The purpose of this survey was to describe nurses’ perceptions of their informatics
competencies regarding HIS usage in daily patient care. Three dependent variables were used:
‘Nursing documentation’, ‘Digital environment’, and ‘Ethics and data protection’.
The ‘Ethics and data protection’ competency score was higher than the scores of ‘Nursing
documentation’ or ‘Digital environment’. This refers to relevant content of the nursing
curriculum relating to data protection and data security principles and ethical rules in daily patient care when using digital services . Digitalization is changing the patient-nurse relationship from a face-to-face to a remote connection. Thus, it requires nurses to remotely identify the patient’s needs for care, to teach and guide the patient according to his/her needs and to assess patient outcomes. The patient’s dignity, integrity, independence and confidentiality and protection of patient data should also be preserved in digital care processes [1 − 2, 4, 16, 22].
Nursing documentation including terminologies is one of the leading areas of expertise in nursing informatics [22 − 23]. Internationally, several standardized terminologies have been developed, validated, translated and used for nursing documentation [27 − 28]. In Finland, nursing documentation skills and competencies are included in the nursing curricula at the Universities of Applied Sciences (UAS), in keeping with the aims of higher education in Europe . However, the national nursing documentation model including the FinCC terminology is not utilized in all health care organizations , which might contribute to the slightly lower total competency score of nursing documentation. Nevertheless, when nursing notes are documented by using a standardized terminology, nursing discharge summaries are also accurate, unified and understandable. Thus, the terminology-based documentation better guarantees the continuity of patient care between primary and specialized care  and supports patient self-care [7, 46].
FinCC is the only nursing terminology translated and validated to the Finnish nursing culture over 20 years ago, and further developed and used in Finnish health care organizations. The latest version, 4.0, translated into both English and Swedish, was published in 2019. The update was based on an end-user survey and e.g., on several national clinical guidelines, legislation, national instructions, and on scientific research . Despite its long history of development and research, there is still wide variation in the knowledge and skills of how to utilize the structured data. This applies both to nurses and nursing managers. Moreover, reporting systems have not evolved due to the lack of statistics required by the nursing managers. Structured and high-quality nursing data is a basis for utilizing big data in nursing and quality management, [14, 22, 28] affecting the reliability of results produced by AI tools, such as problem-solving software programs, to provide support to nurses and help them make more informed decisions in patient care .
Inadequate training, lacking connections with daily work processes, has been presented to associate with the lack of digital skills . According to nurses, the best way to learn is learning by doing . Thus, parallel to teaching how to use the HIS, there is a need to teach terminology use as well as how to integrate the latest information models into information systems and clinical nursing practices and work processes. Unfortunately, in this study, every competency factor category is probably affected by the fact that, despite the continuing training requirements of health care organizations , the continuing training of nurses' use of HIS is not organized systematically among them [33, 38 − 39].
Finland is one of the leading countries in the digitalization of health care . However, the results of this study showed that nurses may not have sufficient competency to manage in a rapidly changing digital environment. New digital platforms and services have generated requirements for nurses to learn digital skills while, at the same time, nurses also need to teach patients how to choose and use the most suitable digital services . For example, mobile devices are already widely used for checking or recording patient data .
The competence ‘digital environment’ appeared to be positively associated with a more recent graduation year, which indicates the more relevant current curricula of the UASs, which include digital skills and competencies. For example, one learning objective in the nursing curriculum is that the nursing student can demonstrate competences in using digital services as a part of holistic patient care [4, 40, 43]. Compared to the inpatient ward, the ‘digital environment’ competence was slightly better in outpatient care and in the virtual hospital, examination, operation, and labour areas and in the emergency room and emergency care. This refers to Finnish national initiatives, such as the HealthVillage.fi digital care services developed by the Virtual Hospital 2.0 project [10 − 11], Self-Care and Digital Value Services , the use of ‘Kanta’, the national data repository, and the national guidance of information management in social welfare and health care. The ‘Kanta’ services include components, such as for citizens My Kanta Pages, and for professionals Prescription Centre and Pharmaceutical Database, Patient Data Repository, Data Management Service, Data Repository for Social Services, and Kanta Personal Health Record. In sum, the Kanta services ensure access to the patient data in situations where the patient receives treatment from many different actors and in different places [7, 49].
Only a minority of the respondents evaluated themselves as beginners or entry-level specialist HIS users, which is a slightly better result than three years ago . Furthermore, nurses’ practical and subjective experience of HIS was associated with all three dependent variables: nursing documentation, digital environment, and ethics and data protection. Since the mean age of the respondents was 46, this might refer to a longer working career, and to the wide implementation and use of HIS both in public and private health care, also in social services where it is increasing, and the continuous development of digital health infrastructure over several years in Finnish health care services .
Conservative interpretation of the results indicates that it takes about six months to learn a new system. This fact needs to be considered when introducing and implementing new systems and services for health care professionals . Nurse’s motivation plays a vital role in eHealth performance and maintenance. Evidence-based methods, such as action planning and participatory approach, should be promoted. Furthermore, plans for user-centered changes in the work environment, motivation, encouragement and social support have been introduced to strengthen the use and success of HIS implementation and informatics competencies [16, 26].
Study limitations of consideration include the fact that the data was collected in the spring of 2020, simultaneously with the onset of the COVID-19 epidemic that challenged Finland’s health care system. Due to this situation, only one reminder was sent, resulting in a final sample size of 3610. Considering this, the lower than anticipated response rate can still be considered a good achievement. The sample included slightly more women and respondents over 40 years of age. However, most of them were registered nurses with a Bachelor of Health Care degree, and HIS end-user groups. Since in a cross-sectional study design interpretations are associations, not causal inferences, in many surveys, the data includes self-reported measures and not an external assessment of experiences or competencies. However, self-assessment is a central part of learning new skills.