An Exploratory Study to Assess the Computer Knowledge, Attitude and Skill Among Nurses in Health care Setting of a Selected Hospital, Ludhiana, Punjab, India.
Emans Evangel Joel Raja , Rajinder Mahal and Veena Barkat Masih
Raja, E.E.J., Mahal, R. and Masih, V.B. (February 2004). An Exploratory Study to Assess the Computer Knowledge, Attitude and Skill Among Nurses in Health care Setting of a Selected Hospital, Ludhiana, Punjab, India. Online Journal of Nursing Informatics (OJNI). Vol. 8, No. 1. [Online]. Available at http://ojni.org/8_1/raja.htm
An explorative study conducted to assess and identify deficit areas of computer knowledge, attitudes and skills among nurses working in the hospital and to examine the relationship among these factors. 120 staff nurses were surveyed by systematic random sampling. Computer knowledge, attitudes and skills were measured by a self-structured computer knowledge questionnaire, computer attitude and skill scale respectively. Data analysis showed that the majority 75% staff nurses had good computer knowledge. 100% of nurses had positive attitudes towards computer utilization. 50.8% and 30.8% had average and fair computer skills respectively. No significant correlation was found between nurses computer knowledge, attitude and skills. The relationships of computer knowledge, attitude and skill were analyzed among nurses with the selected variables like age, sex, designation, years of nursing service, professional qualification, area of nursing service, type of computer training received, frequency of computer usage and monthly family income. Strategies to enhance nurses computer knowledge, attitudes and skills were proposed.
Keywords : Attitude, Computer, Knowledge, Skill, Nursing, Clinical informaties.
Computers influence every sphere of human activity and bring many changes in education, healthcare and scientific research etc. Computers can perform a wide range of activities that save time and help nurses to provide quality nursing care. Nurses need to be aware of the forces having an impact on nursing. Pocklington and Baron stated that nurses acquire new roles because of computerization, it's not a matter of nurses losing jobs due to computerization, it is a matter of changing the job profile (1) computerization could resolve certain problems and derive benefits including reduction in clerical work required of professionals, reduction in printed forms, centralized patient care data etc. Finally, a fast, accurate method of patient identification would give the nurse more time for the direct patient care. The nurse could use more time to develop the nurse-patient concerns and educate patients and relatives about medication and treatments etc. (2). The computerization will improve the efficiency of health care. Its successful implementation is likely to be directly related to nurses computer related knowledge, attitude and skills. Therefore, it is necessary to asses these factors and study the relationships among them. The findings will provde baseline information for nurse administrators in planning ongoing computer training. Since the researcher had interest in computer learning and has undergone extensive training. Hence felt the need to incorporate the learning into practice. Even while working in different institutions the utilization of computer were lacking gave the researcher the insight to take up this project.
Objectives of the Study
Materials and Methods
Non experimental, descriptive approach was considered appropriate for the present study.
Selection and Description of the setting
The present study was conducted in the Chrisitian Medical College and Hospital, Ludhiana, Punjab, India .
This hospital was established in 1894. It is one of the leading, premier, private teaching hospitals in northern part of India . It renders services for all specialities and super specialities. At present this hospital has bed capacity 750. There is a newly built outpatient department with modern facilities and technology. Mostly all the wards are equipped with the computer and interconnected with other wards, outpatient departments and diagnostic laboratories.
The study population consisted of all nurses working in clinical areas of Christian Medical College and Hospital, Ludhiana , Punjab , India .
The systematic random sampling (systematic random sampling is formed by selecting one unit at random and then selecting additional units at evenly intervals until the sample has been formed.) method was adopted to collect the sample (3). A total of 120 nurses were selected by selecting every alternate sample from the list of staff nurses. The study was limited to the clinical areas where the computer access is provided.
Development & Description of the Data Collection Tools
A structured questionnaire was developed after review of literature, experts opinion, and interview with medical informatics experts in the hospital and the personal experience of the investigator in the computer field.
Part I This part consisted of items for obtaining information about demographic variables like age, sex, designation, years of nursing serving, type of computer training received, frequency of computer usage, and monthly family income.
Part II This part consisted of 40 objective type questions to assess the various aspects of nurses computer knowledge. The content area was class ified into four subsections. The first and second subsections consisted of basic components of the computer-10 items. Basic computer terminology-10 items. The respondents were asked to select the options. So correct response scored as 1 and incorrect as 0. Hence higher score was 10 and minimum 0 in each section. Third and fourth consisted of items in true and false type questions mainly from functions of the computer and internet technology. The overall computer knowledge score was class ified into five levels i.e. excellent, good, average, fair and poor.
Part III This part consisted of 40 statements concerning the attitudes of the nurses in health care setting of a hospital related to computers. The statements were developed for the respondents to respond on five point Likert scale, that is strongly disagree. There were 19 positive and 21 negative statements. The negative statements were scored reversely. The nurses computer attitude questionnaire adopted to measure on three components they are belief, motivation and satisfaction. The maximum score was 200 and minimum score was 40 for total forty items. The below and above score of the cut off mark was categorized as negative and positive attitudes respectively i.e. positive attitude is > 120, negative attitude is <120. The attitudes of nurses working in clinical settings related to computer were interpreted by scoring i.e. higher the score, positive attitude and lower the score negative attitude. Also the belief, motivation and satisfaction also interpreted separately.
Part I V This part consisted of 20 statements concerning the basic skills of nurses related to computers in clinical area. This part also sub divided into three parts like general use of computers, consisted of 11 items, word processing consisted of 7 items and system security consisted of 2 items. The investigator observed the nurses skill in operating the computer in clinical areas itself and the evaluation assigned in 3 point Likert type scale, that is yes, to certain extent and No. The score assigned were yes-2, to certain extent-1, and No-0. The maximum score was 40 and minimum 0. The overall skill score was also class ified into five levels like excellent, good, average, fair and poor.
The Pilot study was conducted in the month of October 2002 to ensure the feasibility of the tool. The pilot study was conducted among all staff nurses in the trauma centre. The subjects were informed well in time to give opinion. The investigator and the instructor of the computer center in the college of nursing assessed the computer skills by no concealment non-participant method of observation. Subjects were communicated only in English language.
Reliability of the Tool
The reliability of the nurses computer knowledge questionnaire and computer scale was assessed by the split half method and co-efficient of correlation computed by the Spearman Brown prophecy formula which was 0.8 for computer knowledge and the computer attitude scale was 0.8. The subjects computer skill scale was estimated by the interrator reliability by having two observers observing the event performed by the subjects on the computer simultaneously (4). The recording were independent and on a predetermined skill scale. With the obtained data the rank-order correlation have been used to assess the reliability which was found to be (r=0.9). Hence the tool was found to be highly reliable.
Analysis of data was done in accordance with the objectives of the study. Data obtained had been analyzed in term of descriptive statistics i.e. percentage, mean, range, and standard deviation. Inferential statistics i.e. correlation co-efficient. 't' test and analysis of variance (F) were used to identify the relationship of nurses computer knowledge, attitude and skill among nurses with selected variables and the relationship between the computer knowledge, attitude and skill.
The findings suggest that majority of the nurses are having Good computer knowledge. All the nurses are having positive attitude and results shows that even though with higher belief they don't find much challenging or motivated to utilise computer in the clinical area. The demographic data shows the majority of the nurses were from younger age group working as staff nurses do with diploma in general nursing and had experiences in ward with informal training of the computer. Nurses do possess skill in general use of computer than word processing and system security. Nearly 50% of the nurses are having average computer skill for which they may be making use of that computer skill in clinical areas. These results shows that eventhough nurses are having good computer knowledge and positive attitude they may not be motivated to use computers in clinical area. Hence the computer skill in clinical area was average among nurses. These findings are in accordance with the study conducted by Liu et al (4) revealed that nurses computer skills were at moderate levels. Grigg and Stephens (5) and Browne (6) also revealed similar findings. The findings of the present study demonstrated that the relationship between computer knowledge, attitude and skill was not correlated with each other.
The last objectives of the study was analyzed by assessing the relationship of the independent variables. Among that nurses Age, type of computer training received and frequency of computer usage were influencing the nurses computer knowledge, but sex, designation, years of nursing service, professional qualification, area of nursing service and monthly family income does not influence the nurses computer knowledge. Following that the nurses computer attitude was highly influenced by the designation of nurses. The ward incharges having more positive attitude than staff nurses. This result may be due to the excess use of computer by ward incharges. Also the nurses computer attitude was influenced by Area of nursing service, Type of computer training received and frequency of computer usage. The nurses computer skill influenced by years of nursing service, professional qualification, area of nursing service and type of computer training received. The skill may develop due to the constant use, higher qualification and formal computer training received. Getty et al (7) reported that nurses both non users and users had favourable attitudes, this supported the present study. Dillon et al(8) also reported the similar findings related to nurses computer attitude. Stronge and Brodt (9) also supported the present study findings that nurses length of service and age does nor influence the nurses computer attitude. Birx et al (10) reported the similar findings that undergraduate nursing student computer skills the experimental group has statistically significant gains in computer skills.
This study provides the information that nurses computer knowledge, attitude
were good and positive respectively. But the nurses were not motivated either
by administration and the clinical staff to use computers. Hence the computer
skill was at average level. The strategies for nurse administrators have been
proposed for inservice computer training and also recommended
the informatic syllabus to be included in the nursing curriculum. The following strategies have been recommended. Similar strategies also made by Liu
et al (4).
The author acknowledge the guidance and suggestions of Dr. (Mrs.) Rajinder Mahal, Professor who had given the researcher a clean direction throughout the study. Also the author express his since gratitude to the principal and all the experts in the nursing research panel of College of Nursing, Christian Medical College and Hospital, Ludhiana . The author highly obliged to Dr. Bhatia, Professor of Statistics, Christian Medical College and Hospital who supported me and gave his valuable time in analysis of the data.
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Address for Correspondence
Emans Evangel Joel Raja B.Sc.(N).,RN.,M.Sc(N).,RPN
B-15, Bethany Nagar, Pasumalai, Madurai,
Tamilnadu, India. Pincode-625 004.
Email: emans20022002 @yahoo.co.in
Phone: +91 452 2372244
Evangel Joel Raja MSCN, RN, RPN
Currently a lecturer in psychiatric nursing and guides the students in nursing research for BSCN programme at Matha College of Nursing, Manamadurai, Sivagangai District, Tamilnadu, India. Interested in nursing informatics, nursing research and psychiatric nursing. This paper has been accepted at Medinfo 2004 and was written for the partial fullfillment of Master of Science in Nursing degree in the College of Nursing, Christian Medical College and Hospital, Ludhiana, Punjab, India .
Professor of Nursing and Guide, College of Nursing, Christian Medical College and Hospital, Ludhiana , Punjab. Pincode:141008
Veena Burkat Masih
Professor of Nursing and Co-Guide, College of Nursing, Christian Medical College and Hospital, Ludhiana, Punjab. Pincode:141008