East African Journal of Health and Science

The use and dependence on information technology have recently become increasingly widespread in healthcare and nursing care delivery. The purpose of this study was to assess practices among nursing staff in relation to computerisation and computer use in a tertiary referral hospital. This was a cross-sectional study comprising qualified nurses from all departments. A sample size of 291(100%) nurses participated in the study. Data were collected using questionnaires. Data were analysed using a statistical package for social sciences software version 22. A p-value < 0.05 was considered statistically significant


INTRODUCTION
The use and dependence on information technology (IT) have recently become increasingly widespread in health and nursing care delivery (Goorman and Berg, 2000). Nkosi et al. (2011) assert that many health facilities use computers to enhance the quality of health services and nursing care delivery, increase the scientific information base in medicine and nursing and decrease healthcare costs. Chan (2006) indicates that, historically, computer use in nursing began in the 1970s as the need for more information on its implementation and service documentation increased for nurses. In this period, computers were used effectively in the diagnosis and treatment of the problems of the healthy individual/patient, in planning, applying, and evaluating healthcare and for keeping records among nurses and other healthcare practitioners (Lee, 2005).
Nurse clinicians, educators, researchers, and administrators handle large amounts of data and information during their execution of daily duties. Traditionally, Lee (2005) says that client data are handwritten in an unstructured paper format in multiple versions. This process makes location, abstraction, and comparison of information very slow and difficult, thereby limiting the process of knowledge creation, sharing and development (Hebda and Czar, 2013). Moreover, prompt access to quality information by all stakeholders in the healthcare delivery system requires a structured and secured documentation mechanism for the provision of quality patient care, which can be achieved with Electronic Health Records (DOH, 1998). In the 21st Century, the use of computers has become the global best practice in the management of patient records, with developed countries taking the lead. Gradually, concerted efforts are being focused on phasing out manual paper records in developing countries, which had consumed huge space in antique health record libraries for centuries and notably delayed access to efficient medical care (Da've, 2004).
Several factors that influenced the use of computers among nurses have been documented in research. Some nurses were reported to have been resistant to using Information Technology, while others lacked the required preparedness for the effective application of ICT in nursing practice and documentation (Bertulis, 2008). Likewise, research by Bertulis concluded that nurses lack the time and skills to access and review electronic evidence-based information (Bertulis, 2008). Meanwhile, Lium, Laerum and Schultz et al. revealed that poor ICT implementation process, negative perception, and lack of awareness of the immediate benefits were also reasons for sub-optimal or non-use of ICT (Lium, Laerum, Shultx, et al., 2006). Likewise, Samoutis, Soteriades and Kounalakis et al. demonstrated that a lack of informatics and computer training and technical support increases resistance to use (Samoutis, Soteriades and Kounalakis et al., 2006). Proficiency in using computers has become a necessity in healthcare settings. The benefits of utilising computerised systems are documented. Examples include the decrease in costs and improvement in the quality of health and nursing care provided (Ibrahim, Donelle and Sidani et al., 2019). Besides, computerised systems facilitate communication and reduce the risk of committing medical and nursing errors (Palabindala, Pamarthy and Jonnalagadda, 2016).
Computerisation is ongoing in Kenyatta National Hospital, with a robust master plan to ensure the digitisation of health services. Nurses form the bulk of the hospitals' workforce, they spend more time with patients, and their documentation is immense and diverse. However, nurses have lagged behind in computer use, and this adversely affects all other professionals due to interdependence in healthcare delivery. The purpose of this study was to assess practices among nursing staff in relation to computerisation and computer use in a tertiary referral hospital.

Following ethical approval from the Kenyatta National
Hospital/University of Nairobi (KNH/UON) ethics committee, a cross-sectional study was conducted at a national tertiary teaching and Referral hospital in Kenya.
The study population comprised qualified nurses from all departments in the hospital. Nurses on duty during the data collection period and hospital managers who voluntarily consented to participate were eligible for the study. Those absent from the study unit during the period or unwilling to give consent were ineligible.
Sample determination was done using the formula shown below. The sample size calculated was 291. From this number, proportionate calculations were allocated to all hospital departments pegged on the departmental qualified nurse population. Each departmental proportionate sample formed a stratum. Simple randomised sampling was then applied from all strata. A qualified research assistant with a diploma in nursing was recruited and trained on the consenting and interviewing process. The principal investigator (PI) and Co-Investigators (CIs) provided necessary support supervision during data collection. The PI and CIs performed scheduled and random support supervisory duties through phone calls, field visits and checking on data collection and entry to ensure data integrity was achieved and maintained. Consenting participants filled out the structured questionnaire, which mainly had quantitative characteristics. Data collected was cleaned, validated, and analysed using SPSS version 22 at the descriptive and inferential level of data analysis for qualitative data. A p-value <0.05 was considered statistically significant.
The majority of nurses use computers for ordering supplies at 160 (55%), nursing notes at 41 (14.1%), billing at 64 (22%) and for communication at 26 (8.9%).  ) said that their computers were protected using a password (pvalue < 0.0001), while 11(4%) said they were not. About 227 (78%) nurses said it was possible to correct wrong data entered in the computer (pvalue < 0.0001), while 64(22%) said it was not.  Table 3). The most utilised means of communication by the nurses among colleagues was the telephone, with approximately 251 (86%) of them using it (p-value < 0.0001), while 40 (13.7%) did not. According to the frequency of computer use, 235 (83.3%) of the respondents used computers several times daily; 16(5.5%) weekly, 12(4.1%) fortnightly, 7(2.4%) monthly and 21(7.2%) once a month and this was statistically significant at a P-value <0.0001 as shown in table 4.

DISCUSSION
This study aimed at determining the practices among nursing staff in relation to computerisation and computer use at a national referral hospital. The majority of nurses were in the age group 40-49 years, and the least was 50-59 years 41(14%). The majority of the nurses were aged 40-49 years, in contrast to studies done in Nigeria, where the majority of the respondents were aged 31-40 years (Edward et al., 2020). The majority of the respondents were senior nursing officers in managerial positions, congruence with a study done in Kenya by Kivuti-Bitok where the majority of respondents were nurse managers (Kivuti-Bitok, 2009).
The majority of the nurses used computers for ordering supplies, nursing notes, billing, and communication. Comparatively, Kivuti and Chepchirchir (2011) found that nurse managers utilised computers for various activities such as sending emails, typing personal work, and searching for information on the internet. Contrastingly, in Australia, Hegney Buikstra, Eley and Fallou et al. (2007) found that nurses were using computers to access patient's records, patient's results, continuing professional education and communication (Hegney Buikstra, Eley and Fallou et al., 2007). Similarly , Dumas, Dietz-EOand Connolly (2001) showed that nurses used computers for creating and accessing patientrelated information.
The findings of the study showed that the majority of the nurses were proficient in using computer mouse (93.1%). In regard to typing using a keyboard, 89% were proficient, while 62.2% were proficient with word processors. A similar observation was made in Nigeria, where 77.9% of the nurses had good knowledge of computers, and 98.3% of the respondents knew that it could be used for storing and processing information (Edward et al., 2020 Kivuti-Bitok (2009) found that the majority of the nurses did not receive computer training as part of their basic training in nursing. Many health workers do not have any computer training during their basic training. The majority of the respondents, 96%, said that their computers were protected using a password. Similarly, Hegney Buikstra, Eley and Fallou et al. (2007) found that only 8% of the nurses considered the level of security of patient's records to be poor. They rated workplace policies in security and confidentiality as high, with 58% of the nurses rating it good.
In our study majority of the nurses (82.8%) did not use email as a means of communication; only 17.2% used it. The reason could be the inadequate link of the internet to the available computers. In a national survey in the USA, findings indicated that nurse administrators felt that the ability to use email effectively, operate basic computer Windows applications, and search databases were critical information technology skills for nurses (McCannon and O'Neal, 2003). In addition, Brijendra and Senthil (2015) reported that communication-related activities were highly correlated with the advantages of using computers among nurses. They recommended that communication-related activities should be enhanced in nurses working environment in order to realise the benefit that comes after using computers frequently.

CONCLUSION AND RECOMMENDATION
Computerisation and computer use have significant implications in nursing practice and nursing care service delivery. Factors that influence their adoption and practice have been isolated. This study offers critical elements that can help inform facilities that are computerising their healthcare and nursing services at all levels of healthcare. Narrowing on improving nurses' proficiency in using a computer mouse, typing on the keyboard, use of word processor, having an email and ability to prepare a power-point presentation. Nurse managers need additional in-depth training in computer use so as to offer support to junior staff.