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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 14  |  Issue : 2  |  Page : 59-69

Innovation behavior levels and its relation with TIGER-based nursing informatics competencies among critical care nurses


Nursing Administration Department, Faculty of Nursing, Cairo University, Cairo, Egypt

Date of Submission07-Mar-2017
Date of Acceptance30-May-2017
Date of Web Publication12-Jan-2018

Correspondence Address:
Magda Abd El Hamed Abd El Fattah
PhD in Nursing Administration, Faculty of Nursing, Cairo University, Cairo, 51162
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_13_17

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  Abstract 

Background Currently, worldwide nursing experts have been inspiring nurses to pursue innovation in nursing in order to improve nursing outcomes. As a consequence, practicing nurses ought to have the capability to be receptive to the innovation in their practice environment; therefore, a new specialty called ‘nursing informatics’ (NI) has emerged to keep pace with these emerging innovations.
Aim The aim of this study was to measure the relationship between innovation behavior levels and TIGER-based NI competencies among critical care nurses.
Participants and methods A descriptive correlational design was used in carrying out this study. This study was conducted in a Critical Care Unit at an International Private Hospital in Egypt. The convenience sampling method was used to select 30 participants who met the inclusion criteria to join the study. Data were collected using a three-section questionnaire as follows: (i) demographic data sheet; (ii) Innovation Behavior Questionnaire; and (iii) Nursing Informatics Competency Assessment Tool.
Results More than half of the participants had a moderate level of innovation behavior. Moreover, more than one-third of the studied sample rated themselves as competent in NI. In addition, a significant positive relationship was found between innovation behavior and overall NI competency levels as perceived by the participants.
Conclusion This study contributes to the identification of informatics competency levels that are pertinent to the role of critical care nurses. Moreover, this study signifies that the innovative behavior of critical care nurses would help in generating proactive approach concerning developing a NI competency level in the future.
Recommendation Future studies should relate the demonstrated and perceived NI competency levels in critical care units and other work settings. Moreover, integration of the NI and nursing innovation courses as one of the core courses, and not as an elective, in the nursing curriculum is recommended.

Keywords: competencies, critical care nurses, innovation behavior, nursing informatics


How to cite this article:
Abd El Fattah MA. Innovation behavior levels and its relation with TIGER-based nursing informatics competencies among critical care nurses. Egypt Nurs J 2017;14:59-69

How to cite this URL:
Abd El Fattah MA. Innovation behavior levels and its relation with TIGER-based nursing informatics competencies among critical care nurses. Egypt Nurs J [serial online] 2017 [cited 2018 Jul 23];14:59-69. Available from: http://www.enj.eg.net/text.asp?2017/14/2/59/223090


  Introduction Top


Currently, worldwide nursing experts have been inspiring nurses to pursue innovation in nursing to improve nursing outcomes. Innovation in nursing is about encouraging nurses to utilize their knowledge and abilities to change the old methods of thinking and practicing and to develop new approaches for working that actually enhance nursing practice (Weng et al., 2015). Nursing innovation was defined as the process through which nurses create, set up, assess, and acknowledge innovative new techniques, procedures, or ventures in their hospitals and then modify them into innovative products or services that clients can acknowledge (Weng et al., 2016).

Innovation is likewise fundamental to additionally build up the nursing profession and to guarantee that nurses are prepared to confront the difficulties ahead, and thus remain side by side with innovation. Along these lines, the nurse needs to endeavor to become an expert on his/her selected field, understanding that learning and innovation go as an inseparable unit (Brysiewicz et al., 2015). Innovation is driving the way nurses practice and how they manage care delivery (Omachonu and Einspruch, 2010).

Innovative nurses can be of value to the nursing profession and healthcare by helping in solving some of the critical issues (Le et al., 2015). Because of the fast-paced changes in healthcare, and the challenges and opportunities that face professional nurses, innovative behavior is necessary for the evolution of nursing practice and organizational success (Lachman et al., 2009). To participate in innovative behavior, nurses need management support, resources, a supportive work environment, and knowledge about innovation and nurses’ role. Nursing leadership is vital for establishing and sustaining the structure and circumstances to support the level of intensity, and hence it is necessary for the innovation process (Gratton and Erickson, 2007).

Innovation is also vital to ensure that nurses are equipped to face the challenges ahead, stay abreast with technology. There are a number of examples of innovative products and procedures that have been developed or promoted by nurses, ranging from simple to technologically complex (Mukamana et al., 2016). Healthcare is to some extent new to the science of innovation (Blakeney et al., 2009).

A noteworthy theme of this new healthcare environment is the utilization of technologies to enhance the quality and safety of patient care [Technology Informatics Guiding Education Reform (TIGER), 2009). Nurses have been working in the field of informatics for nearly four decades, as a result of the emergence of numerous new technologies, which has become existent within nursing care, and is not restricted to barcode scanners, computerized provider order entry systems, and the electronic patient records (de Veer et al., 2011; Greer, 2012).

In addition, the emergence of information and communications technology and Electronic Medical Records (EMRs). EMR is used for information transmission, data storage, and, significantly, medical error reduction. In general, an EMR helps improve data integrity, increase productivity, reduce healthcare costs, improve quality of care, and increase caregiver satisfaction (Hebda and Czar, 2009). As the utilization of EMRs at the point of care increases, the demand for healthcare professionals armed with the essential capabilities for applying and managing information also increases (Jeon et al., 2016). These advances in computer information technology require that 21st century nurses acquire and maintain computer competency (Ornes and Gassert, 2007).

In order for practicing nurses to have the capability to be interested in the innovation in their practice environment, a new specialty called ‘nursing informatics’ (NI) has emerged that incorporates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice (McGonigle and Mastrian, 2008). The profession of nursing was among the first health disciplines to embrace informatics through the recognition of NI as a specialty practice area (Bickford, 2015).

However, few researchers have investigated informatics competencies for practicing nurses. Informatics can assist the profession to play a key role in the design, implementation, uptake, and use of next-generation healthcare models. Nurse leaders must recognize and develop essential informatics skills to remain relevant and effective in current and future healthcare transformation (Hussey and Kennedy, 2016). Thus, nursing forces should be equipped with the essential computer and informatics skills to perform their duties safely and effectively (Boykins, 2014).

At least 14 definitions of NI have emerged in the subsequent decades. Most definitions agree that health informatics activities converge between computer science, information science, and health science (Kennedy and Hussey, 2014). Likewise, the term ‘nursing informatics’ has been viewed as a specialization in nursing resources since 1984 (Guenther, 2006). As recognized by the TIGER Initiative, all nurses in every role must be prepared to make health information technology (HIT) the stethoscope for the 21st century (Westra and Delaney, 2008). All the more, as of late, the NI competencies mean that nurses have adequate computer literacy (CL) and information management skills (McGonigle and Mastrian, 2012).

However, Gugerty et al. (2012) defined competence in NI as the knowledge, conduct, and aptitudes required for nurses to gather, store, retrieve, and process and use information. NI involves cognitive science, which focuses on the design of technologies besides the way nurses use technologies (McGonigle and Mastrian, 2012). In 2009, the TIGER Initiative put forth proposals for informatics competency for bedside nurses. The proposals pivot around three foundational themes: basic computer competencies, information literacy (IL), and information management (Hunter et al., 2013a, 2013b).

Concerning the term ‘Computer Literacy’, it is defined as the ability to perform different undertakings with the utilization of a computer (Thede and Sewell, 2010). As regards IL, it is an informatics aptitude that signifies the ability of a person to recognize when information is needed, determine the amount of information needed, and be able to retrieve information efficiently, evaluate its sources, classify, and store. From these activities the user can extrapolate from the data, redraft, and generate new data into the selected electronic health information system (HIS) by applying a set of transferable skills and behaviors (Craig, 2009).

Information management is essential to protect patient security. It includes the following: the ability to use information for decision making; collecting, processing, and presenting data; applying data for decision support; and protecting data and ensuring data integrity (The TIGER Initiative, 2006; Choi and de Martinis, 2013; Sun and Falan, 2013). Continuously, however, NI has gone beyond merely incorporating evidence into practice to empowering the extraction of meaningful data from practice to inform clinical and administrative decisions from bedside to boardroom across the continuum of care. The emerging trends integrating NI competencies and the progress of new corporate NI roles are joining to propel nurses toward health system transformation (Remus and Kennedy, 2012).

In inference, NI competencies improve the capability to troubleshoot device problems, to report issues to the appropriate technical support services, and to communicate follow-ups on devices in need of repair to nursing colleagues. The fulfillment of NI competencies depends on core factors: what an individual knows about informatics, the individual’s attitude toward technology in general, and their concern and enthusiasm to use electronic nursing data and to communicate using technologies (Dionne, 2014).

Significance of the study

The adoption of contemporary innovation necessitates the nursing staff to have innovation conduct to create more proficient work processes and have better productivity and performance (Blakeney et al., 2009). The issue of incorporating HIT into healthcare is complicated by an aging nursing workforce. As indicated by a recent report by the National Center for Health Workforce Analysis (2013), 61.7% of nurses were older than 40 years; these nurses did not grow up with technology, and are therefore considered as beginners in technology and termed digital immigrants (Ball et al., 2011).

In addition, Weng et al. (2012a) declared that nurses are responsible for 80% of healthcare innovations. In the most recent decade, there has been an escalation in electronic health records (EHRs) applied throughout hospitals and ambulatory clinical settings. More than 80% of hospitals and half of the healthcare providers had applied EHRs before the end of 2013. Most of the nurses have become adept at using the EHR and have incorporated the management of patient information within the EHR into their practice (Mitchell, 2015). Consequently, innovation behavior is considered as a future indicator of the informatics specialist and innovator in NI. Currently, nurses at the bedside are challenged by lack of training, skills, competencies related to NI, which recognized as a critical issue influencing safe patient care, the nurse’s comfort with the utilization of a clinical documentation system, and patient outcomes (Ball et al., 2011).

Along these lines, assessment of bedside NI is essential keeping in mind the ultimate objective to provide a training that is customized to nurses (Rahman, 2015). Furthermore, knowing the degree of ICs among practicing nurses might afford the foundation for emerging job-specific standardized ICs in practicing nurses along with the applicable assessment tools. In addition, knowing ICs for practicing nurses might form the foundation for developing appropriate strategies to support nurses in their informatics practice in clinical settings (Hart, 2008).

Consequently, development of NI competencies supports interdisciplinary teamwork, provides evidence to support quality improvement and ensures the incorporation of evidence into practice (Dreher and Fitzgerald Miller, 2006). For that reason, a worth mentioning inspiration behind this study was to shed the light on critical care nurses’ NI competency levels with respect to their innovation conduct.

Aim

The aim of this study was to measure the relationship between innovation behavior levels and TIGER-based NI competencies among critical care nurses

Research question

What is the relationship between innovation behavior levels and TIGER-based NI competencies among critical care nurses?


  Patients and methods Top


Research design

A descriptive, correlational design was used in carrying out this study.

Study setting

This study was conducted in a Critical Care Unit at an International Private Hospital in Egypt with a capacity of 300 beds. This hospital adopts health information system.

Sample

The convenience sampling method was used to select 30 participants who met the inclusion criteria to be incorporated in the current study. The participant selection criteria were as follows: holding a bachelor degree in nursing science, both sex, working as a full time, having a role and responsibility concerned with direct patient care, at least 1 year experience in the nursing profession and in the current place, and at least 6 months of working experience on EMR system.

Data collection tool

The structured questionnaire consists of three sections, which were used to collect data pertinent to study
  1. First section: Demographic data sheet: it contains questions concerning participants’ nursing education and experience.
  2. Second section: Innovation Behavior Questionnaire: it contains 12 items and was developed by Amo (2005) and Janssen (2005). It was a five-item instrument, which used a five-point Likert scale with 1=never to 5=always. As for the categorization innovation levels, the maximum score on the scale is 60, with a minimum of 5. Categorization of innovation levels were as follows: low level of innovation behavior, up to 50%; moderate level of innovation behavior, 51–75%; and high level of innovation behavior, 76% or more.
  3. Third section: Nursing Informatics Competency Assessment Tool: it was developed by Rahman (2015) to measure the perceived NI competency levels based on Patricia Benner’s Dreyfus Model of Skill Acquisition (Benner, 1984) at the beginner and experienced levels in NI. Specialist and informatics innovator levels were not included in this tool as the intent of this tool was to assess the NI competency of nurses that are related to patient care at the bedside.


As for the scoring system, the total number of questions was 30, with 10 questions in the category of CL, 13 questions in informatics literacy, and seven questions in informatics management skills. Each item was rated on a five-point Likert scale (1=not competent to 5=expert). As for the categorization of NI competency level, the maximum score on the scale is 150, with a minimum of 30. The overall percentile score for the items under the total category was as follows: up to 20% as a novice, 21–39% as an advanced beginner, 40–59% as competent, 60–79% as proficient, and 80% or more as expert in overall NI competency. As for the categorization of CL competency level, the maximum score on the scale is 50, with a minimum of 10. The overall percentile score for the items under the total categories were as follows: up to 20% as a novice, 21–39% as an advanced beginner, 40–59% as competent, 60–79% as proficient, and 80% or more as expert in CL competency. As for the categorization of informatics literacy competency level, the maximum score on the scale is 65, with a minimum of 13. The overall percentile score for the items under the total category was as follows: up to 20% as a novice, 21–39% as an advanced beginner, 40–59% as competent, 60–79% as proficient, and 80% or more as expert in informatics literacy competency. As for the categorization of informatics management competency level, the maximum score on the scale is 35, with a minimum of 7. The overall percentile score for the items under the total category was as follows: up to 20% as a novice, 21–39% as an advanced beginner, 40–59% as competent, and 60–79% as proficient, and 80% or more as expert in informatics management competency.

Tool validity

In order to determine content validity, three information technology experts tested the readability of the questionnaire, accuracy, question sequence comprehensiveness of the questions, and relevance of the items in the scales.

pilot study

Upon completing the tool validity, the pilot study was carried out on a convenience sample of three nurses, which constitutes 10% of the total participants, to clarify any ambiguity in the items and to ensure applicability. It also served in estimating the needed time for filling the two tools. No modification was made. Those nurses were included in the study.

Reliability analysis

Upon completing the pilot test, the reliability analysis was performed. The analysis yielded an average Cronbach’s α of 0.824% for each dimension and 0.846 for all items, indicating sufficient internal consistency.

Ethical consideration

To carry out the study, the necessary official approval was obtained from director of the hospital. At the interview with the study participants, oral informed consent was secured from each participant for participation. The participants were informed about the purpose and benefits of the study, and they were informed that their participation is voluntary and assured about complete confidentiality of the obtained data and that the study would not affect the work in any way.

Study procedure

Before conducting the current study, the official permission to conduct the study was obtained from the hospital administrative authority after explanation of the aim of the study. The researcher had gotten a list of all staff nurses numbers from the nursing director, and then the researcher approached the first-line nurse manager to explain the aim of the study and to obtain the permission to approach the study participants. After that, from among all study participants who fulfilled the inclusion criteria, three of them were invited to participate in the pilot study. Thereafter, upon completing the pilot test, the reliability analysis was performed before the collection of final data. After that, upon completing the reliability analysis, the questionnaire was distributed by the researcher to the eligible participants. It was important to the researcher that the nurses did not feel obliged or coerced to participate. Data were collected in January 2016 for 2 weeks.

Statistical analysis

Data entry and analysis were performed using computer software statistical package for the social sciences (SPSS, version 22.0; SPSS Inc., Chicago, Illinois, USA). Data were presented using descriptive statistics in the form of frequencies, percentage, mean and SD, and χ2. For all statistical tests performed, the threshold of significance was fixed at the 5% level (significance of P-value at ≤0.05).


  Results Top


As for the characteristics of the sample under study, the results revealed that 30 participants participated in the study. In terms of the participants’ sex, 56.7% were female and the rest were male. As for nursing education, all of study participants (100%) were holding a bachelor of nursing degree. The studied sample had more than 1 to 5 years of experience in the nursing profession and in the current hospital. In relation to the training program in computers, 40% of them had undergone formal fellowship training in computers, followed by 36.7% who reported that they had gotten self-guided learning about computers. As regards years of experience with EMR, 43.3% had 13–18 months of experience followed by 33.3% with more than 12 months of experience. As for the training adequacy to use the EMR system, 36.7% of the studied sample reported that they were fully prepared to use the EMR system followed by 26.7%, who reported that they were not at all prepared, and, the lowest percentage (13.3%) reported that they were mostly prepared.

[Figure 1] displays innovation behavior levels as perceived by critical care staff nurses, wherein the results revealed that 60% of critical care nurses had scored a moderate percentage score as regards the perceived innovation behavior level, followed by 33.3% of critical care nurses who had scored a low percentage score as regards innovation behavior level. However, less percentage of the studied sample (6.7%) had scored a high percentage on the innovation behavior level.
Figure 1 Innovation behavior levels as perceived by participants (N=30)

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[Figure 2] presents innovation behavior levels of the studied sample classified by sex. The results revealed a nonsignificant difference between the studied sample innovation behavior levels classified by sex (χ2=1.90, significance=0.387), where 69.2% male participants rated themselves as moderate innovator, 11.8% of female nurses rated themselves as high innovator, and none (0.00%) of the male nurses rated themselves as high innovators.
Figure 2 Innovation behavior levels of the studied sample classified by sex (N=30)

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[Figure 3] shows the NI competency levels of the studied sample. The results revealed that 33.3% of the studied sample rated themselves as competent, followed by 23.3% of the studied sample who rated themselves as an advanced beginner, whereas a lower percentage of the studied sample (10%) rated themselves as expert.
Figure 3 Nursing informatics competency levels of the studied sample (N=30)

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As for CL competency levels, 40% of the studied sample rated themselves as competent in the computer skills, followed by 30% of the studied sample who rated themselves as an advanced beginner, and a lower percentage of the studied sample (10%) rated themselves as proficient in computer skills. As for informatics literacy, 33.3% rated themselves as an advanced beginner followed by 20% of participants in the studied sample who assessed themselves as advanced beginner, and a lower percentage of the studied sample (10%) who rated themselves as proficient. As for the information management competency, 30% considered themselves as competent, followed by 23.3% of the studied sample who rated themselves as advanced beginner, whereas less percentage of the studied sample (13.3%) rated themselves as proficient and another 13.3% rated themselves as expert.

[Figure 4] presents NI competency levels of the studied sample classified by sex. As regards the results shown as for the male participants, 46.2% of male participants rated themselves as experts, followed by 30.8% of male participants who ranked themselves as proficient, whereas a lower percentage of the studied sample (23.1%) rated themselves as expert in NI and none (0.00%) of them rated themselves as novice and advanced beginner in NI.
Figure 4 Nursing informatics competency levels of the studied sample classified by sex (N=30)

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As for NI competency levels of female critical care staff nurses, 41.2% of participants in the studied sample rated themselves as an advanced beginner in NI, followed by 35.3% of female critical care nurses who rated themselves as novice in NI, and none of them considered themselves as proficient and expert in NI. In addition, there was a statistically significant difference between male and female critical care nurses in relation to the perceived NI competency levels (χ2=20.22, significance=0.000).

[Figure 5] clarifies the relation between NI competency levels of the participants and their years of experience with EMR. The results revealed that 42.9% of participants in the studied sample who had 19–24 months of experience with EMR rated themselves as proficient in NI followed by 28.6% who considered themselves as an expert in NI; 14.3% of participants in the studied sample rated themselves as competent, and 38.5% of participants in the studied sample who had 13–18 months of experience with EMR considered themselves as competent, whereas the least percentage considered them self as an expert. As for participants with more than 12 months experience with EMR, 40% of the studied sample considered themselves as competent and none of the studied sample considered themselves as proficient and expert.
Figure 5 Relation between nursing informatics competency levels of the participants and their years of experience with electronic medical record (N=30)

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[Figure 6] clearly shows the relation between NI competency level as perceived by critical care nurses and their training adequacy to use the EMR system. The results revealed that there was a statistically significant difference between NI competency level as perceived by critical care nurses and their training adequacy to use the EMR system (χ2=28.63, significance=0.004). As for the fully prepared studied sample for using EMR system, 45.5% of them rated themselves as competent in NI, followed by 27.3% of studied sample perceived themselves as proficient, whereas a lower less percentage of the studied sample (9.1%) perceived themselves as an advanced beginner in NI.
Figure 6 Relation between nursing informatics competency level as perceived by participants and their training adequacy to use the electronic medical record system (N=30)

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As for somewhat prepared studied sample for using EMR system, 42.9% considered themselves as an advanced beginner in NI, whereas none (0.00%) of them considered themselves as novice or expert in NI competency.

As for mostly prepared studied sample for using EMR system, 50% considered themselves as competent, whereas none (0.00%) of them considered themselves as proficient or novice in NI competency. As for the not at all prepared studied sample for using EMR system, 75% considered themselves as novice in NI competency, whereas none (0.00%) of them considered themselves as competent, proficient, or expert.

[Figure 7] presents the relationship between innovation behavior and NI competency levels as perceived by participants. The results revealed that, as for low innovation behavior as perceived by the studied sample, 40% of participants in the studied sample who perceived themselves as low innovator rated themselves as novice in NI. As for moderate innovation behavior as perceived by the studied sample, 55.6% of studied sample who perceived themselves as moderate innovator rated themselves as competent in NI. As for high innovation behavior as perceived by the studied sample, 100% of participants in studied sample who perceived themselves as high innovator rated themselves as novice in NI. In addition, there was significant difference between innovation behavior and NI competency levels as perceived by participants (χ2=21.556, significance=0.006).
Figure 7 Relationship between innovation behavior and nursing informatics competency levels as perceived by participants (N=30)

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  Discussion Top


As the single largest professional group of healthcare, nurses are recognized as being principal to health service delivery at both the managerial and clinical level. Thus, nurses have played a central role in change and transformation of care delivery over numerous years (Hussey and Kennedy, 2016) and they well positioned to contribute to innovation in practice (Hughes, 2006). With respect to healthcare organization reform, healthcare organizations have witnessed an increasing number of evidence-based innovations. Therefore, NI are progressively viewed as a key empowering influence in both change and transition processes and can perceive as a core skill for future health service delivery (Hussey and Kennedy, 2016). Thus, the study sought to measure the relationship between innovation behavior levels and TIGER-based NI competencies among critical care nurses.

The development of innovative behavior is particularly important to the hospital management and human resource management practice, because it contributes to improving employee behavior to maximize organizational efficiency and effectiveness (Xerri, 2013). Coakes and Smith (2007) argue that innovative behavior can be a risky practice for organizations and employees alike. Therefore, it is imperative that organizations seeking to improve innovative behavior establish effective processes that demonstrate support for the employee and their well-being.

To categorize innovation behavior levels as perceived by the study participants, the results revealed that more than half percentage of participants had scored moderate percentage as regards the perceived innovation behavior. This moderate level of innovative behavior could be attributed to the fact that the concept of innovation behavior is relatively new. Innovation behavior is quite a novel and unfamiliar concept. The moderate level of innovation behavior, which found in this study, was in contradiction with Le et al. (2015), who found that the vast majority of participants had a low level of innovation behavior (96.88%). Moreover, the finding of the current study was in a contradiction with Tung et al. (2014), who indicated that most of the respondents (74.48%) had not been taught about innovation and innovative behavior. Thus, they might not realize what nursing innovation behavior is and why it is important.

To classify sex differences with respect to the studied sample innovative behavior levels, the results revealed that a nonsignificant difference between the studied sample innovation behavior levels as classified by sex, wherein more than half of the male participants rated themselves as moderate innovator. Meanwhile, less than a quarter of female nurses’ participants appraised themselves as high innovator and none of male nurses viewed themselves as high innovators. However, the findings of the current study do not support the previous research of Arif et al. (2012), who found a significant difference across sex as female study participants reflected the more innovative work behavior as compared with male study participants.

In the milieu of modern advancement, innovative technologies are introduced at a rapid pace; thus, it is necessary to keep workforces up-to-date with the constant changes. Fresh graduates hired directly from the university campus, productively presented new ideas and describe them into new schemas to meet the needs of the emerging techniques and mechanisms (Passarelli, 2011). Meanwhile, experienced employees are prone to work on the basis of their experience and previous perceptions (Gilley et al., 2008).

NI incorporates information technologies with the skills of nurses in healthcare. It consists of using computer and information technologies, users, and information used during practice (Sun and Falan, 2013). NIC is crucial for providing patient-centered care in healthcare, an industry that uses different technology to support clinical activities − for example, EHRs. Supporting the nursing workforce in NI practices at the unit level is vital for patient care, safe nursing practices, nurse retention, and improved nursing confidence in HIT (Rahman, 2015).

Concerning, NI competency levels of the studied sample, the results revealed that more than one-third of the studied sample percentage rated themselves as competent in NI. However, the less percentage of the studied sample rated themselves as expert. A possible explanation for this as documented in the literature that the newest alumni of the baccalaureate (BSN) nursing programs enter the profession of nursing with some basis in NI. Nevertheless, some nurses are not formally educated in NI or may lack adequate competence in NI, impeding the ability to provide safe and effective patient care (Greer, 2012). This study produced results, which corroborate the findings of Vasuki (2016), which displayed that the studied sample rated their informatics competencies as competent but not proficient in three areas, basic computer skills, informatics knowledge, and informatics skills but not proficient. Moreover, this finding is in agreement with the findings of Hwang and Park (2011), which revealed that nurses perceived their competencies as low; however, the study did not indicate how these results impacted the organization.

CL describes the level of expertise and familiarity an individual has with computers. The term generally refers to the ability to use applications rather than a program. Although, nurses do not need a high degree of computer expertise, effective skills will save time, reduce human error, and nurses may also be able to provide more appropriate and efficient care to their patients (Ghazi et al., 2011). In addition, basic computer skills are essential to communication and documentation (Choi and de Martinis, 2013; Sun and Falan, 2013).

As for CL competency levels, nearly half of the studied sample percentage, rated themselves as competent in the computer skills. However, the less percentage of the studied sample rated themselves as proficient in the computer skills. This study produced results, which corroborate the findings of Gürdaş Topkaya and Kaya (2015), who found that the studied sample had CL was good. By reference to the 1990s, a study was conducted to assess CL, which found that the studied sample had ‘some’ experience in using microcomputers, personal computers, and WordPerfect as well as some keyboard skills (Gassert and McDowell, 1995).

As noted in the literature review, IL skills are essential for the following: in ensuring the patient is given accurate, timely, and relevant information; the ability to decipher relevant and irrelevant information using critical thinking skills; and retrieving, evaluating and using information (The TIGER Initiative, 2006; Choi and De Martinis, 2013; Sun and Falan, 2013). Informatics literacy skills are a nurse’s ability to recognize the need for information to retrieve, evaluate, and use this information appropriately for patient care (Schleyer et al., 2011). As for informatics literacy, more than third of the studied sample percentage rated themselves as an advanced beginner. However, the less percentage of the studied sample rated themselves as proficient. This finding is in agreement with Vasuki (2016) findings, which indicates that participants had a deficit in informatics literacy skills.

Concerning, information management competency, a third percentage of the studied sample rated themselves as competent. However, the less percentage of the studied sample rated themselves as expert. As noted in the literature review, information management is essential to protect patient security, collecting, processing, and presenting data, applying data for decision support, protecting data, and ensuring data integrity (The TIGER Initiative, 2006; Choi and de Martinis, 2013; Sun and Falan, 2013).

As for NI competency levels of the studied sample classified by sex, the results revealed that there was a statistically significant difference between male and female participants in relation to the perceived NI competency levels, wherein nearly half of the male participants rated themselves as expert. Meanwhile, nearly half of the female participants rated themselves as an advanced beginner in NI. These results are consistent with those of Jetté et al. (2010), who reported that there was no sex-biased differences as regards NI resources; they reported lack of knowledge about using spreadsheet programs, presentation software, and courseware, about data security, and about how to analyze the quality of a health-related website and search electronic scientific databases. However, some other studies have claimed that sex might have an influence, as men are more interested in informatics and more confident (Maag, 2006).

As for relation between NI competency levels of the participants and their years of experience with EMR, the results revealed that less than half of the participants in studied sample who had less than 19 to 24 months experience with EMR rated themselves as proficient in NI, more than one-third of the studied sample who had 13–18 months considered themselves as competent, and less than half percentage of the studied sample who had more than 12 months of experience considered themselves as competent. These findings of the current study are consistent with those of Miller et al. (2014), who found a greater percentage of new/novice nurses (∼27%) reported their workplace had been using EHRs for less than 1 year. More than 50% of new/novice nurses and nurse managers reported their workplace had been using EHRs for more than 2 years.

Despite major technical challenges, the EMR system has been met with such enthusiasm that the studied sample is presently being trained on how to use an EMR in their medical practices (Quiles et al., 2008).

As for the relation between NI competency level and participants training adequacy to use the EMR system, the results revealed the following: as for the studied sample that was fully prepared for using EMR system, nearly half percentage of them rated themselves as competent in NI; as for the ‘somewhat prepared’ studied sample for using EMR system, less than half of the studied sample considered themselves as an advanced beginner in NI. As for the ‘mostly prepared’ studied sample for using EMR system, half percentage of the studied sample considered themselves as competent; and as for the not at all prepared’ studied sample for using EMR system, three-quarters of the studied sample considered themselves as novice in NI competency. Because insufficient studies exist about nursing ICs in practicing nurses, the ability to compare results throughout the studies is to some extent restricted. As explained in the informatics literature by Vasuki (2016), nurses are engaged with information systems and different digital tools used for their clinical practice. However, unfortunately, not all graduating (and currently practicing nurses) are fully prepared to use these digital tools to support their practice. This is because nurses are having unlike workplace experiences, consequently, they might partake different preparation levels in informatics.

In addition, this finding is in agreement with Miller et al. (2014), who found most new/novice nurses (90%) reported that they received EHR training in their current workplace. The greatest percentage (39%) of new/novice nurses reported receiving between 9 and 16 h of training, and the greatest percentage of nurse managers (33%) reported receiving greater than 24 h of EHR use training at their current workplace. More than a quarter of new/novice nurses (30%) and nurse managers (26%) reported receiving less than eight hours of training.

As regard the relationship between innovation behavior and NI competency levels as perceived by participants. As for low innovation behavior as perceived by the studied sample, less than half who perceived themselves as low innovator rated themselves as novice in NI. As for moderate innovation behavior as perceived by the studied sample, more than half of the studied sample that perceived themselves as moderate innovator rated themselves as competent in NI. As for high innovation behavior as perceived by the studied sample, the entire studied sample that perceived themselves as high innovator rated themselves as novice in NI. In addition, there was a significant difference between innovation behavior and NI competency levels as perceived by participants. Since this relation has not been found elsewhere, it is perhaps related to innovation behavior as talent is used in nursing to produce knowledge from raw data, which is the foundation of NI to protect health, prevent diseases, and offer personalized care. However, as concluded from the literature review, innovation often arises out of necessity in order to address a need or a gap in technology (Weberg, 2009). Moreover, innovation is the process of generating proactive new approaches, technologies such as learning new competencies in the specialty of NI (ICN 2009; Arif et al., 2012).


  Conclusion Top


This study finding signifies the role of sex in the developing NI competencies and it signifies the role of sex in developing the study participants’ innovative behaviors. Moreover, this study contributes to the identification of informatics competency levels that are relevant to the role of critical care nurses. Likewise, this study signifies that the innovative behavior of critical care nurses would help in generating proactive approach concerning developing NI competency level in the future.

Recommendations

To encourage the innovative abilities of the nurses in the organizations, and create the right environment to eliminate the resistance that may be encountered.
  1. To conduct workshop on innovative thinking and design strategies to improve and facilitate innovation behavior among nurses.
  2. To provide training programs related to innovation in nursing.
  3. To establish a special unit of innovation and creativity and provide them with appropriate technological equipment.
  4. In future research, informatics competencies need to be leveled by nursing leadership roles and responsibilities.
  5. To identifying the predictors of informatics competency, which will help in developing appropriate strategies to prepare informatics-competent graduates.
  6. Future studies should correlate demonstrated and perceived NI competency levels in critical care units and other work settings
  7. To guarantee that nursing alumni are proficient in the era of automated healthcare provision, it is crucial to incorporate those NI and nursing innovations courses as one of the core courses, and not as an elective one, in the nursing curriculum.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
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