Study Design and Settings
This interventional study was conducted using a pretest-posttest design over the intervention and control groups in 2019. The participants included nurses of the critical care units (ICUs, CCUs, and dialysis) selected from three educational hospitals affiliated with Kerman University of Medical Sciences in the southeast of Iran.
Sample
The study population included all nurses (N = 330) working in the critical care units at the time of data collection. The sample size was calculated as 60 using the sample size formula. Later, 20 nurses were selected from each three hospitals using the random number table. Finally, these nurses were randomly assigned into the intervention (n = 30) and control groups (n = 30).The inclusion criteria were having a bachelor's degree and higher as well as at least six months of work experience in the critical care units. The exclusion criteria included having one absence during the course and incomplete questionnaire [12].
Instruments and Data Collection
The instrument used in this study consisted of two questionnaires. The first one was about the nurses' demographic information including gender, age, working experience, organizational position, type of shift, level of education, marital status, history of participation in research courses, information literacy skills, information-seeking skills, and computer skills (Table 2).
The second tool was Nursing Informatics Competency Assessment Tool (NICAT), developed by Rahman in the US in 2015 based on the American Nurses Association )ANA( standards (2008), Technology Information Guiding Education Reform )TIGER( recommendations (2009), and Benner's Dreyfus model of skill acquisition (1984). This tool assesses IT competency in three dimensions of: 1- Computer literacy (10 items, items 1 to 10), 2- Informatics literacy (13 items, items 11 to 23), and 3- Information management skills (7 items, items 24 to 30).
The NICAT should be scored on a five-point Likert scale ranging from one to five: not competent (1 score), somewhat competent (2 scores), competent (3 scores), very competent (4 scores), and expert (5 scores). The overall score range of the instrument is 30-150. Higher scores indicate higher IT competency; a total score of 30 shows novice, a score in the range of 31-59 represents advanced beginner, a score in the range of 60-89 indicates competent, a score from 90 to 119 offers proficient, and a score within 120-150 is considered as an expert [27].
Kleib et al. (2018) aimed at assessing the Canadian nurses' informatics competency and confirmed the NICAT validity using internal consistency. They reported a Cronbach's alpha coefficient of 92% for this scale [28].
This scale was also translated and validated in Iran [29]. For cross-cultural comparison of the translation, the original NICAT was accurately translated into Persian (forward translation). The backward translation of Persian version was done by a proficient English translator. Later, agreement of the translated version with the original version was examined. In order to check the face validity of NICAT, a number of nurses' perception about the items was investigated. Content validity of the Persian version of NICAT was confirmed by two medical informatics specialists and eight faculty members of nursing. Furthermore, 30 nurses participated in the pilot-test of the questionnaire and the Cronbach’s alpha coefficient was used to assess its reliability (α= 0.95).
Outcome measurement
The NICAT was used to evaluate effects of the educational program on the IT competency. The aim was to assess the effect of an educational course on the critical care nurses' IT competency. The self-reported questionnaires were distributed among nurses of the intervention and control groups in the pretest stage (before workshop) and in the posttest stage (one month after the workshop). It should be noted that all participants completed questionnaires simultaneously and attended the routine or traditional programs in hospitals, except that the intervention group was provided with additional material derived from workshop and the control group attended no educational program during this period. In other words, the two study groups had equivalent conditions for work duties and performance. However, in order to increase internal validity of the study, researchers monitored the study conditions thoroughly to ensure that the intervention and control groups were identical in all aspects, except attending the educational program.
Intervention procedure
The workshop was conducted in three eight-hour sessions in three weeks. The intervention group was divided into two groups to increase the members' participation opportunity in the workshop. The educational course was held by one Ph.D. nurse and three experts in medical informatics using lectures, questions and answers, slide presentations, hands-on exercises and online exercises, home work, and educational CDs. Table 1 shows the content presented in this workshop.
Table 1.Topics presented in the workshop
Application of computer tools, hardware, and software such as word processor and Power Point presentation were taught. A variety of information sources including hard copies, electronic files, as well as medical and nursing databases such as CINAL, PubMed, and SID were introduced.
|
Session 1
|
Initially, the educational contents of the previous session were reviewed. Search strategies in databases such as PubMed and Scopus were taught. Later, a variety of electronic search capabilities were explained, such as the ways to subscribe and receive free articles, do simple and advanced search, and conduct limited search (based on the publication year, full text, keywords, Mesh, AND, OR, NOT). The participants practiced what they leaned simultaneously. In this regard, a title "Intubate Patient Care" was introduced. Participants were asked to search the related articles in PubMed database with related keywords and to provide search results. Finally, participants' questions were answered and they were asked to find results of the related articles based on several keywords and to present them in the third session.
|
Session 2
|
This session included application of various technologies such as the Health Information System (HIS) and its various capabilities such as documenting care plan in the medical record, collecting and maintaining patient care data like laboratory data, updating the picture archiving and communication system, and applying the HIS system for patient admission and discharge. Furthermore, participants practiced the contents of prior sessions by retrieving scientific evidences. Finally, nurses were asked to email their articles to the professors.
|
Session3
|
Statistical analysis
The data were analyzed in SPSS 21 using descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (independent samples t-test, paired t-test, chi square, and Fisher's exact test). The Kolmogorov-Smirnov test showed that the data followed a normal distribution. The significance level was considered ≤0.05.