In this study, technophobia among nursing students was at a moderate level. Female students had a higher level of technophobia than men students. In addition, students with higher levels of education were less afraid of technology than other students. Nursing students' skills in using information systems and medical equipment were lower than their computer skills. By increasing computer literacy, the ability to work with health information systems, and the skill of working with medical equipment, the technophobia level of students had a declining trend. From the point of view of nursing students, technophobia happens mostly due to lack of time to learn new technologies, high workload, being questioned for new technological errors, increasing problems following medical equipment and information systems failure, unsuccessful communication of patient information in information systems, the need for good experience and skill in the use of technologies, and the need for a trainer in the use of new technologies.
According to our findings, the level of nursing students’ technophobia is moderate. This study confirms the results of a similar study showing that nurses have moderate levels of computer anxiety [27], and technostress [18]. In line with the results of other studies [30–32], In this study, females had a higher level of technophobia than males. The results of our study showed that the age and marital status of nursing students are not related to their technophobia, which is congruent with the results of other studies [23, 29]. However, there are some previous studies [22, 23, 32, 33] that have shown that middle-aged and older people have a higher level of technophobia than young people. This difference between the results may be due to differences in the age range of the participants. In our study, most of the participants were young and of the same age level. However, in previous studies, the general public with a high age diversity participated. In the present study, nursing students in the last year of study had a lower level of technophobia compared to the students in their early years of study. These results confirm the findings of previous studies [18, 29, 34–36] that have shown by increasing the duration of education the level of technophobia decreases.
According to the results of this study, the computer skills of nursing students such as working with search engines, using search methods, sending emails, and using social networks and the Microsoft Office suite are higher than their skills in using hospital information systems and other health information systems [29, 37]. This result emphasizes the results of previous studies, which revealed that although the computer skills of nursing students are at a high level, their skills in using Electronic Health Record (EHR) systems are not sufficient [38–40]. The results of this study also show that nursing students' skills in using medical equipment such as hemodialysis machines, ventilators, and defibrillators are lower than their computer skills. This result confirms the findings of a systematic review[41] that showed nurses do not have high knowledge and skills in using medical equipment.
In this study, technophobia is less common in students with higher skills in using computers, hospital information systems, and other health systems, and in students with a higher ability to use medical equipment. This result is in line with other studies [23, 41, 42] that showed nurses who have more computer skills, are more capable of using information systems, and have more knowledge and skills in using medical equipment experience less fear and anxiety [41] when using different technologies.
In the present study, from the nursing students' point of view, the main factors related to "skills and job conditions" that lead to technophobia include "insufficient time of nurses to learn new technologies due to their busy schedules", and "fear of being accountable for incorrect results originated from new technologies”. This result is similar to the results of other studies [43, 44] indicating that nurses are worried about the lack of opportunities to learn to work with technologies and endangering their job position because of new technologies.
In addition, nurses are concerned about the correct transfer of patient information to the system when using an information system [39]. Also, according to the results of this study, two factors; "the need for high experience and skill to work with technologies" and "the need for a coach while using technologies", are the main factors related to "low self-confidence when dealing with technologies" that increase the technophobia of nursing students. This finding confirms the results of a study [45, 46] which states that it is more difficult for nurses who are less confident in their skills and abilities to face and work with new technology.
4.1. Limitations
This study had three limitations. First, since this study was conducted in the nursing school of a university, the generalizability of the results to other universities with different educational systems should be done with caution. Second, since this study was performed only on nursing students, the results may be different for students in other disciplines. Hence, it is recommended that future studies examine the extent of technophobia in students of other disciplines, such as medical students. Third, due to the cross-sectional nature of our study, the results are limited to a specific and the results may change over time. Therefore, future studies can examine the gradual change of technophobia over time. However, to our knowledge, this is the first study that evaluated the extent of technophobia and its causes in nursing students. It also examined the relationship between demographic variables and the level of computer and technological skills of nursing students, and their level of technophobia.
4.2. Implications of the study
Various health systems such as Hospital Information System (HIS), Laboratory Information System (LIS), EHRs, and countless medical devices are used in clinical settings[16]. According to the findings of the present study, nursing students' skills in using medical equipment and health information systems are lower than their computer skills.
The findings indicate that nursing schools and medical-educational environments need to invest more in educating students about how to use medical equipment and health information systems. In this regard, similar studies [42, 47, 48] have shown that nursing students at all levels of education, especially students in their early years of education, need to strengthen their technological and computer skills. This goal can be attained by providing relevant computer and technological courses.
In this study, the level of technophobia is higher among students who are less proficient in using medical equipment and information systems. According to studies [13, 18], nurses who are more afraid of technology are more likely to make mistakes when using medical devices and information systems, which can threaten patients’ life.
On the other hand, studies have shown that the provision of computer applications and games[49] and the use of virtual reality [49, 50] can reduce fear and anxiety in various areas such as medical processes, flying, and accidents. In particular, a study [24] showed that the use of a virtual computer-based system reduces technophobia in patients. Therefore, to deal with the technophobia of nursing students and prevent their mistakes while caring for the patient, it is suggested that appropriate educational interventions such as computer software and virtual reality-based applications be provided for these students. According to the results of the present study, women are more afraid of technology than men. This may be due to their gender differences. Men are more eager than women to face a new technology and work harder to learn how to use it [51]. In addition, according to the results of this study, students who are in the early years of study are more concerned than other students when encountering new technology. This may be due to the lower levels of education, poorer technological skills, and lower experience of junior students in clinical settings [34, 35]. Therefore, it is recommended that educational interventions be provided from the beginning of the nursing program to strengthen the technological and computer skills of students, especially females.
Technophobia of nurses is mostly due to reasons such as insufficient time to learn new technologies due to work overload, fear of increasing problems when medical equipment and information systems break down, and insufficient experience and skill of nurses to work with technologies. It seems that a coach is also required when using technology for the first time.The result of this study and other studies [43, 51] suggest that providing technological and computer training opportunities for nurses and strengthening their confidence in their technological skills and abilities reduce their technophobia.