Factors Influencing Documentation in Nursing Care by Nurses at the Federal Medical Centre, Apir, Benue State, Nigeria

Aniekwe Louisa Ngozi1*, Regidor III Dioso1, Emmanuel Ejembi Anyebe2

1Faculty of Nursing, Lincoln University College, Wisma Lincoln, 12-18, Jalan SS 6/12, 47301 Petaling Jaya, Selangor, Malaysia

2Department of Nursing Sciences, Faculty of Clinical sciences, University of Ilorin 240001, Nigeria

*Corresponding Author’s Email: ngozi.louisa@yahoo.com

Abstract

Introduction: Nursing documentation should meet specific and comprehensive standards to achieve its goals, including effective communication, education, research, monitoring, and evaluation within the healthcare system. It should also ensure the collection of essential patient information based on established principles. This study investigated the factors that influence nursing documentation practices at the Federal Medical Centre in Apir, Benue State, Nigeria. The lack of national and local guidelines on nursing documentation has resulted in substandard practices among Nigerian nurses. Methods: The study employed an analytical cross-sectional design. There were 102 participants with a 99.7% response rate. Results: The practice of nursing care documentation was found to be inadequate. The practice of nursing care documentation was significantly linked to not having enough documentation sheets (AOR = 3.271, 95% CI = 1.125– 23.704), not having enough time (AOR = 2.205, 95% CI=1.101–3.413), and not meeting the operational standard of nursing documentation (AOR = 2.015, 95% CI = 1.205–3.70). The results also highlight that while nurses recognise the importance of accurate documentation, several barriers, such as workload, inadequate training, and a lack of resources, hinder effective practice. Finally, more than half of nurses did not document their nursing care. Conclusion: The study concludes that addressing these barriers through targeted interventions could significantly improve documentation quality, thereby enhancing patient care outcomes. Agencies employing nurses must ensure to train them for proper nursing care documentation to improve knowledge and foster awareness among healthcare workers about accurate and thorough documentation practices. This will enable nursing directors and chief executive officers to access adequate documenting supplies, in addition to employing more competent and qualified nurses.

Keywords: Documentation; Federal Medical Centre Knowledge; Nurses Attitude; Nursing Practice

INTRODUCTION

Worldwide, nursing documentation is crucial in the healthcare system (Asamani et al., 2014). Tasew, Mariye and Teklay (2019) defined nursing documentation as the recording of nursing care provided by nurses or other caregivers, under the supervision of a qualified nurse, to plan and deliver care to individual patients. Nursing documentation is the principal clinical information source for meeting legal and professional requirements. It is a vital component of safe, ethical, and effective nursing practices, whether done manually or electronically. Nursing documentation should comply with the legal requirements for nursing care documentation (Ethiopia's & Pif, 2010).

For stakeholders in the health system to be well-informed, nurses must maintain comprehensive records of all care they provide to clients (Molla et al., 2024; Mbabazi & Cassimjee, 2006; Stoumpos, Kitsios & Talias, 2023). Documentation ensures a comprehensive account of patient care, and it serves as a form of legal record that specifies the patient's care and progress (Machudo & Mohidin, 2015). Maintaining comprehensive, timely, and accurate health care records is essential for successful nursing practice (Mutshatshi & Mothiba, 2020; Ma et al., 2023). It is very important that the nurse makes the documentation process very clear, succinct, and legible in a cautious manner to minimize the chances of misinterpretation, legal liability, and adverse patient outcomes resulting from poor communication (Seidu, Abdulai & Aninanya, 2021). Timely and accurate documentation reflects the care provided, promotes collaboration and communication among the health team, meets professional and legislative standards, and facilitates patient care decisions and outcomes of care (Pandit & Pandit, 2009; Blake-Mowatt, Lindo & Bennett, 2013).

On a wider scope, documentation is important in health planning, nursing development, education, research, quality assurance, the allocation of resources, and reimbursement by third- party claimants (Tawfik, Mahfouz & AbdAllah, 2024; Tasew, Mariye & Teklay, 2019). Hardido, Kedida and Kigongo (2023) conducted a study in Nigeria and found that documentation ensures continuity of care, allows for early detection of problems, and ensures a high standard of clinical care. Despite the importance of documentation, nursing reports are frequently incomplete and of poor quality, which compromises patient care and undermines the credibility of the nurse (Kelly, Edwards & Shapiro, 2021; Broderick & Coffey, 2013; De Groot et al., 2022; Seidu, Abdulai & Aninanya, 2021). Improperly charted vital signs may lead to incorrect treatment plans, and uncharted medications and a probable overdose of patients, which may result in poor patient outcomes and increased healthcare costs (Okaisu et al., 2014).

Several factors influence the practice of nursing documentation in developing countries (Fantahun et al., 2023). A descriptive cross-sectional study, which examined the factors influencing documentation practice among nurses in a hospital in Ethiopia, found that the practice of nursing care documentation was inadequate. The study also identified the inadequacy of documenting sheets and time as associated factors (Andualem et al., 2019). Laksono et al. (2022) further asserted in a qualitative study among nurses in Indonesia that nursing documentation remains a problem and pointed out factors such as inadequate supervision on documentation, poor competency issues and lack of confidence and motivation on documentation.

In Uganda, Nakate et al. (2015) reported that barriers to effective nursing documentation include organisational issues, inadequate knowledge on documentation, lack of training, and motivation. In South Africa, a qualitative study revealed that challenges associated with documentation include a lack of time to complete records, an increased patient-to-nurse ratio, and a lack of documentation logistics (Mutshatshi & Mothiba, 2020). Nurses' low knowledge and poor attitudes, in addition to these deficiencies, negatively impact documentation practices. Continuous training, monitoring and evaluation of nurses (Mutshatshi & Mothiba, 2020; Laksono et al., 2022), motivation, provision of documentation policies and materials (Nakate et al., 2015), employment of additional nurses, proper time management, and penalising nurses for poorly written documents could address challenges associated with nursing documentation.

In Ghana, nursing documentation is suboptimal and contributes to adverse health outcomes (Seidu, Abdulai & Aninanya, 2021). Health workers in Ghana are facing lawsuits and other forms of disciplinary proceedings due to recent developments in the health sector (Asamani et al., 2014). Reports have indicated instances of medical negligence and even lawsuits among certain health professionals (Pandit & Pandit, 2009; Oyebode, 2013). In these cases, accurate documentation procedures would definitely have played a key role in preventing such issues. Despite the Nursing and Midwifery Council (NMC) regulating nursing and midwifery training and practise, the NMC is lagging behind due to the absence of national and/or local guidelines on nursing documentation. Furthermore, a variety of stakeholders have criticized nursing documentation on various platforms for unsatisfactory charting practices. Anecdotal evidence indicates that suboptimal or non-documented nursing care occurs in certain instances. This will undoubtedly have serious implications for assessing the care provided to clients. In a study in Eastern Ghana, Asamani et al. (2014) also linked inadequate documentation to an inadequate nurse-patient ratio.

Another study in Winneba, Ghana, revealed that most nurses did not sign or write their initials after documenting care (Seidu, Abdulai & Aninanya, 2021). Furthermore, Seidu, Abdulai, & Aninanya (2021) conducted a previous study in the Tamale Metropolis across five hospitals, reporting very poor nursing documentation. Moreover, Seidu, Abdulai and Aninanya (2021) identified a limitation in previous studies on nursing documentation in Ghana, including the Northern Region, as they focused on assessing the documentation practices of nurses in both private and public institutions, but did not evaluate their knowledge and attitudes towards documentation.

Various factors, including institutional policies, technological resources, staff training, and individual attitudes toward documentation, influence nursing documentation (Tawfik, Mahfouz & AbdAllah, 2024). Studies across different healthcare settings have shown that workload, time constraints, lack of training, and inadequate staffing are significant barriers to effective documentation (Bolado et al., 2023). Research in high-resource settings, for example, frequently emphasises the role of electronic health records (EHR) in improving documentation accuracy, whereas studies in low-resource settings highlight challenges such as lack of access to EHR and insufficient staff training. Recent studies (Forde‐Johnston, Butcher & Aveyard, 2023) underscore the need for ongoing professional development and institutional support to overcome these barriers.

By evaluating the documentation practices of nurses at the Federal Medical Centre Apir, this study aims to bridge the research gap to improve nursing documentation. The study will also assess the factors that determine knowledge, attitudes, and practices related to nursing documentation.

Objectives of the Study

The objectives of the study are threefold: first, to assess the knowledge and attitudes towards nursing documentation among nurses at FMC Apir; second, to evaluate the practices of documentation among these nurses; and third, to examine the factors that influence nursing documentation at FMC Apir.

METHODOLOGY

Study Design and Setting

The study employed an analytical cross-sectional design to assess nursing documentation practice among nurses and midwives and relate it to its exposures at the same time. This study was conducted at the Federal Medical Centre (FMC) in Apir because it has numerous speciality areas and nursing documentation was found to be inadequate. The ethical consent was granted by the Research and Ethics Board of the Federal Medical Centre, before the commencement of the study for permission. The nurses in various settings of the study were approached, and information about the study objective was explained to them. The responsibility of the respondents was clarified, and assurances that their information would be treated confidentially were given to gain their cooperation throughout the study period. Each participant signed informed consent forms, and participation was voluntary.

Study Population

The target population consisted of qualified registered/professional nurses (i.e., enrolled, diploma holders, or graduates) who had at least one year of work experience. All the participants voluntarily consented to the study. The study excluded students and rotational nurses, those with less than a year of work experience, and those on annual or maternity leave. The study selected 288 participants, calculated using the Yamane Formula (Yamane, 1973) (n = 𝑁𝑁1+ (𝑒𝑒) 2), where N is the population size and e, the level of precision. This process was adopted to ensure representativeness of the sample population.

Sampling Procedures

A 2-stage sampling procedure first using a stratified and then a convenient sampling technique was employed. Stratified sampling was ensured for equity in the spread of the sample size across the selected departments of the Centre which included Medicine, Surgery, Obstetrics and Gynaecology and Special Units. Each department comprises distinct wards, which collectively form sub-clusters. From each department, nurses were conveniently selected from the wards.

Data Collection Tool and Procedures

A semi-structured questionnaire was adopted from empirical evidence (Asamani et al., 2014; Seidu, Abdulai & Aninanya, 2021; Andualem et al., 2019). The instrument consisted of four sections: Section A constituted socio-demographics; Section B was knowledge and attitudes toward nursing documentation; Section C entailed documentation practices; and Section D constituted factors that influenced nursing documentation.

The questionnaire was pretested on 12 nurses at the General Hospital Makurdi before actual data collection, but this was not included in the actual data analysis. The researcher supervised the respondents while they filled out the questionnaire, which they later self-administered. The researcher assured the respondents of confidentiality and anonymity. After the data collection exercise, the researcher meticulously reviewed all completed questionnaires to verify the completion of all fields.

The population of nurses at FMC Apir determined the sample size for this study, ensuring a representative sample that would yield statistically significant results. A power analysis was conducted to confirm that the sample size was adequate to detect differences and relationships among the variables studied, with a confidence level of 95% and a margin of error of 5%. A pilot study involving a small sample of nurses not involved in the main study validated the data collection tools, particularly the questionnaire. Feedback from the pilot study was used to refine the questionnaire, ensuring its reliability and validity in acquiring the necessary data.

Data Analysis

In respect to the assessment of the knowledge, attitude and practice of respondents on documentation, several questions were posed for each variable, and each correct/right choice was scored 1 and incorrect/wrong choice was scored 0. The total score for each respondent for each variable was assessed using a composite score by summing all correct answers. The median score for each variable was then calculated and used as the cut-off for determining the levels for knowledge (adequate vs. inadequate), attitude (good vs. bad), and practice (high vs. low). The answered questionnaires were collected from the respondents for data entry. Data was entered and analysed using the Statistical Package for the Social Sciences (SPSS) version 20. To summarise the data, descriptive statistics were used, such as percentages and frequencies. Furthermore, binary logistic regression modeling was done to determine predictors of nursing documentation, and the level of significance was set at p<0.05.

Ethical Consideration

The study received ethical approval from the Ethical Committee of the Federal Medical Centre and the Board on Scientific Research Makurdi, Nigeria with reference number FMH/FMC/MED/108/VOL on 26th August, 2024.

RESULTS

Among the participants, 123 copies of the questionnaire were distributed, but 102 were filled out and returned with valid responses. The response rate was therefore 82.9%.

Table 1 shows the demographic characteristics of the respondents selected for the sample. The majority of the participants, 60 (58.8%), were females and 42 (41.2%) were males. Age characteristics showed that the mean age was (39.4%). For the educational qualification, Diploma holders were 24.5%, Degree holders were 58.8%, 15.7% had certificates in nursing, and 1.0% had SSCE. Regarding the years of experience, the majority (41.1%) had worked for 1–5 years; 40.2% worked for 6–10 years; 12.8% worked for 11–15 years; and 8.0% worked for more

than 15 years.

Table 1: Demographics Distribution of the Respondents

Knowledge of Respondents towards Nursing Documentation

Multiple-choice questions were used to measure the knowledge of respondents regarding nursing documentation, and the mean score was 4.6 (SD ± 1.9). The minimum score was 1.3 and the maximum 8. The total mean score for knowledge questions was 4.6. Among all the respondents, 46 (46.9%) subjects scored above or equal to the mean value, and the rest 48 (53.1%) of them scored below the mean. Fifty-four (53%) of the respondents were found to have poor knowledge of documentation.

Table 2: Knowledge of Respondents Regarding Nursing Documentation

Table 3 presents the respondents' understanding of nursing documentation, their sources of information, and their awareness of the consequences of insufficient documentation, along with the core principles of professional nursing documentation.In understanding the Nursing Documentation, 46.9% of respondents reported having adequate information about nursing documentation, while 53.1% of the respondents reported inadequate information, suggesting that more than half lack comprehensive knowledge of the documentation process. Regarding the sources of information, nursing programs were the primary source for 47.1% of the respondents, while ward nurses provided information for 30.6%, hospital administration for 9.18%, and notes from other nurses for 13.3% of the respondents. Therefore, this data suggests that nursing programs, structured education, and informal learning channels such as notes from peers play a significant role.

Understanding the potential effects of insufficient documentation, the respondents identified several negative outcomes associated with it. It was seen that 29.4% noted the potential for legal impacts, 21.6% highlighted medical blunders as a consequence, 18.6% cited inconsistency in care, 17.6% mentioned poor results in patient outcomes, and 12.7% identified miscommunication within the medical staff as a problem caused by poor documentation. These responses indicate that respondents are aware of both legal and operational risks linked to inadequate documentation practices.

For Core Principles of Nursing Documentation, a large majority of respondents understand key principles for proper nursing documentation, which are: 93.8% agreed that documentation is an essential part of professional nursing practice; 87.7% emphasised that documentation must follow predetermined rules; also, 83.6% noted that documentation must be orderly, factual, precise, and readable; and 91.8% stated that documentation should cover observations and actions taken by the nurse. This result indicates that while most respondents understand the principles of proper documentation, a notable percentage lack adequate information, underscoring the need for enhanced training and awareness programs.

Table 3: Respondents' Understanding of Nursing Documentation

Source: Field survey, 2023

Attitude of Respondents towards Nursing Documentation

Respondents’ attitudes were assessed via a Likert scale, with item scores ranging from strongly agree (4), agree (3), disagree (2) and strongly disagree (1), which had a potential score of 40. The total mean score for attitude was 44 (SD ± 4.9), and scores greater or equal to the mean were categorised as favourable and unfavourable for scores below the mean. The overall attitude score of the respondents showed that more than half of them, 61 (59.8%), had a positive attitude, and the rest, 41 (40.2%), had a negative mindset.

Table 4: Nursing Documentation Attitude Score

Reason Identified for the Poor Nursing Care Documentation Practice

Among the 54 (52.9%) respondents who do not document the care provided to a patient, most 30 (55.6%) of them responded that their reasons for poor documentation were lack of time, shortage of documenting sheets, inadequate staff, lack of motivation from supervisors, and lack of obligation from the employing institution by 12 (22.3%), 8 (14.8%), 3 (5.6%), and 1 (1.9%), respectively, as shown in the table below.

Table 5: Reasons for Poor Documentation by Respondents

Practice of Nurses towards Nursing Documentation

Table 6 presents data on various aspects of nursing documentation practices. The majority of nursing school students (47.1%) document data when instructed, while 13.3% depend on notes from another nurse. It is seen that 60.8% of nurses always document instructions or counseling given to patients, whereas 15.7% rarely do so. The study showed that 66.7% use other process to document that does not require charts should be documented, with only 1% never documenting them. Timing of documentation showed that 76.5% prefer to document whenever convenient, and only 4.9% do so at the close of the shift. In case of error correction in documentation, 81.3% correct errors by striking through and signing, while 16.7% use correction fluid. Therefore, most nurses tend to document when convenient and follow standard error correction methods, although a significant portion lacks consistency in documentation timing and processes.

Table 6: The Practice of Nursing Documentation

Factor Associated with Documentation Practice of Nursing Care Plan

Table 7 shows the factors that influenced nursing documentation. Regarding operational norm for recording nursing care, 72% of respondents agree that there is a standard norm, while 30% disagree. The study revealed that 90% report receiving paperwork in-service education, with only 12% lacking it. Of the total respondent 85% mention an increased workload and inadequate staffing (higher nurse-patient ratio) as issues. About access to a nursing care plan, 79% have access to a care plan, but 23% do not. Report of insufficient documentation sheets showed 88% mention of lack of sufficient documentation sheets. Of the total 95% showed lack of acquaintance with nursing documentation. Nurses also believe there is a lack of commitment from the hospital (82%). For lack of encouragement from bosses, 92% agreed, with 10% disagreeing. Lastly 99% express dissatisfaction with their monthly salary, while only 3% were satisfied. The majority of nurses feel that increased workload, insufficient resources, and lack of institutional support significantly hinder proper nursing documentation.

Table 7: Variables Affecting Nursing Documentation

Source: Field survey, 2022

Using regression analysis, odds ratios with 95% confidence intervals were calculated to assess the statistical significance and strength of association for each variable. Variables having a p value < 0.25 in the bivariate logistic analysis were entered into the Multivariable Logistic Analysis and Adjusted Odds Ratios (AOR) were then calculated to investigate association with controlled confounding variables.

According to the finding, nurses who are not familiar with operational standard of the nursing documentation were twice more likely to have poor nursing documentation practice than those who are familiar (Adjusted Odds Ratio (AOR) = 2.015, 95% CI 1.205, 3.370). Additionally, respondents who lacked time and those who lacked documentation sheets were also two times [AOR = 2.202, 95% CI (1.101, 3.410)] and three times [AOR = 3.269, 95% CI (1.123, 23.701)] more likely to perform poor nursing documentation when compared to those with adequate time and adequate documenting sheets respectively.

DISCUSSION

This cross-sectional study aimed to investigate nursing documentation practice and its associated factors among nurses at FMC Apir. The finding showed that familiarity with operational standards of nursing documentation, lack of time and inadequacy of documenting sheets had a significant effect on nursing care documentation practice.

In line with the present study findings, nurses in Ethiopia, as noted by Adejumo (2014), exercise inadequate nursing care documentation, both in terms of practice and knowledge. This result is higher than that from Indonesia, 33.3% (Motea, Rantetampang & Pongtikuc, 2016) and the University of Gondar hospital, 37.4% (Kebede, Endris, & Zegeye, 2017). The government's priorities in the health sector and the introduction of technology such as smart care, now prevalent in most Nigerian hospitals, could account for this disparity. Another reason could be that nurses' educational development differs across countries (Nursalam, Dang & Arief, 2009). Over half of the people who participated in this study said that nurses did not do a good job of documenting their work. This is similar to a study done in Felege Hiwot referral hospital (87.5%), where medication errors were caused by nursing documentation mistakes (Mekonen, Gebrie & Jemberie, 2020). This finding is lower than 68.3% in South Africa (Olivier & Kyriacos, 2011). Studies favorable to the working environment and organizational structure suggest that this could be due to inadequate knowledge.

This study has identified several barriers that hinder the practice of nursing documentation. Nurses who know about operational standards for nursing documentation are twice as likely to document their care. Similarly, this study found that lack of time and scarcity of sheets were the primary factors negatively influencing nursing documentation practices. Similar to studies conducted in Ethiopia (41.7%) and England (47%), respondents with limited time were twice as likely to document (41.9%).

Other studies have found a non-significant association between knowledge and documentation practice. The knowledge level of participants was low in this study, which contradicts the findings from the University of Gondar hospital (58.3%) (Kebede, Endris & Zegeye, 2017), South Africa (74.9%) (Olivier & Kyriacos, 2011), Iraq (59%) (Hameed & Allo, 2014) and Indonesia (82.7%) (Motea, Rantetampang & Pongtikuc, 2016). The study participants' sociodemographic variability or their varying familiarity with the guidelines' documentation could potentially explain these discrepancies (Kebede, Endris & Zegeye, 2017).

Limitations

The focus of this study is on the factors that influence the documentation of nursing care by nurses at the Federal Medical Centre, Apir and on the practicing nurses who were available at the time of the study.

CONCLUSION

The practice of nursing care documentation among nurses was deemed inadequate. The inadequacy of documenting sheets, lack of time, and unfamiliarity with the operational standards of nursing documentation were factors associated with the practice of nursing care documentation. These findings underscore the need for tailored interventions to address these barriers and improve documentation practices. Future research should examine the impact of targeted training programs on documentation quality and the potential benefits of introducing electronic health records in this setting. Additionally, conducting comparative studies across different healthcare facilities could provide a broader understanding of the factors influencing documentation practices in similar low-resource environments. Additionally, a training program could be implemented to enhance the knowledge of nurses, familiarise them with institutional policy regarding documentation, and provide adequate documentation materials.

This study contributes to the existing body of knowledge by providing insights into the specific factors affecting nursing documentation at FMC Apir. It highlights the unique challenges faced in this context, including workload, inadequate training, and lack of resources.

Conflict of Interest

The authors declare that they have no competing interest.

ACKNOWLEDGEMENT

The author would like to express gratitude to Barrister Lovelyn Ogechukwu Aniekwe for her contribution. The author also extends appreciation to her son, Doctor Donald Chukwudubem Aniekwe, for the support and encouragement. Additionally, the author is thankful to Mr. Francis Uzua for his guidance during the study and Mr. Matthew M. Uzua for his assistance with typesetting and organising the work.

REFERENCES

Adejumo, P. O. (2014). Nurses’ reported practice and knowledge of wound assessment, assessment tools and documentation in a selected hospital in Lagos, Nigeria. African Journal of Medicine and Medical Sciences, 43(2), 149-159.https://ojshostng.com/index.php/ajmms/article/view/852. Accessed on 22nd November, 2022.

Andualem, A., Asmamaw, T., Sintayehu, M., Liknaw, T., Edmealem, A., Gedfew, B., & Bewuket, M. (2019). Knowledge, attitude, practice and associated factors towards nursing care documentation among nurses in West Gojjam Zone public hospitals, Amhara Ethiopia, 2018. Clinical Journal of Nursing Care and Practice, 3(1), 001-013. http://dx.doi.org/10.29328/journal.cjncp.1001010

Asamani, J. A., Amenorpe, F. D., Babanawo, F., & Ofei, A. M. A. (2014). Nursing documentation of inpatient care in eastern Ghana. British Journal of Nursing, 23(1), 48-54. https://doi.org/10.12968/bjon.2014.23.1.48

Blake‐Mowatt, C., Lindo, J. L. M., & Bennett, J. (2013). Evaluation of registered nurses' knowledge and practice of documentation at a Jamaican hospital. International Nursing Review, 60(3), 328-334. https://doi.org/10.1111/inr.12040

Bolado, G. N., Ayalew, T. L., Feleke, M. G., Haile, K. E., & Geta, T. (2023). Documentation practice and associated factors among nurses working in public hospitals in Wolaita Zone, Southern Ethiopia. BMC Nursing, 22(1), 330. https://doi.org/10.1186/s12912-023-01490-8

Broderick, M. C., & Coffey, A. (2013). Person‐centred care in nursing documentation. International Journal of Older People Nursing, 8(4), 309-318. https://doi.org/10.1111/opn.12012

De Groot, K., De Veer, A. J., Munster, A. M., Francke, A. L., & Paans, W. (2022). Nursing documentation and its relationship with perceived nursing workload: a mixed-methods study among community nurses. BMC Nursing, 21(1), 34. https://doi.org/10.1186/s12912-022-00811-7

Ethiopia’s, A. S. P., & Pif, I. F. (2010). Federal democratic republic of Ethiopia ministry of agriculture and rural development. https://efaidnbmnnnibpcajpcglclefindmkaj/https://www.gafspfund.org/sites/default/files/inline- files/7a.%20Ethiopia_CAADP%20Post%20Compact%20Investment%20Plan.pdf. Accessed on 26th December, 2023.

Fantahun, B., Dellie, E., Worku, N., & Debie, A. (2023). Organizational commitment and associated factors among health professionals working in public hospitals of southwestern Oromia, Ethiopia. BMC Health Services Research, 23(1), 180. https://doi.org/10.1186/s12913- 023-09167-3

Forde‐Johnston, C., Butcher, D., & Aveyard, H. (2023). An integrative review exploring the impact of Electronic Health Records (EHR) on the quality of nurse–patient interactions and communication. Journal of Advanced Nursing, 79(1), 48-67. https://doi.org/10.1111/jan.15484

Hameed, R. Y., & Allo, R. R. (2014). Assessment of nurses' knowledge about nursing documentation. Journal of Kufa for Nursing Science. 4(1). 90–98.https://doi.org/10.36321/kjns.vi20141.2448

Hardido, T. G., Kedida, B. D., & Kigongo, E. (2023). Nursing documentation practices and related factors in patient care in Ethiopia: A systematic review and meta‐analysis. Advances in Medicine, 2023(1). https://doi.org/10.1155/2023/5565226

Kebede, M., Endris, Y., & Zegeye, D. T. (2017). Nursing care documentation practice: The unfinished task of nursing care in the University of Gondar Hospital. Informatics for Health and Social Care, 42(3), 290-302. https://doi.org/10.1080/17538157.2016.1252766

Kelly, U., Edwards, G., & Shapiro, S. E. (2021). Nursing policies and protocols: Do nurses really use them? Journal of Nursing Care Quality, 36(3), 217-222.https://doi.org/10.1097/NCQ.0000000000000532

Laksono, A. D., Nantabah, Z. K., Wulandari, R. D., Khoiri, A., & Tahangnacca, M. (2022). Barriers to expanding the national health insurance membership in Indonesia: Who should the target? Journal of Primary Care & Community Health, 13, https://doi.org/10.1177/21501319221111112

Ma, J. H., Bai, Y., Xie, D. S., & Yang, G. F. (2023). Factors influencing the interruption of nursing document writing in the Intensive Care Unit: A cross-sectional survey. Journal of Multidisciplinary Healthcare, 16, 419-427. https://doi.org/10.2147/JMDH.S394817

Machudo, S. Y., & Mohidin, S. (2015). Nursing documentation study at Teaching Hospital in KSA. Nursing and Health, 3(1), 1-6. https://doi.org/10.13189/nh.2015.030101

Mbabazi, P., & Cassimjee, R. (2006). The quality of nursing documentation in a hospital in Rwanda. Africa Journal of Nursing and Midwifery, 8(1), 31-42. https://journals.co.za/doi/pdf/10.10520/EJC19386 . Accessed on 16th January, 2024.

Mekonen, E. G., Gebrie, M. H., & Jemberie, S. M. (2020). Magnitude and associated factors of medication administration error among nurses working in Amhara Region Referral Hospitals, Northwest Ethiopia. Journal of Drug Assessment, 9(1), 151-158.https://doi.org/10.1080/21556660.2020.1841495

Molla, F., Temesgen, W. A., Kerie, S., & Endeshaw, D. (2024). Nurses’ documentation practice and associated factors in eight public hospitals, Amhara region, Ethiopia: A cross-sectional study. SAGE Open Nursing, 10, 23779608241227403. https://doi.org/10.1177/23779608241227403

Motea, P., Rantetampang, A., & Pongtikuc, A. J. I. J. S. B. A. R. (2016). The factor relates to job performance of nurses with health nursing documentation at Paniai General Hospital Papuan Province. International Journal of Basic and Applied Sciences (IJSBAR), 30(4), 231-247. https://core.ac.uk/download/pdf/249335554.pdf . Accessed on 30th , November, 2023.

Mutshatshi, T. E., & Mothiba, T. M. (2020). Nurses’ practices during implementation of the nursing process at a selected public hospital of limpopo province, south africa: A qualitative pilot study analysis. The Open Public Health Journal, 13(1). http://dx.doi.org/10.2174/1874944502013010309

Nakate, G., Dahl, D., Petrucka, P., & Drake, K. B. (2015). The nursing documentation dilemma in Uganda: Neglected but necessary. A case study at Mulago National Referral Hospital. Open Journal of Nursing, 5(12). http://dx.doi.org/10.4236/ojn.2015.512113

Nursalam, F., Dang, L., & Arief, Y. (2009, November). Nursing education in Indonesia: Todays and future trends, In Shanghai International Nursing Conference, Shanghai China. https://doi.org/10.13140/RG.2.1.1697.3920

Okaisu, E. M., Kalikwani, F., Wanyana, G., & Coetzee, M. (2014). Improving the quality of nursing documentation: An action research project. Curationis, 37(2), 1-11. https://doi.org/10.4102/curationis.v37i2.1251

Olivier, J. M., & Kyriacos, U. (2011). Record keeping self-reported attitudes, knowledge and practice behaviours of nurses in selected Cape Town hospitals. Professional Nursing Today, 15(4), 8-9. https://hdl.handle.net/10520/EJC79448. Accessed on February 20th, 2023.

Oyebode, F. (2013). Clinical errors and medical negligence. Medical Principles and Practice, 22(4), 323-333. https://doi.org/10.1159/000346296

Pandit, M. S., & Pandit, S. (2009). Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense-A legal perspective. Indian Journal of Urology, 25(3), 372-378. https://doi.org/10.4103/0970-1591.56206

Seidu, A. A., Abdulai, A., & Aninanya, G. A. (2021). Factors influencing documentation in nursing care by nurses at the tamale teaching hospital, Ghana. UDS International Journal of Development, 8(1), 540-558. https://doi.org.10.47740/567.UDSIJD6i

Stoumpos, A. I., Kitsios, F., & Talias, M. A. (2023). Digital transformation in healthcare: Technology acceptance and its applications. International Journal of Environmental Research and Public Health, 20(4), 3407. https://doi.org/10.3390/ijerph20043407

Tasew, H., Mariye, T., & Teklay, G. (2019). Nursing documentation practice and associated factors among nurses in public hospitals, Tigray, Ethiopia. BMC Research Notes, 12, 1-6. https://doi.org/10.1186/s13104-019-4661-x

Tawfik, E. A. M., Mahfouz, H. H. E., & AbdAllah, N. A. (2024). Factors influencing effective documentation and its relation to patients’ safety as perceived by staff nurses. Journal of Nursing Science Benha University, 5(2), 168-184. https://doi.org/10.21608/jnsbu.2024.362188

Yamane, T. (1973). An introductory analysis. 3rd Edition, Harper and Row, New York. https://www.scirp.org/reference/ReferencesPapers?ReferenceID=1655260. Accessed on 24th July, 2022.