ቁሳቁስ

መሰብሰብ አለመቻል

3.ለማስተዳደር ፈታኝ ከሆኑ ችግሮች ጋር

4.አቅርቧል

5. ሌሎች (ይግለጹ) ----------------------

ክፍል- III. የእውቀት ግምገማ

1.ተጨባጭ እና ተጨባጭ መረጃዎችን መሰብሰብ

27. 2. ለታካሚው የተደረገውን መገምገም

በነርሲንግ ሂደትዎ ላይ
3. የሚከናወኑ ተግባራትን ማሳየት
የመጀመሪያው እርምጃ ነው?
4.በቀጥታ በችግሩ ውስጥ ጣልቃ መግባት

የጎርደን አቀራረብ ዋና ዓላማ?

1.በሥነምግባር መርሆዎች ላይ ያተኩራል
28.
2.የታካሚዎች ምላሾች ላይ ያተኩራል

3. የበሽታው ሂደት / የሕክምና ምርመራ ላይ ያተኩራል

4. በታካሚው ረዳት ፍላጎት ላይ ያተኩራል

1. ግምገማ

29. የነርሲንግ ሂደት አካል ካልሆነ ከተሰጠው 2.አተገባበር

አማራጭ ውስጥ ይምረጡ። 3.እቅድ

4.ግምገማ

5.የተመሰከረለት አሰራር

6.የነርስ ምርመራ

v
30.
ከፍተኛ የደም ግፊት ላለበት ታካሚ 1. እምቅ የነርሲንግ ምርመራ

የርስዎ ተገቢ የነርሲንግ ምርመራ ወደፊት 2.ትክክለኛ የነርሲንግ ምርመራ

ውስብስብነትን ለመከላከል ነው? 3.የህክምና ምርመራ

4.የላብራቶሪ ምርመራ

5. ሌሎች (ይግለጹ)

1. ነርሲንግ ምርመራ ከሌሎች ይልቅ በሽታዎች ላይ

31. ያተኩራል
የነርሲንግ ሂደት ከህክምና
የታካሚ ምላሽ
ምርመራ የሚለየው ምንድን ነው?
2.የነርስ ምርመራ የሚያተኩረው በታካሚው ምላሽ ላይ

ነው።

የታካሚ ምላሽ

3.ሁለቱም በታካሚ ምላሾች ላይ ያተኩራሉ

4. ሁለቱም የታካሚን ችግር ለመፍታት ተመሳሳይ ሂደት

አላቸው

5. ሌሎች (ይግለጹ)

32.
በድርጅትዎ ውስጥ የነርስ ሂደትን ለተሻለ

ስኬት ማነው ግዴታ የሆነው? 1. ሐኪም 2. የታካሚ ቤተሰብ 3. ነርሶች

4. ታካሚዎች 5.ማንም መገለል የለበትም

v
33.
በእቅድዎ ወቅት የእርስዎ ተግባራት 1. ቅድሚያ የሚሰጣቸውን ነገሮች መመደብ

ምንድ ናቸው? 2. የሚጠበቀውን መጥቀስ ይመጣል

3. የታካሚውን መረጃ መመዝገብ

4. ግቦችን መለየት

5.የተጠላለፉ ጣልቃገብነቶችን መለየት

6. ሌሎች (ይግለጹ) -------------------

34. በነርሲንግ ሂደትዎ ትግበራ ወቅት ሚናዎን

1. ጣልቃ ገብነቱን ይጠቁማል
ይምረጡ?
2. የታቀዱትን ጣልቃገብነቶች ተግባራዊ ማድረግ

3.በማካተት የታቀዱትን ጣልቃገብነቶች ማከናወን

የዕለት ተዕለት ኑሮ እንቅስቃሴ

4. የመጀመሪያዎቹ ትግበራዎች የታካሚዎችን ችግር

ለመለወጥ ካልቻሉ ደረጃውን ያቁሙ.

35. ለእርስዎ የነርስ ሂደት ግምገማ መመሪያ 1. የነርሲንግ ምርመራ

ላይሆን የሚችለውን ይምረጡ? 2.የመተባበር ችግሮች

3.ቅድሚያዎች እና የነርሲንግ ጣልቃገብነቶች

4.የሚጠበቀው ይወጣል

5.ሁሉም የመመሪያ መስመሮች ሊሆኑ ይችላሉ

36. ያልተፈታ ትውከት እና ተቅማጥ ጋር 1.ፈሳሽ መጠን ጉድለት

የተዛመዱ የፈሳሽ መጠን ጉድለቶች እንደ 2.ያልተፈታ ማስታወክ እና ተቅማጥ

ደረቅ የአፍ መነፅር እና በደረቁ አይኖች። 3. የደረቁ የአፍ ውስጥ ምሰሶ እና የደረቁ አይኖች

ከተሰጠው የነርሲንግ ምርመራ ከተሰጡት 4.ድርቀት

አማራጮች ውስጥ ኤቲዮሎጂን

ይምረጡ?

v
 ክፍል IV ፤የክህሎት ግምገማ

በሚያደርጉት ድግግሞሽ መሰረት የሚከተሉትን እንቅስቃሴዎች ያስመዝግቡ። በመረጡት ላይ «x»ን

በመጠቀም ምልክት ያድርጉበት።

1. በፍፁም 2.አይደለም3.ያልተወሰነ 4. በመጠኑ 5.በጣም

1 2 3 4 5
ተግባራት

37
የነርሲንግ ልምምድ ንድፈ ሃሳቦችን የመተግበር
ችሎታ

38
የታካሚውን ክብር፣ ግላዊነት እና ሚስጥራዊነት የመጠበቅ ችሎታ(የነርስ

ክህሎትን በመጠቀም)

39
ጠዋት እና አያያዝን እና የኢንፌክሽን ቁጥጥርን ጨምሮ የጤና እና

የደህንነት መርሆዎችን የመለማመድ ችሎታ; አስፈላጊ የመጀመሪያ እርዳታ

እና የአደጋ ጊዜ ሂደቶች

40
መድሃኒት እና ሌሎች ህክምናዎችን ደህንነቱ በተጠበቀ ሁኔታ የማስተዳደር

ችሎታ; (የተሻለ እንክብካቤን ለመስጠት የነርሲንግ ክህሎትን፣

ጣልቃገብነቶችን/እንቅስቃሴዎችን በመጠቀም)

የመጽናናትን, የተመጣጠነ ምግብን, የግል ንፅህናን ማሟላት እና ሰውዬው

41
ለዕለት ተዕለት ኑሮ አስፈላጊ የሆኑትን ተግባራት እንዲጠብቅ ማስቻልን ጨምሮ

ስሜታዊ, አካላዊ እና የግል እንክብካቤን የማገናዘብ ችሎታ; (የተሻለ

v
እንክብካቤን ለመስጠት

v
 የነርሲንግ ክህሎትን፣ ጣልቃገብነቶችን/እንቅስቃሴዎችን በመጠቀም)

41
የታካሚ ፍላጎቶችን ከበሽተኛው፣ ከአንከባካቢ ሰጭዎቻቸው፣ ከቤተሰብ እና

ከሌሎች የጤና ሰራተኞች ጋር በጋራ የሚሰሩ ተገቢ እና ግላዊ የሆኑ የእንክብካቤ

መርሃ ግብሮችን በማቀድ እና በመገምገም ለታካሚ ፍላጎቶች ምላሽ ይስጡ።

ስለተሳትፎህ/ ሽ በድጋሚ አመሰግናለሁ!!!

Annex II. Declaration

We, the undersigned, BSC nurse students declare that this senior essay proposal is our
original works in these Hospitals in partial fulfillment of the requirement of Bachelor
of degree in nursing.

v
NAME OF INVESTIGATORS SIGNATURE

1. TIBEBU ABEBE--------MCM/033/12

2. TIGIST ABEBE----------MCM/034/12

3. TIRUSEW ASSAYE------MCM/035/12

4. TESGANESH TESO-------MCM/114/12

5. ZEKARIAS HABTAMU----MCM/116/12

Place of submission Millennium College of Medicine Asossa Campuse, Department of

BSC Nursing.

Date of submission and the thesis will be submitted for examination

with the approval of advisors.

ADVISOR NAME SIGNATURE

1. GIRMA CHERINET (BSC, MSC)

Annex IV. Assurance of Investigators

We the under signed agrees to accepts the responsibility for the scientific, ethical and
technical conduct of the research project and for provision of required progress reports
as pre-terms and conditions of the research and publication committee of Millennium
College of Medicine Asossa Campus, Department of BSC Nursing.

v
Name of Investigators Signature Date

1. TIBEBU ABEBE----------MCM/033/12

2. TIGIST ABEBE-----------MCM/034/12

3. TIRUSEW ASSAYE------MCM/035/12

4. TESGANESH TESO------MCM/114/12

5. ZEKARIAS HABTAMU- - -MCM/116/12

Advisors Approval

Advisors‘ Name Signature Date

1. Girma Chirnet (BSc, MSc)

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