ABSTRACT
Information and communication technology (ICT) is
transforming the delivery of health care at a fast rate. Nurses who form the
majority of the health workforce are strategically positioned to champion the
transition to digital health care. Ghana is fast adopting eHealth, however
there is little evidence on how well nurses are using these technologies. A
descriptive cross sectional study using a quantitative approach was conducted
aimed at identifying eHealth usage among registered nurses in Cape Coast. A multi
stage sampling technique was employed. Data collated from 206 registered nurses
in Cape Coast revealed that respondents were predominantly female (61.7%) and
38.3% were males. Knowledge, attitude, practice and resources were generally
good. Most of the nurses (65.5%) had good knowledge and more than half of them
(67.5%) generally demonstrated good attitudes towards eHealth. The majority
(54.9%) of respondents also demonstrated a good skill in the use of ICT in
health service delivery. Resources on eHealth were available to most nurses.
Most nurses were found to be using electronic platforms which represented an
opportunity for use as a channel for continuous professional development.
Monitoring and evaluation was either erratic or non-existent. The study proves
that the knowledge, attitude, practice as well as resources were good but there
is a need for improvement in certain areas. It is recommended that nurses take
advantage of electronic platforms and social networks for professional
knowledge sharing as well as support research.
CHAPTER ONE
INTRODUCTION
Information and Communication Technology (ICT) is
transforming the healthcare industry and is now an integral part of providing
healthcare (Canadian Nurses Association, 2006a). Today, health systems are more
efficient and more responsive to clients’ needs due to the incorporation of
ICT. This is evident in the reduced healthcare costs, improved delivery and
effectiveness of healthcare services and increased patient safety and decision
support for clinicians (Remlex, 2007; O’Carroll, Yasnoff, Ward, Ripp, &
Martin, 2007; Acheampong, 2012). Use of ICT in nursing practice in Ghana has
the potential to propel the migration to digital healthcare, yet there are
bottlenecks that threaten attainment of the desired status compared to the
developed world.
Background to the Study
ICT is defined as the machinery, the hardware (computers,
personal digital assistants, mobile phones and other devices) and the software
(the information systems) — that enable information to be manipulated and
transmitted from one place to another (Rumsey & Annasherlock, 2013). When
ICT is used in health and health care, it is termed eHealth. eHealth comprises
telehealth, telemedicine, health informatics, nursing informatics, telecare and
telenursing (The Royal College of Nursing, 2013; World Health Organization,
2016).
The health sector worldwide makes use of information and
communication technology (ICT) to expedite and advance most aspects of
healthcare. These include the use of electronic medical records, virtual office
visits, scheduling appointments online as well as paying for services, and getting medication prescribed electronically (Onu & Agbo,
2013). Various studies have revealed that healthcare providers largely find
eHealth advantageous for continuous professional development (Rouleau, Gagnon,
& Côté, 2015). Health providers, especially nurses, are better able to
communicate and relate with patients using eHealth thereby increasing their
access to healthcare, consolidating the relationship between the patient and
the nurse culminating in better care (Nilsson & Skar, 2010; Sandberg et
al., 2009)
Ghana is successfully running a host of eHealth projects.
They are the District Health Information Management System (DHIMS); the Mobile
Technology for Community Health (MoTeCH); the SENE Pocket Digital Assistant
(PDA) project and the National Health Insurance Authority (NHIA) mechanized
service delivery by ICT (Acheampong, 2012; International Institute for
Communication and Development, 2014).
Nurses form the greatest percentage of health care
professionals worldwide and hence play a crucial role in championing health
care reforms such as the adoption of eHealth (Institute of Medicine, 2004). In
high income countries, nurses interact most with eHealth systems due to the
demands of their work. They are indispensable when it comes to helping patients
set up their own health records, or explaining to them how they can use a
patient portal (Onu & Agbo, 2013). In order to obtain the greatest benefit
from ICT, nurses must necessarily play a leading role in its adoption. However,
various studies have proven that nurses are dissatisfied with electronic health
solutions provided for them due to lack of consultation. Other reasons are that
the computer systems were laborious to use, illogical, slow, complex and
undependable sometimes (Adams, Adams, Thorogood, & Buckingham 2007; While
& Dewsbury, 2011; Azza, 2015). A study involving 10,000 nurses in Australia on
their use of information and communications technology gives insight into the
problem nurses have when it comes to its usage. Despite the benefits they stand
to gain adopting ICT in their work, nurses expressed frustrations such as
restrictions of access to the technology, software that do not always fit job
specifications and lack of training opportunities. Consequently, the level of
use was generally low and confidence in use was low even among those nurses who
were users (Hegney et al., 2007). Nurses in Saudi Arabia currently cannot fully
employ computer technology in their daily practices, and they are limited to
only certain functions in their use of computerized systems (Azza, 2015). Other
studies in Turkey also confirm that most electronic health record
functionalities related to nursing were poorly utilized (Kaya, Asti, Kaya,
& Kacar, 2008; Top
Gider, 2013). According to Rouleau, Gagnon, and Côté (2015),
although electronic health records have been instituted in some health
facilities and are used by clinicians in the provision of healthcare services,
its evaluation by nurses who are by the patient 24 hours a day has received
minimal consideration.
Several countries in Africa are implementing eHealth projects
including Algeria, Benin, Burkina Faso, Burundi, Cameroon, Chad, Republic of
Congo,
Cote d’Ivoire, Ethiopia, Ghana, Kenya, Madagascar, Mali,
Mauritania, Niger, Rwanda, Senegal and South Africa. These technologies can
improve efficiency in time and resource utilization and also facilitate complex
decision making. Diagnosis and treatment of patients can also be enhanced using
these systems. However, these projects in the region continue to be on small
scale and fragmented (Asamoah-Odei et al., 2012;World Health Organization,
2013).
Despite its relevance, Sarfo and Asiedu (2013), reported a
decline in the integration of computers into nursing in many low-income
countries.
The Ghanaian health sector appears to have joined the ICT
revolution. This is evident through the incorporation and use of computers in
health service delivery, management and administration. However, the Ministry
of Health in Ghana intimates that the modest response has not been well
structured (Ministry of Health, 2005). The government of Ghana developed a
policy document on ICT for accelerated development in 2003, an eHealth policy
in 2005 and the national eHealth strategy document in 2010 (Government of Ghana,
2003; Ministry of Health ICT Policy, 2005; Ministry of Health, 2010), all in
the bid to improve the ICT infrastructure in the health sector and facilitate
the adoption of eHealth solutions. Currently, the Ministry of Health has
started equipping facilities with eHealth infrastructure starting from the
Central Region of Ghana.
Statement of the Problem
The Ministry of Health in Ghana adopted the Government of
Ghana’s ICT policy document in 2005 and the National eHealth Strategy in 2010.
The objectives of this strategy were to; improve ICT infrastructure in the
health sector; improve access to and management of health information; improve
access to quality health using telemedicine; and improving ICT knowledge,
capability and utilization among health workers. Ghana is growing significantly
with the development of eHealth in its national health care delivery (Ministry
of Health, 2005, 2010; Sarfo & Asiedu, 2013). Many eHealth initiatives have
sprung up including the DHIMS and MoTeCH and NHIA initiatives. Despite the
remarkable growth in the incorporation of ICTs in healthcare delivery, the projects do not usually survive beyond the pilot phase
(Adjorlolo & Ellingsen, 2013). One dimension of the upsurge of ICT use in
Ghana that is conspicuously missing is the nursing contribution to these
efforts. Nurses, who are major stakeholders in health care delivery claim they
are ill informed about information technology health initiatives and are most
of the time not consulted when implementing these initiatives (Hegney et al.,
2007). This phenomenon is not limited to Ghana or Africa. Top and Gider (2013)
and Kaya et al. (2008), affirm that, although electronic health records are
used in many hospitals in the world and clinicians have reported numerous
benefits from their effective and efficient use, its evaluation by nurses has
received minimal attention. Again, little evidence exists regarding the nursing
contribution within telehealth, especially beyond data input and output
analysis for other members of the health team (While & Dewsbury, 2011).
Since nurses form the largest segment of the health work
force, learning from their experiences and perspectives on eHealth would be
highly relevant for Ghana as we migrate from mechanical to digital health care.
However, various studies have revealed that nurses are the last set of health
care workers to adopt the eHealth revolution for reasons of lack of
consultation prior to implementation (Adams, Adams, Thorogood, & Buckingham,
2007; Azza, 2015). This might have been the reason why the use of eHealth was
found to be lower among nurses than general practitioners in the United Kingdom
(Richards et al., 2005). Some studies have attempted to find out the reasons
influencing this phenomenon (While & Dewsbury, 2011; Afarikumah, 2014).
However, these studies do not capture the Ghanaian nursing context. In Ghana,
there is paucity of literature capturing factors and attitudes of nurses
towards ICT use in health (Afarikumah, 2014). Studies so far reviewed in Ghana
do not isolate the nursing experience and hence do not explore the attitudes,
level of knowledge, practice, facilitators and barriers to nurses’ adoption of
ICT in health.
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