nursing attitudes toward information technology

Upload: christina-barrett

Post on 16-Oct-2015

26 views

Category:

Documents


0 download

DESCRIPTION

nursing and technology

TRANSCRIPT

  • Post-basic nursing students access to and attitudes toward theuse of information technology in practice: a descriptive analysis

    Z. Z. NKOSI PHD , MCUR , B C UR 1, F. ASAH MI S , M PH2 and P. PILLAY MCUR , B C UR 3

    1Associate Professor, University of South Africa (UNISA), 2Researcher and Facilitator, Centre for Rural Health,University of KwaZulu-Natal (UKZN) and 3Lecturer, Durban University of Technology (DUT)

    Introduction

    The healthcare sector worldwide is experiencing a ma-

    jor transformation as a result of information technology

    (IT) (Booysen 2009). For example, hospitals are

    adapting to IT because they reduce costs, increases

    efficiency and effectiveness in the delivery of healthcare

    services. Furthermore, healthcare systems are moving

    towards electronic health records. As a result of this

    transformation, nursing practices have been affected. In

    the UK and America, for example, IT has been closely

    integrated into both nursing curriculum and practices.

    As a result terminologies such as nursing informatics

    and tele-nursing are common in nursing today (McNeil

    et al. 2006).

    Information technology (IT) is an umbrella term used

    to describe all forms of technology both hardware and

    software, used to create, store, exchange and use

    Correspondence

    Z. Z. Nkosi

    Department of Health Studies

    University of South Africa

    UNISA Pretoria

    0003

    South Africa

    E-mail: [email protected]

    NKOS I Z . Z . , ASAH F . & P ILLAY P. (2011) Journal of Nursing Management 19, 876882

    Post-basic nursing students access to and attitudes toward the use ofinformation technology in practice: a descriptive analysis

    Background Nurses are exposed to the changing demands in technology as theyexecute their patient-related duties in the workplace. Integration of Information

    Technology (IT) in healthcare systems improves the quality of care provided. Nursing

    students with prior exposure to computers tend to have a positive influence IT.Methodology A descriptive study design using a quantitative approach and struc-

    tured questionnaire was used to measure the nurses attitudes towards computerusage. A census of 45 post-basic first year nursing management students were

    participated in this study.

    Results The students demonstrated a positive attitude towards the use of a com-

    puter. But access to and use of a computer and IT was limited and nurses in clinics

    had no access to IT. A lack of computer skills was identified as a factor that hinders

    access to IT.

    Conclusion Nursing students agreed that computer literacy should be included in

    the curriculum to allow them to become independent computer users. The

    Department of Health should have IT in all health-care facilities and also train all

    health-care workers to use IT.

    Implications for Nurse Managers With the positive attitudes expressed by the

    students, nurse managers need to create a conducive environment to ensure such a

    positive attitude continues to excel.

    Keywords: attitudes, computer systems, post-basic nursing students, unit managementand information technology.

    Accepted for publication: 4 August 2011

    Journal of Nursing Management, 2011, 19, 876882

    DOI: 10.1111/j.1365-2834.2011.01303.x876 2011 Blackwell Publishing Ltd

  • information in its various forms. It includes both tele-

    phone and computer technology in the same word. It is

    the technology that is driving what has often been called

    the information revolution (Yee 2002). In the presentstudy, IT refers to an interconnected computer system

    which includes printers, scanners, with access to the

    intranet or internet.

    In clinical practices, the advantages of using IT are

    enormous. IT has the potential to make both patients

    and nurses safer, for example computerized charting and

    bar coding for medication administration, has been used

    to minimize errors and to provide access to vast volumes

    of information required to meet the needs of day-to-day

    patient care (IIIyasu et al. 2005). Through the use of IT

    nurses are able to save time on repetitive activities such

    as issuing prescription slips, preparing patients admis-sion and discharge records, giving them more time to

    provide quality services to patients (Willmer 2005). In

    addition, clerical activities such as printing of patients

    forms will be reduced (IIIyasu et al. 2005). Computers

    and innovation theorists report that the introduction of

    computers in organizations has led to fear, anxiety and

    attitudes (Anandarajan et al. 2002). In nursing, for

    example, studies have reported nurses attitudes towardsthe use of a computer (Kivuti-Bitok 2009).

    Nursing students attitudes can affect the success ofchange management and the integration of technology

    into daily patient care. Hence attitudes may affect the

    implementation and the adoption of IT (Smith et al.

    2011). The prevalent components of attitudes towards

    computer usage are computer anxiety, computer liking

    and computer confidence (Alquraini et al. 2007). This

    also involves an array of emotional reactions including

    fear, apprehension, uneasiness and distrust of IT. Fac-

    tors that have led to attitudes towards IT are the level of

    education, years of experience, computer exposure,age, gender, job title and access to a computer (Alqu-

    raini et al. 2007, Kivuti-Bitok 2009).

    The literature report of attitudes towards computer

    usage is affected by nurses level of education. Forexample, senior nurses, such as nursemanagers inKenya,

    have a positive attitude towards IT usage, as compared

    with their subordinates (Kivuti-Bitok 2009). Nurses with

    previous exposure to andwhohave undergone training in

    IT were found to be more confident and had a positive

    attitude towards IT. They tend to learn faster and easier

    than those without computer training or exposure (Ya-

    ghmaie & Jayasuriya 2004). It was found that exposure

    to IT is the only factor that contributed to a positive

    attitude. As a result, many countries have started to

    integrate computer courses into the nursing curriculum

    to build confidence at a very early stage (Yaghmaie &

    Jayasuriya 2004). Multiple factors facilitate or impede

    diffusion and adoption of various innovations and tech-

    nology and these changes also empower people to take

    risks and embrace change (Barr 2002).

    The literature also shows that age and gender influ-

    ence nurses attitudes towards IT (Alquraini et al.2007). It was found that older nurses who had no

    training in the use of computers were more likely to

    display negative attitudes than younger nurses while

    female nurses tend to be slow in engaging with com-

    puting than their male counterparts (Kivuti-Bitok

    2009). Nurses in the present study were between the

    ages of 31 and 60 years old.

    Previous studies have reported on a lack of access to IT

    in the workplace. A lack of access to computers is one of

    the major factors that inhibit access to IT on the entire

    Africa continent (Oak 2007) and most particularly in

    rural areas (Jensen 2005). As a result, the South African

    government, for example, have recognized the impor-

    tance IT plays in strengthening the educational systems of

    the previously disadvantaged communities and have is-

    sued a document that IT should be integrated in all

    schools (Department of Education 2005). The emphasis

    is to promote technology discourse and also to expose

    young students to IT to promote positive attitudes. As a

    result, IT will be introduced in to every institution (high

    schools and colleges) of learning (Department of Educa-

    tion 2005). It is, however, unclear whether the depart-

    ment of health shares the same vision. According to a

    previous study on the learning needs of healthcare pro-

    fessionals in northern KwaZulu-Natal, it was found that

    nurses are less disadvantaged comparedwith doctors and

    allied healthcare workers regarding access to IT (Asah

    2010). In a follow-up study on challenges professional

    nurses encounter after being trained, the researcher found

    that access to a computer was the largest barrier to IT.

    The study found that at nursing colleges in the region,

    northern KwaZulu-Natal, for example, in a class of 17

    students, there is only one computer (Asah 2010).

    Although the advantages of using computers by nur-

    ses are enormous, it has been suggested that before the

    introduction of IT in an institution, for example, it is

    important to understand the staff attitudes towards

    technology because it may influence their successful

    adoption of information competencies and willingness

    to learn computer systems (Maag 2006). The School of

    Nursing at a university in KwaZulu-Natal intends to

    introduce computer courses in the nursing management

    curricula for post-basic students. In order to identify

    factors that influence post-basic nursing students atti-tudes towards computer usage, a study was conducted

    to describe students attitude towards the use of IT. The

    Nurses students access and attitudes to IT

    2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 876882 877

  • findings of the present study will be used as baseline

    information for a School of Nursing, and also for the

    development of continuing educational programmes for

    nurses.

    The objectives were to describe the attitudes of post-

    basic nursing students towards using IT in nursing prac-

    tice; identify the barriers faced by post-basic nursing

    students in accessing information technology in nursing

    practice; and to make recommendations for the unit

    manager in nursing practice regarding computer usage.

    Methodology

    The present study used a quantitative approach and a

    structured self-administered questionnaire to collect

    data. Quantitative research involves investigating the

    phenomena that lends itself to precise measurement and

    quantification (Polit & Beck 2008).

    The target population for the study was post-basic

    nursing students in the Nursing Management pro-

    gramme of a nursing school at a university in KwaZulu-

    Natal. The post-basic nursing students are professional

    nurses who hold a diploma or degree in nursing and are

    already working and hold different posts of responsi-

    bilities at government healthcare facilities in KwaZulu-

    Natal province. Most of the nurses completed their

    educational career during the period whereby comput-

    ers were not available at healthcare facilities. The

    majority of these students do not have access to IT at

    their various facilities. It is only when they are on

    campus (university) that they are able to access the

    universitys IT facilities, library and electronic data-bases. The KZN province, where the present study took

    place, is one of nine provinces in the country. The

    province has the highest HIV/AIDs, sexually transmit-

    ted infections and diarrhoea incidence rates. In addi-

    tion, the population is also experiencing an increase in

    diseases such as multi-drug-resistant tuberculosis (TB),

    extreme drug-resistant TB and malaria (Solidarity

    Research Institute 2009); as a result, the province has a

    high burden of disease (KZN Health 2011).

    The target population was post-basic nursing stu-

    dents and a census of all the students (n = 45) who

    registered for this programme participated in the pres-

    ent study. They were selected using a purposive non-

    probability sampling method. Data were collected by a

    questionnaire adapted from Alquraini et al. (2007).

    These questions were structured in five-point Likert-

    style scale descriptors: 1 = strongly agree, 2 = agree,

    3 = neutral, 4 = strongly disagree and 5 = disagree. The

    Likert-style scale was preferred because it is the most

    commonly used attitude scale, and it provides a better

    spread of opinions relating to attitudes towards IT

    (Stricklin et al. 2003) and has been confirmed that the

    content validity and reliability have been found to be

    high (Alquraini et al. 2007).

    Before the adaptation of the questionnaire, it was

    reviewed by the researchers and also validated by nurse

    educators from the School of Nursing (SON) to obtain

    experts opinions. The questionnaire included itemsabout demographic variables, access to IT, frequency of

    using IT, open-ended questions on factors that inhibit

    access to IT and Likert-style attitudinal statements

    about the use of IT.

    The questionnaire was pre-tested among five profes-

    sional nurses studying in a different programme but who

    have similar characteristics to the study group. This was

    done to determine the effectiveness of the tool and these

    nurses were not included as study respondents during the

    main study. The respondents in the pre-test phase were

    encouraged to give their honest opinions. The question-

    naire was tested to enable the researchers to ensure the

    feasibility, reliability andvalidity of the study tools (Brink

    &Wood 1998). The feedback from the pre-test led to the

    modification and clarification of some of the questions.

    During the month of August 2009, the questionnaire

    was self-administered to post-basic nurses attending a

    nursing services management programme at a university

    in KwaZulu-Natal. The questionnaires were adminis-

    tered by the researchers and collected 1 hour after

    administration. The entire class which comprises 45

    nurses participated in the study, giving a response rate

    of 100%.

    Data analysis

    The researchers collected all questionnaires 1 hour after

    they were administered. The data were checked

    for completeness. Inconsistencies were identified and

    addressed.

    Data were captured and analysed using the SPSS

    statistical package version 15 (SPSS Inc., Chicago, IL,

    USA). Descriptive analysis (frequencies, mean, median,

    mode and cross-tabulations) were used to analyse all

    items on the questionnaire. Responses on the attitudinal

    statements were re-coded from a five-point Likert style

    at a 3-point scale and the new coding style is as follows:

    1 = strongly agree and agree; 2 = neutral, 3 = disagree

    and strongly disagree.

    Results

    Of the 45 questionnaires distributed, all were returned,

    giving a 100% response rate. Forty-two (93.3%)

    Z. Z. Nkosi et al.

    878 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 876882

  • respondents were female and only three (6.7%) were

    males. Other demographic details are shown on Table 1.

    Use of a computer

    Overall, 19 (42%) of the respondents stated that they

    have access to a computer and they all have access to a

    computer at work and this comprises nursing managers

    2 (10.55); hospital-based nurses 11 (58%), and clinic

    matrons 6 (31.%).

    The respondents were asked to state how frequently

    they have used a computer during the month of July.

    Access to IT was compared with the respondents jobtitle and the results show that hospital-based respon-

    dents were the most frequent computer users for the

    month of July (see Table 2).

    Access to information technology (internet andintranet)

    With access to the intranet and internet, nurses will be

    able to communicate with colleagues, access patientsrecords and also electronic resources in databases. Out

    of the 19 respondents who had access to a computer, 13

    (68%) had access to both the internet and intranet and 6

    (32%) did not have access. Surprisingly, clinic managers

    did not have access to either the internet or intranet.

    Factors that hinder access to a computer

    The nurses were asked to list factors that hinder access

    to IT in their healthcare facilities. Content analysis was

    used to codify the factors. The factors were categorized

    under the following five broad headings: lack of com-

    puter skills, lack of access, lack of time, lack of support

    and budgetary constraints. The results are presented in

    Table 3.

    Attitudes towards computer

    The nurses were also presented with 16 computer atti-

    tudinal statements relating to using a computer for the

    delivery of healthcare services. The statements were

    rated on a Likert scale ranging from 1 = agree to

    Table 1Characteristics of respondents (n = 45)

    No. ofrespondents Percent

    GenderFemale 42 93Males 3 7

    Ages (in categories)3135 6 133640 8 184145 14 314650 8 1851+ 9 20

    Access to computerYes 19 42No 26 58

    Job titleNurse manager 1 2Hospital-basedprofessional nurse*

    22 49

    Clinic Matrons 22 49Educational levelDiploma 39 87Degree 6 13

    Facility typeDistrict hospital 19 42Tertiary hospitals 10 22Clinics 16 36

    *Professional nurse is a nurse (general,psychiatry and community)and midwife who has received education and training at an approvednursing school and was registered under the Nursing Act 50 of 1978(SANC, 2011).

    Table 2Computer usage and job title (n = 19)

    How often did you use a computer inthe month of July?

    Mostfrequentusers

    Frequentusers

    Lessfrequentusers Never

    Nursing managers (n = 2) 0 1 0 1Hospital-based (n = 11) 3 0 2 6Clinic managers (n = 6) 2 0 0 4

    The results are in numbers and not in percentages.

    Table 3The factor that hindered access to information technology (IT)(n = 45)

    The factor that hindered accessto a computer

    Frequenciesand percentages

    (n = 45), %

    Lack of computer skills 45 (99.9)Lack of accessNo intranet/internet 20 (44.4)No password 20 (44.4)

    Lack of timeShortage of nurses, thereforenurses are overworked and donot have time to use the computer

    35 (77.7)

    Lack of supportComputer is faulty 18 (40)

    Budget constraints cannot buyadditional information technology

    10 (22.2)

    Multiple responses were received.

    Nurses students access and attitudes to IT

    2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 876882 879

  • 3 = disagree. Although 19 (42%) respondents had

    access to computers, 13 (68%) had access to the

    internet and intranet, but on the attitudinal statements

    the nurses agreed that there are benefits to using infor-

    mation technology in the delivery of healthcare. They

    also strongly disagreed with statements that using a

    computer reduces communication between hospital

    departments (see Table 4).

    Discussion

    Although the present study was restricted to post-basic

    nursing students, the findings raise issues that have

    wider applicability. Of the 45 respondents who partic-

    ipated in the study, 19 have access to a computer, of

    which only 13 have access to the intranet and internet,

    but the overall responses on the attitudinal statements

    were positive which implies that the nurses have a po-

    sitive attitude towards using IT for healthcare delivery.

    These findings are consistent with the findings by

    Hegney et al. (2009) which imply that the post-basic

    nursing students have a positive attitude towards com-

    puter technology and are willing to use IT to improve

    the quality of patient care.

    A lack of computer skills was found to be one of the

    major factors that hinder access to computers (see

    Table 3). No usage of IT in general and computers in

    particular as a result of lack of computer skills is a

    challenge in the advancement of Information Computer

    Technology (ICT) on the African content (Jensen 2005).

    Nabirye and Moss (2008) have lamented on the fact

    that a lack of computer skills has led to nurses not being

    able to take advantage of the advancement in IT.

    Computer skills are broad and from the literature, there

    is no agreement on what computer skills are required by

    nurses, but Gerrish et al. (2006) recommended that

    nurses need to know more than just the Microsoft Suite.

    Their computer training programme should include

    skills on how to perform a literature search on an

    electronic database. As a result of the discrepancy on

    the type of computer skills required by nurses, McNeil

    et al. (2006), however, recommended that IT be closely

    integrated in the nursing curriculum. Thus, nurses will

    be able to understand the importance IT plays in nurs-

    ing and healthcare delivery in general rather than them

    having to learn computer literacy courses as a stand-

    alone programme. Therefore, the challenge is on nurs-

    ing managers and educators to integrate IT into the

    nursing curriculum.

    Although the responses on the attitudinal statements

    show that the nurses have a positive attitude and are

    willing to use computers for work-related purposes, the

    other factors that hinder access to computer as listed on

    Table 3 should be taken into consideration. A positive

    attitude could easily lead to a negative attitude and also

    resistance to computers if nurses are over worked,

    computers are not repaired in time, etc. instead it will

    be better to create an environment that supports the use

    for IT.

    Recommendations for the unit manager

    All professional nurses working in different units should

    have access to IT. More training on the importance of

    Table 4Post-basic staff attitudes to computer use in the workplace (N = 45)

    No. Statements Agree Neutral Disagree

    1 Computers make nurses jobs easier 86.6 8.9 4.42 Computers allow nurses tasks to be more efficient 93.3 6.7 03 Only one person at a time can use the computer terminal, therefore, staff efficiency is inhibited 44.3 22.4 33.34 Computerization of nursing data offers nurses a remarkable opportunity to improve patient care 93.3 4.4 2.25 Computers causes nurses to give less time to give quality care to patients 31.1 6.7 62.206 Paperwork for nurses can be greatly reduced by the use of computer 97.8 2.2 07 Computers allow nurses more time for professional tasks for which he/she is trained 78.70 8.9 13.38 Computers save repeated documentation and allow the nursing staff to become more efficient 88.9 11.1 09 A computer increases costs by increasing the nurses workload 11.2 42.2 46.610 Part of the increase in healthcare costs is because of computer 28.9 20 51.1011 Computer causes a decrease in communication between hospital departments 20 8.9 71.112 Computers represent a violation of patient confidentiality 33.3 22.2 44.413 Orientation of new employees will take longer because of computers and, therefore, unnecessary

    work delays will occur28.9 20 51.10

    14 The more computers in an institution the fewer jobs for employees 35.6 13.3 51.1015 Computers represent a violation of patients privacy 40 13.3 46.616 The increased amount of time spent using a computer is out of proportion to the benefits 11.1 20 68.9

    Agree and strongly agree = 1, neutral = 2, disagree and strongly disagree = 3.

    Z. Z. Nkosi et al.

    880 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 876882

  • IT in healthcare delivery should be imparted in the

    departments and units to empower nurses and create

    awareness on IT in healthcare delivery. Visionary

    nursing leadership is essential to finding new ways to

    apply these technologies to enhance patient care deliv-

    ery and also to create an environment suitable and

    conducive for nurses to use IT. Nursing managers

    should be able to create an environment that supports

    the use of technology for learning so that a broader

    array of learning activities may become independently

    viable to healthcare facilities.

    Limitations of the study

    The present study involved post-basic nursing students

    doing a nursing service management module at this

    university only. The sample was also too small. Gen-

    eralizations outside of this university programme

    should be made cautiously.

    Conclusion

    In the 21st century, healthcare settings are becoming

    increasingly information intensive. It is crucial that

    nurses, who are the largest force of healthcare provid-

    ers, and frontline care providers, are able to fully em-

    brace the opportunities IT present to enable them to

    function efficiently in their daily work.

    The issues raised by this study have implications for

    nursing practice and policy. Therefore, it is important

    to ensure that the obstacles to nurses having access and

    using IT are addressed.

    Source of Funding

    The study was not funded from any source.

    Ethical approval

    Ethical approval to conduct the study was obtained

    from the university Research and Ethics Committee.

    Gateway permission to conduct the study among reg-

    istered post-basic nursing students was granted by the

    Head of the Nursing School.

    All the information was disclosed to the respon-

    dents. Study-subjects anonymity and confidentiality

    was ensured as no names were used on the ques-

    tionnaires. Written consent was obtained from the

    respondents. Furthermore, the respondents were in-

    formed that they were free to either participate or

    withdraw from the study without any repercussions

    whatsoever.

    Acknowledgements

    The authors would like to thank all the respondents of

    this study.

    References

    Alquraini H., Majeed A., Shah M. & Chowdhury R. (2007)

    Factors influencing nurses attitudes towards the use of com-puterizsd health information systems in Kuwaiti hospitals.

    Journal of Advanced Nursing 57 (4), 375381.

    Anandarajan M., Igbaria M. & Anakwe U. (2002) IT accep-

    tance in a less-developed country: a motivational factor

    perspective. International Journal of Information Manage-

    ment 22, 4765.

    Asah F. (2010) The Digital Divide: Challenges Faced by Profes-

    sional Nurses In Northern KZN in Accessing Information

    Technology. Unpublished masters dissertation, School ofCommunity Health, University of KwaZulu-Natal, Durban.

    Barr B.J. (2002) Managing change during an information systems

    transmission. Association of Operating Room Nurses 75 (6),

    10851092.

    Booysen M. (2009) An Assessment of the Computer Literacy

    Status in Nurse Managers in a Private Hospital Group in the

    Nelson Mandela Metropolitan Area. Master thesis, Nelson

    Mandela Metropolitan University, South Africa.

    Brink P. & Wood M. (1998) Advanced Design in Nursing

    Research. Sage, Thousand Oaks, CA.

    Department of Education (2005) Speech by minister of education,

    Pretoria, South Africa [WWW document]. Available at: http://

    www.doe.org.za, accessed 20 February 2011.

    Gerrish K., Morgan A., Mabbortt I. et al. (2006) Factors influ-

    encing use of information technology by nurses and midwives.

    Practice Development in Health Care 5 (2), 92101.

    Health KwaZulu-Natal (2011) Health districts [WWW docu-

    ment]. Available at: http://www.kznhealth.gov.za/districts.htm,

    accessed 10 February 2011.

    Hegney D., Eley R., Soar J. & Buikstra E. (2009) Attitudes of

    Australian nurses to information technology in the workplace:

    a national survey. Information technology, Informatics Nurs-

    ing 27 (20), 114121.

    IIIyasu Z., Abubakar S., Kabir M. & Abbas M. (2005) Computer

    knowledge, attitude and skills among healthcare professionals

    in Aminu Kano Teaching Hospital, Nigeria. Nigerian Journal

    of Medicine 14 (2), 200205.

    Jensen M. (2005) ICT in Africa: a status report [WWW docu-

    ment]. Available at: http://www3.sn.apc.org/africa/afstat.htm,

    accessed 20 November 2008.

    Kivuti-Bitok W. (2009) What do nurse managers want comput-

    erised? Need-based assessment study of middle and functional

    level nurse managers at Kenyatta National Hospital, Kenya

    Health Information in Developing countries 3 (2), 511.

    Maag M. (2006) Nursing students attitudes toward technology:a national study. Nurse Education 31 (3), 112118.

    McNeil B., Elfrink V., Beyea S., Pierce S. & Bickford C. (2006)

    Computer literacy study: report of qualitative findings. Journal

    of Professional Nursing 22 (1), 5259.

    Nabirye R. & Moss J. (2008) Implementing computer-based

    patient records in the Ugandan healthcare systems: challenges

    Nurses students access and attitudes to IT

    2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 876882 881

  • and opportunities. Information technology, Information,

    Nursing 26 (3), 131134.

    Oak M. (2007) A review on barriers to implementing health

    informatics in developing countries [Electronic version]. Jour-

    nal of Health Informatics in Developing Countries 1 (1),

    1922. Available at: http://www.jhidc.org/index.php/jhidc/

    article/view/3, accessed 10 May 2010.

    Polit D. & Beck C. (2008) Nursing Research: Generating and

    Assessing Evidence for Nursing Practice, 8th edn. Lippincot:

    Williams & Wilkins, USA.

    SANC (2011) Regulations relating to approval of and minimum

    requirements for the education and training of a nurse and

    midwife leading to registration. Available at: http://www.sanc.

    co.za, accessed 04 September 2011.

    Smith D., Morris A. & Janke J. (2011) Nursing satisfaction and

    attitudes with computerized software implementation. A quasi-

    experimental study. Computers Informatics Nursing 29 (4),

    245250.

    Solidarity Research Institute (2009) Nurse shortage in South

    Africa: nurse/patient ratios [WWW document]. Available at:

    http://www.solidarity.co.za, accessed on June 2011.

    Stricklin M., Bierer B. & Struk C. (2003) Home care nursesattitudes toward computers: a confirmatory factor analysis of

    the Stronge and Brodt instrument. Computers, Informatics

    Nursing 21 (2), 103111.

    Willmer M. (2005) Promoting practical clinical management

    learning: the current situation about information and commu-

    nication technology capability development in student nurses.

    Journal of Nursing Management 13, 467476.

    Yaghmaie F. & Jayasuriya R. (2004) The roles of subjective

    computer training and management support in the use of

    information technology in community health centres. Infor-

    matics in Primary Care 4 (12), 163170.

    Yee C. (2002) Identifying information technology competencies

    needed in Singapore nursing education. Computers in Nursing

    20 (5), 209214.

    Z. Z. Nkosi et al.

    882 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 876882

  • Copyright of Journal of Nursing Management is the property of Wiley-Blackwell and its content may not becopied or emailed to multiple sites or posted to a listserv without the copyright holder's express writtenpermission. However, users may print, download, or email articles for individual use.