Abstract

Background: To manage the high volume of generated data and enhance the quality of nursing care in the healthcare system, nurses need informatics competencies including 1) basic computer skills, 2) informatics knowledge and 3) informatics skills.

Objective: The aim of this study was to evaluate the informatics competencies of nurses working in hospitals.

Methods: The present study was conducted in 2018 on 200 nurses working in hospitals. The tool used to collect data was the localized Staggers standard questionnaire.

Results: The results of this study showed that 60.6% of nurses have few capabilities regarding informatics competencies. Also, practicing nurses were more able in the area of informatics knowledge rather than the other two areas of basic computer skills and informatics skills.

Conclusion: Informatics competencies of practicing nurses were not at an adequate level which requires the attention of universities and colleges and educational planning in this field.

Introduction

Today, information technology is a critical part of our health care industry and requires healthcare providers to have basic computer knowledge, as well as informatics competencies, to manage and use technology to deliver care (Pordeli, 2017). In early 2000, the American Institute of Medicine (IOM) suggested that hospitals use electronic solutions to improve the quality of care provided to hospitalized patients (Baker, 2001). Previous studies on the consequences of the use of health information technology suggested that countless positive effects on healthcare system had been realized (Buntin et al., 2011). The use of technology and computer systems can facilitate nursing care and support educational resources for nursing studies (Darvish et al., 2014; Rouleau et al., 2017). In addition, the use of information technology in the workplace enables nurses to spend less time documenting patient care and spend more time delivering quality care to patients (Kelley et al., 2011; Chaudhry et al., 2006). In general, the benefits of using information and communication technology in nursing include improved patient safety and improved efficiency of nursing professionals (Rouleau et al., 2017).

Due to extensive integration of health information technology in healthcare, competencies and capabilities in information and communication technology are essential for nursing professionals as healthcare providers (Honey, 2017; Nagle, 2013). In the study conducted by Yang et al. (2014), it was found that nursing managers' informatics competencies were at a medium level (77.6). Choi and De Martinis (2013) showed that nursing students had the required capabilities in the field of informatics.

Nursing informatics competencies can be defined as adequate knowledge, skills and abilities to perform specific informatics tasks (Hunter et al., 2013). Informatics competencies include three features: basic computer skills, informatics knowledge and informatics skills. Basic computer skills refer to the knowledge and ability to use a computer and related technologies (Goldhammer et al., 2013). Informatics knowledge refers to the knowledge to use computer technologies to deploy information sciences. In addition, informatics skills can be defined as the skills to implement instructions, tools and specific methods in informatics (Staggers et al., 2002).

Since the appearance of computer and information technologies in healthcare, the assessment of nursing informatics competencies has become a favorite subject for researchers (Darvish et al., 2014). To meet these increasing needs, a scale for self-assessment of nursing informatics competencies was developed to evaluate informatics competencies in nursing students and practicing nurses. Generally, an instrument's validity and reliability scores depend on the characteristics and specifications of the sample under investigation. The Staggers list of valid competencies is a standardized instrument. However, it has been developed and tested more in communities with a high level of computer knowledge and skills (Sunmoo and Po-Yin, 2009); therefore, this scale must be evaluated in a variety of societies based on development and growth patterns of informatics competencies and according to different backgrounds and cultural contexts (Chang et al., 2011). This study aimed to assess nursing informatics competencies within healthcare organizations.

Methods

This cross-sectional study was conducted in 2018. Data were collected using the researcher- developedquestionnaire. A review of previous studies and evaluation of existing tools and scientific resources associated with nursing informatics competencies was done initially. Based on the study done by Staggers et al. (2001), primary items were extracted with 74 points regarding competencies in three areas including basic computer skills, informatics knowledge and informatics skills. Next, the questionnaire was reviewed by eight nursing experts holding a master's degree or faculty members with at least five years of work experience with hospital information systems and by four information technology professionals holding a bachelor's degree and a minimum of five years of work experience with hospital information systems. Experts assessed the importance of each point using a 5-point Likert scale ranging from "strongly disagree" to "strongly agree."

Questionnaire validity was assessed by experts using a content validity index (CVI) and content validity ratio (CVR) (Farzandipour et al, 2017). The test-retest method was used to assess questionnaire validity and to ensure reproducibility. For this purpose, a validated version of the questionnaire was given to 20 nurses. After a period of two weeks, the participating nurses were asked to fill out the questionnaire again. Cronbach's alpha was used to assess data reliability. Data reliability was calculated as 0.97. A sample of 200 individuals participated in the study. Simple, random sampling was done using a list of nurses with a bachelor's degree or higher and three years of work experience in educational and medical hospitals. Questionnaires distributed among the nurses were composed of two parts: the first part included demographic characteristics including age, sex, marital status, employment, education, work experience, familiarity with computers, frequency of using computers, and interactions with the hospital information system (HIS); the second part included questions related to informatics competencies subscales in a scale of 48 questions. Questionnaire items were rated using a 4-point Likert scale ranging from "completely" to "very low." Data analysis was performed using SPSS software version 20 including descriptive and analytical statistics.

Ethical Considerations

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed and approved by the Ethics Committee of the Institutional Review Board.

Results

Out of 200 questionnaires distributed among nurses, 197 were returned with 98.5% of items answered. Regarding occupational status, the majority of participants (77%) were ward nurses and 11.5 % were directors of nursing. Also, 11.5% were matrons and supervisors. The majority were females (75.5%), 68.5% of whom were married.

The majority of participants (96%) held a bachelor's degree. In terms of years of service, the majority (56.3%) had three to 11 years of work experience. Also, according to respondents' views, 66.5% had relatively good familiarity with computers. In terms of frequency of using computers, the vast majority (59%) used computers more than once a day. In addition, regarding interaction with HIS, the majority (59%) spent less than an hour per shift interacting with the system.

As evident in Table 1 showing the combined scores for questions related to basic computer skills, informatics knowledge and informatics skills, 39.2% of respondents indicated having a high level of knowledge and competence. In the area of informatics skills, 37.4% of respondents reported a high level of competence; this score was lower than that of those who reported high competence in basic computer skills (39.6%) or the percentage of those who reported high competence in informatics knowledge (41%).

Table 1: Distribution of nurses' comments on informatics competencies (number of responses, total %)

Most participants aged 40 and higher had lower computer familiarity skills (P<0.02). Thus, a significant relationship was observed between age and familiarity with computers and basic computer skills (Table 2).

Table 2: Distribution of nurses' comments on the potential in the area of basic computer skills (number of responses, total %)

With regard to informatics knowledge, there was a significant relationship between marriage, familiarity with computers and interaction with the HIS, and nursing informatics knowledge (P<0.02).  To be more specific, most single individuals, those familiar with computers, and those who had more HIS interaction had higher informatics knowledge (Table 3 and 4).

Table 3: Distribution of nurses' comments on the potential in the area of informatics knowledge (number of responses, total %)

Table 4: Distribution of nurses' comments on the potential in the area of informatics skills (number of responses, total %)

Discussion

The findings of this study showed that more than half of the nurses participating in the present study seem to have little ability or skills in the area of informatics competencies. In addition, findings indicate that practicing nurses had higher capabilities in the area of informatics knowledge rather than the other two areas of basic computer skills and informatics skills. Furthermore, they had the least ability in the area of informatics skills. Similarly, Yang et al. (2014) examined current informatics levels of nurse managers. Their findings indicated that informatics competency of these nurse managers was at a moderate range and their computer and informatics skills were lower than informatics knowledge. They suggested that low scores in computers skills and informatics skills be increased through education or training.

Nurses' informatics competencies in Yang et al.'s study (2014) were higher than those of the present study. This could be attributed to the population in Yang et al.'s study having a different level of education, nursing management experience and informatics education compared with the present study, which could influence nurses' informatics competencies. However, similar to the present study, Yang et al. found that the level of informatics competencies of nurse managers is not ideal and, by identifying influential factors, recommended the evaluation of these factors and obstacles.

Results showed that nurses may have higher ability in basic computer skills such as using the Internet and search tools on the Internet and using Windows operating systems and Microsoft Office applications. However, they might be less adept in areas such as backing up files and systems, using antivirus software programs, solving common errors on the computer, changing the default printer, and using computer systems safely. Findings of several studies (Gilmour et al., 2016; González et al., 2017; Saeidi et al., 2014) showed that nurses had the highest skills in working with the Internet, computers, word processors and operating systems. However, the lowest level of ability was observed in the field of documenting care plans, skills and knowledge in informatics, and qualification associated with data entry (Fetter, 2009). As can be observed, the findings mentioned correspond with those of the present study. It seems that practicing nurses need more training on basic computer skills. Hence, to empower nurses in the dynamic healthcare environment, reduce time-consuming paper documentation, improve clinical decisions, reduce errors, reduce duplication and allow nurses to focus on providing patient care, their basic computer skills need to be strengthened.

According to the findings of this study, in informatics knowledge competency the nurses had better understanding and capability in searching for key information on concepts related to the nursing profession. Nevertheless, they had lower capabilities in other areas such as knowledge of file management function in the operating system, recognizing the limitations of computer programs, and analysis of patients' information needs. Other studies show a direct relationship between nurses' knowledge and their skills (Kerie et al., 2018; Munezero et al., 2018). Informatics knowledge is a conceptual and theoretical base for each specialty, without which informatics skills will not be properly obtained. Therefore, it can be concluded that informatics knowledge is the infrastructure for acquiring informatics skills. Thus, as the first step, the level of knowledge and information literacy of nurses needs to be increased through training and appropriate orientation.

Based on the findings of this study, nurses seem to have little ability in terms of informatics skills. Regarding this, results showed that more than half of the nurses participating in the present study had the ability to use HIS to store, retrieve and transmit patient data and the ability to collect data and information related to clinical care. However, they were not proficient in functions such as participation in selection, design, implementation and evaluation of systems; correcting defects when working with the system; or the use of information technology for patient education. Due to the fact that nurses are required to use HIS on a daily basis in the workplace and apply it to patient care, they manifested more competencein this regard. Nonetheless, it seems that since nurses were not involved in the other fields of informatics and had no need to learn these skills, the level of their informatics skills was low.

The results of the study conducted by Jebraeili et al. (2010) confirmed the fact that preparation of human resources for implementation of electronic health records, which is one of the objectives of the Ministry of Health and Medical Education in Iran, was not required. To achieve an acceptable level of preparation, factors which can increase nurses' preparation need to be considered more seriously and nurses need to be trained so that their computer skills and knowledge can be strengthened.

The U.S. National Advisory Council on Nurse Education Practice (NACNEP, 2009) recommended preparing nurses with the aim of adopting intelligent and quality-based information technology use in patient care by implementing five strategies: providing core informatics courses to nursing schools, educating nurses specialized in informatics skills who are able to solve related issues, offering more powerful nursing care through the implication of telecommunication projects, preparing more nursing faculties in the informatics field to facilitate students' skills enhancement, and enhancing collaboration to advance informatics.

In their study on informatics courses, Elahi et al. (2018) included a plan for designing a curriculum of nursing and medical informatics experts. Most experts considered designing a nursing informatics curriculum as necessary and expressed their positive views on nursing informatics as a missing link in the application of knowledge and information that can prove beneficial in nursing, has the potential for innovation and promotion of health and is the basis of professional knowledge development. The curriculum was designed as 12 units of compensatory courses, 16 units of compulsory courses, 14 optional units, 4 units of thesis, and required workshops.

Conclusion

The quality of patient care can be better ensured by communicating effectively and sharing accurate information. This increases the continuity of care, enabling higher quality of care for patients (Casey & Wallis, 2011). Thorough documentation and knowledge development to support evidence-based practice, developing nursing informatics knowledge and nursing informatics competencies seem to be urgently required in Iran since nurses require proper and sufficient information knowledge and communication technology skills for better information management. The teaching of informatics in nursing faculties in Iran is at the level of basic computer skills in a single semester and almost nothing has been done regarding knowledge and skills in informatics. Therefore, a policy based on careful planning and expert review should be adopted in the country and by the Ministry of Health to further nursing informatics lessons in the curriculum of nursing students to raise knowledge, skills and the inclination of nursing students towards informatics in their professions. Therefore, as the basis of nurses' professional skills is shaped through the academic training courses they take (Alberto et al., 2005), inclusion of informatics lessons in university curricula may lead to improvement of their informatics skills (Elahi, et al., 2018).

In this regard, in addition to required and specialized courses, it is suggested that nursing informatics curricula include courses of data base management, clinical information systems, informatics theories and issues, system analysis and design, health data security, information technology project management, and clinical-nursing informatics practicum (University of Pittsburgh, 2018; University of South Alabama, 2017; Vanderbilt University, 2018) to improve nurses' informatics competencies. Despite significant advances in medical science, a lot needs to be done in Iran so that the country can develop in terms of nursing informatics. Hence, it seems necessary to develop this field to enhance nursing in educational, research, clinical and management areas by utilizing the services provided by specialists in this field.

The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.

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Author Bios
Mehrdad Farzandipour is a full professor and head of the Health Information Management Research Center and a faculty member in the Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, IR. Iran.

Hashem Mohamadian is an assistant professor and member of the Research Centre for Social Determinants of Health and a faculty member in the Department of Health Education and Promotion, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR. Iran.

Hossein Akbari is an assistant professor and member of the Clinical Research Center and a faculty member in the Department of Biostatistics and Public Health, Kashan University of Medical Sciences, Kashan, IR. Iran.

Samira Safari, MSc, is a member of the Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, IR. Iran.

Monireh Sadeqi Jabali, Ph.D. student, is a member of the Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, IR. Iran.

Published on July 1, 2020