The increasing use of technology in nursing practice requires nursing students to be competent in nursing informatics with an attitude of acceptance of technology in the healthcare environment.
The objectives of the study were to determine final year nursing students’ perceptions and skills in nursing informatics and their attitudes towards computerisation in nursing practice.
The study population were 198 final year nursing students from a selected university in the Western Cape, South Africa. All-inclusive sampling was used. A descriptive survey was conducted using a self-administered questionnaire which included two validated scales, namely the validated Nursing Informatics Competency Assessment Tool (NICAT) and the Nurses’ Attitudes towards Computerisation scale. Means and 95% confidence intervals (CI) of the ratings of the perceived relevance of nursing informatics skills in nursing practice, perceived levels of competence in nursing informatics skills and attitudes towards computers were calculated.
A total of 91 undergraduate respondents completed the survey. Computer literacy skills were rated overall as most relevant (4.23, 95% confidence interval [95% CI]: 4.06–4.40) and the skills perceived most competent (4.16, 95% CI: 3.81–4.22). The respondents had an overall positive score for attitudes towards computerisation in healthcare (67.34, s.d. = 10.40, 95% CI: 65.18–69.51).
The study concluded that computer literacy skills, informatics literacy skills and information management skills were relevant to nursing practice, despite varying levels of competence in these skills among nurses.
What key insights into the research results and its future function are revealed? How do these insights link to the focus and scope of the journal? It should be a concise statement of the primary contribution of the manuscript; and how it fits within the scope of the journal.
The Fourth Industrial Revolution (4IR) has a major influence on the health sector, with innovative digital changes to treatment, diagnosis and monitoring of patients (Araújo
Even though the relevance of nursing informatics in nursing practice has been widely documented through global research, the integration of nursing informatics in nursing education and the perceived relevance to nursing practice for nursing students have not been widely studied. Studies have shown that although newly graduated nurses are aware of the need to use information systems and skills in practice, they were not sufficiently computer-literate and had insufficient understanding of healthcare information technology to meet nursing practice requirements (Gürdaş Topkaya & Kaya
As nursing students are in the practice environment during clinical placements, there is an expectancy that they should be proficient in ICT (Lee & Clarke
To improve nursing informatics competence, it is important that nursing curricula link the use of information technologies for educational purposes and the use in clinical practice (Forman, Armor & Miller
A descriptive survey, using a self-administered questionnaire, was conducted to investigate the perceived relevance, competence and attitudes towards nursing informatics skills of final year undergraduate nursing students. The study was conducted in a selected school of nursing at a university in the province of the Western Cape in South Africa. The school offers a 4-year undergraduate nursing degree and various postgraduate programmes. Although the nursing students are exposed to a variety of educational technologies such as online learning and high-fidelity simulation during their training, no formal informatics training for nursing practice is offered in the programme.
The targeted population for this study were the 198 final year undergraduate nursing students enrolled in a 4-year undergraduate nursing programme. All-inclusive sampling was used with questionnaires distributed to all 198 students. Final year students were chosen as these students were at the end of their student training and were entering formal nursing practice on graduation.
A self-administered questionnaire based on the validated Nursing Informatics Competency Assessment Tool (NICAT) (Rahman
Data collection was carried out by a trained research assistant during the months of October 2017 and November 2017. To ensure the availability of all students and enough time to complete the questionnaire, the research assistant met the fourth-year nursing students after a class session on a date and time provided by the class lecturers. The self-administered anonymous questionnaires, along with the information sheet and consent, were handed out to all students. An explanation of the study aim was provided, and it was reiterated that the completion of the questionnaires was voluntary and anonymous. The questionnaire took 20 min to complete and was submitted in a box as they exited the classroom.
Data analysis was conducted with SPSS® version 27. Average scores with 95% confidence intervals (CI) for perceived relevance and perceived competence were calculated for all the informatics items in the NICAT and for the three domains of computer literacy, informatics literacy and informatics management. Pearson’s correlation analysis was done to assess correlation among the domains and attitudes. An average score with 95% CI was also calculated for the negative and positive attitudinal statements and an overall attitudes score (out of 100) was calculated after negative rated items were reversed.
Ethics approval was obtained from the University of the Western Cape Humanities and Social Sciences Research Ethics Committee with Ethics reference number: HS17/1/27, and permission to conduct the study was obtained from the university registrar, the head of the nursing school and the relevant lecturer.
A total of 91 (45.9%) of the final year nursing respondents completed the survey. Nearly three-quarters of the respondents were female (65, 71.4%). The ages of respondents ranged between 19 and 49 years with over three-quarters (72, 79.1%) aged between 21 and 30 years (average age 25.8 [±5.6] years). Out of the 91 respondents, only 26 (28.6%) respondents reported that they had attended formal computer training and only four (4.4%) reported that they had attended informatics training.
Nursing informatics skills were measured in terms of perceived relevance and perceived competence in three areas: Computer literacy skills, Informatics literacy skills and Informatics management skills (
Average scores for nursing informatics skills.
Computer Literacy was rated as most relevant (4.2, 95% CI: 4.1–4.4), followed by Informatics Management (4.0, 95% CI: 3.8–4.2), with Informatics Literacy rated as least relevant (3.9, 95% CI: 3.7–4.1), though the ratings were not significantly different, Computer Literacy competence (4.2, 95% CI: 4.04.3) was rated significantly higher than Informatics Management (3.2, 95% CI: 3.0–3.4) and Informatics Literacy which was rated the lowest (3.0, 95% CI: 2.8–3.2). For both Informatics Management and Informatics Literacy, competence was significantly rated lower than relevance (
Strong significant correlations were found between computer literacy and informatics literacy relevance (
Computer literacy skills were rated overall as most relevant (4.23, 95% CI: 4.06–4.40) and the skills perceived most competent (4.16, 95% CI: 3.81–4.22) (
Computer literacy skills.
Computer literacy | Relevance |
Competence |
||
---|---|---|---|---|
Mean | 95% CI | Mean | 95% CI | |
Create, rename, move and delete files using computer operating systems such as Microsoft Windows | 4.56 | 4.17–4.56 | 4.51 | 4.13–4.51 |
Use word processing function such as save, categorise documents, copy, paste and delete | 4.54 | 4.17–4.54 | 4.52 | 4.14–4.52 |
Use of telecommunication tools such as electronic mail and facsimile (fax) | 4.51 | 4.17–4.51 | 4.43 | 4.01–4.43 |
Recognise the basic components of the computer system such as mouse, screen and workstation | 4.51 | 4.13–4.51 | 4.50 | 4.07–4.5 |
Use software to create presentations such as Microsoft PowerPoint | 4.51 | 4.13–4.51 | 4.44 | 4.07–4.44 |
Use external devices such as USB flash drive, digital camera, CDROM | 4.46 | 4.05–4.46 | 4.36 | 3.97–4.36 |
Use of remote communication tools such as Skype, Zoom, WhatsApp, Hangout, etc. | 4.39 | 3.94–4.39 | 4.39 | 4.00–4.39 |
Perform basic computer systems troubleshooting such as checking power source, rebooting computer and printing | 4.39 | 3.94–4.39 | 4.23 | 3.75–4.23 |
Manage computer systems security to protect data, devices and passwords | 4.25 | 3.79–4.25 | 4.07 | 3.58–4.07 |
Navigate computer operating systems to access installed applications and choose active printers | 4.23 | 3.79–4.23 | 4.21 | 3.75–4.21 |
CI, confidence intervals.
Informatics literacy skills were rated overall as the least relevant (3.91, 95% CI: 4.06–4.40, NS) and the respondents perceived themselves to be significantly less competent in the informatics skills (2.97, 95% CI: 2.77–3.12) (
Informatics literacy skills.
Informatics literacy skills | Relevance |
Competence |
||
---|---|---|---|---|
Mean | 95% CI | Mean | 95% CI | |
Use the Internet to locate and download items of interest | 4.56 | 3.71–4.12 | 4.57 | 4.17–4.57 |
Navigate patients’ electronic health records | 4.38 | 3.91–4.38 | 3.02 | 2.41–3.02 |
Review and acknowledge patient orders in an electronic health record | 4.31 | 3.78–4.31 | 2.97 | 2.37–2.97 |
Collect and electronically document patient signs, height and weight | 4.25 | 3.75–4.25 | 3.73 | 3.15–3.73 |
Continue patient care documentation and patient identification when computer system is down | 4.21 | 3.74–4.21 | 3.49 | 2.98–3.49 |
Use electronic systems to assist with admission and discharge process | 4.19 | 3.72–4.19 | 3.39 | 2.92–3.39 |
Develop and document care plan in electronic health record | 4.21 | 3.70–4.21 | 2.81 | 2.21–2.81 |
View trended electronic documentation to understand the effectiveness of nursing interventions | 4.16 | 3.69–4.16 | 3.41 | 2.94–3.41 |
Review electronic point of care data such as urine monitoring data relevant to care such as vitals dipstick, glucose check, and haemoglobin meter, bloods to make timely decisions | 4.16 | 3.64–4.16 | 3.09 | 2.49–3.09 |
Respond appropriately to alerts from clinical decision-making tools such as algorithms, best practice alerts | 4.01 | 3.48–4.01 | 2.91 | 2.35–2.91 |
Conduct literature searches in the accessible proprietary database systems such as CINAHL, EBSCO, etc. | 4.00 | 3.47–4.00 | 3.19 | 2.61–3.19 |
Use medication administration tools such as barcode medication verification and scanning | 3.90 | 3.33–3.9 | 2.86 | 2.30–2.86 |
Use of medication dispensing system or other electronic pharmacy dispensing units | 3.87 | 3.3–3.87 | 2.60 | 2.10–2.60 |
CI, confidence intervals.
Information management skills were rated overall as relevant (4.01, 95% CI: 3.8–4.21) and respondents perceived themselves to be less competent in information management skills than computer literacy skills, but more competent than informatics literacy skills (3.19, 95% CI: 3.00–3.39) (
Information management skills.
Information management | Relevance |
Competence |
||
---|---|---|---|---|
Mean | 95% CI | Mean | 95% CI | |
Protect confidential patient data by logging out, suspending sessions and password protection | 4.34 | 3.92–4.34 | 3.67 | 3.21–3.67 |
Use nursing data for improving practice and for clinical decision-making. | 4.33 | 3.89–4.33 | 3.60 | 3.14–3.60 |
Use data and statistical reports for unit-based quality improvement initiatives and practice evaluation. | 4.32 | 3.85–4.32 | 3.49 | 3.01–3.49 |
Find information stored in the clinical information system to guide patient care such as standardised care plans and guidelines | 4.27 | 3.84–4.27 | 3.62 | 3.17–3.62 |
Use electronic communication with colleagues, patients, or other departments | 4.20 | 3.74–4.20 | 3.54 | 3.06–3.54 |
Use electronic health record and other clinical information system as per organisational policy for documentation. | 4.13 | 3.65–4.13 | 3.00 | 2.43–3.00 |
Use information technology as a primary means of patient safety such as bedside laboratory verification, barcode scanning, etc. | 4.11 | 3.58–4.11 | 3.14 | 2.60–3.14 |
CI, confidence intervals.
The total attitude scores for respondents were 67.34 (s.d. = 10.40, 95% CI: 65.18–69.51) out of a maximum possible score of 100. The range of attitude scores for this sample was 40–94. Generally, the nurses had a positive attitude towards computerisation with the highest scores for reducing workload and increasing efficiency (
Attitudes towards computerisation.
Agreement level/5 | 95% CI | |
---|---|---|
Paperwork for nurses can be reduced greatly using computers | 3.90 | 3.70–4.10 |
Computers save steps and allow the nursing staff to become more efficient | 3.70 | 3.53–3.87 |
Computers make nurses’ jobs easier | 3.55 | 3.33–3.77 |
Computerisation of nursing data offers nurses a remarkable opportunity to improve patient care | 3.55 | 3.34–3.76 |
Increased computer use will allow nurses more time to give patient care | 3.22 | 3.00–3.44 |
Nursing data cannot be manipulated using computers | 2.90 | 2.67–3.13 |
Computers contain too much personal data to be used in an area as open as a nursing station | 3.26 | 3.02–3.5 |
Orientation for new employees takes longer because of computers | 2.93 | 2.68–3.18 |
Only one person at a time can use a computer terminal and, therefore, staff efficiency is inhibited. | 2.92 | 2.69–3.15 |
Computers can cause nurses to give less time to quality nursing care | 2.89 | 2.67–3.11 |
Confidentiality will be sacrificed by patient records being computerised | 2.88 | 2.64–3.12 |
The more computers in an institution, fewer jobs for employees | 2.88 | 2.62–3.14 |
Computers can cause a decrease in communication between hospital departments | 2.78 | 2.54–3.02 |
Because of computers, nurses will face more lawsuits | 2.70 | 2.49–2.91 |
Costs of healthcare are likely to increase because of computers | 2.70 | 2.47–2.93 |
The time spent using computers in health is out of proportion to the benefits | 2.55 | 2.32–2.78 |
Use of computers in healthcare increases costs by increasing the nurses’ workload | 2.50 | 2.25–2.75 |
Computers represent a violation of patient privacy | 2.33 | 2.10–2.56 |
If I had my way, nurses would never have to use computers | 2.17 | 1.94–2.40 |
Computers should only be used in the financial department | 2.04 | 1.81–2.27 |
CI, confidence intervals.
This study investigated the perceived relevance and competence of computer literacy, informatics literacy and informatics management in final year nursing students. In addition, attitudes to computerisation were also investigated.
Overall, computer literacy skills were rated the highest for relevance and competence by the respondents with the highest rated computer literacy skill being using Microsoft Office and Word processing and the lowest relevance and competence ratings for skills to navigate computer operating systems. The high ratings for computer literacy skills, and specifically the high ratings for the use of Word processing, were likely because of the use of Word processing and computers for educational tasks during their training and the use of social media and email to communicate socially and educationally. This is also confirmed in other studies where students are reported to commonly make use of smart phone technologies and computers at home, communicate daily via email, the Internet and social media platforms, complete assignments through the use of computers, and many have received computer training as part of nurse training (Elewa & El Guindy
Informatics literacy skills for use in nursing practice were rated overall as the least relevant and the respondents perceived themselves to be significantly less competent in informatics literacy skills. The modern healthcare environment requires nurses who are capable of successfully implementing clinical information systems, tools and devices (Khezri & Abdekhoda
Although informatics literacy skills were rated the lowest, the highest rated informatics literacy skills were related to using the Internet. The respondents’ involvement in the accessing of research findings, both in the educational and the clinical environment, the documenting of searches as a curriculum requirement in their educational programme, and the exposure to a variety of virtual tools and online environments such as eLearning within their educational programme, could have yielded a greater familiarity with the use of the Internet and Internet-related software and could have been a potential reason why their perceived relevance ratings for this skill were higher. Even so, it is significant to note that previous studies have reported that even though nursing students were frequent Internet users and using the Internet for almost all their study purposes, they had poor literacy skills with regard to the finding of credible and reliable information and were unable to evaluate high-quality from low-quality health resources on the Internet (Rathnayake & Senevirathna
Information management skills in nursing practice were rated overall as relevant, although respondents perceived themselves to be less competent in information management than in computer literacy, but more than informatics literacy. The highest rated information management skill was the confidential data management and using nursing data for improved practice and decision-making in nursing practice. The high ratings in these two skills may relate to the dominance of these skills in nursing curricula. The teaching of confidentiality of patient data is integral in most nursing curricula and the use of data for improved practice and decision-making may be related to the focus on research skills in nurse training to access to evidence-based information. Sound decision-making for improved nursing practice is a prerequisite for evidence-based practice, and is dependent on the skill to retrieve information (Rajalahti et al.
A concern was that respondents rated using electronic health records as less relevant and reported lower ratings of perceived competence. In the current climate, the era of paper-based systems for documenting patient care is drawing to an end, and the use of the electronic health record for all documentation practice will become mandated (Bowling
Informatics literacy and management skills are generally regarded as higher-level nursing informatics competence skills (Choi & De Martinis
Overall, the respondents had positive attitudes towards computerisation, especially positive attitudes around reduced paperwork for nurses and ensuring efficiency in nursing care. This finding was similar to other studies were nurses were reported to have positive attitudes towards computers (Gurdas, Topkaya and Kaya,
The introduction of formal nursing informatics training and the integration of nursing informatics skills as strands in clinical training will help prepare nursing students for the 4IR and the application and use in practice (Kaur & Rawat
With the advent of the coronavirus disease 2019 (COVID-19) pandemic and the 4IR, this study should be repeated with a bigger sample of both nursing students and practising nurses. The data should be anchored in a set of nursing informatics competencies relevant to this context and time and further studies on the perceived relevance and competence of practicing nurses on the nursing informatics will help to identify core nursing informatics competencies for professional nursing practice (Collins et al.
The study was limited to one school of nursing and thus cannot be generalised beyond the specific school. Some questions may have been difficult for respondents to complete and an adaptation of the questions to current practice may be beneficial.
This study investigated final year nursing students’ perceptions on the relevance of nursing informatics skills along with their perceived competence in these skills and their attitudes towards computerisation. Although the educational preparation of the respondents in this study appears to successfully develop computer literacy skills, such as using a computer and accessing and using data, the development of nursing informatics literacy and management skills is inadequate.
The authors would like to acknowledge the support of Ms Rita Abiodun.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
J.C., L.l.R., J.A. and M.B. contributed to the manuscript. J.C. and L.l.R. supervised the student J.A. J.A. and J.C. conceptualised the study. All authors participated in the drafting of the original manuscript. J.A. did the data analysis. J.C., M.B., and L.l.R. contributed to the reviewing and editing of the document.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Data are available on request from the corresponding author, J.C.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.