INTRODUCTION:

Our world has been radically transformed by digital technology, smart phones, tablets, and web enabled devices which have transformed our daily lives and the way we communicate. Medicine is an information rich enterprise and information must be available whenever and wherever it is needed.

BACKGROUND OF THE STUDY:

Jagadish (2012) says, "Electronic Health Records help not only in tracking the patients' health parameters over a prolonged period of time with multiple caregivers but also avoid errors in practice and ensure high standards of patient safety. A survey was undertaken by Koppar (2010) in eleven taluks in India, to assess the quality of healthcare delivery system.

The results of the survey showed that, the quality of healthcare delivery in rural India can be improved by using Information Technology which will assist in capturing medical records.

Sequeira and Kirthi (2010) conducted a study on “Electronic health records documentation: nurses’ attitudes and preferences”. The overall attitude of the nurses’ was very positive towards electronic patient health records documentation. Majority of the nurses prefer to switch over electronic documentation from present paper based documentation.

McBride and Nagle (2006) conducted a study on the attitude of 299 student nurses and 394 RN’s towards computers. The substantive components of the attitude scale strongly recommended the use of computers. Shoham and Snunith (2008) did a study on the attitude and predictive behaviors of 411 nurses in relation to using computers. Strong significant positive correlations were found between the nurses' attitudes, self-efficacy, innovativeness, and intentions to use computers.

Jim and Seif (2012) in their project - DIGHT (Distributed Information store for Global Healthcare Technology) addressed the need for building a highly available information store for Electronic Health Records (EHRs) of the over one billion citizens of India.

STATEMENT OF THE PROBLEM:

A study to assess the perception and attitude of staff nurses towards electronic health records in Sri Ramakrishna hospital, Coimbatore.

OBJECTIVES OF THE STUDY:

1. Assess the perception of staff nurses towards Electronic Health Records

2. Assess the attitude of staff nurses towards Electronic Health Records

3. Find the relationship between attitude of nurses and selected demographic variables.

METHODOLOGY:

A descriptive design was selected for the study. The study was conducted in Sri Ramakrishna Hospital. Using convenient sampling technique, 134 Staff Nurses who had either a B.Sc Degree or Diploma in nursing were selected.

DESCRIPTION OF THE TOOL:

Part A – Demographic details

Part B –Questionnaire on perception of staff nurses towards EHR with 15 items

Part C –Modified Stronge and Brodt’s Nurses’ Attitude Scale.

a. Attitude towards patient care perspective

b. Attitude towards nurses’ perspective

c. Attitude towards technological perspective

DATA COLLECTION PROCEDURE:

After obtaining permission from the Dean, the Nursing Superintendents were informed about the study. The Staff Nurses were explained about the purpose of the study and the questionnaires were distributed to them. The completed questionnaires were collected after 30 minutes.

DATA ANALYSIS AND INTERPRETATION:

The obtained data was coded and analyzed using descriptive statistics. The mean, standard deviation and correlation coefficient was computed. The interpretation of results are given below.

The demographic data showed that, 84.3% of staff nurses were between the age group of 21 to 25 years, 88.1 % were females, 52.2% had a Diploma in Nursing, 31% worked in General wards, 48% had a work experience of 1 to 3 years. 58 % of nurses had completed short term Computer courses. 65% of nurses had computers as subject in their curriculum and 73% of nurses were familiar with computer usage.

TABLE. NO.1 PERCEPTION OF STAFF NURSES TOWARDS ELECTRONIC HEALTH RECORDS ( n = 134 )

S.No.	ITEM	YES		NO
S.No.	ITEM	No.	%	No.	%
1.	Benefits of Computerized documentation in patient care.	128	95.5	6	45
2.	Adequacy of computer knowledge in documentation	103	76.9	31	23.1
3.	Time factor in Electronic documentation of patient care	91	67.9	43	32.1
4.	Documentation of EHR by senior nurses	29	21.6	105	78.4
5.	Possibility of Electronic Health records in a hospital setting	122	91	12	9
6.	Benefits of EHR to the medical records department	123	91.8	11	8.2
7.	Usefulness of Electronic documentation to nursing personnel	105	78.4	29	21.6
8.	Reduction in workload of nursing personnel	98	73.1	36	26.9
9.	EHR documentation in improvement of patient care	96	71.6	38	28.4
10.	Usability of software/computer programs/packages in the clinical setting.	95	70.9	39	29.1
11.	Accessing information on the computer for better patient care.	102	76.1	32	23.9
12.	Usage of scrap paper to document patient information	71	53	63	47
13.	Success in individual nurses implementing EHR	102	76.1	32	23.9
14.	Acquisition of computer skills for nursing professionals	117	87.3	17	12.7
15.	Computers as a significant technological advancement in the health care setting	110	82.1	24	17.9

Table No. 1 shows that, majority 95.5% of nurses perceived that computerized documentation would certainly be beneficial in the health care setting, 67.9% of nurses perceived that use of EHR will help save time and among 134 nurses, 73.1% perceived that electronic documentation will reduce workload of nursing personnel.

Table No.2 RELATIONSHIP BETWEEN ATTITUDE OF NURSES and SELECTED DEMOGRAPHIC VARIABLES (n = 134):

S.No.	Variables	Number	“r” Value
1.	Age ( In years):
	21-25	113	-0.027
	26-30	14	-0.027
	31-35	4
	36-40	3
2.	Qualification of Staff Nurses:
	B.Sc.Nursing	64	0.049
	Diploma In Nursing	70	0.049
3.	Years of Experience:
	Less than 1 year	33	-0.025
	1-3 years	64	-0.025
	3-5 years	21
	5-7 years	9
	7-9 years	7
	9-11 years	2
	11-13 years	1
	13-16 years	1
	16 years and above	2
4.	No: of Nurses who have done Short term computer courses:
	Yes	56	0.262
	No	78	0.262
5.	No: of Nurses who had Computer as a subject in their curriculum
	Yes	87	0.090
	No	47	0.090
6.	No: of Nurses who are familiar with Computer usage:
	Yes	98	0.288
	No	36	0.288

Table 2 shows that, there was a positive correlation between attitude and demographic variables such as, the qualification of nurses, nurses’ who had completed short term computer courses, and those nurses who had computer as a subject in their basic nursing curriculum.

MAJOR FINDINGS OF THE STUDY:

· 58% of nurses had done short term computer courses

· 65% of nurses had computers as a subject in their nursing curriculum.

· 73% of nurses said that they were familiar with the use of computers.

· Majority (95.5%) of nurses perceived that computerized documentation would certainly be beneficial in the health care setting.

· Majority (67.9%) of nurses perceived that use of EHR will help save time.

· Among 134 nurses, (73.1%) perceived that electronic documentation will reduce workload of nursing personnel.

· The assessment of attitude revealed that majority (91.8%) of nurses had a Favorable attitude towards EHR.

· There was a positive correlation between attitude and demographic variables such as, the qualification of nurses, nurses’ who had completed short term computer courses, and those nurses who had computer as a subject in their basic nursing curriculum.

NURSING IMPLICATIONS:

Electronic health records have an immense implication in nursing education, nursing research and nursing management. The findings of the present study will be helpful in developing EHR which will

§ Decrease workload of nurses

§ Save time

§ Improve patient care

CONCLUSION:

It is necessary for the nurses to acquire knowledge on computers and hands on experience, but every nurse should also remember that technology and health informatics is only an enabler and not a substitute for individualized patient care. Electronic health records can introduce nurses to newer knowledge and skills that may improve patient care.

REFERENCES:

1. Anant. R. Koppar,(2012), “Electronic health records to improve health care delivery in rural India: a review available from http://www.hhmglobal.com

2. Jagadish, (2012), “Electronic health records”, A review available from, http:articles.times of india.indiatimes.com

3. Jim Dowling and Seif Haridi, (2012), “Developing a distributed electronic health - record store for India”, A review available from http://ercim-news.ercim.eu.

4. Laitinen. H, Kaunonen. M and Astedt Kurki. P. (2010), “Patient-focused nursing documentation expressed by nurses”, J Clin Nurs, Feb:19(3-4);489-97.

5. Lee.T.T., (2006), “Nurses’ perceptions of their documentation experiences in a computerized nursing care planning system”, A review available from, http://www.ncbi.nlm.nih.gov/ pubmed/17038098, J Clin Nurs, Nov;15(11):1376-82.

6. Lee.T.T., Yeh C.H. and Ho. L.H (2002), “Application of a computerized nursing care plan system in one hospital: experiences of ICU Taiwan”, J Adv Nurs, July;39(1):61-7.

7. Linda.E.Moody, Elaine Slocumb, Bruce Berg and Donna Jackson, (2004), “Electronic health records documentation in nursing: Nurses’ perceptions, attitudes and preferences”, Comput Inform Nurse, 22(6): 337-44, available from http://www.medscape.com.

8. McBride. S.H and Nagle. L.M, (2006), “Attitude towards computers, a test of construct validity”, Compu Nurse, May-Jun;14(3):165-70, available from http://www.ncbi.nlm.nih.gov

9. Stevenson.J.E and Nilsson.G,(2012), “Nurses’ perceptions of an electronic patient record from a patient safety perspective: a qualitative study”, J Adv Nurs, March 68(3): 667-76.

10. Sequeira and Kirthi. S.J, (2010), “Electronic health records documentation:nurses attitudes and preferences in a given hospital”, available from, http://hdl.handle.net.

11. Shoham and Snunith, (2008), “Intentions of hospital nurses to work with computers: Based on the theory of planned behavior”, CIN: Computers, Informatics, Nursing: march/April-Vol 26(2), 106-16..

Received on 14.03.2013 Modified on 20.04.2013

Asian J. Nur. Edu. and Research 3(2): April.-June 2013; Page 93-97