USE OF E-HEALTH IN NURSING PRACTICE AMONG NURSES IN CAPE COAST

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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Item Type: Ghanaian Project Material  |  Attribute: 116 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH50  |  Delivery: Within 30Mins.
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