Knowledge, Availability and Access to Computerized ...

American Journal of Scientific Research ISSN 2301-2005 Issue 72 (2012), pp. 84-88 © EuroJournals Publishing, Inc. 2012 http://www.eurojournals.com/ajsr.htm

Knowledge, Availability and Access to Computerized Electronic Devices in Clinical Nursing Practice Chiejina E N. Nnamdi Azikiwe University Nnewi Campus Odira C C. Nnamdi Azikiwe University Nnewi Campus Abstract This study ascertained knowledge, availability and access to computerized electronic devices by nurses in clinical practice. A descriptive design was used. Simple random sampling was used in selecting 144 nurses from two Teaching Hospitals in the South-East zone of Nigeria for the study. To guide the study, three research questions and one null hypothesis were formulated. The instrument used for data collection was questionnaire titled “Availability, knowledge and Access to Nursing Informatics (QAKANI)”. Mean scores and Wilcoxon Rank Sum test were used in analyzing the data collected. The findings indicated significant difference between availability and access to computerized electronic devices in clinical nursing practice.

Keywords: Knowledge, Availability, Access, Nursing informatics, Clinical nursing

Introduction The health care industry has learned from other industries that computers facilitate speed in communication, accuracy in information, capability of information storage, data retrieval and data revision (Eggland & Heinemann, 1994). The use of electronic devices in health care, known as eHealth, is making administration more efficient and cutting down on patient waiting times (http:// cordis.europa.eu/ictresult). Technological advancements in the health sector have not left out the field of nursing. Kozier, Erb, Berman & Snyder (2004) noted the following innovations in the use of computer in Nursing practice to include Bed-side data entry (which allow recording of client/patient assessments, medication administration, progress notes, care plan updating, patient acuity and accrued charges), the computer-based patient record (CPR) (which permit electronic client data retrieval by care givers, administrators, accreditors and other persons who requires the data), data standardization and classifications (used to describe and measure clinical, disease, procedure and outcome data). Kozier et al (2004) have it that nursing has benefited greatly from the myriad of client monitors. Examples in everyday practice are the digital or tympanic thermometers, digital scales, pulse oximetry, ECG / telemetry/ haemodynamic monitoring, apnoea monitors, fetal heart monitors, blood glucose analysers, ventilators, and intravenous (IV) pumps. These devices can be used in many care settings from intensive care to the home. Delaune & Ladner (2002) explained that most of these computerized gadgets keep records of the most recent values, some can transmit their data to a more sophisticated computer or print out a paper record, some have digital displays that ‘talk’ to the user giving

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instructions or results, and most have error detection or alarms that indicate either that the instrument is malfunctioning or that the assessed valued is outside predetermined parameters. The use of electronic devices including computers have lead to process improvements which allow for less time documenting, more time with patients and therefore an increase in quality of patient care, patient safety and patient outcomes. Courtney, Demiris & Alexandie (2005) pointed out that Information Technology (IT) has the capability to change work processes, communications and the point-of-care for nurses. Lee (2007) observed that computerized documentation has been used “to help nurses organize information and improve work flow”. In addition to assisting with documentation, computerized systems also offer other assistance. Lee (2007) has it that computerized reminders for patient care interventions are very beneficial as well as computer guided interventions linked to diagnosis entered. Delaune & Ladner (2002) enumerated some of the numerous practical advantages of computers to include saving documentation time as data need to be done only once, and that the system avoids duplication, increases legibility and accuracy because the printout is easy to read, and accuracy is achieved through standardized documents that prompt the nurse for information; providing clear decisive and concise key- words which are standardized nursing terminologies (eg alert) which helps to avoid ambiguous phraseology, facilitates statistical analysis of data, enhances implementation of nursing process, enhances critical thinking and decision making by providing access to other data such as laboratory results that can be correlated with the nurses’ assessment data which enables the nurse to detect early any developing trend in the patient (eg decreasing levels in oxygenation), and supports multi disciplinary networking in which information is quickly coordinated and integrated by other departments. According to Hardwick, Pulido & Adelson (2007), the use of portable electronic devices allow nurse to-quickly and efficiently enter vital signs and nursing documentations while at the bed side; they also allow the nurse to look at patient labs, new orders and other information without leaving the patient’s bedside. Strople & Ottani (2006) state that real-time documentation has the benefit of minimizing communication errors and omissions. Studies have shown that use of electronic medical record (EMR) can reduce vital sign documentation errors by more than half compared to traditional paper charts (Gearing, OLney, Davis, Lozano, Smith & Friedman, 2006). Electronic handheld devices also have the capability to be used as a resources tool for nurses. Hardwick et al (2007) stated that many portable devices offer extensive reference materials. This allows the nurse to look for information such as drug lists and clinical references without having to return to the nursing station. Applications such as clocks and timers can assist with medication and treatment reminder as well as other activities that the nurse chooses to set (Hardwick et al, 2007). Hardwick et al (2007) also pointed out that these tools are useful not only in bedside nursing but also in home health settings. Strople & Ottani (2006) observed that the use of handheld devices or other means of electronic reporting has the potential to increase the amount of time that nurses spend on direct patient care. According to them, more time being spent with patients has been shown to decrease some patient problems such as UTI and pulmonary compromise. Strople & Ottani (2006) emphasized that exploring the full potential of an electronic reporting system along with some changes in the report processes holds promise in increasing the quality, effectiveness and efficiency of a patient centered shift report, thereby improving patient safety and patient outcomes. Hardwick et al (2007) also explained that security concerns in relation to confidential patient information can be guaranteed with computers because all patient information can be password protected on electronic devices and computers. Generally, the use of computerized devices in nursing practice can lead to an increase in the efficiency and quality of nursing care, and ultimately in an increase in patient safety.

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Chiejina E N. and Odira C C.

Problem The problem in this study is availability, knowledge and access to computers and other electronic devices by nurses in clinical practice.

Research Questions • • •

To what extent are clinical nurses knowledgeable of how to operate the computerized electronic gadgets in clinical practice? To what extent are electronic devices available for use by nurses in the clinical setting? To what extent do clinical nurses have access to computers and electronic devices in the clinical setting?

Hypothesis •

There is no significant difference between the availability and access to computers and electronic devices for use by nurses in clinical practice.

Method The study was a survey. Simple random sampling was adopted in selecting Nnamdi Azikwe University Teaching Hospital (NAUTH) Nnewi and University of Nigeria Teaching Hospital (UNTH) Ituku Ozala out of the 4 Teaching Hospitals in the South-East zone of Nigeria. Teaching Hospital were chosen for the study because, being centres of excellence and tertiary level of health care services, it is expected that they will be well equipped with innovative devices used in nursing practice. A sample size of 72 registered nurses were selected from each of the selected hospitals. Total number of nurses selected for the study was 144. The instrument used for data collection in the study was questionnaire titled “Availability, knowledge and Access to Nursing Informatics (QAKANI) which is made up of three subsections namely Availability of electronic devices, knowledge of usage of the devices and access to the devices for nursing practice. The instrument was designed by the researchers in 4-point scales ranging from I to 4 with fair/few/ sparingly used having 1 point, good/average/occasionally used having 2 points, very good/moderate/used most of the time 3 points, while excellent/ surplus/Always used has 4 points. The instrument was face validated by three experts in ICT, clinical nursing and Nursing Informatics. These experts were given copies of the draft instrument, research questions and the hypothesis for content validation. The instrument was also subjected to reliability test by collecting data from 20 nurses in a University Teaching Hospital in Rivers State. The aggregate scores were calculated, and then crombach alpha was employed to determine the internal consistency of the items. The result showed reliability co-efficient score of 0.79. The researchers used direct approach method in the data collection. Mean scores were used to answer the research questions while Wilcoxon Rank Sum test was employed in testing the null hypothesis at 0.01 level of significance.

Result Result of the study is presented in the tables below:Table 1:

Descriptive statistics of the measured variables

Variable Knowledge Availability Access Valid N (List wise)

N 144 144 144 144

X 1.7425 2.3411 2.2567

SD 0.45547 0.58515 0.65165

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Table shows that out of 144 respondents, a mean score of 1.7425 with standard deviation (SD) of 0.45547 are knowledgeable in the operation of computerized electronic devices, availability of computerized electronic devices constitutes a mean value of 2.3411 with standard deviation of 0.58515, while access to computerized electronic devices has a mean value of 2.2567 with SD of 0.65165. Table2:

Wilcoxon Rank Sum test for Access-Availability of computerized electronic devices for clinical nursing practice.

Variable Access-Availability

Ranking Order Negative Ranks Positive Ranks Ties Total

N 81a 61b 2c 144

Mean Rank 72.44 70.25

Sum of Ranks 5868.00 4285.00

a: Access < Availability b: Access > Availability c: Access = Availability

Above table 2 indicates that out of the 144 respondents, 81 constitute negative ranks with mean rank of 72.44, while 61 respondents constitute positive ranks with mean rank of 70.25. The table also shows that access is less than availability of the computerized electronic gadgets for 81 respondents, while access is more than availability for 61 respondents. There are only 2 instances in which access and availability are equal. Table 3:

Wilcoxon Rank sum test comparison of Access-Availability of computerized electronic gadgets for clinical nursing practice based on positive ranks

Variables Ranking Order Access-Availability Positive Ranks NB: Z-cal = standard score

N 61

Mean Rank 70.25

Z-cal 1.612

Z-Crit 0.107

Probability P