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How Prepared are Graduate Nurses to Embrace the Information Technology Revolution in Australian University Teaching?  


Dianne Pelletier  RN, BScN, Dip Ed, BEdStud, MSciSoc, FCN(NSW), FRCNA




Australian nurses entering university graduate studies are entering environments which are likely to be experiencing substantial pressure to adopt some of the latest developments in information technology.  As an example, in the university where this study was carried out, the on-line teaching program “TOPCLASS” was introduced.  Within three years it was  being used to deliver  90 subjects (non-nursing)  involving 6,156 students and 11,767 accounts  (Blake,1998). The relative merits of the IT innovations in terms of their effectiveness for teaching and learning,  efficiency or effectiveness in time or money saving is beyond the scope of this paper. The trend is evident and the pressure exists for nursing to take advantage of this and other innovations.  


The majority of the graduate nursing  students at the university where the study was conducted are employed.  Their own work environments, clinical or managerial are also likely to be experiencing significant changes as a result of the introduction of IT.  The literature shows that many practicing nurses lack computer competencies   (Gassert,1998) but it  is important that nurses are able to take advantage of the IT developments in both work and academic contexts   (Travis et al, 1992)   For example, Royle et al believe that  “nurses do not adequately access and use information to enhance knowledge based practice”.   (Royle et al, 1995). It may be that “nurses’ rigid work routines and the limited extent to which information seeking is valued or encouraged in the workplace create major obstacles to pursuing information”  (Blythe and Royle, 1993).  However, there is a strong thrust towards evidence based clinical practice in Australia  (Roberts, 1998)  and effective use of IT in clinical and educational environments is critical to this.   The 2000re Health Council report in NSW   (NSW Health 2000) and  the Centre for Health Online (http://www.health.gov.au/healthonline/  2000)   both signal a move towards more effective information management relying heavily on IT. Such directions will reinforce the need for nurses to be effective information managers.  

Information Technology and Australian Universities  

Technological developments and in particular, the rapid and widespread adoption of the World Wide Web, the Internet and email worldwide have led to significant changes in university teaching.  These developments have led to the use of IT in education that goes far beyond the Computer Assisted Learning or Instruction (CAL or CAI) of a decade ago.  Under the broad banners of flexible learning, on-line or distance learning, many universities are encouraging academics to offer subjects on-line and to interact with students electronically through media such as email.  On-line tutorials, chat rooms, virtual classrooms, video conferences, virtual hospitals and academic supervision are a reality in some institutions  (Hiltz,1995).   


The Australian Minister for Education,  David Kemp (Kemp, 1998)  identified as key objectives the need for flexibility, a culture of responsiveness and innovation, continuing expansion in post secondary education and opportunities for productivity gains .   Such directions can only support universities in their efforts to use IT if such strategies are seen as offering students flexibility and offering possibly cost benefits to the hard pressed institutions.  Certainly, universities are hoping to get cost benefits from the IT initiatives.


Innovation in instructional design and the use of new delivery technologies are rapid and widespread. Two medical curricula (for example University of Sydney) and many law and business subjects and courses (for example University of Technology, Sydney) being taught on the Internet and on intranets in the last two years.  Remote access to library resources is attractive to many students and can be critical for those in more remote communities.  In addition, the community’s expectations of higher education institutions are increasing. Students,  parents and  employers expecting   better outcomes from universities and are increasingly looking for products tailored to their particular interests and needs  (West, 1998).  


IT and The Australian Clinical Context  

As in America, IT innovations are moving from the management and financial areas of the health care system to the clinical arena.  While Australia remains a long way from the end point of an Electronic Medical Record, there are rapid strides being made in information  management in the clinical setting.   Most  large hospitals and metropolitan area health sectors have introduced Patient Administration Systems, Clinical Information Systems and other information management tools that support health care delivery. There are pockets of excellence in on-line image management such as the New Children’s Hospital in Sydney.  The large Royal District Nursing Service in Melbourne is well  advanced in their use of hand held devices  (Romanis et al, 1998).  The state  of New South Wales has undertaken  a Clinical Information Access Project that is placing a computer with Internet access on all hospital wards and community health centre desks for nursing use Nearhos,1998).  Critical care environments are well equipped with computerised monitoring systems and the introduction of Clinical Information Systems is proceeding in several.  Telemedicine projects are underway in most states with 41 projects in New South Wales  (http://www.health.nsw.gov.au/pmd/telehealth/) as health departments try to use IT to over come the tyranny of distance.


Nurses and Computers  

Much has been written about nurses, particularly as a predominantly female group,  and their attitudes to computers   as well as the need to include the teaching of informatics in nursing curricula  (Travis and Brennan, 1998, Gassert, 1998).    It is well known that a positive attitude is likely to facilitate introduction and use of IT  (Lacey,1993) .   Their attitude to computers in general and  their experiences with them in the clinical area have relevance to how they may  view extending their use of them in the university environment .


Although Sultana  (Sultana, 1990) concluded that nurses' attitudes to computers were more unfavourable than favourable positive responses are not an uncommon  finding.   A 1997 study  (Miller and Jeffcote,1997)     found the vast majority (98%) of their 77 respondents working with computers in a clinical environment  had a positive attitude towards the clinical and administrative use of computers.  Eighty-four percent of practice nurses had a computer terminal where they saw patients and  70% used the computer to gain access to clinical information.  However, over three-quarters of respondents felt that their training on computers was either missing or inadequate.  Seventy-four percent of the nurses surveyed when the  computers were introduced to their practice were either hardly consulted  prior to installation, or not at all.  Despite positive feelings about  computerisation, practice nurses appear to be getting insufficient or  inadequate training and support to fully utilize the technology. The attitudes of nurses towards the use of computers still appears to be  mistrustful -- possibly both from the viewpoint of their own ability to operate the technology and of the perceived usefulness of such technology in improving patient care  (Reeve and Wheeler, 1995).  Bradley  (1993)   supports this, finding that computer technology utilized in hospital settings was not meeting the needs of staff nurses. She also  found significant differences among five groups of nurses with nursing administrators reporting the most positive attitudes toward computer technology and maternal-infant nurses  the most negative attitudes toward computer technology. Personal computer use, length of nursing experience, and number of seminars, conferences, and workshops related to computer technology attended by the participants were positively correlated with nurses' attitudes toward computer technology.


Research Question  

Given the current thrust towards the use of IT in universities could nurses, as a predominantly female professional group be disadvantaged in the education stakes if they were not ready, willing and able to embrace the new initiatives? A study was designed to determine  graduate nursing students’ skills in and usage of IT, privately and at work, their interest /willingness to adopt IT initiatives and whether they would be willing to contribute financially for external on-line access to the university.   A written questionnaire-based survey was undertaken.


The Instrument  

An instrument was designed, piloted on 20 graduate diploma students and  revised.   Reliability and validity were not determined. Demographic details were determined through four select a response (tic box) questions.   The remainder of the questions were seven Likert scale,  eight select a response and five open ended questions. 


The Sample  

A convenience sample N=264 was drawn from students undertaking coursework studies at the Masters or Graduate Diploma/Master of Nursing  levels at a metropolitan university in Sydney, Australia.   Questionnaires were distributed in 17 classes.  In 10 classes (N=168) a response rate of 100% was achieved. For three classes (N=51) the response rate was 76%.   For the remaining four classes (N=49) the numbers distributed were not recorded making calculation of a response rate impossible. Overall, the response rate was high.


The Procedure  

Students were invited to complete the questionnaire in class at the beginning of the academic year and completion of the questionnaire was taken as consent to participate.




The demographic profile (N= 264) revealed 33% were entering their first year of study, 49% their second year and 11% their third or more year.  Fifty six percent had been working in nursing eight years or less with 7% working for one year or less.  The range was 1- 39 years.  Eighty three percent had a computer at home and 37% had a modem.  Gender was not determined however, in this institution the graduate nurse population is generally 85% female.


Computer Skill Use and Resources  

Respondents indicated their computer skills on a five point Likert scale with one  nil and five excellent. These data are presented according to their year of study (Figure 1).     About 90% consider their skills “average” or less even by their third year of study.  Fewer than 14% of any year consider themselves “good”.


The percentage of those with no computer skills was relatively low at 10% upon commencement of study. There remains 3% who consider themselves unskilled at the start of their third year of study. Figure 2 shows their primary areas of computer usage.


Use of CINAHL  

The results are presented in some detail for CINAHL (Cumulative Index of Nursing and Allied Health Literature) use based on the premise that use of this database is critical to the study of the discipline at university level.  The frequency of usage by year of program is presented in Figure 3. Forty-five percent of those entering first year claim to be non-users which is surprising if one considers these students are likely to be, in the majority, graduates of a Bachelor of Nursing or equivalent program.  Interestingly, 9% of second years and 4% of third years claim to never use it.  Sixty-seven percent claimed to never use the Cochrane Collaboration Data Base and 50% indicated that they had never heard of it. 


The relationship between CINAHL use and computer skills is presented in Figure 4. This figure shows that 14% of those who never use CINAHL  have no computer skills.  However,  13% claiming average skills and 17% with good skills claim to be non-users of CINAHL. However, non-users of CINAHL also claim to be active in other uses of computers including the Internet.   It may be that they are searching nursing databases and not identifying the term CINAHL with this activity.  It is possible but probably unlikely that they are working solely within MEDLINE or other databases.   Overall, the data indicates that non-usage is not necessarily tied to lack of computer literacy.


Electronic Connection to the University  

Fifty-three percent wanted to connect to the university electronically. Forty-eight percent  were willing to have a subject taught on-line.  Fifty three percent of students who owned a modem demonstrated an  interest in connecting to the university electronically  (Figure 5). Ownership of a computer and modem are likely to be linked to their willingness to connect to the university.   While there are 33% of non modem owners who did not want to connect, 47% non owners did want to connect.


Approximately half of users of word processing packages wanted to connect to the university but  53% were unsure or uninterested.  About 44% of those using computers at work would be unsure or uninterested in connecting to the university whereas 20% are somewhat interested and 36% very interested (Figure 6).  Students were asked if their present facilities would allow them to connect to the university.  Forty-four percent indicated that this would be possible.


Willingness to pay for connection

Twenty-four percent of students indicated they would be interested in connecting  to the university and the on-line study options if it meant a commitment of approximately $250 for a modem and access.  Interestingly, 49% of computer owners were unwilling to incur the cost of $250 to connect.



The issues emerging here relate to both information literacy and information management. There is likely to be a relationship, undetermined in this study  between a nurse’s capacity and performance with IT in the clinical or work environment and their actual or potential use of IT at university.   The research shows that these nurses were not  reaching the levels of computer literacy and information management likely to be needed for professional life in the new millenium.


The results seem to indicate that  the graduate students surveyed were relatively well equipped in terms of home computers and modems.  However, they rated themselves much less equipped in terms of computer skills.   Self rating is acknowledged to be problematic however,  it would seem that there should be some relationship  between what they feel their skills are and their willingness to tackle new IT initiatives and to accomplish set tasks or achieve goals.  This relationship was not determined here. While there may be a “modesty factor” in under reporting their computer skills,  the small percentages claiming good skills is of concern.  It is to be expected that poor computer literacy would interfere with good information management, in the clinical or academic environments.  The universities may have to re-examine their offerings in literacy training at the undergraduate level, if they expect  students to embrace the newer flexible learning strategies. 


Clinical managers wishing to introduce more IT need to note the level of perceived computer literacy described here.  It is not unlikely that those enrolled at the masters level  may be aspiring to a more advanced practice or a leadership role in professional life and as such they could be expected to have or need to acquire more advanced information management skills.   Skills in the use of IT which underpin information management are critical. Word processing remains the most used facility but it would be expected that use of the WWW and email would inevitably increase particularly as the Health Department is facilitating this in the workplace.  


As universities set in place more “user friendly” and less expensive options for students to connect via computers, nurses may start to take up these options more rapidly.  At the time of the study only half of them were both capable and willing.  This research indicates that many nurses   need both educational opportunities and support if they chose  remote access and on-line learning strategies.  Without support, for those without the skills and / or the confidence,  struggling with on-line teaching options may prove a negative IT experience.  Such an experience  at university could then adversely affect their adoption of IT in the workplace.  It is well established that a positive attitude influences the success of  IT implementation and all concerned would like IT experience to be optimal so that quality can be achieved whether in the outcomes of patient care or in student learning.