Post-basic nursing students access to and attitudes toward the

use of information technology in practice: a descriptive analysis

Z. Z. NKOSI P HD, MCUR, B CUR
1
, F. ASAH MI S , MP H
2
and P. PILLAY MCUR, B CUR
3
1
Associate Professor, University of South Africa (UNISA),
2
Researcher and Facilitator, Centre for Rural Health,
University of KwaZulu-Natal (UKZN) and
3
Lecturer, 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
efciency 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: nkosizz@unisa.ac.za
NKOSI Z. Z. , ASAH F. & PI LLAY P. (2011) Journal of Nursing Management 19, 876882
Post-basic nursing students access to and attitudes toward the use of
information technology in practice: a descriptive analysis
Background Nurses are exposed to the changing demands in technology as they
execute 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 inuence IT.
Methodology A descriptive study design using a quantitative approach and struc-
tured questionnaire was used to measure the nurses attitudes towards computer
usage. A census of 45 post-basic rst 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 identied 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 management
and information technology.
Accepted for publication: 4 August 2011
Journal of Nursing Management, 2011, 19, 876882
DOI: 10.1111/j.1365-2834.2011.01303.x
876 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 present
study, 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 towards
the use of a computer (Kivuti-Bitok 2009).
Nursing students attitudes can affect the success of
change 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 condence (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. For
example, senior nurses, such as nurse managers in Kenya,
have a positive attitude towards IT usage, as compared
with their subordinates (Kivuti-Bitok 2009). Nurses with
previous exposure toandwhohave undergone training in
IT were found to be more condent 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 condence 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 inu-
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 ITplays instrengthening 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 compared with 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 inuence 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 inuence 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
ndings 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
quantication (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 ve-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 conrmed 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 items
about 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 ve 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 studytools (Brink
&Wood 1998). The feedback fromthe pre-test led to the
modication and clarication 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 identied 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 ve-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 job
title 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 and
intranet)
With access to the intranet and internet, nurses will be
able to communicate with colleagues, access patients
records 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 ve 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 1
Characteristics of respondents (n = 45)
No. of
respondents Percent
Gender
Female 42 93
Males 3 7
Ages (in categories)
3135 6 13
3640 8 18
4145 14 31
4650 8 18
51+ 9 20
Access to computer
Yes 19 42
No 26 58
Job title
Nurse manager 1 2
Hospital-based
professional nurse*
22 49
Clinic Matrons 22 49
Educational level
Diploma 39 87
Degree 6 13
Facility type
District hospital 19 42
Tertiary hospitals 10 22
Clinics 16 36
*Professional nurse is a nurse (general,psychiatry and community)
and midwife who has received education and training at an approved
nursing school and was registered under the Nursing Act 50 of 1978
(SANC, 2011).
Table 2
Computer usage and job title (n = 19)
How often did you use a computer in
the month of July?
Most
frequent
users
Frequent
users
Less
frequent
users Never
Nursing managers (n = 2) 0 1 0 1
Hospital-based (n = 11) 3 0 2 6
Clinic managers (n = 6) 2 0 0 4
The results are in numbers and not in percentages.
Table 3
The factor that hindered access to information technology (IT)
(n = 45)
The factor that hindered access
to a computer
Frequencies
and percentages
(n = 45), %
Lack of computer skills 45 (99.9)
Lack of access
No intranet/internet 20 (44.4)
No password 20 (44.4)
Lack of time
Shortage of nurses, therefore
nurses are overworked and do
not have time to use the computer
35 (77.7)
Lack of support
Computer is faulty 18 (40)
Budget constraints cannot buy
additional information technology
10 (22.2)
Multiple responses were received.
Nurses students access and attitudes to IT
2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 876882 879
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 benets 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 ndings 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 ndings are consistent with the ndings 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 4
Post-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 4.4
2 Computers allow nurses tasks to be more efficient 93.3 6.7 0
3 Only one person at a time can use the computer terminal, therefore, staff efficiency is inhibited 44.3 22.4 33.3
4 Computerization of nursing data offers nurses a remarkable opportunity to improve patient care 93.3 4.4 2.2
5 Computers causes nurses to give less time to give quality care to patients 31.1 6.7 62.20
6 Paperwork for nurses can be greatly reduced by the use of computer 97.8 2.2 0
7 Computers allow nurses more time for professional tasks for which he/she is trained 78.70 8.9 13.3
8 Computers save repeated documentation and allow the nursing staff to become more efficient 88.9 11.1 0
9 A computer increases costs by increasing the nurses workload 11.2 42.2 46.6
10 Part of the increase in healthcare costs is because of computer 28.9 20 51.10
11 Computer causes a decrease in communication between hospital departments 20 8.9 71.1
12 Computers represent a violation of patient confidentiality 33.3 22.2 44.4
13 Orientation of new employees will take longer because of computers and, therefore, unnecessary
work delays will occur
28.9 20 51.10
14 The more computers in an institution the fewer jobs for employees 35.6 13.3 51.10
15 Computers represent a violation of patients privacy 40 13.3 46.6
16 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.
880 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 876882
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 nding 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 efciently 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 condentiality
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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