CITATION: Abdekhoda, M. & Khezri, H. (2021). Investigating the impact of health informatics literacy on the evidence-based practice of nursing. Online Journal of Nursing Informatics (OJNI), 25(2). https://www.himss.org/resources/online-journal-nursing-informatics
Background: Informatics literacy has been considered a critical issue in improving nursing evidence-based practice. This study was carried out to investigate the impact of health informatics literacy on the evidence-based practice of nursing.
Materials and Methods: This is an analytical study in which the community included nurses working at Tabriz University of Medical Sciences hospitals, 205 of which were selected as the sample population. The instrument used is a questionnaire checked for reliability and validity. The data was entered into SPSS v.22 and correlation analysis and regression were completed. Data were collected from January to April 2018.
Results: The research findings indicated that there is a positive and significant relationship between informatics skills and evidence-based practice ((β=0.63), (P-value<0.01)). Other results showed a positive and significant relationship between information literacy and evidence-based practice ((β=0.45), (P-value<0.01)). In addition, there was a moderate and significant relationship between computer skills and evidence-based practice ((β=0.94), (P-value<0.01)).
Conclusion: Informatics and computer skills are necessary underlying components that support and reinforce the evidence-based practice framework. Therefore, it is suggested that the above-mentioned skills be taught and expanded in order to improve evidence-based practice and be added as part of the educational curriculum for nurses.
Nowadays, considering the significance of information literacy in obtaining official and reliable information, it is necessary for nurses to have high-level information literacy in order to improve their science-based performance (Janave et al., 2015). The clinical team, especially nurses who have a crucial role in caring for patients, should obtain information on the latest changes related to clinical care and update themselves on clinical information (Janave et al., 2015; Khezri & Abdekhoda, 2019; Wadson & Phillips, 2018).
Enhancing information literacy is the basis of critical thinking in nursing, and the requirement for successfully implementing the evidence-based approach in clinical practice. In fact, applying new clinical evidence in developing and enhancing a nurse’s professional life is a critical issue (Janave et al., 2015). The final goal of nursing services is to provide high quality care while improving the outcome of services for patients and society. Naturally, it is expected that the health system services be based on evidence, methods, and scientific decisions (Cullen et al., 2020; Stevens & Cassidy, 1999; Xiang & Hua, 2018).
Health professionals, such as nurses, should have the ability to use up-to-date online clinical care information to enhance the quality of health care services. Nurses have acknowledged that nursing care and methods are significantly affected by information quality and availability (Zigdon et al., 2020). Also, many routine healthcare procedures are based solely on traditional methods, work assumptions and hypotheses, individual skills and unorganized clinical observations (Stevens & Cassidy, 1999).
Evidence-based practice is a framework for clinical practice, which integrates the vigilant, clear and perceptive use of the best available evidence for decision-making regarding patient care. Also, it is vital to undergraduate and graduate nursing education (Haines, 2018; Mackey & Bassendowski, 2017). In fact, the capability of having information literacy includes an architectural understanding of information and the research process, and the ability to search in various electronic and published tools in order to accurately retrieve, select and evaluate information resources based on accuracy, authority, objectivity, currency and coverage of the resources. Thus, creating an effective connection between information needs and findings is beneficial (Abdekhoda, Dehnad, et al., 2016; Abdekhoda et al., 2017).
To effectively search data banks, it is necessary that nurses and nursing students become more familiar with information literacy skills such as how to organize information in data banks, create and arrange search terms and create search strategies that result in obtaining high-quality papers in clinical care (Parvinia Nasab et al., 2014).
According to research carried out by Janave et al. (2015), the American Medical Association announced that 90 percent of health care decisions in the year 2020 would be evidence-based. From the viewpoint of training staff, the insufficient number of personnel for employing evidence-based care (82.5%) was the most important obstacle in not having trained individuals to employ research findings for evidence-based care. As well, the great number of patients (77.5%) stood in second place as a barrier. An insufficient amount of necessary equipment such as computers, Internet access, and electronic notices on wards was considered the least obstacle in regard to carrying out evidence-based care (22%) (Parvinia Nasab et al., 2014).
In Iran, during the past few years, significant changes have taken place in the realm of nursing. Instances such as teaching International Computer Driving Licenses (ICDL) skills, holding weekly scientific seminars in the hospital, instructors being available and nursing students access to up-to-date sources of information in the clinical environment, reduction in the nurses work load in training hospitals, reduction in the nurses working hours between 8 to 24 hours a week, and creating a website in the hospital have been among the changes made to address these needs (Kahouei et al., 2013).
Studies carried out in this realm have focused on the necessity to use evidence-based practice, the viewpoint of nurses and existing obstacles. Also, customers, policymakers and healthcare organizations believe that changing and transforming healthcare services by adopting new approaches, such as using evidence-based practice, and upcoming technology, such as applying Electronic Medical Records (EMRs) are critical (Abdekhoda, Ahmadi, et al., 2016).
Based on the review of literature, the researchers found that nurses’ evidence-based practice competencies are an important issue and are considered in some studies (Elsayed et al.; Fehr, 2014; Janave et al., 2015). “Evidence-based practice is a conscientious, problem-solving approach to clinical practice that incorporates the best evidence from well-designed studies, patient values and preferences, and a clinician's expertise in making decisions about patient care” (Evidence-Based Practice, 2020). Therefore, in alignment with the structural changes related to enhancing nurses’ information technology skills, this study aimed to evaluate the effect of health informatics literacy on evidence-based practice in nursing.
This research was an analytical descriptive study carried out from January to April 2018. The research objective was to investigate the impact of health informatics literacy on the evidence-based practice of nursing. The study setting was in educational hospitals affiliated with Tabriz University of Medical Sciences where registered nurses were working. The research community included nurses working at Tabriz University of Medical Sciences hospitals, 205 of which were selected as the sample population based on Krejcie & Morgan’s table. Krejcie & Morgan (1970) presented tables which show the sample size needed in line with a certain degree of reliability and population size.
The instrument used was a translated questionnaire which was prepared using literature related to information literacy and evidence-based practice such as the doctoral dissertation by Susanne Fehr (2014). In order to check the validity of the questionnaire, a validation form was provided, in which relevance, clarity and simplicity were considered for each item. The validation forms were distributed among 10 specialists in the realm of nursing, health information management and medical informatics. The content validity index (CVI) and content reliability ratio (CVR) were considered for each item and the items that received a low score were eliminated (Patra & Guha, 2018). In order to determine reliability, the questionnaire was distributed among 30 nurses and then the internal correlation among the questionnaire items was measured and Cronbach’s alpha was obtained (98%).
Finally, the questionnaire was developed with seven variables and 65 items, including the variables of demographic information with seven items, job satisfaction had six items, self-efficacy had four items, evidence-based practice had 11 items, computer literacy with 19 items, informatics skills with 10 items, and informatics knowledge with 8 items (Table 1).
To determine the correlation between the variables shown in Table 1, a correlation matrix was constructed. Furthermore, the collected data were analyzed by SPSS v.16. The correlation between variables was measured by Pearson’s correlation and regression tests.
The study was approved by the Ethics Committee of Tabriz University of Medical Sciences (ethical code: IR.TBZMED.REC.1396.58746).
Demographic information of the sample indicated that the average age of most participants was 34 years old. Regarding the level of education, most participants had a bachelor’s degree (76.6%). Also, most participants were on evening-night duty (41.0%) and had the organizational position of ward nurse (58.5%). Most participants spent less than three hours working with the Hospital Information System (HIS) (73.7%) and had work experience of less than five years (43%).
Tables 2 and 3 show a significant relationship was observed between computer skills and evidence-based practice (p=0.001, r=0.43). In addition, B=0.94 for the regression slope showed that with an increase of one unit in computer skills, evidence-based practice increased by 0.94 units on average, with the peak being at β=0.43.
Regarding the coefficient of determination, R2=18.9% of changes in evidence-based practice were depicted by computer skills. R2 indicated that 18.9 percent of the variance of nurse’s evidence-based practice competency was explained by their computer skills.
A significant relationship was observed between informatics knowledge and evidence-based practice (p=0.001, r=0.45). Also, B=0.45 for the regression slope indicated that with an increase of one unit in informatics knowledge, evidence-based practice increased by 0.45 units on average, with the peak being at β=0.45. Regarding the coefficient of determination, R2=20.3% of the changes in evidence-based practice were depicted by informatics knowledge. R2 showed that 20.3 percent of the variance of nurse’s evidence-based practice competency was controlled by their informatics knowledge.
A significant relationship was observed between informatics skills and evidence-based practice (p=0.001, r=0.57). Also, B=0.63 for the regression slope indicated that with an increase of one unit in informatics skills, evidence-based practice increased by 0.63 units on average, with the peak being at β=0.57. Regarding the coefficient of determination R2=32.8% of the changes in evidence-based practice were depicted by informatics skills.
A direct and significant relationship was observed between job satisfaction of nurses and evidence-based practice (p=0.045, r=0.14). Also, B=0.06 for the regression slope showed that with an increase of one unit in job satisfaction of nurses, evidence-based practice increased by 0.06 units on average, with the peak being at β=0.10. R2 was 1.2 percent, indicating that 1.2 percent of the variance of nurse’s evidence-based practice competency was determined by their job satisfaction.
A weak and significant correlation was observed between self-efficacy and evidence-based practice (p=0.002, r=0.25). Also, B=0.07 for the regression slope showed that with an increase of one unit in self-efficacy, evidence-based practice increased by 0.07 units on average, with the peak being at β=0.17. With regard to the coefficient of determination R2=3.2% of the changes in evidence-based practice were depicted by self-efficacy. Also, there was no significant relationship between the variable of age and evidence-based practice, while there was a direct and significant relationship between level of education and evidence-based practice (p=0.04, r=0.14). In addition, there is no significant relationship between evidence-based practice and the duration of time that hospital information systems were used (Table 2 and 3).
Regarding the relationship between informatics skills, informatics knowledge, computer skills, and nurse’s evidence-based practice competency, the research findings indicated that there is a direct and positive relationship between nurse’s health informatics literacy and their evidence-based practice ability. In her doctoral study, Fehr (2014) showed that there is a relationship between informatics capabilities (informatics skills, informatics knowledge, computer skills) and evidence-based practice. Therefore, her results are consistent with the results of our study.
Concerning the relationship between demographic variables and nurses’ evidence-based practice competency, the results of this study show that self-efficacy, job satisfaction and age did not have a significant relationship with the evidence-based practice of nurses. Meanwhile, in Fehr’s (2014) study, job experience, position and work shift did not have a considerable effect on evidence-based practice. In our study, a weak and significant correlation was observed between self-efficacy and evidence-based practice. In her study, Fehr also showed a weak and significant correlation between evidence-based practice and self-efficacy, indicating consistency with our study.
In our study, computer skills included ICDL, Internet resources search skills, skills in using storage devices such as flash memory, memory cards, and USB, ability in using the network and operating system, activating the printer and installing available software and so on, informatics skills including awareness of resources and scientific information in the realm of nursing, converting information needs to research questions, knowledge of how to retrieve evidence, ability to consciously analyze evidence based on a set of standards and informatics knowledge including cooperation in the selection, design, implementation and evaluation process of hospital systems, as a specialized nurse, playing the role of supporter for managers in order to promote novelty and informatics concepts of nursing in the specialized realm are among the effective and determining variables in the evidence-based practice of nurses.
In a study by Eizenberg (2011), the predictive variables of evidence-based practice included teaching, being skilled in finding various research sources, searching and studying technical literature, knowledge sources based on colleagues and systematic methods (inhibiting variables), and knowledge sources based on experience or intuition. In another study, Habibi et al., (2010) claimed that in evidence-based practice nurses face problems and their biggest problems are finding the best evidence, identifying accurate resources, using optimum search methods, and critical evaluation of evidence or generally speaking, problems in using information literacy skills. This indicated that information literacy skills are the best predictors for evidence-based practice. In another study, Moghadam et al., (2016) predicted successful evidence-based healthcare by evaluating the amount of information literacy (understanding information needs, finding information, evaluating information, organizing information, exchange and distribution of information) of faculty members and doctorate students. The findings of these studies are also consistent with our research.
In another study, Elsayed et al., (2017) showed the positive and significant correlation between informatics skills of nursing students and their attitude toward evidence-based practice in nursing. In their research findings, Shifaza et al., (2014) proposed a means for facilitating and implementing evidence-based practice as knowledge in nursing through the provision of educational opportunities, access to resources, access to scientific texts, group work, awareness and creating a research culture, support, motivation, time to discuss ideas with colleagues, protocols, research papers, and discussion of research articles. The findings of this research were also consistent with our findings to some extent.
Evidence-based nursing care is a creative, innovative and skillful method that has an important role in enhancing the quality of clinical practice of nurses. With regard to the results of this and other research studies, which show a positive relationship between health informatics literacy and nurses’ evidence-based practice, it can be concluded that informatics and computer skills are the fundamental components and underlying framework that support and reinforce evidence-based practice in nursing. Thus, enhancing nurse’s health informatics literacy is considered to be a determinant factor in improving evidence-based practice in nursing. Therefore, health informatics literacy should be considered as a critical part of the education of nurses.
Self-reported use of evidence-based practice (EBP) by nurses, instead of measuring its actual use, self-selection biases of the items of the questionnaire, and limiting the setting to nurses working at Tabriz University of Medical Sciences’ hospitals are the main limitations that should be considered in future studies.
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Associate Professor of Health Information Management, Department of Medical Library and Information Science, School of Health Management and Medical Informatics, Tabriz University of Medical Sciences, Iran; Iranian Center of Excellence in Health Management (IceHM), Tabriz University of Medical Sciences, Tabriz, Iran Mohammadhiwa Abdekhoda received his PhD in Health information sciences form Iran University of medical Sciences. Currently working as an Assistance Professor in Health Information Management, Department of Medical Library and Information Sciences, School of Health Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran. His research interest includes Health information systems, information systems adoption, scientometrics, medical library and information sciences.
Ph.D. student of Health Information management, Student Research Committee, Faculty of Management and Information, Tabriz University of Medical Sciences, Iran
Hero Khezri is a PhD student in health information management at Tabriz University of medical science. Hero received a bachelor’s degree in medical records from Kashan University of Medical Science in 2006 and received a Master of Science degree in health information technology from Tabriz University of Medical Sciences in 2014. Research interests include evaluation of information systems, Electronic health records, nursing informatics, and business intelligence. Hero also has nine years’ experience in the medical records department of the hospital.