Perceptions of Nurses towards a Computerized Documentation System

Introduction
This study finding will be served to describe the perceptions of nurses towards the computerization of the documentation system and the possible relationship of demographic variables and attitude. Computerized documentation system identifying patient safety concerns or deviations from standards of care. Background Theory Nursing documentation is an account of the nurses fulfillment of the professional and legal duty of care and an important part of clinical documentation. It has evolved to provide effective communication between health care providers, a plan of care for the patient, an avenue for compensation from health care, and a source for education and research. ( Ammenwerth, mansmann, Iller and eichtadter, 2002) Thorough nursing documentation is a precondition for quality care and efficiency within the health care team. In the past, the use of paperbased documentation systems has been enough to support documentation However according to the work of Ammenwerth et al. (2002), this is very limited investment effort which greatly comprised patient care. The continuous increasing rate of medical errors and arising health care cost are now the driving forces behind the revolutionary transformation of information management, and affects not only nursing but all health care professionals. Attempts and discussions about how to support the nursing process using computer-based documentation systems globally, especially in the United States, hence have been discussed (Kaminski 2005). Health care support through information technology (IT) is posing an increasing rate in an attempt to improve healthcare and reduce cost. Fresh approaches to charting that reduce the time and effort of recording will likely be of broad interest to nurses. Anything that allows more time to be spent with clients and enhances the ease of documentation especially the move routine and standard reports required is a positive move. Institutions are spending many dollars on new computer charting system (Berman, Syder, Kozier and Eib 2008) However, the emergence of change brings with the challenges that must be identified and planned for despite the apparent attractiveness. Many IT applications have failed or have not been implement Philippines, only about 4% of the hospital implementing computerized documentation

Perceptions of Nurses towards a Computerized Documentation System systems have fully adapted. Major factors contributing to this delay in adoption are the financial issues, minimal training facility centers and response of the end users. (DOH, 2010)

User acceptance is often even seen as the crucial factor determining the success or failure of a new project (Ammenwerth et al., 2002).Therefore, the recognition of positive and negative effects of softwares in documentation through the investigation of perceptions of the nurses, is the first step before looking for ways of maximizing advantages and facing disadvantages of IT use (Zhang, Cocosila & Archer, 2010). Insights into nurses perceptions of IT implementations will guide further development of systems to enhance clinical practice (Oroviogoicoechea, Watson & Remirez, 2010). However, reports of nurses underrepresentation in the software development continue to be a setback. Many problems arise in the implementations which are left unspoken due to the lack of authority (Saba and McCormick, 2006). This study endeavors to describe the perceptions of nurses on the computerization process of the documentation system before the application of a new advancement in the healthcare field, and relate these to the demographics of the respondents. Results from the study may become a basis for the participating hospitals when considering and planning to adopt a computerized documentation system in enhancing clinical practice in the near future. Statement of the Problem This study will aim to investigate the perception of nurses toward the adaptation of computerized documentation particularly the electronic medical record in Angeles City. Specifically, this study will answer the following questions: What do nurses think about computers perse? How do they perceive computerized documentation as a well trend? How do computerized documentation affect nurses? At what level of expertise should a nurse have in order to properly computerized documentation? Do computers enhance nurses abilities? Conceptual Framework Input Demographic profile of the participant ( designed profile sheet to be filled up by concerned participants.)

Perceptions of Nurses towards a Computerized Documentation System Process 1. Design own Profile Sheet 2. Adapt a questionare that would elicit information from the respondents. 3. Distribute the designed questionares to concerned respondents or agencies to be filled up by them. 4. Collect questionares distributed earlier. 5. Tabulate the results and formulate conclusions based on the information collected. Output An input to the opinion of nurses towards the computerized form of documentation in Angeles City. Significance of the Study Nurses The nurses will benefit in this study because they will get to know more about computerized documentation and how it affects their career. Furthermore, they will have a better grasp of how the computerized system of documentation works and thus improve the way they use it. Patients There will be a benefit to the patients because they will know how their records are being handled by the health care providers in the hospitals where they are confined in. Since patients has the right to privacy and confidentiality, they could protest if they think that there is a breach of information occurring in the hospital due to computerized documentation system. Hospitals administration They will benefit because they will know how nurses perceive computerized documentation and thus, can make further improvements for the sake of health care providers and their patients. If their form of documentation will improve thus it could be a good investment for the hospital since good service employs more patients. Allied Medical Provider They too will benefit because not only nurse will use computerized documentation but also them, they will know how the computerized documentation can make their work easy and improve service to their patients. Nursing Students Even while studying, if they will read our research, they will have a glimpse on the trend of computerized documentation that hospitals are starting to adapt. They will not be newbies in the new form of hospital documentation and will be able to adapt more easier.

Method
Review of Related Literature The emergence and expanding role of technology in different fields is imminent, and so is its part in improving nursing today. In fact, different

Perceptions of Nurses towards a Computerized Documentation System computer programs have been designed to lessen the workload of the nursing process. Some of which have been geared to enhance and reduce errors in the documentation system.

Conversely, an important issue is the acceptance of the nursing process supported by computer-based nursing documentation. However, several issues arise. For example, nurses may now use predefined care plans without sufficiently adapting them to individual patients. Or, because of low understanding of the nursing process, nurses may complain about the now more time-consuming documentation without exploiting possible benefits. On the other hand, the use of computers to support the nursing process may be a way to increase the acceptance of the nursing process, because it is now much easier than writing care plans by hand (Ammenwerth et al., 2002). Several studies have evaluated the acceptance of nurses with regard to the nursing process and computers. For example, Scarpa, Burkes, and Simpson (2003) analyzed nurses attitudes with regard to computers in general; Vassar (2006) described nurses acceptance of a specific nursing information system; and Bowman (2003) analyzed nurses acceptance of technology in the nursing process. Some authors described the changes of acceptance after the introduction of a computer-based system. For example, Brkle, Murphy, Newton, Sleutel, and Walter (2005) measured the changes of acceptance of computers in nursing after the introduction of a computer-based information system. However, results of such studies yield low acceptance of computers which make the introduction of computer-based systems difficult. This is primarily the reason why these systems need to be evaluated through different methods. Consequently, it has been a head start that few empirical studies have recognized the importance of eliciting responses. A quantitative study by Bagayoko, Dufour, Chaacho, Bouhaddou and Fieschi (2010) assessed the overall end-users view of the whole process of computerization in different hospitals in Mali, Africa. Results from the Likert item scale questionnaire was that, users generally accepted the system and unanimously indicated that the implementation of the program must be expanded to all the departments of the hospitals. Another study (Devine, Williams, Martin, Sittig, Tarczy-Hornoch, Payne and Sullivan, 2010) described prescriber and staff perceptions of implementation of a Computerized Prescriber Order Entry system for medications in the ambulatory setting which was conducted in The Everett Clinic in Washington. A theoretically-based, semi-structured questionnaire

Perceptions of Nurses towards a Computerized Documentation System was used and the overall impressions were favorable. No one wished to return to paper-based prescribing.

Several studies (Goumer, Koeniger-Donohue, Friel & Sudbay, 2007; Kiekkas, Karga, Poulopoulou, Papadoulas & Koutsojannis, 2007; Moody, Slocumb, Berg & Jackson, 2004; Marini, Hasman, Huijer & Dimassi, 2010; Smith, Morris & Janke, 2006) generally described employees perceptions, satisfaction and attitudes towards the adoption of computerization in their departments. Among which, only Smith et al. (2006) found that there is a decrease in positive attitudes toward computerization from the presurvey through postsurvey. Consequently, there has been a study to identify specifically the physicians utilization and perceptions of health information technology (Rosenthal & Layman, 2007) using mailed survey. The study found that a digital divide existed for eastern North Carolina physicians in smaller physician practices. The physicians in smaller practices were less likely to utilize or be interested in utilizing electronic health records, word processing applications, and the Internet. To the researchers knowledge, there has not been a rich stock of information regarding the perceptions of nurses before the adoption of a computerized documentation system, which also supports the statement of Saba and McCormick (2006) that the nursing profession is often an underrepresented body in the progress of informatics in the healthcare industry. Cons:
Privacy Concerns

Clear privacy concerns arise as a result of computerized records. Much like the situation that sometimes occurs with financial information, criminals might try to get medical treatment using someone else's insurance information. Additionally, computerized medical records, especially in a government database, would most likely contain personal information like gender, ethnicity and pre-existing health conditions. Discrimination Computerized medical records could be used to discriminate against potential employees. Just as many companies are requesting credit checks of their applicants to determine financial acumen, what if

Perceptions of Nurses towards a Computerized Documentation System companies could request the medical records of their applicants to determine health status. Pros: 1. Instant Information

Doctors waste precious time and resources retrieving hand-written, scattered medical information on their patients. Computerized medical records can provide doctors with immediate information necessary to treat patients. In emergency situations, the ability to retrieve these records instantaneously can make the difference between life and death. For example, a nurse can pull up an unconscious patient's records and read he is allergic to a certain medication and avoid using those types of drugs on the patient. Lowered Costs Though information technology is expensive to implement, the longterm cost savings can be large. In addition to saving physical space by removing hefty filing cabinets, lowered costs will come as a result of fewer tests and less bureaucracy. Computerized medical records can create one legible, uniform sheet that can be retrieved anywhere in the world. The National Academy of Engineering and Institute of Medicine notes in the book "Building a Better Delivery System" that Brigham and Women's Hospital saves $5 to $10 million annually by using a computerized entry system. Cost reduction is due to fewer lab and drug tests as well as lowered prescribing errors.

Participants Following a typical pilot test population, the instruments will be administered to a smaller group of individuals having similar characteristics as the target population, which will be compose of 10 staff nurses of different attributes chosen randomly from different hospitals in the City of Angeles, Pampanga. Respondents in the actual survey will include 100 staff nurses of varying characteristics employed in private-owned hospitals in Angeles City, Pampanga. These will include Angeles Medical Center, St. Catherine of Alexandria Medical Center, Mother of Perpetual Help Medical Center, Holy Family Medical Center, R.S. Clinic and Medical Center and Ospital Ning Angeles. Justification

Perceptions of Nurses towards a Computerized Documentation System

We chose private staff nurses as our participants because private hospitals are the most likely to adapt such upgrade in technology. Thus, the staff nurses in such hospitals are the one who are with bigger chance to use computerizes documentation. Knowing their perception will help the researchers what they think about Electronic Medical Record.

Instrument Test for Attitudes toward Computers in Healthcare Assessment, a questionnaire developed by June Kaminski, will be used as the research instrument. The questionnaire is a five-level Likert item scale, wherein statements which the respondent will be asked to evaluate is according to any kind of subjective or objective criteria and the level of agreement or disagreement is measured generally. Demographic data included in the questionnaire are age, sex, hospital area, assigned to on the day of the survey, years of experience as a staff nurse, contact hours and ownership of the computer being used.

Review of Related Literature The emergence and expanding role of technology in different fields is imminent, and so is its part in improving nursing today. In fact, different computer programs have been designed to lessen the workload of the nursing process. Some of which have been geared to enhance and reduce errors in the documentation system. Conversely, an important issue is the acceptance of the nursing process supported by computer-based nursing documentation. However, several issues arise. For example, nurses may now use predefined care plans without sufficiently adapting them to individual patients. Or, because of low understanding of the nursing process, nurses may complain about the now more time-consuming documentation without exploiting possible benefits. On the other hand, the use of computers to support the nursing process may be a way to increase the acceptance of the nursing process, because it is now much easier than writing care plans by hand (Ammenwerth et al., 2002). Several studies have evaluated the acceptance of nurses with regard to the nursing process and computers. For example, Scarpa, Burkes, and Simpson (2003) analyzed nurses attitudes with regard to computers in general; Vassar (2006) described nurses acceptance of a specific nursing information system; and Bowman (2003) analyzed nurses acceptance of technology in the nursing process. Some

Perceptions of Nurses towards a Computerized Documentation System authors described the changes of acceptance after the introduction of a computer-based system. For example, Brkle, Murphy, Newton, Sleutel, and Walter (2005) measured the changes of acceptance of computers in nursing after the introduction of a computer-based information system.

However, results of such studies yield low acceptance of computers which make the introduction of computer-based systems difficult. This is primarily the reason why these systems need to be evaluated through different methods. Consequently, it has been a head start that few empirical studies have recognized the importance of eliciting responses. A quantitative study by Bagayoko, Dufour, Chaacho, Bouhaddou and Fieschi (2010) assessed the overall end-users view of the whole process of computerization in different hospitals in Mali, Africa. Results from the Likert item scale questionnaire was that, users generally accepted the system and unanimously indicated that the implementation of the program must be expanded to all the departments of the hospitals. Another study (Devine, Williams, Martin, Sittig, Tarczy-Hornoch, Payne and Sullivan, 2010) described prescriber and staff perceptions of implementation of a Computerized Prescriber Order Entry system for medications in the ambulatory setting which was conducted in The Everett Clinic in Washington. A theoretically-based, semi-structured questionnaire was used and the overall impressions were favorable. No one wished to return to paper-based prescribing. Several studies (Goumer, Koeniger-Donohue, Friel & Sudbay, 2007; Kiekkas, Karga, Poulopoulou, Papadoulas & Koutsojannis, 2007; Moody, Slocumb, Berg & Jackson, 2004; Marini, Hasman, Huijer & Dimassi, 2010; Smith, Morris & Janke, 2006) generally described employees perceptions, satisfaction and attitudes towards the adoption of computerization in their departments. Among which, only Smith et al. (2006) found that there is a decrease in positive attitudes toward computerization from the presurvey through postsurvey. Consequently, there has been a study to identify specifically the physicians utilization and perceptions of health information technology (Rosenthal & Layman, 2007) using mailed survey. The study found that a digital divide existed for eastern North Carolina physicians in smaller physician practices. The physicians in smaller practices were less likely to utilize or be interested in utilizing electronic health records, word processing applications, and the Internet. To the researchers knowledge, there has not been a rich stock of information regarding the perceptions of nurses before the adoption of a computerized documentation system, which also supports the statement

Perceptions of Nurses towards a Computerized Documentation System of Saba and McCormick (2006) that the nursing profession is often an underrepresented body in the progress of informatics in the healthcare industry.

Procedure: 1. Design own Profile Sheet 2. Design a questionare that would elicit inforamtion from the respondents. 3. Distribute to concerned respondents or agencies. 4. Collect questionares distributed earlier. 5. Tabulate the results and formulate conclusions based on the information collected.

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