PERCEPTION OF NURSES ABOUT THE USE OF COMPUTERIZED NURSING

RECORDS TOWARDS ACHIEVING POSITIVE OUTCOMES IN JUTH

BY
Oluwatoyin A. Ogunyewo
Esther M. Mani
,
8
Bature, Y.A. and 9Barki, J.J.
1, 2, 3
Department of Nursing Science, Faculty of Medical Sciences, University of Jos PMB 2084
Jos Plateau State, Nigeria
4, 5, 6, 7
Department of Nursing Science, Faculty of Allied Health Sciences, Bayero University Kano,
Nigeria
8, 9
Ministry of Education, Headquarters, Jos, Plateau State, Nigeria
Abstract:

Computerized nursing record is becoming the global standard for clinical practice. This provides
the needed data for healthcare planning. It can also improve quality of care, accuracy of patients’
information and interdisciplinary communication among other benefits. The study therefore
aimed at evaluating the perception of computerized nursing records among nurses in Jos
University Teaching Hospital (JUTH), Nigeria. The target population was 528 nurses in JUTH,
Nigeria. A descriptive survey was adopted for the study. Data was collected using questionnaire
as the instrument for the study, which was validated and found reliable. Sample size of 228 was
obtained using Slovin’s formula. Participants were selected using stratified random sampling
technique. 228 questionnaires were distributed and 228 were retrieved. This formed a response
rate of 100%. Findings revealed that majority of the respondents (85.1%) were females between
31-52years. Further findings revealed that majority of the respondents (76.8%) had positive
perceptions about computerized nursing records. However, majority of the respondents (75.4%)
were not utilizing computerized nursing records. It is therefore recommended that the teaching
hospital should adopt computerized nursing records as a standard for documentation practice.

Keywords: Computerized nursing records. Healthcare professionals, Positive outcomes,

Secondary health facility

Background of the Study:

The healthcare delivery system of a nation hinges, amongst other things, on how well its
hospitals can deliver qualitative and affordable healthcare to its citizens. Thus, the role of
hospitals in the healthcare delivery system of a nation cannot be overemphasized (Ojo &
Popoola, 2015). Health records are essential for good healthcare and good quality healthcare data
play a vital role in the planning, development and maintenance of optimal healthcare (Adeleke,
2020). The amount and quality of information available to healthcare professionals in patient
care impact the outcome and continuity of patient care. Furthermore, medical information needed
for clinical decision making continues to increase, especially in developing countries. However,
the organization and accessibility of medical information remain poor, usually resulting in
inappropriate decisions and medical errors (Delpierre, Cuzin et al. 2018).
The history of health informatics in Nigeria started in the late 80s when a collaborative research
project between the Computing Centre of the University of Kuopio, Finland; the Obafemi
Awolowo University; and the Obafemi Awolowo University Teaching Hospital (OAUTHC),
Nigeria was initiated (Idowu, Ogunbodede et al. 2019). The joint project produced a very
rudimentary hospital information system based on the Veterans Administration’s (VA)
Admission Discharge Transfer running on a stand-alone personal computer which was in use at
OAUTHC. The plan then was that by 2020 all the Teaching Hospitals in Nigeria would have
health informatics units which could make use of standardised software. Unfortunately, the
system was not tested at OAUTHC and only five teaching hospitals and medical centres use the
system as at 2020. The primary reason for this limited use is the cost of purchasing the
commercial software (Idowu et al. 2019). In 2018, a non-commercial software package called the
State Hospital Network (SHONET) was developed for sharing of hospital resources over the
computer network in Nigeria. The philosophy behind the development of the software was to
minimize the cost of running state hospitals. In 2017, another system was developed at the
Department of Computer Science & Engineering, Obafemi Awolowo University, Nigeria. The
system was designed for referral of patients from one hospital to another such that patient’s case
file, referral note and medical examination result that were transferred manually from one
hospital to another could be transferred over a computer network (Idowu, Adagunodo et al.
2019).
Nigeria is witnessing continuing advocacy and increase in number of individuals yearning for
computerization of health information and healthcare processes. On the other hand, the
Government is evolving plans and strategies for the adoption and implementation of health
information technology (Adeleke, Erinle et al. 2020). To improve the use of information and
communication technology (ICT) in healthcare delivery in the country, the Nigerian Government
developed a 5-year Strategic plan on health with health information system taking a strategic
position. The goal is to provide an effective National Health Management Information System
(NHMIS) by all the governments of the Federation to be used as a management tool for informed
decision making at all levels and for improved healthcare (Adeleke, Erinle et al. 2020). In
furtherance of her efforts to achieve the plan, the Government recognized the need to have a
harmonized health information management through Health Information Technology (HIT). It
was on this premise that the first National Conference on HIT was organized by the Federal
Ministry of Health (FMOH) between November 2 and 4, 2020. The focus of the conference was
to have one harmonized health data management system and the specific objectives were to
compile a list of health information system applications in use in the country, to review the
interoperability of the existing systems, to review the Health Information Technology
components of the country’s e-health strategies and to propose strategies for the establishments
of interoperability standards and capacity building. Subsequently, the National Council on
Health in August 2013 approved the deployment of computerized nursing records in all thirty six
states of the federation, including the Federal Capital Territory (Adeleke, Erinle et al. 2020).
Furthermore, in pursuance of plans to ensure Universal Health Coverage for all citizens by the
year 2020 through leverage on the vast potentials of ICT, the Federal Ministry of Health through
her National Health ICT Strategic Framework 2015-2020 intends to scale-up ICT infrastructure
in all health facilities across the country to ensure they are in step with Health ICT and health
system priorities (FMOH 2016a).
Statement of the Problem:
Paper documentation systems often create fragmented and inconsistent health records that make
it difficult to retrieve data and measure outcomes. In addition to the fragmentation of paper
health records, the use of unstructured or narrative documentation limits the use of and ability to
demonstrate the linkages or relationships between assessment findings, nursing diagnoses,
interventions and expected outcomes in nursing care. Despite advances in computerization in our
society, majority of patients are given handwritten medication prescriptions, and very few
patients are able to email their Nurse without speaking to a live receptionist. Although there is a
growing number of healthcare institutions world-wide who embrace and utilize computerized
nursing records in patient care, most hospitals in Nigeria including JUTH are still using paper
based records for documentation.
With many Secondary Healthcare facilities in Nigeria without electronic health records,
healthcare delivery is sometimes impaired with the current use of temporary cards. The upsurge
in the number of patients seeking health care services requires a fast and efficient records
keeping. This is one of the driving forces behind the research into the barriers militating against
the implementation of the EHR in a Nigerian Secondary Healthcare facility.
The introduction of ICT-based initiatives to transform existing paper-based information
management systems in most public health institutions in developing countries has usually been
a difficult process of change, often fraught with several context-sensitive challenges and
problems such as lack of adequate resources (poor financial resources)and uneven infrastructural
development, inadequate skills and knowledge at a local level to handle new systems and
technologies, fragmented and uncoordinated organizational structure and heterogeneity of
stakeholders, political and bureaucratic constraints.
Objectives of the Research:
This study will be conducted with the following objectives:
1. Determine the perception of nurses on the use of computerized nursing records.
2. Determine the perceived factors that affect the implementation of the computerized
nursing records in JUTH.
Materials and Methods
Research Design:
The study adopted a descriptive survey research method, and questionnaire was used to gather
relevant data from 228 professional nurses in Jos University Teaching Hospital. The descriptive
survey was chosen as the appropriate research design in order to find out the Nurses’ perception
on computerized nursing records and utilization of standardized electronic health records in Jos
University Teaching Hospital, Jos, Nigeria.

Setting for the Study:

The study was carried out in Jos University Teaching Hospital (JUTH), which was established in
1981 by the Federal Government of Nigeria for the purpose of providing tertiary health services
to the populace, training facilities for medical students of the associated University of Jos and
other medical personnel. Jos University Teaching Hospital (JUTH) has 31 departments, 22 wards
and 620 bed capacities. The teaching hospital is located at Lamingo, Jos North Local
Government Area of Plateau State, Nigeria. Jos is the capital city of Plateau State and it
approximately lies between latitude 9.9N and longitude 8.9E. The study area was chosen for this
research work because JUTH is a reference tertiary hospital in Jos committed to research and
provision of quality health care to clients. Hence the hospital will serve as a standard and
reference point for the adoption of computerized nursing records in the state.
Target Population of the Study:
The total population was 528 Nurses in Jos University Teaching Hospital, Nigeria. These Nurses
were at various ranks or cadres such as Chief Nursing Officers, Assistant Chief Nursing Officer,
Principal Nursing Officers, Senior Nursing Officer, Nursing Officer 1 and Nursing Officer 2
with varied years of working experiences. Nurses who were on Maternity leave, annual leave,
terminal leave, study leave or sick leave and excuse duty, were excluded from this study, while
all nurses present and those who consented or agreed to participate in the study were included in
the study.
Sampling Procedure and Sample Size:
Stratified random sampling (SRS) was used in selecting representative samples among Nurses
across the wards/units in the institution. A list of Nurses in the hospital was obtained from the
office of the Director of Nursing Services (DNS). Out of 528 total number of Nurses in the
hospital, 228 Nurses (43.2% of the target population) were selected using a stratified sampling
frame. The Sample Size was calculated using Slovin’s formula which was developed since 1960:
. 𝑛= N
(1+𝑁𝑒2)
Where, n = number of samples,
N = total population
e = Error limit/level of precision
1 = Constant value, then:
Therefore, the Sample Size ≈ 228 Nurses
Instrument for Data Collection:
The instrument used to collect data from the respondents was a 26-point questionnaire
considered appropriate because the respondents were literates, thus can read and write. The
questionnaire consists of 3 sections. Section one consist socio-demographic characteristics (or
bio-data) of respondents. Section two consist questions on perception of computerized nursing
records. Section three consist questions on the positive outcomes resulting from computerized
nursing record in the area of study (JUTH).
The questionnaires were given to the respondents through face to face distribution. Some were
administered indirectly through the unit heads in the institution. The answered questionnaires
were returned to the researcher through hand to hand collection with the assistance of the
ward/unit heads.
Validation and Reliability of Instrument:
The pilot study of the instrument was done in which 10 Nurses in Jos University Teaching
Hospital were given the questionnaire to answer. Observations were noted and corrections were
effected so as to ensure construct validity of the instrument. Content validity was done in which
the questionnaire was given to two experts in the field who went through the tool and a content
validity index (CVI) of 0.75 was obtained, which ensured further validity of the instrument. The
standardized electronic health records questionnaire was tested for reliability using the test-retest
method. It was administered to some subjects within a period of three months during which the
retest was done. The responses were compared for reliability. Pearson’s correlation coefficient
was used to determine the coefficient of correlation which was 0.9771 approximately 0.98.
Hence the questionnaire had 98% reliability
Pilot Study:
In order to determine the feasibility and tenability of this study, the researcher carried out a trial
run to act as an “eye opener” to the researcher. The questionnaire was earlier drafted by the
researcher. This is for the approval of the project supervisor before such questionnaire is put into
use. However, the questionnaire is not regarded as part of the write-up in this chapter but only
treated as an appendix at the end of this project research.
Method of Data Collection:

Two (2) methods of data collection will be employ in this study. These are primary and
secondary methods:

Primary data:

The primary procedure involves the collection of first-hand data from the survey by
administering questionnaires to collect data from the respondents. Meanwhile, total number of
questionnaires will be distributed to the categories of people indicated in the sample size to
collect information.

Secondary data:

This method of data collection in this study involved the review of textbooks, journals,
newspapers and news magazines to obtain data the secondary information about the research
problem. This forms the literature review. The secondary procedures were selected in view of the
fact that most leadership stages and conflict resolution are documented for reference purposes.
Method of Data Analysis:
Data are collected and analyzed using frequency tables and statistical simple percentage
instrument. The frequency table consists of specific variables and response aimed at getting the
reliability and validity of the research questions proposed earlier or tables were used for the
observation of all the data obtained from the investigation. This is a sample and accurate
representation of fact using table and characterized by variable numbers of respondents.
Percentage of respondents in each group of observation respectively, the table of respondents
with higher positive responses is considered conclusion of the study findings. Descriptive
statistical analysis such as simple frequency distribution tables, percentages and mean were
implemented using Statistical Package for the Social Sciences (SPSS). In order to test
hypothesis, inferential statistics such as chi-square was used. The choice of SPSS in the data
analysis was made to avoid errors due to manual calculations.
Ethics Consideration:
A written permission was obtained from the ethical committee of Jos University Teaching
Hospital to conduct the study. The respondents’ consent was sought and the purpose of the study
was explained to them before they voluntarily filled the questionnaires. Data collected for the
study was treated with utmost confidentiality and the names of the respondents was not required
in order to ensure anonymity.
RESULTS
Table 1: Socio-demographic Characteristics of Respondents

Frequency (F) Percentage (%)

Gender Male 34 14.9

Female 194 85.1

Total 228 100.0

Age (Years) 20 – 24 8 3.5

25 – 29 15 6.5

30 – 34 31 13.5

35 – 39 53 23.3

40 – 44 55 24.1

45 – 49 37 16.3

50 – 54 15 6.7
 55 – 60 14 6.2

Total 228 100.0

Marital status Single 33 14.5

Married 172 75.4

Divorced 3 1.3

Widowed 20 8.8

Total 228 100.0

Religion Christianity 195 85.5

Islam 30 13.2

Traditional Religion 3 1.3

Total 228 100.0

Ethnic Groups Hausa 9 3.9

Yoruba 21 9.3

Igbo 25 10.9

Berom 41 17.9

Ngas 33 14.5

Tarok 39 17.1

Afizere 19 8.3

Mupun 11 4.9

Amo 11 4.9

Tiv 19 8.3

Total 228 100.0

Table 1 show that 34 respondents 14.9% of the sampled population were females while 194
respondents representing 85.1% of the sampled population were females. Some of the
respondents numbering 8(3.5%) were between the ages of 20-24years; 15 respondents
representing 16.5% of the sampled population are within the age bracket of 25-29; 31
respondents representing 13.5% of the sampled population are between the age bracket of 30 –
34 years; 53 respondents representing 23.3% are within the age bracket of 35 – 39 years; 55
respondents representing 24.1% are within the age bracket of 40 – 44 years; 37 respondents
representing 16.3% are within the age bracket of 45 – 49 years; 15 respondents representing
6.7% are within the age bracket of 50 – 54 and 14 respondents representing 6.2% are within the
age bracket of 55 – 60 years. The table also shows that33 respondents representing 14.5 of the
sampled population are single; 172 respondents representing 75.4% are married; 3 respondents
representing 1.3% are divorced while 20 respondents representing 8.8 are widowed. It is also
shown that 195 respondents representing 85.5% of the sampled population are Christians; 30
respondents representing 13.2% are Muslim and 3 respondents representing 1.3% are Traditional
believers. Furthermore, the table shows that 9 respondents representing 3.9% of the sampled
population are Hausa; 21 respondents representing 9.3% are Yoruba; 25 respondents
representing 10.9% are Igbo; 41 respondents representing 17.9% are Berom; 33 respondents
representing 14.5% are Ngas; 39 respondents representing 17.1% are Tarok; 19 respondents
representing8.3% are Afiizere; 11 respondents representing 4.9% are Mupun; 11 respondents
representing 4.9% are Amo while 19 respondents representing 8.3% are Tiv.

Table 2: Respondents’ perception on computerized nursing records

Perception on S A A U S D Total Mean SD

computerized D
nursing records
F % F % F % F % F %

Computerized 100 43.8 12 52.6 4 1.8 2 0.9 2 0.9 228 100 1.141 199.
nursing records 0 8
will help patients
easily access and
retrieve their
health
information

Computer 110 48.2 11 50.5 3 1.3 0 0.0 0 0.0 228 100 1.037 219.
nursing records 5 8
improves quality
of care

Computerized 108 47.4 99 43.5 5 2.2 7 3.1 9 3.8 228 100 1.037 219.
nursing records 8
improves
communication
with other
Nurses

Computerized 106 46.5 10 45.7 9 3.9 5 2.1 4 1.8 228 100 1.075 212.
nursing records 4 2
reduces patients’
cost of health
services

Computerized 99 43.5 10 46.5 4 1.7 1 4.8 8 3.5 228 100 1.149 198.
nursing records 6 1 4
takes care of
illegible
handwriting of
Nurses

Computerized 114 50.0 10 46.0 5 2.2 2 0.9 2 0.9 228 100 0.990 230.
nursing records 5 3
makes hospital
statistics and
analysis easier

Computerized 88 38.6 92 40.4 13 5.7 1 7.5 18 7.8 228 100 1.360 167.
nursing records 7 6
will improve the
use of
standardized
nursing
languages.

Computerized 27 11.9 31 13.6 9 3.9 8 35. 80 35.0 228 100 4.201 54.2
nursing records 1 6 .
will take away
most of the time
I’m to give to
patients
 The introduction 21 9.3 25 10.8 11 4.9 8 37. 85 37.2 228 100 5.370 42.5
of computerized 6 8
nursing record
will create more
work for me

Nurses’ duty 111 48.7 10 46.1 3 1.3 5 2.1 4 1.8 228 100 1.026 222.
roster will be 5 2
easier with
computerized
nursing records

Patients’ privacy 54 23.7 49 21.5 7 3.1 5 25. 61 26.8 228 100 2.109 108.
and 7 0 1
confidentiality
will be insecure
with
computerized
nursing records

Paper-based 11 4.9 9 3.9 5 2.1 1 53. 82 35.9 228 100 10.204 22.3
records are better 2 9
than 1
computerized
nursing records

Computer based 119 52.2 10 44.3 3 1.3 2 0.9 3 1.3 228 100 0.957 238.
records should 1 2
replace paper-
based records

Computer based 89 39.1 77 33.8 6 2.6 2 12. 28 12.3 228 100 1.278 178.
records should 8 3 4
be used together
with paper-based
records

Table 2 showed that 100 respondents representing 43.8% of the sampled population strongly
agree to the statement that computerized nursing records will help patients access and retrieve
their health information, 120 (52.6%) of the respondents agree to the statement, 4 (1.8%)
respondents are undecided, 2 (0.9%) respondents strongly disagree, 2 (0.9%) disagree that
computerized nursing records would help patients easily access and retrieve their health
information, the percentage mean score of the respondents was 1.141 while the standard
deviation (SD) was 199.8; 207 respondents representing 98.7% said 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 of the respondents (90%) 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 disagree to 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. Most of the (216)
respondents (73.2%) representing 94.8% perceived that Nurses duty roster would be easier with
computerized nursing records, patients’ privacy and confidentiality of information would be
insecure with computerized nursing records (39%). Majority of the respondents (82%) perceived
that computerized nursing records are better than paper based records, suggested that
computerized nursing records should replace paper-based records (78.5%), and should be used
together with paper-based records (66.2%).

Section C: Respondents’ distribution on perceived factors that affect the implementation of

computerized nursing records in JUTH

Perception on factors that affect Yes No Total

computerized nursing records in JUTH
F % F % F %

Poor government policy and strategy affects 155 67.9 73 32. 228 100
the implementation of computerized nursing 1
records in JUTH

Lack of basic ICT knowledge and skills 182 79.8 46 20. 228 100
affects the implementation of computerized 2
nursing records in JUTH

Poor internet connectivity affects the 190 83.4 38 16. 228 100
implementation of computerized nursing 6
records in JUTH

Financial constraint affects the 171 75.0 57 25. 228 100

implementation of computerized nursing 0
records in JUTH

Inadequate electric supply affects the 146 64.1 82 35. 228 100
implementation of computerized nursing 9
records in JUTH
Table 3 shows that 155 respondents representing 67.9% of the sampled population said “Yes” to
the statement that poor government policy and strategy affects the implementation of
computerized nursing records in JUTH while 73 respondents representing32.1% of the sampled
population answered “No”; 182 respondents representing 79.8% said “Yes” to the statement that
lack of basic ICT knowledge and skills affects the implementation of computerized nursing
records in JUTH while 46 respondents representing 20.2% of the sampled population said “No”;
190 respondents representing 83.4% of the sampled population said “Yes” to the statement that
poor internet connectivity affects the implementation of computerized nursing records in JUTH
while38 respondents representing 16.6% of the sampled population said “No” to the statement
that poor internet connectivity affects the implementation of computerized nursing records in
JUTH; 171 respondents representing 75.0% of the sampled population under said “Yes” to the
statement that financial constraint affects the implementation of computerized nursing records in
JUTH while57 respondents representing 25.0% of the sampled population said “No”;146
respondents representing 64.1% of the sampled population said “Yes” to the statement that
inadequate electric supply affects the implementation of computerized nursing records in JUTH
while 82 respondents representing 35.9% said “No”.

Discussion of Findings:

The Socio-demographic findings revealed that majority of the respondents were females who
were married and were between 31-52 years. Majority of them were Christians and were from
Plateau ethnic groups such as Berom, Mupun, Ngas amongst others. Majority of the respondents
have been working for about 11-30 years. However the mean years of working experience is
about 18years. The explanation that can be given for these findings is that the dominant
population in the nursing profession is females, although male nurses/midwives are still
emerging in the profession. Furthermore, the teaching hospital is located in a state where
majority of the residents are Christians and are Plateau indigenes. (Field Survey, 2021)

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 coincides with the findings of Adeleke et al. (2020)
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) will 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. The system also make 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
(Alpert, 2016).

Most of the respondents perceived that computerized nursing records reduce patients’ cost of
health services. This is similar to the opinion of Wang, Middleton et al. (2018) and other
published studies demonstrated a positive return on investment with the primary areas of savings
including reductions in drug expenditures, improved utilization of radiology tests, improvement
in charge capture, and decreased billing errors.
Most of the respondents perceived that standardized EHR takes care of illegible handwriting of
Nurses. This supports the position of Oroviogoicoechea, Elliott, and Watson (2020) who
observed that computerized documentation systems can 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. Most of the
respondents perceived that the introduction of computerized nursing records would not create
more work for them. On the contrary, (Lee, 2019) observed that Nurses created work around by
developing word files, saving them, then retrieving files and revising for each patient.

Most of the respondents perceived that Nurses duty roster would be easier with computerized
nursing records. More than half of the respondents were not in agreement and strongly disagree
that patients’ privacy and confidentiality of information would be insecure with computerized
nursing records. This could be because both paper and electronic storage systems are susceptible
to security concerns. If a facility stores records electronically, they are vulnerable to access by
unauthorized individuals, when the proper and effective security systems and controls are not in
place and if records are in paper form, they are open to compromise resulting from a break in, the
loss of a record due to human error, or damage as a result of natural disaster.

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. More so, Hicks (2020) stated that one
major concern with completely converting to electronic data is the threat to patient information.
Providers and patients both worry about the implications of going digital. Hence, going digital
could be scary. Many things could go wrong likewise keeping a paper records system. In the
event of a natural disaster, paper records can be destroyed and can never be recovered.

Majority of the respondents who strongly agree and agree by having the perception that poor
government policy and strategy affects the implementation of computerized nursing records in
JUTH. This has been the position of Benson (2019) who suggested that government policies
might constitute the major barriers hindering the adoption of electronic patient record in Nigeria.
A bulletin of the World Health Organization in 2020 identified the need for a robust government
policy on healthcare technologies in Nigeria to facilitate the implementation of e-health
initiatives (WHO, 2020).

Majority of the respondents perceived that lack of basic ICT knowledge and skills affects the
implementation of computerized nursing records in JUTH. A previous study by Ouma and
Herselman (2017) had identified inadequate ICT infrastructure as one of the barriers for
computerized nursing records implementation. Unlike the developed countries that boast of
robust healthcare infrastructures with ample financial support from their governments, the
reverse is the case in most developing countries (Sood, Nwabueze et al. 2018).
Majority of the respondents perceived that poor internet connectivity affects the implementation
of computerized nursing records in JUTH. According to the Nigerian Research Council
(2019),the low speed and expensive internet bandwidth in Nigeria will hinder the
implementation of the computerized nursing records because a high bandwidth is required for
transmission of large images between institutions and as well as accessing the computerized
nursing records itself especially if they contain videos and images (National Research Council,
2019).
Majority of the respondents perceived that financial constraint affects the implementation of
computerized nursing records in JUTH. The implementation of the computerized nursing records
comes with huge financial responsibilities in the form of purchasing necessary software and
hardware, installation, training hospital staff and maintenance which may deter governments and
institutions from embarking on such projects (Martinez, Villarroel et al. 2015).
Majority of the respondents perceived that inadequate electric supply affects the implementation
of computerized nursing records in JUTH. An uninterrupted power supply is a prerequisite for
adoption of computerized nursing records and ensures avoidance of unintended shutdowns that
could lead to loss of data or permanent system damage. The power supply is erratic or non-
existent in many regions of the Sub-Saharan Africa (Benson, 2017). For example, only few cities
and towns in Nigeria have stable and reliable electricity for ten consecutive hours a day. This has
resulted in most internet facilities in Nigeria suffering frequent downtime and equipment damage
due to power interruptions (Idowu et al. 2018).
Conclusion:
The respondents believed that infrastructure issues like power supply and inadequate ICT
equipment; human factors issues like inadequate computer skill among nurses as well as political
issues such as poor administration, corruption and financial constraints are the major challenges
hindering the implementation of the computerized nursing records in Jos University Teaching
Hospital. All the respondents agreed on the benefits of implementing the computerized nursing
records at the hospitals where they work, most importantly the potential of the computerized
nursing records to improve access to and enhance confidentiality and safety of patient data as
well as enhance service delivery. The findings from this study can shed more light on the barriers
which represents stumbling blocks on the path of successful implementation of computerized
nursing records in JUTH and can for the basis for further research especially as the Federal
Government is evolving plans and strategies for the adoption and implementation of health
information technology (Adeleke, Erinle et al. 2015).
Recommendations:
Based on the findings from the study, the following recommendations were made:
1. Hospital management of the teaching hospital should adopt computerized nursing records as
the standard for documentation practices among nurses and other healthcare providers and ensure
regular training of the nursing workforce on this technology in order to ensure better quality of
care.
2. Nursing and Midwifery Council of Nigeria together with Colleges of Nursing and
Departments of Nursing should ensure that computerized nursing record is incorporated within
the nursing curriculum and implemented through teaching of students. This can be ensured
through periodic supervision of the schools.

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