PERCEPTION AND ATTITUDE OF STAFF NURSES ON USAGE OF ELECTRONIC HEALTH RECORD MONITORING

Prof. Jayalakshmi 1 , Mrs. P. Vadivukkarasi Ramanadin 2 and Ms. Anjali N Prajapati 3 . 1. Principal, Shri Vinoba Bhave College of Nursing, Silvassa. 2. Professor, Dept. of OBG (N), Shri Vinoba Bhave College of Nursing, Silvassa. 3. Assistant Professor, Dept. of OBG (N), Shri Vinoba Bhave College of Nursing, Silvassa. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

1871 specialty that integrates nursing science, computer science & information science to manage & communicate data, information & knowledge in nursing practice. (2)Nursing informatics is very essential for nurses & it is useful for integration of data, information & knowledge to support client, nurses and other health care providers in their decision making in all roles & settings. (3)Various research findings denotes that nurses have less time for client care since they spent lot of time in documenting the client report by hand.This scenario is very common in developing & under developed countries.Though nursing informatics is emerging branch of nursing, it doesn't even take up its buds in various countries.Changing the existing practice is one of the difficult tasks commonly.From the ancestor period many of our nurses were practicing documentation by hand written copy.Changing this practice will take much time.Hence this study is aimed to assess the attitude of staff nurses on Electronic Health record Monitor & computer application in nursing care.
Our lives radically changed since the advent of computers.Computers are most reliable & efficient tool for data processing.Back up of data is possible & we can retrieve the data at any time.Though it has got its own flaw the data can be stored forever. (4)Advance in technology is constantly evolving.In fastpaced world of nursing, nursing informatics plays an important role in helping nurses to make decision more rapidly & accurately.As Nurses need to play a vital role in evaluating & implementing new technological advances in their field. (2,3,4,5)Computers minimize the wastage of resources & provide more time for nursing care.The research report shows that there is an impact of EHR on nurses' time reported that using computers in hospitals was significantly associated with time saved for nurses that could be translated into financial savings.The time saved was attributed mainly to the flow of patient information between departments in the hospital. (4)The other research also reported significant time savings that were attributed to nurses' use of a computerized system in the documentation processes in lieu of handwritten documentation. (6)A randomized clinical trial reported reduction in nurses' documentation time that equated to an increase in direct patient care after installing a computerized system in the ICU. (7)Hence this study is aimed to identify the attitude of staff nurses towards computer usage in health care setting & Electronic health record monitoring.

Materials and Methods:-
Quantitative approach with descriptive research design was used.Non-Probability convenient sampling technique was used to select 70 staff nurses working in Shri Vinoba Bhave Civil Hospital, Silvassa.Self administered semi structured questionnaire was used to collect the data.The tool consists of five sections.Section-I includes Sociodemographic variables, Section-II includes Perception of staff nurses on Electronic Health record monitoring, Section -III includes Attitude of staff nurses on EHRM, Section -IV includes PATCH Scale a standardized tool with 50 items to assess an attitude towards computer application in health care setup.Study was analyzed by using both descriptive & inferential statistics.Formal permission was obtained from Director cum Medical Superintendent, Shri Vinoba Bhave Civil Hospital, Silvassa.Oral consent were obtained from the Staff Nurses after explaining the study objectives & ensuring the confidentiality.(Raja), majority (75%) of the staff nurses had good computer knowledge.(Punjab, ludhiyana), one third of the nursing staff had contact with computers prior to start of the study. (8)rception of Staff Nurses on Electronic Health Record Monitor shows maximum number of staff nurses (87) felt that there is a necessity to use EHRM.81% of them were expressed no opinion on uses of EHRM, 50 % of them were mentioned that there is draw back in using EHRM out of which 9% of them were expressed that time consuming is the common draw back.It also shows that 46 % of them were preferred recording by hand written method & 42% of them were preferred EHRM.In contrast to this findings the other study shows that 100% of nurses had positive attitudes towards computer utilization. (9)The enthusiastic attitude of Staff nurses toward using computers on the ward was striking.Nursing staff expected that their work would be easier after the introduction of computers, that electronic data processing would save time, and that the computers would be easy to use.The staff did not express such positive expectations for the use of bedside terminals or portable devices.The results of the other study also shows that, on average, 15% of a nurse's time was spent providing general nursing care, 35% on special nursing care, and 30% on administrative activities.The remaining 20% was used for activities not directly related to nursing. (8)esent study shows that 17% of the Staff Nurses have low positive attitude (17%) towards computer application in nursing practice.Similar finding was observed in a study shows that Nurses had a favorable attitude towards computerization.Non-users had a significantly higher attitude score compared to the users (p = 0.0274). (10)These finding were dissimilar with other findings conducted among the middle and functional level nurse managers.It reveals that nurse managers had very positive attitudes towards use of computers in provision of health care. (11)00% of nurses had positive attitudes towards computer utilization.50.8% and 30.8% had average and fair computer skills respectively.No significant correlation was found between nurses computer knowledge, attitude and skills. (9)esent study also shows according to PATCH Scale 3 (5%) of them had uneasiness to use computers in health care, 30 (42%) of them got limited awareness, 35 (50%) of them got realistic view & only 2 (3%) of them had enthusiastic view.Similar findings were observed in a study which reveals that nurse managers had very positive attitudes towards use of computers in provision of health care.The attitudes of the nurse managers towards use of computers in nursing were not significantly influenced by accessibility to a computer, previous training in computer (p=0.05).However the length of practice as a nurse and the age of the respondents have negative influence on attitudes (p=0.05).Majority of the nurse managers (85%, n=91) did not have computer studies as part of their training in basic nursing, fifty one percent ( n=55) had received training in computers after their basic training in nursing.Majority of the nurses 98.1% (n=105) desired to be trained in computer applications.Most nurse managers (69.1%) on job training in computers. (11)mputer technology has the potential to impact on the structure and delivery of healthcare, challenge the traditional roles and scope of practice, alter the existing boundaries and relationships and reinvent the clinical environment of nursing. (12)he results show that both nurses' informatics competencies and nursing computer system success do have influence on nursing organizational impact. (13)The information systems in place in various hospitals differ in major ways; some have an impact on nursing resource use while others do not.Evidence is strong and consistent that computer systems that manage flow of information between nursing units and ancillary departments save time for nurses . (6)spitals with higher penetration of electronic health records had more RNs employed (coefficient = 0.234, P = 0.002) compared with hospitals with low penetration of electronic health records, even when controlling for adjusted patient-day volumes.This difference decreased for hospitals with higher case-mix index values. (4)There is also strong, but unreplicated, evidence that a work plan or electronic Kardex for each patient saves time at report.On the other hand, systems that emphasize on-line charting and not communications do not save time. (6)plications:-Nursing informatics is very useful for integration of data, information & knowledge to support patients, nurses & other providers in their decision making in all roles & settings.Findings of the study reveals that staff nurses are 1875 having less awareness, uneasiness & negative attitude towards computer application in health care setting.This study insists on developing organizational policies and procedures to implement electronic documentation.It also specifies that to create awareness & educate the staff nurses on the benefit of using computers & electronic documentation.The present study also recommends the nursing curriculum should include nursing informatics & train the students to apply the technology in day to day nursing care activities.This study suggests a Post graduation programme in nursing informatics to strengthen the nursing profession for improving Quality of care.

Conclusion:-
Nurses need to play a role in evaluating & implementing new technological advances.Focus of nursing care is not the machine or technology it is client.Present study shows that majority of the staff nurses are not having positive attitude towards Electronic Health Record Monitoring & not having enthusiastic & idealistic view towards using computers in health care.There are more comfortable with Case sheet method.This view can be changed by various method example in-service education programme on EHRM.The value of nursing informatics is highly emphasized nowadays.Therefore nurse administrators and nurse educators must create and play a important role in helping hospitals to apply information technology slowly into the nursing activities by the employed nurses.

Figure- 1 :
Figure-1:-Attitude Of Staff Nurses Towards Ehrm Note:-Findings of the study show that 27 (39%) of them had very low positive attitude, 12 (17%) of them had low positive attitude, 12 (17%) of them had very low negative attitude & 19 (27%) of them had low negative attitude.

Figure 2 :
Figure 2:-Attitudes Of Staff Nurses According To Patch Scale Attitude of Staff Nurses according To PATCH Scale:-According to PATCH Scale 3 (5%) of them had uneasiness to use computers in health care, 30 (42%) of them got limited awareness, 35 (50%) of them got realistic view & only 2 (3%) of them had enthusiastic view.

Table - 1:-Frequency
And Percentage Distribution Of Staff Nurses According To Their Socio-Demographic

Very Low Positive Attitude Low Positive Attitude Low Negative Attitude Very low Negative attitude 39% 17% 27% 17%
Finding denotes that maximum (84%) number of Staff Nurses knew to operate computers & 43% of them were aware of Electronic Health Record through Friends & Seniors.It is supported by the study findings that the majority 75% staff nurses had good computer knowledge, 50.8% and 30.8% had average and fair computer skills respectively