i
MINISTÈRE DE
L’ENSEIGNEMENT
SUPÉRIEUR
********************
UNIVERSITE DE DOUALA
********************
FACULTE DE MEDECINE ET
DES SCIENCES
PHARMACEUTQUES
******************
INSTITUTE SUPERIEUR
UNIVERSITE SAINT MONICA
BUEA
MINISTRY OF HIGHER
EDUCATION
****************
UNIVERSITY OF DOUALA
*************
FACULTY OF MEDICINE AND
PHARMACEUTICAL
SCIENCES
***************
SAINT MONICA UNIVERSITY
HIGHER
INSTITUTE BUEA
EVALUATION OF KNOWLEDGE AND ATTITUDE OF NURSES TO
INFORMATION TECHNOLOGY ON NURSING CARE DELIVERY AT THE
REGIONAL HOSPITAL, BUEA
A Research Report Submitted to the Department of Nursing and Clinical Psychology,
School of Health and Human Services of Saint Monica University Higher Institute
Buea in Partial Fulfillment of the Requirements for the Award of a
Bachelor Degree in Nursing Science (BNS)
By
OGUNSIJI, PRAISE JESUFEMI
(SHHS22NR002)
Committee Members:
Dr. Divine Nsobineyui, Ph.D., (Chair)
Mrs. Agbor Catherine, MNE., (Member)
November, 2022
ii
EVALUATION OF KNOWLEDGE AND ATTITUDE OF NURSES TO INFORMATION
TECHNOLOGY ON NURSING CARE DELIVERY AT THE REGIONAL HOSPITAL
BUEA
OCTOBER, 2022
OGUNSIJI, PRAISE JESUFEMI
ALL RIGTHS RESERVED
iii
EVALUATION OF KNOWLEDGE AND ATTITUDE OF NURSES TO INFORMATION
TECHNOLOGY ON NURSING CARE DELIVERY AT THE REGIONAL HOSPITAL,
BUEA
A Research Report Submitted to the Department of Nursing and Clinical Psychology,
School of Health and Human Services of Saint Monica University Higher Institute
Buea in Partial Fulfillment of the Requirements for the Award of a
Bachelor Degree in Nursing Science (BNS)
BY
OGUNSIJI, PRAISE JESUFEMI
(SHHS22NR002)
Project Approval Committee Members
Signature:………………………..
Date:……………………………
Divine Nsobinenyui, PhD (Chair)
Signature: …………………………….
Date:………………………..…...
Mrs. Agbor Catherine. (Member)
Signature:……………………….
Prof. Ndeso A. Sylvester (Dean)
Date:…………………………….
iv
ACKNOWLEDGEMENT
I wish to express my heartfelt gratitude to my supervisors, Dr. Divine & Mrs. Agbor Catherine,
whose professional, time and physical support were vital in the completion of this work.
Special thanks go to all staff of Saint Monica University Higher Institute of Buea, for their
professionalism and critics which have played a great deal to my present achievement, especially
my Head of department Mrs. Agbor Catherine.
To my beloved parents Mr. & Mrs. Ogunsiji Sunday Olatunji, who gave me their full support I
needed in my academic achievement.
I am glad to use this medium to express my appreciation to Mr. Agbonyin Micheal and my siblings
for their support and encouragement, which inspired me to work harder. Also, to a friend like a
Blood Brother, Ige Blessing, and my Sweet Sister, Titilayo Rokeebat, I really appreciate your
presence in my life. Not failing to remember my friends, Oladosu Taiwo Janet, Popoola Jerimiah
(Excellent Sax), Mrs. Salau blessing (Mummy praise), Oderinde Stephen, Gbadegesin job and
Ojedokun twins (Ibeji) who assisted me with prayers and financial support throughout period of
my studies.
Above all, to Almighty God who guided and protected me throughout my period of my studies.
v
ABSTRACT
Information technology is defined as an information system that provides procedures to record and
make available information concerning part of an organization to assist organization related
activities. The purpose of this study was to evaluate the knowledge and attitude of nurses to
information technology on nursing care delivery in RHB. This research studied knowledge of
computer facilities, the level of knowledge of these computer facilities, whether the mentioned
computer facilities are used in the hospital. The relevance of information technology in nursing
care delivery and factors hindering the use of ICT in nursing care delivery in RHB were studied
too. Sources of data for this study include library and questionnaire responses. A descriptive
research design was utilized in this study and A Convenient sample of all nurses working in
Regional Hospital, Buea. One hundred and eight (108) nurses were given questionnaire for this
study through the two shifts (morning and night shifts) for one month who were willing to
participate in the study. The results showed that the majority of the studied subjects answered
(Agree) about knowledge questions. The current study concluded that, nurses are responsible for
a substantial part of the patient record and hence are particularly affected by the computerization.
I hereby recommend continuing education for nurses in the area of ICT. This should be included
in the curriculum for training nurses. Nurses should also make personal efforts to acquire ICT
knowledge. All nurses should, therefore, be computer literate in order to embrace the information
revolution that is going on now in the world.
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TABLE OF CONTENT
COVER PAGE.................................................................................................................................i
RESERVATION PAGE..................................................................................................................ii
CERTIFICATION PAGE...............................................................................................................iii
ACKNOWLEDGEMENT ............................................................................................................. iv
LIST OF ABBREVIATIONS ......................................................................................................... x
DEDICATION ................................................................................................................................ x
CHAPTER ONE
INTRODUCTION
Background of the Study ................................................................................................................ 1
Statement of problem ...................................................................................................................... 2
Research Objective ......................................................................................................................... 2
General objective ............................................................................................................................ 2
Specific objectives .......................................................................................................................... 2
Research Questions ......................................................................................................................... 3
Significance of the Study ................................................................................................................ 3
Scope of the study ........................................................................................................................... 4
Definition of terms .......................................................................................................................... 4
Research hypothesis ........................................................................................................................ 5
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CHAPTER TWO
LITERATURE REVIEW
Introduction ..................................................................................................................................... 6
Conceptual Review ......................................................................................................................... 7
Concept of Knowledge ................................................................................................................... 7
Concept of Attitude ......................................................................................................................... 8
Concept of Practice ......................................................................................................................... 9
Knowledge, Attitude and Practice of Patient Teaching: ............................................................... 10
Information and communication technology (ICT) in Nursing .................................................... 10
Definitions and uses of the term in literature ................................................................................ 11
Attributes of health care ICT ........................................................................................................ 11
Competence in nursing ................................................................................................................. 12
Theoretical Review ....................................................................................................................... 15
Empirical Review ......................................................................................................................... 16
Summary of the chapter ................................................................................................................ 18
CHAPTER THREE
METHODOLOGY
Introduction ................................................................................................................................... 19
Area of the study ........................................................................................................................... 19
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Research Design ........................................................................................................................... 20
Population, Sample and Sampling technique ............................................................................... 20
Research Instrument ..................................................................................................................... 21
Validity of Instrument ................................................................................................................... 21
Data collection .............................................................................................................................. 21
Data Analysis ................................................................................................................................ 22
Inclusion Criteria .......................................................................................................................... 22
Exclusion criteria .......................................................................................................................... 22
Ethical Considerations .................................................................................................................. 22
CHAPTER FOUR
RESULTS
Table (1): Frequency distribution of the study sample according to their socio-demographic
characteristics . .............................................................................................................................. 23
Table (2): Frequency distribution of knowledge and understanding of the relevant of ICT to
nursing care delivery among Nurses. ........................................................................................... 26
5. Ability to learn and improve patient care data which is been recorded for future use. ............ 26
Table (3): Frequency distribution of attitude of nurses to the usage of information communication
technology. : .................................................................................................................................. 27
Table (4): Frequency distribution of factors that are hindering the use of ICT among nurses : ... 28
CHAPTER FIVE
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DISCUSSION, CONCLUSION AND RECOMMENDATIONS
Discussion ..................................................................................................................................... 29
Conclusion .................................................................................................................................... 32
Recommendation .......................................................................................................................... 32
REFERENCES ............................................................................................................................. 33
Research Questionnaire ................................................................................................................ 38
x
LIST OF ABBREVIATIONS
RHB: Regional Hospital, Buea.
ICT: Information Communication Technology.
IOM: The International Organization for Migration.
OECD: Organization for Economic Cooperation and Development.
NCSBN: The National Council for State Board of Nursing.
ANMC: Australia Nursing and Midwifery Council.
NMC: Nursing and Midwifery Council.
UCH: University College Hospital.
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LIST OF TABLES
Table (1): Frequency distribution of the study sample according to their socio-demographic
characteristics . .............................................................................................................................. 23
Table (2): Frequency distribution of knowledge and understanding of the relevant of ICT to
nursing care delivery among Nurses. ........................................................................................... 26
5. Ability to learn and improve patient care data which is been recorded for future use. ............ 26
Table (3): Frequency distribution of attitude of nurses to the usage of information communication
technology. : .................................................................................................................................. 27
Table (4): Frequency distribution of factors that are hindering the use of ICT among nurses : ... 28
x
DEDICATION
I dedicate this research work to my parent (Mr. & Mrs. Ogunsiji Sunday Olatunji).
1
CHAPTER ONE
INTRODUCTION
Background of the Study
Information technology is defined as an information system that provides procedures to record and
make available information concerning part of an organization to assist organization related
activities (Flynn, 1998). According to Davis (1999), information technology refers to sending,
processing and receiving information through electronic means or computer. It is a flow of some
sort of information carrying commodity in some network.
Healthcare delivers largely depend on information for effective decision making. Health
information technology is use in prevention of medical records, improving health care qualities,
increasing administration efficiency and healthcare works process and expanding access to
affordable care (IOM, 2002). Many new technologies are becoming available within nursing care,
such as home dialysis equipment or new infusion pumps that changes the nursing staff's daily
routine (Billings et al., 1993). In addition, all kinds of technologies that support distant care, such
as telecare technology, have consequences for nursing professional do not automatically use them
as intended by the developers (Bates et al., 1998, 2001; Schiff et al., 2000). This means that a
substantial proportion of patience/client will not receive the intended care in such a way that they
benefit from this innovation. This article focuses on the determinants of successful introduction of
new technology in nursing care.
There are no age limit or position limit in studying information technology. In October, 1999, the
Guardian newspaper reported that the British Prime Minister Tony Blair took his first tentative
step into Information technology. He admitted his incompetence in computer usage. He then
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attended a two-hour computer training session in a shopping center to be instructed in wordprocessing, e-mail and the internet (Guardian 25 October, 1999). There is need for everybody to
become computer literate. This is important because the world has now entered the information
age.
Statement of problem
Science has since reduced the world to a global village. This is the part and function of information
technology. It is a common knowledge that information and communication technology (ICT) has
come to facilitate and ease interactivity in health care delivery, nursing diagnoses and treatment of
ailments and disease, precision and accuracy in laboratory experiments, medical records keeping
and drug preparation, monitoring of patient’s condition among others. Information and
communication technology (ICT) is, therefore, vital for efficient discharge of duties in
contemporary health institutions. What this means is that nurses in the contemporary health and
health related sectors must be ICT literate and compliance. Nurses should be familiar with relevant
ICT applications in health care delivery.
Research Objective
General objective
The general objective of this study is to evaluate the knowledge of nurses and their attitude towards
the use of information technology on nursing care delivery
Specific objectives
i. To determine the current levels of knowledge and understanding of the relevant of ICT to nursing
care delivery among Nurses in Regional Hospital Buea.
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ii. To determine the attitude of nurses to the usage of information communication technologies in
Regional Hospital Buea.
iii. To find out the factors that are hindering the use of ICT among nurses in regional hospital Buea.
Research Questions
The following research questions will guide this study.
i. What is the level of knowledge and understanding of the relevant of ICT to nursing care delivery
among Nurses in Regional Hospital Buea?
ii. What are the attitude of nurses to the usage of ICT among Nurses in Regional Hospital Buea?
iii. What are the factors that are hindering the use of ICT among nurses in regional hospital Buea?
Significance of the Study
The world has witnessed an information revolution, a combination of massive increase in the
world’s inventory of information and technical development and means to cope with it.
Information technology is the name given to the means of processing and transmitting information.
Information technology is a subject that is very wide. There is hardly no sector of the economy
that information technology is not being applied. For example, in manufacturing, computers are
used to do product design, product packaging. In engineering, computers are used to do different
types of designs. In remote sensing and earth observation, satellite is a computer-based technology
in orbit for data transmission to the ground for interpretation. The world of commerce is far more
4
automated than the actual production of goods. Banking, transportation and distribution of goods
are being more transformed by electronics. The world of commerce is information intensive. It is
required that information be made available on goods, their prices, their utility and the modern
means for paying for those goods. Microcomputers are now widely used in hospitals and medical
practice, medical research and medical decision-making. The new technology offers new hope to
the deaf, blind and the disabled. Diagnostic tests and laboratory analysis are quicker and easier.
Scope of the study
This research work mainly focuses on the evaluation of knowledge and attitude of nurses to
information technology on nursing care delivery among nurses in Regional Hospital Buea,
Cameroon in other to obtain a broader prevalence data from the nurses working at the hospital.
Definition of terms
Evaluation: Evaluation is a systematic determination of a subject merit, with a significance, using
criteria governed by a set of standards.
Knowledge: Knowledge is an awareness of familiarity gained by experience of a fact of a situation.
Attitude: Attitude is a settle way of thinking or feeling about something.
Information: Facts provided or learned about something or someone.
Technology: Technology is the set of knowledge, skills, experience and techniques through which
humans change, transform and use our environment in order to create tools, machines, products
and services that meet our needs and desires.
5
Nursing: Nursing is a profession within the health care sector focused on the care of individuals,
families, and communities so they may attain, maintain, or recover optimal health and quality of
life.
Care: Care is the provision of what is necessary for the health, welfare, maintenance, and
protection of someone or something.
Delivery: Delivery is the part of a health system where patients receive the treatment and supplies
they are entitled to.
Research hypothesis
Null hypothesis

Nurses working in regional hospital, Buea do not have appropriate knowledge and good
attitude towards the use of information technology on nursing care delivery.
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CHAPTER TWO
LITERATURE REVIEW
Introduction
The purpose of this literature review is to explore the scope of competence necessary for the use
of information and communication technology (ICT) in nursing care. The study question of what
competence is required from nurses for the use of information and communication technology
(ICT) in nursing care is its main reference point.
The usage of ICT has steadily increased in all life spheres, including economic, social, political
and cultural (OECD, 2009), as well as health care, caring science and nursing. The gradual
introduction and further extensive utilization of such technological inventions as personal
computer, cell phone and Internet has impacted every aspect of life (OECD 2009), making it
unimaginable to provide services or even function without them. In the health care sector,
especially with the recent general shift to outpatient care, ICT usage has become essential in
decentralized health care provision (Thomassen and Jansen, 2013). However, since the
introduction of digital technology into health care, nurses have been often in opposition, claiming
that use of computerized systems prevents them from capturing “the real nursing” (Darbyshire,
2004), distances nurses from patients and disrupts the rapport (Adams et al., 2007). How do we
provide high quality nursing care in the digital world?
How do we assure our patients that they interact with another human being, not with a machine?
How do we retain that human element?
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Conceptual Review
Concept of Knowledge
According to the New International Webster’s Comprehensive Dictionary of English Language
(2013), knowledge is a result or product of knowing, information or understanding acquired
through experience, practical ability or skill. Knowledge can be acquired in three different
domains namely: cognitive, affective and psychomotor learning. Craven & Hirnle (2006) stated
that cognitive knowledge is the rational thought and involves learning about facts, arriving at a
conclusion, making decisions or drawing inferences. Affective learning result in changed beliefs,
attitudes or values while psychomotor refers to muscular movements that form some sort of
knowledge. Knowledge of patient teaching: As documented by Berman et al., (2012) knowledge
alone is not enough to motivate a person to change behavior. There is need to learn what needs to
be done to change behaviors and acting on the knowledge. Therefore, knowledge must appeal to
the emotion for it to affect behavior. This is because emotion works hand-in-hand with cognitive
process or the way we think about an issue or situation. Patient teaching involves means whereby
attitudes counter- productive to health and wellbeing might have to be altered. For patient teaching
to be effective it must meet the needs expressed by the individual clients themselves. Knowledge
of patient teaching therefore involves the nurses’ ability to have adequate knowledge of different
patient’s disease conditions, the nurses’ ability to identify clients requiring teaching, assessing and
diagnosing their learning needs, planning, implementing, evaluating as well as documenting
patients teaching. Nurses are in a position to promote healthy lifestyles through the application of
health knowledge, the change process, learning theories, and nursing and teaching process, when
teaching patients and their families. Nurses on their own part, should have emotional appeal for
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patient teaching as an integral function of the nurse. It is only then that their knowledge of patient
teaching will affect their behavior.
Concept of Attitude
Attitude as documented in the New International Websters Comprehensive Dictionary of English
language (2013) is defined as a state of mind, behaviour or conduct regarding some matter as
indicating opinion or purpose. Plotnik & Kouyoumdjian (2008) defined attitude as any belief or
opinion that includes an evaluation on some object, person or event along a continuum from
negative to positive that predisposes us to act in a certain way toward that object, person or event.
Altschul & Sinclair (2005) defined attitude as an orientation towards an object or situation, a
readiness to respond in a predetermined manner.
From the above definitions of attitude, one can deduce that attitude is a state of mind about a
matter and it includes evaluation of the matter from negative to positive and taking a stand for
either negative or positive.
Attitude is acquired during the periods of development. Brandt & Witherel (2012) stated that
learning accounts for the most of the attitudes we hold. Passer & Smith (2007) argued that
hereditary variables may affect attitude but believes that they do so indirectly. Plotnik (2008)
opined that our beliefs and values contribute to the attitude formation. He further suggested that
individuals must be consistent in their beliefs and values in order to develop a good attitude, in
other words to stand up for those beliefs and values that we consider very important. Attitude can
have a significant impact on behavior, hence it is used to predict behavior. Passer and Smith (2007)
supported the above view by stating that there are three factors which explain attitude behavior
relationship. First attitude influence behavior more strongly when situational factors that
contradict our attitude are weak. In other words, our intentions to engage in a behavior is strongest
9
when we have a positive attitude toward that behavior, when subjective norms (our perceptions of
what other people think we should do) support our attitudes and when we believe that it is under
our control.
Second reason for attitude relationship is that attitude has a greater influence on behavior when
we are aware of them and when they are strongly held. That is attitude behavior consistency
increases when people consciously think about them or are reminded of their attitudes before
acting.
Passer and Smith concluded that general attitude best predict general behavior and specific attitude
best predict specific behavior. Attitude of nurses towards patient teaching similarly can be
influenced when situational factors that counteract patient teaching are weak.
Patient’s conditions and expectations may influence nurses’ behavior towards patient teaching.
Also, when nurses are aware of their attitude towards patient teaching, it will have greater
influence on their behavior. When nurses think consciously about their attitude toward patient
teaching or are reminded of their attitude before acting.
Concept of Practice
The New International Webster’s Comprehensive Dictionary of English Language (2013) defined
practice as; to make use of habitually or often to apply in action, the act of or process of executing
or accomplishing, doing or performance. The definition implies that nurses should practice or
carry out patient teaching as a professional habit because practice is the behavior outcome of
knowledge and attitude.
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Knowledge, Attitude and Practice of Patient Teaching:
Knowledge of patient teaching alone is not enough to motivate nurses to change their behavior
towards patient teaching. Nurses require to know what needs to be done to achieve effective
patient teaching. Knowledge and attitude will only affect practice when the information is relevant
and a positive attitude is shown toward imparting the knowledge.
Information and communication technology (ICT) in Nursing
Information and communication technology (ICT) is a fairly new concept and even though
numerous researches have been contributed to examining the usage of ICT in nursing, the concept
itself has not been thoroughly analyzed and defined in literature. There is also no clear
differentiation between ICT and related terms such as e-health or telemedcine. In order to examine
the nurses’ competence required for ICT use, health care ICT as a concept is analyzed.
Concept analysis is an examination and description of the basic elements of a word or term that
helps defining the concept and differentiating it from similar concepts (Walker & Avant 2011). It
is necessary particularly in the case of vague or overused terms such as ICT. The aim of this
analysis is to develop an operational definition for the purposes of this final project and distinguish
the term ICT from related terms such as Health. This analysis follows the steps suggested by
Walker and Avant (2011) and starts with the definitions and uses of the term in literature of
different fields and professions, not limited to nursing. Subsequently, the defining attributes are
determined and a model case is identified. Moreover, other exemplars from nursing profession are
provided to describe the relation between ICT and related terms. Finally, health care ICT empirical
references are presented.
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Definitions and uses of the term in literature
Information and communication technology (ICT) is a term developed in the context of
information technology, informatics and computers field. However, its use is not limited to those
fields, as ICT has been widely adopted in other spheres of life. Cambridge Dictionary of Business
English (2013) defines ICT as “the use of computers and other electronic equipment and systems
to collect, store, use, and send data electronically”. In the context of education, Blurton (1999)
defines ICT as “a diverse set of technological tools and resources used to communicate, and to
create, disseminate, store, and manage information.” According to The Organization for Economic
Co-operation and Development (OECD) “ICT products must primarily be intended to fulfil or
enable the function of information processing and communication by electronic means, including
transmission and display” (OECD 2009). Moreover, OECD determines that “ICT has three
components:
information
technology
equipment
(computers
and
related
hardware);
communications equipment; and software” (OECD 2011).
Attributes of health care ICT
In concept analysis, attributes are listed in order to demonstrate the characteristics most frequently
connected to the particular concept and to enable differentiating the concept from other related
terms (Walker & Avant., 2011). The following defining attributes of health care ICT used in
clinical practice were identified: enabling digital data and information management including
accumulating, retrieving, controlling, accepting, manipulating and sharing of data; as well as
enabling communication (Bembridge et al., 2011) of health care professional with patient/client
(Andersen & Jansen, 2013) or other health care professional (Lewis et al., 2012; Varpio et al.,
2009).
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Various authors list devices that do not fulfill these criteria into the group of ICT. For the purpose
of this final project both characteristics mentioned above have to be present in order to include the
device, technology or infrastructure to the ICT category.
Competence in nursing
Competence as generally defined in Oxford Advance Learner’s Dictionary (2000) is “the ability
to do something well” or together with its less frequent version competency “a skill that you need
in a particular job or for a particular task”. Those definitions stress the importance of skills in the
process of gaining competence. However, competence in nursing is hardly limited to skills. Many
nurse researchers and theorists, with Peplau (1988) at the frontline, underline the humanistic side
to nursing and the need to find balance between science and art as a core of nursing practice.
Peplum states clearly that “the most useful nursing services for people can only be achieved if both
the art and the science of nursing are retained, fully developed, and used in nursing practice”
(1988). The artistic aspect encompasses skills, personal ideals, values and attitudes while the
science is synonymous with nursing knowledge. Therefore, the humanistic aspect of nursing plays
a considerable role in the construct of nursing competence, even though it is easier to measure and
value the technical aspects of professional performance (Cowan et al.,2007:). This combination of
art and science as well as the wide scope of nursing contributes to the notion that competence has
become an “elusive term” for various researchers (Axley 2008; Cowan et al., 2007; Garside &
Nhemachena 2013; Scott Tilley 2008). Nevertheless, nursing organizations and researchers try to
define competence in order to develop a certain standard for the delivery of nursing care.
In the United States, The National Council of State Boards of Nursing (NCSBN) in 1996 defined
competence as” the application of knowledge and the interpersonal, decision making and
psychomotor skills expected for the practice role, within the context of public health” (2005).
13
Australian Nursing and Midwifery Council (ANMC) state that competence is “the combination of
skills, knowledge, attitudes, values and abilities that underpin effective and/ or superior
performance in a profession/occupational area”. According to Nursing and Midwifery Council
(NMC) based in United Kingdom, competence comprises of “the knowledge, skills and attitudes”.
Royal College of nursing (2011) states that competency is “the ability to demonstrate the
application of knowledge, understanding, practical and thinking skills to achieve effective
performance in a professional or occupational role”.
The above-mentioned sources stress the importance of the combination of skills, knowledge and
attitudes, while paying less attention to the humanistic aspect of nursing practice. Moreover, a
closer review of the cited sources reveals another issue that make the concept of “competence” so
elusive.
The use of the words “competence” and “competency” is neither consistent nor clearly defined in
nursing literature. Even though some sources distinguish between those two terms, the nursing
literature uses both interchangeably even in the same text, as seen in Axley (2008), Lenburg (1999)
or Scott Tilley (2008), regardless of British or American English variety. Moreover, some authors
assign those words different meanings. Nolan defines competency as “an individual’s actual
performance in a particular situation” while competence is “an individual’s capacity to perform
his or her job functions whether in fact he or she has the knowledge, skills, behaviors and personal
characteristics necessary to function well in a particular situation” (1998). Another approach in
distinguishing between competence and competency is presented by McMullan et al., (2003)
where competence is “job-related, being a description of an action, behavior or outcome that a
person should demonstrate in their performance” and competency is “person-orientated, referring
to the person’s underlying characteristics and qualities that lead to an effective and/or superior
14
performance in a job”. Those definitions address both art and science aspect of nursing, though
not in a consistent way. Correspondingly, Axley (2008) notes that competence attributes include
“attitude, motives, personal insightfulness, interpretive ability, receptivity, maturity, and selfassessment” and Cowan et al., (2007) list additionally personal interests, perceptiveness, and
aspects of personal identity.
Those various descriptions present how multifaceted, complex and elusive the concept of nursing
competence might seem. However, the development of a working definition of competence is
necessary to create a standard for improving education and assessing nurses’ abilities to provide
safe quality care. In the quest for holistic, standardized definition Cowan et al., (2007: 26)
reviewed the literature and concluded that competence can be described as “a complex
combination of knowledge, performance, skills, values and attitudes”. This summarizes well the
attributes mentioned in the definitions above as well as overlaps with RCN’s definition of nursing
as “intellectual, physical, emotional and moral process” (2003). Based on that, the competence in
this final project is defined as application of knowledge, skills, attitude and personal
predispositions in nurse’s professional performance.
It is important to remember, that nursing competence is context and time specific (Garside &
Nhemachena, 2011). As the technology evolves, new competence is necessary to fulfill the nursing
mission. Competence in general information and communication technology (ICT) usage are
routinely required from nurses (Lenburg et al., 2011; NMC 2010) as part of communication
competence. The report developed by The Technology Informatics Guiding Education Reform
(TIGER 2009) Initiative describes the minimum set of competence regarding the use of health
information technology in nursing. It clearly details the technical skills and knowledge with respect
to basic computer competency, information literacy and information management. However, the
15
attitudes or personal characteristics that are the components of competence are omitted in this
report, as in many other studies regarding technology use in caring. Locsin and Purnell (2009)
underline that in the context of utilization of ICT competence must involve such aspects as
intentionality, confidence and compassion. Therefore, this project mainly focuses on exploring the
attitudes and personal predispositions required in the utilization of ICT in nursing care, even
though it also includes the description of skills and knowledge.
Theoretical Review
Ibrahim Badran’s knowledge, Attitude and practice (KAP) Model
Badran (1995) stated that knowledge, Attitude and practice constitute a triad of interactive factors
characterized by dynamism and unique interdependence. According to Badran, Knowledge is the
capacity to acquire, retain and use information and education is prerequisite for knowledge. He
defined attitude as the inclinations to react in a certain way to certain situations to see and interpret
events according to certain disposition or to organize opinions to inherent and interrelated
structures. By practice, he meant the application of knowledge that leads to action. Good practice
is an art that is linked to the progress of knowledge and technology and is executed in an ethical
manner. He also identified several important factors that could influence or control the course of
practice which include conglomerate of information, education, communication and human
resources development, modern technologies, environmental factors etc. Badran stated that triad
of knowledge; attitude and practice in combination govern all aspects of life in human societies
and all the three pillars that make up the dynamic system of life.
16
Application of Theory to the Study;
Nurses acquire knowledge about patient conditions; physical, emotional, physiological, cultural as
well principles of teaching during nursing, midwifery, post basic nursing training as well as
master’s programs in nursing. To retain the knowledge acquired, nurses engage in personal
readings, workshops and conferences in order to refresh their memory.
Attitude: The knowledge that nurses acquired and retained on patient teaching will incline them to
react in a certain way positive or negative way towards patient teaching.
Practice: When nurses apply the rules and knowledge of patient teaching, they will be moved to
action of teaching patients no matter how tight their schedules may appear to be. As nurses to
increase their knowledge and their techniques of patient teaching, they will become perfect in
teaching patients and invariable enhance their practice of patient teaching.
Empirical Review
There is a dearth of literature on knowledge, attitude and practice of patient teaching among nurses
working in the tertiary institutions. However, some of the studies carried out in related area were
reviewed.
Oyetunde and Akinmeye (2015) conducted a study on factors influencing practice of patient
education among nurses at the University College Hospital (UCH) Ibadan Nigeria published in
the open journal of nursing. A cross-sectional descriptive survey design was employed, using 200
nurses. These nurses were selected through stratified and simple random sampling techniques.
The researchers used a self-designed questionnaire in their method and data was analyze using
statistical package for social sciences version 15 (SPSS 15). The study revealed that the knowledge
and practice of patient education among the nurses in UCH Ibadan was high and the knowledge
17
was found to be significantly associated with its practice. The working experience of nurses does
not determine whether they practice patient education or not. Almost all the respondents (70% 90%) in their study affirmed that the nurses’ experience, cultural barriers, workplace, insufficient
staffing, and the complexity of patient’s condition were important factors that influenced the
practice of patient education. The researchers concluded that nurses at the University College
Hospital have good knowledge and positive attitudes towards patient education but could not
practice effectively. The researchers advocated a more critical approach in addressing heavy
workload insufficient staffing, among others needed to improve patient education. Further studies
should be carried out on developing nurses’ roles as patient educators.
In another study by Kemppainen, Tossavainen and Turunen (2013) on Nurses roles in Health
promotion practice; an integrative review. The paper presented an integrative review aimed at
examining the findings of existing research studies (1998-2011) of health promotion practice by
nurses. Systemic computer searches were conducted of the Cochrane data bases, cinahl, pubmed,
and web of science, PSYCLNFO and Scopus databases, covering the period January 1998 to
December 2011). Data were analyzed and the results were presented using the concept map method
of Novak and Gowin. The review found information on the theoretical basis of health promotion
practice by nurses, the range of expertise, health promotion competencies and the organizational
culture associated with health promotion practice. The researcher concluded that nurses consider
health promotion which is an aspect of patient teaching) important but a number of obstacles
associated with organizational culture prevent effective delivery.
In yet another study by Lin Chang, Chang and Lou (2011) on critical care nurses, knowledge,
attitudes and practice of oral care for patients with oral and endotracheal intubation published in
the journal of clinical nursing, twelve (12) adult intensive care units in northern Taiwan were
18
purposively chosen. Two hundred and five nurses (205) were recruited for the study. Data were
collected by structured questionnaire. Findings showed the average percentage indicating the
intensive care unit nurses oral care knowledge, attitude and practices were 58.8%, 79.4% and
49.8% respectively. Researchers discovered that higher scores on oral care knowledge were
associated with nurses performing oral care more frequently. The nurse’s age and the type of
intensive care unit they work in were significant factors related to the frequency of performing
oral care. The researchers concluded that nurses who have more resources for learning about oral
care have greater knowledge about it and provide oral care to intubated patients more frequently.
Summary of the chapter
Information and communication technologies (ICTs) used in the health sector have well-known
advantages. They can promote patient-centered healthcare, improve quality of care, and educate
health professionals and patients. However, implementation of ICTs remains difficult and involves
changes at different levels: patients, healthcare providers, and healthcare organizations. Nurses
constitute the largest health provider group of the healthcare workforce. The use of ICTs by nurses
can have impacts in their practice. The main objective of this review of systematic reviews is to
systematically summarize the best evidence regarding the effects of ICTs on nursing care.
19
CHAPTER THREE
METHODOLOGY
Introduction
This chapter show how the research was conducted. This includes research design, target
population, sample and sampling technique, research instrument, validity of the instrument,
sources of data collection, method of data analysis, ethical consideration.
Area of the study
The Regional Hospital Buea is found in Buea in the Fako Division of the South West Cameroon
on the foot of the mount Cameroon. Regional hospital, Buea, falls under secondary level of hospital
and it serves the people in the south west region of Cameroon. It is about 3km away from the mile
17 motor park. It is situated precisely between the delegations of education and the army barracks,
along the highway to the Bokwango neighborhood. The hospital is made up of many
units/departments/centers including the following unit (male and female), the surgical unit, the
pediatrics unit, the maternity unit, the Laboratory unit, the X-ray unit, the hemodialysis center, the
Tuberculosis center, the theatre department and the Outpatient department (OPD). Each of the
Unit/Department/Centre is headed by a specialist doctor (Surgeons, Gynecologists, Pediatrician).
But control of the wards is done by the ward charges like senior midwives also present in the
hospital are nurses of all categories ranging from Nursing Assistant (NAS) State Registered Nurses
(SRN). Higher National Diploma Nurses (HND), Degree (BNS) and even master degree holder
Nurses (MNE).
20
Research Design
A descriptive research design was utilized in this study. This design is concerned with description
of phenomena of interest and focuses on a single group or population characteristics, attributes,
and or experiences.
Population, Sample and Sampling technique
The study population for this study covered all nurses who work at Buea Regional Hospital, South
West Region Cameroon
A Convenient sample among all the nurses working in Regional Hospital Buea. Total number of
108 nurses will be selected randomly.
Calculation
n=p (100-p) z2/E2
Where:
n=p
(0.3)
100-p
(100-0.3)
z2/E2
952/0.52
n= 0.3(99.7) 0.9025/0.25
n= 29.91× 0.9025 / 0.25
n= 29.91×3.61
n=108.
21
Therefore, sample size was 108
Research Instrument
To achieve the purpose of the study, data was collected using a well-constructed questionnaire
developed by investigator.
The questionnaire consisted of four main sections:
1. Socio-demographic data: It includes data related to: gender, age, marital status, level of
education, department of working and years of experience in and out hospital.
2. Questions related to the level of knowledge and understanding of the relevant of ICT to
nursing care delivery.
3. Questions related to the attitude of nurses to the usage of ICT among Nurses.
4. Questions related to the factors that are hindering the use of ICT among nurses.
Validity of Instrument
The validity of the instrument was established by face and content validity. Ambiguous and nonappropriate questions will be avoided as much as possible. The project was given to the project
supervisor to review for its effectiveness. Necessary corrections were made, and the final
questionnaire was done base on the amendment made by the supervisor.
Data collection
Data was collected according to specific objectives. Data was collected once a week for a period
of 1 months with about 8 to 9 samples collects due to the convenience sampling technique.
22
Data Analysis
Data was analyzed with a descriptive technique using tables, pie chat and bar chat, which make a
report of the findings of the study.
Inclusion Criteria
The inclusion criteria are nurses that are currently working at Regional Hospital Buea.
Exclusion criteria
The Exclusion criteria are nurses that are not currently working at Regional Hospital Buea.
Ethical Considerations
An authorization letter was collected from the administration of St Monica University Higher
Institute and was attached with hand written application to the Southwest Regional Delegation of
public health. After which the letter of permission was taken to the Director of Regional Hospital
Buea, who granted a letter of permission to carry out research. This authorization letter was
attached to another written application to the ward charges.
23
CHAPTER FOUR
RESULTS
Table 1: showed that the majority of the studied sample have experience inside hospital (22.2%),
(41.6%) and (36.1%) respectively, and are General nurses (62.9), Many of the nurses are working
in the maternity unit of the hospital (21.2%), Paediatric unit (9.2%), theatre unit (15.7%), medical
unit (16.1%), surgical unit (13.3%), neonatal unit (12%) and another unit which was (10.1%))
respectively.
Table 1: Frequency distribution showing years of experience, Nurses job and the
departments/unit in the hospital (n=108).
Variables
Years of experience in the
hospital:
<1 year
1≤ 3 years
3-5 years
Nurse job:
Specialist nurse
N
Percentage (%)
24
45
39
22.9
41.6
36.1
25
Nurse supervisor
General nurse
Department/unit:
Pediatrics
Maternity
Theater
Medical
Surgical
Neonatal
Others
15
68
23.1
13.8
62.9
10
23
17
18
15
13
11
9.2
21.2
15.7
16.1
13.3
12
10.1
24
Sex
Male
Female
Figure 1: Sex of respondent
Education
80
60
40
20
0
Nursing diploma
B.sc in nursing
Education 1
Education 2
Post graduate
Education 3
Figure: Educational level of respondents
Age
80
60
40
20
0
20-30 years
31-40 years
Age 1
Age 2
>40 years
Age 3
25
Figure 3: Age of respondents
Table 2: showed that the majority of the studied subjects answered (Agreed) knowledge and
understanding questions especially Ability to learn and improve patient care data which is been
recorded for future use question (45.5%) and majority choose (strongly agreed) to Enable nurses
to share important information with patient family with (37.9%) and the ability to implement
research findings into patient care practices question (37.9%). Many people disagreed to the
Adequately involve patient and family in the care planning to prefer better decision making on
question with (29.6%) also to other question and like consistency with which patient care data
been recorded (39.8 %) also a huge number of people disagreed the question on (44.4%). A quite
number of people choose (strongly Disagreed) that ICT Help decision-making in-patient care
(29.6%).
26
Table 2: Frequency distribution of knowledge and understanding of the relevant of ICT to
nursing care delivery among Nurses. (n=108).
Agree
Strongly
Disagree
Strongly
agree
disagree
Variables
(knowledge
and
understanding)
No
N %
No %
No %
%
o
1. Access to information improve the
41.6 16 14.8 29
ability to allow the patient to 45
26.0 18
16.6
make better care decision.
2. Help decision-making in-patient
16.6 27
25
32
29.6
31
28.7 18
care
3. Enable nurses to share important
34.2 41 37.9 19
information with patient family 37
17.5 11
10.1
4. Adequately involve patient and
family in the care planning to
prefer better decision making on.
31
28.7
32
29.6
16
14.8
47
43.5
11
10.1
3
2.7
29
26.8
5. Ability to learn and improve
patient care data which is been
49
recorded for future use.
6. The consistency with which patient
21
care data been recorded.
19.4
19
17.5
43
39.8
25
23.1
7. The accuracy and validity of the
patient care data being recorded 41
37.9
22
20.3
19
17.5
26
24
16
14.8
23
21.2
26
24.0
24
22.2
48
44.4
41
37.9
26
24
8. Appropriately discharge their
43
duties at the right time
9. The overall safety of parent care
13
10. The ability to implement research
23
findings into patient care practices
45.5
39.8
12.0
21.2
23
18
21.2
9
27
Table 3: showed that the majority of the studied sample was agreed that they did not like working
with computers with (63.8%) while some agreed that working with computers takes too much of
time (66.6%) and many agreed that the use of ICT is not necessary in patients care (56.4%) as well
as some also disagreed that ICT creates distractions during working hours (69.4%) and also
disagreed that the use of computers complicates patients care during documentation (55.5)
respectively.
Table 3: Frequency distribution of attitude of nurses to the usage of information
communication technology. (n=108):
Attitude Aspects
N
%
I did not like working with computers (n= 108):
Agree
Disagree
Working with computers takes too much of time (n= 108):
69
39
63.8
36.1
Agree
Disagree
The use of ICT is not necessary in patients care (n= 108):
Agree
Disagree
ICT creates distractions during working hours (n= 108):
Agree
Disagree
The use of computers complicates patients care during
documentation (n= 108):
Agree
Disagree
72
36
66.6
33.3
61
47
56.4
43.5
33
75
30.5
69.4
48
60
44.4
55.5
28
Table 4: showed that the majority of nurses answered agree to factors that are hindering the use
of ICT among nurses. Many of them said that they did not have access to computer easily (66.6%)
and majority of studied sample also disagreed that they do not have basic skills of operating
computer (75%). And also disagreed to due to unreliability of the electricity supply in the hospital
with (69.4%) and agreed that the computers are not functioning at optimal level (63.8%) while
majority agreed that the network coverage of the network provider in the hospital is bad (67.5%).
Table 4: Frequency distribution of factors that are hindering the use of ICT among nurses
(n=108):
Factor Aspects
N
%
Does not have access to computer easily (n= 108):
Agree
Disagree
Does not have basic skills of operating computer (n= 108):
72
36
66.6
33.3
Agree
Disagree
Due to unreliability of the electricity supply in the hospital (n=
108):
Agree
Disagree
The computers are not functioning at optimal level (n= 108):
Agree
Disagree
The network coverage of the network provider in the hospital
is bad (n= 108):
Agree
Disagree
27
81
25
75
33
75
30.5
69.4
69
39
63.8
36.1
73
35
67.5
32.4
29
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATIONS
Discussion
Current research can be considered as giving some insight, but an incomplete picture of how nurses
use information technology. Nevertheless, evolution both in nursing technological system
theoretical approaches and evaluation research has opened a new road for a more comprehensive
analysis of nursing technologies system implementation (Roger Watson, 2012). The total number
of the studied sample was (108) nurses, majority of them were females where their ages ranged
between 20-30 years. Thus, half or more of them had Bachelor nursing science degree lead to less
than half of them are having ≤ 3 years of working experiences inside the hospital. In researcher
point of view a lot of bachelor nurses prefer to work at private hospitals and travel abroad they
have better chances than diploma nurses. Therefore, bedside nurses in governmental hospitals were
diploma nurses and when the bachelor nurses work in the governmental hospitals they are working
as a head nurse not a bedside nurse.
The results showed that the majority of the studied subjects answered (Agreed) about knowledge
and understanding questions. Raja, Mahal and Masih (2014), agreed with study that the majority
of the studied sample had good communication knowledge through nursing technological system.
In researcher point of view education department in hospital supported nurses with program
training about nursing technological system and other courses helped in nursing work. On the other
side most of nurses were bachelor which mean nursing curriculum contains nursing technologies,
30
English, and computer courses. However, nursing technologies respect to nurse’s responsibilities
and accountability any time in work place through nursing technological system.
majority of the studied sample was agreed that they did not like working with computers with
(63.8%) while some agreed that working with computers takes too much of time (66.6%) and many
agreed that the use of ICT is not necessary in patients care (56.4%) as well as some also disagreed
that ICT creates distractions during working hours (69.4%) and also disagreed that the use of
computers complicates patients care during documentation (55.5) respectively Raja ,Mahal and
Masih (2014),agreed with study that the majority of nurses' access to computer on your unit easily,
while nurses considered they to be an experienced computer as user.. In addition to, they enter data
into the electronic medical record, and do you feel confident about what you are doing. In
researcher point view the hospital supported nurses’ program training about nursing technological
system before they used it. Furthermore, frequency seminar to nurses had problem in
implementation.
The current study findings are similar to those of several studies reported that the majority of the
studied subjects answered agree in attitude questions (normal good attitude). (Mahal and Alhashem
et al., 2007 Raja, Masih, Shah, lindia, Donaa and Moody, 2014). In nurses’ view point that system
positively effect of them knowledge and practices toward children education and system helped of
them near of children brain by uses technology in education or other uses.
Majority of nurses answered agree to factors that are hindering the use of ICT among nurses. Many
of them said that they did not have access to computer easily (66.6%) and majority of studied
sample also disagreed that they do not have basic skills of operating computer (75%) Similar
findings were reported in recent study conducted by Lee et al., (2005), handwriting takes more
31
time than a point-and-click procedure, when the system has slow response time or no available
computers, it may take longer complete a task. And also disagreed to due to unreliability of the
electricity supply in the hospital with (69.4%) and agreed that the computers are not functioning
at optimal level (63.8%) while majority agreed that the network coverage of the network provider
in the hospital is bad (67.5%) This is in line with Raja, Mahal and mashil (2014) who also found
the similar results.
Finally, from point of view, these results showed that even though nurses had good nursing
knowledge and positive attitude they may be motivated to use computers in the hospital. These
findings were in accordance with the study conducted by Rajia et al., (2014), revealed that nurse’s
knowledge toward nursing informatics system were good score levels of nurses had positive
attitude and of them satisfactory practice. Grigg, Stephens, Abubakar, Abbas and Browne (2014),
also revealed similar findings. The findings of the present study revealed that the relationship
between total knowledge according to total attitude and total practice of nursing informatics system
was highly statistically significant. In this regards Gijare, (2012), revealed that providing feedback
is necessary to improve knowledge, attitude, practices and so compliance to nursing informatics
system standard in the world.
32
Conclusion
The current study concluded that, nurses are responsible for a substantial part of the patient record
and hence are particularly affected by the computerization. The appliance of Information Systems
into nursing provides important advantages in the administration of the nursing personnel’s data,
contributing to the improvement of the operating effectiveness of the Nursing Service (Malliarou
et al., 2008). The use of nursing technological system (NTS) has increased completeness of some
nursing documentation elements.
Recommendations
The current study recommended that there is great variability among nursing schools and curricula.
Professional skills learned and opportunities for employment are dependent on the quality and
level of the educational programs. Proficiency in decision making and acquisition of technical
competence to face new challenges are the major areas that must be improved in the nursing
education curricula.
Also, there is a need for continuing education for nurses in the area of ICT. This should be included
in the curriculum for training nurses. Nurses should also make personal efforts to acquire ICT
knowledge. All nurses should, therefore, be computer literate in order to embrace the information
revolution that is going on now in the world.
33
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38
Research Questionnaire
Good day, I, OGUNSIJI PRAISE JESUFEMI, an undergraduate of the department of nursing
and clinical psychology, Saint Monica University Higher Institute is undertaking research on the
topic'' EVALUATION OF KNOWLEDGE AND ATTITUDE OF NURSES TO
INFORMATION TECHNOLOGY ON NURSING CARE DELIVERY AT THE
REGIONAL HOSPITAL, BUEA. I appreciate your involuntary participation.
This questionnaire will be treated with absolute confidentiality.
SECTION A
BIO-DATA ACCORDING TO THEIR SOCIO-DEMOGRAPHIC
INSTRUCTION: TICK [√ ] the appropriate answer
1. Age:
20-30
[ ]
30-40 [ ]
[ ]
Female [ ]
40 and above [ ]
2. Sex:
Male
3. Nurse job:
General nurse [ ]
Nurse supervisor [ ]
Specialist nurse [ ]
4. Education:
Nursing diploma [ ]
B.sc in Nursing [ ]
Post graduate [ ]
5. Years of Experience in The Hospital:
< 1 years. [ ]
6. Department/unit
Pediatrics [ ]
Maternity [ ]
Theater
[ ]
Medical
[ ]
Surgical
[ ]
Neonatal
[ ]
Others
[ ]
≤ 3 years [ ]
3-5 years [ ]
39
SECTION B
The following questions are to assess the knowledge and understanding of the relevant of ICT
to nursing care delivery among Nurses. Indicate your agreement or disagreement by ticking
your answers in the appropriate space:
S/N QUESTIONS
1
Access
to
information
improve the ability to allow
the patient to make better care
decision
2
Help decision-making inpatient care
3
Enable nurses to share
important information with
patient family
4
Adequately involve patient
and family in the care
planning to prefer better
decision making on
5
Ability to learn and improve
patient care data which is
been recorded for future use
6
The consistency with which
patient care data been
recorded
7
The accuracy and validity of
the patient care data being
recorded
8
Appropriately discharge their
duties at the right time
9
The overall safety of parent
care
10
The ability to implement
research findings into patient
care practices
AGREE
STRONGLY
AGREE
DISAGREE STRONGLY
DISAGREE
40
SECTION C
The following questions talks about the attitude of nurses to the usage of information
communication technology. Indicate your agreement or disagreement by ticking your response
in the appropriate space:
S/N QUESTIONS
11
I did not like working with computers.
12
Working with computers takes too much of time.
13
The use of ICT is not necessary in patients care
14
ICT creates distractions during working hours.
15
The use of computers complicates patients care
AGREED
DISAGREE
during documentation.
SECTION D
The following questions talks about the factors that are hindering the use of ICT among
nurses. Indicate your agreement or disagreement by ticking your response in the appropriate
space:
S/N QUESTIONS
16
Does not have access to computer easily.
17
Does not have basic skills of operating computer.
18
Due to unreliability of the electricity supply in the hospital.
19
The computers are not functioning at optimal level.
20
The network coverage of the network provider in the
hospital is bad.
AGREED
DISAGREE