nursing attitudes toward information technology

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.



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.


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.

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