Barriers to use of information and computer technology by Australia’s nurses: a national survey

Aims and objectives. To support policy planning for health, the barriers to the use of health information and computer technology (ICT) by nurses in Australia were determined. Background. Australia, in line with many countries, aims to achieve a better quality of care and health outcomes through effective and innovative use of health information. Nurses form the largest component of the health workforce. Successful adoption of ICT by nurses will be a requirement for success. No national study has been undertaken to determine the barriers to adoption. Design. A self‐administered postal survey was conducted. Method. A questionnaire was distributed to 10,000 members of the Australian Nursing Federation. Twenty possible barriers to the use of health ICT uptake were offered and responses were given on a five point Likert scale. Results. Work demands, access to computers and lack of support were the principal barriers faced by nurses to their adoption of the technology in the workplace. Factors that were considered to present few barriers included age and lack of interest. While age was not considered by the respondents to be a barrier, their age was positively correlated with several barriers, including knowledge and confidence in the use of computers. Conclusions. Results indicate that to use the information and computer technologies being brought into health care fully, barriers that prevent the principal users from embracing those technologies must be addressed. Factors such as the age of the nurse and their level of job must be considered when developing strategies to overcome barriers. Relevance to clinical practice. The findings of the present study provide essential information not only for national government and state health departments but also for local administrators and managers to enable clinical nurses to meet present and future job requirements.     

Preparing for the future: the status of genetics education in diploma-level training courses for nurses in the UK.

This paper offers new information about genetics education provided by diploma level training programmes for nurses in the UK. Those responsible for the development and provision of curricula were asked to complete a questionnaire that attempted to assess the nature of genetics education and their attitudes towards it. The response rate was 84%. Whist genetics teaching is included on all but two training courses, variation in content, delivery and timetable allocation indicates disparity. Genetics is taught for 10 hours or less on most courses, utilizing a limited number of approaches. Most courses do not have compulsory assessment. The majority of respondents (81%) agreed that genetics will have a major impact on health care, and will become an increasingly important issue in education. A small majority (58%) agreed that genetics should have a higher profile in professional training yet many respondents (68%) felt that the teaching they were already offering was appropriate to meet patients' needs. In the absence of any clear national framework for delivery and assessment of genetics education, the author questions whether current training is sufficient to provide nurses with the basic genetic literacy needed to respond to developments in genetics as they impact on health care.     

Information technology-based standardized patient education in psychiatric inpatient care

Title. Information technology‐based standardized patient education in psychiatric inpatient care Aim. This paper is a report of a study to describe nurses’ experiences of information technology‐based standardized patient education in inpatient psychiatric care. Background. Serious mental health problems are an increasing global concern. Emerging evidence supports the implementation of practices that are conducive to patient self‐management and improved patient outcomes among chronically ill patients with mental health problems. In contrast, the attitude of staff towards information technology has been reported to be contradictory in mental health care. Method. After 1 year of using an Internet‐based portal (Mieli.Net) developed for patients with schizophrenia spectrum psychosis, all 89 participating nurses were asked to complete questionnaires about their experiences. The data were collected in 2006. Fifty‐six participants (63%) returned completed questionnaires and the data were analysed using content analysis. Findings. Nurses’ experiences of the information technology‐based standardized patient education were categorized into two major categories describing the advantages and obstacles in using information technology. Nurses thought that it brought the patients and nurses closer to each other and helped nurses to provide individual support for their patients. However, the education was time‐consuming. Conclusion. Systematic patient education using information technology is a promising method of patient‐centred care which supports nurses in their daily work. However, it must fit in with clinical activities, and nurses need some guidance in understanding its benefits. The study data can be used in policy‐making when developing methods to improve the transparency of information provision in psychiatric nursing.     

Patient education and consumer medicine information: a study of provision by Queensland rural and remote area Registered Nurses

Aims and objectives. The aim of the larger study was to ascertain the medication practices of registered and enrolled nurses in rural and remote areas of Queensland after the introduction of the Health (Drugs and Poisons) Regulation. This paper reports on the findings of the role of registered nurses and their confidence in the ability to provide information on medications in a way that the client understands; the frequency of the provision of information to clients prior to discharge; and the frequency of Indigenous Health Workers or interpreters for people without English as a first language. Background. Queensland employs approximately 17% of the Australian registered nurse workforce. In 1996 Queensland changed the Health (Drugs and Poisons) Regulation to allow specific registered nurses, who had undertaken approved postgraduate education and training programmes, to become endorsed for an expanded medication practice role. In particular, it allowed endorsed nurses to administer and supply (but not prescribe) drugs listed in a drug formulary to certain clients using protocols. It was not clear, however, whether the changes to the Regulation reflected the scope of practice, thereby providing adequate legal protection for the nurse. Design. During 2001–02 an exploration of the medication practices of rural and remote area nurses was conducted by the use of a cross‐sectional postal survey. Phase 1 of the study used a facility audit to ascertain facility medication practices and phase 2 of the study used a postal survey to ascertain nurses’ medication practices. Method. All nurses employed in rural and remote health facilities in Queensland were eligible to participate in the study. The nurse registering authority's (the Queensland Nursing Council) register was used to generate a non‐proportional stratified random sample. Of the 1999 questionnaires sent, there were 668 respondents. Of these, 520 were registered nurses. Results. The data indicated that there was a difference between endorsed and unendorsed registered nurses’ medication practice. In particular, it was apparent that endorsed registered nurses were more likely to believe they could explain the side‐effects of medication to clients in a way the patient understood; provided medication education to clients on discharge; and used Indigenous Health Workers or interpreters to explain medications to those clients for whom English was not a first language. However, it was apparent that <50% of all Registered Nurses were providing client medication education or using Indigenous Health Workers or interpreters. Conclusion. It is apparent that the changes to the Regulation have ensured that Registered Nurses who have undergone postgraduate education to enhance their medication practice are more likely to provide client education and consumer medication information. However, the results suggest that the majority of registered nurses in Queensland, whilst believing they have sufficient knowledge of pharmacology to provide client education, often do not provide appropriate medication advice to clients, particularly on discharge from the acute setting. Relevance to clinical practice. It is well recognized that the provision of medication education to clients has several benefits to both the client and the health care system. The lack of client medication education indicated in this study compromises patient's safety as well as their compliance with their medication regime.     

Ethical practice guidelines: an evaluation

Ethical practice guidelines (EPGs) were developed for use in Central Sydney Area Mental Health Service to guide contemporary mental health nursing practice and serve as a resource for clinical mental health nurses in relation to their professional conduct and practice. This survey of mental health nurses aimed to ascertain feedback on the application of the EPGs in the clinical arena. Nurses from the Central Sydney Area Mental Health Service ( n = 350) were asked to complete a 15-item survey developed by the authors. A total of 121 nurses completed the survey. Findings from the survey reveal that the information provided in the EPGs is useful (91%) and the EPGs provide sufficient guidance for practice (94%). Most respondents (96%) reported feeling confident dealing with ethical practice situations and 75% indicated interest in further education and training in this domain. Findings from this survey support the need to explore avenues to facilitate education, discussion and reflective practice in relation to ethical mental health nursing practice .     

Effectiveness of a 6-week online course in the Canadian Triage and Acuity Scale for emergency nurses.

INTRODUCTION: There is increasing interest in 5-level triage systems in emergency departments; however, the adoption of a new system places heavy training demands on ED department nurses and physicians. One emerging training option is online learning. The purpose of this study was to explore the effectiveness of an online course in the 5-level Canadian Triage and Acuity Scale (CTAS) on the clinical practice of the triage nurse. METHODS: Interviews were held with 23 emergency nurses from across Canada. A chart audit of triage codes from 367 charts from 6 hospitals was conducted. RESULTS: The most consistent finding was that the majority of RN staff enjoyed the online course and believed it had improved their triage practice. Nurses believed that their patient assessments were more thorough, accurate, and consistent throughout the department. Improved communication between staff and with patients and families was identified. Nurses reported using what they learned to improve triage assessment. Triage accuracy was high; the overall agreement between CTAS graduates and the chart auditor/expert within one CTAS level was 99.7%. Nurses also identified a number of organizational barriers to CTAS implementation after the course. DISCUSSION: The online format appears to be an effective, efficient, and convenient way to educate large numbers of ED staff in CTAS. Further research is needed regarding the use of multimedia and computer online chat options to further enhance the online learning experience for nurses.     

Ethics in Public Health Practice: A Survey of Public Health Nurses in Southern Louisiana

Abstract The present study was designed to help learn more about the ethical interests and concerns of public health nurses employed in state and local health departments. Self-administered postal questionnaires were mailed to 41 public health nurses employed at health units in Region I of the Louisiana Office of Public Health. Basic demographic information was obtained along with information about the workers' previous instruction or training in ethics and the nature of ethical conflicts encountered in their public health practice. Only 38% (15 of 39) of the surveyed nurses had had formal instruction in ethics. Even fewer (7.3%) had received continuing education on ethics. Most of the nurses felt confident in their ability to recognize an ethical conflict or dilemma in the workplace; fewer felt confident in their ability to resolve an ethical conflict or dilemma. A high proportion of the nurses agreed that there is a need for continuing education courses on ethics for public health workers. Nurses who had received formal ethics instruction were more likely to feel confident in their ability to recognize an ethical conflict in their public health practice. Continuing education programs on ethics are needed that are designed to meet the specific needs of frontline public health workers.     

Primary health‐care nurses and Internet health information‐seeking: Access,barriers and quality checks

Online information is a critical resource for evidence‐based practice and patient education. This study aimed to establish New Zealand nurses' access and evaluation of online health information in the primary care context using a postal questionnaire survey; there were 630 respondents from a random sample of 931 nurses. The majority of respondents were satisfied with work access to online information (84.5%, n = 501) and searched for online information at least several times a week (57.5%, n = 343). The major barrier to online information seeking was insufficient time, but 68 respondents had no work online information access. The level of nursing qualification was significantly correlated with computer confidence and information quality checking. A range of information evaluation approaches was used. Most nurses in study accessed and evaluated Internet information in contrast to the findings of earlier studies, but there were barriers preventing universal integration into practice.     

老年护理人才及专业设置需求调查分析

目的：了解二级甲等及以上医院、社区卫生服务部门及养老机构对老年护理人才数量、知识、核心能力及专业设置需求,为老年护理人才培养提供依据。方法：采用自设问卷对浙江省35家医院、284家社区卫生服务机构及253家养老机构进行调查。结果：医院、社区及养老机构对不同学历老年护理人才均有较大需求,对老年护理知识有不同需求,要求老年护理人才具有老年应急处理和重症抢救能力等9项核心能力;超过70%认为现阶段以开设老年护理班最适宜,超过90%认为有必要开设老年护理专业。结论：医院、社区及养老机构需要不同层次老年护理人才,须以知识、核心能力需求为导向,通过专业设置、课程设置、实践方式等改革培养老年护理人才,以适应我国人口老龄化需要。     

Genetic counseling: A survey to explore knowledge and attitudes of Italian nurses and midwives

In the past, genetic services were delivered to a limited number of families with rare conditions. However, genomics is now being applied to both inherited and common diseases in a range of healthcare settings, and there is a greater need for nurses to understand the basic concepts of genetic health care. The aim of this cross‐sectional survey was to explore the understanding and attitudes of Italian nurses toward genetic health care. A questionnaire was completed by 102 nurses and midwives (85% response rate). Of these, 61% believed that genetic counseling was only an informative and advisory process, and 53.9% could not specify to whom the counseling was aimed. When asked to identify nurses’ role in genetic health care, 62% of the respondents believed they had no role, although 28% believed that nurses could provide information, support, and counseling. These findings indicate that nurses have only partial knowledge of the issues surrounding genetic health care. To prepare nurses for the post‐genomic era, improved genetic education at the undergraduate and postgraduate levels is required.     

Information seeking behavior of occupational health nurses. How nurses keep current with health information.

A questionnaire designed to study the information seeking behavior of professional nurses was mailed to 600 occupational health nurses who work and reside in New York State. A 28% response rate (165 usable replies) was obtained. Results indicated respondents most need to know about government regulations relating to health care, new developments in their area of specialization, drug information, and the psychological aspects of disease. The respondents most frequently looked to peers and colleagues in their agency, personal files and books, and professional organizations as important sources of information. Whereas respondents were less apt to rely on the Internet, MEDLINE, or the hospital library as sources of information used for professional purposes, 38.8% did report they frequently used the Internet to seek health related information. Also, the majority of respondents (65%) indicated interest in continuing education, if it were available, in using the Internet to access health related information. The present study suggests professional nursing organizations have an opportunity to meet members' needs by expediting members' efforts to access and evaluate information using emerging information technologies.     

Factors influencing nurses' attitudes towards the use of computerized health information systems in Kuwaiti hospitals

Title. Factors influencing nurses’ attitudes towards the use of computerized health information systems in Kuwaiti hospitals Aim. This paper reports a survey of nurses’ attitudes towards computerized health information systems, the characteristics that influence these attitudes and the level of nurses’ skills in computer use. Background. The use of such systems in developed countries and in some developing countries has already become a reality. However, nurses as a group of care providers have been found to resist computerization, seeing computerized health information systems as dehumanizing, confusing and uncaring. Nurses with more computer experience tend to have more positive views; education and training positively influence attitudes; and younger and less experienced nurses may have more positive attitudes. Methods. A structured questionnaire was used to measure the attitudes of nurses working in Kuwait towards computerization. A random sample of 574 nurses working in Ministry of Health hospitals were sent a questionnaire, and 530 replies were received (response rate 92·3%). The data were collected from November 2002 to January 2003. Findings. Respondents generally had positive attitudes toward computerized health information systems. Analysis of variance revealed statistically significant differences in attitudes in relation to nationality, level of education, previous experience in computer use, and computer skills (P < 0·05). Multiple regression analysis showed that gender, nationality, education levels, and duration of computer use were statistically significant predictors of attitudes toward computerized health information systems (P < 0·05). Conclusion. With adequate computerized health information system training, the implementation of computerized health information systems could be effective for nurses in providing quality health care, as found in other studies.     

Kansas office-based nurses' evaluation of patient tobacco cessation activities

In this study, we examined the tobacco cessation efforts of nurses working in primary care settings. A 43-item questionnaire was mailed to 1,036 office-based nurses located throughout Kansas. With a response rate of 50.1%, 415 questionnaires were available for analysis. Although 89% of respondents encountered patients who smoked on a daily or weekly basis, only 51% reported documenting their patients' tobacco use, and 38% assessed patients' readiness to quit. Two thirds (66%) of nurses believed that tobacco management was part of their role but only 35% provided cessation advice, 23% recommended nicotine replacement therapy, and 14% provided coping techniques. Nurses cited barriers such as perceiving patients as disinterested or unmotivated to quit (65%) and having little time (55%), skills (32%), or knowledge (25%). Most (91%) agreed that they needed additional tobacco control education. Nurses who were advanced registered nurse practitioners or clinical nurse specialists were more likely to feel confident about their smoking cessation counseling skills compared to nurses with less education (66.7 vs. 31.2%, p =.010). Office-based nurses identified specific barriers that could be addressed through professional education about tobacco management.     

Nurses’ perceived facilitators and barriers to assessing for alcohol use in Taiwan

Aims. To explore nurses’ perceived facilitators and barriers to assessing for alcohol use in Taiwan. Background. Excessive alcohol use has been associated with health, social and legal problems. Helping health care providers to detect and treat hazardous or harmful drinkers is an important worldwide issue. Design. A cross‐sectional design was used. Methods. Nurse participants (n = 741) were recruited from 10 randomly selected hospitals in Taiwan. In these hospitals, nurses were selected from the Emergency Department, psychiatric and gastrointestinal medical–surgical units where most patients with alcohol problems are seen. Data were collected by facilitator and barrier scales as well as a background information form. Results. Nurses identified the top facilitator and barriers to assessing for alcohol use as ‘want to know if patients’ drinking problems are related to their illness’ and ‘patients’ purposefully conceal information’, respectively. Older nurses and those with longer general clinical experience had more perceived facilitators to assessing for alcohol use. Nurses’ perceived facilitator scores were significantly and positively related to their intention scores, whereas their perceived barrier scores were significantly and negatively related to their intention scores. In addition, scores for perceived facilitators and barriers differed significantly by nurses’ education level, work unit, experiences with assessing for alcohol use and previous attendance at training courses for assessing alcohol use. Conclusions. Our results suggest a need to strengthen nurses’ education and training on the assessment of alcohol use in Taiwan. Relevance to clinical practice. Education and training programmes should aim to enhance Taiwanese nurses’ alcohol knowledge, to emphasise the impact of alcohol use on illness and treatment and to enhance nurses’ perceived facilitators and decrease their perceived barriers to assessing for alcohol use.