JOURNAL STUDY ON THE RESEARCH ARTICLE “FACTORS AFFECTING AND AFFECTED BY USER ACCEPTANCE OF COMPUTER-BASED NURSING DOCUMENTATION RESULTS OF A TWO-YEAR STUDY”

The journal is a study about the introduction of a computer-based nursing documentation system on four wards (ward A- Psychiatry unit B- Psychiatry unit C- Pediatric Unit D- Dermatology unit) of the University Hospitals of Heildelberg, Germany. The goal of the study was to evaluate the preconditions and consequences of computer-based nursing process documentation with a special stress on acceptance issues. This study is to show whether the computer-based documentation system can reduce the problems in nursing documentation and which factors influence the acceptance by users.

All the questionnaires were distributed before, during, and after the introduction of the computer-based system. They concentrated on the subjective data that were drawn from the questionnaires and interviews. The result of the quantitative study concentrated on the individual abilities of the users, and they found that computer knowledge and previous acceptance of nursing process are significant predictors of final user acceptance. On the other hand, the qualitative study pointed to the task requirements and the functionality of the system as further important factors that can be explained by the theory of task technology.

The results of each ward were quite unique in regards to the questions given apart from ward C which has a sharp decrease in acceptance score. Well it is somewhat typical that adaptation of a new computer based system takes some time with ward C. It may also be possible that in some other wards, a similar decrease may have occurred during the introduction of the same computer-based system. The stages and process, as described by Prochaska et al.(1992) are listed below:

CONCEPTS:

1. PRE-CONTEMPLATION
Definition: Unaware of the problem, hasn't thought about change
Application: Increase awareness of need for change, personalise information on risks and benefits

2. CONTEMPLATION
Definition: Thinking about change, in the near future
Application: Motivate, encourage to make specific plans

3. DECISION/DETERMINATION
Definition: Making a plan to change plans, setting gradual goals
Application: Assist in developing concrete action

4. ACTION
Definition: Implementation of specific action plans
Application: Assist with feedback, problem solving, social support, reinforcement

5. MAINTENANCE
Definition: Continuation of desirable actions, or repeating periodic recommended step(s)
Application: Assist in coping, reminders, finding alternatives, avoiding slips/relapses (as applies)

The journal study of the computer-based nursing documentation in the four wards wouldn’t represent all the hospitals. For that reason, another study must be done in hospitals who would like to adopt the computer-based nursing documentation because every hospital has nurses with different experience with regards to computers, motivations, age and workflow. Computer-based nursing documentation will be accepted only if proper instructions and teachings were given to the nurses who would utilize it.

REFERENCES:

."Behaviour Change - A Summary of Four Major Theories" [PDF], FHI.

http://www.comminit.com/en/node/27168

The purpose of documentation allows health professionals to communicate about the care provided to the patients. It also promotes good nursing care and supports nurses to meet professional and legal standards[1].

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This study is to show whether the computer-based documentation system can reduce the problems in nursing documentation and which factors influence the acceptance by users.

A more recent definition of Nursing Informatics comes from the American Nurses Association's Scope and Standards for Nursing Informatics Practice (2008): Nursing Informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice.

The introduction of IT to support nursing documentation has effects on nursing care such as:
a. Efficiency of nursing which may decrease charting periods thus allowing more time in direct patient care.

b. Quality of nursing documentation. Most activities of nurses involve collecting, recording and using data. With the use of computer, nurses can easily record patient information as well as retrieving specific data such as assessments, medication administration, progress notes, updating patient’s care plans, among others.

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Computer-based nursing documentation will be accepted only if proper instructions and teachings were given to the nurses who would utilize it.

User acceptance in computer-based documentation will increase as nurses will become more used to this technology. The effects will depend on how it will be used in nursing practice. Computers are just one tool among many to make the work easier and efficient. It doesn’t solve all the existing problems in nursing documentation but offers new possibilities not offered by pen and paper.

References:
a. Kozier, B (2004). Fundamentals of Nursing (7th ed.). New Jersey: Pearson Education Inc

b. [1].Nursing Documentation from http://www.crnbc.ca/downloads/151.pdf

c. Nursing Informatics from http://en.wikipedia.org/wiki/Nursing_Informatics

d. Hannah, K.J., Ball, M.J. and Edwards M.J (2006). Introduction to Nursing Informatics (3rd ed.). New York: Springer

Documentation is an integral part of the nursing process. It serves, not only as a basis in the plan of care, but also an important weapon against legal disputes. It is therefore of great importance to be careful in documentation as in giving medications or in performing other nursing care.
With the advent of technology, nursing must keep abreast with the suitable technology to make our work much more trouble-free, all the while keeping the rigid standards of accuracy we need. But with new technology introduced, new troubles are encountered with the challenges of adaptation. According to the study conducted by Cho and Park (2006), “the implementation of a computer-based nursing record system poses new challenges to the traditional methods of nursing documentation. The cornerstone of such a system providing best care is its ability to capture clinical data during the care process, and to store, aggregate, and analyze the data so as to produce reports that not only describe the care but also improve the understanding of quality, effectiveness, and costs, which can contribute to improving clinical processes. Data standardization is the key to performing these operations.” [1] This is complicated, especially for the older generations of nurses who may have never even been acquainted to the computer. Cho and Park further reiterated, ”it is clear that capturing nursing-process data including assessments, diagnoses, interventions, and outcomes will improve care processes and clinical decision-making. However, our analysis of free-text nurses' notes showed that they cover a broad spectrum. Patient care is a multidisciplinary process, and the requirement for explicit communication and feedback in collaborations is obvious. Other disciplines with interdependent functions allow the production of documentation that requires those departments (such as the pharmacy or the blood bank) and nurses to complete, such as when nurses are involved in administering or assisting. The nurses' notes contain such information in both binary responses (e.g., given/not given, done/not done) and descriptions of the administration process. Contents in nurses' notes range from the most-general to the most-specific classes of nursing information. The notes cover many clinically specific contexts such as direct quotations from patients, physicians, and caregivers. Therefore, the use of free text appears to be inevitable for supporting specific situations and administrative procedures that cannot be efficiently predefined in a Nursing Data Dictionary” [1]
This argument then supports the discrepancy from the inconsistent results from ward C wherein which the results gathered were initially low and remained low for several months. Acceptance to the technology is affected by different barriers. A study based on the same study being commented upon made by Ammenwerth et al. in 2006 identified several barriers including: 1.) Relevant attributes of individuals: Commitment to nursing process as basis for nursing, commitment to nursing care planning, commitment to written nursing documentation, commitment to own professional nursing role (IT as professional tool), acceptance of computers in general, acceptance of computers in nursing, computer skills, typing skills (may be correlated with computers skills), general computer knowledge in years, age of nurses (may be correlated with computer knowledge), professional experience (may be correlated with age), number and motivation of key-users, overall motivation of wards to introduce the system, climate of support and trust within the nursing team, quality management skills of nurses, low expectations with regard to computers and nursing documentation, low number of staff members and work load of ward, low staff fluctuation, low number of part-time staff, night watches and nursing trainees on the ward, commitment to standardisation of nursing tasks (IT as support, or IT reducing individuality of nursing), 2.) Relevant attributes of the task of nursing documentation: Low complexity, amount and level of detail of documentation, clear organization, clearly structured place and time of documentation, quality of implemented predefined nursing care plans, low number of nursing tasks that have to be documented in each shift, low use of documentation (e.g. once per shift), long length of stay of patients, low complexity of patient profiles (children, adults), high use of documentation by other health care professionals, available time during routine work to learn the system, no parallel redundant use of different documentation media (IT, paper), clear agreements with regard to organisation of documentation, availability of nursing standards from other wards or earlier projects, high degree of standardisation of nursing, and 3.) Relevant attributes of the technology: Quality and amount of functionality of software, usability and user friendliness of software, stability and flexibility of software, quality and performance of hardware and network, availability of sufficient number of computers, availability of mobile computers, clear version and update management. [2]
To this point, I agree with the point made by the previous commenter that

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user acceptance in computer-based documentation will increase as nurses will become more used to this technology.

Aggressive and intensive efforts to educate the affected nursing population of the technology and to sway their individual biases of the technology at hand shall penultimately change the way they view and accept the technology’s potential.

1- InSook Cho, PhD, RN and Hyeoun-Ae Park, PhD, RN, Evaluation of the Expressiveness of an ICNP-based Nursing Data Dictionary in a Computerized Nursing Record System (2006), lifted from the Journal of the American Medical Informatics Association, accessed June 22, 2009 from www.pubmedcentral.nih.gov
2 - Elske Ammenwerth, Carola Iller, and Cornelia Mahler, IT-adoption and the interaction of task, technology and individuals: a fit framework and a case study (2006), lifted from the Bio Med Central Medical Informatics and decision Making, accessed June 22, 2009 from the www.pubmedcentral.nih.gov
[b][i]

Due to the mushrooming of science and technology, the advancement of the way of living for almost all of the people totally discernibly.

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“Just as computers have become standard instructional tools in the primary and secondary school system, they are used extensively in all aspects of nursing education.”

The use of computer seems to be expeditious that it is widely used all over the world, may it be at hoe, at work or even in schools.
“

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Computers allow people to communicate effectively across large distance. This technology is extended to nursing education where students at satellite sites participate in educational experiences”

The incorporation of e-learning in the curriculum of college students, is very important that it helps in the prompt distribution of information.

Barabara Kozier, Glenora Erb, Audrey Berman, Shirlee Snyder, Fundamentals of Nursing, (7th ed.) p. 158- 159, New Jersey, Pearson Education Inc.,

Maybe for older and technophobe nurses, the use of computers is quite intimidating. Perhaps the administration can give proper training to those nurses so they can utilize computer-based nursing documentation. For the tech savvy, the transition to computer-based nursing documentation might be easy, if not welcomed. The health system is looking for efficiency among other things and technology utilization is a considerable partner.

But whether nurses prefer pen and paper or computer, nurses are flexible enough to adapt to where the trend is going.

Poissant, L., Pereira, J., Tamblyn, R., & Kawasumi, Y. (2005). The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review . J Am Med Inform Assoc. Retrieved June 23, 2009 from http://www.jamia.org/cgi/content/abstract/12/5/505

Nursing Documentation is for communication amon the health care provider and for legal accountabilities. Also, with the advance technology now a day nurses should not be left behind. But of course this entails challenges as indicated in the last comment,

“But with new technology introduced, new troubles are encountered with the challenges of adaptation.”

“This is complicated, especially for the older generations of nurses who may have never even been acquainted to the computer.”

Yes, it is true but with giving importance on training and support to the users/ new users may address this challenge. As nurses we should be able to,

“… keep abreast with the suitable technology to make our work much more trouble-free, all the while keeping the rigid standards of accuracy we need.”

And according to Ammenwerth et al. (2006), the different attributes, as mentioned on the last comment, affects the acceptance on the IT. While on the interaction between individual, task, and technology, problems may occur. But to emphasized as mentioned in the article of Ammenwerth et al. (2006) “miss fits is between the user and task rather on user and technology. So, again trainings of the users will help a lot. And I agree to
“Aggressive and intensive efforts to educate the affected nursing population of the technology and to sway their individual biases of the technology at hand shall penultimately change the way they view and accept the technology’s potential. “


Reference:
Ammenwerth, E., Iller, C., & Mahler, C.(2006). IT- adaptation and the interaction of task, technology and individuals: a fit framework and a case study.BMC Medical Informatics and Decision Making, 6: 3. Retrieved June 22, 2009, from PubMed Central.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1352353&tool=pmcentrez#id508876

Nursing documentation is an important part of clinical documentation.However, documentation of the nursing process is frequently lacking quality. There are high expectations that computer support in nursing documentation will help improve documentation quality.

Now a days computer technologies is being used in almost all workplaces. But accepting this kind of technology is somehow not easy because not all employees are computer literate, in hospitals for example, aged-nurses would find using computer a little bit confusing because during their school days computers are not widely used yet.

Introducing this kind of technology in hospitals would require administrators to purchase computer units to be used, making it impossible to impose because not all hospitals in the Philippines can afford to buy computer units.

References:

1. Mahler, Cornelia (C); Ammenwerth, Elske (E); Wagner, Andreas (A); Tautz, Angelika (A); Happek, Torsten (T); Hoppe, Bettina (B); Eichstädter, Ronald ® (2007). “Effects of a computer-based nursing documentation system on the quality of nursing documentation”. Retrieved June 23, 2009 from http://www.find-health-articles.com/rec_pub_17685151-effects-computer-based-nursing-documentation-system-quality-nursing.htm

2, Wallen, Erik S (ES); Mulloy, Karen B (KB); (2007),“Computer-based training for safety: comparing methods with older and younger workers”. Retrieved June 23, 2009 from http://www.find-health-articles.com/rec_pub_17137597-computer-based-training-safety-comparing-methods-older-younger-workers.htm