The Quality of Nursing Documents and their Related Factors in the Viewpoint of Nurses Working in Medical Surgical Wards in Educational Hospitals in Tabriz Medical Sciences University, 2008.

Abstract

Abstract: Introduction: Accurate recording if nursing documents as an important performance of nurses has important role in delivery and continuance of nursing cares. Assessing the quality of nursing documents and related factors is a prerequisite in any planning toward improvement of nursing documents. Therefore, the aims of present study were to assessing the quality of nursing documents and related factors. Methods: This study has a descriptive –correlative design and assess the quality of nursing documents and related factors (knowledge, attitude, and management factors). All nurses and head nurses working in Medical –Surgical wards of educational hospitals related to Tabriz University of Medical Sciences (n=195) selected to participate in the study with census sampling method. For assessing the quality of nurses' documents, 2025 recorded documents in five selected part of nursing documents (vital signs, nursing report, drug interventions, I & O of fluids) selected with simple random sampling and consider as criteria of nurses performance. For assessing the quality of nurses' documents researcher prepared checklists was used. The knowledge of nurses assessed by test and their attitude regarding nursing documentation and their viewpoint regarding management factors assessed by researcher prepared questionnaire. Data was analyzed by SPSS software using Pearson, One way ANOVA and independent t test. Results: Result showed that most of nursing documents 83.5% had average quality. Most participants 85.1% had average knowledge and fairy most of them 99.5% had positive attitude towards nursing documentation. Many of participants 78.4% believed that the quality of management support regarding documentation was average. We didn't find any meaningful statistical relation between the quality of nursing documents and knowledge, attitude and management factors. Conclusion: Due to average knowledge and performance of participants and positive attitude of them regard nursing documentation; conduct educational pans may enhance the quality of nursing documents.