INTRODUCTION electronic nursing documentation is still limited in

INTRODUCTION

This study is about perception and attitudes towards
electronic nursing documentation among Universities Malaysia Sarawak UNIMAS. In
this section they will be background of the problem, statement problem,
research questions, research objectives, significant of the research and
definition of terms.

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1.1             
Background of the problem

Nursing documentation is a fundamental component of
nursing to document all the patient data and to improve the quality of care.
According to Potter and Perry (2010) documentation
is anything that is written or electronically made that describe the condition
and care given to the patients. However, paper based documentation is time
consuming and record are not systematic which lead to many missing and
incorrect data. (Cheevakasemsook, Francis, Davis, 2006; Yu, Hailey, & Li,
2008; Gusen et all., 2016).

Thus, starting 1980s many countries started to use electronic
record information system to replace the manual record system (World Health Organization,
2006). The transition not only change the system but also help nurses in work
place and increase the quality of care to all the patient. As mention by
Tronvall (2008) the use of electronic nursing documentation is an important development that
will help all the nurses in documentation care, planning treatment and
evaluating care.

However, the use of
electronic nursing documentation is still limited in some country even though
it has been introduced and planned (World
Health Organization, 2006). As reported by Kelley, Brandon, and Docherty (2011) all the U.S
hospital are expected to use electronic nursing documentation by year 2014 to
improve the quality of care. In Malaysia also started to adopt paperless
documentation with 2 hospitals, hospital Sultanah Aminah Johor Baharu and
Hospital Sibu in year 2006 (Ministry
of Health Malaysia, 2006). This show that Malaysia are still growing in the
use of electronic nursing documentation which means there are a lot of things
that we still can improve for the electronic nursing documentation.

Therefore, it is vital for
us to understand the perception and attitude of student nurse towards
electronic documentation, as young nurses play an important role to enhance the
development of the system and there are the next generation who will use the
electronic nursing documentation.  

 

1.2             
Problem Statement

A study conducted by Stevenson, Nilsson, Petersson, and
Johansson (2010) through a literature review found out that electronic nursing
documentation are not reliable to nursing practices as it does not reflect
nursing practice. For example, in that study mention that the electronic health
record is not available at the bedside which reduce nurses’ time to care for
patient, reduce the control of nurses to make a care plan for the patient as
the system have limited features and the study also mention that the system
does not reduce the workload of nurses. In the study by Furst
et al., (2013) also mention that electronic nursing documentation does not
reduce the workload of nurses because there is lack of training with computer
skill which hinder the real benefit of electronic nursing documentation.

However, in the study of Asaro, and Boxerman (2008)
they mention that the implementation of electronic nursing documentation have
reduce the workload of nurses and physician, and increase the quality of care.
This is because the new system help nurses and physician to record medication
administration automatically, immediately print the order and provide all the
order test in patients’ computerized chart. This also supported by murphy (2011) where the
adoption of electronic documentation would improve the quality of care and the
patient’s safety. With the
electronic nursing documentation also can save time to assess patient care or
maintaining report form which can reduce the medication error thus increase
patient safety (Poissant, Pereira, Tamblyn, & Kawasumi, 2005).

Thus, to reach the maximum use of the electronic
nursing documentation healthcare provider need accept and willing to use the
electronic nursing documentation (Veer & Francke, 2010). Apart from that,
nurses also have to be able to perceive the benefit of electronic nursing
documentation to recognize the important of use of the system (Rogers, 2003). Therefore,
it is important to obtain the perception and attitude of student towards
electronic documentation in order to promote the acceptance and enhancing the
development of the system.

 

1.3             
Research Questions

1.     
What is the
perception of nursing student towards computerized nursing documentation?

2.     
What is the
attitude of nursing student towards computerized nursing documentation?

3.     
Is there any
difference between year 1, year 2, year 3, and year 4 in relation to perception
and attitude towards computerized nursing documentation?

 

 

 

1.4             
Research Objectives

1.     
To assess the perception towards computerized
nursing documentation among nursing students in University Malaysia Sarawak.

2.     
To examine the attitude towards computerized nursing
documentation among nursing students in University Malaysia Sarawak.

3.     
To identify the difference between year 1, year 2,
year 3, and year 4 in relation to perception and attitude towards computerized
nursing documentation

 

1.5             
Significant of Study

This study will provide the data of how nursing
students perceive the benefits or disadvantages of computerized nursing
documentation. With this information it will help us to improve the
computerized nursing documentation for example provide bedside electronic
nursing documentation which increase the time to care more to the patient. Besides
that, with electronic nursing documentation it will help us to reduce workload
and problem regarding nursing. For example, reduce the time to order medication
and review patient, and prevent medication error. The result of the study will
determine the outlook or the system flow according to the nurses’ preferences
and improvement towards the care of the patients. This study also provides a
data for the future, that can determine how the readiness of nurses to practice
the computerized nursing documentation, such as they might need extra knowledge
and training of how to use computer in order to use electronic nursing
documentation. This study also will provide an information toward UNIMAS
nursing student about the important of electronic nursing documentation which
might increase their awareness about the use of electronic nursing
documentation.  

 

1.6             
Definition of Terms

                               
i.           
Perception: Perception is defined as a
result of perceiving or observation (Meriam
webster’s learner’s dictionary, n.d.).  So,
in this study the perception is about the use of computer or electronic devices
in nursing documentation.

                             
ii.           
Attitude: Attitude is a position
assumed for a specific purpose (Meriam
webster’s learner’s dictionary, n.d.). The term of the attitude in this study refer
to the reaction of students towards the computerized nursing documentation.

                           
iii.           
Nursing
student: Student nurse is a person who study to be a nurse in
nursing institution or university (Dictionary.com,
2017). In this study nursing student refer to the
student who study nursing in Faculty of Medicine and Health Sciences, UNIMAS.

                           
iv.           
Electronic nursing documentation: reflect the entire health history of the patient
that is entered or accessed electronically by healthcare provider (World Health
Organization, 2006).

2          LITERATURE REVIEW

Perception
and attitude toward electronic nursing documentation among UNIMAS nursing
students.

2.1       Introduction

Electronic nursing documentation have been
implemented for many years in healthcare facility and yet the implementation
still increasing around the world (Donati et all., 2008). The electronic
nursing documentation are implemented to replace paper documentation and
provide easy access to patient health history that can provide a quality care (Kelley,
Brandon, & Docherty, 2011). However, the transition from paper
documentation to electronic documentation bring a challenge nurses as there are
many functionalities within the electronic documentation (Smith, Smith,
Krugman, & Oman, 2005; Lambooij., Drewes& Koster, 2017). Thus,
understanding the perception and attitude of student nurse will helps overcome
this challenge and maximizing the quality of care to all patient.

So, the aim of this literature review is to
understand the perception and also the attitude of UNIMAS nursing student
towards electronic nursing documentation.

 

2.2       Perception
towards electronic nursing documentation among UNIMAS nursing students

 A study by
Gusen et all., (2016) about perception and utilization of standardised
electronic health record among nurses in JOS University Teaching Hospital
Plateau State, Nigeria revealed that majority of the respondents (76.8%) had
positive perceptions about electronic nursing documentation. This is because
most of the respondent (87.7%) perceived that electronic nursing documentation
were easy to access and retrieve their health information, improve the quality
of care (77.6%) and perceived electronic health record would not create more
work for them (73.2%). In the study by Raddaha, Obeidat, Al Awaisi, and
Hayudini, (2017) also showed that nurses who have high attitude towards
electronic nursing documentation have high perception. They perceived that
electronic nursing documentation are easy to use (96%), the communication among
healthcare worker is good (94%) and they found that all the information is easy
to retrieve (89%). Similarly, study by Munyisia, Yu, and Hailey (2012)
perceived that electronic nursing documentation provide accurate and complete
information about patient health history, reduce documentation errors and help
in develop a care plan. However other research show that 64% respondent
perceived that electronic nursing documentation do not reduce the workload of
nurses (Moody, Slocumb, & Jackson, 2014). This because the use of
electronic nursing documentation is not available at the bedside of the
patient, nurses need to record on the worksheet or paper towel before transferring
the data to electronic chart. Thus, this study is conducted to gain current
understanding towards computerized nursing documentations since there is
differences perception in other research especially to students nurse as there
is lack of research done that looking at their perception about electronic
nursing documentation.

 

2.3       Attitude towards electronic nursing
documentation among UNIMAS nursing students

A study by Moody, Slocumb, & Jackson (2014) at a
large Magnet hospital in Southwest Florida show that 80% of nurses have a good
attitude towards electronic nursing documentation, this is because most of the
nurses are skilled in use of computer and thus drive them to use more of
electronic nursing documentation compared to less experienced use of computer.
Similarly, to the study by Ebrahem, El-Din, Habib, & El Kheir (2014) 77%
nurses have a good attitude toward electronic nursing documentation. However,
other study showed that nurses have less positive attitude towards electronic nursing
documentation (Veer & Francke, 2010). The
reason nurses have less positive attitude is because due to the anxiety working
with electronic documentation and the changing of work routines. In the study
by Geok,
Pawi, Fong, & Ching (2016)
showed less than 50% of the students had positive attitude
towards computerized nursing documentation. This is due to the lack of
technical support whereby when the student faces a problem using the electronic
nursing documentation, they do not know who to refer or ask. In that study also
mention that, the variation of guidance from the lecturers determine the use of
electronic nursing documentation in nursing. Thus, this review of literature
show that there are significant differences in attitude toward electronic
nursing documentation. The factor that causes the differences in attitude are
due to differences in level of education, experience use of computer and
computer skill (Alquraini, Alhashem, Shah, & Chowdhury, 2007). Therefore, it
is important to examine the attitude of nursing students as they are the newer
generation that highly expose to the technology.

 

2.4       Summary      

This literature review show that there are
significant differences in perception and attitude towards electronic nursing
documentation among nurses. In the literature review also only few study done
in young nurses about the perception and attitude of electronic nursing
documentation. Thus, a study is needed to assess perception and attitude of
students nurse toward electronic nursing documentation to provide a data for
the improvement of current system of electronic nursing documentation.

 

 

 

 

 

3          METHODOLOGY 

3.1       Research Design

This study will use quantitative and cross-sectional
design. The use of quantitative in this study is because the collection and
analysis of data is in numeric information which correlate with my objective of
study. Cross sectional design in this study is used to collect the data at one
time during the period of data collection in selected population (Polit &
Beck, 2010).

 

3.2       Population and Sampling

The population is all the UNIMAS nursing students,
216 students. There are nursing students from year one, year two, year three
and year four. Stratified random sampling will be used to collect data
sampling from Year 1, Year 2, Year 3 and Year 4 of the nursing students from
Faculty of Medicine and Health Science, UNIMAS. Stratified random sampling is used
to enhance the representative of the population which subdivided into year of
study in nursing (Polit & Beck, 2010). Inclusion criteria for participants
1. Undergraduate UNIMAS nursing students 2. Willing to participate, for
exclusion criteria 1. Not UNIMAS nursing students 2. Not willing to participate

The sample size calculated using the formula:

 

 

 

n

Required sample size

Z

Z-value indicating the confidences level. In this
study 95% of confident level will be chosen. Z score of 1.96 to denote 95% of
confidences interval.

P

Population proportion
A previous study done in Public teaching Hospital
in Oman (Raddaha, Obeidat, Al
Awaisi, & Hayudini, (2017 )show that high attitude of nurses have good
perception (90%) toward electronic nursing documentation. Based on the research,
the proportion will be used in this study is 0.90.

?

The degree of accuracy indicating the margin
error. 0.05 precision value has been chosen.

 

Calculation;

 

 

 0.09

 n=138, After add 20% total sample size, n=150

Formula to calculate number of nursing students to
be recruited in each year:

(Total number of students in year / Total number of
UNIMAS nursing students) X sample size calculated

YEAR

CALCULATION

TOTAL

1

65/216*150 = 45

45

2

57/216*150 = 40

40

3

43/216*150 = 30

30

4

51/216*150 =35

35

 

Required number of students from each year:

Year one:         45        Year three:      40       Year two:        30        Year
four:        35

 

3.3       Instruments

This study will use
questionnaire adopted from Kowitlawakul,
Chan, Pulcini, and Wang (2015)
which was used to examine factors influencing nursing students’ acceptance of
electronic health records for nursing education (EHRNE) software program. The
permission to use the questionnaire was obtained through email (Appendix 1: Permission
to Use Questionnaire). In this study the questionnaire consists
of 3 sections (Appendix 2: Copies of Instruments Used):

•     
Section one consists socio-demographic
characteristics of respondents which include age, gender and year of study in
UNIMAS.

•     
Section two consist of questions on perception towards
electronic nursing documentation the questionnaire which adopted in and
modified from Kowitlawakul, Chan, Pulcini,
& Wang, 2015. In this section there are 20 question using
Likert scale ranging from “Strongly disagree” to “Strongly agree”. Marks are
given for each item starting from “Strongly Disagree” one marks, “Disagree” two
marks, “Uncertain” three marks, “Agree” four marks and “Strongly” Agree five
marks. If the total marks is range from 20 to 60 it indicate the participant
have poor perception while total marks range from 61 to 100 the participant
have good perception toward electronic nursing documentation.

•     
Section three consist of questions on attitude
towards computerized nursing documentation the questionnaire which adopted in
and modified from Kowitlawakul,
Chan, Pulcini, & Wang, 2015.
In
this section, there are 20 questions using Likert scale ranging from “Strongly
disagree” to “Strongly agree”. Marks are given for each item starting from
“Strongly Disagree” one marks, “Disagree” two marks, “Uncertain” three marks,
“Agree” four marks and “Strongly” Agree fivr marks. If the total marks is range
from 20 to 60 it indicates the participant have poor attitude while total marks
range from 61 to 100 the participant have a good attitude toward electronic
nursing documentation.

 

3.4             
Ethical Approval

An ethical approval will be obtained from the UNIMAS
Ethical Research Committee of Medicine and Health Science (Appendix 3: Ethical
Approval Letter). Participants’ informed consent (Appendix 4: Participant’s Informed Consent Form) will be distributed during the data
collection to inform participants about the purpose, risk and benefit of the
study. Participants also will be notified the use of pseudonyms to keep the
confidentiality of the research data and they are free to withdraw from this
study at any time.

 

3.5       Data Collection

Pilot study will be conducted among eighteen UNIMAS
nursing students (12% of actual sample size). The eighteen students will be randomly
selected from each class and will not be included in the total sample size.
This pilot study will be done in December 2017 before the actual data
collection. A short briefing will be done to class representative from year 1,
year 2 and year 3 before they help me distribute the questionnaire. They will
be given 3 days to distribute and collect back the questionnaire. For the year
4, the questionnaire will be distributed and collected by myself.  Statistical Package for Social Sciences
(SPSS) version 22 will be used to test the reliability and obtain the Cronbach’
alpha value.  According to Polit and Beck
(2010) value of Cronbach’ alpha from 0.70 to 0.80 would be accepted.

The questionnaires will be distributed between December
2017 and January 2018 to the nursing students in the Faculty of Medicine and
Health Sciences, UNIMAS.  All the
questionnaires will be given to the class representative according to the year
except for the year 4 will be done by. A short briefing for the year 1, year 2
and year 3 class representative will be done to explain about this study. They
will be given one week to distribute and collect back the questionnaire.

 

 

3.6       Data Analysis

All the data will be analysed using Statistical
Package for Social Science (SPSS) version-22. Descriptive statistical analysis
such as frequency distribution tables, percentages and mean will be used to
present the results of the data and organize the data in informative manner. If
the data normally distributed, one-way ANOVA using the significant value of 95%
will be used to compare the differences in perception and attitude between year
1, year 2, year 3, and year 4 towards computerized nursing documentation. If
the data is not normally distributed, non-parametric test will be carried out.

 

LIMITATION

This study only involves nursing students in Faculty
of Medicine and Health Sciences (FMHS) thus the small sample size cannot be
generalized to other population of university. This is due to the time
constraints to conduct the study. Besides that, there will be a biasness of
answer expected in year 1 and year 2 nursing students as they do not have the
experience to use the electronic nursing documentation.