Nurses’ concerns about using information systems: analysis of comments on a computerized nursing care plan system in Taiwan

Disentangling the clinical data chaos: User-centered interface system design for trauma centers

This paper presents a year-long study of our project, aiming at (1) understanding the work practices of clinical staff in trauma intensive care units (TICUs) at a trauma center, with respect to their usage of clinical data interface systems, and (2) developing and evaluating an intuitive and user-centered clinical data interface system for their TICU environments. Based on a long-term field study in an urban trauma center that involved observation-, interview-, and survey-based studies to understand our target users and their working environment, we designed and implemented MediSenseView as a working prototype. MediSenseView is a clinical-data interface system, which was developed through the identification of three core challenges of existing interface system use in a trauma care unit-device separation, usage inefficiency, and system immobility-from the perspectives of three staff groups in our target environment (i.e., doctors, clinical nurses and research nurses), and through an iterative design study. The results from our pilot deployment of MediSenseView and a user study performed with 28 trauma center staff members highlight their work efficiency and satisfaction with MediSenseView compared to existing clinical data interface systems in the hospital.

Caring for Computers: The Hidden Work of Clinical Nurses during the Introduction of Health Information Systems in a Teaching Hospital in Taiwan

Implementing health information systems for enhancing patient care and management occurs worldwide. Discovering how nurses, as important system end-users, experience technology-reliant clinical practice involved focus groups (n = 25) and in-depth individual interviews with nurses (n = 4) and informatics staff (n = 3) in a major Taiwanese medical center. This qualitative study explores the unintended effects of these systems on nurses’ role and clinical practice. First, nurses’ additional role caring for computer devices supporting patient care involves highly-demanding invisible effort, especially when tackling system malfunctions affecting patients with urgent conditions. Second, nurses are resourceful in developing solutions to protect patients during unexpected technical malfunctions. Third, troubleshooting using telephone technical support as the first resort is problematic. It is argued that computerization requires nurses to care for co-clients: patients and computers. Managing technical malfunctions is an unintended consequence for nurses, reflecting the hidden work required by new technology.

Factors Associated With Canadian Nurses' Informatics Competency

As digital innovations continue to transform health systems in Canada, it is important to examine registered nurses' preparedness in informatics, and factors associated with informatics competency. An exploratory, descriptive, cross-sectional survey was used to determine self-perceived informatics competencies, and factors associated with competency, among practicing nurses in Alberta. Results from 2844 completed surveys showed that nurses' self-perceived informatics competency was slightly above the mark of competent. Perceptions of competency were highest on foundational computer literacy skills and lowest on information and knowledge management competencies. However, overall informatics competency mean scores varied significantly in relation to age, educational qualification, years of experience, and work setting. The quality of informatics training and support offered by employers contributed the most to variance in mean scores of total and subdomains of informatics competency. Other factors, such as age, educational qualification, work setting, previous informatics education, access to the Internet, use of health technology, access to supporting resources, informatics training, an informatics role, and continuing education in informatics, also contributed to mean scores variance in differing degrees. Findings from this study provide a basis for actionable policies to address informatics educational needs and support requirements among nurses practicing now and in the future.

Standardised care plans for in hospital stroke care improve documentation of health care assessments

AIMS AND OBJECTIVES

To compare stroke unit staff members' documentation of care in line with evidence-based guidelines pre- and postimplementation of a multi-professional, evidence-based standardised care plan for stroke care in the electronic health record.

BACKGROUND

Rapid and effective measures for patients with stroke or suspected stroke can limit the extent of damage; it is imperative that patients be observed, assessed and treated in accordance with evidence-based practice in hospital.

DESIGN

Quantitative, comparative.

METHODS

Structured retrospective health record reviews were made prior to (n 60) and one and a half years after implementation (n 60) of a multi-professional evidence-based standardised care plan with a quality standard for stroke care in the electronic health record.

RESULTS

Significant improvements were found in documentation of assessed vital signs, except for body temperature, Day 1 post compared with preimplementation. Documentation frequency regarding body temperature Day 1 and blood pressure and pulse Day 2 decreased post compared with preimplementation. Improvements were also detected in documented observations of patients' micturition capacity, swallowing capacity and mouth status and the proportion of physiotherapist-documented aid assessments. Observations of blood glucose, mobilisation ability and speech and communication ability were unchanged.

CONCLUSIONS

An evidence-based standardised care plan in an electronic health record assists staff in improving documentation of health status assessments during the first days after a stroke diagnosis.

RELEVANCE TO CLINICAL PRACTICE

Use of a standardised care plan seems to have the potential to help staff adhere to evidence-based patient care and, thereby, to increase patient safety.

The impact of using electronic patient records on practices of reading and writing

The aim of this study was to investigate the use of electronic patient records in daily practice. In four wards of a large hospital district in Finland, N = 43 patients' care and activities were observed and analysed in terms of the Grounded Theory method. The findings revealed that using electronic patient records created a particular process of writing and reading. Wireless technology enabled simultaneous patient involvement and point-of-care documentation, additionally supporting real-time reading. Remote and retrospective documentation was distant in terms of both space and time. The remoteness caused double documentation, reduced accuracy and less-efficient use of time. 'Non-reading' practices were witnessed in retrospective reading, causing delays in patient care and increase in workload. Similarly, if documentation was insufficient or non-existent, the consequences were found to be detrimental to the patients. The use of an electronic patient record system has a significant impact on patient care. Therefore, it is crucial to develop wireless technology and interdisciplinary collaboration in order to improve and support high-quality patient care.

Nurses' perceptions and attitudes towards documentation in nursing

Introduction: Nursing documentation is essential for ensuring a safe, high-quality and continuous nursing care and research work. By means of documentation nurses communicate with each other, other members of the healthcare team and other care providers. The aim of the present research was to investigate nurses' opinions about the importance of nursing documentation. Methods: For the purposes of the study, a quantitative non-experimental research design was employed. A quota sampling included the nursing employees in ten Slovenian hospitals. The survey was composed of closed-ended questions. The data were collected from June 1, 2012 to March 31, 2013. The response rate was 44.95 %. A total of 592 respondents participated in the research, 47.3 % with secondary education and 52.7 % with completed undergraduate study programme. Chrombach's coefficient alpha was 0.898. Descriptive statistics, Kolmogorov-Smirnov test, Spearman's correlation coefficient, and Mann-Whitney U test were used. Results: Nurses with at least college degree attributed more importance to documentation compared to those with secondary education (p = 0.001). Statistically significant correlation was not established (p = 0.98). However, a negative correlation was identified between the time used for documentation and positive attitude towards documentation (p = 0.04). Discussion and conclusion: Nurses perceive documentation as an important part of their work. They believe that documentation enhances transparency, quality and continuity of care, and patient safety. It would be necessary to identify the differences in practices and perceptions of handovers between nurses and other healthcare providers.

Predictors for assessing electronic messaging between nurses and general practitioners as a useful tool for communication in home health care services: a cross-sectional study

Background

Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care.

Objective

The aim of this study was to explore home health care nurses’ assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool.

Methods

The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses.

Results

Over two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, P<.001) if the nurses agreed or strongly agreed that e-messaging was easy to use. The odds of finding e-messaging easy to use were nearly seven times higher (OR 6.9, CI 1.713-27.899, P=.007) if the nurses did not consider the system functionality poor. If the nurses had received training in the use of e-messaging, the odds were over six times higher (OR 6.6, CI 2.515-17.437, P<.001) that they would consider e-messaging easy to use. The odds that a home health care nurse would experience e-messaging as easy to use increased as the full-time equivalent percentage of the nurses increased (OR 1.032, CI 1.001-1.064, P=.045).

Conclusions

This study has shown that technical (ease of use and system functionality), organizational (training), and individual (full-time equivalent percentage) elements had an impact on home health care nurses’ assessments of using e-messaging to communicate with GPs. By identifying these elements, it is easier to determine which interventions are the most important for the development and implementation of ICT systems in home health care services.

Nursing students' attitudes towards information and communication technology: an exploratory and confirmatory factor analytic approach

AIM

The aim of this study was to develop and psychometrically test a shortened version of the Information Technology Attitude Scales for Health, in the investigation of nursing students with clinical placement experiences.

BACKGROUND

Nurses and nursing students need to develop high levels of competency in information and communication technology. However, they encounter statistically significant barriers in the use of the technology. Although some instruments have been developed to measure factors that influence nurses' attitudes towards technology, the validity is questionable and few studies have been developed to test the attitudes of nursing students, in particular.

DESIGN

A cross-sectional survey design was performed.

METHODS

The Information Technology Attitude Scales for Health was used to collect data from October 2012-December 2012. A panel of experts reviewed the content of the instrument and a pilot study was conducted. Following this, a total of 508 nursing students, who were engaged in clinical placements, were recruited from six universities in South Korea. Exploratory and confirmatory factor analyses were performed and reliability and construct validity were assessed.

RESULTS

The resulting instrument consisted of 19 items across four factors. Reliability of the four factors was acceptable and the validity was supported.

CONCLUSIONS

The instrument was shown to be both valid and reliable for measuring nursing students' attitudes towards technology, thus aiding in the current understandings of this aspect. Through these measurements and understandings, nursing educators and students are able to be more reflexive of their attitudes and can thus seek to develop them positively.

Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research

Background

Since the introduction of electronic nursing documentation systems, its implementation in recent years has increased rapidly in Germany. The objectives of such systems are to save time, to improve information handling and to improve quality. To integrate IT in the daily working processes, the employee is the pivotal element. Therefore it is important to understand nurses’ experience with IT implementation. At present the literature shows a lack of understanding exploring staff experiences within the implementation process.

Methods

A systematic review and meta-ethnographic synthesis of primary studies using qualitative methods was conducted in PubMed, CINAHL, and Cochrane. It adheres to the principles of the PRISMA statement. The studies were original, peer-reviewed articles from 2000 to 2013, focusing on computer-based nursing documentation in Residential Aged Care Facilities.

Results

The use of IT requires a different form of information processing. Some experience this new form of information processing as a benefit while others do not. The latter find it more difficult to enter data and this result in poor clinical documentation. Improvement in the quality of residents’ records leads to an overall improvement in the quality of care. However, if the quality of those records is poor, some residents do not receive the necessary care. Furthermore, the length of time necessary to complete the documentation is a prominent theme within that process. Those who are more efficient with the electronic documentation demonstrate improved time management. For those who are less efficient with electronic documentation the information processing is perceived as time consuming. Normally, it is possible to experience benefits when using IT, but this depends on either promoting or hindering factors, e.g. ease of use and ability to use it, equipment availability and technical functionality, as well as attitude.

Conclusions

In summary, the findings showed that members of staff experience IT as a benefit when it simplifies their daily working routines and as a burden when it complicates their working processes. Whether IT complicates or simplifies their routines depends on influencing factors. The line between benefit and burden is semipermeable. The experiences differ according to duties and responsibilities.

Factors influencing nurses' intentions toward the use of mobile electronic medical records

The purpose of this study was to investigate the factors influencing nurses' intentions toward the use of mobile electronic medical records, based on the Theory of Diffusion of Innovations. The cross-sectional study used a structured questionnaire for data collection, focusing on the nurses of a large hospital in southern Taiwan. A total of 720 valid questionnaires were returned yielding a response rate of 82.0%. Multiple regression analysis of the responses identified three innovative characteristics, compatibility, complexity, and observability, as significantly influencing nurses' intentions toward adopting mobile electronic medical records, whereas relative advantage and trialability did not. In addition, nursing seniority affected nurses' intentions significantly toward adopting mobile electronic medical records. Implications of effects of the factors and future research directions are discussed.

Nurses' perception and barriers to use of information communication technology in a teaching hospital in Nigeria

The impact of information technology on nursing has been a subject of discourse for the latter half of the 20th century and the early part of the 21st. Despite its obvious benefits, adapting information technology to healthcare has been relatively difficult, and rates of use have been limited especially in many developing countries. This quantitative study has shown a generally low usage of information technology among nurses in the study setting. Many of the nurses adjudged themselves as novice in information technology, with 37.8% stating that they had never had formal training in information technology and many rating themselves as possessing little or no skill in the use of spreadsheet, databases, and so on. Many (55.6%) stated that they do not have access to information technology despite the fairly widespread satisfactory perception established among them. Results further showed that unreliable network connections, high work demand, inadequate number of computers, poor access to computers consequent on wrong locations, and poor system design with associated failure to fit work demands are some of the major barriers to the use of information technology in the study setting. These factors therefore need to be taken into consideration in any intervention that seeks to improve the nurses' use of information technology in clinical setting.

Factors determining nurse acceptance of hospital information systems

This study proposed an evaluation model, derived from the Technology Acceptance Model and Information System Success Model, to explore factors influencing the acceptance of hospital information systems by nurses. Although many healthcare institutions have applied hospital information systems, relatively few studies have investigated the perceptions of nurses regarding the usefulness, ease of use, or acceptance of these systems. This study recruited the nursing staff of a regional hospital in Taiwan. A total of 297 questionnaires were sent, and 277 were returned, for a response rate of 93.3%. The results indicated that system quality, information quality, and service quality were positively correlated with the perceived ease of use (R=0.69) and perceived usefulness (R=0.72). Information quality has the greatest influence on perceived usefulness (γ3=0.57, P<.001) and ease of use (γ4=0.61, P<.001). Perceived usefulness and ease of use have a significant influence on system acceptance (R=0.75). Perceived usefulness (β1=0.61, P<.001) has a significant influence on system acceptance. These findings indicated that nursing care requires high-quality healthcare information to support the daily activities of nursing professionals. The results of this study also provide a valuable reference for hospital administrators in developing hospital information systems.

Factors Influencing the Success of National Healthcare Services Information Systems

By extending the updated D&M IS success model, this study examines the multi-dimensional aspects to identify influential factors and construct a suitable model for explaining NHSS success in Taiwan. Through the empirical results from the perspective of 1215 public healthcare workers, this study has arrived at several findings. First, eight salient factors were found which influenced NHSS success from the dimensions of user characteristics, organizational context, and system characteristics. Second, the factors of user experience, user training, information quality, service quality, and user satisfaction have a strong positive effect on system use, whereas user attitude and facilitating conditions have a significant and negative effect. Further, user attitude, user training, top management support, system quality, information quality, and service quality are also significantly correlated to user satisfaction. The results of this study can assist governments in other countries in developing more effective NHSS and better e-Government practices.

A study of factors affecting acceptance of hospital information systems: a nursing perspective

BACKGROUND

Hospital information systems (HISs) are widely used in Taiwan, and HIS performance must be carefully evaluated. Nursing personnel are the largest group of staff in a hospital and are the center of care delivery; thus, they play an important role in the adoption and evaluation of HISs.

PURPOSE

The primary objective of this study was to explore the critical factors affecting the acceptance of HISs in Taiwan from a nursing perspective. On the basis of the technology acceptance model, we used six exogenous variables (system quality, information quality, user self-efficacy, compatibility, top management support, and project team competency) as investigation factors.

METHODS

Survey research targeted nursing personnel in the selected case hospital as participants. A total of 545 questionnaires were sent out, and 501 were returned, indicating a valid response rate of 91.9%. Collected data were analyzed using multiple regression analysis.

RESULTS

: Results indicate that user self-efficacy, top management support, compatibility, and information quality have significant impacts on perceived ease of use. In addition, top management support, compatibility, and information quality were identified as having significant impacts on perceived usefulness. Furthermore, nurses' perceived ease of use and perceived usefulness on HISs was found to impact significantly on system acceptance, with 45.1% of the total explained variance.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Results can help managers understand key considerations affecting HIS development and use and may be applied as a reference for system development and improvement.

Factors affecting nurses' attitudes toward computers in healthcare

The purpose of the study was to determine factors affecting nurses' attitudes toward computers in healthcare. This cross-sectional study was carried out with nurses employed at one state and one university hospital. The sample of the study included 890 nurses who were selected via a purposive sampling method. Data were collected by using a questionnaire for demographic information and Pretest for Attitudes Toward Computers in Healthcare Assessment Scale v.2. The nurses, in general, had positive attitudes toward computers. Findings of the present study showed a significant difference in attitudes for different categories of age (P < .001), marital status (P < .05), education (P < .001), type of facility (P < .01), job title (P < .001), computer science education (P < .01), computer experience (P < .001), duration of computer use (P < .001), and place of use of computer (P < .001). The results of the present study could be used during planning and implementation of computer training programs for nurses in Turkey and could be utilized in improving the participation of Turkish nurses in initiatives to develop hospital information systems and, above all, in developing computerized patient care planning.

Why is pain still not being assessed adequately? Results of a pain prevalence study in a university hospital in Sweden

AIM

The aim of this study was to investigate the prevalence of pain and pain assessment among inpatients in a university hospital.

BACKGROUND

Pain management could be considered an indicator of quality of care. Few studies report on prevalence measures including all inpatients.

DESIGN

Quantitative and explorative.

METHOD

Survey.

RESULTS

Of the inpatients at the hospital who answered the survey, 494 (65%) reported having experienced pain during the preceding 24 hours. Of the patients who reported having experienced pain during the preceding 24 hours, 81% rated their pain >3 and 42.1% rated their pain >7. Of the patients who reported having experienced pain during the preceding 24 hours, 38.7% had been asked to self-assess their pain using a Numeric Rating Scale (NRS); 29.6% of the patients were completely satisfied, and 11.5% were not at all satisfied with their participation in pain management.

CONCLUSIONS

The result showed that too many patients are still suffering from pain and that the NRS is not used to the extent it should be. Efforts to overcome under-implementation of pain assessment are required, particularly on wards where pain is not obvious, e.g., wards that do not deal with surgery patients. Work to improve pain management must be carried out through collaboration across professional groups.

RELEVANCE TO CLINICAL PRACTICE

Using a pain assessment tool such as the NRS could help patients express their pain and improve communication between nurses and patients in relation to pain as well as allow patients to participate in their own care. Carrying out prevalence pain measures similar to those used here could be helpful in performing quality improvement work in the area of pain management.

e-Health Technologies in Home Care Nursing

The innovative impact of advancing e-Health technologies is more frequently being discussed in nursing science. Nurses play an important role in collecting data and giving support to other users, especially in home care. Since issues of acceptance play a major role, the following article, which presents findings based on a focus group consisting of the elderly, caretaking relatives and professional nurses, is discussed from an ethical point of view in the context of international debate. It is interesting to note, that to some extent there is substantial ambivalence in the willingness to integrate such technologies into daily care. A need for technical assistance is clearly recognizable, however, limits as well. The authors’ findings indicate that a fundamental discussion on the relevance of e-Health methods in professional nursing needs to be held. It should address the ethical questions of often conflicting interests and rights (protection of identity, privacy and safety) in situations of high vulnerability.

The multimethod evaluation of a nursing information system in taiwan

The purpose of this study was to evaluate the impact of a nursing information system on nurses' daily practice. A multimethod evaluation was used that combined both quantitative and qualitative approaches to explore the influence of this technology from different perspectives. The data collection methods included the following: an evaluation scale of the system function, focus group interviews about the users' experiences, and work sampling observation of their work pattern. The data were collected from October to December 2006. The data analysis contained 623 valid questionnaires, 24 nurses' interview content, and 22830 observed nursing activities. Overall, the results indicated that nurses gave a positive evaluation of the technology in their work routine. However, they were concerned about the inadequacy of the hardware devices and response time, training and workflow change, and personal interactions with physicians and patients. Nurses on the night shift spent more time on documentation than on any other nursing activities during the three shifts. The users' technology adoption could be attributed to device sufficiency and function, content design, and workflow efficiency. It is recommended that organizations provide sufficient computer devices, ensure the content design for nursing documentation, and implement expectations for interdisciplinary cooperation.

Creating history: documents and patient participation in nurse-patient interviews

Strongly worded directives regarding the need for increased patient participation during nursing interaction with patients have recently appeared in a range of 'best-practice' documents. This paper focuses on one area of nurse-patient communication, the hospital admission interview, which has been put forward as an ideal arena for increased patient participation. It uses data from a total of 27 admission interviews, extensive periods of participant observation and analysis of nursing records to examine how hospital admission interviews are performed by nurses and patients. Analysis shows that topics discussed during admission closely follow the layout of the admission document which nurses complete during the interview. Whilst it is tempting to describe the admission document as a 'super technological power' in influencing the interaction and restricting patient participation, this analysis attempts a more rounded reading of the data. Findings demonstrate that, whilst opportunities for patient participation were rare, admission interviews are complex interactional episodes that often belie simplistic or prescriptive guidance regarding interaction between nurses and patients. In particular, issue is taken with the lack of contextual and conceptual clarity with which best-practice guidelines are written.

Two-stage evaluation of the impact of a nursing information system in Taiwan

PURPOSE

This study evaluated the post-implementation impact of a nursing information system and identified issues related to the technology adoption process. Given the high level of investment necessary to implement information systems, evaluation has become vital to ensure successful adoption and use. Improved understanding of implementation difficulties/barriers and factors leading to them can serve as a platform for the development of strategies and education programs for users.

METHOD

The study design was a two-stage data comparison analysis of a nursing information system focusing on computerized nursing care plan use. Data were collected from nurses by questionnaire during the first month (December 2004) and 1 year after system installation (December 2005).

RESULTS

While nurses gave the information technology a higher evaluation score at the second stage than at the early stage, the overall ratings were slightly negative at both stages. Age and pressure to use the system were critical factors at both stages, whereas computer skills and perceived time using the system were vital at the beginning stage of implementation. Issues of concern at both stages were system functionality, efficiency, usability, and user support.

CONCLUSION

Implementation of an information system requires consideration of issues involving hardware and software, staff training, organizational policy, and workflow changes.

Review: evaluating information systems in nursing

AIMS

To review existing nursing research on inpatient hospitals' information technology (IT) systems in order to explore new approaches for evaluation research on nursing informatics to guide further design and implementation of effective IT systems.

BACKGROUND

There has been an increase in the use of IT and information systems in nursing in recent years. However, there has been little evaluation of these systems and little guidance on how they might be evaluated.

METHODS

A literature review was conducted between 1995 and 2005 inclusive using CINAHL and Medline and the search terms 'nursing information systems', 'clinical information systems', 'hospital information systems', 'documentation', 'nursing records', 'charting'.

RESULTS

Research in nursing information systems was analysed and some deficiencies and contradictory results were identified which impede a comprehensive understanding of effective implementation. There is a need for IT systems to be understood from a wider perspective that includes aspects related to the context where they are implemented.

CONCLUSIONS

Social and organizational aspects need to be considered in evaluation studies and realistic evaluation can provide a framework for the evaluation of information systems in nursing.

RELEVANCE TO CLINICAL PRACTICE

The rapid introduction of IT systems for clinical practice urges evaluation of already implemented systems examining how and in what circumstances they work to guide effective further development and implementation of IT systems to enhance clinical practice. Evaluation involves more factors than just involving technologies such as changing attitudes, cultures and healthcare practices. Realistic evaluation could provide configurations of context-mechanism-outcomes that explain the underlying relationships to understand why and how a programme or intervention works.

Nurses' Experiences Using a Nursing Information System

Adoption of information technology in nursing practice has become a trend in healthcare. The impact of this technology on users has been widely studied, but little attention has been given to its influence at the beginning stage of implementation. Knowing the barriers to adopting technology could shorten this transition stage and minimize its negative influences. The purpose of this study was to explore nurses' experiences in the early stage of implementing a nursing information system. Focus groups were used to collect data at a medical center in Taiwan. The results showed that nurses had problems with the system's content design, had insufficient training, were concerned about data security, were stressed by added work, and experienced poor interdisciplinary cooperation. To smooth this beginning stage, the author recommends involving nurses early in the system design, providing sufficient training in keyboard entry skills, redesigning workflow, and improving interdisciplinary communication.

Development and testing of an evaluation scale of personal digital assistants

With the increasingly popular use of PDAs in healthcare, the need for a reliable scale to evaluate this technology has become critical. The authors describe the development and testing of an evaluation scale for PDAs in nurses' daily practice. A review of the literature generated a 30-item questionnaire that was administered online to a convenience sample of 334 hospital nurses in Taiwan. The scale's reliability and validity were established by item and factor analyses. From the original pool of 30 items, 24 were selected and grouped into six major constructs: user preference, nursing efficiency, user training, device features, drug content, and user support. The scale's overall reliability (alpha coefficient) was 0.88. Survey results showed an overall slightly negative score for the evaluation scale for PDAs, indicating a slightly moderate evaluation of PDA use. Additional psychometric analysis and refinement of item wordings are recommended.

Nursing administrators' experiences in managing PDA use for inpatient units

The adoption of information technology in patient care has become a trend in healthcare organizations. The impact of this technology on end users has been widely studied, but little attention has been given to its influence from a management perspective. The purpose of this study was to explore nurse managers' perceived experiences in implementing a policy to adopt personal digital assistant technology. A descriptive, exploratory qualitative approach (one-on-one, in-depth interviews) was used to collect data from 16 nurse managers of inpatient units at a medical center in Taiwan. Interview data were analyzed according to Miles and Huberman's data reduction, data display, and conclusion verification process. The results revealed that nurse managers experienced the limitations of technology, training issues, doctors' obstructive influence, role conflict, and improvement of future personal digital assistant use. These results can be used to improve strategic organizational planning and in-service training programs to implement information systems.

The N-CODES Project Moves to User Testing

For a technology to be implemented successfully, it must be thoroughly tested by the stakeholders who will use it in practice. This article reports on the user testing of the Nurse Computer Decision Support working prototype. Ten acute care nurses with varying levels of education and experience participated in the testing. The study's protocol consisted of a series of tasks requiring the participants to use the system while solving patient problems. Both quantitative and qualitative data on usability, ease of navigation, and nurse satisfaction were collected. The nurses ranked usability and ease of navigation highly. Nurses were excited about the system's clinical potential and felt that it would be useful to all practitioners regardless of experience. Testing the system in an actual clinical setting is the next step, but it is clear that the system has extraordinary potential to improve clinical decision making and patient outcomes.