Nursing Documentation Practices and Influential Factors Among Nurses in Public Hospitals

Main Article Content

Abdullah Obaid Albathali, Bander Rashed Aljohani , Sarah Mohammad Ahmad Alzzi , Khalid Fadus Almutairi , Saleh Abdulrahman Alsaab , Mohammad Abdulrahman M Aldeailej

Keywords

Nursing Practice, Documentation, Nurses, Influencing Factors

Abstract

Objective: The aim of this research was to explore the documentation practices among nurses employed in public hospitals , along with identifying the factors influencing these practices.
Results: This study included 317 participants, achieving a response rate of 99.7%. Findings indicated that the documentation of nursing care was found to be inadequate in 47.8% of cases. Several factors were significantly associated with this inadequacy, including the insufficiency of documenting sheets (AOR=3.271, 95% CI: 1.125-23.704), time constraints (AOR=2.205, 95% CI: 1.101-3.413), and compliance with operational standards of nursing documentation (AOR=2.015, 95% CI: 1.205-3.70). In conclusion, over half of the nurses surveyed did not adequately document their nursing care. It is recommended that healthcare institutions provide training to improve nurses' documentation skills, ensure access to sufficient documenting supplies, and consider hiring additional nursing staff.

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