INTRODUCTION:

Nursing has undergone a significant transformation in recent years, reflecting the evolving nature of healthcare. As a profession, nursing has expanded beyond its traditional boundaries to encompass a wide array of roles and responsibilities. As an integral part of the healthcare delivery system, nursing plays a crucial role in ensuring optimal outcomes for patients¹.

In this century, Nurses are not only caregivers at the bedside, they are also patient advocates, coordinators of care, and evidence-based practitioners. The nursing process is the foundation of professional nursing practice. It is a systematic approach that enhances the delivery of patient-centered care, encompassing five essential steps: assessment, diagnosis, planning, implementation, and evaluation, which remains a fundamental framework guiding the provision of high-quality patient care. While its adoption has been widely recognized as best practice, its specific impact on midwifery remains underexplored. The evolution of nursing has been marked by greater emphasis on collaboration, interdisciplinary teamwork, and a patient-centered approach to care. Nurses are increasingly recognized as key players in healthcare decision-making processes, working closely with physicians and other healthcare professionals to develop and implement patient care plans. The nursing process, with its five key steps of assessment, diagnosis, planning, implementation, and evaluation, continues to serve as a roadmap for delivering personalized and effective care².

As healthcare systems face new challenges and demands, the role of nursing will undoubtedly continue to adapt and evolve. Nurses will continue to be at the forefront of patient care, using their expertise and compassion to provide high-quality care that meets the ever-changing needs of patients and families. The nursing process can be defined as a systematic framework that guides nurses in delivering comprehensive and individualized patient care. The utilization of the nursing process has been associated with improved patient outcomes, enhanced patient satisfaction, and increased efficiency in healthcare delivery, as elaborated by³. Despite its significance, there is a dearth of research exploring the extent to which midwives utilize the nursing process. While there is ample literature underscoring the significance of the nursing process, a conspicuous gap exists in its application within specific healthcare settings. This study aimed to address this gap by conducting a comprehensive examination of the utilization of the nursing process among midwives to provide valuable insights into the challenges and opportunities encountered in this particular context. Although⁴ see the nursing process as the cornerstone of effective nursing practice, however, the extent of its utilization by midwives in various healthcare settings remains a topic of ongoing inquiry. The findings of this study will not only inform future research they will also contribute to the development of evidence-based strategies to enhance their utilization in healthcare facilities. By addressing the current knowledge gap in this area, this study aimed to support the delivery of high-quality, patient-centered care and improve healthcare outcomes. By identifying the factors associated with low utilization, interventions can be developed to enhance the implementation and ultimately improve patient outcomes.⁵ demonstrated the positive impact of the nursing process on patient outcomes, patient satisfaction, and healthcare efficiency associated with reduced medical errors, enhanced patient safety, and improved healthcare resource utilization. The findings offered practical insights and recommendations for healthcare administrators, policymakers, and nursing educators to strengthen the utilization of the nursing process and ultimately improve the quality and safety of patient care. It is the framework within which nurses provide care to patients in an organized and effective manner. Thinking like a nurse is facilitated by midwives using the nursing process in the development of individualized patient plans of care. Historically, the nursing process was first used by Lydia Hall in 1955⁶. In the late 1950s and early 1960s, other nurses began using the term to define the steps used for decision-making while initiating and providing patient care. The Nursing and Midwifery Council of Nigeria adapted the nursing process over two decades ago to be used by nurses in clinical and educational settings⁷. Effective use of the nursing process depends on a midwife's knowledge and familiarity with standardized nursing diagnosis terminology, evidence-based practice, and the ability to evaluate patient response to intervention⁸. The implementation of the nursing process underscores the vital role that nurses play in patient care, moving beyond the traditional focus on medical care alone. Today, nurses are recognized as integral members of the healthcare team, and their accountability in delivering high-quality care is increasingly emphasized. On a global scale, the nursing process has been adopted across a wide array of patient care settings, with varying degrees of utilization among midwives as evidenced by prior research in diverse healthcare contexts⁹. The origins of the nursing process can be traced back to its initial application in medical/surgical wards, from where it gradually expanded to encompass other care areas¹⁰. Education has played a pivotal role in this evolution, with continuing education departments developing numerous courses to equip nurses with the knowledge and skills necessary to effectively utilize the nursing process. At its core, the nursing process serves to identify a patient's health status, potential or actual health problems, and corresponding needs. This systematic approach enhances the quality of care provided to patients, fostering active participation and continuous evaluation tailored to their unique circumstances. By employing the nursing process, midwives are better equipped to address patient problems, deploy appropriate interventions, and communicate effectively with healthcare professionals, thereby optimizing patient outcomes. The nursing process is a cornerstone of contemporary nursing practice, enabling midwives to deliver patient-centered care that is both effective and efficient. As healthcare systems continue to evolve, the importance of the nursing process will grow, underscoring the vital role that nurses play in ensuring positive health outcomes. Despite the established importance of the nursing process, studies have shown that its utilization can vary among healthcare settings and professionals.¹¹ found that proper implementation improved patient care, while¹² highlighted its role in enhancing critical thinking and decision-making. Factors such as organizational culture, resource availability including scarcity of nursing personnel and individual nurse characteristics can influence its implementation. This study aimed to shed light on the specific factors influencing the utilization of the nursing process among midwives, thereby providing insights into potential areas for improvement. This study addressed the dual focus of evaluating the extent of nursing process usage and understanding its impact on midwifery practice.

STATEMENT OF THE PROBLEM:

The nursing process serves as a foundational structure for delivering high-quality patient care, driving positive health outcomes, and ensuring individualized attention. However, the extent to which this framework is utilized by midwives in healthcare settings can vary greatly, ultimately impacting the efficacy and quality of patient care. Within the context of this tertiary Hospital, limited research has been conducted to evaluate the utilization of the nursing process among midwives, leaving the current state of its application in this specific setting largely unknown. The researchers observed that midwives were not consistently applying the nursing process in their daily practice of nursing care. This observation raised concerns about the potential impact on patient outcomes and the overall quality of care provided by midwives. Motivated by this observation, the researchers decided to investigate the use of the nursing process in midwifery practice within this hospital, aiming to identify gaps and recommend strategies to improve its utilization.

At the heart of this issue is the need to understand the extent to which midwives were applying the nursing process in their daily practice. A suboptimal utilization of this process can hinder the delivery of comprehensive, individualized care, ultimately leading to compromised patient outcomes and decreased patient satisfaction. Valuable insights could be gained into the current state of nursing process utilization within this specific healthcare setting by conducting in-depth research and analysis to develop targeted strategies to optimize its implementation and improve patient outcomes. Factors such as workload, time constraints, inadequate resources, and lack of knowledge and skills have been reported as barriers to effective implementation. However, it remains unclear which factors specifically impact the utilization. Therefore, this study aimed to investigate the factors influencing the utilization, contribute to the quality of nursing care, improve patient outcomes, and inform interventions that could optimize the utilization of the nursing process in this hospital.

MATERIALS AND METHODS:

Materials:

A quantitative cross-sectional research design was adopted for this study as it provides a structured and systematic approach to fulfill the research objectives of assessing the level of nursing process utilization¹³.

Study Location:

The study was conducted in a tertiary health institution in Southern Nigeria. The research setting provided access to a range of resources, including medical records, patient data, and healthcare policies, essential for the research study.

Target Population:

The target population comprised 98 midwives working in antenatal, labour and postnatal wards.

Sampling Technique:

A random sampling technique was employed to choose participants from the pool of registered midwives.

Instrument for Data Collection:

The primary data collection tool was a structured questionnaire designed to collect pertinent information regarding midwives’ utilization of the nursing process, divided into four (4) sections. Section A - Socio-demographic data, five (5) items, Section B - utilization of nursing process, ten (10) items, Section C - factors affecting the utilization of nursing process, ten (10) items, Section D - attitude of midwives towards the nursing process, six (6) items. There are thirty-one (31) items altogether, a combination of closed-ended questions and Likert-scale items of a 5-point scale, ranging from Strongly Agree (SA), Agree (A), Undecided (U), Disagree (D), and Strongly Disagree (SD), facilitating a comprehensive assessment of midwives' self-reported utilization of the nursing process.

Method of Data Collection:

The questionnaire was distributed in paper format to participants to gather information on how much midwives utilize the nursing process, designed to be completed within 15-20 minutes, and was promptly collected to prevent any loss. Incomplete responses were excluded from the analysis. Informed consent was obtained from the respondents before administering the questionnaire. The data collection process spanned one week, during which responses were collected and recorded in a secure database.

Method of Data Analysis:

The collected data underwent analysis to identify the relationship between the independent and dependent variables. The study utilized a descriptive statistical approach to analyze data, creating frequency distributions and percentages to address the study objectives and provide answers to the research questions, using the Statistical Package for Social Sciences (SPSS), with a significance level of 0.05.

Ethical Considerations:

All materials used for this research work were duly cited. Informed consent, confidentiality and participant well-being were key priorities. Ethical approval was obtained, and transparency was maintained. Official permission was sought from the hospital's ethics committee before commencing data collection. Participants were assured they could leave the study at any time.

RESULT:

Table 1: Socio-Demographic Characteristics of the Respondents

Variables	Frequency (n=87)	Percent (%)
Gender
Male	18	20.7%
Female	69	79.3%
Age
25-30	25	28.7%
31-35	32	36.8%
36-40	20	23%
41 and above	10	11.5%
Marital Status
Single	25	28.7%
Married	50	57.5%
Divorced	12	13.8%
Education Level
RM	7	8%
RN/RM	60	69%
MSc	10	11.5%
PhD	5	5.75%
Others	5	5.75%
Years of Experience
1 year	8	9.2%
1-5yrs	20	23%
6-10yrs	18	20.7%
11-15yrs	16	18.4%
16-20yrs	25	28.7%
21yrs and above

Source: Field Survey, 2023.

Table 2: Utilization of Nursing Process

S/N	Questions	SA		A		U		D		SD
S/N	Questions	F	%	F	%	F	%	F	%	F	%
1.	I consistently perform thorough assessments of my patients' physical health.	30	34.5%\|	40	46.0%	10	11.5%	5	5.7%	2	2.3%
2.	I effectively use assessment tools and techniques to gather relevant patient data.	25	28.7%	35	40.2%	15	17.2%	8	9.2%	4	4.6%
3.	I effectively identify and prioritize nursing diagnoses for my patients.	28	32.2%	38	43.7%	12	13.8%	6	6.9%	3	3.4%
4.	I regularly reassess and modify nursing diagnoses as the patient's condition changes.	20	23.0%	32	36.8%	18	20.7%	10	11.5%	7	8.0%
5.	I effectively develop individualized care plans for my patients based on their nursing diagnoses.	35	40.2%	30	34.5%	10	11.5%	8	9.2%	4	4.6%
6.	I regularly update and revise care plans to ensure they reflect the changing needs of patients.	32	36.8%	36	41.4%	8	9.2%	7	8.0%	4	4.6%
7.	I consistently carry out nursing activities as outlined in the care plan.	40	46.0%	32	36.8%	6	6.9%	5	5.7%	4	4.6%
8.	I ensure that patients receive safe and high-quality care during the implementation phase.	38	43.7%	28	32.2%	11	12.6%	6	6.9%	4	4.6%
9.	I consistently assess and monitor the effectiveness of nursing activities.	30	34.5%	35	40.2%	13	14.9%	6	6.9%	3	3.4%
10.	I believe that ongoing evaluation is essential for improving patient care and outcomes.	36	41.4%	28	32.2%	11	12.6%	8	9.2%	4	4.6%

Keys: SA-Strongly Agree, A- Agree, U- Undecided, D- Disagree, SD=Strongly Disagree

Source: Field Survey, 2023.

Table 3: Factors influencing utilization of the nursing process

S/N

Statement

The current workload in our hospital often hinders my ability to effectively utilize the nursing process.

(28.74%)

(40.23%)

(11.49%)

(13.79%)

(5.75%)

I often feel overwhelmed by the number of patients and tasks I must attend to, which affects my ability to use the nursing process.

(22.99%)

(34.48%)

(17.24%)

(8.05%)

I believe that a reduced workload would allow me to provide more comprehensive patient care using the nursing process.

(32.18%)

(36.78%)

(9.20%)

(11.49%)

(10.34%)

Time pressures often lead to rushed assessments and care planning, which may impact patient care

(17.24%)

(28.74%)

(20.69%)

(12.64%)

I believe that having more time for patient care would significantly improve my ability to utilize the nursing process effectively.

(34.48%)

(28.74%)

(13.79%)

(11.49%)

I have encountered situations where the lack of essential resources hindered the proper utilization of the nursing process.

(20.69%)

(25.29%)

(16.09%)

(17.24%)

(20.69%)

The availability of resources directly impacts the quality of patient care I can provide through the nursing process.

(36.78%)

(32.18%)

(10.34%)

(9.20%)

(11.49%)

Ongoing training and education on the nursing process are essential for nurses to provide quality patient care.

(25.29%)

(34.48%)

(11.49%)

(13.79%)

(14.94%)

I actively seek out training and educational opportunities to improve my knowledge and skills related to the nursing process.

(40.23%)

(32.18%)

(8.05%)

(9.20%)

(10.34%)

I believe that continuous learning through training and education is crucial for maintaining high standards in nursing practice and the nursing process.

(31.03%)

(33.33%)

(12.64%)

(11.49%)

Keys: SA-Strongly Agree, A- Agree, U- Undecided, D- Disagree, SD=Strongly Disagree

Table 4: Attitude of Midwives towards the utilisation of the nursing process.

S/N

Statement

I feel that the utilization of the nursing process has helped me improve my clinical practice.

(51.72%)

(34.48%)

(9.20%)

(3.45%)

(1.15%)

I perceive the nursing process as a practical and organized approach to patient care.

(45.98%)

(40.23%)

(8.05%)

(4.60%)

(1.15%)

I feel confident in my ability to apply the nursing process effectively.

(43.68%)

(42.53%)

(9.20%)

(3.45%)

(1.15%)

I believe that patient outcomes are improved through the utilization of the nursing process.

(57.47%)

(32.18%)

(6.90%)

(1.15%)

(2.30%)

The nursing process is a valuable tool for identifying patient needs and develop care plans.

(49.43%)

(39.08%)

(8.05%)

(2.30%)

(1.15%)

I believe the nursing process is well integrated into our daily nursing process.

(41.38%)

(44.83%)

(8.05%)

(4.60%)

(1.15%)

Keys: SA-Strongly Agree, A- Agree, U- Undecided, D- Disagree, SD=Strongly Disagree

DISCUSSION:

The first finding from the study indicates that midwives demonstrate a strong commitment to patient care through thorough assessment, effective use of assessment tools (although with room for improvement), prioritisation of nursing diagnoses, and development of individualised care plans. They actively update and revise care plans, ensuring adaptability to patient needs, consistently implement nursing activities, and prioritise patient safety. While they recognise the importance of ongoing evaluation in improving care quality, there is a need for greater consistency in reassessment, modification of diagnoses, and unanimous acknowledgment of the evaluation's significance.

The study highlighted the importance of thorough assessments and the effective use of assessment tools in ensuring high-quality patient care. This agrees with the findings of¹⁴ and¹⁵ who emphasized the significance of comprehensive assessment in improving patient outcomes. They recommended proper training and a continuous education programme to further enhance midwives' ability to perform thorough assessments and utilize assessment tools effectively.¹⁶and¹⁷ also agree that nurses' ability to identify and prioritize nursing diagnoses is crucial for developing targeted care plans. Similarly,¹⁸and¹⁹emphasized the role of accurate diagnosis in personalized patient care. Additionally, the findings of²⁰and²¹have shown that continuous training and mentorship programmes improve midwives' diagnostic skills and a significant number of midwives actively participate in developing and revising individualized care plans. This aligns with the person-centered care approach advocated by²². The findings of the study by²³ also underline the importance of personalized care plans in enhancing patient satisfaction and outcomes. The study revealed a positive attitude towards ongoing evaluation and quality improvement.

The second finding from the study provided valuable insights into the factors influencing the utilization of the nursing process and highlighted several key challenges and areas for improvement in implementation. The study revealed that a substantial number of nurse midwives felt hindered by their current workload and experienced pressure due to time constraints. This finding is in line with the findings of²⁴and²⁵who revealed that high workloads and time pressures contribute to burnout and can compromise patient care.

However, the findings of²⁶and²⁷are at variance with these findings, as they revealed that the significant factor influencing nursing process implementation was the availability of essential resources. Midwives in their study reported encountering situations where the lack of resources affected their ability to implement nursing processes effectively. They therefore recommended that adequate resources, including medical equipment and supplies, are crucial for providing safe and high-quality patient care.

The third finding of the study provided valuable insight into the perception and beliefs about the nursing process, reflecting a positive and largely unanimous agreement among the midwives that the utility and effectiveness have significantly improved their clinical practice. This indicates that the nurse midwives recognize the nursing process as an essential instrument in patient care planning, emphasizing its role in tailoring care to individual patient needs. The strong agreement that patient outcomes are improved through the utilization of the nursing process is particularly noteworthy. This consensus reflects their confidence in the positive influence of the nursing process on patient well-being, underscoring its importance in achieving favorable outcomes. This finding aligns with that of²⁸ which emphasized the positive impact of the systematic nursing process on the quality of care and patient outcomes. Similar findings were reported in research by^29,emphasizing the importance of a structured nursing process in enhancing the efficiency and effectiveness of healthcare delivery. This perception was also supported by the findings of³⁰, who indicated that systematic nursing processes lead to improved patient satisfaction, reduced complications, and better overall outcomes.

This confidence is crucial, as the study by³¹suggested that midwives’ confidence positively correlates with the successful implementation of nursing care plans and interventions. This aligns with the findings of³², emphasizing the essential role of the nursing process in personalized and patient-centered care planning. While the majority of midwives perceive the nursing process as an integral part of their daily routines, a small portion, however, remains uncertain about its integration, as highlighted by the findings of^33,34,35. This uncertainty highlights the need for additional training or support to ensure that all nurses consistently incorporate the nursing process into their practice.

CONCLUSION:

In conclusion, the study's findings demonstrate consensus among nurse midwives regarding the practicality, effectiveness, and positive impact of the nursing process on patient outcomes. They express confidence in their ability to apply the nursing process, emphasizing its vital role in their clinical practice.

LIMITATIONS OF THE STUDY:

1. Sample Size: The study sample size limited the generalizability of the findings to a broader population of midwives.

2. Context-Specific: The findings are specific to a specific Hospital and might not be directly applicable to other healthcare settings with different contexts and challenges.

3. Self-Reporting Bias: The responses obtained are based on self-reports, which might be influenced by social desirability bias, potentially impacting the accuracy of the findings.

RECOMMENDATIONS:

1. Continuous Education and Training: Hospitals should invest in continuous education and training programmes to ensure midwives are updated with the latest methodologies and best practices. This can include regular updates, workshops, and access to resources that enhance their understanding and application of the nursing process.

2. Supportive Work Environment: Creating a supportive work environment that encourages collaboration, knowledge sharing, and mutual support can enhance confidence in effectively utilizing the nursing process.

3. Regular Assessments: Hospitals should conduct regular assessments to identify knowledge gaps and provide targeted training sessions to address these areas. Recognize and acknowledge midwives who consistently demonstrate effective utilization of the nursing process. Creating a culture of appreciation and acknowledgment can motivate and inspire other staff members.

4. Time Management Strategies: Management should recognize the time constraints nurse midwives often face and explore strategies to help them manage their time effectively while still delivering comprehensive patient care. This may include optimizing workflows and reducing administrative tasks.

SUGGESTIONS FOR FURTHER STUDIES:

1. Long-term Impact: Investigate the long-term impact of nurses' perceptions of the nursing process on patient outcomes and overall hospital performance.

2. Comparative Studies: Conduct comparative studies between hospitals with varying levels of nursing process integration to understand the impact on patient care and outcomes.

3. Qualitative Research: Explore the qualitative aspects of midwives' experiences with the nursing process, including challenges faced and successful implementation strategies. Encourage ongoing research on nursing process utilization to assess the impact of implemented changes and identify new opportunities for enhancement.

CONFLICT OF INTERESTS:

The authors declare no conflict of interest.

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Received on 27.01.2026 Revised on 17.02.2026

Accepted on 09.03.2026 Published on 05.05.2026

Available online from May 09, 2026

A and V Pub J. of Nursing and Medical Res. 2026;5(2):60-66.

DOI: 10.52711/jnmr.2026.13

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