Theoretical integration of user satisfaction and technology acceptance of the nursing process information system

Exploring the Usage Effectiveness of a Nursing Charge System

The nursing charge system for inpatient accounting has been utilized in healthcare institutions for years. However, the level of its effectiveness in meeting the needs of nursing services, including further development, has not been systematically evaluated. A cross-sectional study based in Delone and McLean's information system success model was applied to explore the level of effective nursing charge system usage across the five dimensions of system quality, information quality, service quality, user satisfaction, and net benefits. We conducted a survey of the inpatient units of a medical center in Taiwan from June 23, 2021, to July 23, 2021. A total of 214 valid questionnaires were collected. Using a 5-point Likert scale, the dimension with the highest score was information quality (3.71), followed by service quality (3.37), user satisfaction (3.36), net benefits (3.31), and system quality (3.23). Older nurses (r = -0.176) and those with more clinical experience (r = -0.151) viewed the nursing charge system as having less information quality. The comfort level with using the computer was positively associated with system quality (r = 0.396), information quality (r = 0.378), service quality (r = 0.275), user satisfaction (r = 0.417), and net benefits (r = 0.355). The opinions of nurses are vital. User feedback and advice should be investigated regularly to achieve system optimization.

Development of standardized nursing terminology for the process documentation of patients with chronic kidney disease

Introduction

European Nursing care Pathways (ENP) is a professional care language that utilizes software to map care processes and utilize the data for research purposes, process control, and personnel requirement calculations. However, there is a lack of internationally developed terminology systems and subset specifically designed for the nutritional management of CKD. The aim of this study was to create a subset of the standardized nursing terminology for nutrition management in patients with chronic kidney disease (CKD).

Materials and methods

According to the guidelines for subset development, four research steps were carried out: (i) Translation of version 3.2 of the ENP (chapter on kidney diseases) and understanding of the framework structure and coding rules of the ENP; (ii) Identification of relevant six-dimensional nursing terms; (iii) Creation of a framework for the subset; (iv) Review and validation by experts.

Results

A subset for CKD nutritional care was created as part of this project, comprising 630 terms, with 17 causal relationships related to nursing diagnoses, 115 symptoms, 31 causes, 34 goals/outcomes, 420 intervention specifications and 13 resources, including newly developed care terms. All terms within the subset have been created using a six-step maintenance procedure and a clinical standard pathway for nutrition management in the SAPIM mode.

Implications for nursing practice

This terminology subset can facilitate standardized care reports in CKD nutrition management, which is used to standardize nursing practice, quantify nursing, services, guidance on care decisions, promoting the exchange and use of CKD nutrition data and serve as a reference for the creation of standardized subset of nursing terminology in China.

Theory of trust and acceptance of artificial intelligence technology (TrAAIT): An instrument to assess clinician trust and acceptance of artificial intelligence

BACKGROUND

Artificial intelligence and machine learning (AI/ML) technologies like generative and ambient AI solutions are proliferating in real-world healthcare settings. Clinician trust affects adoption and impact of these systems. Organizations need a validated method to assess factors underlying trust and acceptance of AI for clinical workflows in order to improve adoption and the impact of AI.

OBJECTIVE

Our study set out to develop and assess a novel clinician-centered model to measure and explain trust and adoption of AI technology. We hypothesized that clinicians' system-specific Trust in AI is the primary predictor of both Acceptance (i.e., willingness to adopt), and post-adoption Trusting Stance (i.e., general stance towards any AI system). We validated the new model at an urban comprehensive cancer center. We produced an easily implemented survey tool for measuring clinician trust and adoption of AI.

METHODS

This survey-based, cross-sectional, psychometric study included a model development phase and validation phase. Measurement was done with five-point ascending unidirectional Likert scales. The development sample included N = 93 clinicians (physicians, advanced practice providers, nurses) that used an AI-based communication application. The validation sample included N = 73 clinicians that used a commercially available AI-powered speech-to-text application for note-writing in an electronic health record (EHR). Analytical procedures included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and partial least squares structural equation modeling (PLS-SEM). The Johnson-Neyman (JN) methodology was used to determine moderator effects.

RESULTS

In the fully moderated causal model, clinician trust explained a large amount of variance in their acceptance of a specific AI application (56%) and their post-adoption general trusting stance towards AI in general (36%). Moderators included organizational assurances, length of time using the application, and clinician age. The final validated instrument has 20 items and takes 5 min to complete on average.

CONCLUSIONS

We found that clinician acceptance of AI is determined by their degree of trust formed via information credibility, perceived application value, and reliability. The novel model, TrAAIT, explains factors underlying AI trustworthiness and acceptance for clinicians. With its easy-to-use instrument and Summative Score Dashboard, TrAAIT can help organizations implementing AI to identify and intercept barriers to clinician adoption in real-world settings.

Differing Effects of Implementation Leadership Characteristics on Nurses' Use of mHealth Technologies in Clinical Practice: Cross-Sectional Survey Study

BACKGROUND

Leadership has been consistently identified as an important factor in shaping the uptake and use of mobile health (mHealth) technologies in nursing; however, the nature and scope of leadership remain poorly delineated. This lack of detail about what leadership entails limits the practical actions that can be taken by leaders to optimize the implementation and use of mHealth technologies among nurses working clinically.

OBJECTIVE

This study aimed to examine the effects of first-level leaders' implementation leadership characteristics on nurses' intention to use and actual use of mHealth technologies in practice while controlling for nurses' individual characteristics and the voluntariness of use, perceived usefulness, and perceived ease of use of mHealth technologies.

METHODS

A cross-sectional exploratory correlational survey study of registered nurses in Canada (n=288) was conducted between January 1, 2018, and June 30, 2018. Nurses were eligible to participate if they provided direct care in any setting and used employer-provided mHealth technologies in clinical practice. Hierarchical multiple regression analyses were conducted for the 2 outcome variables: intention to use and actual use.

RESULTS

The implementation leadership characteristics of first-level leaders influenced nurses' intention to use and actual use of mHealth technologies, with 2 moderating effects found. The final model for intention to use included the interaction term for implementation leadership characteristics and education, explaining 47% of the variance in nurses' intention to use mHealth in clinical practice (F10,228=20.14; P<.001). An examination of interaction plots found that implementation leadership characteristics had a greater influence on the intention to use mHealth technologies among nurses with a registered nurse diploma or a bachelor of nursing degree than among nurses with a graduate degree or other advanced education. For actual use, implementation leadership characteristics had a significant influence on the actual use of mHealth over and above the control variables (nurses' demographic characteristics, previous experience with mHealth, and voluntariness) and other known predictors (perceived usefulness and perceived ease of use) in the model without the implementation leadership × age interaction term (β=.22; P=.001) and in the final model that included the implementation leadership × age interaction term (β=-.53; P=.03). The final model explained 40% of the variance in nurses' actual use of mHealth in their work (F10,228=15.18; P<.001). An examination of interaction plots found that, for older nurses, implementation leadership characteristics had less of an influence on their actual use of mHealth technologies.

CONCLUSIONS

Leaders responsible for the implementation of mHealth technologies need to assess and consider their implementation leadership behaviors because these play a role in influencing nurses' use of mHealth technologies. The education level and age of nurses may be important factors to consider because different groups may require different approaches to optimize their use of mHealth technologies in clinical practice.

Comparison of nursing diagnostic accuracy when aided by Knowledge-Based Clinical Decision Support Systems with Clinical Diagnostic Validity and Bayesian Decision Models for psychiatric care plan formulation among nursing students: a quasi-experimental study

BACKGROUND

The most suitable and reliable inference engines for Clinical Decision Support Systems in nursing clinical practice have rarely been explored.

PURPOSE

This study examined the effect of Clinical Diagnostic Validity-based and Bayesian Decision-based Knowledge-Based Clinical Decision Support Systems on the diagnostic accuracy of nursing students during psychiatric or mental health nursing practicums.

METHODS

A single-blinded, non-equivalent control group pretest-posttest design was adopted. The participants were 607 nursing students. In the quasi-experimental design, two intervention groups used either a Knowledge-Based Clinical Decision Support System with the Clinical Diagnostic Validity or a Knowledge-Based Clinical Decision Support System with the Bayesian Decision inference engine to complete their practicum tasks. Additionally, a control group used the psychiatric care planning system without guidance indicators to support their decision-making. SPSS, version 20.0 (IBM, Armonk, NY, USA) was used for data analysis. chi-square (χ2) test and one-way analysis of variance (ANOVA) used for categorical and continuous variables, respectively. Analysis of covariance was done to examine the PPV and sensitivity in the three groups.

RESULTS

Results for the positive predictive value and sensitivity variables indicated that decision-making competency was highest in the Clinical Diagnostic Validity group, followed by the Bayesian and control groups. The Clinical Diagnostic Validity and Bayesian Decision groups significantly outperformed the control group in terms of scores on a 3Q model questionnaire and the modified Technology Acceptance Model 3. In terms of perceived usefulness and behavioral intention, the Clinical Diagnostic Validity group had significantly higher 3Q model and modified Technology Acceptance Model 3 scores than the Bayesian Decision group, which had significantly higher scores than the control group.

CONCLUSION

Knowledge-Based Clinical Decision Support Systems can be adopted to provide patient-oriented information and assist nursing student in the rapid management of patient information and formulation of patient-centered care plans.

Healthcare Workers' Perspectives of mHealth Adoption Factors in the Developing World: Scoping Review

BACKGROUND

mHealth applications provide health practitioners with platforms that enable disease management, facilitate drug adherence, facilitate drug adherence, speed up diagnosis, monitor outbreaks, take and transfer medical images, and provide advice. Many developing economies are investing more in mobile telecommunication infrastructure than in road transport and electric power generation. Despite this, mHealth has not seen widespread adoption by healthcare workers in the developing world. This study reports a scoping review of factors that impact the adoption of mHealth by healthcare workers in the developing world, and based on these findings, a framework is developed for enhancing mHealth adoption by healthcare workers in the developing world.

METHODS

A structured literature search was performed using PubMed and Scopus, supplemented by hand searching. The searches were restricted to articles in English during the period January 2009 to December 2019 and relevant to the developing world that addressed: mobile phone use by healthcare workers and identified factors impacting the adoption of mHealth implementations. All authors reviewed selected papers, with final inclusion by consensus. Data abstraction was performed by all authors. The results were used to develop the conceptual framework using inductive iterative content analysis.

RESULTS AND DISCUSSION

Of 919 articles, 181 met the inclusion criteria and, following a review of full papers, 85 reported factors that impact (promote or impede) healthcare worker adoption of mHealth applications. These factors were categorised into 18 themes and, after continued iterative review and discussion were reduced to 7 primary categories (engagement/funding, infrastructure, training/technical support, healthcare workers' mobile-cost/ownership, system utility, motivation/staffing, patients' mobile-cost/ownership), with 17 sub-categories. These were used to design the proposed framework.

CONCLUSIONS

Successful adoption of mHealth by healthcare workers in the developing world will depend on addressing the factors identified in the proposed framework. They must be assessed in each specific setting prior to mHealth implementation. Application of the proposed framework will help shape future policy and practice of mHealth implementation in the developing world and increase adoption by health workers.

Factors influencing the adoption of internet banking: An integration of ISSM and UTAUT with price value and perceived risk

The investigation of users' satisfactions and intentions in using the services provided by commercial banks needs to be focused on internet banking, since this is the widely used banking service. This paper analyzed the satisfactions and behavioral intentions of Malaysian customers in using Internet Banking, applying the Information System Success Model (ISSM) by the integration of adoption and application technology (UTAUT) theory. Some criteria, which were taken into consideration, are as follows: perceived Risk (PR), facilitating Conditions (FC), Price (PV), Performance expectancy (PE), Information Quality (IQ), Service Quality (SEQ), and System Quality (SQ). These aspects are important to measure customers' satisfaction and behavior toward Internet and Online Banking. A sample of 362 valid responses, consisting of Malaysian customers who used E-Banking, was used for the purpose of data collection. The relationship between customers' satisfaction and factors influencing their contentment in using Online Banking was investigated. In order to evaluate this, a model called “Structural Equation Model (SEM)” was developed and used. Findings showed that most of the Online Banking users were satisfied with the system. Hence, it proves that Online Banking System was generally accepted in the Malaysian community. However, this current research is solely focused on the Malaysian community. Therefore, it may provide the necessary grounds for the study of internet banking accreditation, some useful information for the practitioners, policy makers, and the researchers to improve the system of online banking in Malaysia only. For a future study, a more well-structured research, which can accommodate the global need, would be required.

Social networking sites adoption among entrepreneurial librarians for globalizing startup business operations

Purpose

The purpose of this study is to identify the factors leading to adoption of social networking sites (SNS) by librarians of entrepreneurial libraries to provide support to business community in their market research. Identification of these adoption factors will help to design SNS in the way that led to their seamless diffusion in university libraries, making them capable of providing reliable and useful market knowledge to the business community.

Design/methodology/approach

To meet the research objectives, this study is based on the technology adoption model (TAM). The survey was conducted with 50 librarians of various universities across Europe, Asia, America, Africa and Australia, sampled through non probabilistic sampling techniques-purposive and snowball sampling. The collected data are analyzed through partial least squares structural equation modeling (PLS-SEM) to estimate the formulated structural equation model using SmartPLS 3.2.9 software version.

Findings

The results indicate that university librarians have high perception about usefulness and ease of using SNS for meeting their business objectives. The perceived usefulness (PU) is solely based on the prolonged adoption of SNS technology in personal lives of the librarians. The perceived ease of use (PEU) is triggered by the increasing quality of evolving SNS technology, especially user friendliness. The prolonged use of technology, increasing market entry of brands and improving quality of SNS will overcome librarian resistance to use SNS for market research related support to business community. Evolving technologies are more likely to be adopted seamlessly in entrepreneurial libraries.

Research limitations/implications

This study has implications for librarians, entrepreneurs and technology providers. Librarians should have flexible technology adoption policies in place to keep technology adoption synchronized with changing market conditions. Entrepreneurs should share clear and accurate business needs as well as practicing ethical and lawful business practices. They should also help libraries to gain new skills to make future adoption easier. Technology providers should focus on improving the quality of their technology by increasing their functional utilities, performance and reliability as well as making them more user-friendly.

Originality/value

This study investigates technology adoption of SNS in libraries from the perspective of providing market research related services to entrepreneurs rather than just digitalizing library services for student users.

Acceptance of clinical decision support system to prevent venous thromboembolism among nurses: an extension of the UTAUT model

Background

Venous thromboembolism has been a major public health problem and caused a heavy disease burden. Venous thromboembolism clinical decision support system was proved to have a positive influence on the prevention and management of venous thromboembolism. As the direct users, nurses' acceptance of this system is of great importance to support the successful implementation of it. However, there are few relevant studies to investigate nurses' acceptance and the associated factors are still unclear.

Objective

To investigate the determinant factors of nurses' acceptance of venous thromboembolism clinical decision support system with the modified Unified Theory of Acceptance and Use of Technology.

Methods

We designed a questionnaire based on the modified Unified Theory of Acceptance and Use of Technology and then a cross-sectional survey was conducted among nurses in a tertiary hospital in Nanjing, China. Statistically, a Structural Equation Modeling -Partial Least Squares path modeling approach was applied to examine the research model.

Results

A total of 1100 valid questionnaires were recycled. The modified model explained 74.7%, 83.0% and 86% of the variance in user satisfaction, behavioral intention and user behavior, respectively. The results showed that performance expectancy (β = 0.254, p = 0.000), social influence (β = 0.136, p = 0.047), facilitating conditions (β = 0.245, p = 0.000), self-efficacy (β = 0.121, p = 0.048) and user satisfaction (β = 0.193, p = 0.001) all had significant effects on nurses' intention. Although effort expectancy (β = 0.010, p = 0.785) did not have a direct effect on nurses' intention, it could indirectly influence nurses' intention with user satisfaction as the mediator (β = 0.296, p = 0.000). User behavior was significantly predicted by facilitating conditions (β = 0.298, p = 0.000) and user intention (β = 0.654, p = 0.001).

Conclusion

The research enhances our understanding of the determinants of nurses' acceptance of venous thromboembolism clinical decision support system. Among these factors, performance expectancy was considered as the top priority. It highlights the importance of optimizing system performance to fit the users' needs. Generally, the findings in our research provide clinical technology designers and administrators with valuable information to better meet users' requirements and promote the implementation of venous thromboembolism clinical decision support system.

A Comparison of Two Cross-Sectional Studies on Successful Model of Introducing Nursing Information System in a Regional Teaching Hospital in Taiwan

Nursing information system introduction is an important measure for hospital nursing departments to promote the clinical practice of nursing with both efficiency and quality. A comparison of two cross-sectional study designs was adopted, and the information systems success model, as proposed by DeLone and McLean (2003), was used to explore the effectiveness of the six dimensions of system quality, information quality, service quality, use, user satisfaction, and net benefits at 6 and 12 months after the introduction launch of the nursing information system in hospitals. Multiple regression analysis was used across the two cross-sectional studies. The research results found that the nursing information system conformed to the information systems success model, and half a year to 1 year after the introduction of the nursing information system, use affected the nursing information system net benefits via the mediator variable of user satisfaction; however, the effect of full mediation changed to partial mediation effect with time. The research results can be used as a reference for hospitals and nursing administrators for the newly developed nursing information system.

Effect of Electronic Medical Record Quality on Nurses' Perceived Usefulness and Ease of Use

Electronic medical records have been adopted in Korean clinical settings for a few decades. However, there is a lack of studies on the quality, usefulness, and easy use of electronic medical records examined from the perspective of nurses. This study sought the effect of the system quality, information quality, and service quality of an electronic medical record on nurses' perceived usefulness and ease of use of the electronic medical record. A total of 278 nurses from four hospitals completed a self-administered questionnaire using a 5-point Likert scale. The data were analyzed using descriptive statistics and hierarchical multiple regression methods. The results showed that the system, information, and service quality of the electronic medical records explained 36.2% of the variance in perceived usefulness ( F = 51.760, P < .001) and 43.4% of the variance in perceived ease of use ( F = 70.019, P < .001). Thus, these three qualities were significant factors predicting perceived usefulness and ease of use. The close cooperation of stakeholders including administrators, healthcare providers including nurses, and researchers involved in clinical practice will improve electronic medical record quality leading to user-friendly electronic medical record implementation. This study provided statistical interpretations to help in understanding regression analysis.

Usability, Acceptability, and Satisfaction of a Wearable Activity Tracker in Older Adults: Observational Study in a Real-Life Context in Northern Portugal

BACKGROUND

The use of activity trackers has significantly increased over the last few years. This technology has the potential to improve the levels of physical activity and health-related behaviors in older adults. However, despite the potential benefits, the rate of adoption remains low among older adults. Therefore, understanding how technology is perceived may potentially offer insight to promote its use.

OBJECTIVE

This study aimed to (1) assess acceptability, usability, and user satisfaction with the Xiaomi Mi Band 2 in Portuguese community-dwelling older adults in a real-world context; (2) explore the mediating effect of the usability on the relationship between user characteristics and satisfaction; and (3) examine the moderating effect of user characteristics on the relationship between usability and user satisfaction.

METHODS

Older adults used the Xiaomi Mi Band 2 over 15 days. The user experience was evaluated through the Technology Acceptance Model 3, System Usability Scale, and User Satisfaction Evaluation Questionnaire. An integrated framework for usability and user satisfaction was used to explore user experience. Statistical data analysis included descriptive data analysis, reliability analysis, confirmatory factor analysis, and mediation and moderation analyses.

RESULTS

A sample of 110 older adults with an average age of 68.41 years (SD 3.11) completed the user experience questionnaires. Mean user acceptance was very high-perceived ease of use: 6.45 (SD 0.78); perceptions of external control: 6.74 (SD 0.55); computer anxiety: 6.85 (SD 0.47); and behavioral intention: 6.60 (SD 0.97). The usability was excellent with an average score of 92.70 (SD 10.73), and user satisfaction was classified as a good experience 23.30 (SD 2.40). The mediation analysis confirmed the direct positive effect of usability on satisfaction (β=.530; P<.01) and the direct negative effect of depression on usability (β=-.369; P<.01). Lastly, the indirect effect of usability on user satisfaction was higher in individuals with lower Geriatric Depression Scale levels.

CONCLUSIONS

Findings demonstrate that the Xiaomi Mi Band 2 is suitable for older adults. Furthermore, the results confirmed usability as a determinant of satisfaction with the technology and extended the existing knowledge about wearable activity trackers in older adults.

Informational support for depression and quality of life improvements in older patients with cancer: a systematic review and meta-analysis

PURPOSE

To assess and summarize the effects of informational support on depression and quality of life of older patients with cancer.

METHODS

PubMed, MEDLINE, and Web of Science were searched to identify articles written in English and published until March 2021. Studies within 10 years period (2010-2021) were included. Randomized controlled trials were included if they evaluated the impact of informational support on depression and quality of life. All analyses were performed with Review Manager 5.3.

RESULTS

Twelve studies with a total of 2374 participants met the inclusion criteria. Our primary outcomes included depression and quality of life. (1) Depression: results indicated no statistically significant difference and low heterogeneity [SMD = 0.28, 95% CI (- 0.24,0.80), p = 0.45; I² = 0%], (2) Quality of life: in the subgroup analyses of EORTC QLQ-C30, results indicated a significant effect of informational support on quality of life [SMD = 2.84, 95% CI (0.63, 5.05), p = 0.03; I² = 79%]; in the subgroup analyses of FACT and SF-36, there were no significance.

CONCLUSIONS

Informational support could reduce depression and did improve the quality of life in older cancer patients with statistical significance. The findings suggested that informational support was an effective approach to improve depression and quality of life in older patients with cancer.

Patient Satisfaction in Medicine and Dentistry

Health professionals, such as medical and dental clinicians, have scant understanding of patients' experiences and perceptions of satisfaction. Nevertheless, implementing a patient-reported outcome measures (PROMs) research practice in surgical sciences is necessary. Hence, the objective of this article was to better understand patients' satisfaction with their medical and dental care. The methods of the current article are based on a narrative review of the literature strategy. A literature review was conducted using both EMBASE and Medline databases up to July 12, 2020, by combining keywords and terms related to “satisfaction theories” and “patient satisfaction,” and “medicine” or “dentistry/stomatology/odontology.” Patient satisfaction's multidimensional nature has been established since the perceived reasons for satisfaction varied widely among patients. Many aspects of treatment influence participant satisfaction at different stages of the intervention process. An improved understanding of the basis for managing patients' expectations with information reiteratively and efficiently may ultimately reduce patients' potential for negative feelings toward the medical and dental treatment experience. Lastly, the consumerist method may misrepresent the still undertheorized concept of satisfaction in health service.

Digital technology adoption scale in the blended learning context in higher education: Development, validation and testing of a specific tool

The main aim of the present study was to develop, validate and test an extended Technology Acceptance Model (TAM) that contributes to the overall understanding of students' intention to use digital tools in a blended learning context of higher education. The external bidimensional factor of familiarity with digital tools, which is not usually explained by the TAM, was included, and evaluated. Following a four-stage scale development technique, a seven-dimensional 25-item survey was developed, which includes two external correlated variables: familiarity with high-tech digital tools and familiarity with traditional digital tools, two mediator variables—computer anxiety, and perceived barriers, and three response variables, perceived usefulness, perceived ease of use and intention to use. The initial version of the survey was administered on 250 undergraduate students. Next, for another sample of 206 students, latent dimensions of the survey were tested using exploratory factor analysis. The structure of the survey was validated in two other subsequent stages with one sample of 262 responses of undergraduates and one of 310 responses of master's students from two different universities. All students who agreed to participate in research attended blended learning. The validity, reliability and invariance of the instrument were established by psychometric analyses. Collected data indicated that the survey has an adequate multifactorial structure that is reliable and invariant across degree levels. The scale is recommended for use in higher education studies targeting the promotion of blended learning and reduction of negative attitudes of learners toward digital instruments, supporting university professors to select their own efficient way to teach.

Determining Factors Affecting Nurses' Acceptance of a Care Plan System Using a Modified Technology Acceptance Model 3: Structural Equation Model With Cross-Sectional Data

Background

Health information technology is used in nursing practice worldwide, and holistic patient care planning can serve as a guide for nursing practice to ensure quality in patient-centered care. However, few studies have thoroughly analyzed users’ acceptance of care plan systems to establish individual plans.

Objective

Based on the technology acceptance model 3 (TAM3), a user technology acceptance model was established to explore what determines the acceptance of care plan systems by users in clinical settings.

Methods

Cross-sectional quantitative data were obtained from 222 nurses at eight hospitals affiliated with public organizations in Taiwan. Using the modified TAM3, the collected data were employed to analyze the determinants of user acceptance of a care plan system through structural equation modeling (SEM). We also employed moderated multiple regression analysis and partial least squares–SEM to test the moderating effects.

Results

We verified all significant effects from the use of a care plan system among bivariate patterns in the modified TAM3, except for moderating effects. Our results revealed that the determinants of perceived usefulness and perceived ease of use significantly influenced perceived usefulness and perceived ease of use, respectively. The results also indicated that nurses’ perceptions of subjective norm (path coefficient=.25, P<.001), perceived ease of use (path coefficient=.32, P<.001), and perceived usefulness (path coefficient=.31, P<.001) had significantly positive effects on their behavioral intention to use the care plan system, accounting for 69% of the total explained variance.

Conclusions

By exploring nurses’ acceptance of a care plan system, this study revealed relationships among the variables in TAM3. Our results confirm that the modified TAM3 is an innovative assessment instrument that can help managers understand nurses’ acceptance of health information technology in nursing practice to enhance the adoption of health information technology.