ASSESSMENT OF SOCIAL INFLUENCE AND FACILITATING CONDITIONS THAT SUPPORT NURSES ADOPTION OF HOSPITAL ELECTRONIC INFORMATION MANAGEMENT SYSTEM

1.1 Introduction

Hospital Electronic Patient Information Management is an information system that is used to record relevant information relating to the patients. The prescribe drugs, bought drugs, sold drugs and available drugs are processed by the program. It is quite hard job for medical personnel to monitor each patient for 24 hours. Cost reduction pressures and the need for shortened in-patient stays are promoting the use of wireless patient monitoring systems in hospitals (Edan, 2009). The choice of health facility varies from one person to another and from one place to another, and it also depends on certain predisposing factors to the use of health facilities (Oluyemi et al., 2018). Actual utilization of health services will differ in accordance with various factors (MACPAC, 2016; NCHS, 2016).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

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1.2 Background of Study

Exploring the nurses’ perspectives of patient management is imperative since nurses are the most appropriate persons to bring about effective changes within the health systems (Farquhar et al., 2010; Hall et al., 2008). To explore the concept of patient management it is necessary to figure out the salient factors confronted by nurses in their daily nursing duties. Buerhaus, Donelan, Ulrich, Norman, Williams and Dittus (2005) and Teng, Hsiao and Chou (2010) conducted a survey to explore registered nurses and chief nursing officers’ perceptions and found that lack of time was the main reason for failing to maintain quality of care. Additionally, short staffing, time demands and a stressful work environment were reported by hospital nurses in Belgium and Taiwan as obstacles to providing good nursing care to patients (Ma, Lee, Yang and Chang, 2009; Milisen, Abraham, Siebens, Darras and Dierckx de Casterle, 2006).

Stichler and Weiss (2001: 60) argued that Nurses perceptions of patient management are based on nurse-patient relationship, collaborative teamwork, and a work environment with resources and support for nurses in their patient care role”. In a qualitative study conducted by the Ipsos MORI Social Research Institute (2010), findings showed that nurses believe that patient management means looking after the patients, and making sure that they are comfortable and happy in their environment.

Even although nurses are capable of bringing about change that will enhance quality of care in health care delivery, those changes cannot emerge from a vacuum. High quality patient care requires a professional nursing practice environment embedded with high quality leadership and management, good staffing, trustful and mutual nurse-physician relationships, reasonable workloads and favourable working conditions (Van Bogaert et al., 2009; Milisen et al., 2006). Apart from those factors aforementioned, it has been documented that access to quality care training, professional development, involving the nurses in the functioning of the institution and empowering them in decision-making are key elements to heightening quality care in health systems (Roche and Duffield, 2010; Aiken, Clarke, Sloane, Lake and Cheney, 2008; Lake and Friese, 2006; Lake, 2002).

The Nigerian health system is a pyramidal system comprising of the central, intermediate and operational levels. The central level comprises the central departments of the Ministry of Health (MoH) and the national reference or tertiary hospitals geared to provide specialized care. The intermediate level involves the administration of the Department of Health which facilitates and guides the process of the operational level by providing the administrative, logistical, technical and political supervision. The operational level comprises of district hospitals and health centres. This level provides primary and secondary care and is confronted with issues of poor quality of care, whereby a lack of suitably qualified health professionals limits its functionality (WHO Regional Office for Africa, 2009; Kayonga, 2007).

According to the Ministry of Health’s (2008) annual health report, the healthcare system of Nigeria is currently facing numerous problems, including the shortage of human resources, limited material resources, inadequate infrastructure and financial constraints. These limitations are exemplified by the fact that there is only one doctor per 18 000 people, one pharmacist for 38,000 people and one nurse per 1700 people. To grasp the severity of this staff scarcity, one can contrast this situation with that of United Kingdom (UK), where there are 123 nurses and 23 doctors per 10 000 population (Roxburgh, Taylor and Murebwayire, 2009). There are 13 doctors per 10 000 population and 28 nurses per 10 000 globally (World Health Organization, 2009). The figures quoted above pertaining to Nigeria clearly point out that nurses are the main care givers in that country. However, the high nurse patient-ratio of 1:1700 reflects a serious situation where nurses are not able to respond adequately to their daily nursing duties, thus making it difficult for them to improve the quality of care they provide to patients. This is supported by Sturgeon (2010), who states that the high number of patients, which is not commensurate with the number of nursing staff, jeopardizes the confidence of the nurses, thereby hampering their ability to provide high quality care.

The lack of human and other resources is particularly relevant to Nigeria, where nurses and other health professionals are still responding to the challenges resulting from the genocide of 1994. This is illustrated by the findings of a study conducted by Kalinganire (2010), who works for Access Project in Nigeria, a project which aims at assisting some of the health centres to run more efficiently by streamlining the health-related infrastructure. In this study, it is reported that over 300, 000 people living in sectors without a health centre travel six or more hours on foot to seek care in neighbouring sectors. This author emphasized the negative impact of inaccessibility to quality care which results in the emergence of disease as well as an increase in the maternal and child mortality rate.

It has been noted that Nurses in Nigeria do not always perform their required duties with some being inconsistent in taking the patients’ vital signs and others not recording children’s weight (Mote and Richard, 2010). Sturgeon (2010) ascribed these behaviours to be in relation to low staffing, inadequate equipment and lack of incentives to nurses. This was supported by Francis (2010:400) who also identified the “weak professional voice in management decisions” as a contributory factor to poor standards of care. Van Bogaert et al. (2009) suggest that managers create and support nurses’ work environment by allocating appropriate nurse staffing, adequate nurse hours per patient-day, adequate patient to nurse ratios and involving nurses in hospital and unit policies. These management interventions are presently not realistic in Nigeria owing to the above patient ratio context.

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Assessment of Social Influence and Facilitating Conditions that Support Nurses Adoption of Hospital Electronic Information Management System.

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1.3 Statement of Problems

Investigation revealed that the issue of poor quality of care is of significant concern in health care system delivery, particularly in the nursing practice environment (Hurst, 2011; Kendall-Raynor, 2011; Sturgeon, 2010). Even although the factors affecting quality of care have been highlighted by a wealth of literature, few formal studies have been conducted to explore nurses’ perceptions of patient management, especially in the district hospitals in Nigeria.

Few studies have been carried out in the Nigerian context; they have explored the factors affecting quality of care at tertiary level, but did not explore the perceptions of patient management from the nurses’ perspectives. Therefore, such studies are needed in district hospitals where the nursing practice environment is still challenged by poor quality services delivery and working conditions.

Although the Nigerian nursing practice environment is challenged by the shortage of nurses and limited infrastructure to provide high quality care, the contribution of nurses is invaluable. Considering the impact of poor patient management on patient outcomes, it is suggested that exploring the perceptions of patient management among nurses working in two district hospitals in Nigeria will be valuable in order to inform realistic context driven patient management strategies.

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1.4 Aim and Objectives of Study

The aim of the study is to assess the Social Influence and Facilitating Conditions that Support Nurses Adoption of Hospital Electronic Information Management System. In achieving this aim, the following specific objectives were laid out as follows:

1. To explore the nurses’ perceptions towards the adoption of hospital electronic information management system;
2. To evaluate the social influence that support Nurses adoption of hospital electronic information management system;
3. To examine the nurses’ perceptions of their role in providing continuous quality improvement; and
4. To investigate the factors hindering the adoption of hospital electronic information management system in the area under study.

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1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Are there factors hindering the adoption of hospital electronic information management system in the area under study?
• Are any there social influences that support Nurses adoption of hospital electronic information management system?
• What are the nurses’ perceptions towards the adoption of hospital electronic information management system?
• What are the nurses’ perceptions of their role in providing continuous quality improvement?

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1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There are no significant factors hindering the adoption of hospital electronic information management system in the area under study
• H1: There are significant factors hindering the adoption of hospital electronic information management system in the area under study

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1.7 Significance of Study

The results from this study could inform patient management strategies, current and future, not only in the two district hospitals, but could also be applied in other district hospitals in Nigeria as well. The hospital management may be informed of the factors affecting quality care enabling them to adopt new strategies for entrenching appropriate and adequate quality care in the nursing practice environment.

Nurses may take cognizance of their critical role in quality improvement and this might positively influence their attitudes and perceptions towards CQI of care. Likewise, patients, family members, consumers and stakeholders could benefit from this study by receiving efficient, effective, timely and cost-effective nursing care interventions that improve health care outcomes.

The MoH and other stakeholders may be able to utilize the findings from this study to inform the development of education outcomes of interventions for further education, training and professional development for nurses and make the professional nursing practice environment in Nigeria more conducive to providing patient management to Nigerian consumers.

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1.8 Scope of Study

The scope of the research is focused on the Assessment of Social Influence and Facilitating Conditions that Support Nurses Adoption of Hospital Electronic Information Management System.

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1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

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1.10 Operational Definition of Terms

Patient Management: Patient management is defined as care that is provided according to hospitals’ standards and job requirements.

Nurse: For the purpose of this study, a nurse refers to both enrolled nurses (A2) and registered nurses (RN). An enrolled nurse is a nurse that has completed basic nursing, whereas a registered nurse is a nurse who has completed her professional courses in mental health, general nursing or midwifery