International Journal of Computer Trends and Technology (IJCTT) – volume 4 Issue 8–August 2013

Applying Technology Acceptance (TAM) model to

determine the acceptance of Nursing Information
System (NIS) for Computer Generated Nursing Care
Plan among nurses
Babu Dharmarajan#1, Dr.Kasthuri Gangadharan *2
# Associate Professor, Head of the Department, Dept. of Medical Surgical Nursing, Yenepoya Nursing College,
Yenepoya University, Mangalore, India
* Director to Nursing Education, Rajiv Gandhi University of Health Sciences, Bangalore, India

Abstract Technology Acceptance Model (TAM) has been employed to

Background: An advance in the development of information collect the data. Results: The majority of nurses showed
technology and the performance standards in the healthcare positive intention towards perceived usefulness, perceived
systems require an electronic health care record to allow the ease of use and attitude towards Nursing Information System
management of the various sources of clinical data in a (NIS) for computer generated nursing care plan and there was
patient-centered care approach for the health organization significant relation found between perceived usefulness,
which has been well known in nursing, where patient centered perceived ease of use and attitude at p<0.05 and p<0.001
holistic care is central to the majority of nursing models level. Conclusion: Results evidenced the acceptance of
through the nursing process. Methods: An explorative study nursing information system and computer generated nursing
has been carried out to determine the level of acceptance of care plan and also proposed the need to repeat the study after
Nursing Information System (NIS) for computer generated implementing the nursing information system in the actual
nursing care plan among thirty nurses selected by convenience setting and also to identify the usage of the system. Keywords:
sampling technique in the selected hospital, Bangalore, Nursing Information system, Nursing care plan, Technology
Karnataka, India, in the pre implementation stage. Self Acceptance Model
administered Likert’s scale questionnaire based on
Introduction involved in the evaluation phases of information systems, also
Healthcare is delivered in dynamic, complex, ever changing play increasing roles in developing and sustaining the long
environments and to respond proactively for these changes term strategy for accessing patient information 1. The Agency
and the growing demands for clinical information, computer for Healthcare Research and Quality (AHRQ) reports
systems are being devised to collect, store, retrieve, analyze hospitals are experiencing a steady increase in patient care
and communicate health status and health care information 1. costs, along with a nursing resource shortage, as well as
Effectiveness of any health institution depends on its goals expanding healthcare regulation and policy requiring
and objectives, its strategic location, soundness of its increased organizational information on care quality, safety
operations, and efficiency of its management systems2. and outcomes5. Recognition of this growing need for nursing
The development of information systems has been linked to data, the computer based patient record facilitates the
changing needs in the healthcare industry. A computer-based automation of the nursing care planning process. Summarized
patient record (CPR) is essential for integrated healthcare by Meadows “The ability to electronically record, integrate
networks to be able to accomplish strategic goals of fusing and analyze data and information enables nurses to quickly
business and clinical operations. The Institute of Medicine move to the synthesis of nursing knowledge and the
(IOM) noted the trend toward integration within the healthcare development of nursing wisdom, which they can then apply to
industry and the importance of having a CPR to support new patient care6.
care delivery methods3. Information systems are being
deployed in health care systems worldwide, and have the Nursing care plans have been used extensively in educational
potential to change storage of data, way to access and update settings as an essential teaching tool and the value of care
specific information about patients4. planning has been reinforced by the Joint Commission on
Accreditation for hospitals (JCAH), but it remains difficult to
Technology has brought about the automation of nursing find nursing care plans in the clinical setting whereas in
information and data, and the advent of the nursing reality, if care plans are written they are often incomplete,
information system can best be integrated into all phases of outdated, rarely used for determining care and infrequently
the delivery of patient care. Nursing professionals have key relied upon as a means of communicating problem
roles in integrating technology into patient care delivery and management from one shift to another. The nurses view the

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 International Journal of Computer Trends and Technology (IJCTT) – volume 4 Issue 8–August 2013

care plan as another burdensome piece of time consuming H1: Perceived ease of use (EOU) will have a significant
paperwork, preparation or revision of the plan is low in positive influence on perceived usefulness (U)
practice settings. Therefore the plan is not available and H2: perceived usefulness (U) will have a significant positive
consequently is not used because it is not a reliable source of influence on attitude (A) toward using NIS
information. The perpetuation of this cyclical disuse of the H3: Perceived ease of use (EOU) will have a significant
nursing care plan may be ameliorated if care plan construction positive influence on attitude (A) toward using NIS
and modification were quick and simple. A computerized H4: There will be significant association between the level of
program would facilitate this kind of care planning7. acceptance with selected demographic variables of the
subjects
The care plan provides a mechanism for provision of
consistent and coordinated care8. The nursing care plan The tool consisted mixture of Likert’s scale items and
illustrate the sequential and interrelated phases of nursing semantic differential scale items. In the present study the tool
process such as assessment, diagnosis, planning, consists of two parts sections namely Section A and Section
implementation and evaluation, in order to make best possible B. Section A deals with the demographic profile of staff
care decisions and maintain appropriate documentation of nurses and Section B includes the scale consisted of six items
meaningful information9. In a study where 20 nurses were with a seven-point Likert’s scale with a response ranging from
formally interviewed, various questions were posed regarding seven to one, representing Extremely Likely(EL), Quite
the benefits in using a computerized nursing care plan system. Likely(QL), Slightly Likely(SL), Neither(N), Slightly
In addition to the expected response of streamlined care, Unlikely(SL), Quite Unlikely(QU), Extremely Unlikely(EU)
nurses added several areas of benefits which included a in the perceived ease of use and perceived usefulness
reference for their memory for patient details, a learning tool constructs. The total score ranges from 6 to 42 points; a higher
for patient care, and a vehicle to easily modify care plan score indicated a higher degree of perceived ease of use and
content. These responses highlight the creative potential for perceived usefulness as perceived by selected subjects.
nursing care plans as IT solutions are developed10. Nursing Whereas the attitude construct includes four items differential
care plan given its central position in patient care, it would semantic scale the total score ranges from 4 to 2813-16. The
appear obvious that a computerized nursing care plan offers calculated Cronbach alpha for the tool was 0.82 and the tool
great potential in many areas other than just making care more was found to be highly reliable.
efficient11.
Methods
The documentation of the nursing care plan is an important An explorative design has been adopted for the present study
but often neglected part of clinical documentation. Therefore to determine the level of acceptance of nurses towards
there have been some attempts and discussions about how to developed nursing information system for computer generated
support the nursing process using computer based nursing care plan and the thirty nurses are selected by
documentation systems. Motivation is an essential for learning convenience sampling technique who fulfilled inclusive
and important success factors for new computer-based system criteria. After obtaining formal permission from the concerned
are user’s motivation and acceptance of new ways of working authorities the researcher formulated the case scenarios of
as well as user acceptance is often seen as crucial factor for cardiac medical conditions from the patient records and
determining the success or failure of new a project12. In order applied same to the selected samples. The researcher taught
to assess the level of acceptance of nursing information the functioning of the nursing information system by
system for computer generated nursing care plan the demonstrating the patient care plan tabs from the researchers
researcher adopted a modified self-administered questionnaire system. After successful completion of practice session the
based on Fred D. Davis Technology acceptance Model (TAM) each subjects were asked to develop a five nursing care plan
which to predict the degree to which users unfamiliar with a based on the case scenarios written by the researcher by using
particular piece of software will actually use that software the developed nursing information system. At the end of the
after being introduced to it. The goal of TAM is to predict session the researcher administered the tool in order to assess
information system acceptance and diagnose design problems the participants’ level of acceptance towards the developed
before users have any significant experience with a system. nursing information system for computer generated nursing
Davis has developed scales to measure ‘‘perceived care plan. The collected data were coded, organized and
usefulness’’ (U) and ‘‘perceived ease of use’’ (EOU), analyzed using statistical package SPSS 20 version.
“attitude” (A), and Behavioral Intention (BI). By gathering
user perceptions of a system’s usefulness and ease of use, Results and Discussion
developers can more accurately assess whether that system Demographic profile of staff nurses
will ultimately be accepted by users. Based on the description From the findings it was evident that most of the subjects
of Technology Acceptance Model the following hypotheses 19(63.3%) belongs to the age group of 21 to 25 years and
were formulated for the present study in order to assess the majority of the subjects 27(90%) whereas majority of the
level of acceptance of nursing information system for a subjects 21(70%) done General nursing and Midwifery and
computer generated nursing care plan. 7(23.3%) subjects undergone certificate course in computer

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 International Journal of Computer Trends and Technology (IJCTT) – volume 4 Issue 8–August 2013

science and only 1(3.3%) subject completed Diploma in Technology Acceptance Model to predict nurses' intention to
computer science respectively. With respect to overall use telemedicine technology (eICU), 117 participants from
experience most of the subjects 16(53.3%) had 1-3 years of two healthcare systems were participated and the results
experience and previous experience in computer application showed that perceived usefulness is the most influential factor
revealed that maximum number of subjects 18(60%) had no that influences nurses' intention to use the eICU technology19.
sort of experience Exposure to information about nursing The study findings of Tao D (2008) on understanding
information systems showed that majority of the subjects intention to use electronic information resources based on a
19(63.3%) heard during their clinical practice and 10(33.3%) theoretical extension of the technology acceptance model
subjects known during their curriculum. (TAM) by examining the roles of two aspects of e-resource
characteristics, namely, information quality and system
Level of Acceptance of nursing information system quality, in predicting public health students' intention to use e-
Table 1: Assessment of Ease of Use (EOU) among subjects resources for completing research paper assignments revealed
EOU Mean SD Median Mean% that perceived usefulness played a major role in determining
EOU1 6.17 0.83 6.00 88.10 students' intention to use e-resources20.
EOU2 5.30 0.60 5.00 75.71
Table 3: Assessment of Attitude (A) among subjects
EOU3 6.23 0.77 6.00 89.05
A Mean SD Median Mean%
EOU4 5.63 0.72 5.50 80.48
EOU5 5.60 0.93 6.00 80.00 A1 6.57 0.504 7.00 93.81
EOU6 5.60 0.62 6.00 80.00 A2 6.40 0.724 7.00 91.43
EOU 34.53 1.85 35.00 82.22 A3 6.60 0.498 7.00 94.29
A4 6.53 0.507 7.00 93.33
The overall mean score obtained by the subjects was 34.53
A 26.10 1.21 26.50 93.21
(82.22%) with the SD of ±1.85 in the construct of ease of use,
it was evidenced that there was a high perceived ease of use The overall attitude mean score was 26.10(93.21%) with the
about nursing information system. The present study findings SD of ± 1.21, which evidenced the favorable attitude towards
the developed nursing information system. These were
were consistent with the study findings of Stocker, Gary
consistent with the findings of Chow M et.al (2012) on
(2010) who assessed the technology acceptance of electronic
medical records by nurses. The modified Davis survey tool development of a clinical imaging portal to facilitate
was electronically distributed to nurses in 13 hospitals to independent learning in image interpretation and to explore
factors affecting intentions to use the portal based on the
assess Davis' TAM model in acute care settings results
showed that Perceived ease-of-use and perceived usefulness technology acceptance model (TAM), among One hundred
were the variables used to predict intention of nurses to use and twenty-eight nursing students indicated that the portal was
electronic medical records in acute health care settings17. perceived as easy to use, useful and satisfying and structural
Study findings Lu CH, Hsiao JL, Chen RF(2012) on factors equation modeling (SEM) showed that attitude toward using
determining nurse acceptance of hospital information systems the portal exhibited the strongest total effect on behavioral
were similar with present study findings, the researchers intention to use, followed by perceived ease of use and
supported that perceived usefulness and ease of use have a computer self-efficacy21. Also similar to the study findings of
De Veer AJ and Francke AL (2010) who conducted a
significant influence on system acceptance (R=0.75);
questionnaire survey to study the attitudes of nursing staff
Perceived usefulness (β1=0.61, P&lt;.001) has a significant
(685) working in Dutch hospitals, psychiatric organizations,
influence on system acceptance18.
care organizations for mentally retarded people, home care
Table 2: Assessment of Perceived Usefulness (PU) among subjects organizations, nursing homes or homes for the elderly towards
PU Mean SD Median Mean% electronic patient records, results revealed that nursing staff
PU1 6.07 0.64 6.0 86.67 members associate EPR with improved care, especially
PU2 5.53 0.57 5.5 79.05 qualitatively better and safer care and a relatively positive
PU3 5.60 0.50 6.0 80.00 attitude towards EPR was found in three categories of nursing
PU4 5.73 0.52 6.0 81.90 staff in particular, i.e. staff working at least 30hr per week,
PU5 5.77 0.50 6.0 82.38 staff already using EPR and staff working in hospitals, also
PU6 5.60 0.50 6.0 80.00 nursing staff in management positions also tend to have a
PU 34.30 0.95 34.0 81.67 more positive attitude whereas when the Technology
The overall mean score obtained by the subjects was Acceptance Model was tested, attitudes towards EPR were
34.30(81.67%) with the SD of ±0.95 in the construct of primarily associated with job-related characteristics and
perceived usefulness, it was evidenced that there was a high perceived usefulness with respect to quality of care22.
Table 4: Correlation between constructs of TAM
perceived usefulness towards the developed nursing
Constructs r-value p-value
information system and were similar to the study findings of
Kowitlawakul Y (2011) who utilized the Telemedicine
Technology Acceptance Model based on the original

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 International Journal of Computer Trends and Technology (IJCTT) – volume 4 Issue 8–August 2013

compared to GNM and also those who had lesser experience

EOU PU 0.551 0.002 had less favorable attitude whereas higher experience more
EOU A 0.497 0.005 favorable attitude towards the developed nursing information
PU A 0.551 0.002 system and all other parameters had no significant influence
on attitude.
***p<0.001, *p<0.05
The above table evidenced the significant correlations Conclusion: In the pre implementation stage nurses expressed
between the constructs of technology acceptance model, there a positive level of acceptance towards the nursing information
was a significant influence of EOU on PU, EOU on A and PU system for computer generated nursing care plan.
on A at p<0.05 and p<0.001level. The study findings were
similar with the findings of Nkenke E et al,(2012) who tried to Future Implications: The study could be carried out in the
determine the acceptance of Virtual dental implant planning real setting after integrating developed nursing information
software among forty-three third-year dental students of the system for computer generated nursing care plan with the
University of Erlangen-Nuremberg, Germany by existing hospital information system as well as effectiveness
administering a questionnaire based on a combination of the of developed nursing information system in terms of
technology acceptance model and the theory of planned functionality and quality of nursing care plan could be
behavior (C-TAM-TPB). cronbach's(α), pearson product assessed.
moment correlation coefficients, and squared multiple
correlations (R2) were calculated. Results revealed that Acknowledgement: We acknowledge the hospital authorities
pearson correlations were significant for the pair’s perceived and the participants for their constant and continuous support.
usefulness/behavioral intention, perceived usefulness/attitude,
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