Introduction

The standardized nursing care Plan (SNCP) is a developing idea that ushers in a new era of nursing care. According to Kourkouta and Papathanasiou (1), nursing language has rarely been able to describe the same clinical condition in a straightforward, consistent, or dependable way.

The clinical information system must therefore use standardized languages to help clinicians with the documentation of nursing practice (2). The evidence-based tool, which is currently in use in intensive care settings in developed nations including the United States and Sweden, among others, has assisted in labeling and identifying the contributions of nursing to healthcare delivery systems and serving as a clinical protocol in these settings (3).

The SNCP is the name of this evidence-based clinical practice. The benchmark in nursing practice for the overall improvement of care has been standardized nursing care plans, which are published universal plans of action outlining nursing care (4,5). However, it is important to note that the formats of the nursing care plans can vary depending on the institutions (6).

In developed countries, research conducted has shown that the utilization of SNCP brought about glycemic control and slight diastolic blood pressure among patients living with diabetes (3). Also, clinical management and therapeutic commitment to chronic health conditions and reduction in drug-related costs among patients living with chronic diseases were improved with the use of SNCPs (3,7,8). SNCP use has been shown to have positive effects on patient safety and clinical outcomes, as well as a decrease in the frequency of hospital readmissions for patients with chronic illnesses (9).                                                                                                                                                                                            

The utilization of SNCPs and challenges encountered by nurses in Nigeria seems not to have been documented as well as the direct impact of SNCPs on patients’ health. The adoption of SNCP enhances nurses’ ability to plan patient care, leading to improved patient outcomes and treatments (10). Improved clinical care and therapeutic adherence in chronic patients are a few of these outcomes (3,7); also, drug-related expenses have been found to be lower (8,11). Azzolin et al. (7) found that using SNCP effectively improved the management of clients’ in-home care by facilitating self-modification support, behavioral modification, prescribed medication, disease process, dietary counseling, telephone consultation, and energy conservation in heart failure patients.

Azzolin et al. (7) found that using SNCP effectively improved the management of clients’ in-home care by facilitating self-modification support, behavioral modification, prescribed medication, disease process, dietary counseling, telephone consultation, and energy conservation in heart failure patients.

Aim

This scoping review aims to summarize findings from existing literature regarding the experiences of nurses in Nigeria with the use of a standardized nursing care plan.

Materials and Methods

This study followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) standard. To investigate the experience of nurses in the use of SNLs and SNCPs in the hospital and to organize the presentation of the results, the PRISMA checklist for scoping reviews (12) was utilized.

Without necessarily going through the formal procedure of a systematic review, scoping studies assist in summarizing important evidence on a topic (13). The information gained through scoping reviews is frequently used in practice, policy creation, and research (13,14). This process is known as the knowledge-to-action cycle. The scoping review methodology used in this study is based on Arksey and O’Malley’s model (14) and includes six steps: Defining the research question, locating pertinent studies, choosing the best ones, charting the data, compiling, summarizing, and reporting the findings, and consulting with stakeholders.

Research on SNCPs and SNL experience among nurses that was published between 2015 and 2019 was the only type of study that qualified for inclusion. Since a wider perspective was desired, there were no geographical restrictions on eligibility. All studies concentrating solely on students were omitted based on the exclusion criteria used in the study population.

Investigations using qualitative and quantitative designs as well as literature reviews were eliminated in order to offer a larger diversity of investigations. For the purpose of finding pertinent papers, searches were made in four databases: Google Scholar, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Medical Literature Analysis and Retrieval System Online (MEDLARS Online).

The search was carried out between January and February 2019 using pertinent search terms like Nurs*, Nursing Process, Nursing Care Plans*, SNCP, “challenges to the utilization of Standardized care plan”, Advanced Nursing Process”, “Standardized Nursing Languages”, and “Nigeria Nursing Process”. Multiple suffixes were sometimes included in the search result via truncation (i.e., *). First, a general search was done using terms like “Nurs*”, “Nursing Process”, and “Nursing Care Plans”. Boolean operators “AND” and “OR” were employed to, when considered essential, narrow down or broaden the search.

Examples of search terms were “experience of standardized Nursing Languages”, “Standardized Care Plan”, and “Nursing Process”. Finding acceptable search phrases was helped by the Mesh thesaurus (15).

Despite being derived from Mesh terms (i.e., medical subject headings), CINAHL headings contain more terms that are connected to healthcare. Although there may be a slight difference in the subject headings between the two databases, the search terms used for this study were the same across both and included nursing process, standardized nursing language, the experience of nurses with standardized nursing care plans, and standardized nursing care utilization barriers.

Ethical Consideration

Since there was no actual contact with the subjects, no ethical approval was required. Statements on ethical topics are allowed in articles that qualify. The chance of identifying specific individuals was decreased by treating the data as an aggregate.

Results

A total of 520 items were found; 19 of them had duplicate content, and 366 more were eliminated because they were irrelevant. A checklist for literature reviews from the Swedish Agency for Health Technology Assessment and Assessment of Social Services was used for quality evaluation (16). The evaluation involved assigning a score to each article based on various factors, including the degree of systematic errors, transferability, and precision. In order to be included in this review, only 38 publications had to meet the criteria for medium and high quality (see Figure 1).

Objectives, study population, study site, research question, methodology, and outcomes, i.e., experience with standardized nursing care plans, are all pertinent information that may be gathered from the publications. To identify barriers to SNCPs utilization, data were synthesized, mapped, and evaluated.

Table 1 lists a total of 38 papers that were considered for the review (i.e., 33 quantitative and 5 qualitative research). Numerous survey tools used in quantitative studies included questions about participants’ demographics, nursing process, SNCP use, SNL use, and factors affecting SNCPs and SNLs use in the nursing process.

For research with a qualitative design, the interview guides included open-ended questions on whether SNCPs, SNLs, and the nursing process are discussed, as well as experiences, attitudes, challenges, and possible solutions. The articles were from Nigeria, Ghana, Ethiopia, Kenya, Spain, Yogyakarta, the USA, Switzerland, Brazil, Sweden, Oman, South Africa, Democratic Republic of Congo (see Table 1). Findings revealed barriers experienced in SNCPs and SNLs use in the country. The three major categories of the experience were not having the right format of SNCPs on the wards, the Nursing and Midwifery Council of Nigeria not mandating the use of SNCPs, and hospitals not having a policy for the nurses to mandate the use of SNCPs.

Discussion

Our results demonstrate that the experiences of nurses in Nigeria with the adoption of a SNCP are consistent despite the many study contexts the studies considered in this scoping review and their peculiarities.

Format of SNCP on the Wards

Interesting literature reviewed shows that there are several challenges facing the utilization of standardized nursing language and standardized nursing care plans in practice, especially as it relates to developing countries such as Nigeria. The factors considered to be the main challenge by nurses include lack of practical skills in data collection, nursing diagnosis, and objective writing; attitudes of nurses towards the nursing process; lack of staff and equipment; unconducive work environment such as frustrations about the failure to implement the nursing process (17,18) In a recently conducted qualitative study on challenges to the utilization of SNLs in the nursing process booklets in three tertiary health institutions in Nigeria. The findings from the study revealed that inadequate knowledge of SNLs, inadequate staffing, the high load of patients, lack of the write format of SNCPs on the wards and lack of motivation among nurses were the major challenges (19).

Non-mandate by Nursing and Midwifery Council of Nigeria

From the literature reviewed, in the case of Nigeria, Adereti and Olaogun (20) described SNCPs as the adoption of standardized nursing languages (North America Nursing Diagnosis Association International (NANDA-I diagnosis), Nursing Intervention, and Nursing Outcome) into the nursing process that is required in a clinical information system. The SNCPs sets out the basic standard of nursing care and can be used for patients with the same medical condition, for patients receiving similar medical treatment, or for patients with similar nursing problems. Adereti and Olaogun (20), posited that SNCPs offer safe nursing care in the wards that utilize them. Also, it has placed nurses in positions to independently apply the SNCP by observation, assessment, nursing diagnosis, planning, intervention, and evaluation of patients’ care. The Nursing and Midwifery Council of Nigeria (N&MCN) guideline, revealed that the nursing process should provide the basis for the creation of standards for institutional practice (6). However, the N&MCN has not mandated the use of SNCPs in the hospital but the research that has been done in clinical settings shows that Standardized nursing language is utilized in some hospitals in Nigeria (21,22). The Nursing and Midwifery Council of Nigeria has started developments aimed at enhancing, fostering, and securing the position of nursing as a significant and dignified profession by using NANDA-I diagnostic in the nursing process (23). This is done by making it easier for standardized nursing languages (SNLs) to be used in nursing practice. The SNCP has been incorporated into the school curriculum and the Mandatory Continuing Professional Development Programme (MCPDP), even though the Nursing and Midwifery Council of Nigeria has not yet formally adopted it.

Hospital Policy to SNCPs Use

Studies have shown that Standardized nursing language is utilized in some hospitals in Nigeria (21,22) however, there has not been a policy to enforce its use. In a study conducted in Nigeria’s federal teaching hospitals, the utilization of Standardized nursing language enhanced nurses’ documentation of care, thereby translating to improved quality of life in the patients (21). Adereti and Olaogun (20) affirm that SNCP could form a basis for electronic health records, which improves population health. Retainment has been difficult in some of these facilities due to hospital policy (non-enforcement of SNCPs by stakeholders of the hospitals). Although, some teaching hospitals still engage in the teaching of SNLs at the in-service training programs of their nurses. Although several submissions to the literature suggested that electronic health records (EHRs) would be introduced into healthcare institutions across the nation, no mention of nursing concepts in the EHR in public hospitals is made (2,24). While nursing services are crucial to inpatient care, other healthcare professionals occasionally use the data from the nurse’s record as the foundation for their patient management decisions. The adoption of some of the in this review’s variables and their adaptation to context-specific circumstances may lead to the use of SNCP and SNLs for nursing documentation. Additionally, reducing the uncertainty around the discussion and usage of SNCPs can be accomplished by identifying obstacles and implementing enabling factors.

It is important to note the study’s advantages and disadvantages. Contrary to systematic reviews, scoping reviews typically do not evaluate the overall quality of the evidence; rather, they are helpful for summarizing important evidence (25).

While two large databases have been thoroughly searched for studies on health, it’s still possible that pertinent studies (and their findings) haven’t been included. Additionally, the screening of solely English-language papers may lead to the potential omission of pertinent study findings. Despite these drawbacks, this study’s strength is the presenting of crucial data that are pertinent to both practice and education.

Conclusion

The use of SNCPs as a clinical protocol has been reported to have several benefits in developed countries (26-28). Meanwhile, the limited empirical study also shows that the introduction of SNLs which is the basis of SNCP has also improved nurses’ quality of documentation in developing countries such as Nigeria (20,21). Therefore, the authors presume that the usability of SNCPs that are linked with NANDA-I, NIC, and NOC will ensure that nurses’ quality of documentation is improved and sustained. As well as the visibility of nurses in the healthcare sector.

Implications for Practice

A critical thinking approach to education and practice will encourage knowledge of and use of critique of SNCPs that have limits within the healthcare system. Adopting strategies (including routine training, the Nursing and Midwifery Council of Nigeria’s requirement to use SNCPs, and hospital policy to support SNCP use) may promote SNCP utilization in healthcare facilities.

For nurses and other stakeholders to be challenged to accept full adoption in practice, it is crucial to adopt more critical thinking both in practice and training. A critical thinking skill approach will be useful for nurses to achieve meaningful use of SNCPs and its use will hopefully continually boost nurses’ documentation and patient care enhanced without bias.

Recommendations

The SNCP is a new development in nursing practice in Nigeria that serves as an advanced nursing process in evaluating the quality of documentation of nurses. On the strength of SNCP as documented in literature the following recommendations are made:

• There is a dire need to inculcate standardized nursing languages into the curriculum of undergraduate in all the schools in the geopolitical zones at the Baccalaureate and graduate levels in Nigeria.

• Nurse auditors in hospitals should be re-trained on the use of nursing diagnostics and standardized nursing care plans. This will help in eliminating the common errors that, nurse auditors themselves make in the process of teaching the nurses about the uses of standardized nursing languages.

Acknowledgements: The authors wish to acknowledge the stakeholders whose feedback during the seminar described in the methods was a vital part of this scoping review.

Peer-review: Externally peer-reviewed.

Author Contributions: Conception – I.O.O., A.A.O.; Design –  I.O.O.; Supervision –  E.A.K., A.A.O.; Materials – I.O.O., P.O.A., E.A.K.; Data Collection and/or Processing – O.O.O.; Analysis and/or Interpretation – P.O.A., O.O.O.; Literature Review – I.O.O., E.A.K.; Writing – A.A.O.; Critical Review – P.O.A., A.A.O.

Declaration of Interests: No conflict of interest was declared by the authors.

Funding: The authors declared that this study received no financial support.