Record keeping : self-reported attitudes, knowledge and practice behaviours of nurses in selected Cape Town hospitals

Master Thesis


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University of Cape Town

Background: South African law holds nurses accountable for their acts and omissions and all documentation pertaining to patient care may serve as evidence in a court of law or at South African Nursing Council (SANC) hearings. Documentation can confirm or refute negligence and therefore should be an accurate and current reflection of what happened to the patient, particularly as litigation often arises long after care was rendered. Objective: To describe the self-reported attitudes towards, knowledge of and practice behaviours of nurses, and the association between these factors and selected variables (category of nurse, gender, hospital sector, years of experience after registration/enrolment, day/night shift and practice discipline) relative to record keeping. Methods: A quantitative, non-experimental study design, using a cross-sectional survey method to describe attitudes, knowledge and practice behaviour against predetermined measurement scales. Stratified random sampling and a questionnaire was used, with a 52.54% (186/354) response rate. Logistic regression models were fitted to determine factors associated with attitudes, knowledge and practice behaviour, fitted as binary dependent variables, each in a separate model. Strength of association was expressed as an odds ratio (OR), and a p-value of 0.05% was considered significant. Setting: Three tertiary Government hospitals and three Private hospitals in the Cape Town Metropole, South Africa. Findings: Demographically, the sample consisted of 92 Registered Nurses (RNs), 42 Enrolled Nurses (ENs) and 50 Enrolled Nursing Auxiliaries (ENAs) of which 94.62% (n=176) were female and 4.30% (n=8) male. The mean age of all respondents were 42.26 years (range 23 to 64) while 48.92% (n=91) of the respondents had more than 15 years of experience after registration/enrolment. Of the 186 respondents, 54.85% (n=102) worked in Government Hospitals, comprising 53 (51.96%) RNs, 25 (24.51%) ENs and 22 (21.57%) ENAs. The 45.16% (n=84) Private Hospital respondents consisted of 39 (46.43%) RNs, 17 (20.24%) ENs and 28 (33.33%) ENAs. Most respondents (18.82%, n=35) worked in Surgical Units and on day duty (70.43%, n=131). A predominantly positive self-reported attitude towards record keeping was evident (71.74%, n=132/184). The negative attitude ratio in the Private sector (58.49%, n=31/53) was larger than in the Government sector (41.51%, n=22/53) (OR=2.049, 95% CI=1.043-4.025, p=0.037). A larger ratio of respondents working day duty reported a negative attitude (60.00%, n=30/50), compared to those working night duty (40.00%, n=20/50) (OR=2.171, 95% CI=1.066-4.423, p=0.033). Although adequate knowledge levels relative to record keeping were reported by the majority of respondents (74.86%, n=137/183), there were some knowledge deficits. Inadequate knowledge level ratios were more evident amongst ENAs (45.65%, n=21/46) when compared to RNs (30.43%, n=14/46) (OR=4.179, 95% CI=1.873- 9.321, p=0.000). Similarly, acceptable levels of self-reported record keeping practice behaviour were evident amongst the majority of respondents (68.31%, n=125/183). A higher ratio of unacceptable practice behaviour was reported by RNs (39.66%, n=23/58) when compared to ENs (34.48%, n=20/58) (OR=2.727, 95% CI=1.266-5.877, p=0.010). The most prominent practice behaviours reported by respondents included making use of a combination of record keeping approaches when keeping records, having regular record keeping audits, having sufficient supervision relative to record keeping, reading what other nurses have written and nurses writing in the progress notes themselves. The three top ranked barriers to effective record keeping were interruptions while keeping records, insufficient time to effectively keep records and a lack of confidence in the ability to keep accurate records. Conclusion: Although respondents, particularly RNs, reported predominantly positive attitudes towards, adequate knowledge of and acceptable practice behaviour relative to record keeping, there are concerns that the deficiencies amongst ENs and ENAs may have serious implications for patient safety for both the Government and Private Health sectors. Significance to clinical practice: Deficiencies relative to record keeping attitudes, knowledge and practice behaviours were identified. The identified deficiencies could be used to implement record keeping improvement strategies.