The implementation of the nursing process in lower-income countries: An integrative review.
Mojgan Lotfi, Vahid Zamanzadeh, Leila Valizadeh and 3 others
PMID 31871690WHAT IT FOUND
Nursing process implementation in lower-income countries is inconsistent, often poorly documented and not sustained.
Barriers are low nurse knowledge, heavy workload, staff shortages, and weak management support. Electronic tools help documentation but are rarely deployed widely.
Key findings
01The review included 39 studies: 18 on effects of implementation, 9 on software, and 12 on factors affecting implementation.
02Key barriers to implementation are inadequate knowledge of the nursing process among nurses and faculty, plus management factors like high workload, staff shortages, and lack of supervision.
03Electronic documentation of the nursing process is described as more efficient than manual systems and can support decision-making, but its use is limited and not widely available in these settings.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included many small studies with convenience sampling and researcher-made questionnaires, which may overestimate benefits. Quality appraisal found studies were only 'moderate' quality, and none were excluded for low quality, suggesting potential bias in included evidence. The focus on lower-income countries limits generalizability to high-income settings with different resource levels. Heterogeneity of study designs (qualitative, quantitative, mixed) makes direct comparison of effect sizes difficult. The review did not perform a meta-analysis, so pooled effect estimates are not available.
Declared interests
No conflicts of interest declared. Funding was non-U.S. government.
The easy way to misread this
Do not read the positive findings in some studies as evidence that nursing process implementation works reliably in lower-income countries. The review's main conclusion is that it is not implemented extensively or continuously due to systemic barriers like workload and lack of infrastructure, and the evidence base consists largely of small, moderate-quality studies.