Barriers to use of information and computer technology by Australia's nurses: a national survey

Midwives' perceptions towards the ministry of health guidelines for the provision of immediate postpartum care in rural health facilities in Uganda

BACKGROUND

Guidelines for clinical practice have been part of the Ministry of health's efforts to improve the quality of care for over two decades. Their benefits have been documented in Uganda. However, having practice guidelines may not always result in their use in care provision. We explored the midwives' perceptions towards the ministry of health guidelines for providing immediate postpartum care.

METHODS

An exploratory descriptive qualitative study was conducted in three districts in Uganda from September 2020 to January 2021. In-depth interviews with 50 midwives from 35 health centers and 2 hospitals in Mpigi, Butambala, and Gomba districts were done. Thematic analysis of data was done.

RESULTS

Three themes emerged; awareness and use of the guidelines, perceived drivers, and perceived barriers to the provision of immediate postpartum care. The subthemes for theme I included; awareness of the guidelines, variations in the postpartum care practices, variations in preparedness to manage women with complications, and varied access to continuing midwifery education. Fear of complications and litigation were the perceived drivers of guideline use. On the other hand, lack of knowledge, busy maternity units, organization of the care, and the midwives' perceptions about their clients were the barriers to guideline use. Midwives felt that new guidelines and policies regarding immediate postpartum care should be disseminated widely.

CONCLUSION

The midwives felt that the guidelines were good for the prevention of postpartum complications but their knowledge of the guidelines for the provision of immediate postpartum care was suboptimal. They desired on-job training and mentorship to help them bridge the knowledge gaps. Variations in patient assessment, monitoring, and pre-discharge care were acknowledged and said to be due to a poor reading culture and health facility factors like patient-midwife ratios, unit setup, and prioritization of labor.

A Clinical Support App for routine wound management: reducing practice variation, improving clinician confidence and increasing formulary compliance

Wounds continue to be of a global concern. Therefore, a more focussed, evidence-based approach to wound assessment and management is required. The WOUND COMPASS™ Clinical Support App (CSA) is designed to support the health care professional with wound assessment and management at the point of care. This real-world pilot study aimed to determine the utility of the CSA during routine wound management, in multiple care settings. A non-interventional, real-world pilot programme of the CSA was conducted at four sites. Patients received routine wound management. The CSA was programmed to replicate the site's formulary for evidence-based wound management. Anonymised pre- and post-pilot clinician opinion surveys on useability and impact of the CSA were collected and reported. Wound Specialists (n = 7 [100%]) and Non-Wound Specialists (NWS) (n = 58 [82%]) indicated that competence and confidence in wound assessment were enhanced with use of the CSA (100%; 82%). Furthermore, practice variation was reduced because of a greater compliance to their local formulary (n = 7 [100%]; 79% [54%]). This real-world pilot shows the positive impact of the CSA, and the improvements that can be potentially realised via reduction in practice variation, improvement in NWSs confidence when managing wounds and increased formulary compliance.

Barriers and Benefits of Information Communication Technologies Used by Health Care Aides

BACKGROUND

Although information and communication technologies (ICT) are becoming more common among health care providers, there is little evidence on how ICT can support health care aides. Health care aides, also known as personal care workers, are unlicensed service providers who encompass the second largest workforce, next to nurses, that provide care to older adults in Canada.

OBJECTIVE

The purpose of this literature review is to examine the range and extent of barriers and benefits of ICT used by health care workers to manage and coordinate the care-delivery workflow for their clients.

METHODS

We conducted a literature review to examine the range and extent of ICT used by health care aides to manage and coordinate their care delivery, workflow, and activities. We identified 8,958 studies of which 40 were included for descriptive analyses.

RESULTS

We distinguished the following five different purposes for the use and implementation of ICT by health care aides: (1) improve everyday work, (2) access electronic health records for home care, (3) facilitate client assessment and care planning, (4) enhance communication, and (5) provide care remotely. We identified 128 barriers and 130 benefits related to adopting ICT. Most of the barriers referred to incomplete hardware and software features, time-consuming ICT adoption, heavy or increased workloads, perceived lack of usefulness of ICT, cost or budget restrictions, security and privacy concerns, and lack of integration with technologies. The benefits for health care aides' adoption of ICT were improvements in communication, support to workflows and processes, improvements in resource planning and health care aides' services, and improvements in access to information and documentation.

CONCLUSION

Health care aides are an essential part of the health care system. They provide one-on-one care to their clients in everyday tasks. Despite the scarce information related to health care aides, we identified many benefits of ICT adoption.

Factors associated with nurses' user resistance to change of electronic health record systems

Background

Electronic health record (EHR) systems often face user resistance in hospitals, which results in a failure to acquire their full benefits. To implement the EHR successfully, it is crucial to reduce nurses’ resistance to use the system. This study aimed to investigate the factors associated with nurses’ resistance to use the EHR system.

Methods

A descriptive correlational study was conducted with nurses working at four university hospitals in Korea using self-administered questionnaires to measure user resistance behavior, resistance to change, perceived usefulness, perceived ease of use, perceived value, colleagues’ opinions, self-efficacy for change, and organizational support for change. Path analysis was performed to examine direct and indirect association with user resistance behavior.

Results

A total of 223 nurses completed the questionnaires. All seven factors were found to be significantly associated with user resistance, either directly or indirectly. The total effect on user resistance behavior was highest in resistance to change (0.65), followed by perceived usefulness (− 0.33); both had direct but no indirect effects. Conversely, self-efficacy for change (− 0.25), perceived value (− 0.21), colleagues’ opinions (− 0.16), perceived ease of use (− 0.16), and organizational support for change (− 0.05) had indirect but no direct effects.

Conclusions

The study examined the factors associated with nurses’ user resistance behavior after the implementation of a new EHR system. These findings could help hospitals develop better EHR implementation strategies to reduce user resistance behavior among the nursing staff.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-021-01581-z.

'Smart' wound dressings for advanced wound care: a review

Hard-to-heal wounds are a common side-effect of diabetes, obesity, pressure ulcers and age-related vascular diseases, the incidences of which are growing worldwide. The increasing financial burden of hard-to-heal wounds on global health services has provoked technological research into improving wound diagnostics and therapeutics via 'smart' dressings, within which elements such as microelectronic sensors, microprocessors and wireless communication radios are embedded. This review highlights the progress being made by research groups worldwide in producing 'smart' wound device prototypes. Significant advances have been made, for example, flexible substrates have replaced rigid circuit boards, sensors have been printed on commercial wound dressing materials and wireless communication has been demonstrated. Challenges remain, however, in the areas of power supply, disposability, low-profile components, multiparametric sensing and seamless device integration in commercial wound dressings.

Caring for Computers: The Hidden Work of Clinical Nurses during the Introduction of Health Information Systems in a Teaching Hospital in Taiwan

Implementing health information systems for enhancing patient care and management occurs worldwide. Discovering how nurses, as important system end-users, experience technology-reliant clinical practice involved focus groups (n = 25) and in-depth individual interviews with nurses (n = 4) and informatics staff (n = 3) in a major Taiwanese medical center. This qualitative study explores the unintended effects of these systems on nurses’ role and clinical practice. First, nurses’ additional role caring for computer devices supporting patient care involves highly-demanding invisible effort, especially when tackling system malfunctions affecting patients with urgent conditions. Second, nurses are resourceful in developing solutions to protect patients during unexpected technical malfunctions. Third, troubleshooting using telephone technical support as the first resort is problematic. It is argued that computerization requires nurses to care for co-clients: patients and computers. Managing technical malfunctions is an unintended consequence for nurses, reflecting the hidden work required by new technology.

Investigation E-health literacy and correlates factors among Alborz medical sciences students: a cross sectional study

Background Health literacy is one of the goals of public health and the key challenge of health education in the 21st century. This study aimed to determine E-health literacy and correlates among medical sciences students in Karaj, Iran 2017. Methods This cross-sectional study was performed on a thousand students of Alborz University of Medical Sciences. A multi-sectional questionnaire was used to collect data. The first section included age, major, marital status; educational grade, mother and father education, socioeconomic status, health status, membrane in social network and the second compromised a validated Persian version of the E-health literacy. We used t-test and analysis of variance (ANOVA) to compare the mean of variables and for categorical variables x2 was used with SPSS version 19. Results The mean age of the subjects was 25.5 ± 5.6 years, of which 65.3% were male. The medical students constituted the most number of participants (28.6%). Mean eHEALS score was 26.11 ± 6.6 years. There was a significant difference between female and male regarding E-health literacy (P = 0.04). Internet was the most commonly used sources for health information (67%), the majority of the students were members of one of the social networks (77.7%) that telegram and Instagram were among the most popular networks. Conclusion Improving search skills and assessing of health resources in students, especially in medical and Para-medical sciences, is recommended. Social networks can be used as channels for the transmission of the health messages due to high usage among students.

The experiences of nurses using noninvasive ventilation: An integrative review of the literature

BACKGROUND

Noninvasive ventilation (NIV) is a common treatment delivered in critical care and is imperative in the management of many acute respiratory illnesses. Nurses are integral to the initiation and management of NIV, but there is a paucity of evidence on the experiences of nurses in this role.

OBJECTIVES

The aim of this integrative review was to examine the current available research focused on nurses' experiences of using NIV across a variety of healthcare settings.

METHODS

Database searches were conducted using EBSCOhost (health) databases, MEDLINE, and Science Direct. Search terms used were combinations of 'nurs∗' or 'experience∗' with 'noninvasive ventilation', 'non invasive ventilation', 'BiPAP', 'CPAP', or 'positive airway pressure'. Inclusion criteria were studies that focused on the experiences of nurses using NIV, were peer reviewed and published in English, and had research designs (collected and analysed quantitative and/or qualitative data). The studies that met the inclusion criteria were individually examined and rated in accordance with the Joanna Briggs Institute Critical Appraisal Checklist for critical and interpretive research.

RESULTS

The literature search returned a possible 279 matches which were shortlisted based on the title and then again by abstract content before being reviewed in full. After application of inclusion/exclusion criteria, eight articles with a mix of qualitative and quantitative study designs were included in the review. The themes of education, communication, and guideline utilisation were common to many of the findings from both interviews and surveys.

CONCLUSION

The research examined in this literature review reported some difficulties associated with NIV use including limited education, communication, and variable guideline use. Despite this, nurses were generally able to use NIV to provide positive patient outcomes.

CLINICAL TRIAL REGISTRATION NUMBER

NA.

Attitude of physiotherapists toward electronic health record in Croatia

Background

Electronic health record can facilitate everyday clinical practice of physiotherapists. The aim of this study is to determine attitude of physiotherapists towards implementation of information technology in their work and the differences in attitude in relation to gender, age, level of education and type of health institutions.

Methods

This study is a cross-sectional survey of Croatian physiotherapists. The questionnaire ″Attitude of physiotherapists towards implementation of electronic health record included 12 items scored on a Likert-type scale from 1 to 5 and presented the award values as “Disagree”, “Neither agree nor disagree” and “Agree”. Croatian physiotherapists were (n = 267) recruited from 13 health care institutions. For analysis chi square test, t-test, one-way analysis of variance and as a post-hoc Tukey test were used.

Results

Explanatory factorial analysis confirmed two factors: Satisfaction in the work of physiotherapists using computers (SAT) and Necessity of computers in the work of physiotherapists (NEC). Most physiotherapists agree on (SAT) (47.9%) and on (NEC) (51.3%). Male physiotherapists were significantly more likely to disagree with statements related to SAT (p < 0.001) and NEC (p = 0.035) than female physiotherapists. Physiotherapists aged between 46 and 55 years were significantly more like to disagree on NEC in comparison to all the other groups of participants (p < 0.001). Physiotherapists with secondary school degree were significantly more like to disagree on NEC as compared with participants with bachelor’s degree (p = 0.009), as well as in comparison with physiotherapists with a university degree (p = 0.002). Most of the physiotherapists who are employed in Clinical hospitals and in the Speciality hospital agree with that statement (all p > 0.05).

Conclusion

The attitude of Croatian physiotherapists towards electronic health record differs according to the age, gender, level of education and type of health care institutions. This finding can facilitate implementation of electronic health record in physiotherapy.

Trial registration

Not applicable.

eHealth adoption and use among healthcare professionals in a tertiary hospital in Sub-Saharan Africa: a Qmethodology study

Background

The aim of the study was to explore the viewpoints of healthcare professionals (HCPs) on the adoption and use of eHealth in clinical practice in sub-Saharan Africa (SSA). Information and communication technologies (ICTs) including eHealth provide HCPs the opportunity to provide quality healthcare to their patients while also improving their own clinical practices. Despite this, previous research has identified these technologies have their associated challenges when adopting them for clinical practice. But more research is needed to identify how these eHealth resources influence clinical practice. In addition, there is still little information about adoption and use of these technologies by HCPs inclinical practice in Sub-Saharan Africa.

Method

An exploratory descriptive design was adopted for this study. Thirty-six (36) HCPs (18 nurses and 18 physicians) working in the clinical area in a tertiary health institution in SSA participated in this study. Using Qmethodology, study participants rank-ordered forty-six statementsin relation to their adoption and use of eHealth within their clinical practice.This was analysed using by-person factor analysis and complemented with audio-taped interviews.

Results

The analysis yielded four factors i.e., distinct viewpoints the HCPs hold about adoption and use of eHealth within their clinical practice. These factors include: “Patient-focused eHealth advocates” who use the eHealth because they are motivated by patients and their families preferences; “Task-focused eHealth advocates” use eHealth because it helps them complete clinical tasks; “Traditionalistic-pragmatists” recognise contributions eHealth makes in clinical practice but separate from their routine clinical activities; and the “Tech-focused eHealth advocates” who use the eHealth because they are motivated by the technology itself.

Conclusion

The study shows the equivocal viewpoints that HCPs have about eHealth within their clinical practice. This, in addition to adding to existing literature, will help policymakers/decision makers to consider HCPs views about these technologies prior to implementing an eHealth resource.

The Impact of a Web-Based Course Concerning Patient Education for Mental Health Care Professionals: Quasi-Experimental Study

BACKGROUND

Continuing education has an important role in supporting the competence of health care professionals. Although Web-based education is a growing business in various health sectors, few studies have been conducted in psychiatric settings to show its suitability in demanding work environments.

OBJECTIVE

We aimed to describe the impact of a Web-based educational course to increase self-efficacy, self-esteem, and team climate of health care professionals. Possible advantages and disadvantages of the Web-based course are also described.

METHODS

The study used nonrandomized, pre-post intervention design in 1 psychiatric hospital (3 wards). Health care professionals (n=33) were recruited. Self-efficacy, self-esteem, and team climate were measured at 3 assessment points (baseline, 8 weeks, and 6 months). Possible advantages and disadvantages were gathered with open-ended questions at the end of the course.

RESULTS

Our results of this nonrandomized, pre-post intervention study showed that health care professionals (n=33) had higher self-efficacy after the course, and the difference was statistically significant (mean 30.16, SD 3.31 vs mean 31.77, SD 3.35; P=.02). On the other hand, no differences were found in the self-esteem or team climate of the health care professionals before and after the course. Health care professionals found the Web-based course useful in supporting their work and relationships with patients. The tight schedule of the Web-based course and challenges in recruiting patients to use the patient education program with health care professionals were found to be the disadvantages.

CONCLUSIONS

Web-based education might be a useful tool to improve the self-efficacy of health care professionals even in demanding work environments such as psychiatric hospitals. However, more studies with robust and sufficiently powered data are still needed.

Nurses developing confidence and competence in telehealth: results of a descriptive qualitative study

BACKGROUND

The widespread use of telehealth brings benefits to improve access to healthcare for rural and remote populations.

OBJECTIVE

This study explores what nurses considered important to confidently and competently participate in telehealth.

DESIGN

A descriptive qualitative approach was selected.

METHODS

Nine New Zealand Registered Nurses who worked in different clinical settings who use telehealth were identified through snowball sampling, and participated in single semi-structured interviews, which were thematically analysed using a general inductive approach.

FINDINGS

The nurses' experience of using telehealth, from novice to becoming more proficient, was the main theme identified, with sub-themes of: Initial use of telehealth, hands-on training, specialty experience, mentorship and technological know-how. The confidence of nurses using telehealth in this study may reflect their clinical nursing experience.

CONCLUSION

Recommendations include the need for more telehealth education and preparation, including incorporating telehealth in under and postgraduate nursing programmes. Additionally, specific telehealth nursing competencies are warranted.

A qualitative study of new graduates' readiness to use nursing informatics in acute care settings: clinical nurse educators' perspectives

BACKGROUND

There is an increase in demand for newly graduated nurses who are ready to use nursing informatics (NI) efficiently in technology-rich healthcare environments. However, the progress of embedding NI into curricula has been slow worldwide, and literature reports graduates are not ready to use NI tools effectively in the workplace, posing potential threats to patient safety. In the absence of National Standards for NI competencies, graduates' NI needs on entering the workplace need to be explored.

AIM

To identify graduates' NI needs on entering the workplace in acute care settings from the perspectives of clinical nurse educators.

METHODS

A qualitative study using interpretive description with one focus group of six clinical nurse educators was conducted. Clinical nurse educators who are significantly involved in supporting graduates from their first day in the workplace were purposively recruited. The focus group was audiotaped, transcribed verbatim and analysed using thematic analysis.

RESULTS

Graduates were found to be inadequately prepared to use NI tools on entering the workplace. Inefficient hospital systems and a ward culture that was discouraging graduates' NI practice were identified as major barriers to the implementation of NI practice. Lack of exposure to specific hospital systems as undergraduates was also identified as a significant barrier to NI practice among graduates.

CONCLUSIONS

As well as supporting the pre-existing studies on NI skills in graduates and barriers to graduates' NI practice, this current study identified the need for nursing schools to further integrate NI into formal curricula and increased opportunity for exposure to hospital systems as undergraduates. Further studies in multiple settings across Australia are recommended to ensure the transferability of the findings of this study.

Nurses’ perceptions about and confidence in using an electronic medical record system

Introduction:

Nurses are among the largest potential users of electronic medical record (EMR) systems in health care settings. Yet little is known about their perceptions and confidence toward using such systems. This study explored nurses’ perceptions toward and confidence in using the EMR system. Predictors for confidence status in using the system among nurses were postulated.

Methods:

A cross-sectional survey design was used. A sample of 169 nurses were recruited from a general governmental university hospital in Muscat, Oman.

Results:

Most of study participants did not have prior experience with EMR systems elsewhere. About half (52.1%) perceived that they were confident in using the system. A logistic regression model showed nurses who (a) had six or more years of experience in using the system, (b) perceived that their suggestions regarding improving the system were taken into consideration by the system managing team, (c) perceived that the changes introduced in the system were important to their work, and (d) perceived that the information retrieved through the system was updated, to be more likely confident in using the system.

Discussion:

When customizing the EMR system, the informatics team that manages the system is invited to more consider suggestions for improvement that are raised by nurses. More training on the system is suggested to increase confidence among nurses who had little experience in using the system. In order to enhance the preparation of future nurses with contemporary technology-driven health care practices, nursing schools officials are encouraged to include general computer information technology training into nursing curricula.

Applying the Theoretical Domains Framework to identify barriers and targeted interventions to enhance nurses' use of electronic medication management systems in two Australian hospitals

Background

Medication errors harm hospitalised patients and increase health care costs. Electronic Medication Management Systems (EMMS) have been shown to reduce medication errors. However, nurses do not always use EMMS as intended, largely because implementation of such patient safety strategies requires clinicians to change their existing practices, routines and behaviour. This study uses the Theoretical Domains Framework (TDF) to identify barriers and targeted interventions to enhance nurses’ appropriate use of EMMS in two Australian hospitals.

Methods

This qualitative study draws on in-depth interviews with 19 acute care nurses who used EMMS. A convenience sampling approach was used. Nurses working on the study units (N = 6) in two hospitals were invited to participate if available during the data collection period. Interviews inductively explored nurses’ experiences of using EMMS (step 1). Data were analysed using the TDF to identify theory-derived barriers to nurses’ appropriate use of EMMS (step 2). Relevant behaviour change techniques (BCTs) were identified to overcome key barriers to using EMMS (step 3) followed by the identification of potential literature-informed targeted intervention strategies to operationalise the identified BCTs (step 4).

Results

Barriers to nurses’ use of EMMS in acute care were represented by nine domains of the TDF. Two closely linked domains emerged as major barriers to EMMS use: Environmental Context and Resources (availability and properties of computers on wheels (COWs); technology characteristics; specific contexts; competing demands and time pressure) and Social/Professional Role and Identity (conflict between using EMMS appropriately and executing behaviours critical to nurses’ professional role and identity).

The study identified three potential BCTs to address the Environmental Context and Resources domain barrier: adding objects to the environment; restructuring the physical environment; and prompts and cues. Seven BCTs to address Social/Professional Role and Identity were identified: social process of encouragement; pressure or support; information about others’ approval; incompatible beliefs; identification of self as role model; framing/reframing; social comparison; and demonstration of behaviour. It proposes several targeted interventions to deliver these BCTs.

Conclusions

The TDF provides a useful approach to identify barriers to nurses’ prescribed use of EMMS, and can inform the design of targeted theory-based interventions to improve EMMS implementation.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-017-0572-1) contains supplementary material, which is available to authorized users.

Role of information and communication technology in promoting oral health at residential aged care facilities

Information and communication technology (ICT) can provide knowledge and clinical support to those working in residential aged care facilities (RACFs). This paper aims to: (1) review literature on ICT targeted at residents, staff and external providers in RACFs including general practitioners, dental and allied health professionals on improving residents’ oral health; (2) identify barriers and enablers to using ICT in promoting oral health at RACFs; and (3) investigate evidence of effectiveness of these approaches in promoting oral health. Findings from this narrative literature review indicate that ICT is not widely used in RACFs, with barriers to usage identified as limited training for staff, difficulties accessing the Internet, limited computer literacy particularly in older staff, cost and competing work demands. Residents also faced barriers including impaired cognitive and psychosocial functioning, limited computer literacy and Internet use. Findings suggest that more education and training in ICT to upskill staff and residents is needed to effectively promote oral health through this medium.

Readiness of healthcare providers for eHealth: the case from primary healthcare centers in Lebanon

Background

eHealth can positively impact the efficiency and quality of healthcare services. Its potential benefits extend to the patient, healthcare provider, and organization. Primary healthcare (PHC) settings may particularly benefit from eHealth. In these settings, healthcare provider readiness is key to successful eHealth implementation. Accordingly, it is necessary to explore the potential readiness of providers to use eHealth tools. Therefore, the purpose of this study was to assess the readiness of healthcare providers working in PHC centers in Lebanon to use eHealth tools.

Methods

A self-administered questionnaire was used to assess participants’ socio-demographics, computer use, literacy, and access, and participants’ readiness for eHealth implementation (appropriateness, management support, change efficacy, personal beneficence). The study included primary healthcare providers (physicians, nurses, other providers) working in 22 PHC centers distributed across Lebanon. Descriptive and bivariate analyses (ANOVA, independent t-test, Kruskal Wallis, Tamhane’s T2) were used to compare participant characteristics to the level of readiness for the implementation of eHealth.

Results

Of the 541 questionnaires, 213 were completed (response rate: 39.4 %). The majority of participants were physicians (46.9 %), and nurses (26.8 %). Most physicians (54.0 %), nurses (61.4 %), and other providers (50.9 %) felt comfortable using computers, and had access to computers at their PHC center (physicians: 77.0 %, nurses: 87.7 %, others: 92.5 %). Frequency of computer use varied. The study found a significant difference for personal beneficence, management support, and change efficacy among different healthcare providers, and relative to participants’ level of comfort using computers. There was a significant difference by level of comfort using computers and appropriateness. A significant difference was also found between those with access to computers in relation to personal beneficence and change efficacy; and between frequency of computer use and change efficacy.

Conclusion

The implementation of eHealth cannot be achieved without the readiness of healthcare providers. This study demonstrates that the majority of healthcare providers at PHC centers across Lebanon are ready for eHealth implementation. The findings of this study can be considered by decision makers to enhance and scale-up the use of eHealth in PHC centers nationally. Efforts should be directed towards capacity building for healthcare providers.

Exploratory study of the implications of research on the use of smart connected devices for prevention: a scoping review

BACKGROUND

Smart devices and mobile applications are now an integral part of all aspects of everyday life. They are particularly numerous in the field of health, contributing to the movement called ehealth. What is the potential role of these devices as prevention supports? The purpose of this article is to provide an exploratory analysis of the use, efficacy and contribution to conventional prevention strategies.

METHODS

To address this issue, we conducted a scoping-review on the basis of 105 publications from the fields of medicine and human sciences.

RESULTS

Three dimensions of the use of smart devices in the field of health were identified: 1/a quantification tool allowing the users to measure their activities; 2/a tool of self-positioning in the community; 3/an interface between the medical world and the population, modifying the hierarchy of knowledge. However, few published studies have investigated the determinants of the efficacy of these devices and their impact on individual behaviours and professional health practices.

CONCLUSION

Based on the hypothesis of possible integration of these devices in prevention policies, it would be interesting to investigate two research issues: how and under what psycho-socio-environmental conditions can smart devices contribute to the adoption of positive health behaviours? To what degree does the use of smart devices modify the health care professional-patient relationship? Finding answers to these questions could help to define the real place of these devices in prevention strategies by determining their complementarity with respect to other prevention strategies, and the conditions of their efficacy on behaviours and inequalities.

Knowledge and attitudes of doctors towards e-health use in healthcare delivery in government and private hospitals in Northern Uganda: a cross-sectional study

Background

E-health is an essential information sharing tool in healthcare management and delivery worldwide. However, utilization of e-health may only be possible if healthcare professionals have positive attitudes towards e-health. This study aimed to determine the relationships between healthcare professionals’ attitudes towards e-health, level of ICT skills and e-Health use in healthcare delivery in government and private hospitals in northern Uganda.

Methods

Cross-sectional survey design was used. Sixty-eight medical doctors in three government hospitals and four private hospitals in Northern Uganda participated in the study. A pretested self-administered questionnaire was used to collect the required data. Data was analysed using SPSS software Version 19.

Results

Out of the 68 respondents, 39 (57.4 %) reported access to computer and 29 (48.5 %) accessed Internet in the workplace. Majority of healthcare professionals had positive attitudes towards e-health attributes (mean 3.5). The level of skills was moderate (mean 3.66), and was the most important and significant predictor of ICT use among healthcare professionals (r = .522, p < .001); however, attitudes towards e-health attributes did not contribute significantly in predicting e-health use.

Conclusions

The findings suggest need for hospitals managements to strengthen e-health services in healthcare delivery in Northern Uganda.

Prioritizing factors influencing nurses' satisfaction with hospital information systems: a fuzzy analytic hierarchy process approach

Our aim was to use the fuzzy analytic hierarchy process approach to prioritize the factors that influence nurses' satisfaction with a hospital information system. First, we reviewed the related literature to identify and select possible factors. Second, we developed an analytic hierarchy process framework with three main factors (quality of services, of systems, and of information) and 22 subfactors. Third, we developed a questionnaire based on pairwise comparisons and invited 10 experienced nurses who were identified through snowball sampling to rate these factors. Finally, we used Chang's fuzzy extent analysis method to compute the weights of these factors and prioritize them. We found that information quality was the most important factor (58%), followed by service quality (22%) and then system quality (19%). In conclusion, although their weights were not similar, all factors were important and should be considered in evaluating nurses' satisfaction.

Reproductive health professionals' adoption of emerging technologies for health promotion

The purpose of this study was to assess reproductive health professionals' familiarity with and use of various electronic technologies to support health promotion. The study also examined the relationship between demographic characteristics and attitudes and beliefs of the effectiveness of new technologies and perceived barriers for usage. A total of 165 reproductive health professionals at two conferences related to reproductive health in the United States completed the study survey. Personal and organizational factors affected the adoption of electronic technologies for health promotion. This included lack of knowledge, skills, and confidence as well as privacy concerns. The results of the study also suggested that being from an older generation was associated with having lower levels of knowledge, skills, and confidence in using new media. These findings highlight the importance of creating learning opportunities on the use of new technology for health promotion as well as addressing specific perceived barriers among reproductive health professionals in order to promote the adoption of these technologies.

Nurses’ and midwives’ information behaviour: a review of literature from 1998 to 2014

Purpose

– This paper aims to provide an overview of recent literature on nurses’ and midwives’ information behaviour, with a particular focus on sources used and barriers encountered.

Design/methodology/approach

– Comprehensive searching was undertaken and an analysis of the appropriate literature carried out.

Findings

– Practitioners within the nursing profession have a marked preference for interactive and human sources of information. They habitually associate information seeking with professional development rather than with clinical practice. Lack of time is the most frequently reported problem; also, they frequently lack confidence in searching and appraising the professional literature and in applying research in practice. Cultural factors may inhibit information seeking in the workplace, and access to appropriate information technology may be limited.

Practical implications

– As a group, nurses and midwives present significant challenges to health library and information professionals seeking to design services to meet their needs. A perceived lack of access to information resources may be associated with pervasive information literacy skill deficits, with the inability to undertake critical appraisal of material that is retrieved, or with the lack of a workplace culture that is supportive of information seeking. To reach nurses and midwives, more than diligent marketing is required; library and information professionals need to work closely with the holders of nursing and midwifery research, practice development and educational roles within their institutions on “embedded”, specific information initiatives.

Originality/value

– An overview of recent work is presented on the information behaviour of nurses and midwives within developed economies, focusing particularly on the UK. It may be of interest and value to health librarians and to nursing and midwifery educators in facilitating evidence-based practice.

Computerization and its contribution to care quality improvement: the nurses' perspective

BACKGROUND

Despite the widely held belief that the computerization of hospital medical systems contributes to improved patient care management, especially in the context of ordering medications and record keeping, extensive study of the attitudes of medical staff to computerization has found them to be negative. The views of nursing staff have been barely studied and so are unclear. The study reported here investigated the association between nurses' current computer use and skills, the extent of their involvement in quality control and improvement activities on the ward and their perception of the contribution of computerization to improving nursing care. The study was made in the context of a Joint Commission International Accreditation (JCIA) in a large tertiary medical center in Israel. The perception of the role of leadership commitment in the success of a quality initiative was also tested for.

METHODS

Two convenience samples were drawn from 33 clinical wards and units of the medical center. They were questioned at two time points, one before the JCIA and a second after JCIA completion. Of all nurses (N=489), 89 were paired to allow analysis of the study data in a before-and-after design. Thus, this study built three data sets: a pre-JCIA set, a post-JCIA set and a paired sample who completed the questionnaire both before and after JCIA. Data were collected by structured self-administered anonymous questionnaire.

RESULTS

After the JCIA the participants ranked the role of leadership in quality improvement, the extent of their own quality control activity, and the contribution of computers to quality improvement higher than before the JCIA. Significant Pearson correlations were found showing that the higher the rating given to quality improvement leadership the more nurses reported quality improvement activities undertaken by them and the higher nurses rated the impact of computerization on the quality of care. In a regression analysis quality improvement leadership and computer use/skills accounted for 30% of the variance in the perceived contribution of computerization to quality improvement.

CONCLUSIONS

(a) The present study is the first to show a relationship between organizational leadership and computer use by nurses for the purpose of improving clinical care. (b) The nurses' appreciation of the contribution computerization can make to data management and to clinical care quality improvement were both increased by the JCI accreditation process.

Attitudes of nursing staff towards computerisation: a case of two hospitals in Nairobi, Kenya

Background

The health sector is faced with constant changes as new approaches to tackle illnesses are unveiled through research. Information, communication and technology have greatly transformed healthcare practice the world over. Nursing is continually exposed to a variety of changes. Variables including age, educational level, years worked in nursing, computer knowledge and experience have been found to influence the attitudes of nurses towards computerisation. The purpose of the study was to determine the attitudes of nurses towards the use of computers and the factors that influence these attitudes.

Methods

This cross sectional descriptive study was conducted among staff nurses working at one public hospital (Kenyatta National Hospital, (KNH) and one private hospital (Aga Khan University Hospital (AKUH). A convenience sample of 200 nurses filled the questionnaires. Data was collected using the modified Nurses’ Attitudes Towards Computerisation (NATC) questionnaire.

Results

Nurses had a favorable attitude towards computerisation. Non-users had a significantly higher attitude score compared to the users (p = 0.0274). Statistically significant associations were observed with age (p = 0.039), level of education (p = 0.025), duration of exposure to computers (p = 0.025) and attitudes towards computerisation.

Conclusion

Generally, nurses have positive attitudes towards computerisation.

This information is important for the planning and implementation of computerisation in the hospital as suggested in other studies.

Barriers to evidence-based practice utilization in psychiatric/mental health nursing

Many psychiatric/mental health nursing (PMHN) practices have been affected by old traditions and haphazard trial and error instead of by established scientific evidence. The purpose of this article is to explore and analyze the barriers surrounding evidence-based practice (EBP) in PMHN. I identify some strategies to overcome these barriers in an attempt to incorporate EBP within the framework of PMHN services. Barriers explain the lack of EBP in today's PMHN environment. The barriers identified in this research are: the nature of the evidence, the contribution of the psychiatric nursing researchers to EBP, the personal characteristics of psychiatric nurses, and organizational factors. While the barriers to EBP for PMHN practice are clearly apparent, the challenge, now, is to build up creative strategies through which psychiatric nurses are better able to provide EBP care as part of their everyday performance. Adaptation of a more dynamic form of EBP, increasing the number of PMHN researchers, conducting clinical research projects, choosing suitable journals for publication, training the psychiatric nurses about computer skills, integrating the EBP principles into nursing curricula, developing journal clubs, and offering organizational facilitators are essential prerequisites for the achievement of EBP in the PMHN field. It is no longer justifiable for psychiatric nurses to be deficient in knowledge and skill since the advantages of EBP for patients are well-documented.

The effects on health behavior and health outcomes of Internet-based asynchronous communication between health providers and patients with a chronic condition: a systematic review

BACKGROUND

In support of professional practice, asynchronous communication between the patient and the provider is implemented separately or in combination with Internet-based self-management interventions. This interaction occurs primarily through electronic messaging or discussion boards. There is little evidence as to whether it is a useful tool for chronically ill patients to support their self-management and increase the effectiveness of interventions.

OBJECTIVE

The aim of our study was to review the use and usability of patient-provider asynchronous communication for chronically ill patients and the effects of such communication on health behavior, health outcomes, and patient satisfaction.

METHODS

A literature search was performed using PubMed and Embase. The quality of the articles was appraised according to the National Institute for Health and Clinical Excellence (NICE) criteria. The use and usability of the asynchronous communication was analyzed by examining the frequency of use and the number of users of the interventions with asynchronous communication, as well as of separate electronic messaging. The effectiveness of asynchronous communication was analyzed by examining effects on health behavior, health outcomes, and patient satisfaction.

RESULTS

Patients' knowledge concerning their chronic condition increased and they seemed to appreciate being able to communicate asynchronously with their providers. They not only had specific questions but also wanted to communicate about feeling ill. A decrease in visits to the physician was shown in two studies (P=.07, P=.07). Increases in self-management/self-efficacy for patients with back pain, dyspnea, and heart failure were found. Positive health outcomes were shown in 12 studies, where the clinical outcomes for diabetic patients (HbA1c level) and for asthmatic patients (forced expiratory volume [FEV]) improved. Physical symptoms improved in five studies. Five studies generated a variety of positive psychosocial outcomes.

CONCLUSIONS

The effect of asynchronous communication is not shown unequivocally in these studies. Patients seem to be interested in using email. Patients are willing to participate and are taking the initiative to discuss health issues with their providers. Additional testing of the effects of asynchronous communication on self-management in chronically ill patients is needed.

The opinions about e-health among nurses employed in hospitals located in an urban area in Poland

The acceptance of e-health solutions by users representing the main professional groups in the healthcare system is of key importance for the successful development of this field. The attitude of nurses to information technology may influence the process of shaping an e-health environment. This survey was conducted to assess the use of information technologies and opinions about e-health among nurses employed in hospital centers located in an urban area in Poland. The questionnaire included items on the use of computers and the Internet, perception of the importance of e-health systems, and opinions about the roles and benefits of e-health for healthcare stakeholders. The questionnaire was distributed to 215 nurses participating in extension courses. The analysis was performed on 153 questionnaires accepted after quality control. The respondents were convinced about the importance of information technology in the delivery of healthcare services and specifically of e-health systems; however, there was a significant group that expressed skepticism about the need for the development of e-health services in Poland at the moment. The respondents indicated the Ministry of Health, the National Health Fund, and public health specialists as the stakeholders who should have the most important role in initiating e-health development.

Root Cause Analysis: Using Theory of Constraints Application to Measure the Impact of Employee Demographics on the Adoption of Information Technology Equipment

This paper uses Theory of Constraints (TOC) improvement questions to measure how employees' demographics influence their adoption of various Information Technology Equipments (ITEs) in organisations. Survey questions in the form of a Likert scale are prepared to address these possible effects. The number of total participants was 216 and they were from two universities: Argosy University, Atlanta campus; and Brigham Young University, Provo campus. The research question for this study asked how the factors of age, gender, race, and education level positively or negatively influence employees' attitudes toward ITE adoption at their place of employment. A Pearson product-moment correlation coefficient was computed to assess the relationships and the Kruskal–Wallis and the Mann–Whitney U tests were used to compare the independent groups. The results suggested that there was a correlation among age, race and education level and indicated that age negatively correlates with employees' level of comfort with ITE use. There was a statistically significant difference at the 0.01 level between White and Black participants.

Methods, strategies and technologies used to conduct a scoping literature review of collaboration between primary care and public health

AIM

This paper describes the methods, strategies and technologies used to conduct a scoping literature review examining primary care (PC) and public health (PH) collaboration. It presents challenges encountered as well as recommendations and 'lessons learned' from conducting the review with a large geographically distributed team comprised of researchers and decision-makers using an integrated knowledge translation approach.

BACKGROUND

Scoping studies comprehensively map literature in a specific area guided by general research questions. This methodology is especially useful in researching complex topics. Thus, their popularity is growing. Stakeholder consultations are an important strategy to enhance study results. Therefore, information about how best to involve stakeholders throughout the process is necessary to improve quality and uptake of reviews.

METHODS

This review followed Arksey and O'Malley's five stages: identifying research questions; identifying relevant studies; study selection; charting the data; and collating, summarizing and reporting results. Technological tools and strategies included: citation management software (Reference Manager®), qualitative data analysis software (NVivo 8), web conferencing (Elluminate Live!) and a PH portal (eHealthOntario), teleconferences, email and face-to-face meetings.

FINDINGS

Of 6125 papers identified, 114 were retained as relevant. Most papers originated in the United Kingdom (38%), the United States (34%) and Canada (19%). Of 80 papers that reported on specific collaborations, most were descriptive reports (51.3%). Research studies represented 34 papers: 31% were program evaluations, 9% were literature reviews and 9% were discussion papers. Key strategies to ensure rigor in conducting a scoping literature review while engaging a large geographically dispersed team are presented for each stage. The use of enabling technologies was essential to managing the process. Leadership in championing the use of technologies and a clear governance structure were necessary for their successful uptake.

Behavioral health providers' beliefs about health information exchange: a statewide survey

OBJECTIVE

To assess behavioral health providers' beliefs about the benefits and barriers of health information exchange (HIE).

METHODS

Survey of a total of 2010 behavioral health providers in a Midwestern state (33% response rate), with questions based on previously reported open-ended beliefs elicitation interviews.

RESULTS

Factor analysis resulted in four groupings: beliefs that HIE would improve care and communication, add cost and time burdens, present access and vulnerability concerns, and impact workflow and control (positively and negatively). A regression model including all four factors parsimoniously predicted attitudes toward HIE. Providers clustered into two groups based on their beliefs: a majority (67%) were positive about the impact of HIE, and the remainder (33%) were negative. There were some professional/demographic differences between the two clusters of providers.

DISCUSSION

Most behavioral health providers are supportive of HIE; however, their adoption and use of it may continue to lag behind that of medical providers due to perceived cost and time burdens and concerns about access to and vulnerability of information.

Adoption of an Internet-based patient education programme in psychiatric hospitals

Internet-based patient support systems are widely assumed to predict a future trend in patient education. Coherent information is still lacking on how patient education is adopted in psychiatric hospitals and how information technology is used in it. Our aim was to describe nurses' adoption of an Internet-based patient education programme and the variables explaining it. The study was based on Rogers' model of the diffusion of innovation. The Internet-based patient education sessions were carried out by nurses on nine acute psychiatric inpatient wards in two Finnish hospitals. They were evaluated with reports and analysed statistically. Out of 100 nurses, 83 adopted the programme during the study period. The nurses fell into Rogers' groups, late majority (72%), laggards (17%), early majority (7%), early adopters (3%) and innovators (1%). Three groups were formed according to their activity: laggards, late majority, adopters (including early majority, early adopters, innovators). There was a statistical difference between the nurses' programme adoption between the two hospitals (P= 0.045): more laggards (65% vs. 35%) and adopters (73% vs. 27%) in the same hospital. The findings help to provide insight into the contexts and settings when adopting information technology programmes in the area of mental health care.

An evaluation of the usability of a computerized decision support system for nursing homes

BACKGROUND

Computerized decision support systems (CDSSs) have the potential to significantly improve the quality of nursing care of older people by enhancing the decision making of nursing personnel. Despite this potential, health care organizations have been slow to incorporate CDSSs into nursing home practices.

OBJECTIVE

This study describes facilitators and barriers that impact the ability of nursing personnel to effectively use a clinical CDSS for planning and treating pressure ulcers (PUs) and malnutrition and for following the suggested risk assessment guidelines for the care of nursing home residents.

METHODS

We employed a qualitative descriptive design using varied methods, including structured group interviews, cognitive walkthrough observations and a graphical user interface (GUI) usability evaluation. Group interviews were conducted with 25 nursing personnel from four nursing homes in southern Norway. Five nursing personnel participated in cognitive walkthrough observations and the GUI usability evaluation. Text transcripts were analyzed using qualitative content analysis.

RESULTS

Group interview participants reported that ease of use, usefulness and a supportive work environment were key facilitators of CDSS use. The barriers identified were lack of training, resistance to using computers and limited integration of the CDSS with the facility's electronic health record (EHR) system. Key findings from the usability evaluation also identified the difficulty of using the CDSS within the EHR and the poorly designed GUI integration as barriers.

CONCLUSION

Overall, we found disconnect between two types of nursing personnel. Those who were comfortable with computer technology reported positive feedback about the CDSS, while others expressed resistance to using the CDSS for various reasons. This study revealed that organizations must invest more resources in educating nursing personnel on the seriousness of PUs and poor nutrition in the elderly, providing specialized CDSS training and ensuring that nursing personnel have time in the workday to use the CDSS.

Assessment of organizational readiness for e-health in a rehabilitation centre

PURPOSE

The aims of this study were to assess organizational readiness for e-health among the staff of an out-patient rehabilitation centre and to identify the personal characteristics of potential users that may have influenced readiness.

METHODS

A cross-sectional study was conducted with 137 clinicians, 28 managers, and 47 nonclinical staff in a rehabilitation centre in Montreal, Quebec, Canada. All participants completed a self-administered questionnaire assessing organizational readiness for e-health. The measure contained three subscales: Individual, Organizational and Technological. Data were also collected on the users' profile, use of technologies and typical response to new information.

RESULTS

Generally, participants considered themselves ready to adopt e-health in their work (X = 73.8%, SD = 8.5) and they also had a favorable view of the technologies in place (X 73.8%, SD = 7.2). However, they perceived the center as being only moderately ready (X 66.6%, SD = 9.8) for e-health changes. Perceived workload and position/duties in the organization were found to have an impact on readiness for e-health.

CONCLUSIONS

These results underscore the importance of addressing organizational readiness for change as a multidimensional concept. Based on these results, implementation strategies tailored to the specific profile of a rehabilitation organization were identified.

Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly

BACKGROUND

Computerized decision support systems (CDSSs) have been shown to help health care professionals to avoid errors and improve clinical practice and efficiency in health care. Little is known about its influence on nursing practice and outcomes for residents in nursing homes.

AIM

The aim of this study was to evaluate the effects on the risk for and prevalence of pressure ulcers (PUs) and malnutrition of implementing a CDSS to improve prevention and care of PUs and also to improve nutrition in the elderly in nursing homes.

DESIGN SETTING AND PARTICIPANTS

The study used a quasi-experimental design with two intervention groups and one control group. A convenience sample of residents from 46 units in 15 nursing homes in rural areas in Norway was included. A total of 491 residents participated at baseline in 2007 and 480 residents at follow-up in 2009.

METHODS

The intervention included educational sessions in prevention of PUs and malnutrition for registered nurses (RNs) and nursing aides (NAs) in the two intervention groups. In addition, one intervention group (intervention group 1) had a CDSS integrated into the electronic healthcare record (EHR) based on two research-based risk assessment instruments: the Risk Assessment Pressure Scale (RAPS) for PU risk screening and the Mini Nutritional Assessment (MNA(®)) scale for screening nutritional status. In each participating nursing home trained RNs and NAs examined all residents who consented to participate on the RAPS and the MNA(®) scale. This examination included a skin assessment and details about PUs were collected.

RESULTS

The proportion of malnourished residents decreased significantly in intervention group 1 between the two data collection periods (2007 and 2009). No other significant effects of the CDSS on resident outcomes based on the RAPS and MNA(®) scores were found.

CONCLUSION

CDSSs used by RNs and NAs in nursing homes are still largely unexplored. A CDSS can be incorporated into the EHR to increase the meaningful use of these computerized systems in nursing home care. The effects of CDSS on healthcare provider workflow, clinical decision making and communication about preventive measures in nursing home practice still need further exploration. Based on results from our study, recommendations would be to increase both sample size and the number of RNs and NAs who participate in CDSS education programs.

The integration of Information and Communication Technology into nursing

OBJECTIVES

To identify and characterise different profiles of nurses' utilization of Information and Communication Technology (ICT) and the Internet and to identify factors that can enhance or inhibit the use of these technologies within nursing.

METHODS

An online survey of the 13,588 members of the Nurses Association of Barcelona who had a registered email account in 2006 was carried out. Factor analysis, cluster analysis and binomial logit model was undertaken.

RESULTS/FINDINGS

Although most of the nurses (76.70%) are utilizing the Internet within their daily work, multivariate statistics analysis revealed two profiles of the adoption of ICT. The first profile (4.58%) represents those nurses who value ICT and the Internet so that it forms an integral part of their practice. This group is thus referred to as 'integrated nurses'. The second profile (95.42%) represents those nurses who place less emphasis on ICT and the Internet and are consequently labelled 'non-integrated nurses'. From the statistical modelling, it was observed that undertaking research activities an emphasis on international information and a belief that health information available on the Internet was 'very relevant' play a positive and significant role in the probability of being an integrated nurse.

CONCLUSION

The emerging world of the 'integrated nurse' cannot be adequately understood without examining how nurses make use of ICT and the Internet within nursing practice and the way this is shaped by institutional, technical and professional opportunities and constraints.