Practical and Professional Nursing Perception of Nurses about the Computerized Nursing Records in Selected Primary Health Centres in Jos Metropolis

Computerized nursing records are becoming a pivot on which the health information processes leverage across countries. It provides the needed data for healthcare planning. It also improves quality of care, accuracy of patients’ information or interdisciplinary communi- cation. The study aimed at examining the perception of computerized nursing records among nurses in primary health centers in Jos Metropolis. The study population was nurses working in the primary health centers in Jos Metropolis, Plateau State. A cross-sectional, descriptive, and non-experimental design was used for this study. Data was collected using questionnaire. A total of two hundred and twenty-eight (228) nurses constituted the respondents for this study. Convenience sampling technique was adopted in administering the questionnaire. Two hundred and twenty-eight copies of questionnaire were distributed, and all were retrieved thereby creating the response rate of 100%. The data collected was analyzed using per-centages and frequency counts. Findings revealed that majority of the respondents had positive perceptions about computerized nurs- ing records while the 75.5% reveal that they were yet to commence the use of computerized nursing records.


Introduction
The healthcare delivery system of a nation is anchored on the ability of its health facilities to come up with positive outcomes in the aspect of qualitative and affordable healthcare to its citizenry. In effect, the role of primary health centres in the healthcare delivery system of a nation cannot be overemphasized. Healthcare data play a vital role in the planning, development and maintenance of sustainable healthcare [1,2]. The magnitude and quality of information accessible to healthcare professionals in patient care modify the outcome and continuity of client care. In addition, health information needed for clinical decision making assumes bourgeoning dimension, especially in Lower Middle-Income Countries. The trends show that the health/ medical information is poorly designed with the resultant effect on decisions that may lead to clinical errors [3].
Health informatics in Nigeria predates the present times. The starting point was in the late 80s when a collaborative research project was instituted toward creating a synergy between a teaching hospital in Nigeria and some Universities [4]. The product of that collaboration appeared in terms of rudimentary hospital information system based on the Veterans Administration's (VA) Admission Discharge Transfer running on a discrete personal computer which was what the teaching was using during the period under consideration. Part of the projection was that by 2020 all the Teaching Hospitals in Nigeria would have health informatics units that could make use of standardized software. The goal of achieving the feat became watered down due to the affordability challenges that confronted the teaching hospitals in Nigeria. Thereafter, further developments took place as a means of extending knowledge on its design. The purpose of the design was to enhance the referral of patients from one hospital to another. Put differently, information concerning patients could be transmitted over a computer network [5].
Sensitization on the use of computer to document health information and its attendant processes are gaining ground in Nigeria in the present time while on the part of government, there is evolution of plans and strategies toward the espousal of health information technology [1]. Further to this, the Nigerian Government has come up with a 5-year blueprint geared toward creating a potent National Health Management Information System that will serve as a fulcrum for making informed decisions at all levels of health care [1]. The use computer for the documentation and sharing of information is just coming up, and a lot of health facilities are yet to upgrade their information documentation system. The commitment to this will require attitudinal change without which no meaningful breakthrough will be recorded. Against this backdrop, it was necessary to know how nurses perceive the introduction of the computer technology as this will determine their readiness to embrace the change occasioned by this technology.

Objectives
• To determine the perception of nurses about the use of computerized nursing records among nurses in selected health centres in Jos Metropolis • To determine the perceived factors that could influence the use of computerized records among nurses in selected health centres in Jos Metropolis

Materials and Methods
The study was carried out in selected primary health centres in Jos Metropolis. Eight health facilities were used for this study. Four health centres were selected each from the two local government areas that constitute Jos Metropolis. The study population was nurses working in these health facilities. The population of nurses working in these centres was 250. The nurses are experiencing attrition as there has not been regular replacement of those nurses that have either retired or left voluntarily hence total population sampling was employed. Questionnaire was the instrument used in eliciting their responses. It was segmented into three parts as these include: socio-demographic data, items on perception of nurses about the use of computerized nursing records; and perceived factors that may affect the implementation of computerized nursing records. The instrument was pretested by administering it to nurses in another health setting. A total of two hundred and fifty copies of the instrument were administered but 228 copies were retrieved thus creating 91.2% response rate. The process of administering the instrument entailed seeking permission from the gate keepers. The ethics considerations took the dimension of providing informed decisions in order to obtain their consent. Respondents were given an assurance as to the adherence to the values of confidentiality and anonymity. The right to withdraw without victimization was conceded to them. The data was analyzed by using descriptive statistics. Table 1 shows that 34 respondents 14.9% were females while 194 (85.1%) respondents are females. Some, 8 (3.5%) of the respondents were between the age category of 20-24 years; 15 (16.5%) respondents were within the age bracket of 25-29; 31 (13.5%) respondents are between the age bracket of 30 -34 years; 53 (23.3%) respondents are within the age bracket of 35 -39 years; 55(24.1%) respondents were within the age bracket of 40 -44 years; 37 (16.3%) respondents were within the age category of 45 -49 years; 15 (16.7%) respondents were within the age bracket of 50 -54 while 14 (6.2%) respondents were within the age bracket of 55 -60 years. The  Table 2 shows that 100 (43.8%) strongly agree to the statement that 'computerized nursing records will help patients access and retrieve their health information', 120 (52.6%) of the respondents indicated agree to the statement, 4 (1.8%) respondents were undecided, 2 (0.9%) respondents strongly disagreed: 2 (0.9%) disagreed; 207 respondents representing 98.7% agreed that computerized nursing records improves quality of care; 210 (90.9%) of the respondents said computerized nursing records improves communication with other nurses; and reduces patients' cost of health services (92.2%). Majority (90%) of the respondents perceived that computerized nursing records takes care of illegible handwriting of nurses and makes hospital statistics and analysis easier (96%); however, 161 (70.6%) respondents differed on the statement that 'computerized nursing records would not take away most of the time they are to give to patients', 171 (75%) respondents disagreed that computerized nursing records would create more work for them. Majority, 216 (94.8%) perceived that Nurses duty roster would be easier with computerized nursing records while 103 (45.2%) acquiesced to the issue of whether patients' privacy and confidentiality of information would be insecure with computerized nursing records, Majority, 203 (89%) differed on the assertion that 'paper-based records are better than computerized  nursing records. of the respondents (82%) perceived that computerized nursing records are better than paper-based records, 220 (96.5%) agreed to the item that 'computerized nursing records should replace paper-based records' while 116 (72.8%) were of the opinion that computerized nursing records be used together with paper-based records.

Discussion
The socio-demographic findings reveal that majority of the respondents were females who were married and were between 31-52 years. Majority of them are Christians, and hail from different ethnic groups in the Plateau State. Majority of the respondents have been working for about 11-30 years. However, the mean years of working experience is about 18years. The study reveals the preponderance of females in nursing, and majority of whom are Christians. Jos metropolis is a Christian dominated location. Furthermore, the teaching  hospital is located in the State where majority of the residents are Christians and are Plateau indigenes [6]. This finding aligns with who indicated that Jos is Christian dominated area [6]. The study found that majority of the respondents had positive perception about the impact of computer nursing records on patient care. Most of the respondents perceived that standardized EHR improves quality of care. This finding is consistent with the findings of Adeleke et al., [1] in a study among healthcare providers at National Hospital, Abuja who reported that virtually, all healthcare professionals in the study, which included nurses indicated that Information Communication Technology (ICT) would improve medical care quality. Similarly, majority of the respondents perceived that computerized nursing records would help patients easily access and retrieve their health information. Majority of the respondents perceived that computerized nursing records improve communication with other healthcare providers. This assertion finds its support in Alpert [7] which emphasizes that computerized system makes it possible for the services a patient needs-office visits, testing, surgery, hospital visits and so on to be coordinated and scheduled over the course of a single visit, rather than time-consuming multiple visits. There was a preponderance of the respondents who perceived that computerized nursing records reduce patients' cost of health services. This is similar to the finding of Devkota et al. [5] indicating that widespread implementation of electronic health system decreases healthcare expenditure, and improves patient safety, and healthcare efficiency and outcomes. Most of the respondents perceived that standardized EHR takes care of illegible handwriting of Nurses. This finds its support in Robin [8] which indicated that computerized documentation systems could improve nurses' access to more complete, accurate, legible and up-to-date patient data.
The study found that more than half of the respondents perceived that computerized nursing records would not take away most of the time they are to give to patients. Put differently, the care time dedicated to patients would not be compromised. Most of the respondents perceived that the introduction of computerized nursing records would not create more work for them. This is consistent with Aldosari et al., [9] indicating that a strong positive correlation exists between usefulness and perceived ease of use electronic medical records thereby resulting in a positive effect on nurse's acceptance. Most of the respondents perceived that nurse's duty roster would be easier with computerized nursing records. More than half of the respondents were not in agreement claiming that patients' privacy and confidentiality of information would be insecure with computerized nursing records. However, this assertion contradicts Terry et al., (2019) which indicates that electronic medical records in Canadian primary health care practice resulted in an expansion of the availability of data. Majority of the respondents perceived that computerized nursing records were better than paper-based records and should replace paper-based records or they should be used together with paper-based records. This could be as a result of its perceived benefits such as decreased costs, easy accessibility, and legibility of health records among others. This finding aligns with Devkota et al., [5], Robin [8].
Findings further indicate that majority of the respondents perceive poor government policy and strategy affects the implementation of computerized nursing records in primary health centres. This is in line with the position of Benson [10] who suggested that government policies might constitute the major barriers hindering the adoption of electronic patient record in Nigeria. The World Health Organization, [11] indicated the need for a robust government policy on healthcare technologies in Nigeria to facilitate the implementation of e-health initiatives. Majority of the respondents perceived that lack of basic ICT knowledge and skills affects the implementation of computerized nursing records in primary health centres. This finding is consistent with Ouma et al., [12] that identified inadequate ICT infrastructure as one of the barriers for computerized nursing records implementation. This is required to enhance the knowledge and training of the personnel while in contrast, the developed countries parade adequate healthcare infrastructures with overwhelming financial support from their governments [13]. Majority of the respondents perceived that poor internet connectivity affects the implementation of computerized nursing records in the primary health centres. This finds its support in Nigeria Research Council [14], Edward et al., [15], who asserted that the low speed and costly internet bandwidth in Nigeria will affect the actualization of the computerized nursing records as high bandwidth is needed for accessing and transmitting large images. Majority of the respondents perceived those financial constraints affect the execution of computerized nursing records in the primary health centres. Martinez et al., [16] asserted that implementation of the computerized nursing records is not cost effective as large amounts are required for the logistics involved. Majority of the respondents perceived that inadequate electric supply affects the implementation of computerized nursing records. Erratic power supply has been found as an element that impedes the successful outcomes of this computerized technology. Stable electricity is required to ensure the optimal functioning of the System [10].

Conclusion
The relevance of this study cannot be discountenanced as the health care services are getting more technologically-driven. Computerized health records system is an integral part of this technology. It is highly valued in primary health care as these remains the grass root health services. The rural population health challenges and dynamics need to be well documented in order to meet their expectations in terms of profiling. The attendant challenges notwithstanding, the collateral advantages are enormous as to adopt this innovation.