Knowledge management capability in nursing care performance in selected teaching hospitals in South-West Nigeria.

Abstract

This study investigated knowledge management (KM) capability in nursing care performance in selected teaching hospitals in South-west, Nigeria. The specific objectives of the study were: to investigate the factors of KM capability influencing nursing care performance outcomes in health institutions in South-west Nigeria; investigate the relationship between knowledge infrastructure and knowledge process in KM capability; and examine how KM capability can be leveraged to support nursing care performance outcomes. The study was underpinned by pragmatic paradigm which combines both quantitative and qualitative research methods. A survey research design was employed along with convergent mixed methods design to conduct the research. The sample of the study comprised of registered nurses working in the various clinical units of the selected teaching hospitals in the South-west region of Nigeria. The selected teaching hospitals are University College Hospital, Ibadan and Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. Proportionate stratified sampling was used for quantitative data collection using questionnaires, while a purposive sampling method was used for qualitative data collection using semi-structured interviews. The questionnaire was administered to 320 registered nurses, 298 (93.13%) of whom returned the questionnaires. Semi-structured interviews were also conducted with 9 Deputy Directors of Nursing Services (DDNS) from both hospitals. To ensure reliability and validity of the results, an item-total correlation, and principal component analysis (PCA) was applied on the pre-tested questionnaire, while the internal consistency and reliability was also checked by applying Cronbach’s Alpha (α) Coefficient. The result of the pilot study showed that the research instruments were valid and reliable. The data collected from the main study were initially analysed for missing values, sample, descriptive and normality testing using SPSS version 22.0 with a final number of 298 responses. The two-step approach to structural equation modelling (SEM) was then applied using AMOS version 22.0. The structural models were developed to test the hypothesised relationships and answer the research questions. The findings indicated that there were more females compared to males in the two teaching hospitals. The majority of the respondents from the two teaching hospitals were between the ages of 31-35 years. The highest qualification held by the nurses is the basic registered nurses (RN) certificate. The findings revealed that most of the younger registered nurses between the ages of 21-30 years from the two teaching hospitals had spent between 1-5 years in the profession. On the other hand, the older nurses between the ages of 46-55 years were found to have more work experience. The findings of the study established that information technology was found to have significant influence on nursing care performance, while organisational culture and organisational structure was not a significant predictor of nursing care performance. However, the indirect positive effects were confirmed by the data. The results also indicated that knowledge process positively influenced nursing care performance. The study revealed that information technology, organisational structure, and organisational culture in KM infrastructure are found to influence KM process positively and significantly (knowledge acquisition, conversion, application, and protection) in the two teaching hospitals. The study further revealed that the combined relationship between the dimensions of knowledge infrastructure (information technology, organisational structure, and organisational culture) and knowledge process strongly and significantly influence nursing care performance in the teaching hospitals. In leveraging knowledge management capability to support nursing care, the identified challenges in the study were: lack of knowledge management policy; paucity of information technology infrastructure; lack of information technology support for the nurses; shortage of nurses; out-dated and obsolete equipment; dilapidated infrastructure; inconsistent supply of consumables and materials; power failure and erratic electricity; insufficient budget from the Federal Government; lack of motivational incentives; inadequate working conditions and poor salary. Some of the solutions proffered were provision of adequate financial resources and replacement of out-dated equipment by the government; implementation of information technology facilities; provision of consistent power supply and employment of more skilled nurses, while ensuring continuous re-training. The study concluded that the performance of the registered nurses is primarily informed by the influence of information technology support, type of organisational culture and organisational structure of the teaching hospitals. Based on the findings of the study, the recommendations are made in the following areas: knowledge management policy, investment in information technologies (IT), knowledge management infrastructure, knowledge management strategies, change management, top management support, knowledge management measurement, and training.