Factors affecting and affected by user acceptance of computer-based nursing documentation: results of a two-year study

Abstract

Objectives: The documentation of the nursing process is an important but often neglected part of clinical documentation. Paper-based systems have been introduced to support nursing process documentation. Frequently, however, problems such as low quality of documentation are reported. It is unclear whether computer-based documentation systems can reduce these problems and which factors influence their acceptance by users.

Design: We introduced a computer-based nursing documentation system on four wards of the University Hospitals of Heidelberg and systematically evaluated its preconditions and its effects in a pretest-posttest intervention study. For the analysis of user acceptance, we concentrated on subjective data drawn from questionnaires and interviews.

Measurements: A questionnaire was developed using items from published questionnaires and items that had to be developed for the special purpose of this study.

Results: The quantitative results point to two factors influencing the acceptance of a new computer-based documentation system: the previous acceptance of the nursing process and the previous amount of self-confidence when using computers. On one ward, the diverse acceptance scores heavily declined after the introduction of the nursing documentation system. Explorative qualitative analysis on this ward points to further success factors of computer-based nursing documentation systems.

Conclusion: Our results can be used to assist the planning and introduction of computer-based nursing documentation systems. They demonstrate the importance of computer experience and acceptance of the nursing process on a ward but also point to other factors such as the fit between nursing workflow and the functionality of a nursing documentation system.

Figure 1.

Median acceptance scores of the nursing process (1 = minimum, 4 = maximum) on the four study wards for each of the three measurement points (first = before introduction second = during introduction, third = after introduction of a computer-based nursing documentation system). Only the 31 nurses who answered all available questionnaires are included.

Figure 2.

Median acceptance scores of computers in general (1 = minimum, 4 = maximum) on the four study wards, for each of the three measurement points (first = before introduction second = during introduction, third = after introduction of a computer-based nursing documentation system). Only the 31 nurse who answered all available questionnaires are included.

Figure 3.

Median acceptance scores of computers in nursing (1 = minimum, 4 = maximum) on the four study wards, for each of the three measurement points (first = before introduction second = during introduction, third = after introduction of a computer-based nursing documentation system). Only the 31 nurses who answered all available questionnaires are included.

Figure 4.

Correlation among years of computer experience, three acceptance scores (nursing process, computers in general, computers in nursing) before the introduction, and the overall acceptance score of the computer-based nursing documentation system PIK after 9 months of use (visualization of the results presented in Table 10▶). The lines indicate a positive correlation. The correlation index and the significance level (* = p < 0.05; ** = p < 0.01) for the correlation is indicated beside each arrow.