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Student nurses' conceptions of computers in hospitals Abbott, Karen Elizabeth 1988

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STUDENT NURSES' CONCEPTIONS OF COMPUTERS IN HOSPITALS By KAREN ELIZABETH ABBOTT B.Sc.N., Lakehead U n i v e r s i t y , 1975 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS  in THE FACULTY OF GRADUATE STUDIES Department o f A d m i n i s t r a t i v e , A d u l t And Higher  We accept t h i s t h e s i s as conforming to the r e q u i r e d standard  THE UNIVERSITY OF BRITISH COLUMBIA November, 1988 ®Karen E l i z a b e t h Abbott, 1988  Education  In  presenting  degree freely  at  this  the  available  copying  of  department publication  this or of  thesis  in  partial  fulfilment  of  University of  British  Columbia,  I agree  for  and  reference  thesis by  this  for  his thesis  scholarly  or for  her  Department The University of British Columbia Vancouver, Canada  I further  purposes gain  requirements that the  agree that  may  representatives.  financial  permission.  DE-6 (2/88)  study.  the  It  shall not  be  by  understood be  an  advanced  Library shall  permission  granted  is  for  for  the that  allowed without  make  it  extensive  head  of  my  copying  or  my written  ABSTRACT The  t r e n d toward  i n c r e a s e d computerization i n Canadian  h o s p i t a l s has p r o f o u n d  implications f o rhospital  n u r s e s , t h e m a j o r i t y o f whom a r e e d u c a t e d c o l l e g e n u r s i n g programs.  Educators,  employed  i n community  i n response  to this  t r e n d , must be a t t e n t i v e t o t h e q u a l i t y o f s t u d e n t when p l a n n i n g f o r c o m p u t e r c o n t e n t purpose o f t h i s phenomenological  learning  i n nursing curricula.  s t u d y was t o i d e n t i f y  The  how  s t u d e n t n u r s e s , e n r o l l e d i n a community c o l l e g e n u r s i n g program, c o n c e p t u a l i z e t h e impact employed n u r s e s . relation to their:  Students'  year)  c o n c e p t i o n s were a n a l y z e d i n  (a) a t t i t u d e t o w a r d  (b) l e n g t h o f c l i n i c a l Thirty-five  o f c o m p u t e r u s e on h o s p i t a l  computers, and  experience.  (11 f i r s t - y e a r ,  11 s e c o n d - y e a r  a n d 13 t h i r d -  s t u d e n t s e n r o l l e d i n t h e n u r s i n g program a t Cariboo  C o l l e g e i n Kamloops, B r i t i s h Columbia, Three broad,  and t e n f o r c e d - r e s p o n s e ,  were i n t e r v i e w e d . questions  generated  b o t h q u a l i t a t i v e a n d q u a n t i t a t i v e d a t a , w h i c h were r e p o r t e d as p r i m a r y  and secondary  findings.  Data a n a l y s i s , through use o f t h e constant  comparative  method, was c a r r i e d o u t on a f o r m a t i v e a n d s u m m a t i v e b a s i s . F i n d i n g s i n d i c a t e d t h a t s u b j e c t s had l i t t l e computer use by nurses today. c o m p u t e r s may be u s e d b y n u r s e s limited,  awareness o f  T h e i r k n o w l e d g e o f how i n t h e f u t u r e was a l s o  and appeared t o c e n t e r around t h r e e broad  areas:  iii nursing,  communication, and  Subjects  administration.  conceptions of the impact of computer use  h o s p i t a l employed nurses f e l l (a) n u r s i n g  image,  (d) workload.  i n t o four  (b) p r o f e s s i o n a l i s m ,  categories: (c) p a t i e n t care,  and  T h e i r comments on these f o u r c a t e g o r i e s were  further c l a s s i f i e d into three:sub-categories, whether they f e l t t h a t the i n c r e a s e d use (a) enhance,  on  (b) d e t r a c t from* or  d e t r a c t from, each category.  indicating  of computers would:  (c) both enhance  I t was  found that  and  subjects'  conceptions d i f f e r e d i n complexity i n d i r e c t p r o p o r t i o n  to  the year i n which they were e n r o l l e d i n the program and  also  the l e n g t h of t h e i r c l i n i c a l  experience.  The m a j o r i t y  s u b j e c t s had p o s i t i v e a t t i t u d e s toward computer use. a d d i t i o n , i t was  found t h a t there was  of In  a significant  r e l a t i o n s h i p between complexity of conception  and a t t i t u d e .  Students enter n u r s i n g programs with e s t a b l i s h e d conceptions and  attitudes.  The  goal i n p l a n n i n g  computer  programs must be t o sequence computer content through the  use  of a taxonomy of l e a r n i n g outcomes, so t h a t q u a l i t y of learning i s a p r i o r i t y ,  and p o s i t i v e a t t i t u d e s are  fostered.  iv TABLE OF CONTENTS Table o f Contents L i s t of Tables L i s t of Figures Acknowledgement  ..  i i x x i  v x i i  .  1  CHAPTER 1. INTRODUCTION BACKGROUND  4  A National  Study.  4  A Provincial Project  7  Local Factors.......  8  PURPOSE  9  REASEARCH MODEL: NURSING INFORMATICS PYRAMID  11  RESEARCH QUESTIONS.  13  D E F I N I T I O N OF TERMS.  .'  14  2. REVIEW OF LITERATURE..  18  COMPUTERS I N HOSPITALS  19  E v o l u t i o n o f Computers i n H o s p i t a l s  19  D e v e l o p m e n t s i n Canada  20  Developments i n B r i t i s h Columbia  22  Computer Support F o r N u r s i n g P r a c t i c e  26  I s s u e s C o n c e r n i n g C o m p u t e r Use  28  ATTITUDES TOWARD COMPUTER USE  29  D e f i n i t i o n Of A t t i t u d e H i s t o r i c a l R e v i e w Of S t u d i e s A t t i t u d e s Toward Computers Factors  A f f e c t i n g Usage  30 On N u r s e s ' 30 37  v LEARNING TO USE COMPUTERS  39  L e a r n i n g Need....  40  L e a r n i n g Needs Of N u r s e s R e g a r d i n g C o m p u t e r s . . . .  42  Computer L i t e r a c y F o r Nurses  48  E v a l u a t i o n Of L e a r n i n g  52  SUMMARY.  ..  3. METHODOLOGY  56  58  DESCRIPTION OF SUBJECTS  .  59  Sample S e l e c t i o n . . . . . .  ••••  59  S u b j e c t s ' E x p o s u r e To C o m p u t e r C o n t e n t  63  INSTRUMENTATION  66  PROCEDURES.....  68  Data C o l l e c t i o n . . . Researcher's Role  ....  68 71  :  ANALYSIS OF INTERVIEWS  75  Formative Analysis  75  Summative A n a l y s i s  78  A n a l y s i s Of C o n c e p t u a l D a t a  79  A n a l y s i s Of A t t i t u d i n a l D a t a  86  A n a l y s i s Of R e s p o n d e n t  89  ESTABLISHING V A L I D I T Y SUMMARY  Profiles  AND R E L I A B I L I T Y  90 93  vi FINDINGS  ..  PRIMARY FINDINGS. .  94  .  95  CONCEPTUAL FINDINGS  95  A w a r e n e s s Of C o m p u t e r Use By H o s p i t a l E m p l o y e d N u r s e s Today  96  K n o w l e d g e Of How C o m p u t e r s May Be U s e d By H o s p i t a l E m p l o y e d N u r s e s I n The F u t u r e . . . . . . C a t e g o r i e s Of C o n c e p t i o n s May  Of How  Computers  Impact H o s p i t a l Employed Nurses Nursing  Image;.  I l l  .  112  P a t i e n t Care Workload  102  116 ,..  121  Professionalism  126  C o m p l e x i t y Of C o n c e p t i o n s .... R e l a t i o n s h i p Of C o n c e p t i o n To C l i n i c a l Experience. ... ATTITUDINAL  131 135  FINDINGS.  136  D e s i r e To P u r c h a s e A Computer Or To Take A Computer C o u r s e .  136  R a t i n g On An A t t i t u d e S c a l e . . . . . . . . .  138  R e l a t i o n s h i p Between C o n c e p t i o n  And Attitude.-143  SECONDARY FINDINGS. DEMOGRAPHICS. ....... . .  . 146 ....  ... 147  Age. . .  147  F o r m a l E d u c a t i o n P r i o r To E n t e r i n g The Cariboo C o l l e g e N u r s i n g Program  14 9  Amount Of E d u c a t i o n S p e c i f i c To C o m p u t e r s O b t a i n e d O u t s i d e The C a r i b o o C o l l e g e N u r s i n g Program 151 E n v i r o n m e n t F o r F i r s t Hands-On C o m p u t e r Experience........  153  vii C o m p u t e r E x p e r i e n c e I n The C a r i b o o C o l l e g e N u r s i n g Program  155  V i e w s On C o m p u t e r C o n t e n t C o l l e g e N u r s i n g Program  156  I n The C a r i b o o  COMPUTER ACCESS AND . USAGE  159  C o m p u t e r A c c e s s A n d Usage A t C a r i b o o C o l l e g e . 1 5 9 C o m p u t e r A c c e s s A n d Usage A t Home  163  F a m i l y U s e - O t h e r Than V i d e o Games......... 164 Spouse Or S i g n i f i c a n t  Other  Children. ...  164 164  SUMMARY OF PRIMARY AND SECONDARY FINDINGS  165  DISCUSSION, CONCLUSION  168  RECOMMENDATIONS, SIGNIFICANCE, AND  DISCUSSION  OF FINDINGS  168  DISCUSSION  OF PRIMARY FINDINGS  169  Research Question 1 Research Questions Research Question DISCUSSION  169 (a) a n d (b)  (c)  OF SECONDARY FINDINGS  179 185 187  Demographics  187  Computer A c c e s s And Usage.  189  G E N E R A L I Z A B I L I T Y OF FINDINGS  190  LIMITATIONS  191  OF THE STUDY.  RECOMMENDATIONS......  193  G e n e r a l Recommendations  193  L o c a l Recommendations.  194  viii SIGNIFICANCE OF RESEARCH  196  CONCLUSION  198  REFERENCES  .  . 200  APPENDICES A. COMPUTER SYSTEMS I N CANADIAN HOSPITALS  208  B. LETTER REQUESTING PERMISSION TO INTERVIEW  209  C. LETTER OF PERMISSION FROM CARIBOO COLLEGE  .. 211  D. LETTER OF INTRODUCTION E. CONSENT FORM. . . F. INTERVIEW SCHEDULE G. RESEARCH AUTHORIZATION. ... .  212 213 215 219  H. THEMES  220  I . CATEGORIES GROUPED  221  J . COMPUTER USE BY NURSES  222  ix L I S T OF TABLES TABLES 1. STRUCTURE OF THE CARIBOO COLLEGE NURSING PROGRAM BY YEARS, SEMESTERS, AND C L I N I C A L ROTATIONS  15  2. NUMBER OF C L I N I C A L HOURS I N EACH SEMESTER AND YEAR OF THE CARIBOO COLLEGE NURSING PROGRAM  .  17.  3. FREQUENCY OF MALE AND FEMALE STUDENTS I N THE A C C E S S I B L E POPULATION OF CARIBOO COLLEGE NURSING STUDENTS FROM WHICH A SAMPLE WAS DRAWN  .  63  4. SCHEDULED HOURS OF COMPUTER AWARENESS CONTENT I N EACH SEMESTER OF THE CARIBOO COLLEGE NURSING PROGRAM.  66  5. CHARACTERISTICS OF QUALITY OF CONCEPTION  84  6. FREQUENCY OF RESPONSE INDICATING STUDENTS' KNOWLEDGE OF HOW COMPUTERS WILL BE USED I N HOSPITAL NURSING I N THE FUTURE  107  7. RANKING OF CATEGORIES BY PERCENTAGE OF SUBJECTS' I N EACH YEAR WHO DISCUSSED THE CATEGORY  129  8. PERCENTAGE OF SUBJECTS WHO DISCUSSED EACH CATEGORY AND SUB-CATEGORY OF CONCEPTION  130  9. FREQUENCY OF HIGH AND LOW LEVEL RESPONSES INDICATING COMPLEXITY OF CONCEPTION  132  10. FREQUENCY OF RESPONSE INDICATING THE NUMBER OF CATEGORIES OF CONCEPTION DISCUSSED  133  1 1 . FREQUENCY OF RESPONSE OF.RATINGS ON A F I V E POINT LIKERT-TYPE ATTITUDE SCALE  142  ;  12. FREQUENCY OF RESPONSE OF SUBJECTS' ATTITUDES TOWARD COMPUTER USE I N HOSPITALS. . . .  143  13. FREQUENCY OF RESPONSE RELATING LEVEL OF CONCEPTION AND ATTITUDE  146  1.4. AGE RANGES OF SUBJECTS I N EACH YEAR OF THE CARIBOO COLLEGE NURSING PROGRAM  148  15. FORMAL EDUCATION PRIOR TO ENTERING THE CARIBOO COLLEGE NURSING PROGRAM.  150  16. AMOUNT OF FORMAL EDUCATION S P E C I F I C TO COMPUTERS OBTAINED OUTSIDE THE CARIBOO COLLEGE NURSING PROGRAM. 151  X  17. SETTINGS OUTSIDE THE CARIBOO COLLEGE NURSING PROGRAM WHERE FORMAL COMPUTER EDUCATION WAS OBTAINED  153  18. I N I T I A L HANDS-ON COMPUTER EXPERIENCE I N NURSING AND NON-NURSING ENVIRONMENTS  154  19. PERCENTAGE OF SUBJECTS I N EACH YEAR WHO CARIBOO COLLEGE VAX SYSTEM  160  USE THE  20. BARRIERS I D E N T I F I E D BY SUBJECTS TO USE OF THE CARIBOO COLLEGE VAX SYSTEM  161  2 1 . FREQUENCY OF SUBJECTS WITH ACCESS TO A COMPUTER AT HOME  163  xi L I S T OF FIGURES FIGURES 1. NURSING INFORMATICS (NI) PYRAMID 2. RELATIONGHIP OF SUB-CATEGORIES TO CATEGORIES CONCEPTION 3. NURSES AND TECHNOLOGY  12 OF  166 199  xii ACKNOWLEDGEMENTS  I w i s h t o e x p r e s s my a p p r e c i a t i o n t o t h e members o f my t h e s i s committee:  Dr. D a n i e l P r a t t ,  and Dr. H a r o l d  f o r t h e i r a d v i c e and c o n s t r u c t i v e c r i t i c i s m . thank  Ratzlaff  I a l s o wish t o  t h e a d m i n i s t r a t i o n o f C a r i b o o C o l l e g e i n Kamloops,  B r i t i s h C o l u m b i a f o r t h e i r m o n e t a r y s u p p o r t , a n d my c o l l e a g u e s i n t h e N u r s i n g department f o r t h e i r and e n c o u r a g e m e n t .  I owe a s i n c e r e d e b t  understanding  to the nursing  students at Cariboo College f o r t h e i r w i l l i n g  participation  i n t h e study. Finally,  I owe a d e b t  f o r h i s constant support  o f g r a t i t u d e t o my h u s b a n d ,  Carl,  a n d l o v i n g e n c o u r a g e m e n t , a n d t o my  c h i l d r e n , Mark a n d S u z a n n e f o r t h e i r p a t i e n c e a n d understanding.with  a Mom e n g a g e d i n g r a d u a t e  f i v e year p e r i o d .  I t h a n k my Dad, James Guppy, f o r h i s  encouragement toward and my m o t h e r - i n - l a w ,  advanced e d u c a t i o n e a r l y Grace Abbott,  p r o v i d e d my c h i l d r e n i n my a b s e n c e .  s t u d i e s over a  i n my c a r e e r ,  f o r t h e l o v i n g care she  1 CHAPTER 1 Introduction  There i s l i t t l e  d o u b t t h a t we a r e l i v i n g  i n an  i n c r e a s i n g l y t e c h n o l o g i c a l s o c i e t y , where i n f o r m a t i o n i s being has  generated a t a p r e v i o u s l y unheard o f r a t e .  trend  p r o f o u n d i m p l i c a t i o n s f o r s o c i e t y , a s a t t e m p t s a r e made  t o adapt t o these f o r c e d The  h e a l t h care  changes.  system i s moving toward i n c r e a s e d  c o m p u t e r t e c h n o l o g y a s a means o f p r o c e s s i n g information. and  This  l a r g e volumes o f  Movement i n t h i s d i r e c t i o n p o s e s many  concerns, not only  use o f  questions  f o rh e a l t h care p r a c t i t i o n e r s  t h e m s e l v e s , b u t f o r t h e i n s t i t u t i o n s where t h e s e p r a c t i t i o n e r s a r e e d u c a t e d a n d t h e p r a c t i c e s e t t i n g s where t h e y a r e employed. In B r i t i s h Columbia computers and computer a p p l i c a t i o n s o f t e c h n o l o g y have been q u i e t l y c r e e p i n g  into health  s e t t i n g s a t a steady r a t e over t h e l a s t decade. the  care  Nurses a r e  l a r g e s t s i n g l e group o f h e a l t h p r o f e s s i o n a l s employed i n  h e a l t h care  settings i n this.province.  A s s o c i a t i o n Of B r i t i s h C o l u m b i a  The R e g i s t e r e d  (R.N.A.B.C.) r e p o r t s  t h e r e w e r e 24,128 p r a c t i s i n g members i n May, 1988.  Nurses that  Because  o f t h e i r numbers, n u r s e s w i l l  h a v e a t r e m e n d o u s i n f l u e n c e on  the  use o f computers i n p r a c t i c e  adoption of the increased  settings.  I n d i v i d u a l acceptance i s c r i t i c a l  o r f a i l u r e o f any i n n o v a t i o n  t o the success  such as use o f computers  (Hall &  2 Louckes,  1979).  Some l i t e r a t u r e s u g g e s t s t h a t n u r s e s a r e w i l l i n g a n d ready t o begin t h e e d u c a t i o n a l process o f l e a r n i n g t h e technical skills computers  required f o rsatisfactory u t i l i z a t i o n of  (Krampf & R o b i n s o n ,  technical skills  1984).  While a c q u i s i t i o n o f  i s v e r y i m p o r t a n t , i n s t i t u t i o n s must become  c o n c e r n e d w i t h how t h e y c a n p r o v i d e a c o m f o r t a b l e f e e l i n g o f acceptance There  f o r t h e s e i n n o v a t i o n s (Krampf & R o b i n s o n ,  i slittle  information i n the literature  development o f t h e a f f e c t i v e domain o f u s e r s .  1984).  about Gaps e x i s t  c o n c e r n i n g nurses' a t t i t u d e s toward t h e use o f computers and how t h e u s e o f c o m p u t e r s w i l l  affect their role.  s u r v e y s on a c c e p t a b i l i t y h a v e b e e n c o n d u c t e d systems  have been implemented  Miller,  & Bailey,  1975).  (Whitehouse,  after  Most computer  Preston, Tobin,  I f n u r s e s a r e t o be p r o a c t i v e ,  r a t h e r t h a n r e a c t i v e t o c h a n g e , more e d u c a t i o n i s n e e d e d t o h e l p n u r s e s make w i s e c h o i c e s a b o u t t h e s e i n n o v a t i o n s w h i c h may i n t u r n , h a v e i m p a c t upon t h e i r The  practice.  i n c r e a s i n g use o f computers i n h e a l t h c a r e has  profound i m p l i c a t i o n s f o r n u r s i n g e d u c a t i o n (Ronald, There of  1983).  i s growing evidence o f a surge o f i n t e r e s t by s c h o o l s  n u r s i n g i n computer t e c h n o l o g y .  This interest  presumably,  i s due i n p a r t t o t h e i n c r e a s e d u s e o f c o m p u t e r s i n n u r s i n g a d m i n i s t r a t i o n and p r a c t i c e Romano, 1986) .  ( P a r k s , Damrosch, H e l l e r , &  However, v e r y few a u t h o r s a d d r e s s t h e  e d u c a t i o n a l needs r e l a t e d t o t h e u s e o f computers by h e a l t h  3 care p r o f e s s i o n a l s ,  i n either their i n i t i a l educational  programs, or through c o n t i n u i n g e d u c a t i o n a c t i v i t i e s  (Hannah,  1983) . T h e r e i s a d e a r t h o f i n f o r m a t i o n on what n u r s e s  and  n u r s i n g s t u d e n t s c u r r e n t l y . k n o w and d e s i r e t o know a b o u t computers  (Parks e t a l , 1986).  major American  I t appears  that only four  s t u d i e s i d e n t i f y i n g t h e l e a r n i n g needs o f  n u r s e s have been r e p o r t e d i n t h e l i t e r a t u r e i n t h e decade  (Walker,  & P a r k s 1985;  1981;  Ronald,  1983;  & Parks e t a l . 1986).  last  H e l l e r , Romano, D a m r o s c h , Ronald  (1983)  focused  h e r a t t e n t i o n on t h e l e a r n i n g n e e d s o f n u r s e e d u c a t o r s , w h i l e Walker  ( 1 9 8 1 ) , H e l l e r e t a l . ;(1985) and P a r k s e t . a l .  (1986),  s t u d i e d t h e l e a r n i n g needs o f s t u d e n t n u r s e s e n r o l l e d i n b a c c a l a u r e a t e or masters  programs. .  As a d i r e c t r e s u l t o f a t t e m p t s t o i d e n t i f y l e a r n i n g needs i n r e l a t i o n t o computers,  nurses'  a number o f  p r e s c r i p t i v e a r t i c l e s and t e x t s h a v e b e e n w r i t t e n 1982;  S k i b a , 1983;  Skiba,  1987) .  approaches  Ronald,  1983;  Hannah, 1983;  (Edmunds,  & Ronald  T h e s e a u t h o r s p r e s e n t s t e p by s t e p "how  & to"  f o r c u r r i c u l u m p l a n n i n g and f o r c o n t e n t  development.  T h e i r w r i t i n g appears  q u a n t i t y o r amount o f c o n t e n t t o be  t o be  f o c u s e d on  the  i n c l u d e d when d e v e l o p i n g  c o m p u t e r a w a r e n e s s c o u r s e s , r a t h e r t h a n on a s s e s s m e n t o f t h e q u a l i t y of The  learning.  absence of r e p o r t e d s t u d i e s i s evidence of a v o i d  i n f o r m a t i o n a v a i l a b l e on s t u d e n t s e n r o l l e d i n c o m m u n i t y  of  4 c o l l e g e n u r s i n g p r o g r a m s i n Canada i n t e r m s o f t h e i r a t t i t u d e t o w a r d , k n o w l e d g e o f , and computers i n n u r s i n g . graduates of these addition,  One  must be  cognizant  to  of the  fact  that  p r o g r a m s p r i m a r i l y work i n h o s p i t a l s .  information concerning  conceptions and  l e a r n i n g needs, i n r e g a r d  nursing  In  students'  about the r o l e of computers i n h o s p i t a l n u r s i n g  the q u a l i t y of t h e i r conceptions  e x i s t e n t i n the  a p p e a r s t o be  non-  literature.  Background  A National  I n M a r c h 1987,  The  Study  National Federation  Of N u r s e s '  r e l e a s e d t h e r e s u l t s o f i t s t h i r t e e n month n a t i o n a l This three part study, principal  e n t i t l e d I n f o s t a t , prepared  i n v e s t i g a t o r Kay  study. by  Desborough, s t u d i e d r e g i s t e r e d  nurses c u r r e n t l y u s i n g computers i n Canadian h e a l t h agencies.  The  p u r p o s e was  t o document t h e e f f e c t s  care and  i m p l i c a t i o n s o f p a t i e n t management s y s t e m s on n u r s e s nursing care, and  and  to provide nursing leaders with  q u a n t i t a t i v e i n f o r m a t i o n t o d i r e c t and  making f o r c u r r e n t use  and  Unions  support  f u t u r e development of  and  qualitative decision these  systems. S t u d y 1 was  a q u a l i t a t i v e research  study  i n v o l v i n g taped  i n t e r v i e w s w i t h 45 r e g i s t e r e d n u r s e s f r o m n i n e h e a l t h  care  5 agencies use  i n E a s t e r n , C e n t r a l and W e s t e r n C a n a d a .  of the constant  conceptual  comparative  (a) t h e c o n t e x t  computer e d u c a t i o n , personal  a n a l y s i s technique,  c a t e g o r i e s emerged from t h e d a t a .  c a t e g o r i e s were:  Through  (a s e t o f  four  These interrelated  o r g a n i z a t i o n a l , computer system,  and  f a c t o r s ) i n which t h e computer system i s used;  (b) t h e e f f e c t s on t h e n u r s e ; o f n u r s i n g c a r e ; and generated  (c) t h e e f f e c t s on t h e d e l i v e r y  (d) t h e e f f e c t s on t h e p a t i e n t .  the hypothesis  computerized  that the context  c a r e , and  Study 1  i n which nurses  the d e l i v e r y of nursing .  on p a t i e n t s .  Study 2 s e t out t o q u a n t i f y t h e f a c t o r s i d e n t i f i e d s u b j e c t s i n S t u d y 1 and  o f n u r s i n g c a r e , and p a t i e n t s .  the d e l i v e r y  A 50 q u e s t i o n s u r v e y  u s i n g t h e f a c t o r s i d e n t i f i e d i n S t u d y 1,  c o m p l e t e d by agencies  393  r e g i s t e r e d nurses  tool,  was  i n fourteen health  care  i n Canada.  I t was  found t h a t the context  s y s t e m i s u s e d by n u r s e s  i n which the  computer  d e t e r m i n e s t h e e f f e c t s on  t h e d e l i v e r y o f n u r s i n g c a r e , and p a t i e n t s .  Of  relevance  were  i n shaping  the focus of t h i s study  correlational findings indicating:  (a) a  r e l a t i o n s h i p between computer e d u c a t i o n nurses'  by  t o determine t h e r e l a t i o n s h i p between  and t h e e f f e c t s o f c o m p u t e r s on n u r s e s ,  compiled  use  p a t i e n t i n f o r m a t i o n management s y s t e m s  d e t e r m i n e s t h e e f f e c t s on n u r s e s ,  context  the  nurses,  particular  positive  f a c t o r s and  the  p e r c e p t i o n s of the e f f e c t s of u s i n g computers  on  6 nurses,  (b) a n e g a t i v e r e l a t i o n s h i p b e t w e e n c o m p u t e r  system  f a c t o r s and t h e n u r s e s ' p e r c e p t i o n s o f t h e e f f e c t s o f u s i n g computers  on n u r s e s ,  use o f c l i n i c a l  (c) a p o s i t i v e r e l a t i o n s h i p b e t w e e n t h e  a p p l i c a t i o n s and t h e n u r s e s ' p e r c e p t i o n s o f  t h e e f f e c t s o f u s i n g computers c a r e a n d on p a t i e n t s ,  and  on t h e d e l i v e r y o f n u r s i n g  (d) a s i g n i f i c a n t  relationship  b e t w e e n t h e age o f t h e n u r s e a n d t h e n u r s e s ' p e r c e p t i o n s o f t h e adequacy of computer In a d d i t i o n ,  training.  comments f r o m t h e n u r s e s i n d i c a t e d a number  o f f i n d i n g s w h i c h were a l s o r e l e v a n t i n s h a p i n g t h i s R e l e v a n t f i n d i n g s were: knowledge about  computers,  (a) few n u r s e s h a v e a b r o a d (b) many n u r s e s h a v e p r o b l e m s  e n t e r i n g d a t a from a keyboard, computer s e c u r i t y ,  study.  (c) n u r s e s f e e l u n e a s y  with  about  (d) some n u r s e s were n e g a t i v e a b o u t  computer system f a c t o r s , e s p e c i a l l y i n terms o f slow  response  t i m e , d o w n t i m e , and t h e s t r u c t u r e and u s e f u l n e s s o f c o m p u t e r applications,  (e) more o l d e r t h a n y o u n g e r  nurses, reported  t h a t t h e t r a i n i n g t o use t h e computer had been i n a d e q u a t e , ( f ) many n u r s e s r e p o r t e d s t r e s s , , f r u s t r a t i o n and d i s c o m f o r t a s s o c i a t e d w i t h u s i n g computers,  (g) n u r s e s e x p r e s s e d  c o n c e r n s about t h e l e g a l and e t h i c a l w i t h u s i n g computers,  implications  associated  (h) most n u r s e s were t o l d t h a t  systems were e x p e c t e d t o i n c r e a s e e f f i c i e n c y  computer  and  e f f e c t i v e n e s s , b u t i n s t e a d t h e y have added t o w o r k l o a d , ( i ) n u r s e s c o m p l a i n e d t h a t computer systems t h a t were supposed  t o save t i m e , are i n o r d i n a t e l y  time-consuming.  and  7 Part 3 involved the dissemination t h i s study t o Canadian nurses. indicate that despite  of the findings  from  O v e r a l l f i n d i n g s of the study  a l a r g e number o f n e g a t i v e  about t h e use o f computers by n u r s e s ,  comments  65.5% o f t h o s e  sampled  w o u l d recommend t h e u s e o f c o m p u t e r s f o r m a n a g i n g p a t i e n t information.  I m p l i c a t i o n s and recommendations from t h e s t u d y  were i d e n t i f i e d f o r t h e N u r s e s U n i o n s , N u r s i n g Nursing  P r a c t i c e , Nursing  Research. educating  Administration,  and  Education, Nursing  The r e c o m m e n d a t i o n : t h a t t h o s e i n v o l v e d i n p r o f e s s i o n a l nurses c o l l a b o r a t e t o develop  g u i d e l i n e s f o r t r a i n i n g n u r s e s t o use computers f o r managing patient information  was a f a c t o r i n s h a p i n g t h i s  A Provincial  study.  Project  I n M a r c h 1987, t h e M i n i s t r y o f A d v a n c e d E d u c a t i o n a n d Job  T r a i n i n g i n B r i t i s h Columbia provided  funding  support t o  the B r i t i s h Columbia I n s t i t u t e o f Technology t o develop course materials  f o r n u r s e s and n u r s i n g  to the perceived  need f o r nurses t o l e a r n about computers.  The p r o j e c t ,  entitled,  i n J u n e , 1987. outset  Computers I n N u r s i n g  P r o j e c t , began  (a) r e v i e w o f e x i s t i n g  and i n f o r m a l  co-ordinators  materials,  interviews with nurse educators at  s e l e c t e d n u r s i n g programs, nursing  i n response  D a t a was c o l l e c t e d f r o m f o u r s o u r c e s a t t h e  of the project:  (b) f o r m a l  students,  (c) i n f o r m a l  interviews  with  o f h o s p i t a l computer systems i n v a r i o u s  8 Vancouver nursing  h o s p i t a l s , and  (d) random s a m p l i n g o f t h e  general  populace.  I n p u t f r o m t h e s e s o u r c e s was curriculum.  The  used t o develop  curriculum included three  a  modules:  (a) b a s i c c o m p u t e r l i t e r a c y , .(b) an o v e r v i e w o f c o m p u t e r a p p l i c a t i o n s i n h e a l t h c a r e , and professional issues. all  The  (c) l e g a l ,  and  t h r e e m o d u l e s were d i s t r i b u t e d  n u r s i n g programs i n B r i t i s h Columbia  1988,  ethical  i n May  and June o f  w i t h t h e e x p e c t a t i o n t h a t t h e y w o u l d be t a i l o r e d  to  meet t h e n e e d s o f i n d i v i d u a l p r o g r a m s , and i n c o r p o r a t e d n u r s i n g c u r r i c u l a i n September,  Local  Factors  (R.N.) d i p l o m a p r o g r a m i n n u r s i n g .  Its faculty,  c o l l e g e a d m i n i s t r a t i o n , i s l o b b y i n g f o r degree s t a t u s i n response t o the Canadian ( a d o p t e d i n 1982)  into  1988.  Cariboo College c u r r e n t l y o f f e r s a Registered  position  to  Nurses  Nurse  supported  by  granting  Association  that the baccalaurate  degree  s h o u l d be t h e o n l y e n t r y l e v e l t o p r o f e s s i o n a l n u r s i n g p r a c t i c e i n C a n a d a by t h e y e a r 2000. C o l l e g e a d m i n i s t r a t i o n i s committed  A d d i t i o n a l l y , the to implementing  computer  t e c h n o l o g y a n d i s e n c o u r a g i n g a l l i t s f a c u l t y and s t a f f become c o m p u t e r l i t e r a t e , who  purchase  of charge.  computers, The  to  by o f f e r i n g t a x b e n e f i t s t o t h o s e  a n d by m a k i n g c o u r s e s a v a i l a b l e f r e e  C a r i b o o C o l l e g e n u r s i n g department  is  9 r e p r e s e n t e d b y a f a c u l t y member on t h e C o m p u t e r s  In Nursing  Project.  T h i s i n d i c a t e s t h e d e p a r t m e n t ' s commitment t o  advancing  c o m p u t e r u s e amongst  Royal  i t s student  body.  I n l a n d H o s p i t a l , t h e only acute care f a c i l i t y i n  Kamloops, i s p r e s e n t l y i n t h e b e g i n n i n g  stages of  i m p l e m e n t i n g a h o s p i t a l p a t i e n t management s y s t e m (HPMS) s u p p l i e d by T r a v e n o l H e a l t h c a r e  I n f o r m a t i o n S e r v i c e s , Canada.  The p r o j e c t e d p l a n i s f o r n u r s e s  t o be u s i n g c o m p u t e r s on t h e  nursing u n i t s within f i v e years. c l i n i c a l placements f o r Cariboo w e l l a s p r o v i d i n g employment  This f a c i l i t y  provides  C o l l e g e n u r s i n g s t u d e n t s , as  f o rthe majority of i t s nursing  graduates.  Purpose  Developments c o n c e r n i n g computer t e c h n o l o g y  on t h e  Canadian n u r s i n g scene n a t i o n a l l y , p r o v i n c i a l l y and l o c a l l y , c o u p l e d w i t h i d e n t i f i e d gaps i n t h e l i t e r a t u r e , evidenced  especially  by t h e l a c k o f r e s e a r c h i n v o l v i n g s t u d e n t  e n r o l l e d i n community  c o l l e g e n u r s i n g programs, s e r v e as  i n d i c a t o r s o f t h e need f o r f u r t h e r study.  I t would appear  that the s i t u a t i o n regarding the implementation and computer t e c h n o l o g y  i n nursing education  Columbia, a t t h e present time, politicians,  nurses  i s solely  o f computers  in British  i n t h e hands o f  a d m i n i s t r a t o r s , a n d f a c u l t y , who a l l c l a i m t o  have t h e i n t e r e s t s o f t h e s t u d e n t  and q u a l i t y e d u c a t i o n a t  10 heart.  Unfortunately,  nursing students,  who  t h i s does not will  due  t o t h e i n c r e a s e d use  and  the p r a c t i c e s e t t i n g s . The  primary  be  allow for input  d i r e c t l y a f f e c t e d by  of computers i n both the  purpose of t h i s study  nursing students,  from  changes educational  i s to identify  i n a community c o l l e g e n u r s i n g  how  program,  c o n c e p t u a l i z e the r o l e of computers i n h o s p i t a l n u r s i n g . i s the researcher's  It  b e l i e f that i n order to s u c c e s s f u l l y  implement computer content: i n t o n u r s i n g c u r r i c u l a i n t h i s province to  and  indeed  nationally,  an a t t e m p t must f i r s t  understand the perspective, of the  content By  is  students  conceptualize the  c o m p u t e r s i n h o s p i t a l n u r s i n g and by  clinical  analyzing  i n r e l a t i o n t o the nurse's:  e x p o s u r e , and  researcher's  of  where t o  i n t o the c u r r i c u l a of  o f n u r s i n g may  be  facilitated.  community  The  u l t i m a t e g o a l i s t o promote p o s i t i v e acceptance  t o w a r d computer use q u a l i t y of student  Although  of  (b) a t t i t u d e t o w a r d c o m p u t e r s , i t i s  i n c o r p o r a t e computer content college schools  role  their  (a) l e n g t h  a n t i c i p a t e d t h a t d e c i s i o n s a b o u t when, and  responding  f o r whom t h e  intended.  i d e n t i f y i n g how  complexity  students  be made  i n h o s p i t a l n u r s i n g and  to increase  l e a r n i n g about computers i n n u r s i n g  t o a knowledge.of the student's  i t i s recognized  t h e s i s i s q u a l i t y of l e a r n i n g .  by  perspective.  t h a t b o t h t h e q u a n t i t y and  of l e a r n i n g are e q u a l l y important,  the  quality  t h e main i s s u e i n t h i s  11 Research Model: Nursing  In  o r d e r t o more e f f e c t i v e l y  p o s e h y p o t h e s e s , and in  Informatics Pyramid  interpret results,  nursing informatics w i l l  t h i s study.  Nursing  identify i n i t i a l  i n f o r m a t i c s (NI)  i s t h e use  of  i s one  The  and u s e r s , a r e a r r a n g e d  NI  s t r u c t u r e , i n which to  research  (Schwirian,  1986).  technology,  t o form the t r i a n g u l a r base of  pyramid, d e p i c t i n g the f a c t that they The  (see  model f o r r e s e a r c h i n n u r s i n g i n f o r m a t i c s  l o c a t e meaningful  i n t e r a c t t o form  apex o f t h e p y r a m i d i s t h e g o a l o r  the NI  the  o b j e c t i v e toward which a l l the other elements are d i r e c t e d . The  i n t e r a c t i v i t y of a l l the elements i s b i d i r e c t i o n a l ,  nature  a l l o w i n g an i n v e s t i g a t o r t o e n t e r t h e m o d e l a t  p o i n t i n terms of p o s i n g r e s e a r c h questions h y p o t h e s e s , w h i l e a t t h e same t i m e , to  s e e where a p a r t i c u l a r s t u d y  o f k n o w l e d g e r e l a t e d t o NI  fits  or  in any  developing  a l l o w i n g the  researcher  i n t o t h e l a r g e r scheme  (Schwirian,  1986).  of  to  NI P y r a m i d  Three elements of the model, i n f o r m a t i o n ,  activity.  guide  i n r e l a t i o n t o the care  (Hannah, 1 9 8 5 ) .  which provides a four-dimensional d e v i s e and  research  or the e d u c a t i o n a l p r e p a r a t i o n of i n d i v i d u a l s  p r a c t i c e the d i s c i p l i n e F i g u r e 1)  a model f o r  be u s e d as a f r a m e w o r k t o  i n f o r m a t i o n t e c h n o l o g i e s by n u r s e s patients,  questions,  12 GOAL  COMPUTER HARDWARE INFORMATION  SOFTWARE  1 USER I CONTEXT F i g u r e 1.  Nursing  Informatics  (NI) P y r a m i d  ( S c h w i r i a n , 1986, p . 135)  For t h e purposes o f t h i s study, and  t h i r d year n u r s i n g students  USERS a r e f i r s t ,  second,  e n r o l l e d i n a community  c o l l e g e n u r s i n g p r o g r a m w h i c h i s p r e p a r i n g them f o r employment i n h o s p i t a l s . awareness content  INFORMATION i s t h e c o m p u t e r  ands k i l l s t h a t student  nurses,  enrolled i n  c o m m u n i t y c o l l e g e n u r s i n g p r o g r a m s , n e e d t o work  comfortably  :  and  e f f e c t i v e l y w i t h computers i n h o s p i t a l s .  the a c c e s s i b i l i t y and a v a i l a b i l i t y software skills,  t o f a c i l i t a t e both  o f computer hardware and  (a) a c q u i s i t i o n o f c o m p u t e r  a n d (b) u s e i n t h e j o b s e t t i n g .  (a) t h e p r i m a r y  TECHNOLOGY i s  GOALS a r e t w o - f o l d :  g o a l i s t o d e t e r m i n e how s t u d e n t  nurses  c o n c e p t u a l i z e t h e r o l e and f u n c t i o n o f computers as they e f f e c t n u r s e s i n h o s p i t a l s , a n d (b) t h e s e c o n d a r y g o a l i s t o i d e n t i f y how t h e f i n d i n g s may b e i n c o r p o r a t e d i n t o  planning  f o r implementing  computer c o n t e n t  i n community  college  nursing curricula.  Research  One b r o a d  Questions  and t h r e e s p e c i f i c q u e s t i o n s guided  this  study:  1. How do n u r s i n g s t u d e n t s  i n a community  college nursing  program c o n c e p t u a l i z e t h e r o l e o f computers i n h o s p i t a l nursing?  (a)  Is there a difference  i n c o m p l e x i t y among  second, and t h i r d - y e a r n u r s i n g s t u d e n t s ' of t h e r o l e o f computers i n h o s p i t a l  (b)  experience?  What i s t h e r e l a t i o n s h i p b e t w e e n n u r s i n g conceptions  students'  o f the. r o l e o f c o m p u t e r s i n h o s p i t a l  n u r s i n g , and t h e i r a t t i t u d e hospital  students'  o f t h e r o l e o f computers i n h o s p i t a l  n u r s i n g , and l e n g t h o f c l i n i c a l  (c)  conceptions  nursing?  What i s t h e r e l a t i o n s h i p b e t w e e n n u r s i n g conceptions  first,  nursing?  toward  computers i n  D e f i n i t i o n Of  The  Terms  t e r m s r e l e v a n t t o t h i s s t u d y a r e l i s t e d and  defined  below.  Community C o l l e g e N u r s i n g P r o g r a m : taught  i n three settings:  and u n i v e r s i t y .  N u r s i n g i n Canada i s  hospital,  community  T h i s s t u d y f o c u s e s on n u r s i n g p r o g r a m s  b a s e d i n t h e community c o l l e g e s e t t i n g . this  college,  s t u d y f o c u s e s on one  More  c o l l e g e program:  specifically,  the  C o l l e g e N u r s i n g Program, i n Kamloops, B r i t i s h  Cariboo Columbia,  Canada.  C a r i b o o C o l l e g e N u r s i n g Program:  The  n u r s i n g program at  C a r i b o o C o l l e g e i s a t w e n t y - f o u r month p r o g r a m s p r e a d t h r e e academic y e a r s . prepare  I t ' s mandate i s t w o - f o l d :  students t o s u c c e s s f u l l y complete  the  over  (a) t o  national  r e g i s t r a t i o n exams t o e n t e r t h e n u r s i n g p r o f e s s i o n , and (b) t o p r e p a r e  s t u d e n t s t o meet m i n i m a l  standards  of  n u r s i n g p r a c t i c e , as s p e c i f i e d by t h e R e g i s t e r e d N u r s e s A s s o c i a t i o n of B r i t i s h Columbia, e m p l o y e d i n a c u t e and  so t h a t t h e y may  long term care f a c i l i t i e s  g r a d u a t i o n from t h e program.  be  upon  15 Cariboo  C o l l e g e N u r s i n g Program S t r u c t u r e :  month C a r i b o o  Table  twenty-four  C o l l e g e n u r s i n g program i s d i v i d e d  academic years divided  The  and s i x semesters.  into c l i n i c a l  rotations  into  three  Each semester i s f u r t h e r as i n d i c a t e d  i n Table  1.  1.  S t r u c t u r e Of The C a r i b o o Semesters, And C l i n i c a l  YEAR 1  2  3  Nursing:  hospital  ROTATIONS  (September-December)  1  2 (January-April)  1  3 (September-December)  2  4 (January-Apri1)  2  5 (September-December)  2  6 (January-April)  2  Nurses p r a c t i s e  settings.  Years,  Rotations  SEMESTER  1  Hospital  C o l l e g e N u r s i n g P r o g r a m By  nursing i n a variety of  Some h o s p i t a l s  serve c l i e n t s i n a  s p e c i f i c age g r o u p , s u c h a s g e r i a t r i c o r p e d i a t r i c hospitals.  O t h e r s s e r v e t h e needs o f acute  care c l i e n t s ,  a n d some a r e e v e n s p e c i a l i z e d  disease process, The  hospital  general acute nurses  or long term i n terms o f  such as r e h a b i l i t a t i o n and b u r n  setting referred care h o s p i t a l .  t o i n t h i s study  hospitals.  i s the  I n 1985, t h e m a j o r i t y o f  p r a c t i s i n g i n B r i t i s h Columbia worked i n h o s p i t a l s  16 (76.5%) and  p r i m a r i l y i n acute care  News, 1986,  p.  A t t i t u d e s are  p r e d i s p o s i t i o n s w h i c h i n f l u e n c e how  be  or unfavourably.  one  learned responds, e i t h e r  A t t i t u d e s toward computers  o b s e r v e d i n t h e b e h a v i o u r o f an  i n d i v i d u a l such  h i s \ h e r w i l l i n g n e s s o r r e s i s t a n c e t o use t h i s s t u d y , s t u d e n t a t t i t u d e was neutral,  or negative  by  the  students'  The  noting  R o l e Of C o m p u t e r s I n H o s p i t a l f o r m e d by  from p a r t i c u l a r s ( K e r l i n g e r 1986). o u r p a s t e x p e r i e n c e s and learn to conceptualize (Marton, 1981).  generalizations  t h e i r own  reality  as t h e y grow  are  i n hospital nursing be  up  therefore  (b)  u s e d by n u r s e s i n t h e  In a d d i t i o n , the  of  (a) a w a r e n e s s  t o d a y , and  t h i s s t u d y , c o n c e p t i o n s were a n a l y z e d  by  People  Students' conceptions or a b s t r a c t i o n s  c o m p u t e r s may  conception.  formed  i n f l u e n c e our p e r c e p t i o n .  g e n e r a l i z a t i o n s b a s e d on t h e i r :  c o m p u t e r use  Nursing:  Concepts are  r o l e of computers i n h o s p i t a l n u r s i n g  o f how  by  a  comments d i r e c t e d t o w a r d c o m p u t e r s  Conceptions express abstractions  f o r m e d by  r a t i n g s on  interviews  C o n c e p t i o n s Of  the  In  d e t e r m i n e d t o be p o s i t i v e ,  assessing  p o s i t i v e and\or n e g a t i v e  may  as  a computer.  f i v e p o i n t L i k e r t - t y p e a t t i t u d e s c a l e and  during  (R.N.A.B.C.  16).  A t t i t u d e s Toward Computers:  favourably  facilities  knowledge  future.  In  t o form c a t e g o r i e s  q u a l i t y of  of  students'  of  17 c o n c e p t i o n s were a s s i g n e d a r a t i n g o f h i g h o r l o w c o m p l e x i t y b a s e d on s p e c i f i c  Length  characteristics.  Of C l i n i c a l E x p e r i e n c e :  was m e a s u r e d i n h o u r s .  Length  of clinical  experience  I t v a r i e d f o r f i r s t , second, and  t h i r d year Cariboo C o l l e g e n u r s i n g students as o u t l i n e d i n T a b l e 2.  T a b l e 2. Number Of C l i n i c a l H o u r s I n E a c h S e m e s t e r A n d Y e a r Of The C a r i b o o C o l l e g e N u r s i n g Program  YEAR 1  2  3  SEMESTER  SEMESTER  1  95  2  95  3  204  4  204  5  312  6  432  B e c a u s e t h e number o f h o u r s  of clinical  HOURS  YEAR HOURS  190  408  744  experience  i n c r e a s e s s i g n i f i c a n t l y each y e a r , r e l a t i o n s h i p s between s u b j e c t s w i l l be d i s c u s s e d i n t e r m s o f y e a r s i n t h e p r o g r a m throughout  t h e study.  The e x c e p t i o n w i l l be when r e p o r t i n g  and d i s c u s s i n g t h e a n s w e r t o r e s e a r c h q u e s t i o n number t w o .  18 CHAPTER 2 R e v i e w Of  Review of the  literature will  main s u b s e c t i o n s t o a l l o w a logical pattern. Hospitals," It  b e g i n s by  The  B r i t i s h C o l u m b i a and o v e r v i e w o f how  h o s p i t a l s by issues  The  "Computers  an  review of studies  In study.  computers in  This i s followed  a brief introduction  to  use.  " A t t i t u d e Toward C o m p u t e r Use," of the  variables  o f a t t i t u d e b e g i n s by  a t t i t u d e , and  i s followed  by  an  :  i d e n t i f i c a t i o n of  is  in  looking  at  historical  on n u r s e s ' a t t i t u d e s t o w a r d c o m p u t e r  focus s h i f t s to the  by  c u r r e n t l y being used i n  o v e r v i e w o f one  discussion  into  within hospitals  r e s t o f Canada.  t h e n by  of  nurses c o n c e r n i n g computer  what i s meant by  Then t h e  the  three  of materials  a context f o r the  more s p e c i f i c a l l y ,  second subsection  study.  subsection  computers are  aimed at p r e s e n t i n g the  organized into  general evolution  n u r s e s , and  r a i s e d by  The  first  t r a c i n g the  be  for organization  i s aimed at p r o v i d i n g  w i t h i n h o s p i t a l s , and  an  Literature  use.  factors  a f f e c t i n g computer usage. The  t h i r d subsection  " L e a r n i n g , " i s aimed at  presenting  l e a r n i n g as a c h a n g e i n c o n c e p t i o n , t h e r e b y b r i n g i n g o t h e r main v a r i a b l e of the  study i n t o focus.  of l e a r n i n g begins w i t h  attempt to define  and  then turns  to  an  f o c u s on  studies  l e a r n i n g needs of n u r s e s w i t h  The  the  discussion  learning  which i d e n t i f y  r e g a r d t o computers.  need,  the Finally,  19 the  notion  of computer l i t e r a c y  f o r nurses i s discussed/  and  a taxonomy f o r e v a l u a t i n g q u a l i t y o f l e a r n i n g i s b r i e f l y described.  Computers In  The  Hospitals  purpose of t h i s subsection  (a) t r a c e t h e g e n e r a l  h i s t o r i c a l e v o l u t i o n of  technology i n h o s p i t a l s , Canadian context,  is fivefold,  (b) p u t  current  computer use  by  Hospitals  (1984) n o t e t h a t c o m p u t e r s  1 9 5 0 ' s , and  administrative tasks  s u c h as c a l c u l a t i n g p a y r o l l ,  analyzing medical s t a t i s t i c s ,  generating  They p o i n t  out  the p o s s i b i l i t y  (a) h o s p i t a l a d m i n i s t r a t o r s of automating h e a l t h care  (b) e q u i p m e n t became more r e f i n e d and  for  inventory and  that during  f a c t o r s shaped developments toward  computerization:  entered  a t t h a t t i m e were u s e d o n l y  c o n t r o l , t a b u l a t i n g p a t i e n t c h a r g e s and  1960's, t h r e e  concerning  nurses working i n h o s p i t a l s .  Hannah  h o s p i t a l s i n the  overview  used i n h o s p i t a l s to  (e) h i g h l i g h t i s s u e s  E v o l u t i o n Of C o m p u t e r s I n  B a l l and  situation in  (d) p r e s e n t a s h o r t  o f t h e ways i n w h i c h c o m p u t e r s a r e b e i n g s u p p o r t n u r s i n g p r a c t i c e , and  computer  this evolution into a  (c) i d e n t i f y t h e  h o s p i t a l s i n B r i t i s h Columbia,  designed to:  the  increased  were e x p o s e d t o  activities,  sophisticated,  and  20 (c) m a n u f a c t u r e r s r e c o g n i z e d h e a l t h care The  the p o t e n t i a l f o r s a l e s i n  the  market.  1970's saw  t h e d e v e l o p m e n t and  hospital information  installation  of  systems, w i t h s p e c i a l - s e r v i c e computer  f u n c t i o n s , developed f o r s p e c i f i c h o s p i t a l departments such as:  pharmacy, d i e t a r y , r a d i o l o g y , l a b o r a t o r y  electrocardiology. o f f i n d i n g a way  The  focus  1980's has  information  planning, expert  and  the  systems.  refinement of h o s p i t a l  a b e t t e r understanding  information care  i n c r e a s e d use  of i n f o r m a t i o n data bases  Many a u t h o r s ,  i n c l u d i n g O'Brien  has  not  q u i c k l y as o n c e p r e d i c t e d , m a i n l y o f computer hardware,  recently  of  the development of computerized p a t i e n t  note that computerization  knowledge,  one  other.  brought the  s y s t e m s and  needs o f n u r s e s ,  o f d e v e l o p m e n t t h e n became  f o r these i s o l a t e d s p e c i a l - s e r v i c e functions  t o communicate w i t h each The  and  (1984),  advanced i n h e a l t h care due  to:  (a) t h e h i g h  (b) h e a l t h p r o f e s s i o n a l s l a c k  (c) a s h o r t a g e o f p r o c e s s i n g  (d) u n s o p h i s t i c a t e d  and  experts,  and  as  cost  of until  technology.  D e v e l o p m e n t s I n Canada  E f f o r t s a r e u n d e r w a y by the  a v a r i e t y of people to  s t a t u s of computing e f f o r t s  a r t i c l e published reported the  i n t h e The  determine  i n h o s p i t a l s i n Canada.  Canadian Nurse i n June,  1988  r e s u l t s o f a s u r v e y done by K a r e n Webber o f  An  21 H a l i f a x i n M a r c h , 1987. chronic care agencies  She c o n t a c t e d  85 h o s p i t a l s a n d  i n a l l t h e Canadian provinces  and  t e r r i t o r i e s where c o m p u t e r t e r m i n a l s w e r e i n p l a c e on n u r s i n g units.  She f o u n d t h a t a c o m p u t e r s y s t e m was f i r s t  n u r s i n g u n i t i n 1977.  By M a r c h , 1987, t h i r t y  u s e d on a  sites  used  c o m p u t e r s f o r t h e management o f p a t i e n t i n f o r m a t i o n . t h i r t y agencies,  the provinces  as t h e h a r d w a r e , a n d s o f t w a r e compiled  where t h e y  The  a r e found, as w e l l  b e i n g u s e d b y e a c h , were  and p u b l i s h e d i n c h a r t form i n t h e a r t i c l e .  modified version of t h i s chart  ( s e e A p p e n d i x A) p r e s e n t s  sense o f t h e d i v e r s i t y o f systems b e i n g the country  A  and r a i s e s t h e q u e s t i o n  implemented  a  across  o f how n u r s e s w i l l  cope  w i t h t h i s d i v e r s i t y a s t h e y move f r o m one employment situation to  another.  I n 1987, The C a n a d i a n N a t i o n a l H e a l t h C a r e C o m p u t e r S u r v e y was c o n d u c t e d b y The Kennedy G r o u p , an i n d e p e n d e n t health-care  i n f o r m a t i o n s y s t e m s c o n s u l t i n g f i r m b a s e d i n San  Francisco.  This survey  collect  acute  for  337 i n s t i t u t i o n s . this  major attempt t o  i n f o r m a t i o n on a l l C a n a d i a n h o s p i t a l s w i t h more t h a n  150  to  was t h e f i r s t  care beds.  study.  F i n d i n g s have r e c e n t l y been  One f i n d i n g i s o f p a r t i c u l a r  (with the exception  t r a n s f e r , c e n t r a l p a t i e n t index,  of  admissions\  medical  and p h a r m a c y ) i n t h e m a j o r i t y o f i n s t i t u t i o n s limited.  interest  I t was f o u n d t h a t t h e s t a t u s o f a u t o m a t i o n i n  nine p a t i e n t care areas, discharge\  reported  records,  s u r v e y e d was  22 The patient  Kennedy Group p r e d i c t e d c a r e a r e a s was  growth i n the  future.  automation i n major  a n t i c i p a t e d t o be They p o i n t e d  a r e a s , w h i c h i m p a c t on t h e h o s p i t a l s across the  that  out  the that  a l l nine major  d e l i v e r y of p a t i e n t  country, are  N u r s i n g , as  patient  to i n i t i a t e the  care areas, i s poised  care i n  a c t i v e l y planning  s e l e c t i n g automated systems.  t e c h n o l o g y , w h i c h may  most s i g n i f i c a n t  one  of  and  these  use  w e l l i n t u r n , change t h e  for  of  face  such of  the  profession.  Developments In B r i t i s h  The  Columbia  i n t r o d u c t i o n of computers i n t o h o s p i t a l s i n  Columbia appears t o have l a g g e d b e h i n d t h e it and  struggle,  1960's and  computerization w h i c h was  (O'Brien,  1984).  a brief description  In the  consistent  e a r l y 1970's t h e  with the  Association  computers t o run  illustrate  first  r e s t of the  this  hospital  country.  (V.G.H.) and  the  (B.C.H.A.) a c q u i r e d  f i n a n c i a l and  early seventies, and  politics  occurred i n B r i t i s h Columbia, a happening  Columbia Health  laboratory  To  and  follows.  time, Vancouver General H o s p i t a l  the  r e s t o f Canada  a p p e a r s t o h a v e b e e n i n f l u e n c e d d r a m a t i c a l l y by power s t r u g g l e s  British  At  that  British  main frame  p a y r o l l systems.  As  well,  by  V.G.H. i n s t a l l e d c o m p u t e r s i n i t s  radiology  departments.  four other h o s p i t a l s i n the province  By had  the  mid-seventies,  installed different  23 l a b o r a t o r y systems included).  (Royal I n l a n d H o s p i t a l i n Kamioops  U n f o r t u n a t e l y , t h e r e was a b l o s s o m i n g o f a w i d e  range o f minicomputers i n B r i t i s h Columbia h o s p i t a l s ,  without  any j o i n t p l a n n i n g o r c o n s i d e r a t i o n o f f u t u r e n e e d s . I n 1975, t h e p r o v i n c i a l government consulting firm,  Systemhouse,  computer p l a n n i n g .  appointed  a  t o a d v i s e i t on h o s p i t a l - b a s e d  This r e s u l t e d i n a committee, comprised  of d i r e c t o r s o f f i n a n c e from t e n h o s p i t a l s i n t h e p r o v i n c e , being  f o r m e d t o f i n d a common, a p p r o a c h t o h o s p i t a l  systems u s i n g I n t e r d a t a computers. the  I n t e r d a t a system had f a i l e d ,  By 1980 i t was c l e a r  due t o o u t - o f - d a t e  l a b o r a t o r y systems, and i n a p p r o p r i a t e At t h i s p o i n t , O'Brien  computer that  hardware,  software.  (1984) p o i n t s o u t t h a t l a c k o f  f u n d i n g was a m a j o r p r o b l e m , e v e n t h o u g h a g e n c i e s were w i l l i n g t o c o - o p e r a t e i n a common a p p r o a c h . different  Consequently,  approaches c o n t i n u e d t o be t a k e n by i n s t i t u t i o n s .  The M i n i s t r y o f H e a l t h , A d v i s o r y Committee  i n 1980, f o r m e d a h o s p i t a l  Computer  a n d a c o n s u l t a n t was h i r e d t o d e v e l o p a  computer p l a n f o r f o u r d i f f e r e n t groups o f h o s p i t a l s : (a) h o s p i t a l s w i t h I n t e r d a t a s y s t e m s , - (b) l a r g e n o n - t e a c h i n g hospitals  (Royal I n l a n d H o s p i t a l i n Kamioops  (c) v e r y s m a l l h o s p i t a l s ,  included),  a n d (d) l a r g e t e a c h i n g  hospitals.  Two V a n c o u v e r h o s p i t a l s , L i o n ' s G a t e a n d The U n i v e r s i t y Of B r i t i s h C o l u m b i a  (U.B.C.), e m b a r k e d  course toward computerization  on a v e r y  about t h i s t i m e .  different Lion's  Gate  H o s p i t a l was p a r t o f a p i l o t p r o j e c t , whose o b j e c t i v e was t o  24  implement  a hospital-wide  f o c u s o f w h i c h was areas.  (IBM) p a t i e n t c a r e s y s t e m , t h e  on p a t i e n t c a r e , p a r t i c u l a r l y  i n nursing  However, j u s t b e f o r e t h e t e r m i n a l s were t o be  installed,  t h e p i l o t p r o j e c t was a b o r t e d .  M e a n w h i l e , t h e new  M i n i s t r y Of H e a l t h f o r m e d t h e B r i t i s h  C o l u m b i a H o s p i t a l s S h a r e d Systems d e v e l o p s h a r e d h o s p i t a l computer  S o c i e t y , t o f u n d and systems.  This system, a  d e c e n t r a l i z e d one, w h i c h o p p o s e d t h e c e n t r a l s y s t e m c o n c e p t , was  d e s i g n e d t o a c h i e v e c o s t c o n t r o l i n h o s p i t a l s by  systems. was  T h i s new  system, a c c o r d i n g t o t h e M i n i s t r y ' s  t o be i m p l e m e n t e d  first  i n departments which  a d m i t t i n g and d i s c h a r g e , and f i n a n c i a l  to  a l s o p l a n n e d t o implement  pharmacy, "Shared  nursing applications but,  d a t e , t h i s has n o t m a t e r i a l i z e d .  a b i d e by t h e "Shared Systems"  services.  plan,  lend  t h e m s e l v e s t o c o m p u t e r i z a t i o n , s u c h as l a b o r a t o r y ,  Systems"  sharing  H o s p i t a l s who  agreed t o  approach, would r e c e i v e  funding  f o r a l l the n e c e s s a r y hardware. L i o n ' s Gate H o s p i t a l , to  faced with t h i s  situation,  decided  go a h e a d w i t h t h e i r p l a n s f o r i n s t a l l i n g a c o m p l e t e  p a t i e n t care system. facts:  T h e i r d e c i s i o n was  (a) t h e i r e x i s t i n g  s o f t w a r e needed  replacing,  financial  b a s e d on s e v e r a l :  system hardware  and  (b) t h e y w e r e happy w i t h t h e w e l l  p r o v e n IBM s y s t e m u s e d by a t l e a s t t e n h o s p i t a l s i n C a n a d a , and May,  (c) t h e y h a d a h i g h l e v e l o f commitment f r o m s t a f f . 1983,  an IBM m a i n f r a m e  was  installed.  In  25 The B r i t i s h C o l u m b i a H e a l t h A s s o c i a t i o n  (B.C.H.A.),  r e p r e s e n t i n g t h e p r o v i n c e s ' h o s p i t a l s , had a l s o chosen, a t a b o u t t h e same t i m e , t o u s e IBM c o m p u t e r s  and have  since  c o n v e r t e d p a y r o l l s u p p o r t f o r i t s members o n t o an IBM mainframe.  B.C.H.A. o f f e r s a c c e s s a n d c o m p u t e r s u p p o r t f o r  members c h o o s i n g t o u s e t h e IBM p a t i e n t c a r e s y s t e m ,  similar  t o t h e one a t L i o n ' s G a t e .  their  They e n v i s i o n e d o f f e r i n g  computer s e r v i c e s t o h o s p i t a l s throughout t h e p r o v i n c e and t o d a t e s e v e r a l members a r e u s i n g t h e i r Meanwhile,  services.  c o m p u t e r i z a t i o n had been phased i n t o t h e  U.B.C. H e a l t h S c i e n c e s C e n t e r H o s p i t a l s i n c e i t ' s 1980.  opening i n  I t was, a t t h a t t i m e , t h e most c o m p u t e r i z e d h o s p i t a l  i n C a n a d a , due t o r e a d y a v a i l a b i l i t y built.  o f f u n d s when i t was  C o m p u t e r i z a t i o n t h e r e had i t s b e g i n n i n g s w i t h a  l a b o r a t o r y system, f o l l o w e d by a d m i t t i n g , pharmacy,  health  r e c o r d s , r a d i o l o g y , n u r s i n g s t a t i o n communication, and financial  systems.  The s y s t e m l i n k s t h e h o s p i t a l t o g e t h e r  t h r o u g h 160 t e r m i n a l s a n d a l l o w s e a c h n u r s i n g s t a t i o n t o c o m m u n i c a t e w i t h 15 d e p a r t m e n t s , o t h e r n u r s i n g s t a t i o n s , a n d the nursing o f f i c e .  Data General minicomputers which use  Meditech software, a r e used. As t h i s d i s c u s s i o n i l l u s t r a t e s ,  by u s i n g  several  h o s p i t a l s as examples, n u r s e s w o r k i n g i n l a r g e o r s m a l l h o s p i t a l s i n B r i t i s h Columbia f i n d themselves caught i n t h e middle o f t h r e e v a s t l y d i f f e r e n t approaches t o h o s p i t a l i n f o r m a t i o n systems:  (a) c e n t r a l i z e d ,  (b) d e c e n t r a l i z e d , a n d  26 (c) i n d i v i d u a l d e p a r t m e n t s y s t e m s 1987). and  To d a t e ,  nurses  (Mikuleky and L e d f o r d ,  i n many h o s p i t a l s i n B r i t i s h  Columbia  a c r o s s t h i s c o u n t r y have n o t had a l o t o f i n p u t  c h o i c e o f systems t h a t w i l l b e n e f i t n u r s i n g . h o s p i t a l a d m i n i s t r a t i o n s , and a l l h o s p i t a l including nursing, are being  into  Currently,  both  departments,  f a c e d w i t h making tough  d e c i s i o n s as t o w h i c h approach t o t a k e , and a r e w e i g h i n g t h e pros  a n d c o n s o f e a c h , b a s e d on f i n a n c i a l c o n s t r a i n t s w i t h i n  their respective  institutions.  Computer Support F o r N u r s i n g P r a c t i c e  Computer s u p p o r t  f o rnursing practice i s i n i t s infancy  i n C a n a d a , a s i d e n t i f i e d i n t h e f i n d i n g s o f The Kennedy G r o u p (1988).  Although  much h a s b e e n w r i t t e n i n n u r s i n g  l i t e r a t u r e , t h e i n t e n t o f t h e f o l l o w i n g d i s c u s s i o n i s merely to present  an o v e r v i e w  o f how c o m p u t e r s c a n be u s e d b y  to support  their practice,  nurses  a n d n o t t o d i s c u s s any one  application i n detail. B a l l a n d Hannah  (1984) d i s c u s s d i r e c t c o m p u t e r  f o r n u r s i n g p r a c t i c e under t h e f o l l o w i n g headings: monitoring,  documentation, p a t i e n t care planning,  s e r v i c e computer f u n c t i o n s , and h o s p i t a l management s y s t e m s .  support patient  special-  information  The u s e o f t h e c o m p u t e r f o r  a d m i n i s t r a t i v e t a s k s such as q u a l i t y a s s u r a n c e , c l a s s i f i c a t i o n systems f o r n u r s i n g workload  patient  d e t e r m i n a t i o n and  27 unit staffing, indirect  a n d r e p o r t i n g , a l l a f f e c t t h e n u r s e i n an  way.  M i k u l e k l y and L e d f o r d f o r computers.  (1987) n o t e d  They f o u n d t h a t n u r s e s  v a r i e t y o f f u n c t i o n s , which they areas:  nursing applications use computers f o r a  c a t e g o r i z e under t h e g e n e r a l  (a) p a t i e n t c l a s s i f i c a t i o n a n d s t a f f i n g  requirements,  (b) a d m i n i s t r a t i o n , ( f o r s u c h t h i n g s a s p e r s o n n e l q u a l i t y assurance  s t u d i e s , and b u d g e t i n g ,  records, .  and word p r o c e s s i n g  f o r such t h i n g s as u p d a t i n g p o l i c i e s and p r o c e d u r e s ) , (c) n u r s i n g p r a c t i c e ( i n b o t h t h e ;  and  at the bedside,  central nursing  station,  f o r order entry, r e s u l t s r e p o r t i n g ,  monitoring patient's p h y s i o l o g i c a l functions, generating n u r s i n g c a r e p l a n s , and m a i n t a i n i n g c l i n i c a l (d) n u r s i n g e d u c a t i o n Although small acute  and r e s e a r c h .  the m a j o r i t y o f nurses  working  i n medium a n d  c a r e h o s p i t a l s i n Canada a r e n o t p r e s e n t l y u s i n g  many o f t h e s e and  r e c o r d s ) , and  applications, a l l are using patient monitoring,  a number a r e u s i n g a t l e a s t one o r more  applications.  other  The f u t u r e p r o m i s e s t o i n u n d a t e  the nurse w i t h  more c o m p u t e r a p p l i c a t i o n s , a s a l l h o s p i t a l s s t r i v e f o r efficient  i n f o r m a t i o n management, a n d q u a l i t y p a t i e n t c a r e .  28 Issues  With the present  C o n c e r n i n g C o m p u t e r Use  trend of society, transforming  i n d u s t r i a l t o an i n f o r m a t i o n  s o c i e t y , many i s s u e s a r e b e i n g  r a i s e d b y n u r s e s a b o u t how t h i s c h a n g e w i l l practice of nursing.  B a l l a n d Hannah  impact  w h i c h c a n a l s o be v i e w e d as i s s u e s i n n u r s i n g  expectations, practice,  (b) u s e r s '  eight  care,  informatics:  unrealistic  (c) c h a n g e i n t h e t r a d i t i o n a l p r o c e d u r e s a n d  (d) i n s u f f i c i e n t  (e) i m p r o v i n g  their  (1984) i d e n t i f y  broad sources o f r e s i s t e n c e t o computers i n h e a l t h  (a) o v e r s e l l b y t h e v e n d o r ,  from an  involvement o f nurses,  " o l d systems" versus  s h i f t i n g t o new p a r a d i g m s ,  (f) f e a r o f l e a v i n g t h e "Gutenberg C u l t u r e , " o r p r i n t e d word, (g) c u r r i c u l u m c h a n g e s , a n d (h) f e a r o f t h e unknown. each o f these e i g h t broad i s s u e s deserves s p e c i f i c o n l y two i s s u e s w i l l (a)  be o u t l i n e d b r i e f l y i n t h i s  job expectations,  a n d (b) t e c h n o l o g y  While  attention study:  and touch.  Many n u r s e s a r e r a i s i n g t h e i s s u e t h a t t h e y a r e e x p e c t e d t o do e v e r y t h i n g more go  t h e y d i d t h i r t y y e a r s ago, p l u s a g r e a t  (Hope, 1984) .  Romano  (1985) s t a t e s t h a t n u r s e s must l e t  o f c e r t a i n a r e a s w h i l e t a k i n g on new o n e s .  a r e no l o n g e r  deal  She f e e l s we  i n an i n d u s t r i a l s o c i e t y w i t h a f a c t o r y  m e n t a l i t y , b u t r a t h e r , we a r e i n a k n o w l e d g e i n t e n s i v e e r a and  must p r a c t i s e a c c o r d i n g l y .  experience trends  a shift i n their  I t seems t h a t e v e n i f n u r s e s  own m e n t a l i t i e s , t o r e f l e c t t h e  o f s o c i e t y , t h e y a r e o f t e n l o c k e d i n t o employment  29 s i t u a t i o n s where t h e f a c t o r y m e n t a l i t y p r e v a i l s . burnout  are o f t e n the r e s u l t of such  The  situations.  p r o f e s s i o n o f n u r s i n g i s b o t h an a r t and a s c i e n c e ,  w i t h t h e s e two advent  S t r e s s and  components f o r m i n g i t s c o r n e r s t o n e s .  With  the  o f c o m p u t e r t e c h n o l o g y i n t o h o s p i t a l s , many n u r s e s  have v o i c e d concerns dehumanized.  about t h e danger of the p a t i e n t  John N a i s b i t t  (1982) s u g g e s t s t h a t  institutions  s u c h as h o s p i t a l s s h o u l d c o n s i d e r "human b a l l a s t , " t o u c h component, when t h e y i n t r o d u c e a new  becoming  or a high  technology.  He  f e e l s t h a t t h e more t e c h n o l o g y a r o u n d p e o p l e , t h e more p e o p l e n e e d t h e human t o u c h . I s s u e s r e l a t i n g t o t h e i n c r e a s e d use of t e c h n o l o g y s o c i e t y i n g e n e r a l , and by n u r s e s  in particular,  away by p r e t e n d i n g t h e y do n o t e x i s t . d i s c u s s e d , debated,  will  not  T h e s e i s s u e s must  and c o n f r o n t e d by n u r s e s who  by go be  wish to  b r e a k down e x i s t i n g b a r r i e r s o f r e s i s t a n c e t o w a r d  computer  technology.  A t t i t u d e s Toward C o m p u t e r  The  t h r e e f o l d purpose  of t h i s  subsection i s to:  (a) d i s c u s s what i s meant by a t t i t u d e , historical toward usage.  Use  (b) p r e s e n t  r e v i e w o f r e p o r t e d s t u d i e s on n u r s e s '  computers,  and  (c) i d e n t i f y  an  attitudes  factors affecting  computer  30  D e f i n i t i o n Of A t t i t u d e  A u n i v e r s a l l y a c c e p t e d d e f i n i t i o n o f a t t i t u d e does n o t appear i n t h e l i t e r a t u r e and, c o n s e q u e n t l y , t h e r e a r e a wide variety of professional For  uses and d e f i n i t i o n s o f t h e term.  t h e purposes o f t h i s study, t h e d e f i n i t i o n posed by  Fishbein  and Ajzen  predisposition  describing  (1975),  a t t i t u d e as "a l e a r n e d  t o respond i n a c o n s i s t e n t l y  u n f a v o u r a b l e manner w i t h  favourable or  respect t o a given object"  (p.  6)  w i l l be adopted. The  l i t e r a t u r e , as r e v i e w e d by Stronge and B r o d t  indicates  certain generally  attitudes: attitudes  (a) a t t i t u d e s  relatively  stable  accepted c h a r a c t e r i s t i c s of  are learned,  areestablished,  (b) o n c e s o c i a l  t h e y a r e c o n s i d e r e d t o be  a n d e n d u r i n g , a n d (c) a t t i t u d e s  antecedent o f behaviour.  In considering  a r e an  these  c h a r a c t e r i s t i c s o f a t t i t u d e , i t became c l e a r t h a t  persons'  a t t i t u d e s toward computers a r e l e a r n e d and i n f l u e n c e willingness  or resistance  (1985),  their  t o use computers.  H i s t o r i c a l R e v i e w Of S t u d i e s On N u r s e s ' Attitudes  Toward C o m p u t e r s  A r e v i e w o f t h e l i t e r a t u r e on n u r s e s ' a t t i t u d e s computers i n d i c a t e s  a shift  i nattitude.  toward  Nurses i n t h e  1960's a n d 1 9 7 0 ' s were v e r y n e g a t i v e , w h i l e n u r s e s i n t h e  31 1980's a r e b e c o m i n g i n c r e a s i n g l y more p o s i t i v e . Reznikoff, Holland,  and  Strobel  f u l l - t i m e h o s p i t a l employees at the  (1967) s u r v e y e d a l l I n s t i t u t e of  Living  (psychiatric hospital) i n Hartford, Connecticut, t h e i r e x i s t i n g a t t i t u d e s toward computers.  to  determine  They u s e d a  m o d i f i e d v e r s i o n o f a q u e s t i o n n a i r e d e v e l o p e d by K o b l e r , the U n i v e r s i t y of  W a s h i n g t o n , w h i c h c o n s i s t e d o f 35  e a c h r a t e d on a s i x - p o i n t s c a l e , r a n g i n g agree" t o " s t r o n g l y disagree." employees, student  Because of the separate  study  c o m p u t e r s was  undertaken.  and  senior nursing students  at the  Connecticut.  The  t h e end  Stroebel,  a q u e s t i o n n a i r e t o 54  junior  f r o m . f i v e diploma programs,  of t h e i r  a  nurses toward  Rosenberg, R e z n i k o f f ,  (1967) a d m i n i s t e r e d  and  negative  groups.  of the a t t i t u d e s of student  Ericson  rotation,  They r e p o r t e d t h a t o f a l l t h e  f i n d i n g s of R e z n i k o f f e t a l . (1967),  and  the beginning  items,  from " s t r o n g l y  n u r s e s were c o n s i s t e n t l y more  than the other occupational  at  at  3-month p s y c h i a t r i c  I n s t i t u t e of L i v i n g i n Hartford, students  were e x p e c t e d t o u s e  automated  nursing notes during t h e i r r o t a t i o n at that i n s t i t u t i o n . q u e s t i o n n a i r e u s e d was  d e v e l o p e d by K o b l e r ,  R e z n i k o f f e t a l . (1967). c o m p u t e r and was  no  and m o d i f i e d  A t e s t - r e t e s t comparison  n o n - c o m p u t e r g r o u p s was  made.  Although  The by  of there  s i g n i f i c a n t d i f f e r e n c e i n a t t i t u d e s between the  two  g r o u p s a t t h e o u t s e t , f i n d i n g s a f t e r t h r e e months i n d i c a t e d t h a t exposure of n u r s i n g students  t o automated n u r s i n g  notes  32 during t h e i r p s y c h i a t r i c a f f i l i a t i o n  l e d t o a favourable  change i n t h e i r a t t i t u d e t o w a r d t h e u s e o f computers i n patient  care.  Chang  (1984) p o i n t e d o u t t h a t i n t h e 1 9 7 0 ' s , o n l y a f e w  n u r s e s were i n v o l v e d i n c o m p u t e r a p p l i c a t i o n s i n n u r s i n g . Startsman and Robinson  (1972) d e v e l o p e d a n d a d m i n i s t e r e d  a  s h o r t a t t i t u d e s c a l e a n d a n o p e n - e n d e d q u e s t i o n n a i r e t o 338 physicians, paramedical medical  centre.  staff,  Of t h i s  39 w e r e s t a f f n u r s e s  and students  at a university  s a m p l e , 69 were s t u d e n t  (approximately  nurses and  1/3 o f t h e s a m p l e ) .  Results i n d i c a t e d t h a t nurses had a r e l a t i v e l y a t t i t u d e when c o m p a r e d t o t h e o t h e r g r o u p s .  negative  The r e l i a b i l i t y  o f t h e a t t i t u d e s c a l e u s e d was .87, u s i n g a s p l i t - h a l f c o r r e l a t i o n method. Because o f t h e i n c r e a s e d t r e n d toward automation i n t h e health care Clark  i n d u s t r y , seven years  later,  Melhorn, L e g l e r and  (1979) u s e d a m o d i f i e d v e r s i o n o f t h e S t a r t s m a n a n d .  Robinson q u e s t i o n n a i r e .  They s u r v e y e d a s a m p l e o f 180,  thirty  o f whom w e r e s t a f f n u r s e s a n d s i x o f whom were  nurses  (approximately  report the r e l i a b i l i t y Findings  1/6 o f t h e s a m p l e ) .  student  They d i d n o t  coefficient of this modified  tool.  i n d i c a t e that t h e respondents d i s p l a y e d a p o s i t i v e  o v e r a l l a t t i t u d e t o w a r d computers, as i n d i c a t e d by a w i l l i n g n e s s a n d e v e n a d e s i r e t o l e a r n more a b o u t t h e m i n t h e i r d a i l y work.  The r e s p o n d e n t s who u s e d t h e c o m p u t e r more  e x t e n s i v e l y , a n d on a d a i l y b a s i s , w e r e more p o s i t i v e .  33 Ronald o f 159  (1983) s t u d i e d t h e l e a r n i n g n e e d s and a t t i t u d e s  n u r s i n g f a c u l t y members w i t h a m a s t e r s d e g r e e  a b o v e , and who  taught  i n schools of nursing w i t h i n the  continental United States.  She  u s e d S t a r t s m a n and  a t t i t u d e s c a l e f o r t h e a t t i t u d e component o f t h i s reliability  o f t h e s c a l e on t h e s t u d y  c o e f f i c i e n t alpha. nursing educators  s a m p l e was  F i n d i n g s of the study  Robinson's study.  .63,  had p o s i t i v e a t t i t u d e s t o w a r d  c o m p u t e r ' s e f f i c i e n c y and  Chang  i m p o r t a n c e t o s o c i e t y , and  (1984) s u r v e y e d  groups:  majority. Chang.  156  volunteer  (1980) a d o p t i o n  less  and  accept  (a) t h e p a c e s e t t e r s ,  A l l s u b j e c t s had  This study  attended  participants,  t o change and  typology,  (b) t h e  middle  workshops conducted  e x p e c t a t i o n s o f computer use  in their  with respect to t h e i r  relationships with clients,  personal  relationship to  the  p r o f e s s i o n , and v i e w o f t h e h e a l t h c a r e s y s t e m and c a r e c o s t s , and  by  l o o k e d at the d i f f e r e n c e between:  (a) p a c e - s e t t e r s and t h e m i d d l e - m a j o r i t y  lives,  the  computers.  assigned u s i n g Houle's i n t o two  using  computers.  p o s i t i v e i n r e l a t i o n t o t h e i r w i l l i n g n e s s t o use of  The  indicate that  T h e i r a t t i t u d e s were more p o s i t i v e w i t h r e s p e c t t o  t h e use  or  (b) t h e two  health  groups i n t h e i r w i l l i n g n e s s t o  i n t e r a c t w i t h the computer t o a c c o m p l i s h  specific  nursing  activities. The  C o m p u t e r Use  Expectations  data c o l l e c t i o n i n the study.  Scale  I t was  (CUES) was  divided into  used f o r the  34 f o l l o w i n g two  sections:  (a) S e c t i o n 1 was  w i l l i n g n e s s t o i n t e r a c t w i t h computers.  related to  Nine items  had  an  i n t e r n a l c o n s i s t e n c y u s i n g Cronbach's alpha of  .77,  while s i x  items  .78,  and  had  examined s e p a r a t e l y had  a reliability  r e l a t e d to the  of  .83,  and  i n f l u e n c e of  a reliability  use  nurses should and  with a  responses i n r e l a t i o n to  She  greater computer  include increased experience  w i t h computer  (1985) c o m p l e t e d a d e s c r i p t i v e s t u d y future education  based n u r s i n g p r a c t i c e .  She  nursing service personnels'  i n the area of  assessed  nurse educators'  schools  h o s p i t a l s and  and  A  NLN-  o f n u r s i n g i n New  England  s e l e c t e d , f r o m w h i c h t h r e e i n s t i t u t i o n s were c h o s e n .  T h i r t y - s i x s u b j e c t s were i n t e r v i e w e d , u s i n g an schedule  w h i c h c o n s i s t e d o f b o t h d i r e c t and  questions,  aimed at c o l l e c t i n g data  (a) a t t i t u d e ,  (b) k n o w l e d g e , and  employment v a r i a b l e s . nurses,  A l l of the  i n three  interview  open e n d e d areas:  (c) d e m o g r a p h i c  and  s u b j e c t s were r e g i s t e r e d  t h e m a j o r i t y o f whom were f e m a l e  to  computer-  k n o w l e d g e o f , and a t t i t u d e s  s t r a t i f i e d random s a m p l e o f t w e l v e  was  use  i n order  toward, computer a p p l i c a b i l i t y t o n u r s i n g p r a c t i c e .  accredited baccalaureate  of  future.  :  f a c i l i t a t e planning  to  suggests t h a t the education  i n f o r m a t i o n management in the Merrow  was  computers.  ( p a c e s e t t e r s ) were a l s o s i g n i f i c a n t l y more w i l l i n g  i n t e r a c t w i t h computers.  three  (b) S e c t i o n 2 o f t h i s t o o l  Chang f o u n d t h a t t h e g r o u p r e s p o n d i n g percentage of favourable  of  (97.2%) and  held  35 masters degrees. researcher  At the c o n c l u s i o n of the  s u b j e c t i v e l y assigned  interview,  the  e a c h s u b j e c t an a t t i t u d e  rating. Findings the types  suggest t h a t although  t h e r e were d i f f e r e n c e s i n  o f s t a t e m e n t s made by v a r i o u s g r o u p s  service personnel  and  nurse educators,  (nursing  people with  u s i n g a c o m p u t e r i n n u r s i n g p r a c t i c e , and  those  experience  without,  and  people from v a r y i n g e d u c a t i o n a l programs), the m a j o r i t y  of  nurses interviewed  and  (22)  were c o n s i d e r e d  t o be p o s i t i v e ,  e i g h t were n e u t r a l , i n t h e i r a t t i t u d e s t o w a r d c o m p u t e r u s e nursing practice. have a n e g a t i v e  S i x o f the: r e s p o n d e n t s were c o n s i d e r e d  a t t i t u d e t o w a r d computer use  availability  of a r e l i a b l e ,  s p e c i f i c a l l y t o measure n u r s e s ' was  nonexistent  either:  f o r years,  and  valid tool  researchers  designed  found themselves  f o r a l a r g e v a r i e t y of  (b) d e s i g n i n g t h e i r own  tools,  or  (c) s u b j e c t i v e l y  a s s i g n i n g s u b j e c t s an a t t i t u d e r a t i n g b a s e d on t h e generated i n t h e i r studies. designed  f o r nurses,  and  The  i n 1985,  t h e i r a t t e n t i o n on d e v e l o p i n g  personnel.  a t t i t u d e s toward computers  (a) u s i n g t o o l s d e s i g n e d  audiences,  to  i n nursing  p r a c t i c e , with the majority being nursing s e r v i c e The  in  n e e d was  data  apparent f o r a  S t r o n g e and  Brodt  tool  focused  such a t o o l t o measure  nurses'  a t t i t u d e s toward computers. They d e v e l o p e d a L i k e r t - t y p e s c a l e t o m e a s u r e a t t i t u d e s toward computerization. originally  nurses'  S i x t y - s i x s t a t e m e n t s were  included i n the questionnaire.  After obtaining  36 index of d i s c r i m i n a t i o n scores f o r a l l items, those were i n c l u d e d i n t h e f i n a l v e r s i o n o f t h e t o o l . q u e s t i o n n a i r e was p i l o t e d b y 60 p e o p l e ,  a b o v e .50  The  made up o f j u n i o r a n d  s e n i o r n u r s i n g s t u d e n t s as w e l l as f a c u l t y a t M a r y c r e s t C o l l e g e i n D a v e n p o r t , Iowa.  The f i n a l  twenty  item  q u e s t i o n n a i r e i s b e l i e v e d t o be v a l i d a n d r e l i a b l e , r = .90 s p l i t - h a l f r e l i a b i l i t y c o e f f i c i e n t , Spearman-Brown p r o p h e c y In nurses  summary, t h e n ,  with  using the  formula. i t appears t h a t t h e a t t i t u d e s o f  t o w a r d s c o m p u t e r s h a v e become p r o g r e s s i v e l y more  p o s i t i v e over t h e years.  R e c e n t l y , a s p e c i f i c t o o l has been  deemed v a l i d a n d r e l i a b l e a s a means o f c o l l e c t i n g q u a n t i t a t i v e a t t i t u d i n a l data  (Stronge  & Brodt,  1985) . I t s  use by r e s e a r c h e r s i n v a r i o u s p a r t s o f t h e w o r l d s h o u l d a l l o w for  t h e c o l l e c t i o n o f comparable q u a n t i t a t i v e data, which  w i l l p r o v i d e a more g e n e r a l s e n s e o f n u r s e s ' towards computers. literature,  Although  w h i c h was t h o u g h t  ;  attitudes  a review of the nursing t o r e f l e c t t h e major i s s u e s  c o n c e r n i n g t h e u s e o f c o m p u t e r s b y n u r s e s , was t h e means u s e d to  generate  statements  f o r inclusion i n the tool,  i t is  p o s s i b l e t h a t t h e r e were o t h e r i s s u e s i m p o r t a n t  t o nurses  w h i c h were n o t r e p o r t e d i n t h e l i t e r a t u r e ,  consequently  were e x c l u d e d .  Even though a t o o l has been developed  measures q u a n t i t a t i v e d a t a , t h e r e s t i l l d e a r t h o f q u a l i t a t i v e d a t a on n u r s e s ' attitudes,  thus  and  which  a p p e a r s t o be a  and student  nurses'  l e a v i n g a sense o f not t r u l y knowing t h e  37 p e r s p e c t i v e of the i n d i v i d u a l nurse or student nurse. Accordingly/  i n o r d e r t o t r u l y p r e s e n t an a c c u r a t e p i c t u r e  of  t h e a t t i t u d e s o f n u r s e s toward computer use, t h e r e appears  to  be a n e e d t o mesh t h e two  r e s e a r c h paradigms.  Factors Affecting  Usage  A t t i t u d e measurement i s an i n t e g r a l p a r t o f g a i n i n g  an  u n d e r s t a n d i n g o f an i n d i v i d u a l ' s b e h a v i o u r , i n v i e w o f t h e f a c t t h a t a t t i t u d e has a s i g n i f i c a n t i n d i v i d u a l ' s response.  i n f l u e n c e on  S t r o n g e and B r o d t  (1985)  an indicated  t h a t i f an i n d i v i d u a l ' s a t t i t u d e t o a g i v e n o b j e c t  ( s u c h as a  c o m p u t e r ) i s known, i t c a n be u s e d i n c o n j u n c t i o n w i t h o t h e r v a r i a b l e s t o p r e d i c t and e x p l a i n r e a c t i o n s o f t h e to that  individual  object.  Demographic v a r i a b l e s /  s u c h as age, h a v e b e e n commonly  thought t o i n f l u e n c e the r a t e of adoption of i n n o v a t i o n s such as u s e o f c o m p u t e r s  (Chang,  1984).  E x p e r t s have f o u n d  i n d i v i d u a l s i n t h e i r m i d - t h i r t i e s and younger  tend to  q u i c k l y t o t h e computer,  w h i l e those over f i f t y  l i k e l y t o be i n t i m i d a t e d  (Inman,  I n a s u r v e y o f 237  that adapt  a r e more  1983).  f u l l - t i m e p r o f e s s i o n a l nurses i n a  m e t r o p o l i t a n h o s p i t a l i n n o r t h e a s t e r n Ohio, the f i n d i n g s K r a m p f and R o b i n s o n  (1984)  of  were i n c o n t r a d i c t i o n t o t h e  f i n d i n g s o f most r e s e a r c h e r s .  The  age r a n g e s a n d f r e q u e n c i e s  o f t h e r e s p o n d e n t s i n t h e i r s t u d y were:  20-29 y e a r s  38 (n = 95)/  30-39 y e a r s  (n = 3 0 ) .  (n = 7 1 ) ,  W i t h t h e use  40-49 y e a r s  of a two-part w r i t t e n  t h e y f o u n d t h a t most o l d e r a d u l t s d i d n o t threatened the  by  the  computer.  a d u l t , the higher  extensive  the  (n = 4 1 ) ,  the  and  questionnaire,  appear t o  be  They a l s o f o u n d t h a t t h e  l e v e l of education,  exposure to the  and  older  the  more  c o m p u t e r , t h e more l i k e l y  computer problem would c h a l l e n g e ,  50+  a  rather than f r u s t r a t e ,  the  respondents. Although the  l i t e r a t u r e revealed  that i n i t i a l  computer  r e s i s t a n c e i s f r e q u e n t l y a s s o c i a t e d w i t h an i n d i v i d u a l ' s perceptions  that  (a) a g o o d m a t h e m a t i c s b a c k g r o u n d i s a  p r e r e q u i s i t e f o r computer use, numerous e r r o r s , K r a m p f and disproving.  and  (b) c o m p u t e r s t e n d t o make  Robinsons'  S i x t y - s i x percent of the  (1984) r e s u l t s w e r e respondents i n t h e i r  s u r v e y f e l t t h a t a m a t h e m a t i c s b a c k g r o u n d was for  computer competency, w h i l e  eighty-seven  t h a t t h e y b e l i e v e d c o m p u t e r s t o be Houle  (1980) n o t e d t h a t t h e  o f c o m p u t e r s , as w i t h any correlated with favourable this,  Chang  percent  indicated  r a t e of adoption of the innovation,  previous  is positively  e x p e r i e n c e and, use  use  of  from  computers,  influence nurses' expectations.  :  l i t e r a t u r e i n d i c a t e d a l a g between computer  p o t e n t i a l and Parks,  s e t t i n g , may  necessary  relatively error free.  (1984) d e d u c e d t h a t p r e v i o u s  whatever the The  other  not  current  l e v e l of usage of computers i n  e t a l . (1986) n o t e d t h a t  factors evident  in  l i t e r a t u r e w h i c h m i g h t e x p l a i n t h i s phenomenon a r e  nursing.  the shortage  of n u r s i n g f a c u l t y w i t h computer e x p e r t i s e , r e l u c t a n c e o f f a c u l t y t o l e a r n computer s k i l l s to  and t o m o d i f y t h e c u r r i c u l u m  i n c l u d e them, l i m i t e d c h o i c e o f c o m p u t e r s o f t w a r e  textbooks,  and  a n d l a c k o f c o n s e n s u s c o n c e r n i n g what s h o u l d  be  i n c l u d e d i n a computer e d u c a t i o n f o r n u r s e s . Although  some a t t e n t i o n h a s b e e n p l a c e d on a t t i t u d e  o t h e r f a c t o r s w h i c h may  and  a f f e c t computer usage s u c h a s : age,  l e v e l o f e d u c a t i o n , and e x p o s u r e t o a computer, t h e f i n d i n g s are often c o n t r a d i c t o r y . individuals,  A s more demand i s b e i n g p l a c e d  i n c l u d i n g nurses,  t o use computers i n t h e i r  work, i t i s c l e a r t h a t much work r e m a i n s t o be  L e a r n i n g To Use  As p o i n t e d o u t t h u s  on  done.  Computers  f a r , whether nurses  not, computer use i n n u r s i n g i s becoming a  are ready or reality.  T h e r e f o r e , t h e onus w i l l  be on n u r s i n g e d u c a t i o n p r o g r a m s t o  p r o v i d e computer content  i n their curricula,  nurses  a n d a l s o on  t o l e a r n how t o u s e t h i s new t e c h n o l o g y .  Pivotal to  the development o f programs, i s t h e i d e n t i f i c a t i o n o f nurses' c o m p u t e r l e a r n i n g n e e d s , a n d a means o f d e t e r m i n i n g t h e s e n e e d s h a v e b e e n met. fourfold, need, nurses  designed  to:  whether  The p u r p o s e o f t h i s s u b s e c t i o n i s  (a) d i s c u s s what i s meant b y l e a r n i n g  (b) h i g h l i g h t s t u d i e s a b o u t t h e l e a r n i n g n e e d s o f w i t h regard t o computers,  literacy  f o r nurses,  and  (c) d i s c u s s c o m p u t e r  (d) d i s c u s s e v a l u a t i o n o f l e a r n i n g ,  40 and t h e n o t i o n  o f a taxonomy t o d e t e r m i n e q u a l i t y o f  learning.  Learning  Houle  (1972) d e f i n e d  Need  "need" as a c o n d i t i o n o r s i t u a t i o n  i n which something necessary o r d e s i r a b l e i s r e q u i r e d o r wanted.  He n o t e d t h a t i t i s o f t e n u s e d t o e x p r e s s t h e  d e f i c i e n c i e s o f an i n d i v i d u a l o r some c a t e g o r y o f p e o p l e , either generally,  o r i n some s e t o f c i r c u m s t a n c e s .  i n d i c a t e d t h a t a n e e d may be p e r c e i v e d persons possessing  He  by t h e p e r s o n o r  i t ( f e l t n e e d ) , o r b y some o b s e r v e r  (ascribed need). Knowles  (1980) n o t e d t h a t an e d u c a t i o n a l  need i s  s o m e t h i n g p e o p l e o u g h t t o l e a r n f o r t h e i r own good, f o r t h e good o f t h e o r g a n i z a t i o n , an e d u c a t i o n a l  o r f o r t h e good o f s o c i e t y .  need as t h e d i s c r e p a n c y  individuals,  or organizations,  or,  words, t h e d i s t a n c e  i n other  between  He saw  what  want t o be a n d what t h e y a r e ; b e t w e e n an a s p i r a t i o n a n d a  reality. Boone  (1985) d e f i n e d  "need" as a d e f i c i e n c y ,  imbalance,  l a c k o f a d j u s t m e n t , o r gap, between t h e p r e s e n t s i t u a t i o n and a s e t o f s o c i e t a l norms b e l i e v e d t o be more d e s i r a b l e . i m p l i e d a gap b e t w e e n what i s a n d what o u g h t t o b e .  He  Beatty  (1981) r e f e r r e d t o t h e same phenomenon a s a m e a s u r a b l e discrepancy  e x i s t i n g between a p r e s e n t s t a t e o f a f f a i r s and a  41 d e s i r e d s t a t e o f a f f a i r s as a s s e r t e d n e e d , o r by It  an  'authority' of  should  educational, needs.  be  and  that therefore,  'owner'  a l l needs o f a d u l t s  education  of  :  r a t h e r t h a n a whim.  would agree t h a t need p r o v i d e s  dealing  Adult  with  educators  a deep m o t i v a t i n g  i s no  are  c a n n o t meet a l l  N e e d i s a v a g u e t e r m , p e r c e i v e d t o be  l e a r n i n g , even though t h e r e  an  need.  obvious t h a t not  something e s s e n t i a l ,  its  e i t h e r by  drive  for  u n i v e r s a l a g r e e m e n t as  to  definition. B e c a u s e t h e d e f i n i t i o n o f n e e d i s v a g u e , so a l s o i s  d e f i n i t i o n o f the p r o c e s s of needs assessment.  the  Monette  (1977) s t a t e d t h a t g e n e r a l l y , n e e d s a s s e s s m e n t i s c o n c e r n e d with for  l e a r n i n g needs. i d e n t i f y i n g and  I t a p p e a r s t o be  responding to various  requirements f o r educational Scriven determination ought t o be, the  goal  and  therefore  not  be  possible  action.  of the  d i f f e r e n c e b e t w e e n what i s and  or between t h e  a c t u a l and  the present s t a t e .  many, t o be i t i s the  the  first  step  the  first  often the  case.  including p o l i t i c a l p r o g r a m m e r s ' own  step  the  ideal,  what  or between  Needs a s s e s s m e n t i s i n program  planning,  essence of adult education.  (1978) f e e l s t h a t e v e n t h o u g h i d e a l l y , should  method  (1978) s t a t e d t h a t n e e d s a s s e s s m e n t i s a  s t a t e and  b e l i e v e d , by  a systematic  Griffith  needs assessment  i n programming, i n p r a c t i s e t h a t  Many o t h e r  factors affect  is  programming,  power s t r u c t u r e s w i t h i n i n s t i t u t i o n s ,  b i a s , attempts to p r o f i t a b l y u t i l i z e  the  unused  42 space, and a t t e m p t s Although  to increase  revenues.  o p i n i o n s d i f f e r as t o t h e d e f i n i t i o n o f n e e d  and n e e d s a s s e s s m e n t , t h e d e t e r m i n a t i o n o f n e e d t h r o u g h use  o f a n e e d s a s s e s s m e n t i s b e l i e v e d by many t o be  important  an  s t e p i n p r o g r a m p l a n n i n g , and as s u c h , must  c o n s i d e r e d i n p l a n n i n g computer awareness and  the  be  literacy  programs f o r n u r s e s .  L e a r n i n g Needs Of N u r s e s R e g a r d i n g  A n d e r s o n , Gremy and P a g e s  Computers  (1974) a p p e a r t o h a v e done t h e  b e g i n n i n g work i n t h e a r e a o f e d u c a t i o n o f h e a l t h p e r s o n n e l i n medical informatics,  i d e n t i f y i n g t h e n e c e s s i t y f o r more  and b e t t e r e d u c a t i o n o f b o t h p r a c t i t i o n e r s and the h e a l t h c a r e d i s c i p l i n e s about m e d i c a l proposed  t h r e e l e v e l s of p r e p a r a t i o n :  students i n  informatics.  (a) The  first  They  would  be  a g e n e r a l l e v e l o f computer e d u c a t i o n , d e s i g n e d t o p r o v i d e a g e n e r a l k n o w l e d g e o f c o m p u t e r s and d a t a p r o c e s s i n g , f o r a l l health service users; t h o s e who  (b) t h e s e c o n d  w o u l d be d e s i g n e d  for  w o u l d k e e p t h e i r m a i n o r i e n t a t i o n as members o f a  p a r t i c u l a r h e a l t h c a r e d i s c i p l i n e , b u t who  w o u l d be i n v o l v e d  i n w o r k i n g w i t h e x p e r t s i n d a t a p r o c e s s i n g , on p r o j e c t s i n v o l v i n g b o t h t h e d e s i g n and  implementation  of systems;  and  (c) t h e t h i r d w o u l d i n v o l v e e x t e n s i v e t r a i n i n g f o r t h o s e c o n s i d e r e d t o be e x p e r t s i n b o t h t h e i r p a r t i c u l a r h e a l t h c a r e d i s c i p l i n e s and c o m p u t e r s c i e n c e , and who  would spend the  43 major p a r t of t h e i r time i n v o l v e d i n the development i n i t i a t i o n o f new  computer systems.  Hannah  out, t h a t t h e o n l y f l a w i n t h e r e s e a r c h  (1983)  and  pointed  of Anderson et a l .  (1974) i s t h a t t h e i r m o d e l s u g g e s t s d e t a i l e d o b j e c t i v e s o n l y i n t h e c o g n i t i v e domain overlooks  (Bloom e t a l . 1 9 5 6 ) , and  t h e a f f e c t i v e domain  (Krathwohl,  completely  Bloom &  Masia,  1964). S e v e r a l m a j o r s t u d i e s h a v e b e e n done i n t h e  last  w h i c h i d e n t i f y computer l e a r n i n g needs f o r n u r s e s . (1981) s u r v e y e d 193 U n i t e d S t a t e s , who computerization,  r e g i s t e r e d n u r s e s f r o m 29 were r e c o g n i z e d  and  t h e d e s i r e d k n o w l e d g e was  h i g h e s t were t h o s e  a s s o c i a t e d with the nurses' nursing.  From t h i s  she  educators  recognized  percentage of respondents p r o g r a m s , and  the  lowest  the need f o r  reliability  developing  education.  She  nursing  d e s i r e d l e v e l of knowledge i n  noted that the  (50.9%) t a u g h t percentage  in  highest baccalaureate  (8.2%) t a u g h t  B o t h s c a l e s u s e d t o measure n u r s i n g  c u r r e n t k n o w l e d g e and  She  directly  (1983) s u r v e y e d a n a t i o n a l s a m p l e o f 159  s i x t e e n computer areas.  of  current or a n t i c i p a t e d r o l e s i n  on t h e i r c u r r e n t and  programs.  categories  found that the areas i n which  e d u c a t i o n a l o b j e c t i v e s f o r n u r s i n g computer Ronald  i n nursing  a s k e d them t o r a n k e l e v e n She  Walker  s t a t e s i n the  as e x p e r t s  computer l e a r n i n g needs.  decade  i n diploma  educators'  d e s i r e d knowledge about computers  c o e f f i c i e n t s of  .93,  using coefficient  found t h a t the n u r s i n g educators  who  had  alpha.  participated in  the  study  h a d an i d e n t i f i e d n e e d t o l e a r n a b o u t c o m p u t e r s .  The  s u b j e c t s p e r c e i v e d t h e m s e l v e s as h a v i n g  a low l e v e l o f  knowledge about computers, and w i s h e d t o have a h i g h  level.  R o n a l d r e p o r t e d t h a t t h e r e was a s i g n i f i c a n t d i f f e r e n c e i n t h e s u b j e c t s ' c u r r e n t k n o w l e d g e a n d l e a r n i n g n e e d s b a s e d on the type  o f program i n which they taught.  educators  teaching  She f o u n d t h a t  i n graduate programs had t h e h i g h e s t  o f c u r r e n t knowledge and t h e lowest respect t o computers.  level  l e a r n i n g need w i t h  As i n Walker's study  (1981),  Ronald  f o u n d t h a t t h e a r e a s i n w h i c h t h e d e s i r e d k n o w l e d g e was h i g h e s t , was i n a r e a s d i r e c t l y a s s o c i a t e d w i t h t h e n u r s e s ' current or anticipated roles.  Ronald concluded  t h a t a needs  a s s e s s m e n t o f e a c h g r o u p o f l e a r n e r s s h o u l d be done, s o t h a t p r o g r a m s c o u l d be d e v e l o p e d t o p r o v i d e  learners  o p p o r t u n i t i e s t o i d e n t i f y a n d meet t h e i r own l e a r n i n g needs.  This  with  individual  i s consistent with the b e l i e f s of adult  education. H e l l e r e t a l . (1985) d e s c r i b e d t h e a p p r o a c h o f a t a s k f o r c e e s t a b l i s h e d at t h e U n i v e r s i t y o f Maryland i n October, 1983,  which s t u d i e d t h e c u r r i c u l u m i m p l i c a t i o n s o f computer  applications i n nursing.  The t a s k f o r c e was made up o f  r e p r e s e n t a t i v e s o f f a c u l t y and s t u d e n t s , work i n A p r i l ,  1984.  through networking baccalaureate students  and completed i t s  D a t a was c o l l e c t e d f r o m t h e l i t e r a t u r e ,  and s i t e v i s i t s ,  nursing students  as w e l l as a survey  (n = 5 6 ) , m a s t e r s  (n = 5 1 ) , a n d f a c u l t y members  (n = 7 4 ) .  of  nursing  45 The  q u e s t i o n n a i r e u s e d f o r t h e s u r v e y was  v e r s i o n of Ronald's Walker's  (1983) i n s t r u m e n t , w i t h some i t e m s  (1981) t o o l .  In the t o o l ,  authors, the r e l i a b i l i t y q u e s t i o n n a i r e was knowledge, for  .95  faculties'  .96  as a d a p t e d by  ( c o e f f i c i e n t alpha)  from  the  of the r e v i s e d  f o r baccalaureate students' desired  f o r masters s t u d e n t s ' d e s i r e d knowledge,  .91  assessment of d e s i r e d knowledge f o r  b a c c a l a u r e a t e s t u d e n t s , and  .91  d e s i r e d knowledge f o r masters T h i s s u r v e y was  for  faculties'  t h e f i r s t t o m e a s u r e what  R e s u l t s of the survey  h i g h l e v e l of knowledge.  w a n t e d t o know.  s t u d e n t s needed t o  revealed that students desired a  I n some a r e a s , f a c u l t y  evident thought  s t u d e n t s n e e d e d t o know l e s s t h a n  I n most a r e a s  f a c u l t y thought  students  masters  s t u d e n t s n e e d e d t o know more t h a n t h e y d e s i r e d t o know. f i n d i n g s i n t h i s s t u d y were and W a l k e r ' s  directly  c o n s i s t e n t w i t h Ronald's  (1981) s t u d i e s , i n t h a t t h e a r e a s  d e s i r e d k n o w l e d g e was  and  suggest  (1983)  i n which  current or  H e l l e r e t a l . (1985) c o n c l u d e  a d v o c a t i n g the need t o i n c l u d e content c a p a b i l i t i e s and  The  the  h i g h e s t , were t h o s e t h a t w e r e most  a s s o c i a t e d with the nurses'  nursing roles.  of  students  However, a d i s c r e p a n c y was  with faculty expectations. that baccalaureate  assessment  students.  w a n t e d t o know, and what f a c u l t y t h o u g h t know.  a modified  anticipated  t h e i r study  by  about computer  a p p l i c a t i o n s i n nursing i n the curriculum,  s e v e r a l a p p r o a c h e s t o t h i s end.  They s e e  faculty  d e v e l o p m e n t as t h e c o r n e r s t o n e t o s u c c e s s f u l c u r r i c u l u m  46 implementation. Merrow  (1985),  i n her study  nursing service personnels'  of nursing educators'  and  knowledge o f and a t t i t u d e s t o w a r d  computer use i n n u r s i n g p r a c t i c e , found t h a t knowledge o f c o m p u t e r u s e i n n u r s i n g p r a c t i c e was computer use i n n u r s i n g p r a c t i c e . who  were r a t e d as m i n i m a l l y  related to current  I n d i v i d u a l s i n her  study  knowledgeable about computer use  i n n u r s i n g p r a c t i c e , never use a computer. A more r e c e n t  s t u d y was  c o n d u c t e d by P a r k s  e t a l . (1986)  at a l a r g e American urban u n i v e r s i t y school o f n u r s i n g . was  c o l l e c t e d a s p a r t o f t h e work o f a T a s k F o r c e  b y t h e Dean o f t h e S c h o o l  of Nursing,  Data  appointed  t o d e t e r m i n e what  knowledge, r e l a t e d t o computer a p p l i c a t i o n s i n n u r s i n g , s h o u l d be i n c l u d e d i n t h e c u r r i c u l u m . s t u d y was two f o l d : baccalaureate  (a) t o d e s c r i b e  students'  (n = 105) p e r c e p t i o n s  The p u r p o s e o f t h e faculty  (n = 7 1 ) ,  (n_ = 124) , a n d m a s t e r s  of t h e i r  students'  l e v e l o f c u r r e n t knowledge  the d e s i r e d l e v e l o f knowledge about a s p e c t s  o f computer  a p p l i c a t i o n s i n n u r s i n g , and  faculty  perceptions  (b) t o d e s c r i b e  o f t h e l e v e l o f knowledge about computer  application i n nursing of baccalaureate Parks  and m a s t e r s  e t a l . (1986) u s e d two v e r s i o n s  a n d one f o r s t u d e n t s )  questionnaire provided  students.  (one f o r f a c u l t y  o f an amalgam o f R o n a l d ' s (1983)  a n d W a l k e r ' s (1981) s c a l e .  ranging  and  tool  E i g h t major components o f t h e  evidence of high i n t e r n a l  f r o m .91-.95, u s i n g c o e f f i c i e n t a l p h a .  consistency Correlations  47 between r e p o r t e d amounts of computer i n s t r u c t i o n  and  p e r c e i v e d c u r r e n t knowledge, u s i n g Pearson's c o r r e l a t i o n c o e f f i c i e n t , were .53 f o r b a c c a l a u r e a t e  students,  masters students,  Data was  and  .50 f o r facuity.  f a c u l t i e s ' computer usage, f o r seven a c t i v i t i e s s t a t i s t i c s , t e s t scoring) through use of a 0-4 c o e f f i c i e n t alpha r e l i a b i l i t y  The  was  95-100%, but  collected  on  (e.g., scale.  The  f o r the p o s s i b l e range of  scores, on the the seven items was students  .45 f o r  .74.  Response r a t e f o r  f a c u l t y had only 49%.  f i n d i n g s i n d i c a t e t h a t students  and f a c u l t y had  low  l e v e l s of knowledge about computer a p p l i c a t i o n s , and d e s i r e d high l e v e l s .  T h i s i s c o n s i s t e n t with the f i n d i n g of Ronald  ( 1 9 8 3 ) , and H e l l e r et a l . ( 1 9 8 5 ) .  F a c u l t y usage was  shown t o  be p o s i t i v e l y a s s o c i a t e d with c u r r e n t knowledge. The  authors  data on students'  c l a i m t h i s r e s e a r c h t o be the f i r s t  reported  computer l e a r n i n g needs, from both f a c u l t y  and student p e r s p e c t i v e s .  However, H e l l e r et a l . (1985)  appear t o have been the f i r s t  to r e p o r t such f i n d i n g s .  are not r e f e r e n c e d by Parks et a l . ( 1 9 8 6 ) .  They  I t appears, from  the l i t e r a t u r e reviewed, t h a t nurses are making an attempt to understand the computer l e a r n i n g needs of v a r i o u s groups w i t h i n the p r o f e s s i o n .  48 Computer L i t e r a c y  Although  attempts  For  Nurses  a r e b e i n g made t o d e t e r m i n e t h e .  l e a r n i n g needs o f s t u d e n t s , p r a c t i s i n g educators,  interestingly  nurses,  and  nurse  e n o u g h , t h e r e a p p e a r s t o be no  clear  c o n s e n s u s on r e q u i r e d c o m p e t e n c i e s i n c o m p u t e r k n o w l e d g e usage.  To  definition  compound m a t t e r s , of the term  widespread acceptance. coined i n the  t h e r e a p p e a r s t o be  I t seems t h a t t h e t e r m was  Skiba  works); their  of:  computer c a p a b i l i t i e s  their  and t h e  i s one  c o i n e d by M a r v i n  "computer l i t e r a c y i s a s h i f t i n g s e t o f  and  knowledge of  This d e f i n i t i o n  a p p e a r s t o be  o f most e d u c a t o r s .  Winther  skills,  congruent w i t h  feelings  educators  a l i k e d i s a g r e e as t o t h e e x t e n t o f  necessary  for different  levels  and  circumstances"  intuitive  nurses.  computer  c o m p u t e r s c a n be u s e d  s o c i a l l y defined, i n response t o changing 97).  the  r e p r e s e n t a t i o n i n f l o w c h a r t s ) " (p. 8 ) .  1  (p.  "an  (an i n t r o d u c t i o n t o t h e n o t i o n  A more concise d e f i n i t i o n (1983):  (how  advantages\disadvantages);  of a l g o r i t h m design a l g o r i t h m s and  have  literature.  c o m p u t e r a p p l i c a t i o n s (how  relative  first  references t o i t are  (1983) d e f i n e d c o m p u t e r l i t e r a c y as  understanding  gained  s i n c e t h e n , numerous a u t h o r s  d e f i n e d i t i n a m u l t i t u d e o f ways and abundant i n n u r s i n g  no  " c o m p u t e r l i t e r a c y " , w h i c h has  1 9 6 0 ' s , and  or  Practitioners  of students  the  and  literacy  and  practising  49 While there  i s disagreement over t h e l e v e l o f l i t e r a c y  n e e d e d , most e d u c a t o r s (1982) f i n d i n g ,  would agree w i t h Hardin  and Skiba's  i n t h e i r c o m p a r a t i v e a n a l y s i s o f computer  l i t e r a c y education  f o rnurses,  t h a t no s i n g l e e d u c a t i o n a l  s t r a t e g y i s l i k e l y t o be e f f e c t i v e i n a c h i e v i n g l i t e r a c y f o r a l l nurses.  These a u t h o r s  computer  provided  a  conceptual  framework f o r e x a m i n i n g computer l i t e r a c y components, and l o n g and s h o r t range g o a l s . f o r e d u c a t i n g Many a u t h o r s nature  nursing  personnel.  a d d r e s s e d t h e n e c e s s i t y t o examine t h e  o f l e a r n e r s e n r o l l e d i n n u r s i n g p r o g r a m s when  d e s i g n i n g programs, p l a n n i n g c u r r i c u l a , content  f o r computer courses..  and d e v e l o p i n g  Krampf and R o b i n s o n  s t a t e d t h a t e d u c a t i o n a l p r o g r a m s f o r n u r s e s must  (1984)  incorporate  l e a r n i n g a c t i v i t i e s which are c o n s i s t e n t with t h e characteristics of adult learners. some o f t h e s e  characteristics,  Tarnow  (1979)  described  w h i c h must be c o n s i d e r e d  when  w o r k i n g w i t h a d u l t l e a r n e r s . . They i n c l u d e d t h e : (a) l e a r n e r s ' r e a d i n e s s  and c a p a b i l i t i e s ,  t h e m a t e r i a l t o be l e a r n e d , learning,  (b) r e l e v a n c e o f  (c) s a t i s f a c t i o n d e r i v e d f r o m t h e  (d) e f f e c t i v e n e s s o f i m m e d i a c y o f a p p l i c a t i o n a n d  t a n g i b l e r e w a r d s , a n d (e) o p p o r t u n i t y t o make m i s t a k e s take  and t o  risks. Krampf and R o b i n s o n  flexible, itself  fail-proof,  i s the f i r s t  learners.  (1984) f e l t t h a t a s l o w - p a c e d ,  human i n t e r a c t i o n w i t h t h e c o m p u t e r  step i n the educational process  They f e l t t h a t t h i s  f o r adult  "hands-on" i n s t r u c t i o n  should  50 progress  from simple t o complex.  knowledgeable resource person troubleshooting,  They a l s o f e l t t h a t a  s h o u l d be  available for  as i t w o u l d seem t h a t , d e p e n d i n g on  i n s t r u c t o r s approach, the a d u l t l e a r n e r s ' i n i t i a l leads to e i t h e r a p o s i t i v e or negative a t t i t u d e , to  the  experience which  tends  persist. Ronald  attempts  (1979) d o c u m e n t e d i n t h e l i t e r a t u r e t h e  to incorporate medical  curriculum.  i n f o r m a t i c s i n the  c u r r i c u l u m p l a n n i n g and 1983;  nursing  S i n c e t h e n a number o f p r e s c r i p t i v e a r t i c l e s  t e x t s have been w r i t t e n which p r e s e n t  Skiba,  first  Ronald,  content  1983:  "how  and  t o " approaches t o  development  (Edmunds,  Hannah,1983; & R o n a l d  1982;  & Skiba,  1987) A t t e n t i o n h a s b e e n g i v e n by s h o u l d be  s e v e r a l a u t h o r s t o what  i n c l u d e d i n s p e c i f i c l e v e l s of nursing education  allow nurses  t o a c h i e v e computer l i t e r a c y .  Hannah  (1983),  f o r i n s t a n c e , f o c u s e d h e r d i s c u s s i o n on t h e p l a c e o f informatics i n a baccalaureate nursing curriculum. al.  (1986) i d e n t i f i e d t h e f o l l o w i n g s p e c i f i c  medical Parks  baccalaureate to help nurses  l e v e l s of n u r s i n g programs.  l e v e l they would i n c l u d e :  the masters l e v e l , e d u c a t i o n and  At  content  research  (a) u s i n g c o m p u t e r s effects  (c) " h a n d s - o n " e x p e r i e n c e ;  related to administration,  applications.  be  the  c a r e f o r p a t i e n t s , (b) t h e c o m p u t e r s '  on q u a l i t y o f h e a l t h c a r e , and  et  knowledge  r e l a t e d t o computer a p p l i c a t i o n s i n n u r s i n g , which s h o u l d i n c l u d e d i n two  to  at  51 All origin,  of t h e l i t e r a t u r e reviewed t o date i s American i n w i t h t h e e x c e p t i o n o f Hannah  o f C a l g a r y , A l b e r t a , Canada.  (1983) a t t h e U n i v e r s i t y  She r e p o r t e d t h e commitment o f  the n u r s i n g f a c u l t y at t h a t u n i v e r s i t y with regard t o the development and implementation o f m e d i c a l i n f o r m a t i c s , a t h r e e f o l d approach,  which  i n c l u d e d community  using  service,  r e s e a r c h and t e a c h i n g . I t appears  t h a t some a t t e n t i o n h a s b e e n g i v e n t o  a t t e m p t i n g t o u n d e r s t a n d what c o m p u t e r l i t e r a c y  i s a n d how i t  r e l a t e s t o n u r s e s , so t h a t programs c a n be d e s i g n e d t o address t h e i r computer l e a r n i n g needs. appears  In doing so,  i t  t h a t some a t t e n t i o n h a s a l s o b e e n g i v e n t o t h e  l e a r n e r , t h e l e a r n i n g c o n t e x t and managing t h e l e a r n i n g experience.  Topics addressed  include: characteristics of the  a d u l t l e a r n e r , t e a c h i n g methods, t e c h n i q u e s and d e v i c e s , l e v e l l i n g o f content f o r s p e c i f i c groups o f nurses, sequencing  o f c o n t e n t and s t r a t e g i e s f o r i m p l e m e n t a t i o n o f  c o m p u t e r c o n t e n t i n t o n u r s i n g c u r r i c u l a . However, l i t t l e o r no a t t e n t i o n h a s b e e n g i v e n t o a s s e s s m e n t o r e v a l u a t i o n o f e i t h e r t h e q u a n t i t y o r q u a l i t y o f t h e l e a r n i n g which from t h e s e  efforts.  results  52 E v a l u a t i o n Of L e a r n i n g  Dahlgren conception.  (1978) d e s c r i b e s l e a r n i n g a s a c h a n g e i n He f e e l s t h e r e i s a q u a l i t a t i v e s h i f t  conception t o another  when l e a r n i n g h a s o c c u r r e d .  o f l e a r n i n g o r change i n c o n c e p t i o n quantitative (Marton  p r i m a r i l y on:  1976).  Evaluation  involves both  (how much) a n d q u a l i t a t i v e  & Saljo,  f r o m one  (how w e l l )  aspects  This research study i s focused  (a) i d e n t i f y i n g t h e c o n c e p t i o n s  of students  e n r o l l e d i n a c o m m u n i t y c o l l e g e n u r s i n g p r o g r a m on t h e r o l e of computers i n h o s p i t a l n u r s i n g , conceptions  (b) a r r a n g i n g  their  i n t o u n i t s o r c a t e g o r i e s , a n d (c) e v a l u a t i n g t h e  complexity or q u a l i t y of these conceptions. discussion w i l l  Therefore,  this  f o c u s p r i m a r i l y on t h e q u a l i t a t i v e a s p e c t s o f  the e v a l u a t i o n o f l e a r n i n g , even though i t i s r e c o g n i z e d t h a t b o t h t h e q u a n t i t a t i v e and q u a l i t a t i v e dimensions  are equally  important. There a r e few i n s t r u m e n t s learning. The  f o r measuring t h e q u a l i t y o f  Four e v a l u a t i o n devices w i l l  be d e t a i l e d  briefly.  most w i d e l y known i s B l o o m ' s Taxonomy ( B l o o m ,  Englelhart, Furst, H i l l , Biggs  and C o l l i s  & Krathwohl,  1956) .  According t o  ( 1 9 8 2 ) , t h i s taxonomy was d e s i g n e d t o  p r o v i d e t e a c h e r s w i t h a means o f o r d e r i n g i t e m s hierarchial  in a  l e v e l o f q u a l i t y f o r t e s t i n g purposes.  The  h i e r a r c h y s u b s c r i b e d t o by Bloom e t a l . c o n s i s t e d o f s i x levels:  knowledge, comprehension, a p p l i c a t i o n ,  analysis,  53 s y n t h e s i s , and e v a l u a t i o n .  Most e d u c a t o r s a r e f a m i l i a r  with  t h i s t a x o n o m y , and e v e n t h o u g h i t h a s d e f i n i t e m e r i t s , most will  r e a d i l y admit  i t s shortcomings  as b e i n g :  (a) i t s  i n t e n d e d use t o guide t h e s e l e c t i o n o f items f o r c o n s t r u c t i n g tests,  r a t h e r t h a n as a means o f e v a l u a t i n g t h e q u a l i t y o f a  student's response difficulty  t o a p a r t i c u l a r i t e m , and  (b)  the  of d e v i s i n g items t o assess beyond t h e  comprehension l e v e l o f t h e taxonomy. S c h r o d e r , D r i v e r and  Streufert  (1967) d e v e l o p e d  an  e v a l u a t i o n device to assess the q u a l i t y of w r i t t e n essays i n terms of f o u r l e v e l s of conceptual s t r u c t u r e .  Through t h e  c o u r s e o f t h e i r r e s e a r c h , t h e y found t h a t low l e v e l s s t r u c t u r a l complexity i n students' responses  of  were not  i n c o m p a t i b l e w i t h "good" m a r k s , i n t h e t e r m s o f r e c a l l factual  of  detail.  Marton  and  Saljo  (1975) r e p o r t t h e f i n d i n g s o f a  research study they d i d w i t h students at the U n i v e r s i t y Gothenburg.  Two  groups of twenty  f i r s t - y e a r s t u d e n t s were  asked t o read t h r e e s e c t i o n s of a textbook. e a c h g r o u p w e r e g i v e n two t h e y had  read the f i r s t  The  students i n  d i f f e r e n t types of questions  two  sections.  W h i l e one  o t h e r g r o u p r e c e i v e d q u e s t i o n s w h i c h demanded a  q u e s t i o n s was  the  thorough  A common s e t o f b o t h t y p e s  given a f t e r the f i n a l  after  group  r e c e i v e d q u e s t i o n s r e q u i r i n g d e t a i l e d f a c t u a l answers,  meaning o f t h e passage.  of  of  s e c t i o n had been r e a d .  They f o u n d e v i d e n c e t o s u g g e s t t h a t s t u d e n t s a d a p t  their  way  54 of l e a r n i n g according t o t h e i r conceptions  o f what  r e q u i r e d o f them a n d t h e i r i n d i v i d u a l c o n c e p t i o n s  was of  learning. Much o f t h e work on t h e e v a l u a t i o n o f q u a l i t y o f learning,  l i k e the study  just cited,  h a s b e e n done i n Sweden  at t h e U n i v e r s i t y o f Guthenberg, u s i n g a phenomenological approach t o study  student  colleagues are working  learning.  Marton and h i s  w i t h i n a q u a l i t a t i v e approach t o  l e a r n i n g , w h i c h assumes t h a t most human l e a r n i n g d e p e n d s on meaning and i s d i r e c t e d t o w a r d i t ,  a n d t h a t what a  l e a r n s c a n o n l y be g a u g e d f r o m t h e s t u d e n t ' s They a r e i n t e r e s t e d i n "what," r a t h e r t h a n  student  own p e r s p e c t i v e .  "how much," i s  learned. The g e n e r a l r e s e a r c h a p p r o a c h u s e d by t h e s e has  been t o use s e m i - s t r u c t u r e d tape  recorded interviews,  w h i c h a r e t r a n s c r i b e d , t o p r o v i d e t h e d a t a t o be The a i m o f a n a l y s i s , i n t h i s t y p e  researchers  analyzed.  of research, i s to y i e l d  d e s c r i p t i v e c a t e g o r i e s of the q u a l i t a t i v e v a r i a t i o n found i n the e m p i r i c a l data. they map  T h e s e d e s c r i p t i v e c a t e g o r i e s f o r m what  c a l l t h e outcome s p a c e , w h i c h i s a k i n d o f an  analytical  o f v a r i a t i o n i n what h a s b e e n l e a r n e d f r o m a g i v e n  learning  task.  F u r t h e r r e s e a r c h by M a r t o n a n d S a l j o (1976) r e p o r t e d that student  responses t o a l e a r n i n g episode  c l a s s i f i e d into four levels,  c o u l d be  showing i n c r e a s i n g grasp  c o m p l e x i t i e s o f t h e m a t e r i a l t h a t was  taught.  of the  55 The l e v e l s a r e o r d e r e d i n t e r m s o f c h a r a c t e r i s t i c s t h a t i n c l u d e p r o g r e s s i o n from concrete t o a b s t r a c t , an i n c r e a s i n g number o f o r g a n i z i n g d i m e n s i o n s , i n c r e a s e d c o n s i s t e n c y , and use o f o r g a n i z i n g o r r e l a t i n g p r i n c i p l e s and h y p o t h e t i c a l p r i n c i p l e s u s e d a t t h e most c o m p l e x end ( B i g g s and C o l l i s , 1982, p 1 4 ) . I n l o o k i n g a t t h e work o f B l o o m ( 1 9 6 7 ) , and  M a r t o n and  a g r e e m e n t among t h e  three  proceed i n a hierarchy quality. and  (1976), i t appears t h a t t h e r e  that q u a l i t a t i v e evaluation  of l e v e l s ,  Attention w i l l  Collis  Saljo,  Saljo  (1956), Schroder et a l .  now  be  could  in increasing structural  d i r e c t e d t o t h e work o f  (1982), which i s s i m i l a r t o t h a t of Marton  Biggs and  (1976).  B i g g s and  Collis  (1982) b e g a n t h e i r work w i t h  a s s u m p t i o n t h a t t h e q u a l i t y o f l e a r n i n g d e p e n d s on b o t h e x t r i n s i c and an e x t r i n s i c  i n t r i n s i c to the  learner.  An  f a c t o r i s q u a l i t y of i n s t r u c t i o n .  f a c t o r s i n c l u d e motivation,' developmental stage, knowledge.  A f t e r extensive  a n a l y s i s , they  subscribed t h e i r work. c a l l e d the  t o l e a r n i n g q u a l i t y , as a p o i n t  the factors,  example  of  Intrinsic and  prior  refuted  d e v e l o p m e n t a l s t a g e as a f r a m e o f r e f e r e n c e ,  Their  is  and  rather,  of departure  for  They d e v e l o p e d a t a x o n o m y o f l e a r n i n g o u t c o m e s , Structure  of Observed Learning  Outcomes  (SOLO).  SOLO Taxonomy i s o r d e r e d i n t e r m s o f f i v e l e v e l s o f  l e a r n i n g outcome:  (a) p r e s t r u c t u r a l , (b) u n i s t r u c t u r a l ,  (c) m u l t i s t r u c t u r a l , (d) r e l a t i o n a l , abstract.  B i g g s and  Collis  and  (e)  extended  (1982). e m p h a t i c a l l y  that although they believe there  point  are n a t u r a l stages i n  out the  56 g r o w t h o f l e a r n i n g any  complex m a t e r i a l or s k i l l ,  l e v e l s are s i m i l a r t o , but developmental stages  logically distinct  s u b s c r i b e d t o by P i a g e t  their  from,  the  (1950)  and  others. Those e s p o u s i n g it  the b e n e f i t s of the  as a u s e f u l t o o l t o h e l p e d u c a t o r s  the q u a l i t y of l e a r n i n g that takes teach w i t h i n t h e i r classrooms.  ;  SOLO Taxonomy h e r a l d  make j u d g e m e n t s a b o u t  place i n the courses  they  I t i s an a t t e m p t a t e m p i r i c a l  c l a s s i f i c a t i o n o f l e v e l s o f l e a r n i n g outcome, i n a f o r m w h i c h has  widespread It  applicability.  a p p e a r s t h a t t h e work o f e v a l u a t i n g t h e q u a l i t y  l e a r n i n g i s on t h e i n c r e a s e , e s p e c i a l l y i n Sweden Australia, provide  and  that educational researchers  educators  quality. in  T h e r e a p p e a r s t o be  nursing l i t e r a t u r e to t h i s  and  are s t r i v i n g  i n g e n e r a l w i t h an u n d e r s t a n d i n g  c o n c e p t o f q u a l i t y o f l e a r n i n g and  of  i f anything,  to  the  a means o f a s s e s s i n g  little,  of  that  reported  end.  Summary  Nurses working i n Canadian h o s p i t a l s are a l r e a d y or r a p i d l y b e c o m i n g a f f e c t e d by  increased computerization,  noted i n the  Kennedy G r o u p S u r v e y  review  f i n d i n g s o f The  of l i t e r a t u r e reveals a dearth  s t u d i e s , and with nurses':  of reported  are as  (1988) .  A  Canadian  o n l y a s m a l l number o f A m e r i c a n s t u d i e s , d e a l i n g (a) a t t i t u d e s t o w a r d c o m p u t e r  use,  57 (b) k n o w l e d g e a b o u t c o m p u t e r s , and computer usage.  The  (c) f a c t o r s a f f e c t i n g  studies reviewed  p r a c t i c e , nursing educators  f o c u s on n u r s e s  and b a c c a l a u r e a t e  l e v e l n u r s i n g students, w i t h the obvious recent  l i t e r a t u r e on c o l l e g e p r e p a r e d  any  nursing students,  the  hospitals.  l i t e r a t u r e does, however, p o i n t t o the need f o r  computer e d u c a t i o n  f o r a l l nurses,  w i t h much e m p h a s i s  p l a c e d on t h i s h a p p e n i n g w i t h i n n u r s i n g e d u c a t i o n W h i l e s e v e r a l "how to a i d content courses  masters  absence of  m a j o r i t y o f which are employed i n Canadian The  and  in  being  settings.  t o " a r t i c l e s and t e x t s h a v e b e e n p u b l i s h e d  d e v e l o p m e n t and  implementation  of  computer  i n t o c u r r i c u l a of n u r s i n g schools, there appears t o  have been l i t t l e  thought given t o assessing the q u a l i t y  learning that takes place there. t h i s Canadian study  The  of the conceptions  indication,  then,  of for  of nursing students  a community C o l l e g e b a s e d p r o g r a m , i s c l e a r .  in  58 CHAPTER 3 Methodology  The m e t h o d o l o g y u s e d  i n t h i s study i s based  on t h e  q u a l i t a t i v e r e s e a r c h t r a d i t i o n c a l l e d phenomenology, and i s aimed a t t h e g e n e r a t i o n o f t h e o r y .  Phenomenology d e r i v e s  f r o m a p h i l o s o p h i c a l o r i e n t a t i o n t o w a r d human e x p e r i e n c e a s the experience e x i s t s i n the consciousness of the i n d i v i d u a l . It considers subjective r e a l i t y experience.  as t h e essence  o f human  Phenomenology g u i d e s t h e g e n e r a t i o n and  i n t e r p r e t a t i o n o f d a t a t o d e s c r i b e phenomena f r o m t h e p o i n t o f v i e w o f t h e i n d i v i d u a l who knows t h e p r o b l e m (Thorne,  1988).  description,  intimately  I t i s s u b s t a n c e - o r i e n t e d , and aimed a t  analysis,  and u n d e r s t a n d i n g o f e x p e r i e n c e s  (Marton,1981). T h i s s t u d y was d e s i g n e d t o s e e k an e m p a t h e t i c understanding of students' conceptions of the role of computers i n h o s p i t a l n u r s i n g from s t u d e n t s ' d e s c r i p t i o n s o f what i t means t o them.  Student  c o n c e p t i o n s s e r v e d as t h e  object of analysis i n t h i s research. Audio-taped interview,  interviews, using a semi-structured  s c h e d u l e were c o n d u c t e d .  Transcripts  f r o m t h o s e i n t e r v i e w s were a n a l y z e d t o y i e l d  generated  descriptive  c a t e g o r i e s o f t h e q u a l i t a t i v e v a r i a t i o n s found i n t h e subjects'  statements.  I n summary, t h e n , t h e m e t h o d o l o g y u s e d  i n t h e s t u d y was  59 p h e n o m e n o l o g y , and t h e p e r s p e c t i v e was The  components o f t h e method w i l l  detail  i n the  be  t h a t of the  described  student.  i n greater  s e c t i o n s which f o l l o w .  D e s c r i p t i o n Of  Subjects  Sample S e l e c t i o n  The students  t a r g e t p o p u l a t i o n f o r t h i s r e s e a r c h was  e n r o l l e d i n community c o l l e g e n u r s i n g programs i n  B r i t i s h Columbia.  E v e n t h o u g h i t was  recognized  community c o l l e g e n u r s i n g programs v a r y have t h e  a c c e s s i b l e p o p u l a t i o n was  a l l first,  first-year, total  numbers o f s t u d e n t s 47  a c c e s s i b l e p o p u l a t i o n o f 171 It  i s important  c o n s i s t e d o f two composed o f 51  third  year  diploma  (January-April)  i n each year were:  i n s e c o n d - y e a r , and  in a  identified  College's  n u r s i n g program i n the w i n t e r semester The  The  s e c o n d , and  e n r o l l e d i n Cariboo  these  beginning  t h e i r programs are a l l o r g a n i z e d  s i m i l a r f a s h i o n i n terms of semesters.  nursing students  that  i n length, they a l l  same mandate t o p r e p a r e n u r s e s as  p r a c t i t i o n e r s and  1988.  a l l nursing  57  of in  67 i n t h i r d - y e a r , g i v i n g a students.  t o note that the t h i r d - y e a r c l a s s ,  very d i s t i n c t groups.  The  first  so c a l l e d " r e g u l a r " s t u d e n t s ,  d i p l o m a n u r s i n g p r o g r a m was  designed.  The  group  f o r which  was the  second group  composed o f 16 r e g i s t e r e d p s y c h i a t r i c n u r s e s  (R.P.N.'s),  was who  60 w e r e e n r o l l e d i n a n R.P.N. A c c e s s P r o g r a m . were t a k i n g a m o d i f i e d d i p l o m a t h e i r p s y c h i a t r i c education r e g i s t e r e d nurses. students  These  n u r s i n g program t o supplement  and t o enable  t h e m t o become  T h i s R.P.N, g r o u p j o i n e d t h e " r e g u l a r "  i n September,1987, a t t h e b e g i n n i n g  year  o f t h e program  1988,  approximately  students  (semester  of the t h i r d  5 ) , and graduated  i n March  one month b e f o r e t h e " r e g u l a r " s t u d e n t s .  They w e r e n o t i n c l u d e d i n t h e t h i r d - y e a r p o p u l a t i o n , a s t h e y were u n c h a r a c t e r i s t i c o f t h a t group i n t e r m s o f e d u c a t i o n a l experience,  program l e n g t h and c u r r i c u l u m  content  modification. The  " r e g u l a r " diploma  nursing student  population,  w h i c h t h e s a m p l e was d r a w n , numbered 155 s t u d e n t s . permission,  t o p a r t i c i p a t e i n t h e study,  (see A p p e n d i x B) a n d o b t a i n e d  College.  B e c a u s e t h e a c c e s s i b l e p o p u l a t i o n was (149 f e m a l e s a n d 6 m a l e s ) ,  t o sample o n l y t h a t group.  students  o f t h e program.  predominantly  i t was i n i t i a l l y  decided  A t a b l e o f random numbers was  u s e d t o i d e n t i f y a sample o f t h i r t y each year  was s o u g h t  ( s e e A p p e n d i x C) i n J a n u a r y ,  from t h e V i c e - P r e s i d e n t o f Cariboo  female,  Written  allowing the researcher t o i n v i t e selected  nursing students  1988,  from  female s t u d e n t s , t e n from  These randomly s e l e c t e d f e m a l e  w e r e a p p r o a c h e d t o p a r t i c i p a t e i n t h e s t u d y b y means  of a l e t t e r o f i n t r o d u c t i o n , which o u t l i n e d the purpose o f t h e r e s e a r c h , p r o c e d u r e s t o be c a r r i e d o u t ,  and i t a s s u r e d  them o f c o m p l e t e a n o n y m i t y a n d c o n f i d e n t i a l i t y  61 (see A p p e n d i x D ) .  They w e r e r e q u e s t e d  to indicate  their  w i l l i n g n e s s t o p a r t i c i p a t e i n t h e study by r e t u r n i n g a s i g n e d consent  form  (see A p p e n d i x E) t o t h e r e s e a r c h e r ' s m a i l b o x a t  Cariboo  College.  T e l e p h o n e c o n t a c t was t h e n made w i t h e a c h s u b j e c t who had  r e t u r n e d t h e s i g n e d consent/  convenient  t o schedule  time t o conduct t h e i n t e r v i e w .  t h i r d - y e a r female  a mutually  A l l second and  s u b j e c t s who w e r e r a n d o m l y s e l e c t e d w e r e  willing to participate.  One f e m a l e  first-year  subject  r e f u s e d t o p a r t i c i p a t e b e c a u s e s h e l i v e d o u t o f t o w n a n d was unable  t o schedule  the interview f o r a mutually  time.  She made i t v e r y c l e a r t h a t s h e was i n t e r e s t e d i n t h e  r e s e a r c h a n d v o l u n t e e r e d names o f c l a s s m a t e s interested i n taking her place. not used but,  convenient  who m i g h t b e  However/ t h e s e names w e r e  r a t h e r , t h e random numbers t a b l e was o n c e  used t o s e l e c t t h i s t e n t h female Flexibility  s u b j e c t from  :  again  first-year.  and a d a p t a b i l i t y o f s e l e c t i o n and sampling  d e c i s i o n s , as w e l l as t h e i r i n t e g r a t i o n throughout t h e research process, (Goetz  are hallmarks of q u a l i t a t i v e  & LaCompte,1984).  j o i n t processes  As t h e study unfolded/  of data c o l l e c t i o n ,  through t h e  coding, and a n a l y s i s o f  d a t a , c o n c e p t i o n s b a s e d on t h e f e m a l e became v e r y a p p a r e n t .  research  subjects' perspective  Thus, i t was d e c i d e d t o a l s o s e e k o u t  c o n c e p t i o n s b a s e d on t h e m a l e s t u d e n t s ' p e r s p e c t i v e .  The  s m a l l numbers o f m a l e s t u d e n t s e n r o l l e d i n t h e C a r i b o o C o l l e g e n u r s i n g program r e f l e c t t r e n d s f o r males employed i n  62 nursing. male"  " L e s s t h a n 2% (468 i n 1985) o f B.C. n u r s e s a r e  (R.N.A.B.C. News, 1986, p 1 6 ) . F i v e o f t h e s i x male s t u d e n t s e n r o l l e d i n t h e program,  (one i n e a c h o f f i r s t y e a r ) , were a p p r o a c h e d  and second-year  and t h r e e i n t h i r d -  by l e t t e r t o p a r t i c i p a t e i n t h e s t u d y .  One m a l e t h i r d - y e a r s t u d e n t was n o t a p p r o a c h e d ,  b e c a u s e he  was d o i n g a c l i n i c a l p e r c e p t o r s h i p i n an o u t l y i n g g e o g r a p h i c a l l y removed from Kamloops. d i s t a n c e made i t t o o d i f f i c u l t convenient interview time. forms,  This  geographic  t o schedule a mutually  Upon r e c e i v i n g t h e s i g n e d  t h e male s u b j e c t s were a l s o approached  s c h e d u l e an a p p o i n t m e n t  hospital,  consent  by t e l e p h o n e t o  t i m e t o be i n t e r v i e w e d .  At that  p o i n t , t h e y were i n f o r m e d t h a t t h e y had n o t been randomly s e l e c t e d b e c a u s e o f t h e i r s m a l l numbers, b u t t h a t t h e y w e r e i n t e n t i o n a l l y being i n v i t e d t o participate. c h o s e t o do s o , e v e n g i v e n t h o s e In  A l l five  readily  circumstances.  summary, t h e t o t a l a c c e s s i b l e p o p u l a t i o n o f " r e g u l a r "  d i p l o m a n u r s i n g s t u d e n t s y i e l d e d t h e study sample breakdown i n t e r m s o f y e a r a n d s e x d e p i c t e d i n T a b l e 3 on t h e f o l l o w i n g page.  63 T a b l e 3. F r e q u e n c y Of M a l e A n d F e m a l e S t u d e n t s I n The A c c e s s i b l e P o p u l a t i o n Of C a r i b o o  College Nursing  S t u d e n t s From W h i c h A  Sample Was Drawn  A C C E S S I B L E POPULATION YEAR  CLASS  1  1990  2 3  MALE  TOTAL  56  1  57  10  1  11  1989  46  1  47  10  1  11  1988  47  4  51  10  3  13  149  6  155  30  5  35  TOTAL:  FEMALE  Subjects'  technology last  i n nursing, a conscious four years  FEMALE  e f f o r t h a s b e e n made o v e r  t o i n c o r p o r a t e computer awareness  i n t o the nursing curriculum at Cariboo  content  was p l a c e d i n t h e N u r s i n g i n each year  College.  P e r s p e c t i v e s Course,  o f t h e program.  The b r i e f  o u t l i n e w h i c h f o l l o w s i n d i c a t e s what was c o v e r e d the three The  TOTAL  i n c r e a s e d use o f computer  content  i s taught  MALE  E x p o s u r e To C o m p u t e r C o n t e n t  In response t o the perceived  the  SAMPLE  This which  content i n each o f  years. f i r s t - y e a r subjects  seminar scheduled  ( c l a s s o f 1 9 9 0 ) , h a d a two h o u r  i n s e m e s t e r 1, i n w h i c h t h e y  were  64 i n t r o d u c e d t o t h e computer system a t C a r i b o o given the opportunity  C o l l e g e , and  f o r a h a n d s on e x p e r i e n c e .  This  s e m i n a r was l e d b y a p e r s o n e m p l o y e d i n c o m p u t e r s e r v i c e s a n d was h e l d i n a c o m p u t e r l a b .  Subjects  were e n c o u r a g e d t o s e n d  m a i l m e s s a g e s t o a n u r s i n g i n s t r u c t o r , t o e n a b l e them t o h a v e some p r a c t i c a l u s e o f t h e c o m p u t e r .  A h a n d o u t was g i v e n t o  e a c h s u b j e c t w i t h i n f o r m a t i o n on how t o a c c e s s college  the Cariboo  system.  I n a d d i t i o n , t h i s group a l s o had a two hour s e m i n a r l e d by  a member o f t h e f i r s t - y e a r n u r s i n g f a c u l t y ,  discussed:  (a) t h e i r e x p e r i e n c e s  w i t h computers,  h i s t o r y o f computers i n h e a l t h c a r e , disadvantages  o f c o m p u t e r s , a n d (d) t h e i s s u e s  second-year subjects  of f i r s t  (b) t h e  concerning  i n health  care.  ( c l a s s o f 1989), had s i m i l a r  f o u r hour computer awareness seminars scheduled  (as o u t l i n e d above)  f o r them w h i l e t h e y were e n r o l l e d i n s e m e s t e r one year.  I n s e m e s t e r 4. o f s e c o n d y e a r ,  these  were r e q u i r e d t o r e a d c u r r e n t l i b r a r y r e a d i n g s i n n u r s i n g as p a r t o f t h e i r N u r s i n g  Perspectives course. these  articles  i n t o a compulsory assignment about N u r s i n g  Future.  Even though computer awareness content specifically  i n t h i s course,  d i s c u s s i o n on s e v e r a l Third-year  subjects  on c o m p u t e r s  m a j o r i t y o f s u b j e c t s i n t e g r a t e d i n f o r m a t i o n from  taught  they  (c) t h e a d v a n t a g e s a n d  nurses with i n c r e a s i n g computerization The  i n which  I n The  was n o t  i t came up i n c l a s s  occasions.  subjects  ( c l a s s o f 1 9 8 8 ) , were a l s o a l l  The  65 scheduled,  i n semester 1 of f i r s t  computer awareness course by  a two  oh  College's  with  s u b j e c t s r e c e i v e d no  hands-on computer e x p e r i e n c e  and  the structured  while e n r o l l e d i n the  second  o f t h e p r o g r a m , h o w e v e r , d i s c u s s i o n on t h e e f f e c t s o f  computer t e c h n o l o g y the Nursing year,  As  hour  followed  s e s s i o n on a c c e s s i n g  computer system.  second-year s u b j e c t s , these  year  t o a t t e n d a two  "Computers i n N u r s i n g , "  hour hands-on p r a c t i c a l  using Cariboo  year,  on n u r s i n g p r a c t i c e was  Perspectives course.  integrated into  In semester 5 of  third  s e v e r a l s u b j e c t s d i d r e s e a r c h p a p e r s on t e c h n o l o g y  n u r s i n g as a r e q u i r e d a s s i g n m e n t i n t h e N u r s i n g course.  Perspectives  I n a d d i t i o n , s e m e s t e r 6 s u b j e c t s were i n t r o d u c e d  a computer a s s i s t e d i n s t r u c t i o n  (C.A.I.) program  intent i n i n t r o d u c i n g students i n preparing  time of the  study,  t o t h i s p r o g r a m was  I n summary, a l i m i t e d amount o f c o n t e n t  College.  incorporated i n t o the Nursing of t h i r d - y e a r .  o f f e r e d one package.  At  the  College. .  i n computer  made a v a i l a b l e t o a l l s u b j e c t s e n r o l l e d i n t h e  n u r s i n g program at Cariboo  exception  t o promote  the o n l y n u r s i n g r e l a t e d C.A.I,  p r o g r a m owned by t h e n u r s i n g d e p a r t m e n t a t C a r i b o o  a w a r e n e s s was  The  f o r t h e i r r e g i s t r a t i o n exams.  t h i s was  to  entitled  N u r s e S t a r , w h i c h i s a c o m p u t e r i z e d exam t e s t b a n k .  i t s use  in  This content  was  P e r s p e c t i v e s Course, w i t h  the  I n t h i r d - y e a r , s u b j e c t s were a l s o  i n s t r u c t i o n a l s e s s i o n w i t h a C.A.I, t e s t bank  T h i s p a c k a g e was  designed  to give students  i n answering m u l t i p l e choice questions  as p r e p a r a t i o n  practice for  66 w r i t i n g the n a t i o n a l r e g i s t r a t i o n examinations. d e p i c t s how t h e c o m p u t e r a w a r e n e s s c o n t e n t  Table 4  i s dispersed  throughout t h e program.  T a b l e 4. S c h e d u l e d H o u r s Of C o m p u t e r A w a r e n e s s C o n t e n t I n E a c h S e m e s t e r Of The C a r i b o o  College Nursing  Program  SCHEDULED HOURS SEMESTER  F I R S T YEAR  SECOND YEAR  4  1  THIRD YEAR  4  4  2 3 4  Perspectives  Perspectives  5  -  Perspectives Nurse  6  Star  Instrumentation  An  i n t e r v i e w schedule  the researcher  ( s e e A p p e n d i x F) was d e v e l o p e d b y  i n which three  semi-structured  questions  formed t h e framework f o r c o l l e c t i n g q u a l i t a t i v e d a t a t o answer t h e b r o a d and s p e c i f i c r e s e a r c h q u e s t i o n s . interview questions data  were a i m e d a t :  from which c a t e g o r i e s o f student  The t h r e e  (a) g a t h e r i n g  descriptive  conceptions  of the role  67 of  computers i n h o s p i t a l n u r s i n g c o u l d be g e n e r a t e d , and  (b) d e t e r m i n i n g e a c h  student's a t t i t u d e toward  computers i n h o s p i t a l n u r s i n g .  In addition,  the role of  i n order t o  o b t a i n q u a n t i t a t i v e d e m o g r a p h i c d a t a a n d d a t a on c o m p u t e r usage, a respondent response at  profile  sheet, c o n s i s t i n g of t e n f o r c e d -  a n d o p e n - e n d e d q u e s t i o n s , was d e v e l o p e d  t h e end o f each i n t e r v i e w schedule. The  1988,  i n t e r v i e w s c h e d u l e was f i r s t  w i t h two second-year  p i l o t e d i n January  n u r s i n g s t u d e n t s , and r e s u l t e d i n  further focused questions. to  and i n c l u d e d  I t a l s o p r o v i d e d an o p p o r t u n i t y  c r i t i q u e the researcher's interviewing s k i l l s .  Necessary  r e v i s i o n s t o t h e t o o l and i n t e r v i e w i n g s t y l e were  addressed.  The  r e v i s e d i n t e r v i e w s c h e d u l e was a g a i n p i l o t e d i n F e b r u a r y  1988,  w i t h two d i f f e r e n t  second-year  r e v i s i o n s were made a n d i t was f e l t ready  f o r use.  pilots,  students.  Minor  a t t h a t t i m e t h a t i t was  S e c o n d - y e a r s t u d e n t s were c h o s e n f o r t h e  because t h e r e s e a r c h e r had e a s i e r access t o t h a t  g r o u p o f s t u d e n t s on a r e g u l a r b a s i s ,  and second  y e a r was  between t h e o t h e r two y e a r s . The  i n t e r v i e w schedule and accompanying  respondent  p r o f i l e were s c r e e n e d by t h e U n i v e r s i t y o f B r i t i s h  Columbia  B e h a v i o r a l S c i e n c e s S c r e e n i n g Committee F o r Research and Other  S t u d i e s I n v o l v i n g Human S u b j e c t s .  grounds f o r t h i s r e s e a r c h study  A p p r o v a l on e t h i c a l  (#B88-058) i n v o l v i n g human  s u b j e c t s was o b t a i n e d on M a r c h 10, 1988 (see A p p e n d i x G ) .  68 Procedures Data  T h i r t y - f i v e audiotaped f r o m 30-45  Collection  interviews, ranging  m i n u t e s , were c o n d u c t e d i n March and A p r i l , 1988.  These t o o k p l a c e a t m u t u a l l y  convenient  within the privacy of the researcher's times  were s t a g g e r e d  scheduled  i n length  scheduled office.  times Interview  w i t h o n l y one o r t w o i n t e r v i e w s  p e r d a y , on a l t e r n a t e d a y s , s o a s n o t t o j e o p a r d i z e  the q u a l i t y of the interviews with i n t e r v i e w e r f a t i g u e . one  occasion,  t h r e e i n t e r v i e w s were h e l d on one d a y b e c a u s e  of t h e l a c k o f a v a i l a b i l i t y examination outset to  schedules  o f t h e s u b j e c t s due t o f i n a l  a t t h e end o f t h e semester.  At the  o f e a c h i n t e r v i e w , s u b j e c t s were a s k e d i f t h e y  t h e i n t e r v i e w being tape recorded,  readily  On  agreed  and a l l s u b j e c t s  agreed.  A semi-structured was u s e d , w h i c h e n a b l e d  i n t e r v i e w schedule the researcher  ( s e e A p p e n d i x F)  t o gather  comparable  d a t a b e t w e e n s u b j e c t s w i t h i n t h e same a n d d i f f e r e n t y e a r s o f the n u r s i n g program  (Bogdan & B i k l e n 1 9 8 2 ) .  were a s k e d i n t h e o r d e r  A l l questions  o u t l i n e d i n t h e schedule  only minor rewordings of t h e questions  t o make them  c o n s i s t e n t w i t h t h e i n t e r v i e w e r ' s and s u b j e c t s ' Q u e s t i o n s were r e w o r d e d when i t was n e c e s s a r y t h e i r meaning t o s u b j e c t s .  Probing  i n f o r m a t i o n and c l a r i f i c a t i o n  and w i t h  style.  to clarify  f o r additional  o f answers t o o k p l a c e i n each  69 interview. If  a subject addressed a question before  t h e q u e s t i o n was  still  asked i n sequence but  a c k n o w l e d g e d t h a t t h e q u e s t i o n had communicated t o the l i s t e n i n g but  omission  q u e s t i o n by t h e Kirchhoff,  1988).  words i n t h e avoid t h i s , two  of the  The  four p i l o t  researcher  i n v e s t i g a t i o n of  was  a t t e m p t s w e r e made t o e l i c i t  cognizant  Bevis, of  and  a &  "putting  a weakness i n t h e  During  and m a i n t a i n  data  to  first  collection,  the uniqueness  each s u b j e c t ' s i n t e r p r e t a t i o n of h i s or her (Munhall,  the  consciously attempted  o b s e r v e d t o be interviews.  been  subject with  (Knafr, P e t t e n g i l l ,  s u b j e c t ' s mouth," and as i t was  This  been s a i d p r e v i o u s l y ,  or cursory  interviewer  interviewer  i n t e r v i e w e r had  i n a d d i t i o n , provided the  also precluded  the  asked,  been addressed.  subject that the  o p p o r t u n i t y t o e x p a n d on what h a d  i t was  of  experience  1982).  A t t h e c o n c l u s i o n o f e a c h i n t e r v i e w , s u b j e c t s were thanked f o r t h e i r p a r t i c i p a t i o n , to  and  asked i f they would  r e c e i v e a copy of t h e i r t r a n s c r i p t .  first  year  student  who  had  c o m p u t e r s , i n d i c a t e d she the other  s u b j e c t s was  i s not necessary  O n l y one  one  subject,  considerable experience  would l i k e a copy.  The  o f , " I know what I ' v e  and  with  said,  so i t  t o have a copy."  of the program i n which the  (b) s u b j e c t w i t h i n e a c h y e a r .  student  was  a  r e a c t i o n of  T a p e s were i d e n t i f i e d w i t h a number i n d i c a t i n g (a) y e a r  like  the:  enrolled,  Numbers f r o m 1-10  were  70 used t o i d e n t i f y female  s u b j e c t s a n d 11-13 t o i d e n t i f y  male  subjects. Immediately  a f t e r each i n t e r v i e w , t h e researcher wrote a  s h o r t summary o f t h o u g h t s , interview.  These i n i t i a l  begin the process  f e e l i n g s and r e a c t i o n s t o t h e thoughts  and  the researcher t o  of a n a l y s i s simultaneously with the data  c o l l e c t i o n phase o f t h e r e s e a r c h . generated  enabled  I n t h i s s t u d y , t h e o r y was  by t h e j o i n t o p e r a t i o n s o f d a t a c o l l e c t i o n ,  a n a l y s i s of data.  G l a s e r and S t r a u s s  coding,  (1967) p o i n t o u t  that the generation of theory, coupled with the notion of t h e o r y as p r o c e s s ,  r e q u i r e s t h a t a l l o p e r a t i o n s b e done  t o g e t h e r a s much a s p o s s i b l e a n d i n t e r t w i n e d c o n t i n u a l l y  from  the b e g i n n i n g o f t h e study t o t h e end. A dictaphone verbatim  was u s e d t o t r a n s c r i b e t h e a u d i o  i n t o a computer i n o r d e r t o generate  the i n t e r v i e w s .  tapes  transcripts of  O r i g i n a l s o f t h e t r a n s c r i p t s were s t o r e d i n  a s a f e p l a c e f o r f u r t h e r r e f e r e n c e l a t e r as t h e s t u d y unfolded.  Photocopies  used as w o r k i n g generated.  o f t h e o r i g i n a l s were t a k e n a n d were  d o c u m e n t s f r o m w h i c h t h e a n a l y s i s was  These t r a n s c r i p t i o n s , t o g e t h e r w i t h t h e w r i t t e n  r e a c t i o n s t o t h e i n t e r v i e w s , p r o v i d e d 455 p a g e s o f d a t a . D u r i n g t h e t w o month p e r i o d o f t i m e when  student  i n t e r v i e w s , t r a n s c r i p t i o n o f t a p e s , c o d i n g and b e g i n n i n g a n a l y s i s was o c c u r r i n g , i n f o r m a l d i s c u s s i o n s were a l s o h e l d with:  (a) members o f t h e C o m p u t e r s I n N u r s i n g  o f t h e R.N.A.B.C.,  I n t e r e s t Group  (b) t h e s t e e r i n g c o m m i t t e e members f o r t h e  71 Computers I n N u r s i n g P r o j e c t ,  and  College Nursing faculty.  intent of these discussions  The  (c) c o l l e a g u e s a t C a r i b o o was  t o d e t e r m i n e t h e c l i m a t e and p r e s e n t s t a t e o f t h e a r t o f computers i n b o t h h o s p i t a l and e d u c a t i o n a l s e t t i n g s B r i t i s h Columbia.  In a d d i t i o n ,  g a t h e r i n g i n t e r v i e w was  within  a scheduled information  h e l d with the D i r e c t o r of  Patient  Care S e r v i c e s a t R o y a l I n l a n d H o s p i t a l i n Kamloops t o determine:  (a) t h e s t a t u s o f c o m p u t e r i m p l e m e n t a t i o n a t t h e  local hospital, selection,  and  (b) t h e d e g r e e o f n u r s i n g i n p u t i n t o (c) p l a n s f o r e d u c a t i n g n u r s e s t o u s e  system it.  These i n f o r m a l d i s c u s s i o n s p r o v i d e d t h e r e s e a r c h e r w i t h a sense of t h e p r e s e n t s t a t e o f t h e a r t of computer use n u r s e s i n h o s p i t a l s i n Kamloops and t h e r e s t o f Columbia,  and a l s o a s e n s e o f how  British  n u r s e s and s t u d e n t  are b e i n g educated t o use t h e s e computers.  by  nurses  The i n f o r m a t i o n  g l e a n e d f r o m t h e s e d i s c u s s i o n s , as w e l l as f r o m t h e r e v i e w o f the l i t e r a t u r e ,  provided a context f o r interpretation  d i s c u s s i o n of t h e f i n d i n g s from t h i s  Researcher's  and  study.  Role  B e c a u s e t h e n a t u r e o f t h i s s t u d y was  both inductive,  generative, designed t o d i s c o v e r a n a l y t i c c o n s t r u c t s or categories,  i t was  expected t h a t the s u b j e c t i v i t y of the  researcher would i n f l u e n c e the a n a l y s i s 1984).  Bogdan and B i k l e n  ( G o e t z & LeCompte  (1982) p o i n t o u t t h a t  the  and  72 r e s e a r c h e r i s t h e key of  i n q u a l i t a t i v e research.  t h e s t u d y , t h e r e s e a r c h e r was  k e e n l y aware o f  v a r i a b l e s i m p i n g i n g on t h i s s t u d y f r o m t h a t  improved  I t was  instructor,  a second-year  and a g r a d u a t e  U n i v e r s i t y of B r i t i s h It  c o u l d be  unique  a n t i c i p a t e d t h a t data a n a l y s i s would  by t h e r e s e a r c h e r ' s i n s i g h t ,  a p r a c t i s i n g nurse,  time  a member o f t h e n u r s i n g  f a c u l t y a t C a r i b o o C o l l e g e and as s u c h , was  perspective.  At the  argued  from her e x p e r i e n c e  n u r s i n g t h e o r y and  student i n adult education at  that the dual r o l e  of  incongruent  These s t u d e n t s had  i n s t r u c t o r \ r e s e a r c h e r , who  a l l b e e n t a u g h t by was  s t u d e n t s were t a u g h t  (September-December, 1987)  second-year  the  As w e l l ,  clinically by  (January-April,  s i x t e e n of i n the  fall  the  i n s t r u c t o r \ r e s e a r c h e r , p r i o r t o her c l i n i c a l the w i n t e r semester  and  carrying a f u l l teaching load  i n n u r s i n g theory throughout t h e year.  semester,  which  A: r a p p o r t h a d b e e n e s t a b l i s h e d  b e t w e e n t h e i n s t r u c t o r \ r e s e a r c h e r and t h e p r e s e n t  the second-year  the  Columbia.  c o u l d be p e r c e i v e d by t h e s u b j e c t s t o be  class.  as  clinical  i n s t r u c t o r \ r e s e a r c h e r put the r e s e a r c h e r i n a p o s i t i o n  p o s s i b l y uncomfortable.  be  release during  1988).  Because of s t a f f i n g changes i n t h e n u r s i n g department a t Cariboo College, students e n r o l l e d i n the t h i r d - y e a r c l a s s w e r e a l l t a u g h t n u r s i n g t h e o r y by t h e i n s t r u c t o r \ r e s e a r c h e r i n both t h e i r f i r s t Additionally,  and  second  years of the program.  over h a l f t h e t h i r d - y e a r c l a s s had been  taught  73 by  the instructor\researcher i n the c l i n i c a l  p a s t two y e a r s .  Several  students had a l s o had t h e  i n s t r u c t o r \ r e s e a r c h e r as a c l i n i c a l and  second  area over t h e  instructor,  both i n f i r s t  year.  I t was f e l t t h a t t h e f a m i l i a r i t y a n d r a p p o r t  that  e x i s t e d between t h e i n s t r u c t o r \ r e s e a r c h e r and b o t h second and t h i r d - y e a r s t u d e n t s , - c o m p e n s a t e d f o r any r o l e subjects  might have f e l t  deterrent,  and t h a t  instead of being  and c o o p e r a t i o n  third-year subject  had r e c e i v e d a p r o b a t i o n a r y  evaluation  from t h e researcher  rotation.  A t t h e t i m e s h e was v e r y  researcher subject  a  i t enhanced d a t a c o l l e c t i o n , because t h e comfort  levels of subjects  beginning  incongruency  were i n c r e a s e d .  One  clinical  i n a second year  clinical  angry, but a t t h e  o f h e r t h i r d y e a r s h e came b a c k a n d t h a n k e d t h e f o r h e l p i n g h e r t o c o r r e c t h e r weaknesses.  was n o t r e p l a c e d b y a n o t h e r f o r two r e a s o n s :  This (a) I t  was f e l t t h a t t h e i s s u e h a d h a p p e n e d l o n g e n o u g h p r i o r t o t h e study and had been d e a l t w i t h s u f f i c i e n t l y so t h a t interfere with the subject's  i t d i d not  a b i l i t y t o p a r t i c i p a t e , and  (b) t h e t i m i n g o f t h e i n t e r v i e w was c l o s e t o t h e e n d o f t h e s e m e s t e r , a n d many o f t h e o t h e r f i n i s h e d t h e i r practicum  t h i r d - y e a r students had  a n d were n o t a v a i l a b l e .  Throughout t h e i n t e r v i e w i n g phase o f t h e study, t h e i n s t r u c t o r \ r e s e a r c h e r was c o g n i z a n t regarding nursing  previous  o f h e r own  biases  knowledge o f s u b j e c t s ' performance i n t h e  program and a c c o r d i n g l y ,  t r i e d t o consciously  check  74 against  this.  researcher the  knew p r e v i o u s l y a s q u i t e n e g a t i v e ,  i n t e r v i e w as b e i n g The  the  F o r e x a m p l e , one t h i r d - y e a r s u b j e c t ,  very  who h a d n o t h a d any c o n t a c t  had a d i f f e r e n t r e l a t i o n s h i p .  were n o t f a m i l i a r w i t h t h e r e s e a r c h e r it  came a c r o s s i n  p o s i t i v e towards computers.  f i r s t - y e a r subjects  researcher,  was f e l t t h a t p e r c e i v e d  These  with  subjects  a s an i n s t r u c t o r , a n d  incongruency o f r o l e would  t h e r e f o r e be r e d u c e d o r n o n - e x i s t e n t . different consideration  whom t h e  This posed a  f o r the researcher.  very  Accordingly,  she  worked e s p e c i a l l y h a r d a t i n c r e a s i n g t h e comfort l e v e l o f these subjects,  so t h a t they f e l t  complete data i n t h e i n t e r v i e w s . acquainted subject  and i n r a p p o r t  r e l a x e d enough t o r e v e a l Time was s p e n t g e t t i n g  b u i l d i n g w i t h each  p r i o r t o t h e commencement o f e a c h  The  researcher  was a l s o c o g n i z a n t  first-year  interview.  o f h e r own p o s i t i v e  a t t i t u d e t o w a r d computer use i n h o s p i t a l s , and c o n s c i o u s l y t r i e d not t o reveal that p o s i t i v e bias t o the subjects. Several  subjects  asked t h e researcher  t o r e v e a l how s h e f e l t  about computer use by n u r s e s , a f t e r t h e i r i n t e r v i e w had terminated. point  i n t h e i r i n t e r a c t i o n , served  subjects during  The f a c t t h a t t h e y p o s e d t h a t q u e s t i o n ,  were u n a b l e t o d e t e c t  the actual audio-taped  at that  a s an i n d i c a t i o n t h a t  or respond t o researcher interview.  bias  75 A n a l y s i s Of I n t e r v i e w s  Two  s t r a t e g i e s were employed i n a n a l y z i n g d a t a  from t h e i n t e r v i e w s . d a t a was  ongoing  Although the process of a n a l y s i s  or formative throughout  f o r m a l o r s u m m a t i v e a n a l y s i s was was  generated  t h e s t u d y , t h e more  done a f t e r a l l o f t h e  c o l l e c t e d and a l l t h e i n t e r v i e w s were t r a n s c r i b e d  & Biklen,  1982).  f o r m a t i v e and  of  F o r t h e sake o f c l a r i t y  of  data (Bogdan  discussion,  s u m m a t i v e a n a l y s i s w i l l be d i s c u s s e d  separately.  Formative A n a l y s i s  Formative  a n a l y s i s i n c l u d e d what G l a s e r and  (1967) d e s c r i b e as t h e c o n s t a n t c o m p a r a t i v e analysis.  Strauss  method o f  T h i s i s a p r o c e s s whereby comparisons  made b e t w e e n and among s u b j e c t s f r o m e a c h y e a r  of data sampled.  I n t e r v i e w s were s c h e d u l e d t o e n s u r e t h a t d a t a from second,  and t h i r d - y e a r s t u d e n t s was  so t h a t d i f f e r e n c e s i n c o n c e p t i o n s among t h e y e a r s c o u l d be Immediately  first,  collected concurrently, ( i f any)  b e t w e e n , and  ;  tested.  a f t e r each  i n t e r v i e w , and p r i o r  to  t r a n s c r i b i n g the audio tapes, the r e s e a r c h e r wrote summary o f t h o u g h t s ,  are  feelings,  a short  and r e a c t i o n s t o t h e  i n t e r v i e w , as w e l l as any u n u s u a l c i r c u m s t a n c e s w h i c h i n f l u e n c e the q u a l i t y of the s u b j e c t ' s responses.  could  During  an  76 interview,  one f i r s t - y e a r f e m a l e  s u b j e c t , r e v e a l e d t h a t she  was n o t t h i n k i n g s t r a i g h t b e c a u s e s h e h a d j u s t f o u n d o u t t h a t h e r Dad h a d c a n c e r . had  j u s t found  A second-year  s u b j e c t , even though she  o u t s h e was p r e g n a n t ,  t h i s news a f f e c t h e r r e s p o n s e s .  d i d not appear t o l e t  A circumstance  with a  d i f f e r e n t e m o t i o n a l component o c c u r r e d i n an i n t e r v i e w w i t h a t h i r d - y e a r female  subject.  She h a d j u s t come f r o m a j o b  i n t e r v i e w where s h e h a d s u c c e s s f u l l y o b t a i n e d h e r f i r s t j o b as a n u r s e .  She was v e r y n o t i c e a b l y e x c i t e d a t t h e o u t s e t o f  t h e i n t e r v i e w , and gave v e r y s h o r t , t o - t h e - p o i n t answers until  s h e s e t t l e d down a b o u t f i v e m i n u t e s i n t o t h e i n t e r v i e w ,  and t h e n o f f e r e d more d e t a i l e d  responses.  During t h e t r a n s c r i p t i o n , process, which i n v o l v e d l i s t e n i n g t o t h e tapes and t y p i n g t h e d i a l o g u e d i r e c t l y t h e computer, thoughts d a t a and i n s i g h t s which  and a s s o c i a t i o n s between  transcript  came t o t h e r e s e a r c h e r w e r e a l s o  r e c o r d e d a s o b s e r v e r comments.  Both t h e i n i t i a l  observer  comments, a n d t h o s e made d u r i n g t h e t r a n s c r i p t i o n were r e c o r d e d under t h e b r o a d h e a d i n g s and  (b) a t t i t u d e .  into  of:  process,  (a) c o n c e p t i o n s ,  This served t o focus the analysis  around  the areas o f i n t e r e s t i d e n t i f i e d by t h e r e s e a r c h q u e s t i o n s guiding the study. As t h e c o n c u r r e n t p r o c e s s o f d a t a c o l l e c t i o n a n d a n a l y s i s proceeded,  i t became n e c e s s a r y t o s t o p  ongoing  periodically  and r e f l e c t on what a p p e a r e d t o be e m e r g i n g f r o m t h e d a t a . Data generated  f r o m s i x s u b j e c t s (two f r o m e a c h  year)  77 c o n s i s t i n g o f t h e t r a n s c r i p t s a n d a l l o b s e r v e r comments w e r e r e a d o n c e a g a i n a n d a memo o r summary was w r i t t e n o f what appeared t o be emerging. comparison memos.  The t e c h n i q u e o f c o n s t a n t  b e t w e e n , a n d among y e a r s was u s e d i n w r i t i n g  T h i s p r o c e s s o f memo w r i t i n g was c a r r i e d o u t  each group o f s i x Transcripts  after  interviews.  appeared w e l l used as the r e s e a r c h u n f o l d e d  and e a c h one h a d i d e a s j o t t e d i n m a r g i n s , u n d e r l i n e d , a n d k e y w o r d s and p h r a s e s circled.  these  important  sections  used by s u b j e c t s  A l l data, i n c l u d i n g t r a n s c r i p t s , observer  comments,  and memos g e n e r a t e d when c o m p a r i n g e a c h g r o u p o f s i x interviews,  were i d e n t i f i e d b y number a n d f i l e d  systematically  i n order t o f a c i l i t a t e  retrieval  f o r use l a t e r  in the process o f a n a l y s i s . Ideas were t e s t e d w i t h s u b j e c t s ,  i n e a c h y e a r , who w e r e  known b y f a c u l t y t o b e p e r c e p t i v e a n d a r t i c u l a t e .  This  h e l p e d t o advance the f o r m a l a n a l y s i s  (Bogdan &  Biklen, schedule  1982).  Although  o f the study  t h e q u e s t i o n s oh t h e  c o n t i n u e d t o be asked  interview  as o r i g i n a l l y o u t l i n e d ,  f o c u s e d p r o b i n g was u s e d t o t e s t o u t h u n c h e s .  Review o f the  l i t e r a t u r e continued f o r the purpose o f enhancing analysis  andthe generation o f theory.  more  the  78 Summative A n a l y s i s  Following t h e concentrated formative process of data c o l l e c t i o n and a n a l y s i s ,  a short break  was t a k e n f r o m t h e  study t o a l l o w f o r r e f l e c t i o n and s y n t h e s i s o f i n f o r m a t i o n p r i o r t o t h e commencement o f s u m m a t i v e a n a l y s i s . overwhelming volume o f t r a n s c r i p t s , indicated  The  n o t e s , a n d memos  t h e n e e d t o o r g a n i z e t h e d a t a i n t o a more  manageable form,  so t h a t r e l a t i o n s h i p s  c o u l d be e x a m i n e d more  readily. Initially,  the transcript  examined t o c a p t u r e t h e f u l l g e n e r a t e d by t h a t s u b j e c t .  o f one s u b j e c t a t a t i m e was  range and d i v e r s i t y o f t h e d a t a Then, a t t e n t i o n  i d e n t i f y i n g d a t a from t h a t i n d i v i d u a l s two m a i n b r o a d h e a d i n g s attitude.  After  transcript,  under t h e  o f t h e study, conceptions and  a t t i t u d i n a l a n d c o n c e p t i o n a l d a t a were  i d e n t i f i e d from each o f t h e t h i r t y - f i v e attention  was f o c u s e d on  was t h e n . d i r e c t e d t o w a r d  (a) b e t w e e n t h e t w o b r o a d h e a d i n g s , between s u b j e c t s e n r o l l e d  transcripts,  identifying  relationships:  a n d (b) w i t h i n a n d  i n each year o f t h e program.  M a n i p u l a t i o n o f d a t a was f a c i l i t a t e d b y u s e o f a computer.  A s e p a r a t e computer f i l e  was made f o r e a c h  s u b j e c t , u n d e r e a c h o f t h e two b r o a d h e a d i n g s and a t t i t u d e ) .  (conceptions  Data s u p p o r t i n g each broad heading  from t h e s u b j e c t ' s t r a n s c r i p t conscious attempt  was  and t y p e d i n t o t h e f i l e .  was made t o p r e s e r v e t h e s u b j e c t s '  pulled A  79  •  p e r s p e c t i v e by u s i n g h i s \ h e r e x a c t words. were d e v e l o p e d , heading  files  i t became c l e a r t h a t d a t a s u p p o r t i n g e a c h  f u r t h e r separated  itself  i n t o sub-headings.  c o p i e s o f t h e a t t i t u d e and c o n c e p t i o n were p r i n t e d a n d became w o r k i n g analysis.  As t h e s e  files  Hard  f o r each s u b j e c t  documents f o r f u r t h e r  For c l a r i t y of presentation, the process  of data  r e d u c t i o n a n d a n a l y s i s o f d a t a p e r t a i n i n g t o e a c h o f t h e two broad headings,  as w e l l as t h e respondent p r o f i l e s , a r e  discussed separately.  A n a l y s i s Of C o n c e p t u a l  Data  Because t h i s phenomenologic r e s e a r c h i s o f t h e second o r d e r p e r s p e c t i v e , aimed a t d e s c r i p t i o n , a n a l y s i s , and understanding  o f s u b j e c t s ' v i e w s on c o m p u t e r s i n h o s p i t a l s ,  t h e i r v i e w s were c o n s i d e r e d as c a t e g o r i e s o f d e s c r i p t i o n (Marton  1981).  S e v e r a l s t e p s were i n v o l v e d i n g e n e r a t i n g  c a t e g o r i e s w h i c h were g r o u n d e d i n t h e d a t a .  The f i r s t  step  i n v o l v e d t h e g a t h e r i n g o f data from each s u b j e c t ' s t r a n s c r i p t that pertained t o his\her.view or conception of the role of computers i n h o s p i t a l n u r s i n g . computer f i l e  entitled  T h i s d a t a was t y p e d i n t o a  "conceptions,"  and t h e d a t a  was  c l e a r l y i d e n t i f i e d b y u s i n g t h e same number a s t h e s u b j e c t ' s transcript. The  second s t e p , aimed a t t h e g e n e r a t i o n o f c a t e g o r i e s  o f c o n c e p t i o n , was t h e o r g a n i z a t i o n o f t h e c o n c e p t u a l  data  80 under t h e f o l l o w i n g f i v e sub-headings, earlier analysis:  w h i c h emerged  from  (a) a w a r e n e s s o f c o m p u t e r u s e i n h o s p i t a l  nursing today,  (b) k n o w l e d g e o f how c o m p u t e r s w i l l be u s e d b y  nurses working  i n hospitals i n the future,  (c) v i e w s on how  c o m p u t e r s may a f f e c t t h e j o b \ r o l e o f t h e n u r s e w o r k i n g hospital, working  (d) v i e w s on how c o m p u t e r s may b e n e f i t  i n hospitals,  nurses  a n d (e) v i e w s on how c o m p u t e r s may  l i m i t nurses working i n h o s p i t a l s . all  in a  On f u r t h e r e x a m i n a t i o n o f  t h e d a t a on c o n c e p t i o n s , f r o m e a c h  s u b j e c t , i t became  e v i d e n t t h a t t h i s breakdown, a l t h o u g h u s e f u l f o r s t a r t i n g t o determine  categories of conception, alternately resulted i n  fragmenting the data. To r e d u c e to  t h i s fragmentation o f data, which c o u l d l e a d  i n a c c u r a t e a n a l y s i s and i n t e r p r e t a t i o n o f f i n d i n g s ,  g l o b a l approach  t o t h e a n a l y s i s o f t h e d a t a on c o n c e p t i o n s  was s u b s e q u e n t l y t a k e n . on s u b j e c t s ' : today,  I t was d e c i d e d t o s e p a r a t e t h e d a t a  (a) a w a r e n e s s o f c o m p u t e r u s e i n h o s p i t a l s  ;  a n d (b) k n o w l e d g e o f how c o m p u t e r s may b e u s e d b y  h o s p i t a l employed nurses i n t h e f u t u r e , file.  a more  A s i t was f e l t  from t h e c o n c e p t i o n ' s  t h a t these f i n d i n g s would p r o v i d e t h e  backbone o r c o n t e x t f o r s u b j e c t s ' o t h e r  conceptions  c o n c e r n i n g computers i n h o s p i t a l n u r s i n g , t h e s e d a t a were a n a l y z e d , and r e p o r t e d s e p a r a t e l y . of  The r e s u l t i n g c a t e g o r i e s  d e s c r i p t i o n of subject's conceptions of the role of  c o m p u t e r s i n h o s p i t a l n u r s i n g , t h u s emerged f r o m t h e remaining data i n the conception  file.  81 Once a g a i n , t h e t r a n s c r i p t s , memos w e r e r e v i e w e d ,  o b s e r v e r comments,  and  along w i t h the r e v i s e d conceptions  and t o p i c s and t h o u g h t s w h i c h h a d b e e n i n t r o d u c e d by s u b j e c t s were i d e n t i f i e d .  Extensive l i s t s  words, p h r a s e s , and s e n t e n c e s  file,  the  were made o f  from the t h i r t y - f i v e i n t e r v i e w s  w h i c h seemed t o d e s c r i b e t h e s u b j e c t s ' way  of  These l i s t s  (see A p p e n d i x  were t h e n r e d u c e d t o 43 themes  T h e s e 43 t h e m e s w e r e r e - e x a m i n e d grouped,  thinking. H).  and r e l a t e d themes were  r e s u l t i n g i n t h e emergence o f f o u r c a t e g o r i e s .  The  c a t e g o r i e s w e r e named t o r e f l e c t t h e o v e r a l l n a t u r e o f t h e themes t h e y r e p r e s e n t e d At t h i s p o i n t ,  (see A p p e n d i x I ) .  i t became a p p a r e n t  stemmed f r o m c o n c e p t i o n s o f how  that subject  computers impact  responses  hospital  employed nurses, r a t h e r than c o n c e p t i o n s of the r o l e computers i n h o s p i t a l n u r s i n g .  The  p o s e d a t t h e o u t s e t o f t h e s t u d y was  of  broad research question revised to read:  How  do  n u r s i n g s t u d e n t s i n a community c o l l e g e n u r s i n g program c o n c e p t u a l i z e the impact nurses?  The  o f c o m p u t e r s on h o s p i t a l  word p r o c e s s i n g f u n c t i o n of t h e  employed  computer  f a c i l i t a t e d o r g a n i z a t i o n of data under each of the f o u r categories of conceptions.  Subsequent r e v i e w o f the  data  determined the p r o p e r t i e s or a t t r i b u t e s c h a r a c t e r i s t i c e a c h c a t e g o r y , and t h e s e were g r o u n d e d i n t h e d a t a  i n Chapter  of  through  t h e use o f d i r e c t examples t a k e n from t h e t r a n s c r i p t s . w i l l be d i s c u s s e d i n some d e t a i l  final  This  4.  Through the p r o c e s s of c o n s t a n t comparison  i t became  82 obvious two  t h a t some s u b j e c t s f o c u s e d t h e i r a t t e n t i o n on o n l y  categories of conceptions, while others r e a d i l y  three or four.  discussed  I t a l s o became e v i d e n t t h a t some s u b j e c t s  chose t o d i s c u s s e i t h e r a l l p o s i t i v e o r n e g a t i v e c h a r a c t e r i s t i c s o f t h e c a t e g o r i e s chosen, w h i l e presented both.  others  Comments f r o m e a c h s u b j e c t ' s t r a n s c r i p t  were t h e n o r g a n i z e d a c c o r d i n g t o s u b - c a t e g o r i e s  indicating  w h e t h e r t h e s u b j e c t saw t h e u s e o f c o m p u t e r s b y h o s p i t a l employed nurses  a s (a) e n h a n c i n g ,  (c) b o t h e n h a n c i n g Intuitively, in  (b) d e t r a c t i n g f r o m , o r  and d e t r a c t i n g from t h a t  category.  the researcher could ascertain a difference  the q u a l i t y of i n d i v i d u a l subjects' conceptions  a means o f m e a s u r i n g t h i s . : determined  for:  and sought  Q u a n t i t a t i v e measures c o u l d be  (a) t h e number o f c a t e g o r i e s o f c o n c e p t i o n s  d i s c u s s e d b y e a c h s u b j e c t , a n d (b) w h e t h e r t h e y saw e a c h category enhancing employed n u r s e s .  o r d e t r a c t i n g from t h e r o l e o f h o s p i t a l I t became a p p a r e n t  that these q u a n t i t a t i v e  m e a s u r e s m i g h t s e r v e a s one means o f d e t e r m i n i n g t h e complexity or q u a l i t y of the subjects' conceptions, drawing  and o f  comparisons between s u b j e c t s e n r o l l e d i n each year o f  t h e program.' The  first  s p e c i f i c research q u e s t i o n posed at t h e outset  o f t h e s t u d y was s u b s e q u e n t l y  r e v i s e d t o read:  d i f f e r e n c e i n c o m p l e x i t y between f i r s t , year nursing students' conceptions on h o s p i t a l e m p l o y e d  nurses?  Is there a  second, and t h i r d -  o f t h e impact  o f computers  83 In an attempt  t o answer t h i s r e v i s e d f i r s t  r e s e a r c h q u e s t i o n , once a g a i n t h e t r a n s c r i p t s but t h i s time, t h e r e s e a r c h e r searched complexity of conceptions, determine linked.  were r e v i s i t e d ,  each t r a n s c r i p t f o r  o r a q u a l i t a t i v e measure, t o  how t h e c a t e g o r i e s a n d t h e i r p r o p e r t i e s w e r e Determination  firstly  specific  of quality  of conceptions  was made  by r e a d i n g a l l t h e c o n c e p t u a l data from each s u b j e c t  and  intuitively  and  low l e v e l s o f conception.  determined  a r r a n g i n g them i n t h r e e p i l e s : h i g h , medium,  commonalities  Secondly,  the researcher  w i t h i n each group o f t r a n s c r i p t s  w h i c h p r o m p t e d t h e r e s e a r c h e r t o r a t e them i n a c e r t a i n way. I t was d e c i d e d t h a t t h e r e was o f t e n a f i n e l i n e b e t w e e n t h e middle was  rating,  and t h a t o f e i t h e r  high o r low. Therefore, i t  d e c i d e d t o u s e j u s t t h e two o p p o s i t e r a t i n g s o f h i g h , a n d  low l e v e l s o f c o m p l e x i t y o f c o n c e p t i o n s ,  i n order that  d i s t i n c t i o n s m i g h t be f o u n d b e t w e e n s u b j e c t s i n e a c h A number o f c h a r a c t e r i s t i c s as h a v i n g e i t h e r  whether they f e l t  t h e y would be enhanced o r d e t r a c t e d  t o q u a l i f y t h e i r statements.  feeling of d i s b e l i e f .  setting,  Little  from,  little  They t a l k e d a b o u t  computers i n s i m p l i s t i c , m a g i c a l terms,  draw r e l a t i o n s h i p s  Subjects  d i s c u s s e d t h e c a t e g o r i e s and  but d i d so i n s h o r t , " t o - t h e - p o i n t " answers, w i t h attempt  year.  were u s e d t o r a t e s u b j e c t s  high or low l e v e l s of conception.  w i t h low l e v e l conceptions  clear  often portraying the  o r no a t t e m p t s  between t h e i r e x p e r i e n c e s  were made t o i n the c l i n i c a l  o r t o r e f e r t o happenings i n other f i e l d s .  They  84 o f t e n spoke as i f t h e y were removed from t h e s i t u a t i o n ,  and  seemed r e l u c t a n t t o v o i c e o p i n i o n s o r s u g g e s t i o n s . S u b j e c t s who were r a t e d a s h a v i n g h i g h l e v e l s o f c o n c e p t i o n a p p e a r e d much more r e a l i s t i c  i n their opinions,  and went b e y o n d j u s t t a l k i n g a b o u t t h e c a t e g o r y t o o f f e r suggestions  a n d v o i c e p e r s o n a l v i e w s on i t .  They t e n d e d  to  d i s c u s s t r e n d s i n n u r s i n g , and s o c i e t y i n g e n e r a l , as w e l l as to  r e l a t e t h e d i s c u s s i o n t o t h e i r own c l i n i c a l  Table  experiences.  5 shows, d i a g r a m a t i c a l l y , what c h a r a c t e r i s t i c s  were  i n c l u d e d i n each l e v e l of q u a l i t y o f conception.  Table  5.  C h a r a c t e r i s t i c s Of Q u a l i t y Of  Conception  LOW C a t e g o r i e s And  HIGH Sub-Categories  Magical, Simplistic  Quality  Hypothesized  About C a t e g o r i e s  Realistic Detailed Quality  Few R e l a t i o n s h i p s  R e l a t e d To C l i n i c a l A n d O t h e r  Few  O p i n i o n s And  Suggestions  Personalized  Situation  Opinions  D i s t a n c e d From  Situation  The s u b j e c t s i n e a c h y e a r , who f e l l e i t h e r moved t o h i g h e r , o r l o w e r ,  i n the middle  were  l e v e l s o f c o n c e p t i o n by  reviewing t h e i r transcripts considering the following: (a) t h e number o f c a t e g o r i e s d i s c u s s e d ,  (b) d i s c u s s i o n o f  85 whether each category  was e n h a n c e d o r d e t r a c t e d f r o m ,  number o f c h a r a c t e r i s t i c s  a n d (d) c o m p a r i n g t h e q u a l i t y o f t h e i r  conceptions  with those  will  The  of other  s u b j e c t s i n t h e h i g h and low  Two f i r s t - y e a r s u b j e c t s , who f e l l  serve  the  (high o r low) o f q u a l i t y o f  conception,  groups.  (c)  as examples o f t h i s  process.  d e c i s i o n t o move one o f t h e s e  the high l e v e l o f conception  i n t h e middle,  f i r s t - y e a r subjects t o  was b a s e d on t h e f o l l o w i n g :  (a) t h r e e c a t e g o r i e s d i s c u s s e d ;  (b) b o t h enhancement a n d  d e t r a c t i o n s o f t w o c a t e g o r i e s , a n d o n l y enhancement o f t h e t h i r d were d i s c u s s e d ; experienced  (c) made one r e f e r e n c e t o a n i n c i d e n t  i n the hospital,  a n d t h i s i n c i d e n t was d i s c u s s e d  i n r e l a t i o n t o how i t w o u l d be a f f e c t e d b y c o m p u t e r u s e ; (d) g a v e one o p i n i o n a n d s u g g e s t i o n  f o r what m i g h t b e done;  (e) p e r s o n a l i z e d t h e d i s c u s s i o n on one o c c a s i o n ; q u a l i t y of conception  was more c o n g r u e n t w i t h t h o s e o f  subjects placed i n the high The fell  level.  d e c i s i o n t o move t h e o t h e r  f i r s t - y e a r s u b j e c t who  i n t h e middle t o the low l e v e l of conception  on t h e f o l l o w i n g :  and (f) t h e  (a) t h r e e c a t e g o r i e s were  was b a s e d  discussed;  (b) b o t h enhancement a n d d e t r a c t i o n s o f two c a t e g o r i e s , a n d o n l y t h e d e t r a c t i o n s o f t h e t h i r d were d i s c u s s e d ; reference  only t o her c l i n i c a l  experience;  r e l a t i o n t o employment i n a g l o b a l s e n s e ; the  situation;  (d) one o p i n i o n i n (e) d i s t a n t f r o m  and (f) t h e q u a l i t y o f c o n c e p t i o n s  congruent w i t h those  of subjects placed  (c) one  was more  i n the low l e v e l .  86 Frequency counts to determine  and c h i - s q u a r e d i s t r i b u t i o n s were u s e d  t h e r e l a t i o n s h i p b e t w e e n h i g h and  c o n c e p t i o n s and  subjects':  length of c l i n i c a l  (a) y e a r i n t h e p r o g r a m , and  experience.  presented i n Chapter  low l e v e l of  These f i n d i n g s  will  (b)  be  4.  A n a l y s i s Of A t t i t u d i n a l D a t a  The  first  step of analysis  of s u b j e c t s ' a t t i t u d e  the r o l e of computers i n h o s p i t a l of data i n the t r a n s c r i p t s which Firstly,  a computer f i l e  toward  n u r s i n g , was i d e n t i f i c a t i o n indicated  attitude.  named " a t t i t u d e " was  created,  and  s e c o n d l y , s u b - f i l e s , c l e a r l y i d e n t i f i e d by number, w e r e made f o r each s u b j e c t .  At the beginning stage of  a t t i t u d i n a l d a t a was  t a k e n v e r b a t i m from each t r a n s c r i p t  t y p e d i n t o e a c h s u b j e c t ' s sub areas:  (a) i n i t i a l  (c) b a r r i e r s  t o use,  analysis,  file  experience, and  under the f o l l o w i n g  (b) s u b s e q u e n t  four  experience,  (d) g e n e r a l a t t i t u d i n a l comments.  O r g a n i z a t i o n o f t h e a t t i t u d i n a l d a t a i n t h i s manner, a t outset, f a c i l i t a t e d headings On  the f i r s t  examination  study.  o f t h e d a t a , i t became c l e a r  three areas, although h e l p f u l  o r g a n i z i n g t h e volume o f d a t a c o l l e c t e d , clear picture  the  the process of data r e d u c t i o n under  w h i c h were more r e l e v a n t t o t h i s further  and  that  i n terms of and  i n presenting a  of the s u b j e c t ' s experience w i t h computers,  c o u l d n o t be u s e d i n a s s e s s i n g s u b j e c t ' s a t t i t u d e t o w a r d  the  87 r o l e of computers i n h o s p i t a l n u r s i n g .  Although  i n t e r e s t i n g t o know i f a s u b j e c t ' s i n i t i a l  i t was  and subsequent  experiences with a computer were p o s i t i v e or n e g a t i v e , and t o know the circumstances  surrounding the development of these  a t t i t u d e s , these p e r s o n a l experiences were a l l u n r e l a t e d t o hospital nursing.  The l i t e r a t u r e p o i n t s t o a c o r r e l a t i o n  between a s u b j e c t ' s i n i t i a l  and subsequent computer  experience and h i s \ h e r a t t i t u d e toward a computer, but t h i s study d i d not s e t out t o t e s t such  correlations.  Subjects i n d i c a t e d a number o f l o c a l b a r r i e r s t o use o f the Cariboo C o l l e g e VAX computer system.  On r e f l e c t i o n ,  these were f e l t t o be misplaced under t h e heading, " A n a l y s i s Of A t t i t u d i n a l Data".  Data s u p p o r t i n g b a r r i e r s t o computer  usage was subsequently  analyzed with other computer usage  data i n the respondent  p r o f i l e analysis  section.  A l l t h e data i d e n t i f i e d under the two areas:  initial  experience, and subsequent experience with a computer, were not f e l t t o be d i r e c t l y r e l a t e d t o t h i s study.  However, they  p r o v i d e d the r e s e a r c h e r with an i n d i c a t i o n o f where each o f the s u b j e c t s were i n terms of t h e i r own p e r s o n a l  comfort  l e v e l and growth o f a t t i t u d e toward computer use i n g e n e r a l . This data was f e l t t o i n f l u e n c e the study i n d i r e c t l y ,  so i t  was analyzed u s i n g frequency counts, and used t o p r o v i d e background i n f o r m a t i o n about the s u b j e c t s e n r o l l e d i n each year o f the program. under t h e heading  The f i n d i n g s are r e p o r t e d i n Chapter 4  "Secondary F i n d i n g s , " and are a l s o  88 d i s c u s s e d i n Chapter 5 i n terms o f making r e c o m m e n d a t i o n s a s a n outcome o f t h i s  local  study.  T h r e e m a i n s u b - h e a d i n g s were c o n s i d e r e d i n d e t e r m i n i n g each s u b j e c t ' s  a t t i t u d e toward t h e r o l e o f computers i n  hospital nursing. a five point of  Firstly,  Likert-type  a l l subjects  attitude scale,  " 1 " was c o n s i d e r e d t o b e n e g a t i v e ,  negative, positive.  "3" n e u t r a l ,  rated  t h e m s e l v e s on  f o r which a r a t i n g  "2" moderately  "4" m o d e r a t e l y p o s i t i v e , and " 5 "  I f s t u d e n t s gave a range o f s c o r e s , o r r a t e d  t h e m s e l v e s b e t w e e n t h e w h o l e numbers on t h e s c a l e , number was c o n s i s t e n t l y  t a k e n as t h e r a t i n g .  S e c o n d l y , i t was n o t e d w h e t h e r s u b j e c t s desire  t h e lower  indicated  a  t o p u r c h a s e a home c o m p u t e r , o r t a k e a c o m p u t e r  course.  A p o s i t i v e response t o e i t h e r o f these  questions  might i n d i c a t e a p o s i t i v e a t t i t u d e t o w a r d computers, as i t indicated  the subject's  toward l e a r n i n g out  that  t o commit t i m e a n d money  t o use a computer.  This study d i d not s e t  t o determine i f subjects': a t t i t u d e s  g e n e r a l were c o n s i s t e n t use  desire  i n hospital nursing.  with  toward computers i n  t h e i r a t t i t u d e toward computer  However, i t was i n t u i t i v e l y  felt  i f a s u b j e c t had a p o s i t i v e a t t i t u d e toward computers i n  general,  he\she might a l s o have a p o s i t i v e a t t i t u d e  computer use i n h o s p i t a l  nursing.  T h i r d l y , b o t h t h e t r a n s c r i p t s - and subject's  toward  hard copies o f each  a t t i t u d e f i l e made a t t h e o u t s e t o f t h e a n a l y s i s  were r e v i s i t e d .  A l l comments i n d i c a t i n g t h e s u b j e c t ' s  89  a t t i t u d e toward the r o l e of computers i n h o s p i t a l n u r s i n g were examined, and examples of comments were c i t e d from the t r a n s c r i p t s t o ground the r e s e a r c h e r ' s s u b j e c t i v e r a t i n g of the s u b j e c t ' s a t t i t u d e i n the data. process was  The outcome of t h i s  t o r a t e each s u b j e c t as b e i n g e i t h e r p o s i t i v e ,  n e u t r a l , or negative about computer use i n h o s p i t a l n u r s i n g . Once an a t t i t u d e r a t i n g was a t t e n t i o n was question. read:  t u r n e d t o answering  determined  f o r each s u b j e c t ,  the t h i r d r e s e a r c h  L i k e the others, t h i s one was  also revised to  What i s the r e l a t i o n s h i p between n u r s i n g students'  conceptions of the impact  of computers on h o s p i t a l employed  nurses, and students' a t t i t u d e s toward computers? counts, and percentages  t h a t had been determined  Frequency earlier in  the study, were used as measures of h i g h or low l e v e l s of conception and p o s i t i v e or negative a t t i t u d e . s t a t i s t i c a l s i g n i f i c a n c e of r e l a t i o n s h i p s was  The t e s t e d between  the two v a r i a b l e s by u s i n g the chi-square d i s t r i b u t i o n . These f i n d i n g s are presented i n Chapter  4.  A n a l y s i s of Respondent P r o f i l e s  Frequency counts, means, and percentages analyze the data generated Demographic data was  from the respondent  analyzed, i n c l u d i n g :  (a)  were used t o profiles. age,  (b) e d u c a t i o n a l experience p r i o r t o e n t e r i n g the Cariboo C o l l e g e n u r s i n g program,  (c) education s p e c i f i c t o computing  90 (excluding experience  i n the Cariboo  p r o g r a m ) , and  (d) a c c e s s  u s a g e d a t a was  analyzed  at Cariboo  College,  (other than video the researcher Cariboo and  use.  College  nursing  t o a c o m p u t e r a t home. including:  (a) u s e  (c) b a r r i e r s t o u s e ,  games).  Findings  Computer  a t home,  and  (b)  (d) f a m i l y  from t h i s data  provided  w i t h a c l e a r e r p i c t u r e of the backgrounds  F i n d i n g s from the  respondent p r o f i l e s are  of  reported  under the heading "Secondary F i n d i n g s . "  E s t a b l i s h i n g V a l i d i t y And  Reliability  A number o f s t r a t e g i e s w e r e e m p l o y e d t o e n h a n c e reliability  through each step of t h i s  i s concerned with the r e p l i c a b i l i t y validity  use  C o l l e g e s u b j e c t s i n terms of t h e i r computer knowledge  i n Chapter 4.  and  use  of research  i s concerned with the accuracy  Reliability  and  Reliability findings,  and  of those f i n d i n g s .  v a l i d i t y w i l l be d i s c u s s e d  e s t a b l i s h i n g b o t h e x t e r n a l and  study.  validity  i n terms  of  i n t e r n a l c o n t r o l s f o r each.  A number o f c o n t r o l s were e m p l o y e d t o e n h a n c e e x t e r n a l reliability,  or the extent t o which independent  working i n the  same o r s i m i l a r c o n t e x t  consistent results. describe the  A t t h e o u t s e t , c a r e was  obtain taken  to  s t r u c t u r e of the n u r s i n g program i n the  c o m m u n i t y c o l l e g e where t h e its  would  researchers  study  t o o k p l a c e , and  s t r u c t u r e i n t e r m s o f l e n g t h , and  hours i n each year.  The  process  to  t h e number o f  of the  s e l e c t i o n of  identify clinical subjects  91 i n c l u d e d s u c h d e t a i l s a s how t h e y w e r e c o n t a c t e d , role of the researcher  i n r e l a t i o n t o them.  and t h e  The s e t t i n g a n d  c o n d i t i o n s under which t h e i n t e r v i e w s took p l a c e , t h e interview tool,  a n d d e t a i l s o f how t h e i n t e r v i e w s w e r e  c o n d u c t e d were a l s o d e s c r i b e d i n d e t a i l .  I n a d d i t i o n , an  o u t l i n e o f t h e computer content  i n each semester o f t h e  n u r s i n g program  Analysis of interviews, i n  terms o f both  was i n c l u d e d .  f o r m a t i v e and summative a n a l y s i s , and a  d e t a i l e d d e s c r i p t i o n o f how c a t e g o r i e s o f d e s c r i p t i o n were a r r i v e d a t , was g i v e n c o n s i d e r a b l e a t t e n t i o n . Internal r e l i a b i l i t y , a s i n g l e study,  o r t h e q u e s t i o n o f whether, w i t h i n  m u l t i p l e observers  would agree  (LeCompte &  G o e t z , 1982) was d e a l t w i t h i n a number o f ways. were t a p e  recorded  were s u b s e q u e n t l y rater  t o preserve  transcripts,  a l l d a t a and t h e i n t e r v i e w s  t r a n s c r i b e d verbatim.  reliability,  To d e t e r m i n e  inter-  c l e a n c o p i e s o f t h e same f o u r i n t e r v i e w  and c o p i e s o f t h e d r a f t s generated  step of the data reduction process advisors.  Interviews  during  each  were g i v e n t o b o t h t h e s i s  E a c h a d v i s o r was a s k e d t o r e a d t h e d a t a a n d t o  independently  assess  the researcher's  the r e s u l t t h a t each a d v i s o r concurred assessment.  analysis of i t , with with the researcher's  In a d d i t i o n , t h e researcher used  verbatim  comments f r o m s u b j e c t ' s t r a n s c r i p t s t o s u p p o r t Validity  findings.  i s b e l i e v e d t o be a s t r e n g t h o f t h i s t y p e o f  research  (LeCompte & G o e t z , 1 9 8 2 ) .  To e n h a n c e i n t e r n a l  validity  i n terms o f h i s t o r y and m a t u r a t i o n ,  a l l interviews  92 were c o n d u c t e d i n a two month p e r i o d  (March a n d A p r i l ,  1988)  O b s e r v e r e f f e c t s w e r e c o n t r o l l e d i n t h e f o l l o w i n g ways: (a) s u b j e c t s were i n f o r m e d t h a t t h e i r s t a t u s a s s t u d e n t s C a r i b o o C o l l e g e w o u l d i n no way be a f f e c t e d by  their  p a r t i c i p a t i o n or n o n - p a r t i c i p a t i o n i n the study; comments, w h i c h i n c l u d e d o b s e r v a t i o n s  at  (b) o b s e r v e  of subject's  behavior  d u r i n g t h e i n t e r v i e w were w r i t t e n a f t e r e a c h i n t e r v i e w , and these observations  were n o t e d where i t was f e l t t o h a v e  a f f e c t e d t h e f i n d i n g s ; a n d (c) s u b j e c t s were o f f e r e d  copies  of t h e i r t r a n s c r i p t s . S e l e c t i o n and s a m p l i n g f o l l o w e d r i g o r o u s of subgroups w i t h i n t h e t o t a l  student  identification  population,  d e c i s i o n s were made t o i n c l u d e an e q u a l  and t h e n  number o f  first,  second, and t h i r d - y e a r female s u b j e c t s , because t h e m a j o r i t y of students  i n e a c h c l a s s was f e m a l e , a n d t h e c l a s s s i z e s  were r e l a t i v e l y e q u a l .  As e a c h c l a s s h a d m a l e s t u d e n t s , i t  was t h e n d e c i d e d t o i n c l u d e them t o e n h a n c e t h e v a l i d i t y o f the  findings.  The r e g i s t e r e d p s y c h i a t r i c n u r s e  g r o u p was e x c l u d e d , in populations  b e c a u s e t h a t g r o u p w o u l d n o t be  of nursing  students  i n other  M o r t a l i t y was n o t a p r o b l e m i n t h i s Threats t o external v a l i d i t y o b s t r u c t or reduce a study's generalizability.  (R.P.N.)  programs.  study.  are those e f f e c t s that  comparability  The r e s e a r c h e r  included  and  i d e n t i f i e d the audience t o  w h i c h t h e s e r e s u l t s m i g h t be g e n e r a l i z e d e a r l y i n t h e research  as b e i n g  community c o l l e g e n u r s i n g programs, and  93 acknowledged t h e f a c t t h a t even though these programs i n t e r m s of. l e n g t h a n d r e q u i r e d number o f c l i n i c a l t h e y s h a r e a common m a n d a t e .  hours,  C a r e was t a k e n t o u s e common  n u r s i n g terminology t o d e f i n e c a t e g o r i e s which m e a n i n g i n any n u r s i n g e d u c a t i o n a l s e t t i n g . all  differ  would have  S u b j e c t s were  a s k e d t h e same q u e s t i o n s , i n t h e o r d e r l i s t e d i n t h e  i n t e r v i e w schedule, t o a l l o w f o r comparisons  t o be drawn  a c r o s s and between y e a r s .  Summary  I n summary, d a t a a n a l y s i s f o r t h i s s t u d y was c a r r i e d o u t b o t h on a f o r m a t i v e a n d a s u m m a t i v e b a s i s .  A combination of  s t r a t e g i e s f o r a n a l y s i s was e m p l o y e d when a n a l y z i n g i n t e r v i e w transcripts. induction, and  T h e s e s t r a t e g i e s i n c l u d e d : (a) a n a l y t i c  (b) c o n s t a n t c o m p a r i s o n ,  (d) e n u m e r a t i o n  (Gpetz  (c) t y p o l o g i c a l  & LeCompte, 1 9 8 4 ) .  i n d u c t i o n was u s e d i n i t i a l l y  Analytic  t o scan t h e data f o r coding  c a t e g o r i e s a n d f o r r e l a t i o n s h i p s among c a t e g o r i e s . comparison  analysis,  a c r o s s c a t e g o r i e s was u s e d t h r o u g h o u t ,  Constant  and  t y p o l o g i c a l a n a l y s i s was u s e d t o a n a l y z e c o n c e p t u a l d a t a i n o r d e r t o p l a c e i t i n a taxonomy. or t h e use of frequency q u a n t i t a t i v e dimension  In addition,  enumeration,  c o u n t s , was e m p l o y e d t o a d d a t o t h e d a t a , so t h a t  b e t w e e n s u b j e c t s i n e a c h y e a r c o u l d be made.  comparisons  94 CHAPTER 4 Findings  As t h e r e s e a r c h u n f o l d e d , i t became e v i d e n t t h a t t h e findings  divided  (a) p r i m a r y  naturally  findings,  i n t o two d i s t i n c t  or those findings  groups:  related to the  r e s e a r c h q u e s t i o n s p o s e d a t t h e o u t s e t , a n d (b) findings,  secondary  or those r e l a t e d t o the subjects' i n d i v i d u a l  computer use and computer e x p e r i e n c e s w h i l e e n r o l l e d as students i n the Cariboo College diploma Primary  findings  will  q u e s t i o n s as a g u i d e . in  be p r e s e n t e d b y u s i n g t h e r e s e a r c h  For c l a r i t y  r e l a t i o n t o conceptions w i l l  relationships variables. will  n u r s i n g program.  of presentation, findings  be d i s c u s s e d f i r s t ,  because  a r e drawn l a t e r b e t w e e n c o n c e p t i o n s a n d o t h e r  F i n d i n g s under t h e heading  "Conceptual F i n d i n g s "  be o r g a n i z e d u n d e r f i v e s u b - h e a d i n g s :  computer use by h o s p i t a l employed nurses (b) c o n c e p t i o n s o f how c o m p u t e r s w i l l employed nurses  i n the future,  o f how c o m p u t e r s i m p a c t  (a) a w a r e n e s s o f today,  be u s e d b y h o s p i t a l  (c) c a t e g o r i e s o f c o n c e p t i o n s  h o s p i t a l employed  nurses,  (d) c o m p l e x i t y o f c o n c e p t i o n s , a n d (e) r e l a t i o n s h i p o f conception t o c l i n i c a l  experience.  F i n d i n g s under t h e heading be  addressed  purchase  "Attitudinal Findings" w i l l  under t h r e e sub-headings:  a computer o r t o t a k e a course,  attitudinal  scale,  (a) d e s i r e t o (b) r a t i n g on an  a n d (c) r e l a t i o n s h i p b e t w e e n  conception  95 and  attitude. Secondary f i n d i n g s w i l l  headings: usage.  be p r e s e n t e d u n d e r two  (a) d e m o g r a p h i c s , and  The  p r i m a r y and  (b) c o m p u t e r a c c e s s  and  c h a p t e r c o n c l u d e s w i t h a summary o f b o t h  the  secondary  findings.  Primary  Findings  Conceptual  The  sub-  broad  Findings  r e s e a r c h q u e s t i o n was  unfolded, to read:  How  r e v i s e d as t h e  study  do n u r s i n g s t u d e n t s i n a c o m m u n i t y  c o l l e g e n u r s i n g program c o n c e p t u a l i z e the impact on h o s p i t a l e m p l o y e d n u r s e s ?  Conceptions,  of computers  or thoughts,  f o r m e d by b o t h o u r k n o w l e d g e o f p r e s e n t h a p p e n i n g s and expectations of future events.  are our  T h e r e f o r e , as a p o i n t o f  departure i n addressing t h i s question, d e s c r i p t i v e data frequency illustrate  counts  of s u b j e c t s ' responses  will  be  and  reported to  their:  (a) a w a r e n e s s o f c o m p u t e r u s e (b) k n o w l e d g e o f how employed nurses  i n h o s p i t a l n u r s i n g today,  computers w i l l  i n the  future.  be u s e d by  hospital  and  96 A w a r e n e s s Of C o m p u t e r Use  By H o s p i t a l E m p l o y e d N u r s e s Today  C o m p u t e r t e r m i n a l s were n o t at Royal April,  a v a i l a b l e on n u r s i n g u n i t s  Inland H o s p i t a l at the time of the  1988).  Therefore,  c o m p u t e r t e r m i n a l s as t h e y Eight f i r s t - y e a r ,  nine  s u b j e c t s d i d not  fact.  One  e v e n p i c t u r e i n my  first-year  " I can't  w o u l d be  set-up...how t h e y would have i t . "  s e c o n d - y e a r , and  see n u r s e s  and  using  five third-year  stated:  six  (March  c a r r i e d out t h e i r j o b s \ r o l e s .  s e c o n d - y e a r , and  s u b j e c t s commented on t h i s  study  subject  m i n d where t h e Six  computers  first-year,  seven t h i r d - y e a r s u b j e c t s i n d i c a t e d  a w a r e n e s s t h a t c o m p u t e r s were b e i n g u s e d i n t h e  lab at  local hospital.  fact that  Several subjects discussed the  the  computerized l a b r e s u l t s a f f e c t e d the nurse i n d i r e c t l y .  :  It  p r o v i d e d h i m \ h e r w i t h l e g i b l e r e s u l t s t h a t were a v a i l a b l e quickly.  Norms p r i n t e d on t h e r e p o r t s a i d e d t h e n u r s e i n  doing p a t i e n t assessments.  Three t h i r d - y e a r s u b j e c t s  computers which are connected d i r e c t l y t o the facilitate  i n t e n s i v e care u n i t  (I.C.N.) u n i t ,  important  at Royal  (I.C.U.) and  lab tours scheduled  care  i n t e n s i v e care  Inland Hospital. I t i s  t o note that subjects i n a l l three years  program had experience  lab, to  speed i n r e p o r t i n g r e s u l t s t o such c r i t i c a l  areas as, the nursery  cited  as p a r t o f t h e i r  of  the  clinical  when t h e y were e n r o l l e d i n s e m e s t e r 2 o f  the  program. Subjects  mentioned s e v e r a l other  areas i n the  local  97 h o s p i t a l where t h e y t h o u g h t c o m p u t e r s were b e i n g u s e d . first-year,  and f o u r t h i r d - y e a r s u b j e c t s n o t e d t h a t  were b e i n g u s e d i n t h e A d m i t t i n g Department.  One  Two  computers  first-year  a n d one s e c o n d - y e a r s u b j e c t t h o u g h t t h e y were b e i n g u s e d i n the  r e c o r d s d e p a r t m e n t , w h i l e one  t h e i r use i n X - r a y .  One  first,  second-year student noted  one s e c o n d , and t h r e e  y e a r s u b j e c t s n o t e d t h e i r use i n t h e Pharmacy  third-  Department.  The h o s p i t a l ' s a d m i n i s t r a t i v e f u n c t i o n s were f e l t  by  one  f i r s t - y e a r a n d f i v e s e c o n d - y e a r s u b j e c t s t o be c o m p u t e r i z e d . T h i r d - y e a r s u b j e c t s d i d not mention the h o s p i t a l ' s a d m i n i s t r a t i v e functions, although they are presently computerized.  S p e c i f i c examples  by s u b j e c t s i n c l u d e d : payroll,  of a d m i n i s t r a t i v e uses noted  o p e r a t i n g room  (OR)  scheduling,  s t o c k t a k i n g , d a t a s t o r a g e o f r e c o r d s , and  availability.  One  first,  one s e c o n d , a n d no  subjects i d e n t i f i e d monitors, computerized thermometers,  S u b j e c t s v a r i e d i n t h e i r awareness h o s p i t a l was  system.  One  controllers  hospital. that the  local  r i g h t now  total  f i r s t - y e a r subject noted that  n o t r e a l l y t o o s u r e o f what was  computers  (IVAC)  i n the beginning process of implementing a  h o s p i t a l computer she was  third-year  and c o m p u t e r i z e d i n t r a v e n o u s (IMED)  as ways c o m p u t e r s were b e i n g u s e d a t t h e  bed  i n the h o s p i t a l ,  happening  while another  with felt,  "they a r e coming."  One  she h a d h e a r d t h a t ,  " t h e y a r e c o m i n g and I f e e l t h a t f r o m t h e  way  people are t a l k i n g ,  second-year subject mentioned  computers  a r e moving  that  i n t o the system  98 fast."  A s e c o n d - y e a r s u b j e c t , who  Records Department was  of the h o s p i t a l ,  c h a n g i n g over t o a computer  had worked  i n the Medical  knew t h a t t h e h o s p i t a l  system.  T h i r d - y e a r s u b j e c t s seemed more i n f o r m e d , b u t gave  a  v a r i e t y o f r e s p o n s e s , i n terms o f t h e t i m e frame f o r implementation.  One  t h i r d - y e a r subject noted, "They'll  o n l i n e a t t h e e n d o f t h e summer o r s o m e t h i n g . . . I t h i n k i s the plan."  Another stated,  w i l l be g e t t i n g them i n t h e new open i n t h e summer."  Two  wing, which i s s c h e d u l e d t o  subjects noted that i t looked l i k e  O t h e r s w e r e l e s s s p e c i f i c as i n d i c a t e d by t h e (a) " I t i s g o i n g t o come i n t o o u r  (b) " q u i t e a ways i n t h e f u t u r e , " and definitely First,  floors.  following hospital",  (c) " t h e p l a n i s  i n t h e f u t u r e f o r R.I.H. t o become c o m p u t e r i z e d . " s e c o n d , and t h i r d - y e a r s u b j e c t s were n o t v e r y  aware o f what was  happening i n h o s p i t a l s o u t s i d e of  as i n d i c a t e d by t h e s e t e n e x a m p l e s 1. 2.  that  "I think that hopefully they  we w e r e f i v e y e a r s away f r o m g e t t i n g them on t h e  comments:  be  of t h e i r  Kamloops,  comments:  I'm n o t aware o f them b e i n g u s e d i n o t h e r c e n t e r s . I'm n o t aware o f a l o t t h a t i s h a p p e n i n g i n n u r s i n g w i t h computers today. 3. I'm n o t aware o f them b e i n g u s e d by n u r s e s . 4. I'm n o t r e a l l y aware o f w h a t ' s h a p p e n i n g o r w h a t ' s b e i n g done w i t h c o m p u t e r s i n n u r s i n g e l s e w h e r e . 5. I d o n ' t know how c o m p r e h e n s i v e o t h e r h o s p i t a l s a r e . 6. I'm n o t aware o f what i s g o i n g on. I d o n ' t r e a l l y know t h a t much a b o u t i t . 7. I'm n o t aware o f a n y t h i n g h a p p e n i n g i n t h e p r o v i n c e . 8. I h a v e n ' t r e a l l y t h o u g h t about, i t o r d i s c u s s e d i t w i t h anybody. 9. I d o n ' t know enough a b o u t t h e f i e l d . 10. I d o n ' t know what i s g o i n g on anywhere e l s e .  S e v e r a l s u b j e c t s made r e f e r e n c e t o h a p p e n i n g s w i t h i n B r i t i s h Columbia, but h a p p e n i n g s was husband had  t h e i r awareness of  minimal.  computers."  surgery  at St. P a u l ' s ' H o s p i t a l i n  i n d i c a t e d t h a t n e i t h e r she  aware t h a t  " t h e h o s p i t a l was  are being used i n places  had  invaded  l i k e C h i l d r e n ' s but,  I'm  never discussed i t with her.  d i d h e r p e r c e p t o r s h i p had  thought they  by they  taking big her  used computers, One  s u b j e c t n o t e d t h a t t h e P h a r m a c y i n Salmon Arm she  her  Another second-year subject noted t h a t  m o t h e r w o r k e d as a n u r s e i n V i c t o r i a and t h a t she  nor  A second-year subject s t a t e d , "I imagine  quesses here."  her  s p e c u l a t e d t h a t c o m p u t e r s were i n v o l v e d i n h i s  c a r e , e v e n t h o u g h she h u s b a n d was  A f i r s t - y e a r subject noted that  undergone h e a r t  V a n c o u v e r , and  provincial  but  third-year H o s p i t a l where  a computer, w h i l e  another  would not have computers i n s m a l l e r h o s p i t a l s .  Another t h i r d - y e a r subject noted that the h o s p i t a l s i n Nanaimo and  a l l the doctor's  o f f i c e s were b e i n g  connected  a c e n t r a l computer, w h i l e another thought t h a t they b e i n g u s e d i n h o s p i t a l s "back e a s t Subjects' provinces  s u b j e c t s t a t e d t h a t she  also minimal. had  and  she  across the country.  by n u r s e s i n  One  heard awhile  h o s p i t a l s i n N e w f o u n d l a n d were b e i n g t r y i t out,  were  i n Toronto."  awareness o f computer use  o f C a n a d a was  happenings i n the United  other  second-year  ago  that  l i n k e d by  the  computer t o  speculated t h a t t h i s would spread Subjects'  to  right  seemed s l i g h t l y more aware o f  States.  A first-year  subject  100 vaguely in  r e c a l l e d t h a t one  of the teachers  had  spoken t o them  c l a s s about computers i n a h o s p i t a l i n C a l i f o r n i a .  second-year subjects r e f e r r e d to the video hospital  system t h a t they  the n u r s i n g program. hospital care.  seen w h i l e i n the  and  how  computers had  s u b j e c t s made t h e  total  first  I t showed a p a t i e n t a d m i t t e d  in California,  Third-year  had  about a  Two  year  to  of  a  influenced his  f o l l o w i n g comments:  1.  I know t h a t t h e r e a r e h o s p i t a l s i n t h e S t a t e s t h a t a r e a l m o s t e n t i r e l y r u n by c o m p u t e r s . 2. I've h e a r d t h a t some h o s p i t a l s i n t h e S t a t e s h a v e c o m p u t e r s and t h e y u s e them a t t h e b e d s i d e a l s o . 3. They a r e i n t h e n u r s i n g s t a t i o n s . I know t h a t ' s h a p p e n i n g now, somewhere i n t h e S t a t e s . 4. I b e l i e v e t h a t c o m p u t e r s a r e u s e d by n u r s e s i n t h e S t a t e s . 5. They a r e u s e d a l o t more i n t h e S t a t e s and t h a t t h e y w i l l e v e n t u a l l y be c o m i n g up t o C a n a d a . E v i d e n c e s u g g e s t e d t h a t a s m a l l number o f s u b j e c t s read a r t i c l e s p e r t a i n i n g t o computers i n n u r s i n g . course  of the  interviews, three  r e f e r e n c e t o t h i n g s t h e y had  the  During  the  f i r s t - y e a r s u b j e c t s made  read.  commented, " I ' v e done t h e r e a d i n g s p a p e r s we  had  One  second-year  subject  t h a t were p e r t i n e n t t o  the  h a n d e d i n i n t h e P e r s p e c t i v e s C o u r s e on n u r s i n g  f u t u r e , but  t h a t was  all.  I d i d n ' t get  T h a t same s u b j e c t made t h e comment, "my l a c k i n g , but  I am  revealed t h a t they subsequently  a student." had  Two  i n t o any  extras."  background i s  third-year subjects  r e a d a number o f a r t i c l e s  and  w r i t t e n p a p e r s on C o m p u t e r s I n N u r s i n g .  brought t h e i r papers t o the  in  i n t e r v i e w and  one  subject  Both read  f r o m h i s p a p e r t o i l l u s t r a t e a p o i n t b e i n g made i n t h e interview.  Two  o t h e r t h i r d - y e a r s u b j e c t s made r e f e r e n c e  to  101 a r t i c l e s t h e y had O n l y two  read.  s u b j e c t s had a c t u a l l y seen a computer used  by  n u r s e s o r h a d u s e d one p e r s o n a l l y i n a h o s p i t a l s e t t i n g .  A  first-  y e a r s u b j e c t h a d w o r k e d as a c a n d y s t r i p e r i n a  hospital in Victoria,  and she h a d  s e e n c o m p u t e r s t h a t were  b e i n g p i l o t e d i n a n u r s i n g s t a t i o n t o keep t r a c k o f p a t i e n t ' s room a s s i g n m e n t s . week's t r a i n i n g ,  A second-year  s u b j e c t had r e c e i v e d a  and she h a d d i r e c t work e x p e r i e n c e w i t h t h e  o r i g i n a l computers i n the m e d i c a l r e c o r d s department at R o y a l Inland Hospital.  Her  comment was,  "I'm  o n l y j u s t aware o f  what I ' v e w o r k e d w i t h i n m e d i c a l r e c o r d s . " A t t h i s p o i n t i n t i m e , s u b j e c t s d i d n o t seem t o p e r s o n a l i z e t h e use o f computers i n t h e h o s p i t a l s e t t i n g , e v i d e n c e d by t h e s e two " I t i s not r e a l l y  comments f r o m f i r s t - y e a r s u b j e c t s :  i m p a c t i n g me  r e a l l y aware o f any b i g i m p a c t second-year  Others  r i g h t now," on me  I don't  and  "I'm  as a n u r s e . "  s u b j e c t commented, " I d o n ' t  t o do w i t h them.  as  feel like  t h i n k i t p e r t a i n s t o me  not One  I h a v e much at  all."  noted:  1. I t h i n k t h e y a r e g o o d f o r l a b r e s u l t s b u t t h e y d o n ' t d i r e c t l y r e l a t e t o me a t a l l a t t h i s p o i n t . My work ...what I'm d o i n g i n t h e h o s p i t a l i s n o t b e i n g h e l p e d by computers,I don't t h i n k . You see v e r y l i t t l e o f i t i n nursing. 2. I'm n o t r e a l l y aware o f how t h e y a r e i m p a c t i n g me indirectly. 3. A p p l y i n g t h e m t o my j o b i s h a r d f o r me t o s a y b e c a u s e I'm n o t r e a l l y w o r k i n g w i t h them p e r s e . Computers have not i m p a c t e d me as f a r as a p r a c t i c a l f a s h i o n i n t h e c l i n i c a l setting. 4. I h a v e n ' t h a d e n o u g h e x p o s u r e t o know much more. 5. I ' v e n e v e r r e a l l y s e e n t h e a p p l i c a t i o n .  102 I n summary, s u b j e c t s ' a w a r e n e s s o f c o m p u t e r u s e h o s p i t a l s today experiences.  appeared t o center mainly  around t h e i r  D i r e c t h a n d s - o n e x p e r i e n c e by  c o m p u t e r s i n t h e h o s p i t a l s e t t i n g was s e v e r a l s u b j e c t s noted  r e a d and  Although  a video  year nursing, the m a j o r i t y of  s u b j e c t s w e r e u n a w a r e o f h a p p e n i n g s on b o t h t h e and n a t i o n a l s c e n e .  local  subjects to  non-existent.  a r t i c l e s t h e y had  t h e y h a d b e e n shown i n f i r s t  in  provincial  A s m a l l number o f s u b j e c t s w e r e  vaguely  aware t h a t h o s p i t a l s i n t h e U n i t e d S t a t e s w e r e more a d v a n c e d i n terms of technology.  S u b j e c t s ' awareness d i d not  t o i n c r e a s e d r a m a t i c a l l y as t h e y p r o g r e s s e d  i n the  appear  program,  a l t h o u g h t h i r d y e a r s u b j e c t s p r o v i d e d more d e t a i l e d descriptions of t h e i r conceptions. thirty-five use  s u b j e c t s h a v e n e x t t o no a w a r e n e s s o f c o m p u t e r  in hospitals locally,  K n o w l e d g e Of How N u r s e s I n The  provincially,  C o m p u t e r s May  h o s p i t a l employed nurses areas:  or  nationally.  Be U s e d By H o s p i t a l E m p l o y e d  Future  S u b j e c t s ' k n o w l e d g e o f how  broad  I t appears then t h a t a l l  Two  be u s e d  by  i n the f u t u r e , centered around t h r e e  (a) n u r s i n g ,  (c) c o m m u n i c a t i o n .  c o m p u t e r s may  (b) a d m i n i s t r a t i o n , and  of these areas  involve direct  c o m p u t e r u s e by n u r s e s , w h i l e t h e o t h e r i n v o l v e s i n d i r e c t use.  A p p e n d i x J d e t a i l s t h e i t e m s c i t e d by  i n t e r v i e w s , under each of these t h r e e broad  subjects i n their areas.  In  103 addition, and  several subjects reported  t h e i r t h o u g h t s o f where,  when c o m p u t e r s m i g h t be p h y s i c a l l y p l a c e d  units.  Firstly,  on t h e n u r s i n g  f i n d i n g s o f s u b j e c t s ' v i e w s o f how c o m p u t e r s  may b e u s e d b y h o s p i t a l e m p l o y e d n u r s e s i n t h e f u t u r e w i l l b e reported,  followed,  secondly,  by f i n d i n g s r e l a t e d t o  s u b j e c t s ' t h o u g h t s o f w h e r e , a n d when t h i s m i g h t The use  f i r s t broad area  by t h e nurse:  (a) a s a t e a c h i n g  p h y s i o l o g i c a l monitoring, planning  nursing  "nursing,"  care,  occur.  included direct tool,  (b)  for  (c) f o r d o c u m e n t a t i o n ,  a n d (e) a s a r e f e r e n c e  computer  (d)  for  source.  C o m p u t e r u s e b y n u r s e s f o r d o c u m e n t a t i o n p u r p o s e s was t h e one area t h a t t h e m a j o r i t y of subjects noted s e c o n d - y e a r , and 69% t h i r d - y e a r ) .  (91% f i r s t - y e a r , 91%  One t h i r d - y e a r  subject  h o w e v e r , s t a t e d t h a t s h e d i d n o t t h i n k we'd s e e a w h o l e l o t o f t h e n a r r a t i v e a n d f l o w c h a r t i n g done on c o m p u t e r s f o r some time,  a n d h e r r a t i o n a l e was t h a t t h e s y s t e m p r e s e n t l y u s e d i s  "good a n d f a s t " .  O t h e r s however, t h o u g h t t h a t " a l l  documentation and a l o t o f t h e c l e r i c a l  s t u f f c o u l d be on  computers." All  eleven  first-year  only four second-year computers as r e f e r e n c e  (100%),  ten third-year  (77%), but  (36%) s u b j e c t s n o t e d t h e u s e o f topis.  The one a r e a t h a t t h e m a j o r i t y  o f t h e s e s u b j e c t s m e n t i o n e d was a s a s o u r c e f o r d r u g information  and c o m p a t i b i l i t i e s .  Computer u s e f o r p h y s i o l o g i c a l m o n i t o r i n g was n o t e d b y a v e r y  s m a l l number o f s u b j e c t s  of patients  i n each  year:  104 first-year 3).  One  (n = 5 ) , and  u s e d more f o r p a t i e n t m o n i t o r i n g  d o n ' t t r u s t them, so I w o u l d s t i l l  every  ten minutes."  A n o t h e r n o t e d t h a t as t e c h n o l o g y  moves  r o u t i n e on t h e r e g u l a r Four f i r s t - y e a r ,  care areas,  it...it  but  by n u r s e s ,  will  c o u l d not  p a t i e n t t o g i v e h i s \ h e r own not He but  i f you  no  One-third  t h a t t h e human c o n t a c t  use  t h i s was  factor. used  year  subject  He  felt  had  t o be  "scariest  part."  information,  there. subjects  of t h e computer t o g e n e r a t e n u r s i n g c a r e p l a n s ,  second-year  o n l y a s m a l l number o f f i r s t - y e a r  " c o m p u t e r s m i g h t be  and  (n = 3 ) ,  (n = 2 ) , and t h i r d - y e a r (n = 2 ) , s u b j e c t s .  second-year subject s a i d ,  the  that i t could  a r e a u n d e r n u r s i n g u s e s i d e n t i f i e d by  n o t e d by  with  see t h e c o m p u t e r t e a c h i n g  insulin.  still  A  reasonably  thought t h a t the computer c o u l d p r o v i d e the  final  second-year  want t o s p e n d  do t h e a c t u a l i n j e c t i o n , w h i c h i s t h e  The was  become more  i s n ' t much t e a c h i n g  s t a t e d t h a t t h e c o m p u t e r w o u l d h a v e t o be t h a t he  be  done i f c o m p u t e r s a r e  doesn't rush t h i n g s along."  and  only  because of the time  " c o m p u t e r s h a v e a l l day  friendly,  not  o f c o m p u t e r s as a t e a c h i n g t o o l .  t h o u g h t t h a t more m i g h t be  because:  will  floors.  f i r s t - y e a r subject stated that there  She  checking  f i v e t h i r d - y e a r , and  s u b j e c t s n o t e d t h e use  b e i n g done r i g h t now  functions, stated: thing  i n the c r i t i c a l  be  they  the  i n t o the h o s p i t a l , p a t i e n t monitoring evident  t h i r d - y e a r (n =  s e c o n d - y e a r s u b j e c t , e v e n t h o u g h she t h o u g h t  w o u l d be "I  (n = 3 ) , s e c o n d - y e a r  used to  One  105 generate nursing care plans A third-year subject said,  i n some e x p e r i m e n t a l h o s p i t a l s . " "you c o u l d u s e t h e computer t o  d r a w up a b e t t e r c a r e p l a n , b y i n d i v i d u a l i z i n g a care  plan." The  second broad area  "communication," i n c l u d e d  computer use by t h e nurse f o r communication w i t h : nurses, and  standard  (b) d o c t o r s ,  direct  (a) o t h e r  (3) p a t i e n t s , (4) h o s p i t a l d e p a r t m e n t s ,  (5) o t h e r h o s p i t a l s .  Use o f t h e c o m p u t e r t o f a c i l i t a t e  communication between n u r s e s r e c e i v e d m i n i m a l a t t e n t i o n by subjects i n a l l three years.  One f i r s t - y e a r s u b j e c t  said  t h a t when s h e shows up f o r work i n t h e f u t u r e , s h e w i l l  have  a number, a n d when s h e e n t e r s t h a t i n t o t h e c o m p u t e r , s h e will  r e c e i v e a w h o l e p r i n t - o u t o f n o t o n l y who s h e i s t o c a r e  for, but also, the patients l i s t e d care.  i n order  of p r i o r i t y of  The p r i n t - o u t w o u l d a l s o i n d i c a t e n o t e s on t h e  p a t i e n t ' s c o n d i t i o n , a n d what i s e x p e c t e d a s f a r a s p a t i e n t care  f o rthat s h i f t .  M o s t o f t h e s u b j e c t s who  discussed  communication between n u r s e s focused  t h e i r d i s c u s s i o n around  communication a t t h e change o f s h i f t  and w i t h u p d a t i n g t h e  nursing Use doctors  Kardex. o f computers t o f a c i l i t a t e  communication  with  a l s o r e c e i v e d m i n i m a l a t t e n t i o n , and t h e s u b j e c t s  mentioned i t focused l e g i b l e doctors'  on d o c t o r s u s i n g i t t o c o m m u n i c a t e  orders.  O n l y one f i r s t - y e a r s u b j e c t  the use o f computers by p a t i e n t s t o f a c i l i t a t e with the nurse.  who  noted  communication  She i l l u s t r a t e d h e r p o i n t w i t h an e x a m p l e o f  106 an a p h a s i c p a t i e n t . (n = l j a n d s e c o n d communication third  (n=3),  year subjects  mentioned  between h o s p i t a l departments,  the majority of  (n = 9) y e a r s u b j e c t s c h o s e t o d i s c u s s t h i s a r e a o f  usage. any  W h i l e o n l y a v e r y s m a l l number o f f i r s t  C o m m u n i c a t i o n b e t w e e n h o s p i t a l s was n o t m e n t i o n e d  first-year,  third-year,  a n d o n l y a. m i n i m a l number o f s e c o n d a n d  subjects.  One t h i r d - y e a r s u b j e c t s t a t e d t h a t s h e  f e l t p e o p l e s ' m e d i c a l h i s t o r i e s were g o i n g t o be around  on l i t t l e  by  carried  c a r d s , a n d n u r s e s w o u l d be a b l e t o a c c e s s  them a n d u p d a t e t h e i n f o r m a t i o n w h e r e v e r t h e p a t i e n t  goes  across the country. The  t h i r d broad area " a d m i n i s t r a t i o n , " i n c l u d e d i n d i r e c t  use by t h e nurse statistics.  for:  (a) s c h e d u l i n g , (b) f i n a n c e , a n d (c)  Less than 25% o f s u b j e c t s i n each y e a r  these a d m i n i s t r a t i v e uses.  One s e c o n d - y e a r  noted  subject noted,  "I'm s u r e t h e y w i l l be u s e d more on t h e a d m i n i s t r a t i v e s i d e ' and e v e n t u a l l y t r i c k l e down i n t o t h e w a r d s , b u t I c a n ' t s e e that f o r a long time."  A third-year subject said,  would h e l p w i t h b i l l i n g p a t i e n t s ,  i f we e v e r g e t down t o  c h a r g i n g f o r every tongue d e p r e s s o r b e i n g used, the United States."  Table  "computers  a s t h e y do i n  6 p r e s e n t s a summary o f t h e t h r e e  a r e a s d i s c u s s e d b y s u b j e c t s i n d i c a t i n g t h e i r k n o w l e d g e o f how c o m p u t e r s may be u s e d  i n hospital nursing i n the future.  107 Table  6.  F r e q u e n c y Of Response I n d i c a t i n g S t u d e n t s ' C o m p u t e r s May Be U s e d I n H o s p i t a l N u r s i n g  K n o w l e d g e O f How I n The F u t u r e  YEAR FIRST COMPUTER USE  = 11)  IN THE FUTURE  SECOND (n = I D  THIRD (n = 13)  f  <%)  f  (%)  f  documentation  10  (91)  10  (91)  9  reference  11  (100)  4  (36)  10  (77)  monitoring 3  (27)  5  (45)  3  (23)  4  (36)  0  (0)  5  (38)  3  (27)  2  (18)  2  (15)  1  (9)  3  (27)  9  (69)  nurses  4  (36)  3  (27)  1  (8)  doctors  2  (18)  5  (45)  5  (38)  other h o s p i t a l s  0  (0)  1  (9)  1  (8)  patients  1  (9)  0  (0)  0  (0)  finance  2  (18)  2  (18)  3  (23)  statistics  1  (9)  1  (9)  3  (23)  scheduling  1  (9)  1  (9)  2  (15)  (%)  NURSING  source  physiological teaching  tool  nursing care  plans  (69)  COMMUNICATION hospital  departments  ADMINISTRATIVE  108 Several subjects, i n a l l years,  speculated  a s t o when  t h e y t h o u g h t c o m p u t e r s w o u l d be p h y s i c a l l y p l a c e d i n h o s p i t a l s f o r use by n u r s e s .  Two f i r s t - y e a r s u b j e c t s made  the f o l l o w i n g g l o b a l statements: will  (a) " I n f i v e y e a r s ,  be e v e r y w h e r e , " a n d (b) " I t h i n k t h e r e w i l l  them."  (a) " I d o n ' t t h i n k t h e y  move a s f a s t a s I h a v e b e e n r e a d i n g a b o u t . lot  o f h o s p i t a l s but I don't t h i n k t h e y ' r e  every  hospital.  can't  really  long  be a l o t o f  Two s e c o n d - y e a r s u b j e c t s were more s k e p t i c a l  t h e i r observations:  they  with  are going t o They w i l l  be i n a  g o i n g t o be i n  P e o p l e g e t t o o e x c i t e d t o o s o o n , " a n d (b) " I  s e e a g r e a t d e a l more c o m p u t e r s c o m i n g i n f o r a  time." S p e c u l a t i o n a b o u t where c o m p u t e r s w o u l d be p l a c e d i n t h e  hospital  f o r use by n u r s e s o c c u r r e d .  of the f i r s t - y e a r ,  t h i r t y - s i x percent  t h i r t y - e i g h t percent  Seventy-three  percent  o f t h e second-year, and  of the third-year subjects  thought  t e r m i n a l s w o u l d be s i t u a t e d a t t h e n u r s i n g s t a t i o n .  Three  s u b j e c t s were s p e c i f i c when s p e c u l a t i n g a b o u t t h e number o f t e r m i n a l s a t t h e desk: 1. P r o b a b l y one o r two maximum-per w a r d a s t h e r e a r e two R.N's w o r k i n g a t one t i m e so t h a t t h e y c a n e a c h u s e them. 2. I'm t r y i n g t o t h i n k o f t h e n u r s i n g s t a t i o n on t h e f l o o r I'm on w i t h two t e r m i n a l s on e i t h e r s i d e a n d a k e y b o a r d i n f r o n t o f them a n d one a t t h e d e s k w i t h a c c e s s t o whatever you need f o r your p a t i e n t . 3. Two c o m p u t e r s a t e a c h n u r s i n g s t a t i o n a n d one b y t h e d r u g counter.  F o u r s u b j e c t s p o i n t e d out t h a t t h e head n u r s e would have a terminal i n her o f f i c e .  A second-year subject  stated,  109 "I  w o u l d be  really  s u r p r i s e d i f the head nurse d i d n ' t  one  sitting  on h e r  d e s k , so she  b e c a u s e she ward." one  l i k e s an  scan p a t i e n t s '  desk, but  doctors  u s . . . y o u know, t h e y ' l l  say  s a i d , "the  w i l l p r o b a b l y get  them  t h e y n e e d them, t h a t ' s  seven t h i r d - y e a r , but  subjects  who  discussed  subjects  as a m o n i t o r i n g and  one  that  and  pressure  blood  readings subject  "the  there  s i g n s and  as c a r e  at the bedside.  the  She  monitoring  entered  w o u l d be  automatically.  readings  One  third-year beds  Another t h i r d - y e a r  Not  the  into i t to  m i n i t y p i n g pads at e v e r y  at the bedside!"  to  thermometer  a t e r m i n a l b e t w e e n two  i s completed.  subject  bedside.  stated,  a l l subjects  at the bedside f o r a " l o t of  years."  and chart  were  "I as  o p t i m i s t i c or e n t h u s i a s t i c , n o t i n g t h a t computers would be  you.  went on  having the  A p a r t i c u l a r l y enthusiastic third-year subject hope t h e y a r e  a Several  c o n n e c t e d t o t h e t e r m i n a l , so t h a t  t a l k e d a b o u t s c r e e n s and  in  noted that  enter  e a c h n u r s e w o u l d h a v e an a c c e s s c o d e t o g e t right there  firstThe  o r as  physiological  u l t i m a t e " w o u l d be  w o u l d j u s t be felt  device,  :first-year subject  i n t o the t e r m i n a l  speculate  three  r e t r i e v a l at the bedside.  would take the p a t i e n t ' s v i t a l directly  typical."  second-year s u b j e c t s .  t a l k e d i n terms of constant  of the p a t i e n t , while  before  c o m p u t e r s a t t h e b e d s i d e d i d so  terms o f e i t h e r i t s use vehicle f o r data entry  no  her  head n u r s e would have  C o m p u t e r s a t t h e b e d s i d e were m e n t i o n e d by year,  files,  o v e r a l l p i c t u r e o f t h e p a t i e n t s on  A third-year subject  on h e r  could  have  not  110 Four subjects  n o t e d a number o f c r e a t i v e ways c o m p u t e r s  may  i n f l u e n c e the nurses'  the  future.  job of medication a d m i n i s t r a t i o n  T h e s e were n o t  i n c l u d e d w i t h the three  a r e a s o f u s a g e , as t h e y w e r e t h e m e d i c a t i o n a d m i n i s t r a t i o n , and methods c o n s i d e r e d in  t e r m s o f how  year subjects for  t o be  u n c o n v e n t i o n a l and  used today.  w o u l d be  medications."  A third-year subject  attached  the p i l l s  Three  w o u l d be  future.  One  w o u l d be  thought that  b e c a u s e t h e y do  I n summary, s u b j e c t s c o m p u t e r use  by  there.  She  personally,  patients  so a t home.  conceptualized  three  broad areas  c o m m u n i c a t i o n , and  for administrative  i n d i r e c t use  the nurse f o r nursing  One  f i n d i n g under the broad area of n u r s i n g  The  majority  use  by  i n a l l three  the nursing majority  a r e a was  stands  alone.  computer  (91% f i r s t - y e a r ,  91%  Another i n t e r e s t i n g f i n d i n g i n  that a l l f i r s t - y e a r  of t h i r d - y e a r s u b j e c t s  and  functions.  years envision  nurses f o r documentation purposes third-year).  use  of  future.  by  69%  she  own  T h e s e a r e a s i n c l u d e d d i r e c t use  second-year,  the  noted that  h o s p i t a l employed nurses i n the  of subjects  used  a c o m p u t e r i z e d pharmacy  f e l t most p a t i e n t s were c a p a b l e o f t a k i n g t h e i r medications,  first-  subject  t o computers g i v i n g  a b l e t o p r e s s a b u t t o n on  m a c h i n e and  futuristic  g i v i n g the medications  instead robots  w o u l d be  quite  i n d i c a t e d that p o s s i b l y robots  won't be  to  a l l comments r e l a t e d t o  technology i s being  "Maybe we  broad  o n l y comments s p e c i f i c  medication a d m i n i s t r a t i o n i n the  stated,  in  (77%)  (100%),  noted the  and use  the of  Ill c o m p u t e r s by was  n u r s e s as a r e f e r e n c e  source.  O n l y one  finding  p a r t i c u l a r l y noteworthy, i n terms of i t ' s importance t o  the s u b j e c t s , i n the area of communication. third-year subjects  (69%)  n o t e d t h e use  nurse f o r interdepartmental a d m i n i s t r a t i v e use  communication.  o f c o m p u t e r s was  w h e r e , and setting.  A very  majority  o f c o m p u t e r s by  not  of  i n t e r e s t t o s u b j e c t s w i t h l e s s t h a n 25% this application.  The  the  The particular  i n each year  s m a l l number o f s u b j e c t s  noting  discussed  when c o m p u t e r s w o u l d be p l a c e d i n t h e h o s p i t a l The  m a j o r i t y of f i r s t - y e a r s u b j e c t s  (73%)  c o m p u t e r s a t t h e n u r s i n g s t a t i o n , w h i l e a number o f years  of  (46%)  Categories  d i s c u s s e d computers at the  Of C o n c e p t i o n s Of How  discussed third-  bedside.  C o m p u t e r s May  Impact  H o s p i t a l Employed Nurses  The  t h i r t y - f i v e nursing subjects readily discussed  conceptions nurses. i d e a s and  o f how  c o m p u t e r s may  Lengthy exhaustive  impact h o s p i t a l employed  l i s t s t h a t were made o f comments,  words g e n e r a t e d from t h e t r a n s c r i p t s ,  analysis process, Appendix H).  were e v e n t u a l l y r e d u c e d t o 43 t h e m e s  f o l l o w i n g four categories of conception:  Appendix I ) . each category.  e a r l y i n the  T h e s e themes were f u r t h e r r e d u c e d t o  ;(b) p a t i e n t c a r e ,  (c) w o r k l o a d , and  (see  the  (a) n u r s i n g  image,  (d) p r o f e s s i o n a l i s m  F o u r s t e p s were u s e d t o n o t e t h e Firstly,  their  each category  was  (see  findings for  defined,  and  112 secondly,  examples taken  used t o support  from the i n t e r v i e w t r a n s c r i p t s  the existence of the category.  examples c i t e d i n each c a t e g o r y sub-categories  T h i r d l y , the  were g r o u p e d i n t e r m s o f  and p e r c e n t a g e s  Lastly,  were r e p o r t e d , b o t h  f o r m t h r o u g h o u t t h e s e c t i o n , and conclusion of the s e c t i o n .  i n Tables  commented on e a c h m a i n and  Nursing  Image.  Nursing  image has  in descriptive 7 and  8 at  the  These q u a n t i t a t i v e f i n d i n g s  sub  who  category.  r e c e i v e d considerable a t t e n t i o n i n the  nursing l i t e r a t u r e i n recent years. o t h e r s see n u r s e s  and how  Nursing  image r e f e r s t o  the nurse sees h e r s e l f .  The  h u s b a n d and w i f e n u r s i n g r e s e a r c h t e a m o f B e a t r i c e and Kalisch,  a t t h e U n i v e r s i t y Of M i c h i g a n ,  They n o t e t h a t n u r s i n g i s a n u n d e r r a t e d :  image.  profession i n  America which i s p o r t r a y e d n e g a t i v e l y i n the media 1983).  Philip  have w r i t t e n  e x t e n s i v e l y o f t h e i r r e s e a r c h f i n d i n g s on n u r s i n g  Kalisch,  North  (Kalisch &  I n an a t t e m p t t o d i s p e l t h i s n e g a t i v e  media  image, t h e p r o f e s s i o n a l a s s o c i a t i o n i n B r i t i s h C o l u m b i a  has  a c t i v e l y u n d e r t a k e n a n a t i o n a l media campaign t o p o r t r a y n u r s i n g i n a p o s i t i v e way N u r s i n g has  the  frequency  p r o v i d e a s e n s e o f t h e number o f s u b j e c t s i n e a c h y e a r  how  the  of whether they enhanced or d e t r a c t e d from  j o b \ r o l e of h o s p i t a l employed n u r s e s . counts  were  to the  public.  m a t u r e d as a p r o f e s s i o n i n r e c e n t  years.  113 In response practice,  t o s o c i a l and t e c h n o l o g i c a l changes i n n u r s i n g  and an improved  t h e o r y base,  s p e c i a l i z a t i o n h a s g a i n e d momentum traditional  (Lane,1985).  image i s one o f t h e n u r s e  the s p e c i a l i z a t i o n i s s u e i s debated  the issue of However, t h e  as a g e n e r a l i s t .  by n u r s e s ,  As  i n their  professional a s s o c i a t i o n s across the country, the e f f e c t s technology,  a n d more s p e c i f i c a l l y ,  the nurses' t r a d i t i o n a l g e n e r a l i s t undoubtly  surface.  included i n this  computer use,  will  h a v e on  image a s a c a r e g i v e r w i l l  A p p e n d i x I g i v e s a b r e a k d o w n o f themes  category..  T w e n t y d i r e c t q u o t a t i o n s h a v e b e e n drawn f r o m s u b j e c t s ' i n t e r v i e w s t o i l l u s t r a t e t h e i r c o n c e p t i o n s o f t h e impact o f c o m p u t e r s on h o s p i t a l e m p l o y e d n u r s e s , they p o r t r a y .  For clarity  i n t e r m s o f t h e image  of presentation, these  have been o r g a n i z e d i n t o t h e two s u b c a t e g o r i e s : o f , and d e t r a c t i o n from,  t h e image o f t h e n u r s e .  1-5 were f e l t t o i l l u s t r a t e  quotations enhancement Quotations  s u b j e c t s ' c o n c e p t i o n s o f how t h e  t r a d i t i o n a l c a r e g i v i n g image o f t h e n u r s e m i g h t be e n h a n c e d by u s e o f c o m p u t e r s i n h o s p i t a l s .  Quotations  6 - 2 0 were .  f e l t t o i l l u s t r a t e t h e i r c o n c e p t i o n s o f how c o m p u t e r u s e might d e t r a c t from t h e n u r s e s ' t r a d i t i o n a l c a r e g i v i n g image.  C o m p u t e r s ENHANCE The C a r e g i v i n g Image 1.  2.  Most n u r s e s a r e n u r s e s because t h e y l i k e t h e p e r s o n a l care. The c o m p u t e r i s o n l y a t o o l t o h e l p h e r l o o k a f t e r people. They w i l l a l l o w h e r t o do h e r j o b , a n d t o be a b e t t e r more e f f i c i e n t n u r s e . N u r s i n g i s such a hands-on t h i n g . That can n o t change. P e o p l e w i l l s t i l l need t o be b a t h e d and have t h e i r  114  3. 4. 5.  d r e s s i n g s changed. T h a t ' s what t h e y t h i n k a b o u t when they think of nurses. C o m p u t e r s w i l l g i v e n u r s e s more t i m e f o r t h o s e t h i n g s , w h i c h i s what p e o p l e w a n t . The p u b l i c ' s e s t e e m w o u l d go up and n u r s e s w o u l d be s e e n as b e i n g modern and u p d a t e d . C o m p u t e r s w i l l n e v e r do b a s i c p a t i e n t c a r e . They w i l l e n a b l e t h e n u r s e t o s p e n d more t i m e a t t h e b e d s i d e . The p a t i e n t w a n t s t h e human t o u c h a l o n g w i t h t h e c o m p u t e r . You c a n ' t s u b s t i t u t e t h e human e l e m e n t . The n u r s e ' s t o u c h i s i m p o r t a n t t o t h e p a t i e n t b u t he a l s o w a n t s t h e a c c u r a c y p r o v i d e d by modern t e c h n o l o g y .  C o m p u t e r s DETRACT FROM The 6. 7.  8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.  C a r e g i v i n g Image  P a t i e n t s might t h i n k t h a t computers are a v e r y impersonal way o f d o i n g t h i n g s . The d i v i s i o n o f work w o u l d c h a n g e . . . a n d so p e r h a p s you w o u l d h a v e t h e w o r l d s e g m e n t e d , and somebody w o u l d know a l l a b o u t one l i t t l e s m a l l a r e a and somebody w o u l d know a n o t h e r , b u t who w o u l d i n t e g r a t e i t a l l and r e a l l y know t h e human b e i n g as a w h o l e p e r s o n ? I e n v i s i o n two g r o u p s o f n u r s e s . . o n e d o i n g a l o t o f t h e t e c h n i c a l t h i n g s and t h e o t h e r d o i n g t h e c a r e - g i v i n g . More e x p e c t e d o f you c o m p u t e r - w i s e and l e s s e x p e c t e d o f you i n p a t i e n t c a r e . Maybe a p p e a r i n g more as a t e c h n i c i a n o r a p e r s o n who w o r k s a c o m p u t e r , i n s t e a d o f a p e r s o n who i s by t h e b e d s i d e as a n u r s e . N u r s e s w i l l j u s t be an e x t e n s i o n o f t h e c o m p u t e r . A l l h i g h t e c h and l o w t o u c h . Computer j o b a l m o s t . . y o u ' r e d e a l i n g w i t h a machine, not a person. P a t i e n t s w i l l see us as s e c r e t a r i e s . N u r s e s w i l l be more t e c h n i c a l . They m i g h t d e p e r s o n a l i z e n u r s i n g . N u r s e s may l o s e t h e i r c a r i n g a t t i t u d e . Now y o u ' r e n o t j u s t n u r s e b u t , c o m p u t e r t e r m i n a l operator. Two l e v e l s o f w o r k e r s , t h o s e who a r e c o m p u t e r l i t e r a t e and t h o s e who a r e n o t . N u r s i n g w i l l become m a c h i n e - o r i e n t e d . Although a l a r g e m a j o r i t y of second-year  subjects  (91%)  commented on image o f t h e n u r s e , 50% o f t h o s e s u b j e c t s f o c u s e d t h e i r comments on t h e s u b - c a t e g o r y  of the  nurses  i m a g e , b e i n g d e t r a c t e d f r o m o r s e e n as l e s s p o s i t i v e w h i l e  115 o n l y 10%  focused  their  n u r s e s image b e i n g  enhanced.  both sub-categories: seven per  cent  comments on t h e The  sub-category  remaining  e n h a n c e m e n t , and  40%  of  discussed  detraction.  o f t h e t h i r d - y e a r s u b j e c t s made  Seventy-  image-related  comments and,  as w i t h t h e s e c o n d - y e a r s u b j e c t s , more  (40%)  their  focused  w o u l d be  40%  percentage who  of f i r s t - y e a r  commented, 50%  image w o u l d be how  (20%).  discussed both sub-categories.  (55%)  i t w o u l d be  enhanced.  A  The  smaller  s u b j e c t s commented on  d i s c u s s e d o n l y how  d e t r a c t e d f r o m , and Half  no  (50%)  subjects  t h e n u r s e ' s image  d e t r a c t e d from r a t h e r than enhanced  remaining  Of t h o s e  a t t e n t i o n o n l y on how  the  the  image.  nurse's  subjects discussed  only  d i s c u s s e d b o t h sub-  categories. Comments f r o m two  subjects contrasted the  image  seemingly p o r t r a y e d t o s u b j e c t s about the d i f f e r e n c e s between critical  c a r e and  geriatric  nurses:  1.  I have t h i s g r e a t f e a r of n u r s i n g becoming a l l h i g h - t e c h and n o - t o u c h . You c a n s e e i t i n t h e a d m i r a t i o n we h o l d f o r i n t e n s i v e c a r e n u r s e s who s p e n d most o f t h e i r t i m e w i t h m a c h i n e r y . We l o o k down on t h e l o n g - t e r m c a r e n u r s e s who s p e n d most o f t h e i r t i m e w i t h p a t i e n t s . 2. The b a s i c d i f f e r e n c e b e t w e e n y o u r g e r i a t r i c n u r s e w i t h no e q u i p m e n t and y o u r I.C.U. n u r s e . The p u b l i c i s i n awe o f t h e I.C.U. n u r s e b e c a u s e o f t h e e q u i p m e n t she i s a b l e t o h a n d l e and c o n t r o l b e c a u s e t h e y f e e l o v e r w h e l m e d by i t .  Comments f r o m f o u r s u b j e c t s i l l u s t r a t e t h e i r about nurses needing t o c o n t i n u e where human t o u c h  concerns  t o p o r t r a y a c a r i n g image,  remains important,  becomes more w i d e s p r e a d i n h o s p i t a l s :  as t h e u s e  of  computers  116 1.  The image o f t h e n u r s e a s a c a r e g i v e r w o u l d r e m a i n t h e d o m a i n o f t h e n u r s e b e c a u s e humans n e e d humans. 2. P e o p l e n e e d human t o u c h . 3. T h e r e a r e some p e o p l e who a r e b e t t e r w i t h m a c h i n e s a n d t h e r e a r e some p e o p l e who e v e n t h o u g h t h e y a r e g o o d w i t h machines/ don't care t o g i v e t h e i r l i f e t o t h a t k i n d o f work...they p r e f e r t o give t h e i r l i f e t o c a r i n g f o r people.  I n summary, t h e c a t e g o r y n u r s i n g m a i n l y by second  (91%),  image was  f o l l o w e d by t h i r d  first-year  (55%) s u b j e c t s .  each year,  who d i s c u s s e d  The m a j o r i t y  discussed  (77%), and then of subjects,  t h i s category focused  from  their  a t t e n t i o n on how t h e t r a d i t i o n a l c a r e g i v i n g image o f h o s p i t a l employed n u r s e s might be d e t r a c t e d use.  Subjects'  affected/  from by i n c r e a s e d  c o n c e r n s a b o u t t h e n u r s e s ' image  appeared t o center  computer  being  around a concern f o r nurses  l o s i n g t h e c a r i n g , h u m a n i s t i c q u a l i t i e s which have t r a d i t i o n a l l y b e e n c e n t r a l ' t o t h e image t h e y ' v e  Patient  portrayed.  Care.  Nurses working i n t h e h o s p i t a l s e t t i n g c o n s i s t e n t l y r e p o r t t h a t t h e i r main a r e a o f f o c u s i s p a t i e n t c a r e . publishers 1971  of Nursing  magazine's f i r s t  i s s u e i n November,  e c h o e d t h i s when t h e y p r o m i s e d t h a t t h e m a g a z i n e w o u l d  f o c u s on " t h e t r u e s i d e o f n u r s i n g . . p a t i e n t years l a t e r ,  t h e same m a g a z i n e p u b l i s h e d  author of that a r t i c l e ,  care."  an a r t i c l e  "What's Happened To The E s s e n c e Of N u r s i n g : The  The  Fifteen entitled,  P a t i e n t Care? "  O l i v e Burner, focused her  117 a t t e n t i o n on t h e n e g l e c t majority  of working nurses.  q u a l i t y of p a t i e n t care  i s given  to the  s i c k and  nursing  stated goal  promotes w e l l n e s s .  She  n u r s e who  concerns  With the  nurses, others  ( B a l l & Hannah, 1984;  i d e n t i f i c a t i o n of the o f c o m p u t e r s by  n u r s e s , and  cares  science  increased  by  care,  use  of  the  concerns r e l a t e d to the  use  openly  made t o b r i n g  focus of n u r s i n g back t o i t s t r u e s i d e . . . p a t i e n t  nurses'  of  encouraging nurses to  category of p a t i e n t care  that  Through  these i s s u e s , attempts are being  The  for  e c h o t h e s e same  & Romano, 1 9 8 5 ) .  i s s u e s and  care  attention  expresses concern  i s m o v i n g away f r o m t h e t r u e a r t and  providing basic bedside care.  discuss  of a l l h e a l t h  (1986) f e e l s t h a t l i t t l e  i n t r i n s i c worth of the  c o m p u t e r t e c h n o l o g y by  silent  S t r i v i n g t o p r o m o t e optimum  i s the  w o r k e r s ; however, B u r n e r  the  of the bedside nurse, the  the  care.  r e f e r s to f u n c t i o n s of  the  job or r o l e i n v o l v e d i n b o t h d i r e c t hands-on p a t i e n t  and  those t h a t a f f e c t her  i n d i r e c t way.  D i r e c t hands-on care  procedures, patient teaching, patients.  care  P a t i e n t care  and  to the p a t i e n t i n include  nursing  communication  with  i s a f f e c t e d i n d i r e c t l y by  as c o m m u n i c a t i o n w i t h o t h e r  d e p a r t m e n t s and  n u r s e s ' k n o w l e d g e b a s e , and  a t t i t u d e toward the  Appendix I gives  an  such  things  colleagues,  a b r e a k d o w n o f themes i n c l u d e d  the  job. in this  category. Thirty d i r e c t quotations  have been drawn f r o m  i n t e r v i e w s t o i l l u s t r a t e t h e i r conceptions of the  subjects' impact  of  118 c o m p u t e r s on h o s p i t a l e m p l o y e d n u r s e s , d e l i v e r y of p a t i e n t p a t i e n t care. organized  i n t o two  i n terms of  These q u o t a t i o n s  sub-categories:  enhancement o f ,  d e t r a c t i o n from, the d e l i v e r y of p a t i e n t c a r e . 1-18  were f e l t t o i l l u s t r a t e  how  computer use  would enhance her d e l i v e r y o f p a t i e n t c a r e . were f e l t t o i l l u s t r a t e  how  computer use  d e t r a c t from her d e l i v e r y of p a t i e n t  C o m p u t e r s ENHANCE The 1.  the have been and  Quotations by t h e  nurse  Quotations  19-30  by t h e n u r s e w o u l d  care.  D e l i v e r y Of P a t i e n t C a r e  L e s s o f t h e m o n i t o r i n g l e v e l o f f u n c t i o n and more o f t h e i n t e r p r e t a t i o n and a n a l y s i s o f d a t a . 2. U p - t o - d a t e i n f o r m a t i o n w o u l d be r e a d i l y a v a i l a b l e . 3. R e a d a b l e p r i n t w i l l mean l e s s d e c i p h e r i n g e r r o r s and t i m e saved. I t i s a n n o y i n g t o t r y and d e c i p h e r d o c t o r s ' orders. 4. Computers would keep your knowledge about t h e p a t i e n t current. 5. I t w o u l d f a c i l i t a t e c o m m u n i c a t i o n b e t w e e n d o c t o r s and n u r s e s , b e c a u s e now i t seems t h a t d o c t o r s a r e j u s t r u n n i n g i n a n d o u t a n d you a r e s u p p o s e d t o c a t c h them w h e n e v e r you c a n . I t i s h i t and m i s s . 6. I t could a l e r t nurses to c e r t a i n things (elevated blood work). 7. The c o m p u t e r c o u l d f a c i l i t a t e t h e d e v e l o p m e n t o f n u r s i n g care p l a n s from s t a n d a r d care p l a n s . 8. I t w o u l d be l i k e h a v i n g a t e a c h e r on t h e w a r d a l l t h e time. You c o u l d go t o i t and a s k q u e s t i o n s . 9. P a t i e n t ' s w o u l d be c o n f i d e n t t h a t t h e y c o u l d g e t information to the doctor. Now t h e y h a v e t o t e l l t h e n u r s e and i f she f o r g e t s , i t ' s a p r o b l e m . She c o u l d j u s t punch i t i n t o the computer. 10. The c o m p u t e r c o u l d a n a l y z e i n f o r m a t i o n t h a t i t h a s and g i v e s e v e r a l p o s s i b l e n u r s i n g d i a g n o s e s and t h e n t h e n u r s e c o u l d go t o t h e p a t i e n t and t h e n come b a c k and compare i t w i t h what t h e c o m p u t e r i s t e l l i n g them. I t w o u l d f o r c e t h e n u r s e t o go t o t h e p a t i e n t . 11. I n f o r m a t i o n w o u l d be r e a d i l y a c c e s s i b l e and a v a i l a b l e ( a b o u t new d r u g s and t h i n g s t h e n u r s e n e e d s t o know t o care f o r the p a t i e n t ) . 12. I t w o u l d be a s o u r c e o f b a c k - u p i n f o r m a t i o n ( a l e r t i n g t h e n u r s e t o a d m i n i s t e r m e d i c a t i o n s i f she f o r g e t s ) .  119 13. 14. 15. 16. 17. 18.  P a t i e n t s w o u l d f e e l s a f e r and more r e l a x e d w i t h monitoring devices r a t h e r than worrying i f the nurse i s g o i n g t o pop i n . The n u r s e w o u l d h a v e an o v e r a l l p i c t u r e o f t h e p a t i e n t and what t h e i r s t a t u s i s . T h e r e w o u l d be more c o m m u n i t y h e a l t h t i e s , w h i c h c o u l d lead to e a r l i e r discharges. I t h i n k t h e r e w o u l d be more t i m e w i t h t h e p a t i e n t f o r b e d s i d e n u r s i n g and l e s s t i m e w r i t i n g a l l o f t h e t h i n g s i n the c h a r t s . The p a t i e n t w o u l d be more i n f o r m e d i f you u s e d i t f o r spur-of-the-moment t e a c h i n g . They w o u l d c a t c h l i t t l e e r r o r s . I f you w e r e c h a r t i n g t h e m e d i c a t i o n s you g a v e and you f o r g o t t o c h a r t one, i t w o u l d s a y . . h o l d i t t h e r e . You m i s s e d t h a t medication.  C o m p u t e r s DETRACT FROM The 19.  D e l i v e r y Of P a t i e n t  Care  The b i g g e s t p r o b l e m I see i s a c c u r a c y o r p u t t i n g i n t h e c o r r e c t d a t a . That's a mind s e t . You a r e e i t h e r l i k e t h a t o r you a r e n o t . 20. A l l t h a t m i g h t be r e q u i r e d o f t h e n u r s e m i g h t be t h e n u r s i n g p r o c e d u r e s themselves, not the i n t e r a c t i o n anymore w i t h t h e p a t i e n t . 21. N u r s e s w o u l d be i n t e r a c t i n g w i t h t h e c o m p u t e r , n o t t h e i r c o l l e a g u e s , about t h e i r p a t i e n t s . 22. As l o n g as t h e p a t i e n t s d o n ' t become numbered, you s t i l l have t h a t q u a l i t y of c a r e . I'm a f r a i d we won't know them as p e o p l e , b u t r a t h e r j u s t as f i l e s . 23. The n u r s e m i g h t h a v e t h e t e n d e n c y n o t t o come i n and c h e c k on them so many t i m e s a s h i f t . 24. We m i g h t be t e m p t e d t o see what t h e c o m p u t e r s a y s , i n s t e a d o f r e l y i n g on y o u r own judgment ( f o r p a t i e n t assessment). 25. Time away f r o m t h e b e d s i d e . I c a n j u s t see t h e e x t r a t i m e s a v e d b e i n g s p e n t s i t t i n g a r o u n d g a b b i n g and b e i n g a t t h e nurses s t a t i o n . 26. We m i g h t be c o m m u n i c a t i n g more w i t h t h e c o m p u t e r t h a n t h e patient. 27. A b a r r i e r m i g h t be s e t up b e t w e e n t h e n u r s e and t h e p a t i e n t , w i t h the p a t i e n t f e e l i n g anxious about the machinery. 28. Maybe y o u r a s s e s s m e n t s k i l l s w o u l d g e t r u s t y , b e c a u s e you a r e d e p e n d i n g on t h e c o m p u t e r more t h a n you a r e d e p e n d i n g on y o u r s e l f t o a s s e s s . 29. F o r most p e o p l e who r e s i s t c h a n g e t h e y w i l l be an e x t r a h e a d a c h e , and t h e p r o b l e m you W i l l s t a r t t o r u n i n t o w i l l be i n r e g a r d t o q u a l i t y o f c a r e . 30. Too much s t e r e o t y p i n g , i n t h e s e n s e t h a t you h a v e a p a t i e n t come i n w i t h C.O.P.D. ( c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e ) , and t h e y w o u l d h a v e a c a r e p l a n f o r  120 t h e C.O.P.D. p a t i e n t and i t w i l l s p e c i f i c to the i n d i v i d u a l . O v e r 90% s e c o n d , and care and  of the  92%  category. third  (67%)  subjects  third-year) The  cent of the use  Twenty p e r  of f i r s t who  (64%),  subjects and  c o m p u t e r use  cent of the  and  not  first,  91%  patient  second  commented on t h i s  t o c o m p u t e r use  enhancing p a t i e n t care, on  (100%  (80%), category  both enhancing,  d e l i v e r y of p a t i e n t care.  first-year  commented o n l y  i n each year  year subjects  d e t r a c t i n g from the  generalized  made comments u n d e r t h e  majority  made comments i n r e l a t i o n  be  Eighteen  commented o n l y on also eighteen  percent care.  commented o n l y  the  s u b - c a t e g o r y , enhancement o f p a t i e n t c a r e ,  and  none  the  second-year subjects mentioned only d e t r a c t i o n  from  patient care. subjects care,  commented o n l y on  while  detract  Twenty-five per  2. 3. 4. 5. 6.  enhancing p a t i e n t  i n each year speculated  t h e t i m e t h a t m i g h t be  p a p e r w o r k t o f o c u s on p a t i e n t c a r e . 1.  of  i t ' s use  would  care.  subjects  t h e n u r s e would use  on  third-year  e i g h t p e r c e n t m e n t i o n e d o n l y how  from p a t i e n t  Several  cent of the  computer use  per  computer  d e t r a c t i n g from p a t i e n t  second-year subjects  and  as t o  f r e e d up  Comments  whether from  included:  You c o u l d be f r e e d up t o s p e n d more t i m e a t t h e b e d s i d e , but whether or not t h e y d i d t h a t i s something e l s e . I t d e p e n d s on t h e i n d i v i d u a l w h e t h e r t h e y u s e t h a t t i m e with the p a t i e n t . I t a l l comes b a c k t o t h e n u r s e ' s p e r s o n a l i t y (how she spends her t i m e ) . Q u a l i t y t i m e w i t h t h e p a t i e n t i s up t o t h e i n d i v i d u a l nurse. Some n u r s e s w i l l make t h e a d j u s t m e n t s and some won't. I t w i l l f r e e up t h e n u r s e t o go t o t h e b e d s i d e , b u t  121  7. 8. 9.  w h e t h e r o r n o t t h e n u r s e w i l l go t o t h e b e d s i d e i s another matter. I'm t h i n k i n g I w i l l go t o t h e p a t i e n t . T h a t ' s my personality. I t i s an i n d i v i d u a l t h i n g . You c a n ' t g u a r a n t e e i t (how time i s spent) f o r everybody. I w o u l d hope t h a t n u r s e s w o u l d u s e t h e t i m e n o t s i t t i n g around t h e desk g o s s i p i n g , b u t t o s i t and t a l k t o patients. I n summary, t h e c a t e g o r y o f p a t i e n t c a r e was  by  a l l first-year  third  (92%) y e a r ,  subjects  (100%),  and n e a r l y  subjects.  a l l second  discussed  (91%), and  I t appears t h a t t h e m a j o r i t y o f  i n a l l y e a r s c a n r e a d i l y i d e n t i f y how p a t i e n t  care  w o u l d be e n h a n c e d w i t h t h e u s e o f c o m p u t e r s b y h o s p i t a l employed nurses year) . three  (82% f i r s t - y e a r ,  100% s e c o n d - y e a r , 92% t h i r d -  T h e r e i s a d e f i n i t e c o n c e r n among s u b j e c t s years i n terms o f m a i n t a i n i n g  with the increased  q u a l i t y of patient  use o f computers.  c o n s e n s u s among t h e s u b j e c t s  in a l l care  T h e r e seemed t o be a  t h a t a t t i t u d e and p e r s o n a l i t y  a f f e c t how t h e i n d i v i d u a l n u r s e w o u l d c h o o s e t o s p e n d t h e e x t r a t i m e t h a t m i g h t be f r e e d up b y  increased  computerization.  Workload.  W o r k l o a d i s a u n i v e r s a l i s s u e i n any j o b , a n d n u r s i n g i s no  exception.  In the current  C o l u m b i a , a r t i c l e s on n u r s i n g featured  i n t h e media.  B r i t i s h Columbia  economic m i l i e u o f B r i t i s h shortages are frequently  The R e g i s t e r e d  Nurses A s s o c i a t i o n of  (R.N.A.B.C.) s u r v e y s 167 f a c i l i t i e s  monthly  122 to  o b t a i n d a t a on n u r s i n g v a c a n c i e s i n t h e p r o v i n c e .  A l t h o u g h t h e number o f v a c a n c i e s f l u c t u a t e f r o m month t o month, t h e d a t a g i v e s a c l e a r s e n s e o f t r e n d s . t h e r e were 474 v a c a n c i e s . nursing,  I n May,  1988,  Of t h o s e , 175 were i n g e n e r a l d u t y  108 i n c r i t i c a l c a r e , 85 i n o t h e r s p e c i a l t i e s ,  long term-care r e l a t e d p o s i t i o n s ,  75 i n  a n d 31 i n a d m i n i s t r a t i o n  and o t h e r . T h i s i s s u e o f n u r s i n g s h o r t a g e i s uppermost i n t h e minds of  most n u r s e s a n d s t u d e n t n u r s e s , a n d i s d i s c u s s e d i n  Nursing P e r s p e c t i v e s courses throughout the Cariboo C o l l e g e n u r s i n g program. such as:  N u r s i n g s h o r t a g e s a r e caused by  n o t enough g r a d u a t e s t o f i l l  n u r s i n g v a c a n c i e s , and  l o s s o f p r a c t i s i n g n u r s e s due t o b u r n o u t ,  lack of recognition  and r e w a r d f o r b e d s i d e n u r s i n g , a n d l o w s a l a r y Workload  scales.  r e f e r s t o t h e amount o f work p e r f o r m e d  e x p e c t e d t o be p e r f o r m e d by an e m p l o y e e . to  variables  I t seems  or  reasonable  expect that the c u r r e n t n u r s i n g shortage would a f f e c t the  workload of p r a c t i s i n g nurses.  In addition, the nature of a  n u r s e ' s work a n d t h e a c t u a l w o r k l o a d i s c h a n g i n g .  "Today's  n u r s e i s w o r k i n g l o n g e r a n d v e r y d i f f e r e n t l y t h a n she d i d even f i v e y e a r s ago"  ( B a n n i n g , 1987, p . 3 ) .  t h e themes i n c l u d e d i n t h i s  Appendix  I  lists  category.  T h i r t y d i r e c t q u o t a t i o n s h a v e b e e n drawn f r o m  subjects'  i n t e r v i e w s , t o i l l u s t r a t e t h e i r c o n c e p t i o n s o f t h e impact o f c o m p u t e r s on t h e w o r k l o a d o f h o s p i t a l e m p l o y e d n u r s e s . Q u o t a t i o n s 1-8 were f e l t t o i l l u s t r a t e t h e i r c o n c e p t i o n s o f  123 how  computer use by nurses would enhance,  positive  e f f e c t on) t h e i r workload.  ( i . e . , have a  Quotations 9-30  f e l t t o i l l u s t r a t e s u b j e c t s ' conceptions of how by nurses would d e t r a c t from on) t h e i r  3. 4. 5.' 6. 7. 8.  ( i . e . , have a n e g a t i v e e f f e c t  (Positive  10. 11. 12. 13. 14. 15.  Effect)  I t cuts down on a l o t of r e c o r d i n g time. I t w i l l save time as f a r as l o o k i n g through masses of books. Computers c o u l d be a time management t o o l , c u t t i n g out a l o t of unnecessary running around. There would be an i n c r e a s e of s t a f f at the outset t o input data but i t won't be R.N.'s. They w i l l not r e p l a c e nurses. They d i d n ' t r e p l a c e teachers. I t c o u l d shorten the paperwork t h a t the nurse has t o do. Computers are a t o o l t o h e l p you do your job more e f f i c i e n t l y . o r t o save time. In a twelve hour s h i f t , how many times do you have t o wait f o r a c h a r t ? How many times do you have t o wait f o r a phone order or t o get r e s u l t s phoned from the l a b . I f you add a l l of t h a t time up, i t i s r e a l l y phenomenal. A computer w i l l save a l o t of time.  Computers DETRACT FROM Workload 9.  computer use  workload.  Computers ENHANCE Workload 1. 2.  were  (Negative E f f e c t )  I t i s f a i r l y important t h a t nurses who are going t o use the system have input i n t o the system. Nurses know the n u r s i n g r o l e and must work with the programmer, or i t i n c r e a s e s n u r s i n g workload, not decreases i t . You'd d e f i n i t e l y need more than one t e r m i n a l . I f we have to wait around t o use i t , i t won't h e l p us. You spend the money and b r i n g i n a computerized system, t h e r e f o r e you don't need s t a f f (less s t a f f might i n c r e a s e workload). Downtime. Things do go wrong with computers. I t adds t o the nurses' work. I t i s n ' t cheap but i t ' s cheaper than paying s t a f f ( l e s s s t a f f would be employed and the workload would i n c r e a s e ) . Are they going t o have the money t o r e p l a c e the equipment? Old, f a u l t y equipment means more h a s s l e f o r the nurse. I f you are keying i n data with the e x p e c t a t i o n t h a t  124  16.. 1  17. 18. 19. 20. 21. 22.  23. 24. 25.  26. 27.  28. 29. 30.  you're going t o get i n f o r m a t i o n back i n some manner t h a t you can use, then i f i t doesn't come back i n t h a t way, you tend t o get f r u s t r a t e d and not use the system. The c o s t would be a s t r o n o m i c a l t o have enough t e r m i n a l s a v a i l a b l e t o be a c t u a l l y e f f e c t i v e . Unless t h e r e are enough, the work w i l l i n c r e a s e . I t w i l l probably take me t e n minutes t o c h a r t now and one h a l f an hour on a computer, u n t i l I get used t o i t . Power f a i l u r e . . I know people who have l o s t s t u f f they are working on because somebody has p u l l e d out the p l u g . I can see a l o t of t h i n g s f a l l i n g on the shoulders o f the nurse. They w i l l occupy a l o t ; o f time at the beginning f o r the nurses l e a r n i n g how t o use them and g e t t i n g user friendly. You'd have t o l e a r n how t o type. I f t h i n g s were more computerized, t h e r e would be l e s s need f o r nurses, because the nurse c o u l d then do t h i n g s q u i c k e r and maybe they would cut back on s t a f f and i n s t e a d o f b e i n g able t o spend more time, you wouldn't have more time. They're going t o say, you used t o be able t o do i t b e f o r e with t h i s many nurses and now you can do i t with l e s s because t h e r e i s l e s s t o do. The nurse u s i n g a l o t o f computers might be expected t o look a f t e r more p a t i e n t s . I f you are going t o have t o s i t t h e r e and wait your t u r n to c h a r t , they w i l l not decrease the nurses' workload. You almost wonder i f you are g e t t i n g t o the p o i n t where you spread a nurse too t h i n . Everyone w i l l be f e e l i n g overworked and can't work t o t h e i r f u l l p o t e n t i a l . People leave the f i e l d or i t gets t o the p o i n t where even the r e a l l y d e d i c a t e d ones l o s e i n t e r e s t or j u s t get t h a t negative a t t i t u d e . Work w i l l get h e a v i e r i f the nurse i s r e s p o n s i b l e f o r p u t t i n g i n the data because w e ' l l have more c l e r i c a l d u t i e s than we have now. With computers comes t h e . i d e a t h a t e v e r y t h i n g should be more s t r e a m l i n e d and t h e r e f o r e you'11 probably be r e q u i r e d t o maybe even do more c h a r t i n g than we do. They w i l l say.."you have a computer, you should be f a s t e r ! " The p e r c e p t i o n w i l l be t h a t your workload has decreased but i t w i l l have i n c r e a s e d . I t w i l l be a l i t t l e more s t r e s s f u l , because i t ' s j u s t one more t h i n g t h a t you have t o do. Roles w i l l be cut and taken over by computers. The more of a good t h i n g you get the more you expect and the more the government expects and the more everybody expects. The demands w i l l be.great on the nurse; j u s t p o l i t i c a l you know. Instead o f being at the bedside, you w i l l have to keep up with the l a t e s t systems.  125 , The c a t e g o r y o f w o r k l o a d was d i s c u s s e d b y a l l s u b j e c t s e n r o l l e d i n a l l y e a r s o f t h e program.  The m a j o r i t y o f  s u b j e c t s i n e a c h y e a r commented on b o t h t h e p o s i t i v e , a n d n e g a t i v e e f f e c t s o f c o m p u t e r u s e on t h e w o r k l o a d o f h o s p i t a l employed nurses third-year). second-year,  (91% f i r s t - y e a r ,  55% second-year,  Nine percent of subjects i n both f i r s t a n d none i n t h i r d - y e a r ,  subjects i n first-year,  and  commented o n l y on t h e  computer enhancing t h e n u r s e s ' w o r k l o a d .  year  a n d 92%  None o f t h e  a n d o n l y a s m a l l number i n s e c o n d -  (36%) a n d t h i r d - y e a r  ( 8 % ) , commented o n l y on how  c o m p u t e r u s e b y t h e n u r s e may h a v e n e g a t i v e e f f e c t s on h e r workload.  A large majority of subjects i n a l lthree years  c i t e d t h e f a c t t h a t i f n u r s e s have t o l e a r n t o use :  in  t h e w o r k p l a c e , i t may i n c r e a s e t h e i r In  100%  computers  workload.  summary, w o r k l o a d was t h e one c a t e g o r y d i s c u s s e d b y  of subjects i n a l lthree years.  While a l l f i r s t - y e a r  s u b j e c t s commented on how c o m p u t e r u s e may e n h a n c e t h e nurses' workload, a l l t h i r d - y e a r ,  a n d a number o f s e c o n d - y e a r  s u b j e c t s , d i s c u s s e d d e t r i m e n t s t o t h e nurse, i n terms o f i n c r e a s i n g workload. initially  S u b j e c t s appeared t o f e e l  the nurse w i l l  l e a r n i n g t o use computers proficient,  that  have h e r w o r k l o a d i n c r e a s e d by b u t t h a t o n c e s h e becomes  w o r k l o a d may be d e c r e a s e d , u n l e s s management  decides t o cut s t a f f or increase p a t i e n t care assignments.  126 Professionalism.  The  debate over whether o r not n u r s i n g  has, p r e v a i l e d i n n u r s i n g of t h i s and,  circles  f o r years.  s t u d y , i t i s assumed t h a t n u r s i n g  i s a profession F o r t h e purpose  i s a profession,  as s u c h , h a s a s p e c i f i c body o f knowledge, a d h e r e s t o a  formal  code o f e t h i c s and i s g o v e r n e d by a p r o f e s s i o n a l  association.  I n a d d i t i o n , Standards of Nursing  a p p r o v e d b y The C a n a d i a n N u r s e s A s s o c i a t i o n 1979,  a n d b y The R e g i s t e r e d  Columbia  P r a c t i c e were  (C.N.A.) i n J u l y ,  N u r s e s A s s o c i a t i o n Of B r i t i s h  (R.N.A.B.C.) i n S e p t e m b e r , 1984.  The a s s u m p t i o n i s  t h e n made t h a t t h e n u r s e i s a p r o f e s s i o n a l , g o v e r n e d b y a l l r u l e s and r e g u l a t i o n s o f t h e p r o f e s s i o n . t h e themes i n c l u d e d  i nthis  category.  Twenty-four d i r e c t quotations subjects'  Appendix I o u t l i n e s  h a v e b e e n drawn f r o m  interviews t o i l l u s t r a t e t h e i r conceptions ofthe  p o s s i b l e i m p a c t o f c o m p u t e r s on h o s p i t a l e m p l o y e d n u r s e s , i n terms o f t h e i r p r o f e s s i o n a l i s m . illustrate  subjects'  Q u o t a t i o n s 1-12 were f e l t t o  c o n c e p t i o n s o f how t h e u s e o f c o m p u t e r s  might enhance t h e n u r s e s ' p r o f e s s i o n a l i s m .  Q u o t a t i o n s 13-24  w e r e f e l t t o r e l a t e t o t h e i r c o n c e p t i o n s o f how t h e u s e o f ; computers by h o s p i t a l employed n u r s e s , might d e t r a c t their  professionalism.  C o m p u t e r s ENHANCE 1.  from  Professionalism  I t may be e a s i e r t o d e t e c t tasks properly.  n u r s e s who d o n ' t p e r f o r m  their  127 2.  E t h i c a l dilemmas w i l l be e a s i e r t o s o l v e through computers because there i s t h a t b a r r i e r t h a t separates people. 3. A c c o u n t a b i l i t y may change. 4. I guess they can b u i l d safeguards i n t o computers t o m a i n t a i n the i n d i v i d u a l ' s r i g h t t o p r i v a c y . 5. There i s going to be more emphasis p l a c e d on n u r s i n g d e c i s i o n s ; not n e c e s s a r i l y n u r s i n g d i a g n o s i s . 6. I'm r e a l l y not too concerned about the l e g a l aspects of i t because I'm sure t h a t somebody w i l l work t h a t out because i t i s a very h i g h concern f o r a m a j o r i t y of people. 7. I t would decrease the p o t e n t i a l f o r drug abuse t o some degree, because of i n v e n t o r y c o n t r o l . 8. I t h i n k t h a t to some degree you'd see more a c c o u n t a b i l i t y with regards to time management, wastage of s u p p l i e s . 9. Messages would be documented. I'm j u s t concerned about having e v e r y t h i n g documented, i n case i t i s your word . against the pharmacist. 10. Information i n the computer would be accepted p r a c t i c e w i t h i n the i n s t i t u t i o n . 1 1 . I t would be n i c e t o have some l e g a l and e t h i c a l s c e n a r i o s w r i t t e n on the computer t h a t a nurse c o u l d access, f o r review, when faced with a s i t u a t i o n . 12. You c o u l d use i t t o cut down on l e g a l problems because you are able to s t r e a m l i n e what you are supposed to be saying because everybody would be speaking the same language. Computers DETRACT FROM P r o f e s s i o n a l i s m 13. I don't understand how you are going to a v o i d going back to e d i t your p a t i e n t care notes t h a t are two days o l d . 14. Right now you r e l y on the doctor's w r i t t e n orders to p r o t e c t you i n every way. What happens i f the system becomes i n f i l t r a t e d by human v i r u s e s and the orders are lost? 15. The p a t i e n t ' s p r i v a c y might be invaded. 16. There might be l e s s r e s p o n s i b i l i t y i n some ways as f a r as p a t i e n t care goes, you can always say i t was the computer's f a u l t . 17. Computers do make e r r o r s . They're not p e r f e c t and i f something goes wrong, who do you blame? 18. When doctors hand w r i t e orders, i f there i s an e r r o r , . then t h a t ' s t h e i r e r r o r . I f i t ' s on the computer, then you say i t ' s the computer's f a u l t . 19. I t won't stand up as w e l l as a chart t h a t was hand w r i t t e n i n court because: you can a l t e r a computer f i l e , whereas you r e a l l y can't a l t e r a c h a r t . 20. B i g Brother watching over you! 2 1 . People e n t e r i n g i n t o the computer system t h a t have no  128 right. 22. C o m p u t e r s c a n k e e p t r a c k o f e a c h i n d i v i d u a l n u r s e and how he\she spend t h e i r day. You w i l l no l o n g e r h a v e t h e n u r s e who i s a b l e t o s i t down a n d h a v e a l o n g c h a t a n d n o t f e e l g u i l t y t h a t she i s c h a r g i n g t h e p a t i e n t X number o f d o l l a r s a m i n u t e t h a t you a r e s i t t i n g t h e r e . 23. I ' d be r e a l l y c o n c e r n e d a b o u t b e i n g a b l e t o c o n v e y e x a c t l y what I want t o s a y on t h e n a r r a t i v e c h a r t i n t h e c o m p u t e r , t h a t i t r e m a i n s as c o n c i s e , a n d t h a t i t s a y s what I want i t t o s a y . 24. K e e p i n g t r a c k o f n u r s e s by t h e e m p l o y e r . I t i s g o i n g t o be l i k e a b i g c l u b h e l d o v e r y o u r h e a d . A s m a l l e r number o f s u b j e c t s i n e a c h y e a r commented on computers first who  as t h e y r e l a t e t o t h e n u r s e as a p r o f e s s i o n a l  and s e c o n d - y e a r ,  62% t h i r d - y e a r ) .  (64%  Most o f t h e s u b j e c t s <  commented, d i d so m a i n l y i n r e l a t i o n t o o n l y t h e  d e t r a c t i o n s p l a c e d on t h e n u r s e as a p r o f e s s i o n a l  (86%  y e a r , 71% second-year,  of  computers  44% t h i r d - y e a r ) by t h e u s e  i n her j o b \ r o l e .  percent of second-year, s u b j e c t s , who  No  first-year,  first-  twenty-nine  and e l e v e n p e r c e n t o f t h i r d - y e a r ,  d i s c u s s e d t h i s c a t e g o r y , commented on how  the  p r o f e s s i o n a l i s m o f t h e n u r s e m i g h t be e n h a n c e d t h r o u g h t h e use o f computers. second-year,  Fourteen per cent of f i r s t - y e a r ,  and f o r t y - f o u r p e r c e n t o f t h i r d - y e a r  d i s c u s s e d t h e c a t e g o r y i n t e r m s o f how be b o t h e n h a n c e d , In  no  subjects,  professionalism  might  and d e t r a c t e d f r o m t h r o u g h c o m p u t e r u s e .  summary, t h e c a t e g o r y o f p r o f e s s i o n a l i s m  was  commented on by s l i g h t l y more t h a n h a l f o f t h e s u b j e c t s i n all  three years.  t h i s c a t e g o r y , was  The  o v e r a l l f o c u s by s u b j e c t s c o m m e n t i n g  i n r e l a t i o n t o l e g a l and e t h i c a l  as w e l l as p r o f e s s i o n a l r e s p o n s i b i l i t y a n d  issues,  accountability.  on  129 Two m a l e s u b j e c t s d i s c u s s e d n u r s i n g a c c o u n t a b i l i t y w i t h t h e computer b e i n g used as " b i g b r o t h e r . " Table  7 b e l o w i n d i c a t e s t h e r a n k i n g o f c a t e g o r i e s as  d e t e r m i n e d by t h e p e r c e n t a g e o f s u b j e c t s i n each year commented on e a c h c a t e g o r y .  Number  r a n k a n d number "4" t h e l o w e s t . category,  who  "1" i n d i c a t e s the highest  W o r k l o a d was t h e m a j o r  and p a t i e n t c a r e t h e second c a t e g o r y  subjects e n r o l l e d i n a l l three years.  d i s c u s s e d by  Image a n d  p r o f e s s i o n a l i s m a l t e r n a t e d between t h i r d and f o u r t h p l a c e f o r both  first,  and t h i r d - y e a r s u b j e c t s .  Note t h a t  second-year  s u b j e c t s commented e q u a l l y on p a t i e n t c a r e a n d image, a n d t h a t e a c h was r a n k e d  a s number " 2 , " t h e r e b y  eliminating the  number " 3 " r a n k i n g .  Table  7.  R a n k i n g Of C a t e g o r i e s By P e r c e n t a g e Of S u b j e c t s Y e a r Who D i s c u s s e d  The  In Each  Category  YEAR FIRST  SECOND  THIRD  CATEGORY  (n = 11)  (n = 11)  (n = 13)  WORKLOAD  1  (100%)  1 (100%)  1 (100%)  PATIENT CARE  2  (100%)  2  (91%)  2  (91%)  IMAGE  4  (55%)  2  (91%)  3  (77%)  PROFESSIONALISM  3  (64%)  4  (64%)  4  (62%)  130 T a b l e 8 p r o v i d e s a n o v e r a l l q u a n t i t a t i v e summary o f t h e f i n d i n g s d i s c u s s e d i n t h i s s e c t i o n on s u b j e c t s ' conception.  categories of  I t a l l o w s one t o s e e a t a g l a n c e t h e p e r c e n t a g e s  o f s u b j e c t s e n r o l l e d i n e a c h y e a r who d i s c u s s e d e a c h and  category  sub-category.  T a b l e 8. P e r c e n t a g e Of S u b j e c t s Who D i s c u s s e d E a c h C a t e g o r y A n d Sub-Category  Of C o n c e p t i o n  YEAR CATEGORY AND  FIRST  SUB-CATEGORY  (n = 11)  WORKLOAD (TOTAL)  100  . enhance detract both  20 0 80  0 50 50  25 8 67 77  10 50 40  20 40 40 62  64 0 86 14  0 8 92 92  91  (TOTAL) 64  (n = 13) 100  91  55  THIRD  9 36 55  18 18 64  enhance detract both  enhance detract both  100  100  enhance detract both  PROFESSIONALISM  (n = 11)  9 0 91  PATIENT CARE (TOTAL)  IMAGE (TOTAL)  SECOND  29 71 0  11 44 44  131 Complexity  The  Of  Conception  first  s p e c i f i c r e s e a r c h q u e s t i o n was:  difference i n complexity year nursing students'  between f i r s t ,  conceptions  on h o s p i t a l e m p l o y e d n u r s e s ? the study,  s e c o n d , and  of the  During  Is there  that  d i f f e r e d i n terms of t h e i r q u a l i t y or  T h i s i s not  an o r i g i n a l o b s e r v a t i o n ,  and  Findings w i l l  now  subjects'  complexity.  Collis  i n Sweden  be p r e s e n t e d  on  (1982) i n A u s t r a l i a  on e v a l u a t i n g t h e q u a l i t y o f l e a r n i n g t h r o u g h u s e Taxonomy.  of  f i n d i n g s were  i n f l u e n c e d by t h e work o f M a r t o n e t . a l . ( 1 9 8 4 ) and  computers  the a n a l y s i s process  conceptions  Biggs  third  impact of  i t became o b v i o u s t o t h e r e s e a r c h e r  q u a l i t y o f l e a r n i n g , and  a  of the  t o answer  SOLO  this  question. All  s u b j e c t s r e s p o n s e s were r a t e d as h a v i n g  h i g h o r low  l e v e l of complexity  b a s e d on g e n e r a l  o u t l i n e d i n C h a p t e r 3,  and  presented  Three f i r s t - y e a r  year having  i n T a b l e 5.  ( 6 4 % ) , and  ( 3 6 % ) , and  were r a t e d as h a v i n g complexity  (27%), seven  low  while eight f i r s t - y e a r  four t h i r d - y e a r (31%),  l e v e l conceptions,  s u b j e c t s w e r e r a t e d h i g h , and  T a b l e 9 g i v e s an i n d i c a t i o n o f how were r a t e d .  characteristics  or q u a l i t y of t h e i r responses.  of the  criteria  second-  n i n e t h i r d - y e a r ( 6 9 % ) , s u b j e c t s were r a t e d  high l e v e l conceptions,  four second-year  (54%)  specified  either a  (73%),  subjects  i n terms of Overall, sixteen  as  the  nineteen (46%)  s u b j e c t s w i t h i n each  low. year  132 T a b l e 9. F r e q u e n c y Of H i g h A n d Low L e v e l R e s p o n s e s I n d i c a t i n g C o m p l e x i t y Of C o n c e p t i o n  YEAR FIRST COMPLEXITY  SECOND  (n = 11)  THIRD  (n = 11)  (n = 1 3 )  OF CONCEPTION  f  (%)  f  (%)  f  (%)  HIGH  3  (27)  7  (64)  9  LOW  8  (73)  4  (36)  4  TOTAL  11 (100)  The subjects  11 (100)  number o f c a t e g o r i e s  three.  sample o f t h i r t y - f i v e  categories.  19  (54)  (31)  16  (46)  35 (100)  three,  and a r e p r e s e n t e d  (54%) s u b j e c t s ,  (45%) o f t h e f i r s t - y e a r  The d i s t r i b u t i o n  s u b j e c t s was:  c a t e g o r i e s , 37% d i s c u s s e d  (69)  I t appears t h a t t h e  (55%) a n d t h i r d - y e a r  f o u r c a t e g o r i e s w h i l e most  subjects discussed  (%)  o f c o n c e p t i o n s d i s c u s s e d by  on t h e f o l l o w i n g page i n T a b l e 10.  discussed  N = 35 f  13 (100)  i n e a c h y e a r was a l s o t a b u l a t e d ,  m a j o r i t y of second  TOTAL  f o rthe total  14% d i s c u s s e d  and 49% d i s c u s s e d  two four  133 T a b l e 10. F r e q u e n c y O f R e s p o n s e I n d i c a t i n g The Number Of C a t e g o r i e s Of Conception  Discussed  YEAR FIRST NUMBER OF  SECOND  (n = 11)  (n = 11)  THIRD  TOTAL  (n = 1 3 )  N = 35  CATEGORIES  f  (%)  f  (%)  f  (%)  f  (%)  2  2  (18)  1  (9)  2  (15)  5  (14)  3  5  (45)  4  (36)  4  (31)  13  (37)  4  4  (36)  6  (55)  7  (54)  17  (49)  TOTAL  11  (99)  Firstly,  11 (100)  13 (100)  35 (100)  f i n d i n g s w e r e e x a m i n e d t o s e e i f t h e r e was a n y  r e l a t i o n s h i p b e t w e e n t h e number o f c a t e g o r i e s d i s c u s s e d b y subjects  (see T a b l e s  conceptions.  9 and 10), and t h e c o m p l e x i t y o f t h e i r  Three p o i n t s a r e r e l e v a n t i n making comparisons  b e t w e e n s u b j e c t s ' c o m p l e x i t y o f c o n c e p t i o n , a n d t h e number o f c a t e g o r i e s they discussed:  (a) t h e number o f c a t e g o r i e s  c a n n o t b e t a k e n on i t s own a s a m e a s u r e o f c o m p l e x i t y o f conception,  (b) n o t a l l s u b j e c t s r a t e d a s h a v i n g h i g h  levels  o f c o n c e p t i o n d i s c u s s e d f o u r c a t e g o r i e s , a n d (c) some s u b j e c t s r a t e d as h a v i n g four categories.  low l e v e l s o f conception  discussed  134 It was second  I n t e r e s t i n g t o note t h a t o v e r a l l , the m a j o r i t y  (64%),  and t h i r d  o f conception  (69%)  year s u b j e c t s , had  about the impact o f computers on  employed n u r s e s .  The  years a l s o d i s c u s s e d third-year).  majority  four categories  (55% second-year,  four discussed  and the remainding t h r e e ,  discussed  one at two  rated  f i r s t - y e a r subjects  a high l e v e l , discussed discussed  three as  four c a t e g o r i e s  of  r a t e d as  three.  conceptualizing  f o u r c a t e g o r i e s , w h i l e the  (see Table 9), and t h e i r year i n the program  program  responses i n d i c a t i n g t h e i r l e v e l  of  are d i r e c t l y p r o p o r t i o n a l t o t h e i r year i n the  (X = 4.90,  conceptualized subjects.  Using a  directional test for s t a t i s t i c a l significance, i t  appears t h a t , s u b j e c t s ' conception  other  f i n d i n g s of s u b j e c t s ' l e v e l of complexity  were examined t o determine p o s s i b l e r e l a t i o n s h i p s . chi-square  Only  three.  Secondly, the of c o n c e p t i o n s  as  rated  w h i l e the remaining t h r e e d i s c u s s e d  of the t h r e e  54%  four  Seven of the nine, t h i r d - y e a r s u b j e c t s ,  c o n c e p t u a l i z i n g at a h i g h l e v e l , d i s c u s s e d conception,  hospital  Of the seven, second-year s u b j e c t s  categories.  level  of s u b j e c t s e n r o l l e d i n those  c o n c e p t u a l i z i n g at a h i g h l e v e l , categories,  a high  of  p_ <.05)  .  F i r s t year  subjects  at a lower l e v e l , then second, and  third-year  There appears t o be a s i g n i f i c a n t d i f f e r e n c e i n  the complexity of conceptions of f i r s t subjects  ( X 2 = 4.21,  p_<.05), and  subjects  (X 2 = 2.94,  p_<.05).  first  and  third-year  and  second-year  However, t h e r e  appears t o be  no  135 s i g n i f i c a n t d i f f e r e n c e i n the complexity o f conceptions o f second and t h i r d - y e a r s u b j e c t s ( X 2 =  .066,  p_>.05).  To answer the r e s e a r c h q u e s t i o n then, t h e r e does appear to be a d i f f e r e n c e i n complexity between f i r s t , t h i r d - y e a r s t u d e n t s ' conceptions of the impact on h o s p i t a l employed nurses.  second,  and  o f computers  In a d d i t i o n , a l l s u b j e c t s w i t h  h i g h l e v e l s o f c o n c e p t i o n about the impact  o f computers on  h o s p i t a l employed nurses, d i s c u s s e d e i t h e r t h r e e or f o u r c a t e g o r i e s of c o n c e p t i o n .  R e l a t i o n s h i p Of Conception  The  second  To C l i n i c a l Experience  s p e c i f i c r e s e a r c h q u e s t i o n was:  What i s the  r e l a t i o n s h i p between n u r s i n g students' conceptions o f the impact  of computers on h o s p i t a l employed nurses, and  l e n g t h o f the s t u d e n t s ' c l i n i c a l experience?  the  Clinical  experience i n c r e a s e s each year students are e n r o l l e d i n the Cariboo C o l l e g e n u r s i n g program hours second-year,  744  p r e v i o u s paragraphs, of the impact appears  (190 hours f i r s t - y e a r ,  hours t h i r d - y e a r ) .  408  As r e p o r t e d i n the  the complexity o f students'  of computers on h o s p i t a l employed  conceptions nurses  t o be d i r e c t l y p r o p o r t i o n a l t o the s t u d e n t s ' year i n  the program.  Then, the complexity o f students'  about the impact a l s o appears  conceptions  of computers on h o s p i t a l employed  nurses  t o be d i r e c t l y p r o p o r t i o n a l t o the l e n g t h o f the  students' c l i n i c a l  experience.  136 Attitudinal  Findings  Another q u e s t i o n posed a t t h e o u t s e t o f t h i s study was: Is t h e r e a r e l a t i o n s h i p between n u r s i n g s t u d e n t s ' conceptions of t h e r o l e o f computers i n h o s p i t a l n u r s i n g and t h e i r a t t i t u d e toward computers?  As noted i n Chapter 3/ t h i s  q u e s t i o n was r e v i s e d as t h e r e s e a r c h u n f o l d e d t o be: Is t h e r e a r e l a t i o n s h i p between n u r s i n g s t u d e n t s ' c o n c e p t i o n s o f the  impact o f computers on h o s p i t a l employed nurses, and  s t u d e n t s ' a t t i t u d e s toward computers? Because a t t i t u d e i s b e l i e v e d behavior  t o be r e f l e c t e d i n one's  (Stronge & Brodt, 1985), t h e f i r s t  finding  relates  t o t h e s u b j e c t ' s expressed d e s i r e t o purchase a home computer or t o take a computer course. subjects'  r a t i n g on a f i v e p o i n t  Descriptive included  The second f i n d i n g Likert-type  comments from t h e s u b j e c t s '  t o support these r a t i n g s .  indicates  attitude  scale.  t r a n s c r i p t s are  The t h i r d f i n d i n g  supports a r e l a t i o n s h i p between s u b j e c t s '  conceptions and  t h e i r a t t i t u d e s toward computer use i n h o s p i t a l  nursing.  D e s i r e To Purchase A Computer Or To Take A Computer Course  Six o f t h e t h i r t y - f i v e s u b j e c t s  (17%) r e p o r t e d a d e s i r e  t o purchase a home computer sometime i n t h e f u t u r e . six,  t h r e e were f i r s t ,  subjects,  Of t h e  one second, and two t h i r d - y e a r  the f o l l o w i n g  s i x q u o t a t i o n s were taken d i r e c t l y  137 from s u b j e c t s ' t r a n s c r i p t s : 1. We a r e l o o k i n g a t p u r c h a s i n g one t h i s summer f o r S e p t e m b e r f o r the school season. 2. I ' d l i k e t o buy my own. 3. I w o u l d n ' t m i n d h a v i n g my own. 4. We've t a l k e d a b o u t b u y i n g a c o m p u t e r f o r o u r home b u t r i g h t now we c a n ' t a f f o r d i t , b u t maybe one d a y . 5. I'm t h i n k i n g o f g e t t i n g one i n t h e f u t u r e . 6. T h e r e a r e s e v e r a l t h a t I want t o b u y b u t I d o n ' t h a v e t h e money now. Maybe a f t e r I g r a d u a t e . Only  f i v e of the t h i r t y - f i v e  d e s i r e t o t a k e a computer c o u r s e . first,  s u b j e c t s (14%) Of t h e f i v e ,  and t h r e e were t h i r d - y e a r s t u d e n t s .  No  expressed two  were  second-year  s u b j e c t s e x p r e s s e d a d e s i r e t o t a k e a computer c o u r s e . f o l l o w i n g f i v e q u o t a t i o n s were t a k e n d i r e c t l y  a  The  from s u b j e c t s '  transcripts: 1.  2. 3.  4. 5.  I w o u l d l i k e t o l e a r n more a b o u t c o m p u t e r s p e r s o n a l l y / e v e n i f I h a v e t o t a k e an e x t r a c o u r s e . I looked into i t t o t a k e a c o u r s e t h i s summer, j u s t an i n t r o d u c t i o n , a n d t o use t h e w o r d - p r o c e s s o r and t h e d i f f e r e n t p a c k a g e s t h a t you can use. I'm c o n s i d e r i n g t h a t I m i g h t t a k e a c o m p u t e r c o u r s e t h i s summer i f I c a n f i t i t i n t o w o r k . I've t r i e d t o t a k e a computer c o u r s e , but w i t h s c h o o l you c a n ' t , a n d i n t h e summertime I w o r k , so I h a v e n ' t h a d t h e opportunity. I r e a l l y w o u l d l i k e t o l e a r n how t o u s e one! I t i s n o t t h a t I d o n ' t want t o l e a r n . Some p e o p l e may j u s t s h y away f r o m i t i f t h e y d o n ' t know how, b u t n o t me, I w o u l d l i k e t o l e a r n how t o u s e i t . I ' d l i k e t o t a k e a c o u r s e and l e a r n more a b o u t t h e m . One o f my g o a l s , o n c e I g e t my d i p l o m a , i s t o do a c o u r s e i n c o m p u t i n g j u s t t o l e a r n how t o u s e i t a n d be e l o q u e n t in i t . A v e r y s m a l l number o f s u b j e c t s e n r o l l e d i n a l l t h r e e  years of the n u r s i n g program expressed a d e s i r e t o purchase home c o m p u t e r . of f i r s t  No  second-year,  a n d o n l y a v e r y s m a l l number  and t h i r d - y e a r s u b j e c t s , e x p r e s s e d a d e s i r e t o t a k e  a  138 a computer course.  Of those who  d i d comment, time and money  appear to be b a r r i e r s p r e v e n t i n g achievement of t h e i r s t a t e d desire.  R a t i n g On An A t t i t u d e Scale  All  s u b j e c t s when, asked to r a t e t h e i r a t t i t u d e toward  computers i n h o s p i t a l nursing, on a f i v e p o i n t L i k e r t - t y p e s c a l e , d i d so without  hesitation.  c o n s i d e r e d to be negative,  A score of "1"  "2" moderately  "3" n e u t r a l , "4" m o d e r a t e l y , p o s i t i v e , A score of "1" e n r o l l e d i n any gave two  was  One  "5"  positive.  second-year s u b j e c t  r a t i n g s and q u a l i f i e d her answer with the f o l l o w i n g look at e f f i c i e n c y i t would be  look at the t h r e a t of decreased  patient,  negative,  not chosen by a s u b j e c t  year of the program.  statement, " I f you i f you  (negative)  and  was  i t would be about "1.5."  realistic,  "4.5," but  i n t e r a c t i o n with  As long as i t i s kept  I t h i n k i t w i l l be very good."  Because of the  very p o s i t i v e comments throughout the i n t e r v i e w , t h i s was  rated a  the  subject  "3."  Only s i x of the t h i r t y - f i v e subjects a t t i t u d e as "2"  (moderately n e g a t i v e ) .  (17%)  Three of  rated t h e i r those  s u b j e c t s were i n f i r s t - y e a r , three i n second-year, and none were i n t h i r d year. The  A l l were female.  f i r s t - y e a r subjects who  made these  comments:  r a t e d t h e i r a t t i t u d e as  "2"  139 1. I'm not very p o s i t i v e . I t h i n k t h e y ' l l be more a c c u r a t e and up t o date but I t h i n k a l o t more mistakes are going to be made. 2. I don't l i k e i t ! I have not had a p o s i t i v e experience w i t h a computer up t o t h i s p o i n t . I f they were i n t r o d u c e d i n t o the h o s p i t a l at f i r s t I would be a l i t t l e r e s e n t f u l u n t i l I got used t o i t and more experienced. Then i t would depend on what k i n d of t e a c h i n g I had. I don't r e a l l y l i k e s t r i c t t e a c h i n g where you are p e n a l i z e d f o r every mistake. I'd have t o be f o r c e d t o use i t u n t i l I got i n t e r e s t e d . I'm j u s t not i n t e r e s t e d i n computers at all. 3. I j u s t t h i n k t h a t as f a r as the h o s p i t a l goes, the b i g t h i n g i s the hands-on c a r e . You can never r e p l a c e the human touch w i t h anything, and I can see from my l i t t l e experience how much a good nurse a f f e c t s the w e l l b e i n g of the p a t i e n t . I t would take a l o t away from the nurses.  One  second-year s u b j e c t became v i s a b l y a g i t a t e d as  she  looked at the computer on the r e s e a r c h e r ' s desk d u r i n g the interview. and at  She  said,  I t h i n k , oh God! you.  I'm  futuristic.  "I look over t h e r e at your computer I t looks so t y p i c a l .  It's just looking  t r y i n g t o d e s c r i b e i t but i t ' s hard. I can't e x p l a i n i t .  now  I t looks  You want t o take a step  back i n s t e a d of a step forward up t o computers."  When asked  what would t r i g g e r her t o take a s t e p forward toward computers she commented, "Knowing i t would h e l p me.  Knowing  t h a t : r e d l i g h t s f l a s h e d a l l over i t and I would know what t o do.  I'm  n e g a t i v e because of my  past experiences  with  computers, l a c k of use of computers, and I can't see any need for  i t at the moment." Another second-year s u b j e c t , who  a t t i t u d e s c a l e , made these comments: i n t o computers, I would have taken  chose "2" on the " I f I wanted t o get  "Computers.". The  people  140 who go i n t o n u r s i n g people.  u s u a l l y l i k e p e o p l e a n d want t o t a l k t o  I don't t h i n k I enjoy t h e t e c h n i c a l t h i n g s .  mean t o s o u n d n e g a t i v e , feel that  but personally,  I h a v e t o l e a r n them.  I j u s t d o n ' t want t o  I don't l i k e them.  I'd  r a t h e r p u t my e x t r a e n e r g y l e a r n i n g a b o u t a p r o t o t y p e I learned  about t h e computer.  I don't  before  But, a f t e r years of c l i n i c a l  w o r k , I m i g h t want t o b e c a u s e I m i g h t want t h e s t i m u l a t i o n . " The t h i r d s e c o n d - y e a r s u b j e c t " I g u e s s I'm n e g a t i v e the  who was n e g a t i v e  noted:  a b o u t c o m p u t e r s b u t , j u s t a t home o n  one we h a v e , h a l f t h e t i m e t h e t h i n g d o e s n ' t w o r k a n d I  j u s t have t h a t  fear that  computers and n u r s i n g .  i t w i l l b e t h e same t h i n g I j u s t don't t r u s t them."  Eleven of the subjects (neutral, wait category, subjects  with  and s e e ) .  (31%) r a t e d t h e i r a t t i t u d e a s " 3 "  The m a j o r i t y  Were i n t h i r d - y e a r  (54%).  of subjects  i n this  Comments made b y t h e s e  included:  1. I r e a l l y d o n ' t know y e t . I ' l l h a v e t o g e t i n a n d work w i t h them m y s e l f . I g u e s s I'm a w a i t a n d s e e . 2. I'm n o t t o t a l l y a g a i n s t h a v i n g c o m p u t e r s . I guess I w i l l e v e n t u a l l y f e e l c o m f o r t a b l e working w i t h computers i f I am e x p o s e d t o them f o r a l o n g e n o u g h p e r i o d . 3. I'm i n f a v o u r o f t h e m b e i n g t h e r e , b u t I'm n o t k n o w l e d g e a b l e e n o u g h t o r e a l l y know w h a t ' s g o i n g o n t o know what a r e g o i n g t o b e t h e p r o b l e m s w i t h them y e t . 4. C o m p u t e r s do h a v e a p l a c e , i t ' s j u s t t h e a n x i e t y t o w a r d s them.  Thirteen "4"  of the subjects  (moderately p o s i t i v e ) .  (37%) r a t e d t h e i r a t t i t u d e a s  Frequencies o f those r a t i n g  t h e m s e l v e s a t "4" were d i s t r i b u t e d a l m o s t e v e n l y three  years,  with  four i n both f i r s t  amongst t h e  and second-year, and  141 five i n third-year.  Comments t a k e n d i r e c t l y  t r a n s c r i p t s of these subjects  from t h e  included:  1.  On t h e w h o l e I'm p o s i t i v e . L e t ' s u s e i t w h e r e i t h a s demonstrated t h a t i t i s d e f i n i t e l y o f v a l u e , and l e t ' s not t r y t o f o r c e i t i n t o a r e a s where i t h a s n ' t b e e n d e m o n s t r a t e d t h a t i t i s good. 2. I t h i n k t h e y w i l l b e more b e n e f i c i a l t h a n t h e y w i l l b e negative. 3. I t h i n k c o m p u t e r s w i l l b e p o s i t i v e a n d t h e y w i l l come. 4.1 t h i n k t h e y a r e c o m i n g a n d t h e r e i s no g e t t i n g away f r o m them. I f e e l I ' v e come a l o n g way s i n c e my f i r s t experience. 5. I d o n ' t t h i n k we h a v e much c h o i c e i n t h e m a t t e r . They a r e g o i n g t o come a n d I t h i n k t h a t i f y o u c a n j u s t r e a l i z e t h a t a n d n o t f i g h t i t , y o u ' l l b e a h e a d o f t h e game b e c a u s e you c a n a t l e a s t go i n t o i t w i t h an a t t i t u d e . . . o k a y t h i s i s g o i n g t o b e p a r t o f my j o b a n d I ' l l h a v e t o l e a r n i t , so I m i g h t a s w e l l l e a r n i t a s b e s t I c a n . 6. I t h i n k t h a t i f I t o o k t i m e a n d I h a d t i m e t o l e a r n , I would l i k e i t . 7. I w o u l d r e a l l y l i k e t o s e e t h e m come i n t o o u r h o s p i t a l . 8 . 1 w o u l d b e p o s i t i v e i f t h e y w e r e t o come i n t o t h e c l i n i c a l setting.  Five  s t u d e n t s s a i d t h e i r a t t i t u d e was " 5 " ( p o s i t i v e ) .  Three were i n f i r s t - y e a r , one  was i n t h i r d - y e a r .  one was i n s e c o n d - y e a r , a n d a l s o  Comments made b y t h e s e f i v e  subjects  were: 1. -2. 3. 4.  I t h i n k i t i s a very p o s i t i v e t h i n g . I'd r e a l l y l i k e i t i n the h o s p i t a l . Definitely positive! I am j u s t gung-ho on t h i s ! I f e e l my t h o u g h t s a r e s o p o s i t i v e about h a v i n g computers, u s i n g i t t o i t s f u l l e s t a d v a n t a g e s o t h a t I c a n h a v e more t i m e w i t h my p a t i e n t . I t i s j u s t s o m o t i v a t i n g f o r me! 5. I l i k e c o m p u t e r s v e r y much. I t h i n k i t w o u l d b e a g r e a t asset t o nursing. T a b l e 11 p r o v i d e s  a summary o f t h e f r e q u e n c i e s  and  p e r c e n t a g e s o f r e s p o n s e on a f i v e p o i n t L i k e r t - t y p e a t t i t u d e scale f o r subjects  i n each  year.  142 Table 11. F r e q u e n c y Of R e s p o n s e O f R a t i n g Oa A F i v e P o i n t Attitude  Likert-Type  Scale  YEAR FIRST RATING*  (n = 11)  SECOND  THIRD  (n = 11)  TOTAL  (n = 13)  f  (%)  f  (%)  f  (%)  f  (%)  1  0  (0)  0  (0)  0  (0)  0  (0)  2  3  (27)  3  (27)  0  (0)  6  (17)  3  1  (9)  3  (27)  7  (54)  11  (31)  4  4  (36)  4  (36)  5  (38)  13  (37)  5  3  (27)  1  (9)  1  (8)  5  (9)  * 1 = negative,  2 = moderately negative,  4 = moderately p o s i t i v e ,  3 = neutral/  5 = positive  The o v e r a l l a t t i t u d e o f s u b j e c t s was p o s i t i v e computers i n h o s p i t a l n u r s i n g , w i t h eighteen s u b j e c t s s a y i n g t h e i r a t t i t u d e was p o s i t i v e Eleven five  (31%) were n e u t r a l  subjects  "2"). and  N = 35  toward  (51)% of the ("4" o r " 5 " ) .  ("3"), a n d o n l y s i x o f t h e t h i r t y -  (17%) were c o n s i d e r e d  t o be n e g a t i v e  ("1" o r  One o f t h e m a l e s u b j e c t s r a t e d h i s a t t i t u d e a s " 3 " ,  the other  f o u r were a l l p o s i t i v e .  summary o f s u b j e c t s ' a t t i t u d e s  T a b l e 12 p r o v i d e s  (negative, neutral,  toward computer use i n h o s p i t a l s .  a  positive)  143 T a b l e 12. F r e q u e n c y Of R e s p o n s e Of S u b j e c t s ' A t t i t u d e s T o w a r d  Computer  Use I n H o s p i t a l s  YEAR FIRST (n = 11)  SECOND (n = 11)  THIRD  TOTAL  (n = 13)  N = 35  ATTITUDE RATING*  f  (%)  f  (%)  f  (%)  f  (%)  NEGATIVE  3  (27)  3  (27)  0  (0)  6  (17)  NEUTRAL  1  (9)  3  (27)  7  (54)  11  (31)  POSITIVE  7  (64)  5  (45)  6  (46)  18  (51)  * R a t i n g s on a f i v e - p o i n t L i k e r t - t y p e a t t i t u d e s c a l e w e r e combined t o p r o v i d e t h e f i n d i n g s  ( n e g a t i v e = " 1 " and "2",  n e u t r a l = "3", p o s i t i v e = "3" and " 4 " ) .  R e l a t i o n s h i p Between C o n c e p t i o n And A t t i t u d e  A t h i r d question posed at the outset of t h e study r e v i s e d t o be:  What i s t h e r e l a t i o n s h i p b e t w e e n  students' conceptions employed nurses,  was  nursing  o f t h e i m p a c t o f c o m p u t e r s on h o s p i t a l  and s t u d e n t ' s a t t i t u d e s t o w a r d computers?  In o r d e r t o a s s e s s t h e r e l a t i o n s h i p between c o n c e p t i o n and attitude,  i t was i n i t i a l l y  d e c i d e d t o f o c u s on s u b j e c t s who  were r a t e d a s n e g a t i v e , b e c a u s e t h e m a j o r i t y o f s u b j e c t s i n t h e s t u d y were p o s i t i v e about c o m p u t e r s coming i n t o t h e  144 h o s p i t a l s e t t i n g , and a l s o p o s i t i v e about the nurse becoming more i n v o l v e d with them.  Measures of a t t i t u d e were the  s u b j e c t ' s r a t i n g on the a t t i t u d i n a l s c a l e . conceptions  were:  conceptions,  and  (1) r a t i n g of the l e v e l of complexity (2) the number of c a t e g o r i e s of  d i s c u s s e d by each s u b j e c t . e a r l i e r i n t h i s chapter Firstly, conceptions  Measures of of  conception  These r a t i n g s have been r e p o r t e d  (Tables 9,  10,  11 and  12).  f i n d i n g s on the number of c a t e g o r i e s o f  d i s c u s s e d by the s i x (three f i r s t ,  second-year) s u b j e c t s with n e g a t i v e  d i s c u s s e d two  d i s c u s s e d t h r e e , and two  three  a t t i t u d e s , were examined  t o determine p o s s i b l e r e l a t i o n s h i p s . the s u b j e c t s had  and  I t appears t h a t one  categories, three  had d i s c u s s e d f o u r .  of  had  There does not  appear t o be an obvious r e l a t i o n s h i p between the number of c a t e g o r i e s d i s c u s s e d and a t t i t u d e . Secondly, f i n d i n g s on i n d i v i d u a l s u b j e c t s ' complexity conceptions  and a t t i t u d e s were examined t o determine  relationships. negative  I t appears t h a t a l l s i x s u b j e c t s  a t t i t u d e s toward computer use  with  in hospitals,  c o n c e p t u a l i z e the use of computers at a low  level.  On  the  other hand, of the e i g h t s u b j e c t s i n f i r s t - y e a r c o n s i d e r e d have low  of  l e v e l conceptions,  t h r e e had n e g a t i v e  f i v e had p o s i t i v e a t t i t u d e s . year with a low  t h r e e had  a positive attitude.  t h i r d - y e a r s u b j e c t s with low  a t t i t u d e s , and  Of the f o u r s u b j e c t s i n second-  l e v e l of conception,  a t t i t u d e s , and one had  to  negative  A l l f o u r of the  l e v e l conceptions  had p o s i t i v e  145  attitudes. In examining conception, second-year, positive  s u b j e c t s r a t e d as h a v i n g a h i g h l e v e l  i t appears t h a t a l l (three f i r s t - y e a r , seven nine third-year) these  attitudes  toward  T h e r e a p p e a r s t o be c o n c e p t i o n and  attitude  s u b j e c t s , a l s o have  computer use  in  hospitals.  a significant relationship (X 2 =  7.25,  p_<.01).  attitudes.  S u b j e c t s w i t h a low l e v e l o f c o n c e p t i o n a r e d i v i d e d of having a p o s i t i v e  or negative a t t i t u d e .  have a low l e v e l o f c o n c e p t i o n .  s u m m a r i z e s l e v e l s o f c o n c e p t i o n and computers.  attitude  i n terms  However, a l l s i x  w e r e i d e n t i f i e d i n t h e s t u d y as h a v i n g  negative attitude,  between  A l l subjects  w i t h a h i g h l e v e l o f c o n c e p t i o n have p o s i t i v e  s u b j e c t s who  of  toward  a Table  13  146 Table 13. Frequency o f Response R e l a t i n g L e v e l Of Conception And Attitude  YEAR CONCEPTION AND ATTITUDE  FIRST (n = 11)  SECOND (n = 11)  THIRD (n = 13)  TOTAL N = 35  HIGH CONCEPTION: POSITIVE ATTITUDE  3  7  9  19  NEGATIVE ATTITUDE  0  0  0  0  POSITIVE ATTITUDE  5  1  4  10  NEGATIVE ATTITUDE  3  3  0  6  11  11  13  35  LOW CONCEPTION:  TOTAL  Secondary F i n d i n g s  Secondary f i n d i n g s were generated through a n a l y s i s o f the q u e s t i o n s on the respondent p r o f i l e i n t e r v i e w schedule.  s e c t i o n o f the  Two types of q u e s t i o n s were used:  (a) forced-response, r e q u i r i n g s u b j e c t s t o s e l e c t a. response from two o r more a l t e r n a t i v e s ; and (b) open-ended, a l l o w i n g s u b j e c t s t o c o n s t r u c t the responses.  Because t h e q u e s t i o n s  on t h e p r o f i l e were designed t o o b t a i n an understanding o f  147 the  background  o f t h e s u b j e c t s , t h e y sought  v a r i e t y of seemingly unrelated f a c t s . secondary f i n d i n g s s e c t i o n ,  i n f o r m a t i o n on  Consequently,  a p p e a r s a t t i m e s t o be  d i s j o i n t e d c o l l e c t i o n of unrelated facts.  The  of  secondary f i n d i n g s t o primary f i n d i n g s w i l l  in  C h a p t e r 5.  this  a  relationship be  addressed  In order t o present the secondary f i n d i n g s i n  a succinct fashion, they w i l l headings:  a  (a) d e m o g r a p h i c s ,  be p r e s e n t e d u n d e r  two  (sub-sections A-F),  and  (b) c o m p u t e r a c c e s s a n d u s a g e ,  ( s u b - s e c t i o n s A-C).  Demographics  A.  Age  At the time of the interviews majority of subjects, and t w e n t y - f o u r .  The n e x t l a r g e s t age g r o u p was (20%).  One  between ages f o r t y and f o r t y - n i n e ,  between ages f i f t y and f i f t y - n i n e . s t u d e n t p o p u l a t i o n who  year.  49% f i r s t - y e a r ,  ;  The  between  second-year s u b j e c t a n d one total  first-year  was  "regular"  1988  were d i s t r i b u t e d  57% s e c o n d - y e a r ,  and 43%  T a b l e 14 i n d i c a t e s t h e b r e a k d o w n o f s u b j e c t s  each year, i n terms  the  were between t h e ages o f e i g h t e e n and  t w e n t y - f o u r i n March and A p r i l , follows:  1988),  (60%) w e r e b e t w e e n t h e a g e s o f e i g h t e e n  t w e n t y ^ f i v e and t w e n t y - n i n e was  (March & A p r i l ,  o f age  range.  as  thirdwithin  148 Table 14. Age  Ranges Of S u b j e c t s In Each Year Of The Cariboo  College  Nursing Program  YEAR FIRST (n = 11) AGE  RANGE  f  (%)  SECOND  THIRD  (n = 11) f  (%)  TOTAL  (n = 13) f  N = 35 f  (%)  (%)  18 - 24  5  (45)  8  (73)  8  (62)  25 - 29  3  (27)  1  (9)  3  (23)  7  (20)  30 - 39  2  (18)  1  (9)  2  (15)  5  (14)  40 - 49  0  (0)  1  (9)  0  (0)  1  (3)  50 - 59  1  (9)  0  (0)  0  (0)  1  (3)  11  (99)  (100)  35  (100)  TOTAL  11  (100)  13  21  (60)  In summary, t h e m a j o r i t y o f s u b j e c t s who p a r t i c i p a t e d i n the study,  i n a l l t h r e e years, were between t h e ages o f  e i g h t e e n and twenty-four.  The age group t h a t ranked second  f o r a l l t h r e e years was t w e n t y - f i v e t o twenty-nine. m a j o r i t y o f s u b j e c t s i n a l l t h r e e years  (80%) ranged i n age  between e i g h t e e n and twenty-nine as d i d t h e m a j o r i t y the " r e g u l a r " n u r s i n g p o p u l a t i o n .  The  (68%)  The age range o f t h e  sample appears t o be r e p r e s e n t a t i v e o f t h e t o t a l p o p u l a t i o n e n r o l l e d i n each year o f t h e program.  student  in  149 B. F o r m a l E d u c a t i o n Nursing  P r i o r To E n t e r i n g The C a r i b o o  Program  Twenty-six subjects experience Cariboo  College  (74%) h a v e h a d f o r m a l  educational  beyond t h e h i g h s c h o o l l e v e l p r i o r t o e n t e r i n g t h e  C o l l e g e n u r s i n g program.  experiences  included:  These  university transfer college  non-university t r a n s f e r c o l l e g e courses, non-degree u n i v e r s i t y courses,  high school.  subjects  t r a n s f e r c o l l e g e courses,  s u c h as  nursing d i r e c t l y  (46%) h a d t a k e n  and t h r e e  subjects  subjects  (40%) w i t h e x p e r i e n c e  h a d one f o r m a l e d u c a t i o n a l e x p e r i e n c e n u r s i n g program, e l e v e n  from  university (9%) h a d  u n i v e r s i t y degrees p r i o r t o e n t e r i n g t h e program. fourteen  degrees,  courses.  (26%) e n t e r e d  Sixteen subjects  courses,  university  and o t h e r c o u r s e s ,  c o r r e s p o n d e n c e a n d work r e l a t e d Only nine  educational  beyond h i g h  While school  p r i o r to entering the  (31%) h a d two e x p e r i e n c e s .  One  f i r s t - y e a r s u b j e c t was n o t t y p i c a l o f t h e s a m p l e , i n t h a t had a l a r g e v a r i e t y o f e d u c a t i o n a l e x p e r i e n c e s the c a t e g o r i e s . of formal  T a b l e 15 i n d i c a t e s a b r e a k d o w n  educational experience  entering the Cariboo  from four o f of the  of subjects p r i o r to  College nursing  program.  she  level  150 Table 15. Formal E d u c a t i o n Nursing  P r i o r To E n t e r i n g The Cariboo  College  Program  YEAR FIRST (n = 11)  SECOND (n = 11)  THIRD  TOTAL  (n = 13)  N = 35  FORMAL EDUCATION  f  (%)  f  (%)  f  (%)  f  (%)  HIGH SCHOOL  1  (9)  4  (36)  4  (31)  9  (26)  U.T. COLLEGE  5  (45)  4  (36)  7  (54)  NON U.T. COLLEGE  2  (18)  2  (18)  5  (38)  9  (26)  UNIVERSITY DEGREE  2  (18)  1  (9)  0  (0)  3  (9)  UNIVERSITY NON DEGREE  3  (27)  1  (9)  0  (0)  4  (11)  OTHER  3  (27)  1  (9)  4  (31)  8  (23)  TOTAL  16  *  * The frequency  13  16  20  counts r e p o r t e d i n these columns do not t o t a l  the i d e n t i f i e d n's f o r each year,  as twelve s u b j e c t s  i n d i c a t e d more than one e d u c a t i o n a l  experience.  The m a j o r i t y o f s u b j e c t s who p a r t i c i p a t e d i n t h i s had e d u c a t i o n a l experience t o e n t e r i n g t h e Cariboo first-year, directly  (46)  beyond t h e h i g h s c h o o l l e v e l  C o l l e g e n u r s i n g program.  school.  prior  Only one  and f o u r second and t h i r d - y e a r s u b j e c t s  from h i g h  study  entered  151 C. Amount Of E d u c a t i o n S p e c i f i c To Computers Obtained  Outside  The Cariboo C o l l e g e N u r s i n g Program  Fourteen s u b j e c t s (40%) had no e d u c a t i o n s p e c i f i c t o computing p r i o r t o e n t e r i n g t h e n u r s i n g department. twenty-one who had, n i n e t e e n  Of t h e  (54%) had o n l y one formal  experience, while one f i r s t - y e a r s u b j e c t had two.  Another  f i r s t - y e a r s u b j e c t had a number o f u n i v e r s i t y and c o l l e g e courses, as w e l l as a l o n g h i s t o r y o f v a r i e d e x p e r i e n c e s , with computers i n t h e workplace. EXPERT.  She was c o n s i d e r e d t o be an  Table 16 i l l u s t r a t e s t h e amount o f formal computer  e d u c a t i o n s u b j e c t s have had o u t s i d e t h e n u r s i n g department.  Table 16. Amount Of Formal E d u c a t i o n S p e c i f i c To Computers  Obtained  Outside The Cariboo C o l l e g e N u r s i n g Program  YEAR AMOUNT OF FORMAL COMPUTER  FIRST  SECOND  (n = 11)  (n = 11)  THIRD (n = 13)  TOTAL N = 35  EDUCATION  f  (%)  f  (%)  f  (%)  f  (%)  NONE  3  (27)  3  (27)  8  (62)  14 (40)  ONE EXPERIENCE  6  (55)  8  (73)  5  (38)  1? (54)  TWO EXPERIENCES  1  (9)  0  (0)  0  (0)  1  (3)  MORE THAN TWO  1  (9)  0  (0)  0  (0)  1  (3)  152 These e d u c a t i o n a l e x p e r i e n c e s  w i t h computers took  i n a v a r i e t y of types of s e t t i n g s i n c l u d i n g : c o l l e g e , t h e s c h o o l system, and t h e w o r k p l a c e . s u b j e c t had two  had  had  taken  taken u n i v e r s i t y l e v e l  computing courses  e i t h e r elementary, twelve,  s i x took  while (34%)  Of  these  s i x were s e c o n d - y e a r s u b j e c t s , w h i l e t h r e e were I t appeared  s u b j e c t s who  had  taken  from computer  i n the s c h o o l system, t h a t the focus of these  on p r o g r a m m i n g .  content  one  Twelve s u b j e c t s  j u n i o r h i g h or h i g h s c h o o l .  discussions with those  was  Only  w h i l e i n the school system i n  f i r s t h a n d t h r e e were t h i r d - y e a r .  courses  university,  computer c o u r s e s ,  taken c o l l e g e l e v e l courses.  place  A total  of three subjects took  courses  computer  i n c o r p o r a t e d w i t h programs o t h e r than n u r s i n g , w h i l e other types of courses,  work-related courses. percentage  Table  17  such  as c o r r e s p o n d e n c e  summarizes t h e frequency  o f s u b j e c t s i n e a c h y e a r , who  obtained  formal  education s p e c i f i c t o computers, i n s e t t i n g s o u t s i d e Cariboo C o l l e g e n u r s i n g program.  the  and and  153 Table 17. S e t t i n g s Outside The Cariboo C o l l e g e N u r s i n g Program Where Formal Computer E d u c a t i o n Was  Obtained  YEAR FIRST FORMAL COMPUTER  (n = I D  SECOND  THIRD  (n = 11)  (n = 13)  TOTAL (N = 35)  EDUCATION  f  (%)  f  (%)  •f  (%)  f  (%)  UNIVERSITY COURSE  1  (9)  0  (0)  0  (0)  1  (3)  COLLEGE COURSE  2  (18)  0  (0)  0  (0)  2  (6)  SCHOOL SYSTEM  3  (27)  6  (55)  3  (23)  12  (34)  INCORPXCOURSE  2  (18)  0  (0)  1  (8)  3  (9)  CORRESP\WORK  3  (27)  2  (27)  1  (8)  6  (17)  11  TOTAL* *Total  8  5  24  frequency does not equal n as s e v e r a l s u b j e c t s had  o b t a i n e d formal e d u c a t i o n s p e c i f i c t o computers i n more than one type o f s e t t i n g .  D. Environment F o r F i r s t Hands-On Computer Experience  Subjects reported that t h e i r i n i t i a l computer variety subjects  experience w i t h a  (other than w i t h v i d e o games) took p l a c e i n a o f environments.  A l a r g e m a j o r i t y o f the t h i r t y - f i v e  (91%) had t h e i r i n i t i a l  experience with a computer  154 prior  t o e n t e r i n g the Cariboo C o l l e g e N u r s i n g program.  t h a t number, e i g h t e e n , experience p o s i t i v e l y .  (56%)  described their  program. Table  t o t h e one  18 p r e s e n t s a summary o f t h e f r e q u e n c y  s u b j e c t s who  had  their  in  nursing or non-nursing  initial  and  year. percentage  e x p e r i e n c e w i t h computers  environments.  18.  I n i t i a l Hands-On C o m p u t e r E x p e r i e n c e Nursing  I n N u r s i n g And  Non-  Environments  ENVIROMENT NON  FREQUENCY  PERCENTAGE  11  49  work  6  17  home  5  14  college - non-nursing  4  11  3  9  35  100  NURSING school/university  NURSING college - nursing TOTAL  a  i n the nursing  These t h r e e were a l l e n r o l l e d i n t h i r d -  of  Table  initial  Only t h r e e s u b j e c t s had not had  computer hands-on e x p e r i e n c e p r i o r  Of  155 E.  Computer E x p e r i e n c e  I n The  Cariboo  College  Nursing  Program  Computer c o n t e n t  i s incorporated i n t o the  College nursing curriculum, mainly  i n the  Cariboo  Nursing  P e r s p e c t i v e s C o u r s e , as o u t l i n e d i n C h a p t e r t h r e e Several subjects spontaneously p r e s e n t l y being taught not  voiced opinions  (Table  on t h e  content  i n the program, even though they  asked a d i r e c t question to e l i c i t  T h e s e o p i n i o n s u s u a l l y came i n t h e d e s c r i b i n g t h e i r i n i t i a l and  specific  course  of  4).  were  information.  subjects  subsequent experiences  with  a  computer. All  s u b j e c t s i n e a c h y e a r were e x p o s e d t o s e m i n a r s i n  s e m e s t e r one  of f i r s t - y e a r .  mentioned the to  seminars,  be p o s i t i v e .  the seminars,  and  Nine f i r s t - y e a r subjects s i x of the nine  Seven s e c o n d - y e a r s u b j e c t s  and  four of the  I n c l u d i n g the three  experience  w i t h a computer i n the  third-year subjects  seminars. positive  Of t h o s e  (46%)  s u b j e c t s who  F i f t y - n i n e per experience  first  students,  cent  year  year  had  their  seminars,  62%  mentioning the  be initial only  computer  f o u r r e c a l l e d t h e m as Overall,  them  mentioned  them t o  being  of a l l subjects  s e m i n a r s as a c o m p u t e r  of those  f o u n d i t t o be  first  mentioned the  learning experiences.  mentioned the  (64%)  seven c o n s i d e r e d  positive.  six  considered  (82%)  first  experience. year  positive.  Twelve t h i r d - y e a r s u b j e c t s  (92%)  mentioned the  Nurse  156 S t a r program. to  Of t h a t number, only f o u r found the  be p o s i t i v e .  The main reason  programs, which were a source  seemed t o be  of student  F. Views On Computer Content In The  experience  faulty  frustration.  Cariboo  College  Nursing  Program  Subjects content  spontaneously v o i c e d t h e i r o p i n i o n s on computer  i n the Cariboo  subjects  (63%)  C o l l e g e n u r s i n g program.  f e l t t h a t computer content  should be  i n the n u r s i n g program, e i t h e r as a separate i n c o r p o r a t e d i n t o the n u r s i n g course. subjects  (55% f i r s t - y e a r ,  thought t h a t a computing course  numbers of  year.  One  should be a p r e - r e q u i s i t e t o  female f i r s t - y e a r s u b j e c t s t a t e d t h a t she would A third-year  has used computers i n a job s e t t i n g , s t a t e d , "I  d e f i n i t e l y would say you  r e a l l y need t h a t t r a i n i n g program."  A v a r i e t y of o p i n i o n s were expressed asked t o d e s c r i b e how  they  Eleven  expressed  own  third-year)  male s u b j e c t  f o r c e h e r s e l f t o go u n t i l she got i n t e r e s t e d . s u b j e c t who  or  i n the n u r s i n g program  i n c r e a s e d with each succeeding  One  included  course,  63% second-year, 69%  wanting more computer content  nursing.  The  Twenty-two  subjects  (31%)  when s u b j e c t s were  l i k e t o l e a r n t o use  i n a self-directed fashion.  a computer.  the d e s i r e t o l e a r n on One  their  third-year subject  t h a t f a c u l t y should make sure t h a t everybody does i t , by keeping a l i s t .  Another s u b j e c t f e l t  she c o u l d be  self-  felt  157 d i r e c t e d once she r e a c h e d a c e r t a i n p o i n t  i n terms o f  proficiency. T e a c h i n g t e c h n i q u e s were d i s c u s s e d Thirteen  subjects  subject to-one.  o f t h e method o f t e a c h i n g .  Three  expressed a d e s i r e f o r one-to-one i n s t r u c t i o n . stated emphatically  that  That p a r t i c u l a r s u b j e c t  i t should was v e r y  computers throughout h e r i n t e r v i e w . i n d i c a t e d she d i d n ' t  Thirteen  subjects  manual o r a b o o k l e t . t o l e a r n by r e a d i n g  negative  Another  and n o t p r o g r e s s i n g .  have t h a t k i n d o f p a t i e n c e , "  (60%),  f o r h a l f an  " I j u s t don't  she s a i d .  (37%) e x p r e s s e d t h e d e s i r e t o h a v e a One m a l e s u b j e c t  and by t r i a l  s t a t e d t h a t he  computer.  One f e m a l e s u b j e c t  practise,  they  used  s t a t e d she wanted t h e Several  s t a t e d t h e y p r e f e r r e d a p e r s o n r a t h e r t h a n a book.  A n o t h e r s t a t e d she l i k e d t o be c o r r e c t e d saw  that  Twenty-one o f  stated they l i k e d a supervised  i n s t r u c t o r t o be h o n e s t a n d s t r a i g h t w i t h h e r . subjects  liked  a n d e r r o r , b u t he n o t e d  o r h a v i n g t h e i n s t r u c t o r a v a i l a b l e t o them, w h i l e the  towards  subject  i s f r u s t r a t i n g when t h e b o o k i s i n c o r r e c t .  those sampled  One  DEFINITELY be one-  want t o b e s i t t i n g t h e r e  hour w a i t i n g f o r help  it  subjects.  (37%) e x p r e s s e d t h e d e s i r e t o h a v e a  d e m o n s t r a t i o n as p a r t subjects  by s e v e r a l  as she went, as she  no p o i n t , i n d o i n g s o m e t h i n g w r o n g t w o o r t h r e e  b e c a u s e i t ' s more d i f f i c u l t established a pattern. h a v i n g someone t h e r e  times  t o c o r r e c t a n e r r o r when y o u ' v e  One s u b j e c t  you can ask:  stated,  "I like  always  What am I d o i n g w r o n g ? "  158 Sixteen  subjects  experience. subjects  (46%)  As one  (26%)  s t a t e d they would l i k e hands-on  s u b j e c t noted, "I l e a r n by d o i n g . "  Nine  s t a t e d they l i k e d a step by step approach,  from simple t o more complex. Opinions v a r i e d as w e l l on the amount of theory p r a c t i c e needed i n programs. would l i k e theory subject  Nine s u b j e c t s  on computers.  One  (26%)  s t a t e d they  f i r s t - y e a r female  s t a t e d t h a t she d i d not want the t e c h n i c a l i t i e s ,  r a t h e r , she wanted a p r a c t i c a l a p p l i c a t i o n t h a t she r i g h t away. you  and  should  A second-year s u b j e c t know the reason why  you  could  s t a t e d she b e l i e v e s  While s i x f i r s t  second-year s u b j e c t s expressed a d e s i r e f o r the  use  that  are h i t t i n g a c e r t a i n  r a t h e r than having whatever happens.  but  key,  and  practical  a p p l i c a t i o n , the t h i r d year s u b j e c t s d i d not mention t h i s . One  f i r s t - y e a r s u b j e c t expressed a d e s i r e t o l e a r n how  edit  to  essays. Subjects  expectations  also discussed placed  the r a t e f o r l e a r n i n g and  on them.  F i f t e e n subjects  t h a t they would l i k e t o work at t h e i r own year s u b j e c t  (43%)  speed.  stated  One  s t a t e d t h a t a l o t of computer teachers  so they j u s t rush along.  Six subjects  second  have been  u s i n g them so long t h a t they don't understand t h a t you know how,  the  don't  (17%)  expressed the d e s i r e f o r a p o s i t i v e s u c c e s s f u l experience when l e a r n i n g about computers. subject said:  s t a t e d she  One  female second year  d i d not want t o " f e e l l i k e an i d i o t . "  " I t ' s b e t t e r i f I don't touch i t at a l l ,  She  r a t h e r than  159 a d m i t t h a t I d o n ' t know what I'm d o i n g . control."  I hate being  out of  S e v e r a l s u b j e c t s n o t e d t h e d e s i r e t o have a  course  f r e e from grades. I n summary, when a s k e d how t h e y computers, s u b j e c t s expressed  l i k e t o l e a r n about  a variety of opinions.  appears t h a t t h e m a j o r i t y o f s u b j e c t s computer content a separate courses,  that  s h o u l d be i n c l u d e d i n t h e p r o g r a m e i t h e r a s  course  or incorporated into existing  nursing  b u t t h e r e d i d n o t appear t o be concensus  s u b j e c t s about: pacing  (63%) f e l t  It  among  (a) p r e f e r r e d t e a c h i n g t e c h n i q u e s ,  of content,  (b)  a n d (c) e v a l u a t i o n o f l e a r n i n g .  Computer A c c e s s And Usage  A. C o m p u t e r A c c e s s A n d U s a g e A t C a r i b o o  All  Cariboo  College  students  College  have f r e e access  C o l l e g e VAX m a i n f r a m e s y s t e m b y v i r t u e o f t h e i r status. use by  However, 7 1 % o f t h e n u r s i n g s t u d e n t s  t h e system. year,  system.  to the student  s a m p l e d do n o t  T a b l e 19 i n d i c a t e s t h e b r e a k d o w n o f s u b j e c t s  i n d i c a t i n g t h e i r use o f t h e Cariboo Of t h e t e n s u b j e c t s who u s e i t ,  f o r word p r o c e s s i n g ,  C o l l e g e Vax  eight  and two f o r m a i l messages  (80%) u s e i t only.  160 Table  19.  Percentage C o l l e g e VAX  Of S u b j e c t s In Each Year Who  Use The  Cariboo  System  YEAR FIRST (n = 11) VAX  USE  SECOND  THIRD  (n = 11)  (n = 13)  TOTAL (N =  35)  f  (%)  f  (%)  f  (%)  f  (%)  YES  3  (27)  2  (18)  5  (38)  10  (29)  NO  8  (73)  9  (82)  8  (62)  25  (71)  Even though s u b j e c t s have f r e e access t o the C o l l e g e Vax  system, they i d e n t i f i e d nine b a r r i e r s p r e v e n t i n g  them from u s i n g the system. second-year  However, one  first-year,  and t h r e e t h i r d - y e a r s u b j e c t s d i d not  any b a r r i e r s . processing.  Cariboo  one  identify  These s u b j e c t s a l l use the system f o r word Table 20 i n d i c a t e s a summary of the b a r r i e r s ,  arranged i n descending  order of frequency of response,  noted  by s u b j e c t s i n each year which prevent them from u s i n g the Cariboo C o l l e g e VAX  system.  161 Table 20. Barriers VAX  I d e n t i f i e d By S u b j e c t s To Use Of The Cariboo C o l l e g e  System  YEAR FIRST (n = 11)  SECOND (n = 11)  BARRIERS  f  (%)  f  TIME\WORKLOAD  5  (45)  5  ACCESSNAVAIL  4  (36)  LACK OF KNOWLEDGE  4  NO NEED TO USE  THIRD  TOTAL  (n = 13)  N = 35  f  (%)  f  (%)  (45)  7  (54)  17  (49)  5  (45)  5  (38)  14  (40)  (36)  3  (27)  6  (46)  13  (37)  3  (27)  3  (27)  4  (31)  10  (29)  NEGATIVE ATTITUDE  1  (9)  3  (27)  3  (23)  10  (29)  PHYSICAL  4  (36)  0  (0)  3  (23)  7  (20)  FEAR OF UNKNOWN  1  (9)  3  (27)  3  (23)  7  (20)  NOT  MECHANICAL  2  (18)  2  (18)  1  (8)  5  (14)  TYPING ABILITY  2  (18)  0  (0)  0  (0)  2  (6)  <%')  I t i s i n t e r e s t i n g ' t o note t h a t some p a r a l l e l s may  be  drawn between what s u b j e c t s i d e n t i f y as b a r r i e r s t o computer use  i n the c o l l e g e ,  and what they d i s c u s s e d i n terms of t h e i r  c o n c e p t i o n s of the impact of computer use on h o s p i t a l employed nurses.  The major b a r r i e r  Cariboo C o l l e g e VAX All  subjects  (49%) t o use o f the  computer appears t o be time and workload.  (100%) d i s c u s s e d workload as a category o f  162 conception/  i n t e r m s o f t h e i m p a c t c o m p u t e r s may h a v e on t h e  workload o f h o s p i t a l employed nurses.  Many s u b j e c t s  noted  t h a t t h e w o r k l o a d o f t h e h o s p i t a l employed nurse would be i n c r e a s e d w h i l e h e \ s h e was l e a r n i n g t o u s e a c o m p u t e r . Accessability,  and a v a i l a b i l i t y /  w h i c h was t h e b a r r i e r  ranked  s e c o n d b y t h e s u b j e c t s , was a l s o d i s c u s s e d b y many i n t e r m s of p o s s i b l y i n c r e a s i n g t h e nurse's workload i n t h e h o s p i t a l . L a c k o f k n o w l e d g e was n o t e d a s a b a r r i e r b y 3 7 % o f t h e s u b j e c t s ; t h i r t e e n o f whom w e r e i n t h i r d - y e a r .  Typing  a b i l i t y was n o t e d a s a b a r r i e r t o u s e b y o n l y t w o s u b j e c t s , b o t h o f whom w e r e f i r s t  year,  b u t was n o t m e n t i o n e d i n t h e  discussion of categories of conception. A negative (one  first-year,  a t t i t u d e t o w a r d c o m p u t e r s was n o t e d b y s e v e n three second-year, three  s u b j e c t s as a b a r r i e r i n u s i n g t h e Cariboo  third-year) College  system.  S i x s u b j e c t s r a t e d t h e m s e l v e s on a f i v e - p o i n t L i k e r t - t y p e s c a l e as h a v i n g hospital nursing  a negative  a t t i t u d e toward computer use i n  (three f i r s t - y e a r ,  three second-year).  It  appears t h a t , w i t h t h e e x c e p t i o n  o f t h e second year  some s u b j e c t s o n l y h a v e n e g a t i v e  a t t i t u d e s towards t h e use o f  a computer i n s p e c i f i c s e t t i n g s .  subjects,  163 B. C o m p u t e r A c c e s s A n d U s a g e A t Home  Eighty percent c o m p u t e r a t home.  o f s u b j e c t s do n o t h a v e a c c e s s  T h i s means 28 s u b j e c t s e i t h e r h a v e no  c o m p u t e r i n t h e i r home, o r no r e a d y a c c e s s friend or relative. year with access  toa  t o that of a  T a b l e 21 i n d i c a t e s t h e s u b j e c t s i n e a c h  t o a c o m p u t e r a t home.  Table 21. Frequency Of S u b j e c t s  W i t h A c c e s s To A C o m p u t e r A t Home  YEAR FIRST (n = 11) HOME ACCESS  f.  YES NO  ,SECOND (n = 11)  THIRD (n = 13)  N = 35  (%)  f  (%)  f  (%)  f  (%)  3  (27)  2  (18)  2  (15)  7  (20)  8  (73)  9  (82)  11  (85)  28  (80)  Of t h e s e v e n s u b j e c t s who h a v e a c c e s s home, f o u r  TOTAL  (57%) a r e u s i n g them, a n d t h r e e  t o a computer a t (43%) a r e n o t .  One o f t h e n o n - u s e r s i s a s e c o n d - y e a r s u b j e c t who r a t e d h e r s e l f as h a v i n g  a negative  a t t i t u d e toward computers.  o t h e r two n o n - u s e r s s t a t e d t h e y  were i n t e r e s t e d i n u s i n g  them, b u t c o u l d n o t f i n d t h e t i m e t o l e a r n .  The  164 G.  Family  U s e - O t h e r Than V i d e o Games  S p o u s e Or S i g n i f i c a n t  Other.  S i x o f t h e spouses o r s i g n i f i c a n t others Subjects  (55%), f i v e o f second-year s u b j e c t s  of t h i r d - y e a r subjects total  (23%) u s e c o m p u t e r s .  of first-year (45%), and t h r e e This gives a  o f f o u r t e e n o f t h e s p o u s e s o r s i g n i f i c a n t o t h e r s (40%)  of s u b j e c t s u s i n g computers.  The number u s i n g c o m p u t e r s i s  i n v e r s e l y p r o p o r t i o n a l t o s u b j e c t s ' y e a r i n t h e program.  Children Twenty-seven children.  of the subjects  (77%) s a m p l e d h a v e no  Of t h e e i g h t s u b j e c t s w i t h c h i l d r e n , t h r e e a r e i n  f i r s t - y e a r and t h e i r c h i l d r e n a l l use computers a t s c h o o l . One s e c o n d - y e a r s u b j e c t e m p h a t i c a l l y music education  s t a t e d t h a t she v a l u e d  a  f o r h e r c h i l d r e n over computers.  A c c e s s t o c o m p u t e r s a t home i s n o t a r e a l i t y subjects e n r o l l e d i n the Cariboo College Nursing  f o r most Program.  Even t h o u g h t h i s group does have f r e e a c c e s s t o t h e c o l l e g e ' a main  f r a m e VAX s y s t e m , a s s t u d e n t s ,  a number o f b a r r i e r s w e r e  n o t e d by t h e s u b j e c t s which p r e v e n t t h e m a j o r i t y from u s i n g it  t o any g r e a t e x t e n t .  The m a i n b a r r i e r s a p p e a r t o b e  workload, and a c c e s s a b i l i t y and a v a i l a b i l i t y .  I t appears  t h a t t h e spouses and c h i l d r e n o f s u b j e c t s a r e moderate computer  users.  165 Summary Of P r i m a r y  And  Secondary  F i n d i n g s w e r e r e p o r t e d as b e i n g secondary.  Primary  e i t h e r primary  f i n d i n g s i n d i c a t e that the  s u b j e c t ' s awareness of computer use minimal/  and  p r i m a r i l y focused  local clinical were not  United  agency  (R.I.H.).  k n o w l e d g e o f how  areas of usage:  majority of and  future centered  The  n o t e d t h e use Subjects'  c o m p u t e r s w i l l be  (a) n u r s i n g ,  (c) a d m i n i s t r a t i o n .  subjects  nationally in  u s e d by h o s p i t a l  around three  broad  and  majority of subjects i n a l l three  of computers f o r documentation purposes.  conceptions  (a) n u r s i n g i m a g e ,  technology.  (b) c o m m u n i c a t i o n  o f how  h o s p i t a l employed nurses f e l l  computers w i l l  impact  Subjects'  (c) w o r k l o a d ,  and  comments, w i t h i n e a c h  f o u r c a t e g o r i e s , were f u r t h e r c l a s s i f i e d i n t o  sub-categories i n c r e a s e d use  i n d i c a t i n g whether s u b j e c t s f e l t of computers would:  f r o m o r ! ( c ) b o t h enhance and  2.  (a) e n h a n c e ,  that (b)  of  three the detract  d e t r a c t from the category.  r e l a t i o n s h i p of sub-categories in Figure  on  into four categories:  (b) p a t i e n t c a r e ,  (d) p r o f e s s i o n a l i s m . these  The  i n the  s e v e r a l seemed t o f e e l t h a t h o s p i t a l s i n t h e  employed n u r s e s i n the  years  typical  on h i s \ h e r e x p e r i e n c e s  S t a t e s w e r e more a d v a n c e d i n t e r m s o f  Subjects'  or  i n h o s p i t a l s today i s  aware o f h a p p e n i n g s p r o v i n c i a l l y  Canada, but  Findings  to categories i s  The  represented  166  Categories  Nursing image Patient care Workload Professionalism  Detract  Enhance  F i g u r e 2. R e l a t i o n s h i p Of S u b - C a t e g o r i e s To Categories  All  s u b j e c t s commented on e i t h e r two,  categories o f conception and  but  overall,  three, or four  the m a j o r i t y o f second  third-year subjects discussed a l l four categories.  Subject's  conceptions  d i f f e r e d i n complexity  d i r e c t p r o p o r t i o n t o the year the  Of C o n c e p t i o n  i n which they  or quality, i n were e n r o l l e d i n  program. A very  s m a l l number o f s u b j e c t s s p o n t a n e o u s l y  a d e s i r e t o purchase a computer, o r t o t a k e course.  expressed  a computer  The o v e r a l l a t t i t u d e o f s u b j e c t s t o w a r d c o m p u t e r s i n  h o s p i t a l n u r s i n g was p o s i t i v e . were r a t e d a s h a v i n g  negative  A l l s i x o f t h e s u b j e c t s who a t t i t u d e s were f e m a l e .  were i n f i r s t - y e a r a n d t h r e e were i n s e c o n d - y e a r .  Three  In  a d d i t i o n , t h e r e appears t o be a r e l a t i o n s h i p between a subject's complexity All  o f conception,  s i x subjects with negative  conception,  and h i s \ h e r  attitude.  a t t i t u d e s had a low l e v e l o f  and a l l s u b j e c t s w i t h a high l e v e l o f conception  167 had p o s i t i v e a t t i t u d e s . Secondary f i n d i n g s i n d i c a t e t h a t t h e m a j o r i t y of s u b j e c t s were between t h e ages o f e i g h t e e n and had e d u c a t i o n  beyond t h e h i g h s c h o o l  entering the Cariboo  level.  However,  40% h a d no. f o r m a l  number o f s u b j e c t s e x p r e s s e d negative,  twenty-four, Prior to  C o l l e g e n u r s i n g program, t h e m a j o r i t y o f  s u b j e c t s had a hands-on computer e x p e r i e n c e games).  and  views,  about t h e experience  (excluding  computing education.  While access  f o r most s u b j e c t s access  they had w i t h computers i n  t o c o m p u t e r s a t home i s n o t a  ( 8 0 % ) , a l l s u b j e c t s , as s t u d e n t s  t o the Cariboo  C o l l e g e VAX  are u s i n g t h i s system (21%). for this  l a c k of use; workload  availability  of terminals  a p p e a r t o be  paramount.  A  b o t h p o s i t i v e and  t h e i r n u r s i n g p r o g r a m , w i t h some e v e n m a k i n g s u g g e s t i o n s change.  video  for  reality have  free  c o m p u t e r s y s t e m , b u t few  A number o f b a r r i e r s were (49%), a c c e s s i b i l i t y  cited  and  ( 4 0 % ) , and l a c k o f knowledge  (37%)  168 CHAPTER 5 D i s c u s s i o n , Recommendations,  S i g n i f i c a n c e , And C o n c l u s i o n s  D i s c u s s i o n Of F i n d i n g s  T h i s s t u d y s e t o u t t o . a n s w e r one b r o a d , a n d t h r e e s p e c i f i c r e s e a r c h q u e s t i o n s . . As a n t i c i p a t e d a t t h e o u t s e t , due t o t h e p h e n o m e n o l o g i c n a t u r e  of t h e study, t h e questions  were r e f i n e d d u r i n g t h e d a t a c o l l e c t i o n and a n a l y s i s phase t o read:  1. How do n u r s i n g s t u d e n t s  i n a community  college nursing  p r o g r a m c o n c e p t u a l i z e t h e i m p a c t o f c o m p u t e r s on h o s p i t a l employed n u r s e s ?  (a) I s t h e r e a d i f f e r e n c e i n c o m p l e x i t y b e t w e e n second, and t h i r d - y e a r n u r s i n g  first,  students'conceptions  o f t h e i m p a c t o f c o m p u t e r s on h o s p i t a l  employed  nurses?  (b) What i s t h e r e l a t i o n s h i p b e t w e e n n u r s i n g conceptions  o f t h e i m p a c t o f c o m p u t e r s on h o s p i t a l  employed n u r s e s , clinical  students'  and t h e l e n g t h o f s t u d e n t s '  experience?  :  169 (c) I s t h e r e a r e l a t i o n s h i p b e t w e e n n u r s i n g conceptions  o f the impact  employed nurses,  and  students'  o f c o m p u t e r s on  students' a t t i t u d e  hospital toward  computers?  F i n d i n g s were p r e s e n t e d or secondary. d i s c u s s e d by  In t h i s chapter, primary  Then, t h e g e n e r a l i z a b i l i t y o f t h e :  Finally,  and  f i n d i n g s are research  computer usage.  f i n d i n g s , as w e l l as  s i g n i f i c a n c e of the study are  local  conclusions.  D i s c u s s i o n Of P r i m a r y  Research  Because conceptions  Findings  Question  1  a r e f o r m e d by o n e ' s a w a r e n e s s o f  "what i s , " and by a k n o w l e d g e o f "what may were a s k e d  be,"  questions  at the outset of the study t o determine  (a) a w a r e n e s s o f c o m p u t e r u s e (b) k n o w l e d g e o f how employed nurses  the  addressed.  t h e c h a p t e r e n d s w i t h b o t h g e n e r a l , and  r e c o m m e n d a t i o n s and  primary  T h i s i s f o l l o w e d by a d i s c u s s i o n o f  f i n d i n g s on d e m o g r a p h i c s , and  limitations,  4 as e i t h e r  f o c u s i n g on e a c h o f t h e r e f i n e d  questions separately. secondary  i n Chapter  i n h o s p i t a l n u r s i n g today,  c o m p u t e r s may  i n the  future.  context f o r understanding  subjects':  be u s e d by  hospital  These v i e w s p r o v i d e d  students' conceptions  about  a the  and  170 i m p a c t o f c o m p u t e r s on h o s p i t a l e m p l o y e d Overall,  nurses.  i t appears t h a t s u b j e c t s e n r o l l e d i n  the  C a r i b o o C o l l e g e n u r s i n g program, have a l a c k of awareness computer use  i n h o s p i t a l nursing today.  a w a r e n e s s may  Subjects'  be p a r t i a l l y e x p l a i n e d by t h e  fact that  are not p r e s e n t l y u s i n g computers at Royal I n l a n d (R.I.H.),  the  experience of the  place.  of  nurses  Hospital  f a c i l i t y where t h e m a j o r i t y o f t h e i r  takes  lack  clinical  In that l o c a l f a c i l i t y , at the  i n t e r v i e w s , computer use  c o n s i s t e d of  department systems i n non-nursing areas.  of  time  individual  In a d d i t i o n ,  s u b j e c t s ' l a c k of awareness appears t o i n d i c a t e t h a t  the  computer awareness content  Nursing  Perspectives  course i n the  p r e s e n t l y included i n the ;  Cariboo College  n u r s i n g program i s  inadequate. M o s t s u b j e c t s were aware o f t h e p r e s e n c e o f c o m p u t e r s i n the  l a b a t R.I.H..  This  f i n d i n g i s not  s u b j e c t s h a v e a c c e s s t o , and  s u r p r i s i n g , as a l l  r e f e r to the  computerized  reports i n patient charts during t h e i r c l i n i c a l The  Travenol  data  and  experience.  H o s p i t a l P a t i e n t Management S y s t e m i s e x p e c t e d  t o be p i l o t e d a t R . I . H . i n t h e records,  lab  business  admitting, payroll,  medical  d e p a r t m e n t s i n O c t o b e r , 1988.  i s presently being  entered  not  seem t o be  did  know t h a t t h e r e were p l a n s  i n t o the  system, s u b j e c t s  aware o f t h a t f a c t , h o w e v e r s e v e r a l  t o t a l p a t i e n t s y s t e m a t R.I.H Because of t h e i r present  f o r the  Although  subjects  i n s t a l l a t i o n of  sometime i n t h e  did  a  future.  l a c k of d i r e c t hands-on use  of  171 computers i n t h e h o s p i t a l ,  subjects at t h i s point i n their  c a r e e r , do n o t a p p e a r t o r e l a t e p e r s o n a l l y t o t h e u s e o f computers i n n u r s i n g .  While a l l s u b j e c t s a r e exposed t o  c o m p u t e r i z e d equipment such as i n t r a v e n o u s thermometers and m o n i t o r s ,  controllers,  during t h e i r c l i n i c a l  experience,  most do n o t a p p e a r t o r e l a t e t h i s t o c o m p u t e r u s e . they  Instead,  d i s c u s s e d computers i n r e l a t i o n t o a c t u a l t e r m i n a l s  keypads. informed  with  Perhaps t h i s i s so because s u b j e c t s have n o t been regarding various types  applications presently being  o f computers, and computer  used.  I t was i n t e r e s t i n g t o n o t e t h a t many o f t h e s u b j e c t s , p r i o r t o t h e commencement o f t h e i n t e r v i e w s , made b l a n k e t statements informing the researcher knew n o t h i n g  same s u b j e c t s , - e x p r e s s e d  express had  t h e i r views,  A f t e r t h e i n t e r v i e w , many o f thanks f o r the opportunity t o  and s e v e r a l e x p r e s s e d  s o many v i e w s t o o f f e r .  surprise that  u n a n t i c i p a t e d outcome o f t h e r e s e a r c h , t o heighten  they  One s e c o n d - y e a r s u b j e c t s a i d , " I  d i d n ' t t h i n k I knew much. You made me t h i n k . "  served  they  a b o u t c o m p u t e r s , a n d f o r h e r n o t t o e x p e c t them  t o know much i n t h e i n t e r v i e w . these  of the fact that  T h i s was an  and i n d e e d  i t probably  t h e a w a r e n e s s o f a number o f s u b j e c t s b y  drawing t h e i r a t t e n t i o n t o computer use by h o s p i t a l employed nurses. study  Several subjects expressed  an i n t e r e s t i n s e e i n g t h e  when i t was c o m p l e t e d . Even though a g e n e r a l  i n t r o d u c t i o n t o computer use i n  n u r s i n g i s p a r t o f t h e c o m p u t e r s e m i n a r s i n s e m e s t e r one, a n d  172 computer use  i s discussed i n f o r m a l l y i n the  Perspectives course, of computer use the country.  subjects i n a l l years  These f i n d i n g s a r e c o n s i s t e n t w i t h t h o s e who  R o n a l d , 1983; Most C a r i b o o  work e x p e r i e n c e  College nursing students  C a n a d i a n N u r s e p u b l i c a t i o n and,  access  to i t ,  was  particularly  do n o t  Subjects  the a r t i c l e s ,  and  due  (Webber, are subjects  aware o f  to the  had  had  happenings  f a c t t h a t most  of  books p e r t a i n i n g t o computers i n n u r s i n g  are American i n o r i g i n . i n the  a f t e r the  were v a g u e l y  i n the United States, probably  subscribe  even i f they  relevant a r t i c l e  not p u b l i s h e d u n t i l  been i n t e r v i e w e d .  of  ( H e l l e r et a l . ,  w h i c h n o t e d t h e h o s p i t a l s i n Canada w h i c h  computerized,  of  & Parkes et a l . , 1986).  t o The  one  and  studied nurses with d i f f e r e n t types  e d u c a t i o n a l b a c k g r o u n d s and  1988)  l a c k e d knowledge  by n u r s e s i n o t h e r p a r t s o f t h e p r o v i n c e ,  other researchers  1985;  Nursing  s e m e s t e r one  The  f i l m t h a t has  been used y e a r l y  s e m i n a r on c o m p u t e r a w a r e n e s s  discusses  t h e t o t a l h o s p i t a l s y s t e m a t an A m e r i c a n h o s p i t a l , E l Camino Medical Two  Center i n C a l i f o r n i a . f i r s t - y e a r s u b j e c t s r a i s e d the p o i n t of not  knowing the r o l e of the nurse. how,  and  This r a i s e s the question  when t o s e q u e n c e c o m p u t e r c o n t e n t  program.  i n the  a very  (b) do n o t  as t h e y :  l i m i t e d number o f c l i n i c a l h o u r s  c u r r e n t l y see  of  nursing  I t m i g h t be t o o e a r l y t o i n t r o d u c e s t u d e n t s  o f a t o t a l h o s p i t a l s y s t e m i n s e m e s t e r one, o n l y had  yet  (95  to  use  (a)  have  hours),  a s y s t e m i n o p e r a t i o n a t R.I.H.,  and  173 (c)  a r e j u s t b e g i n n i n g t o be s o c i a l i z e d i n t o t h e r o l e o f a  nurse.  I f a s t u d e n t i s u n s u r e o f what h i s \ h e r r o l e as a  h o s p i t a l employed  nurse w i l l  be, i t i s d i f f i c u l t  himself\herself i n that role, be used, t o a s s i s t h i m \ h e r S u b j e c t s ' knowledge h o s p i t a l employed  in  administration.  years.  o f how  computers  (a) n u r s i n g ,  may  role. be u s e d  and  Computer use f o r d o c u m e n t a t i o n  c i t e d by t h e m a j o r i t y o f s u b j e c t s i n a l l t h r e e  T h i s i s not s u r p r i s i n g because  of:  (a) t h e  t h e i r p a t i e n t s from t h e i r f i r s t  clinical  w h i l e e n r o l l e d i n t h e program.  emphasis  (b) t h e  e x p e c t a t i o n t h a t a l l s t u d e n t s document t h e c a r e t h e y  historically,  by  (b) c o m m u n i c a t i o n ,  p l a c e d on t h e i m p o r t a n c e o f d o c u m e n t a t i o n , and  last,  might  The most f r e q u e n t l y m e n t i o n e d u s e s w e r e  the area of nursing.  p u r p o s e s was  i n c a r r y i n g out t h a t  computers  nurses i n the f u t u r e , c e n t e r e d around t h r e e  b r o a d areas o f usage: (c)  a n d t o know how  t o see  give  experience, to t h e i r  Students i n a l l years,  c o m p l a i n about not h a v i n g s u f f i c i e n t t i m e t o  document t h e c a r e t h e y g i v e as s o o n as i t i s c o m p l e t e d . b o m b a r d e d by a d v e r t i s i n g i n t h e m e d i a t o u t i n g t h e of how  computers  One  o f computers  for  purposes.  s u r p r i s i n g f i n d i n g was  either first  efficiency  f o r i n f o r m a t i o n management, i t i s e a s y t o s e e  s u b j e c t s would t h i n k about t h e u t i l i t y  documentation  When  (36%) o r t h i r d  t h a t v e r y few s u b j e c t s i n  (38%) y e a r , and none i n s e c o n d  y e a r , d i s c u s s e d t h e use o f computers  as t e a c h i n g  tools.  T e a c h i n g and l e a r n i n g p r i n c i p l e s a r e t a u g h t i n t h e f i r s t  year  174 o f t h e n u r s i n g p r o g r a m , and  students  are e v a l u a t e d  clinical  rotation,  teaching  i n t o t h e i r d e l i v e r y of p a t i e n t care.  students  are not  However,  i n t r o d u c e d t o , o r e x p e c t e d t o use (C.A.I.) p a c k a g e s a t any  C o l l e g e n u r s i n g p r o g r a m , and  have d i f f i c u l t y  e n v i s i o n i n g t h e use  l e a r n i n g p a c k a g e s by  computer  p o i n t i n the  consequently  appear t o  of computer a s s i s t e d  p a t i e n t t e a c h i n g packages i n h o s p i t a l n u r s i n g . nursing students  Use  of C.A.I,  to f a c i l i t a t e  their  l e a r n i n g i n the e d u c a t i o n a l environment might i n c r e a s e a b i l i t y t o u n d e r s t a n d how t o o l by b o t h s t a f f ,  and  c o m p u t e r s may  s u b j e c t s d i s c u s s e d t h e use o n l y 36%  application. use  of the  be u s e d as a  (100%),  and  third  o f c o m p u t e r s as a  second-year subjects noted  (77%)  this  as a  1988), were j u s t c o m p l e t i n g  f i r s t Pharmacology course  source  i n w h i c h t h e y were e x p o s e d t o  G i v e n t h e volume o f i n f o r m a t i o n  a  short  first-year  a r e r e q u i r e d t o become f a m i l i a r w i t h , i t i s n o t  s u r p r i s i n g then,  t h a t a l l f i r s t - y e a r subjects noted the  o f c o m p u t e r s as a r e f e r e n c e It  the  their  t r e m e n d o u s amount o f d r u g i n f o r m a t i o n i n a r e l a t i v e l y  students  this  F i r s t - y e a r s u b j e c t s , at the time of  (March and A p r i l ,  time span.  year  discussed  f o r c o m p u t e r s d i d so i n r e l a t i o n t o i t s u s e  study  teaching  reference  M o s t s u b j e c t s , i n a l l y e a r s , who  of drug information.  their  p a t i e n t s i n the h o s p i t a l environment.  While the m a j o r i t y of f i r s t  source,  each  on t h e i r a b i l i t y t o i n c o r p o r a t e p a t i e n t  assisted instruction Cariboo  after  source,  f o r drug  i s s u r p r i s i n g t h o u g h t h a t o n l y 36%  use  information.  of the  second-year  175 s u b j e c t s n o t e d t h e use Second-year students  o f c o m p u t e r s as a r e f e r e n c e  administer  prescribed medications for  the  f i r s t time,  source.  a l a r g e number o f r e g u l a r l y  t o a group of p a t i e n t s i n the h o s p i t a l  and  are r e q u i r e d t o research  and  be  f a m i l i a r w i t h t h e s e d r u g s p r i o r t o a d m i n i s t e r i n g them. second-year students  presently:  prepared drug information uniform area, call  (a) p u r c h a s e  cards  pockets f o r easy r e f e r e n c e  while  i n the  clinical  (b) r e f e r t o d r u g t e x t s on t h e n u r s i n g u n i t / and t h e h o s p i t a l pharmacy f o r d r u g i n f o r m a t i o n  facilities perceived  absence of  (c)  i f they  second-year s u b j e c t s d i d not c o m p u t e r as a r e f e r e n c e  At the time of the working side-by-side to l e a r n the  study,  and  drug routes,  discuss  were order  of a h o s p i t a l employed  i n the program, t h e y are  responsible  l a r g e numbers o f a l l t y p e s o f d r u g s , by a l l  o r no  s u p e r v i s i o n from the  a t t h i s p o i n t , when s t u d e n t s  function independently,  route.  administer.  are expected  t h e y become a c u t e l y aware o f  tremendous r e s p o n s i b i l i t y p l a c e d  They  i n s t r u c t o r , and  f o r knowing about the drugs they  Historically,  might  i n the h o s p i t a l i n  i n c l u d i n g the d i r e c t intravenous  receive l i t t l e responsible  third-year subjects  expectations  At t h a t p o i n t  appear t o  the  source.  with preceptors  r o l e and  administering  study,  are  computer  r e l a t i v e ease of o b t a i n i n g drug i n f o r m a t i o n  of the  nurse.  The  i n the h o s p i t a l at the time of the  e x p l a i n why  for  commercially  which they c a r r y i n t h e i r  unable to obtain i t elsewhere.  use  Most  on them f o r s a f e  the  drug  to  are  176 administration.  The  t o see t h e u t i l i t y  majority of t h i r d - y e a r subjects  appeared  o f a c o m p u t e r as a t o o l f o r o b t a i n i n g d r u g  i n f o r m a t i o n , w h i c h w o u l d e n a b l e them t o p e r f o r m t h e i r safely,  and  role  efficiently.  V e r y few  s u b j e c t s d i s c u s s e d use  o f the computer  by  h o s p i t a l employed nurses f o r communication purposes. e x c e p t i o n was  the t h i r d - y e a r s u b j e c t s .  them commented on  i t s use  h o s p i t a l departments.  This i s not  p r e c e p t o r s h i p where t h e y  nurse.  Sixty-nine percent  of  as a means o f c o m m u n i c a t i o n b e t w e e n  subjects, at the time of the  transition  The  study,  s u r p r i s i n g as t h i r d - y e a r were d o i n g  their  are expected t o begin  from the r o l e of a student  Their preceptorship  clinical  t o make t h e  to that of a graduate  i n c l u d e s more t e a m l e a d i n g  functions which e n t a i l s increased r e s p o n s i b i l i t y  for  communicating w i t h other h o s p i t a l departments. A d m i n i s t r a t i v e n u r s i n g a p p l i c a t i o n s are not c o m m u n i t y c o l l e g e n u r s i n g p r o g r a m , and the  l o w numbers o f s u b j e c t s who  f a c i l i t a t e these Despite  stressed i n a  t h i s was  c i t e d use  reflected  o f a computer t o  functions.  t h e i r apparent l a c k o f computer awareness  knowledge, s u b j e c t s e n r o l l e d i n each o f the t h r e e conceptualized the  and  years  i m p a c t o f c o m p u t e r s on h o s p i t a l e m p l o y e d  nurses i n four categories: care,  in  (c) w o r k l o a d , and  (a) n u r s i n g image,  (d) p r o f e s s i o n a l i s m .  i n t e r e s t i n g t o note that a l l of these t o p i c s which h i s t o r i c a l l y  (b) p a t i e n t It is  categories relate  are d i s c u s s e d i n the  Nursing  to  177 Prespectives College  course throughout the  nursing  t o not  r e a s o n s why  of subjects,  of workload.  c a r r y an  as n u r s i n g  secondly,  larger,  and  experience, recent  Cariboo  surprising that  commented on t h e  students they are  they are  t o be  h e a v y by  college  a l s o e x p e c t e d t o c a r r y an  more c o m p l e x p a t i e n t - c a r e  the  category expected  academic workload, i n terms of  hours, which i s considered but  i t i s not  i n a l l years,  Firstly,  only  years of the  program.  T h e r e a r e two majority  three  contact  standards increasingly  load i n t h e i r  clinical  i n each s u c c e e d i n g semester of the program.  m e d i a c o v e r a g e , and  Perspectives  c o u r s e on t h e  increased  a t t e n t i o n i n the  issue of nursing  nurses l e a v i n g the p r o f e s s i o n  due  With  Nursing  shortages,  and  t o b u r n o u t b r o u g h t on  h e a v y w o r k l o a d s , i t i s s m a l l wonder t h a t t h i s  by  category  r e c e i v e d t h e most a t t e n t i o n . P a t i e n t care,  the  amount o f a t t e n t i o n by  category r e c e i v i n g the subjects,  i s the  second l a r g e s t  focus of the  clinical  component i n a l l y e a r s o f t h e p r o g r a m , a l t h o u g h more d e s k r e l a t e d t y p e s o f d u t i e s , s u c h as t e a m l e a d i n g , i n s e c o n d and  third-year.  f i r s t - y e a r subjects  I t i s i n t e r e s t i n g that  commented on p a t i e n t c a r e ,  main f o c u s of a t t e n t i o n i n the year. third  A slightly (91%)  clinical  s m a l l e r number o f t h e  year subjects  possibly reflects a shift  are  introduced 100%  which i s  component o f second  of  (91%),  commented on p a t i e n t c a r e .  the  the  first and This  i n a t t e n t i o n t o w a r d more t e a m -  l e a d i n g t y p e s o f a c t i v i t i e s as  students progress through  the  178 program. Although the majority third  (77%)  nursing  year subjects  of f i r s t  commented on t h e  noticeably  less.  related to f i r s t - y e a r subjects'  category  lack of:  issue of nursing  and  of  subjects  (a)  be  understanding  (b) a w a r e n e s s o f  o f t e n p o r t r a y e d : i n . t h e m e d i a , and  a t t e n t i o n the  (91%),  This might p o s s i b l y  r o l e of h o s p i t a l employed n u r s e s ,  nurses are the  second  image, t h e p e r c e n t a g e s o f f i r s t - y e a r  c o m m e n t i n g was  of the  (55%)  how  (c) k n o w l e d g e  of  image i s r e c e i v i n g f r o m  the p r o f e s s i o n a l a s s o c i a t i o n . A small majority 64%  s e c o n d , 62%  of subjects  third-year)  professionalism.  This  discussed  the  (64%  category  first, of  f i n d i n g supports the b e l i e f ,  many, t h a t e v e n t h o u g h t h e the  i n each year  held  s o c i a l i z a t i o n process of  adopting  c h a r a c t e r i s t i c s of a p r o f e s s i o n a l nurse begins i n  educational  s e t t i n g , i t i s o f t e n not  until  a  by  the  student  graduates t h a t he\she s t a r t s t o i d e n t i f y h i m s e l f \ h e r s e l f  as  being  of  a p r o f e s s i o n a l who  i s b o u n d by  a p r o f e s s i o n a l code  ethics. Subjects' categories  t o d i s c u s s how  (image, p a t i e n t c a r e ,  professionalism) or  choice  c o u l d be:  (c) b o t h e n h a n c e d and  s u p e r f i c i a l way  each of the  workload,  (a) e n h a n c e d ,  detracted  i n t h i s study.  The  four  and (b) d e t r a c t e d  f r o m , was  analyzed  from  in a  frequency of s u b j e c t s ,  each year,  c o m m e n t i n g on e a c h o f t h e t h r e e  tabulated.  Although t h i s unsophisticated  sub-categories quantitative  in was  179 m e a s u r e a l l o w e d f o r some c o m p a r i s o n s y e a r s , i t might have proven had  more i n t e r e s t i n g ,  and i n f o r m a t i v e  some c o r r e l a t i o n s b e e n done b e t w e e n i n d i v i d u a l s u b j e c t s '  a t t i t u d e s toward  c o m p u t e r s , and w h e t h e r t h e y f o c u s e d  d i s c u s s i o n on how from, of  t o be made b e t w e e n  or  computer use:  (a) e n h a n c e d ,  their  (b) d e t r a c t e d  (2) b o t h e n h a n c e d and d e t r a c t e d f r o m ,  each  category  a difference i n complexity  between  conception discussed.  Research  Questions  T h e r e a p p e a r s t o be  (a) and  (b)  first,  second,  and t h i r d - y e a r s u b j e c t s ' c o n c e p t i o n s o f  impact  o f c o m p u t e r s on h o s p i t a l e m p l o y e d n u r s e s .  the  This  d i f f e r e n c e a p p e a r s t o be d i r e c t l y p r o p o r t i o n a l t o t h e y e a r i n which  s u b j e c t s are e n r o l l e d i n the program.  number o f c l i n i c a l h o u r s  Because  the  i n c r e a s e s s i g n i f i c a n t l y w i t h each  a d d i t i o n a l year of the program s p e c i f i c research questions  (see C h a p t e r  (a) and  1, T a b l e  (b) w i l l be  2),  discussed  together. L e a r n i n g t h e r o l e and e x p e c t a t i o n s o f t h e n u r s e , through  a gradual s o c i a l i z a t i o n process over  Therefore, i n t u i t i v e l y ,  one  occurs  time.  w o u l d e x p e c t t h a t as  students  p r o g r e s s through the n u r s i n g program, t h e i r c o n c e p t i o n s  would  become more s o p h i s t i c a t e d in terms, o f k n o w i n g :  (a) what  their  (b) how  their  J  r o l e as a h o s p i t a l e m p l o y e d n u r s e m i g h t be, r o l e m i g h t be  impacted  and  on by a v a r i e t y o f v a r i a b l e s .  This  180 study v e r i f i e d these e x p e c t a t i o n s . succeeding impact  Subjects i n each  y e a r o f t h e program were a b l e t o c o n c e p t u a l i z e t h e  c o m p u t e r s may  higher l e v e l .  h a v e on h o s p i t a l e m p l o y e d n u r s e s  Thus t h e f i n d i n g i s c o n s i s t e n t w i t h  at a  the  c u r r i c u l u m d e s i g n of the Cariboo C o l l e g e n u r s i n g program w h i c h s e q u e n c e s n u r s i n g c o n t e n t t o be t a u g h t t h e s i m p l e and t h e n m o v i n g t o t h e  starting  complex.  E v e n t h o u g h t h e r e i s a t t e n t i o n drawn t o t h e l e a r n i n g needs o f n u r s e s 1974; al.,  W a l k e r , 1981; 1985;  Merrow, 1985;  a p p e a r t o be e i t h e r :  use  or  1983;  computer  (Anderson et a l . ,  Hannah, 1983;  & P a r k s e t a l . , 1986)  Heller  et  t h e r e does  not  (a) a c o n s e n s u s o f r e q u i r e d  competencies f o r nurses use,  i n the l i t e r a t u r e ,  Ronald,  from  w i t h r e g a r d t o computer knowledge  (b) a w i d e l y a c c e p t e d  and  approach f o r t e a c h i n g nurses  to  computers. P r e s e n t l y , t h e r e a r e no  norms o f what i s e x p e c t e d knowledge o r use d i r e c t i o n has  i n terms of the l e v e l  f o r nurses.  of computer  T h i s l a c k o f a more g l o b a l  served to focus the i d e n t i f i c a t i o n  l e a r n i n g needs a t t h e l o c a l provincial,  s t a t e d p r o v i n c i a l or n a t i o n a l  level.  The  of computer  i s s u e of l a c k of  and n a t i o n a l norms i s a c o n c e r n  to educators  f e e l t h a t s t u d e n t s , upon g r a d u a t i o n , s h o u l d be p r e p a r e d  who to  work n o t o n l y i n l o c a l h o s p i t a l f a c i l i t i e s b u t a l s o i n o t h e r h o s p i t a l s across the The  country;.  M i n i s t r y Of A d v a n c e d E d u c a t i o n And  B r i t i s h Columbia, i s moving a l i t t l e  Job T r a i n i n g i n  c l o s e r t o some  181 s t a n d a r d i z a t i o n o f p r o g r a m m i n g by Nursing  s u p p o r t i n g t h e Computers  P r o j e c t / and by m a k i n g t h r e e  In  l e a r n i n g modules  a v a i l a b l e f r e e of charge t o a l l n u r s i n g programs i n B r i t i s h Columbia.  This again,  s i m i l a r t o those authors 1983;  i s a "what t o " and  described i n the  (Edmunds/ 1982;  Skiba,  & Ronald & Skiba,  1987).  a "how  l i t e r a t u r e by  1983;  reasons.  Firstly,  incorporated  and  n u r s i n g programs, i n B r i t i s h Columbia, Unless  use  an a t t e m p t i s made  existing  i n someone's o f f i c e .  the modules are designed  frameworks, they  t o be  Secondly, even though  a d a p t e d by  individual  programs  f i t t h e i r p a r t i c u l a r l o c a l needs, t h e r e i s a danger t h a t  without  follow-up,  these  adaptations  will  n o t be  T h i r d l y , t h i s p a c k a g e d a p p r o a c h assumes t h a t t h e l e a r n i n g needs of a l l s t u d e n t s be  1988.  them, t h e m o d u l e s a r e doomed t o s i t on a s h e l f  c o l l e c t i n g dust  to  September,  f o l l o w - u p t o i n d i v i d u a l p r o g r a m s as  attempt t o use  into  i n t h i s a p p r o a c h f o r a number o f  i n c o r p o r a t e t h e modules, i n t o t h e s e to provide  their  i n t e n t o f t h e m o d u l e s i s commendable,  a v a r i e t y of c u r r i c u l a frameworks. to  Hannah,  These modules, w i t h  e x i s t i n g n u r s i n g p r o g r a m s i n t h e p r o v i n c e by  problems are inherent  a number o f  R o n a l d , 1983;  s t a t e d o b j e c t i v e s , a r e e x p e c t e d t o be  Even though the  t o " approach  a fallacy,  same.  a l o n g w i t h t h e n o t i o n t h a t one  work f o r a l l ( S k i b a , The  are the  made. computer  T h i s we approach  know t o will  1982).  dimension missing  i n t h i s t h r u s t , and  approaches c h r o n i c l e d i n n u r s i n g l i t e r a t u r e ,  in  other  i s how  to  182 e v a l u a t e l e a r n i n g which t a k e s p l a c e as a r e s u l t o f such efforts. it has  W i t h no a g r e e d  upon c r i t e r i o n o f a d e q u a c y  i s d i f f i c u l t t o evaluate i f t h e expected occurred.  This study demonstrates  existing,  level of learning  that the quality of  c o n c e p t i o n s d i f f e r s between s t u d e n t s e n r o l l e d i n d i f f e r e n t y e a r s o f a community c o l l e g e n u r s i n g program.  By s u b s c r i b i n g  t o t h e n o t i o n t h a t l e a r n i n g i s a change i n c o n c e p t i o n (Dahlgren,  1978),  one must t h e n a s k two q u e s t i o n s :  How c a n  l e a r n i n g be m e a s u r e d ? , a n d how c a n t h e q u a l i t y o f l e a r n i n g b e changed?  W i t h i n t h e c o n t e x t o f n u r s i n g programs i n B r i t i s h  Columbia,  n o t o n l y must a t t e n t i o n b e p l a c e d on t h e c u r r i c u l a r  content  (modules) b u t a l s o on how c u r r i c u l a c a n be  operationalized t o allow f o r the i n c l u s i o n of these i n a way w h i c h w i l l e n h a n c e t h e q u a l i t y o f s t u d e n t One  approach  modules learning.  t h a t c a n be u s e d t o o p e r a t i o n a l i z e  c u r r i c u l a r g o a l s i s t o u s e a taxonomy l i k e t h e SOLO Taxonomy of Biggs and C o l l i s  (1982) .  SOLO, o r a s i m i l a r t a x o n o m y , may  be u s e d t o s p e c i f y a c c e p t a b l e o r u n a c c e p t a b l e  levels of  performance w i t h r e g a r d t o n u r s e s ' knowledge o f , and use o f computers i n each semester,  a n d y e a r o f community c o l l e g e  n u r s i n g programs.  When a t t e m p t i n g t o s e q u e n c e c o m p u t e r  content f o r nurses  i n t h e c u r r i c u l a o f n u r s i n g programs, i t  w o u l d seem l o g i c a l t o b u i l d on e x i s t i n g k n o w l e d g e b y a t t e m p t i n g t o u s e a t e s t e d t a x o n o m y , s u c h a s t h e SOLO taxonomy. Although  t h i s study f o r m a l l y grouped s u b j e c t s ' conceptions  183 i n t o two  l e v e l s of complexity:  intuitively  obvious  t o low e x i s t e d .  h i g h , and  low,  t h a t i n f a c t a range of l e v e l s ,  The  SOLO t a x o n o m y i d e n t i f i e s  l e a r n i n g outcomes w h i c h r e p r e s e n t a s h i f t conception  from low t o h i g h .  c u r r i c u l a r content be  i t was from h i g h  five levels  i n complexity  Because the sequencing  of  of  of  from t h e s i m p l e t o the complex appears t o  i n h e r e n t i n t h e c u r r i c u l a o f most n u r s i n g p r o g r a m s , u s e  a taxonomy o f l e a r n i n g outcomes t o f a c i l i t a t e computer c o n t e n t  seems t o be  long  of  sequencing  overdue.  Hands-on e x p e r i e n c e t o i n c r e a s e s t u d e n t s ' c o m f o r t  levels  u s i n g a c o m p u t e r , as w e l l as t h e o r e t i c a l d i s c u s s i o n s a b o u t the impact use  o f computer use  on n u r s e s  c a n be  sequenced  o f a taxonomy, w h i c h i s aimed a t c h a n g i n g  of conception.  students'  I t appears t h a t u n l e s s a student  i n a p a r t i c u l a r area, h i g h l e v e l responses  expected.  This i s supported  i n d i v i d u a l s who computer use T h i s two  level  has  experience  by M e r r o w ' s  through  are  (1985) f i n d i n g  not  that  were r a t e d as m i n i m a l l y k n o w l e d g e a b l e a b o u t  i n n u r s i n g p r a c t i s e had  never used a computer.  pronged approach s h o u l d s e r v e t o i n c r e a s e computer  a w a r e n e s s and k n o w l e d g e w h i c h s h o u l d s e r v e t o i n c r e a s e t h e complexity of students' conceptions h o s p i t a l employed Use for:  of computer use  by  nurses.  o f a taxonomy o f l e a r n i n g o u t c o m e s t h e n , w o u l d a l l o w  (a) t h e o r g a n i z a t i o n o f l e a r n i n g c o m p o n e n t s i n t o  h i e r a r c h y o f l e v e l s o f i n c r e a s e d a b s t r a c t i o n , (b)  a  systematic  o r d e r i n g o f c o m p o n e n t s i n t h e a p p r o p r i a t e o r d e r , and  (c)  the  184 e v a l u a t i o n o f t h e success The  of the t o t a l  i n c l u s i o n o f computer c o n t e n t  community c o l l e g e programs elsewhere,  instructional  episode.  i n nursing curricula i n  i n B r i t i s h Columbia, and  c o u l d t h e r e f o r e be a c h i e v e d  U l t i m a t e l y , t h e c u r r i c u l u m framework  i n a logical fashion.  of individual  programs  would s e r v e as t h e b l u e p r i n t f o r i n c o r p o r a t i n g computer content  w h i c h i s o r g a n i z e d a c c o r d i n g t o a taxonomy.  The q u e s t i o n o f how t h e q u a l i t y o f s t u d e n t s ' l e a r n i n g can be changed a d d r e s s e s  t h e n o t i o n o f moving  students  from a  c e r t a i n l e v e l o f l e a r n i n g t o one w h i c h i s q u a l i t a t i v e l y higher.  S e v e r a l p o s s i b l e ways t o move s t u d e n t s  l e v e l o f c o n c e p t i o n t o a h i g h e r one a r e :  from a low  (a) i n c r e a s e  awareness about t h e use o f computers b o t h w i t h i n , t h e i r immediate environment, of conception  their  and o u t s i d e  (b) d i s c u s s t h e f o u r c a t e g o r i e s  i n t e r m s o f how e a c h may be e n h a n c e d a n d  d e t r a c t e d f r o m , a n d (c) t e a c h a b o u t n o n - k e y b o a r d  operated  computer a p p l i c a t i o n s which a r e b e i n g used i n h o s p i t a l s .  An  e f f o r t must b e made t o b r o a d e n t h e c o n t e x t o f c o m p u t e r u s e s o t h a t s t u d e n t s do n o t become t o o s e t i n t h e i r own s m a l l n u r s i n g world, but r a t h e r a r e able t o r e l a t e happenings i n their field  t o the world at large.  By d o i n g t h i s ,  open t h e d o o r f o r c r o s s - f e r t i l i z a t i o n d i s c i p l i n e s which i n i t s e l f  educators  o f i d e a s among  enhances q u a l i t y o f c o n c e p t i o n .  185 Research  Q u e s t i o n (c)  The m a j o r i t y o f s u b j e c t s i n t h i s s t u d y h a d a p o s i t i v e a t t i t u d e toward computer use i n h o s p i t a l n u r s i n g . congruent of  with the trends indicated i n the nursing l i t e r a t u r e  n u r s e s b e c o m i n g more p o s i t i v e  1985).  This i s  ( R o n a l d , 1983 & Merrow,  T h i s s t u d y f o u n d t h a t s u b j e c t s r a t e d as h a v i n g  n e g a t i v e a t t i t u d e s t o w a r d c o m p u t e r u s e by h o s p i t a l n u r s e s were:  (a) a l l f e m a l e , a n d  employed  (b) e n r o l l e d i n f i r s t ,  and  second-year. It  was n o t s u r p r i s i n g t h a t t h e s u b j e c t s w i t h n e g a t i v e  a t t i t u d e s t o w a r d c o m p u t e r u s e by h o s p i t a l e m p l o y e d n u r s e s were f e m a l e , g i v e n t h e a t t e n t i o n p a i d by some a u t h o r s i n t h e l i t e r a t u r e t o t h e n o t i o n o f women h a v i n g a n e g a t i v e "mind set"  toward technology  (Menzies, 1982).  I t i s essential to  p o i n t out though,  t h a t t h e s m a l l sample s i z e o f male  in  h a v e skewed t h e f i n d i n g s .  t h i s s t u d y may  nurses  Previous  e x p e r i e n c e h a s b e e n f o u n d b y some ( H o u l e , 1980 a n d Chang, 1984) t o a f f e c t a t t i t u d e .  Comments, t a k e n f r o m t h e  t r a n s c r i p t s of the subjects i n t h i s study w i t h negative attitudes  (see C h a p t e r  4), lend support t o t h i s  notion.  However, i t was s u r p r i s i n g t h a t t h i r d - y e a r s u b j e c t s w e r e more p o s i t i v e t h a n b o t h f i r s t Based  and second-year  on a r e v i e w o f t h e l i t e r a t u r e ,  i t was f e l t ,  o u t s e t , t h a t t h i r d - y e a r s u b j e c t s might a t t i t u d e s toward computer use.  subjects. at the  h a v e more n e g a t i v e  More a t t e n t i o n seems t o be  186 f o c u s e d on c o m p u t e r s u s e now, work s e t t i n g ,  i n the e d u c a t i o n a l environment,  and m e d i a , t h a n t h r e e y e a r s  e n t e r e d the n u r s i n g program.  The  ago  when t h a t g r o u p  positive attitudes  of  t h i r d - y e a r s u b j e c t s m i g h t be e x p l a i n e d by t h e f a c t t h a t  they  now  a  h a v e more o f an u n d e r s t a n d i n g  nurse  i s , a r e more c o m f o r t a b l e  a p p e a r t o be may  w i t h i t , and  consequently,  a b l e t o see t h e p o s i t i v e e f f e c t s t h a t c o m p u t e r s  h a v e on them as h o s p i t a l One  o f what t h e i r r o l e as  employed  nurses.  o f t h e most s i g n i f i c a n t r e s u l t s o f t h i s s t u d y i s t h e  f i n d i n g t h a t t h e r e i s a r e l a t i o n s h i p between s u b j e c t s ' attitudes  toward  computer use.by h o s p i t a l  and t h e c o m p l e x i t y o f t h e i r c o n c e p t i o n s . were a b l e t o t h i n k c o m p l e x l y hospital who  nurses,  A l l subjects  about the impact  who  of computers  had p o s i t i v e a t t i t u d e s .  c o n c e p t u a l i z e d about such t h i n g s at a lower  divided all  employed nurses,  employed  Subjects  l e v e l were  i n terms of both p o s i t i v e or n e g a t i v e a t t i t u d e s ;  s i x subjects with a negative attitude  had  on  yet,  low l e v e l s  of  conception. In l o o k i n g at the t r a n s c r i p t s  of the s i x negative  s u b j e c t s w i t h low l e v e l c o n c e p t i o n s , their attitude  back t o the f a c t t h a t they  i n any  depth.  " d i d not  t o move b e y o n d t h a t p o i n t .  s u b j e c t s who  had p o s i t i v e a t t i t u d e  c o n c e p t i o n , may  obvious  that  seemed t o " b l o c k " them f r o m b e i n g a b l e t o  discuss t h e i r conceptions  unable  i t was  They k e p t  coming  l i k e c o m p u t e r s , " and  were  On t h e o t h e r h a n d , and  low l e v e l s  of  not have been a b l e t o a r t i c u l a t e t h e i r  ideas  187 o r may two  have been p r e o c c u p i e d  as i n d i c a t e d by t h e e x a m p l e s  subjects discussed i n Chapter  D i s c u s s i o n Of  4.  Secondary  Secondary f i n d i n g s i n t h i s study demographics/  and  computer usage.  The  Findings  were r e p o r t e d more  on  significant  f i n d i n g s , under each h e a d i n g , are s i n g l e d out i n the  of  and  discussed  f o l l o w i n g paragraphs.  Demographics  T h i s sample d i f f e r e d from t h a t of o t h e r i n the nursing l i t e r a t u r e .  The  studies  subjects i n t h i s study  e n r o l l e d i n a C a n a d i a n community c o l l e g e n u r s i n g whereas o t h e r  s t u d i e s , with the exception  h a v e b e e n A m e r i c a n and u n i v e r s i t y programs Parks  were  program  o f Hannah  (1983),  dealt with subjects enrolled i n  (Walker,  1981;  H e l l e r e t a l . , 1985;  &  et a l . , 1986). The  m a j o r i t y o f s u b j e c t s who  were between t h e ages o f e i g h t e e n  participated in this and  twenty-four,  by t h e g r o u p r a n g i n g b e t w e e n a g e s t w e n t y - f i v e and nine.  reported  Inman  followed twenty-  (1983) n o t e d t h a t e x p e r t s h a v e f o u n d t h a t  individuals in their mid-thirties, q u i c k l y t o the computer w h i l e those l i k e l y t o be  study  intimidated.  and  younger, tend t o  fifty  K r a m p f and  and  Robinson  adapt  o v e r a r e more (1984)  found  188 t h a t most o l d e r a d u l t s do n o t computer.  This study  displayed a negative t h e age  found t h a t of the  s i x subjects  range of e i g h t e e n t o twenty-four,  (1983) r e p o r t i n g .  (between a g e s t h i r t y  The  who  and  and  one  was  between  This i s contradictory to  A l l seven of the o l d e r fifty-nine)  toward computers which supports Robinson  the  a t t i t u d e t o w a r d c o m p u t e r s , f i v e were i n  t w e n t y - f i v e and t w e n t y - n i n e . Inman's  a p p e a r t o be t h r e a t e n e d by  subjects  had p o s i t i v e  attitudes  t h e f i n d i n g s o f Krampf  and  (1984). nursing f a c u l t y at Cariboo  t h a t t h e t r e n d a p p e a r s t o be  College i n t u i t i v e l y  f o r students  feel  t o t a k e some s o r t  of f o r m a l e d u c a t i o n p r i o r t o e n t e r i n g the n u r s i n g program. The  f i n d i n g s i n t h i s study  a s s u m p t i o n one students literate.  lend support  This study  hands-on computer e x p e r i e n c e  o n l y 34% h a d  are  computer  found t h a t while the m a j o r i t y  t h e n u r s i n g p r o g r a m , 40% h a d  no  formal computing  The  n u r s i n g f a c u l t y must be  s t u d e n t s have developed general  (based  positive.  If this students  appears t o  aware t h a t  an a t t i t u d e t o w a r d c o m p u t e r s i n  on t h e i r p r e v i o u s e x p e r i e n c e ) , p r i o r  e n t e r i n g t h e n u r s i n g p r o g r a m , and be  experience,  t h e common a s s u m p t i o n t h e n t h a t  coming out of h i g h s c h o o l are computer l i t e r a t e , questionable.  of  prior to entering  exposure i n the s c h o o l system.  sample i s t y p i c a l ,  be  The  often hears i n casual conversation i s that  coming out of h i g h s c h o o l today  s u b j e c t s had  and  to this belief.  t h i s must n o t be  to assumed t o  189 Subjects' content  v e r b a l i z a t i o n of wanting increased  i n the n u r s i n g program r e f l e c t s s o c i e t a l t r e n d s ,  p o s s i b l y t h e i r p e r c e p t i o n t h a t they w i l l to  computer  need t h i s  and  knowledge  p e r f o r m t h e i r r o l e as h o s p i t a l e m p l o y e d n u r s e s i n t h e  future.  Findings that subjects p r e f e r a v a r i e t y of  approaches, i f faced w i t h having  t o l e a r n t o use  learning  computers,  are c o n s i s t e n t w i t h the c h a r a c t e r i s t i c s of adult l e a r n e r s t h e p r i n c i p l e s o f t e a c h i n g and adult education  l e a r n i n g documented i n t h e  literature.  C o m p u t e r A c c e s s And  Usage  Even t h o u g h a l l s u b j e c t s have a c c e s s C o l l e g e c o m p u t e r s y s t e m , few vital  f o r n u r s i n g f a c u l t y who  planning  f o r the  i n t o the Cariboo  t o the  are u s i n g i t .  Cariboo  This discovery  are charged w i t h  is  curriculum  i n t e g r a t i o n o f t h e B.C.I.T. l e a r n i n g m o d u l e s C o l l e g e n u r s i n g program i n September  Faculty's expectations and  and  regarding  student  use  of  1988.  computers,  t h e i r r e l a t i v e comfort w i t h computers i n e d u c a t i o n a l  s e t t i n g s must be  c a r e f u l l y examined.  c o m p u t e r s a r e t o become a n o t h e r t o o l , comfortable  I f i t i s believed that w h i c h n u r s e s must  with i n order to p r a c t i s e nursing, f e l t  i d e n t i f i e d by  s u b j e c t s p r e v e n t i n g t h e i r use  t h e e d u c a t i o n a l s e t t i n g s h o u l d be i n c r e a s e d use  hospital  s e t t i n g s , becoming a r e a l i t y ,  barriers  of computers i n  examined, not  With the  be  ignored.  o f c o m p u t e r s by n u r s e s e m p l o y e d i n i t i s up t o  educators  190 to provide  students  w i t h o p p o r t u n i t i e s t o use  computers i n  t h e e d u c a t i o n a l s e t t i n g so t h a t t h e y w i l l be b e t t e r a b l e t r a n s f e r t h a t knowledge t o the h o s p i t a l  G e n e r a l i z a b i l i t y Of  to  setting.  Findings  In c o n s i d e r i n g the g e n e r a l i z a b i l i t y of the r e s u l t s t h i s r e s e a r c h , s e v e r a l p o i n t s must, be  considered.  of  The  s u b j e c t s u s e d i n t h i s r e s e a r c h were a l l e n r o l l e d i n a community c o l l e g e d i p l o m a s e l f - s e l e c t e d sample.  n u r s i n g p r o g r a m , and  Community c o l l e g e d i p l o m a  programs, i n B r i t i s h Columbia, d i f f e r not c o n t e x t , and p r a c t i c u m e x p e r i e n c e e m p h a s i s on c o m p u t e r c o n t e n t all  of these  but  nursing  only i n length,  a l s o i n terms of  in their curricula.  community c o l l e g e d i p l o m a  must meet t h e a p p r o v a l  as s u c h w e r e a  However,  n u r s i n g programs:  c r i t e r i a of the Program  (b) a r e c h a r g e d w i t h e d u c a t i n g  p r a c t i t i o n e r s who This study the  meet a minimum s t a n d a r d  focused  on one  data c o l l e c t e d ,  and  beginning practice.  p a r t i c u l a r s e t t i n g w h i c h means  and  This  researcher  comprehensiveness of  i s e s p e c i a l l y i n t e r e s t e d i n the  b e t w e e n what i s r e c o r d e d Cariboo  British  for safe  f i n d i n g s are grounded i n t h a t s e t t i n g .  i s i n t e r e s t e d i n the accuracy  (a)  Approvals  Committee o f t h e R e g i s t e r e d Nurses A s s o c i a t i o n of C o l u m b i a , and  the  and what was  College nursing students  the  "fit"  actually occurring with  at the time  of the  study.  However, i t i s t h e r e s e a r c h e r ' s b e l i e f t h a t community  191 c o l l e g e s i n B r i t i s h C o l u m b i a s h a r e more s i m i l a r i t i e s , t h a n differences,  i n t h a t a l l are p r e p a r i n g  practitioners. may  Therefore,  be p o s s i b l e .  at these  I t i s now  beginning  generalizability  of these  results  up t o o t h e r r e s e a r c h e r s t o  f i n d i n g s i n l i g h t of the p e c u l i a r i t i e s  look  of t h e i r  own  community c o l l e g e n u r s i n g programs. As  already noted,  the primary  f i n d i n g s of t h i s  study  have i m p l i c a t i o n s f o r a l l community c o l l e g e n u r s i n g programs. In a d d i t i o n , the primary findings, may  be  findings,  ( s p e c i f i c t o the Cariboo  a c t e d on l o c a l l y t o a f f e c t  r e s e a r c h b a s e d on t h e s t u d e n t s '  coupled  change w h i c h i s grounded i n  perspective.  There are s e v e r a l l i m i t a t i o n s  Study  of t h i s  become e v i d e n t as t h e s t u d y u n f o l d e d . i s t h a t i t i s weak on c r o s s - c o m p a r i s o n s attempts  major  between  limitation institutions.  focused  on one  institution  and  only  1987) .  A second l i m i t a t i o n of data c o l l e c t i o n . fact  The  study t h a t have  were made t o make c o m p a r i s o n s w i t h i n  between y e a r s , the study (Strauss,  secondary  C o l l e g e n u r s i n g program)  L i m i t a t i o n s Of The  Although  with the  t h a t i t was  i s i n h e r e n t i n t h e i n t e r v i e w method  A couple  o f s u b j e c t s commented on  d i f f i c u l t t o " t h i n k on t h e s p o t . "  the presence of a tape  r e c o r d e r d i d not  the subjects nervous, probably  the  However,  a p p e a r to_make any  b e c a u s e s u b j e c t s were  of  familiar  192 with u s i n g both audio and video equipment throughout  the  n u r s i n g program. The t i m i n g of the i n t e r v i e w s might have been d e t r i m e n t a l t o the q u a l i t y of responses. and A p r i l may  1988,  Interviews were h e l d i n March  T h i s time p e r i o d was  not i d e a l as s u b j e c t s  have been p r e o c c u p i e d with f i n a l examinations  scheduled e a r l y i n A p r i l .  Two  which were  subjects i n p a r t i c u l a r ,  appeared t o be p r e - o c c u p i e d d u r i n g the i n t e r v i e w s : recent news of her f a t h e r ' s i l l n e s s ,  one  by  and the other with a job  interview. A f i n a l l i m i t a t i o n was i n her f i r s t  a p e r s o n a l one f o r the r e s e a r c h e r  attempt t o do q u a l i t a t i v e r e s e a r c h .  At  times  the volume of i n f o r m a t i o n obtained d u r i n g the i n t e r v i e w s , and generated by the formative and summative data a n a l y s i s , overwhelming.  was  In p a r t i c u l a r , the volume of data generated  the forced-response questions on the respondent s e c t i o n of the i n t e r v i e w schedule  by  profile  (although of b e n e f i t i n  understanding the sample) tended t o c h a l l e n g e the r e s e a r c h e r t o remain focused on the r e s e a r c h q u e s t i o n s .  193 Recommendations General  Recommendations  A number o f r e c o m m e n d a t i o n s a r e o f f e r e d f o r c o n s i d e r a t i o n by c o m m u n i t y c o l l e g e n u r s i n g p r o g r a m s :  (1) E f f o r t  s h o u l d be p l a c e d on p r o v i d i n g f a c t u a l i n f o r m a t i o n  on c u r r e n t h a p p e n i n g s w i t h r e g a r d t o c o m p u t e r u s e  in  n u r s i n g , t o s t u d e n t s e n r o l l e d i n community c o l l e g e n u r s i n g programs.  The  intended purpose of  this  recommendation i s t o h e i g h t e n student n u r s e s ' and a w a r e n e s s o f l o c a l , p r o v i n c i a l , (2) C o m p a r a t i v e  r e s e a r c h n e e d s t o be  knowledge  and n a t i o n a l t r e n d s .  done:  a. I n h o s p i t a l s , b o t h b e f o r e and a f t e r c o m p u t e r s a c t u a l l y u s e d by n u r s e s , t o d e t e r m i n e  the q u a l i t y  n u r s e s ' c o n c e p t i o n s and t h e i r a t t i t u d e s computer use. develop  are of  about  T h i s d a t a c o u l d t h e n be u s e d t o  and e v a l u a t e c o m p u t e r l e a r n i n g  experiences  with the intent of f o s t e r i n g p o s i t i v e a t t i t u d e s  and  high l e v e l s of conception. b. To d e t e r m i n e  i f t h e c o n c e p t i o n s and a t t i t u d e s  of  s t u d e n t s e n r o l l e d i n o t h e r community c o l l e g e n u r s i n g programs, both w i t h i n ,  and o u t s i d e t h i s p r o v i n c e ,  are s i m i l a r t o those of students at Cariboo C o l l e g e . c. To d e t e r m i n e  i f student nurses' conceptions of  a t t i t u d e s toward  c o m p u t e r u s e by h o s p i t a l  and  employed  . nurses d i f f e r  194  from those of nurses already  employed i n Canadian h o s p i t a l s . (3) F u r t h e r work n e e d s t o be done t o e i t h e r d e v e l o p , o r a d a p t t h e u s e o f an e x i s t i n g taxonomy w h i c h may  be u s e d i n community  of learning  outcomes  college nursing  programs  t o f a c i l i t a t e t h e s e q u e n c i n g and e v a l u a t i o n o f t h e q u a l i t y o f s t u d e n t s ' l e a r n i n g about computers. (4) A t t e n t i o n n e e d s t o be f o c u s e d p r o v i n c i a l l y ,  and  n a t i o n a l l y on d e t e r m i n i n g d e s i r e d l e v e l s o f c o n c e p t i o n o f computer use f o r s t u d e n t s e n r o l l e d i n each y e a r o f n u r s i n g p r o g r a m s , a n d a l s o a t t e n t i o n n e e d s t o be  focused  on t h e l e v e l o f c o m p u t e r c o m p e t e n c y e x p e c t e d a t t h e c o m p l e t i o n o f community  c o l l e g e n u r s i n g programs.  (5) R e s e a r c h i s n e e d e d t o d e t e r m i n e t e a c h i n g t e c h n i q u e s t o f a c i l i t a t e moving s t u d e n t s ' c o n c e p t i o n s o f computer use f r o m one l e v e l t o a n o t h e r w h i c h i s q u a l i t a t i v e l y distinct.  Local  Recommendations  A number o f r e c o m m e n d a t i o n s a r e o f f e r e d f o r c o n s i d e r a t i o n by t h e C a r i b o o C o l l e g e n u r s i n g  program:  (1) F a c u l t y s h o u l d s t r i v e t o i n t e g r a t e more c o m p u t e r a w a r e n e s s c o n t e n t t h r o u g h o u t t h e n u r s i n g p r o g r a m i n an attempt t o decrease the mystique of computers.  195 (2) The f a c u l t y n e e d s t o b u i l d e x p e c t a t i o n s curriculum that students as p r o d u c i n g  into the nursing  use a computer f o r such t h i n g s  papers o r weekly anecdotal  notes i n order t o  increase t h e i r comfort l e v e l with using (3) The n u r s i n g d e p a r t m e n t . s h o u l d l o b b y a d m i n i s t r a t i o n more a s s e r t i v e l y and  availability  computers.  college  f o r greater  accessability  o f computer t e r m i n a l s f o r use by n u r s i n g  students. (4) The c u r r i c u l u m c o m m i t t e e s h o u l d c o - o r d i n a t e of computer content  the inclusion  throughout t h e n u r s i n g program by  u s i n g a taxonomy w h i c h would a l l o w f o r t h e q u a l i t y o f learning  t o be  evaluated.  (5) F a c u l t y s h o u l d  s t r i v e t o i n c o r p o r a t e t h e use o f n u r s i n g  C.A.I, l e a r n i n g  p a c k a g e s as a method o f i n s t r u c t i o n  (where a p p l i c a b l e ) i n o r d e r  f o r students  t h i s computer a p p l i c a t i o n .  One i n t e n t  that students learning  to  experience  i n doing  this i s  who u s e d c o m p u t e r s t o f a c i l i t a t e t h e i r  own  m i g h t be more a b l e t o , i d e n t i f y w i t h t h e c o m p u t e r  as a v a l u a b l e t e a c h i n g t o o l f o r u s e i n t h e h o s p i t a l . (6) An a t t e m p t s h o u l d be made t o a s c e r t a i n attitudes  t o w a r d computers by u s i n g a t o o l t o  measure a t t i t u d e Brodt  (1985) .  l i k e t h e one d e v e l o p e d b y S t r o n g e a n d  T h i s c o u l d be done on e n t r y i n t o t h e  program so t h a t f a c u l t y negative  students'  students  could develop strategies  become more p o s i t i v e .  t o help  196 S i g n i f i c a n c e Of  Research  R e s u l t s o f t h i s study w i l l p r o v i d e guidance faculty  i n community c o l l e g e s ,  nationally,  locally,  f o r nursing  p r o v i n c i a l l y and  who a r e r e s p o n s i b l e f o r i m p l e m e n t i n g  content into nursing c u r r i c u l a . valuable f o rhospital  The r e s u l t s  computer  will  a l s o be  i n - s e r v i c e c o - o r d i n a t o r s , who a r e  r e s p o n s i b l e f o r p l a n n i n g computer e d u c a t i o n programs f o r n u r s e s who h a v e g r a d u a t e d programs. faculty  from community c o l l e g e n u r s i n g  They w i l l be o f i m m e d i a t e b e n e f i t t o n u r s i n g  in  B r i t i s h C o l u m b i a who a r e e x p e c t e d t o i m p l e m e n t  the t h r e e modules developed  as a r e s u l t  NURSING PROJECT i n t o t h e i r : c u r r i c u l a  o f t h e COMPUTERS I N  i n September, 1988.  T h i s s t u d y was b a s e d on t h e p r e m i s e  that learning i s a  change i n c o n c e p t i o n , and t h a t t h e r e i s a q u a l i t a t i v e  shift  f r o m one c o n c e p t i o n t o a n o t h e r when l e a r n i n g h a s o c c u r r e d (Dahlgren,  1978).  Students  e n t e r community c o l l e g e n u r s i n g  programs w i t h e s t a b l i s h e d c o n c e p t i o n s o f computers and computer use by n u r s e s .  I t a p p e a r s l o g i c a l t h e n , t h a t upon  e n t r a n c e t o a community c o l l e g e n u r s i n g p r o g r a m , s h o u l d be made t o i d e n t i f y a n d a s s e s s s t u d e n t s ' of  computer use so t h a t c u r r i c u l a  attempts conceptions  d e c i s i o n s may be made.  This study found t h a t t h e complexity o f students c o n c e p t i o n s was d i r e c t l y p r o p o r t i o n a l t o t h e i r year program, and t o t h e l e n g t h o f t h e i r c l i n i c a l This finding  i nthe  experience.  p r o v i d e s evidence t h a t computer content i n  197 c o m m u n i t y c o l l e g e n u r s i n g c u r r i c u l a s h o u l d be move f r o m more s i m p l e c o n c e p t s c l i n i c a l hours  are r e l a t i v e l y  sequenced t o  e a r l y i n t h e p r o g r a m , when t h e low,  and  students are  just  b e i n g i n t r o d u c e d t o t h e r o l e o f a n u r s e , t o more c o m p l e x concepts  l a t e r i n t h e p r o g r a m , when t h e c l i n i c a l h o u r s  g r e a t e r , and  s t u d e n t s a r e more aware o f t h e i r r o l e as  This study a l s o found t h a t t h e r e i s a  are nurses.  relationship  between the q u a l i t y o f s t u d e n t s ' c o n c e p t i o n s o f t h e impact c o m p u t e r s on h o s p i t a l e m p l o y e d n u r s e s toward of  computers.  students'  attitudes  I t appears t h a t students w i t h h i g h  conception toward  attitudes.  and  computer, u s e  B a s e d on t h i s  finding,  levels  a l s o have p o s i t i v e attempts  must be made t o  f o s t e r p o s i t i v e a t t i t u d e s i n nursing students, i f the of  of  intent  n u r s i n g programs i s t o f a c i l i t a t e the development of h i g h  l e v e l c o n c e p t i o n s among i t s ' The  students.  f i n d i n g s o f t h i s s t u d y a r e s p e c i f i c t o one  ( C a r i b o o C o l l e g e ) and t i m e informatics  (1988) .  (NI) r e s e a r c h p y r a m i d  setting  By u s i n g t h e n u r s i n g ( S c h w i r i a n , 1986),  at  the  outset, to i d e n t i f y research questions, t h i s study  has  c o n t r i b u t e d t o our p r e s e n t knowledge about s t u d e n t  nurses  c o n c e p t i o n s o f , and hospitals.  a t t i t u d e s toward  computer use  in  However, c h a n g e i s i n e v i t a b l e and t h e r e f o r e t h e  s e a r c h must c o n t i n u e f o r a d e e p e r u n d e r s t a n d i n g nurses' c o n c e p t i o n s of the impact  of  student  computers are p r e s e n t l y  h a v i n g and w i l l c o n t i n u e t o h a v e on them as h o s p i t a l nurses.  employed  198 Given t h e emphasis today p r a c t i c e and e d u c a t i o n , t h i s  f o r research-based study w i l l  provide  nursing guidance,  f r o m t h e s t u d e n t s ' p e r s p e c t i v e , as t o w h e r e t h e f o c u s o f e d u c a t i o n a l p r o g r a m s must l i e a n d w i l l provide both develop  stimulate educators t o  sides of t h e issues t o enable  students t o  more c o m p l e x ways o f v i e w i n g c o m p u t e r u s e i n t h e i r  work w o r l d .  Because t h i s  study  i s t h e o n l y one o f i t s k i n d  known t o t h e r e s e a r c h e r , t h e q u a l i t a t i v e d a t a g e n e r a t e d  will  s e r v e as a f o u n d a t i o n f o r o t h e r s t u d i e s .  Conclusion  As  computer t e c h n o l o g y  country, nurse  educators  moves i n t o h o s p i t a l s ,  are expected  t o prepare  across  this  students t o  i n c o r p o r a t e i t s use i n t o t h e i r n u r s i n g p r a c t i c e .  With the  C a n a d i a n N u r s e s A s s o c i a t i o n (C.N.A.) s t a n d on e n t r y t o p r a c t i s e t h a t , b y t h e y e a r 2000 b e g i n n i n g n u r s e s  will  require  a b a c c a l a u r e a t e degree t o e n t e r t h e n u r s i n g p r o f e s s i o n , i n c r e a s e d a t t e n t i o n i s b e i n g p l a c e d on p r e p a r i n g a n u r s e can cope w i t h t h e s e and o t h e r t r e n d s i n n u r s i n g .  The  who  nature  o f t h e s e p r o p o s e d changes i n n u r s i n g programs i s r e c e i v i n g c o n s i d e r a b l e a t t e n t i o n i n n u r s i n g c i r c l e s and attempts a r e b e i n g made t o make r e c o m m e n d a t i o n s b a s e d on  scientific  knowledge and r e s e a r c h . T h i s s t u d y h a s p o i n t e d o u t t h a t a s we d e v e l o p p r o g r a m s , we must c o n s t a n t l y p a y a t t e n t i o n t o how  these we  199 s o c i a l i z e n u r s e s t o assume t h e i r r o l e i n t h e Presently,  profession.  n u r s e s appear t o be concerned about  a C a t c h 22  p o s i t i o n i n terms o f f e e l i n g t h e p u l l between t e c h n o l o g y and the p a t i e n t  (see F i g u r e 3 ) .  One t h i r d - y e a r  s u b j e c t became  v e r y e m o t i o n a l a s she n o t e d , " I f e e l t h a t t h e p a t i e n t i m p o r t a n t . With computers,  i s more  t h e f e a r i s g e t t i n g away f r o m t h e  patient."  Patient <  Nurse  > Technology  F i g u r e 3. N u r s e A n d T e c h n o l o g y  The  onus i s on e d u c a t o r s t o s o c i a l i z e s t u d e n t n u r s e s s o  t h a t t h e y can m a i n t a i n t h e i r e q u i l i b r i u m w i t h i n t h i s pull  situation.  push-  We must l i s t e n t o o u r s t u d e n t s a n d r e s p o n d  t o them a s i n d i v i d u a l s , w i t h v a r i e d a t t i t u d e s t o w a r d , a n d c o n c e p t i o n s o f computer use.  Above a l l ,  we must s t r i v e , t o  enhance t h e q u a l i t y o f t h e i r c o n c e p t i o n s t h r o u g h t h e u s e o f a taxonomy i n programming computer c o n t e n t .  200 REFERENCES A l e x a n d e r , M., S i e g e l , C , D l u g a c z , Y., & F i s c h e r , S. ( 1 9 8 3 ) . 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W o r k i n g W i t h A d u l t L e a r n e r s , E d u c a t o r , S e p t . - O c t . , 34-40.  Nurse  The Kennedy G r o u p , (1988) . The S u r v e y : C a n a d i a n H e a l t h c a r e C o m p u t e r I n d u s t r y : P o i s e d F o r G r o w t h . R e p r i n t e d From H e a l t h c a r e C o m p u t i n g A n d C o m m u n i c a t i o n s Canada, J a n \ F e b , T h o r n e , S. ( 1 9 8 8 ) . Q u a l i t a t i v e N u r s i n g Research-When Why? NRIG N e w s l e t t e r . 6_ ( 1 ) , 3-4.  And  W a l k e r , J . A. ( 1 9 8 1 ) . D e t e r m i n i n g E d u c a t i o n a l Needs o f . P r o f e s s i o n a l N u r s e s P e r t a i n i n g To C o m p u t e r i z a t i o n I n Nursing Practice. Unpublished doctoral d i s s e r t a t i o n , U n i v e r s i t y o f Houston, Houston, Texas.  3  207 Webber, K. ( 1 9 8 8 ) . C o m p u t e r s And N u r s i n g : S t a t e o f The The C a n a d i a n N u r s e , J u n e , 47-48.  Art  W h i t e h o u s e , C , P r e s t o n , T., T o b i n , G., M i l l e r , J . & B a i l e y J . (1975) . W e s t m i n i s t e r H o s p i t a l C o m p u t e r S y s t e m U s e r A t t i t u d e s . ACTA A n e s t h e s i o l o g i c a B e l g i c a ( 2 3 ) , 205-214. W i e r s m a , W. ( 1 9 8 6 ) . R e s e a r c h M e t h o d s I n E d u c a t i o n An I n t r o d u c t i o n ( 4 t h e d . ) . B o s t o n : A l l y n and B a c o n , I n c .  208 Appendix  A  COMPUTER SYSTEMS I N CANADIAN HOSPITALS PROVINCE AND HOSPITAL  HARDWARE  B r i t i s h Columbia Peace A r c h D i s t r i c t H o s p i t a l Grace H o s p i t a l L i o n s Gate H o s p i t a l Shaughnessy H o s p i t a l U.B.C. H e a l t h S c i e n c e s C e n t r e  IBM Data General IBM VT 220 Data General  Alberta F o r t McMurray R e g i o n a l H o s p i t a l Calgary General Hospital Charles Camsell General Hospital Glenrose R e h a b i l i t a t i o n Hospital F o r e s t Grove U n i v e r s i t y Of A l b e r t a H o s p i t a l Red D e e r H e a l t h C a r e C e n t r e  IBM UNISYS ( B u r r o u g h s ) Tandem Tandem CADO Tandem E l e c t r o n i c Data Systems  Ontario K e n o r a D i s t r i c t F o r The A g e d St. Joseph's H e a l t h Centre Chedoke-McMaster H o s p i t a l s York C e n t r a l Sunnybrook M e d i c a l C e n t r e Mississauga Hospital The H o s p i t a l F o r S i c k C h i l d r e n U n i v e r s i t y H o s p i t a l , London  CADO Beehive DEC IBM Telex Data General Hewlett Packard E s p r i t Systems  New B r u n s w i c k R e s t i g o u c h e N u r s i n g Home S a i n t John R e g i o n a l H o s p i t a l U n i t e d C h u r c h Home F o r S e n i o r s L o c h Lomond V i l l a Chaleur Regional Hospital K. E. S p e n c e r M e m o r i a l Home  CADO Technicon IBM PC AT IBM S y s t e m 36 Burroughs CADO  Nova S c o t i a V i c t o r i a General  Sperry  Hospital  Newfoundland V a l l e y V i s t a N u r s i n g Home St. C l a r e ' s Mercy H o s p i t a l G e n e r a l H o s p i t a l C o r p . (HSC)  Burroughs Data General Data General  N o t e . A d a p t e d From " C o m p u t e r s A n d N u r s i n g : S t a t e o f The A r t " by K. Webber, 1 9 8 8 , The C a n a d i a n N u r s e , J u n e , p . 4 8 .  210 B e c a u s e o f t h e t i m e c o n s t r a i n t s d i c t a t e d t o me b y t h e university,  a n d my own commitment t o f i n i s h t h i s  while working  half-time this  r e p l y a t your e a r l i e s t attention,  semester,  convenience.  research  I would a p p r e c i a t e a  P l e a s e f o r w a r d t o my  a l e t t e r a u t h o r i z i n g p e r m i s s i o n f o r me t o  interview Cariboo  College nursing students.  This  letter  s h o u l d be a d d r e s s e d t o : Dr.  S. C o r e n  Chairman, B e h a v i o r a l Sciences The  O f f i c e o f Research  U.B.C.  send a l l t h e necessary  c o m m i t t e e a s one s u b m i s s i o n ,  Committee  Services  Room 3 3 1 , IRC B u i l d i n g , I w i l l then  Screening  documentation t o t h e  a f t e r c o n s u l t i n g w i t h my  thesis  advisors. Thank y o u i n a d v a n c e f o r y o u r h e l p i n t h i s m a t t e r .  Please  do n o t h e s i t a t e t o c o n t a c t me f o r f u r t h e r c l a r i f i c a t i o n .  Sincerely,  Karen  Abbott  Nursing Faculty  213 Appendix E  CONSENT FORM Student Nurses And Computers In H o s p i t a l s As p a r t o f my Masters Program at t h e U n i v e r s i t y o f B r i t i s h Columbia, I am conducting a r e s e a r c h study t o l e a r n more about how n u r s i n g students view the use o f computers i n hospital settings. S e v e r a l s t u d i e s have been completed which d e a l with student nurses' p e r c e p t i o n s about computers. These s t u d i e s are predominantly American, and the students are e n r o l l e d i n e i t h e r b a c c a l a u r e a t e or masters degree programs. T h i s leaves a v o i d o f i n f o r m a t i o n a v a i l a b l e on Canadian student nurses, most of whom are educated i n community c o l l e g e s , and employed in hospitals. T h i s study focuses on t h i s p a r t i c u l a r group. Your c o o p e r a t i o n i s v i t a l t o the study's outcome. You have been randomly s e l e c t e d t o take p a r t i n t h i s study. The i n t e r v i e w w i l l take 30 minutes o r l e s s . I t w i l l be taped and w i l l be scheduled at a mutually convenient time. Following the taped i n t e r v i e w , a w r i t t e n t r a n s c r i p t w i l l be made o f the i n t e r v i e w and r e t u r n e d t o you f o r your v e r i f i c a t i o n . With the e x c e p t i o n o f myself, and.my s u p e r v i s o r y committee at t h e U n i v e r s i t y o f B r i t i s h Columbia, no one w i l l have access t o the i n t e r v i e w tapes or t r a n s c r i p t s . You may be assured o f complete c o n f i d e n t i a l i t y . You w i l l be i d e n t i f i e d by a number on the t r a n s c r i p t , and the data w i l l be a v a i l a b l e only f o r the use of the r e s e a r c h e r . Data e v e n t u a l l y may be made a v a i l a b l e t o other r e s e a r c h groups. However, a l l i d e n t i f i c a t i o n w i l l be d e l e t e d . You have t h e r i g h t t o r e f u s e t o p a r t i c i p a t e or t o withdraw from the study at any time. I f you choose not t o p a r t i c i p a t e , you can be assured t h a t t h i s w i l l i n no way e f f e c t your student s t a t u s at Cariboo C o l l e g e . T h i s r e s e a r c h w i l l be w r i t t e n i n the form o f a Masters t h e s i s and, upon completion,. w i l l be a v a i l a b l e , i n the l i b r a r y system at the U n i v e r s i t y o f B r i t i s h Columbia.  215 Appendix F INTERVIEW SCHEDULE: STUDENT NURSES AND COMPUTERS I N HOSPITALS INTRODUCTION Thank y o u f o r a g r e e i n g t o b e i n t e r v i e w e d . I am w o r k i n g on a research p r o j e c t that looks at nursing students' thoughts about t h e r o l e o f computers i n h o s p i t a l n u r s i n g . I'm g o i n g t o a s k y o u q u e s t i o n s a b o u t y o u r own e x p e r i e n c e w i t h c o m p u t e r s / a n d a b o u t how y o u v i e w t h e i r u s e i n h o s p i t a l nursing. The w h o l e i n t e r v i e w s h o u l d t a k e 20-30 m i n u t e s o r l e s s . I ' d a l s o l i k e t o t a p e r e c o r d i t s o t h a t I c a n l i s t e n t o y o u more c a r e f u l l y now, a n d l a t e r on I ' l l r e v i e w what y o u s a i d . I s t h a t a l l r i g h t w i t h you? QUESTION 1 F i r s t I ' d l i k e you t o t h i n k back t o t h e f i r s t t i m e you can r e c a l l u s i n g a computer. I t c o u l d be r e c e n t l y , o r i t c o u l d be some t i m e a g o , maybe i n s c h o o l o r maybe o u t s i d e o f s c h o o l . Think back t o your f i r s t e x p e r i e n c e w i t h a computer. T e l l me about i t . a. I f n o t a b l e t o r e c a l l t h e f i r s t these probes: - a u t o m a t i c bank t e l l e r ? - home c o m p u t e r ?  time o f computer u s e , use  b. What h a p p e n e d a s y o u s e t a b o u t u s i n g i t ? (1) What was d i f f i c u l t ? (2) What was t h e b e s t p a r t ? (3) How d i d y o u f e e l ? c. Now, t e l l me a b o u t a r e c e n t e x p e r i e n c e (as r e c e n t a s p o s s i b l e ) when y o u u s e d a c o m p u t e r . (1) What was i t l i k e ? (2) Was i t d i f f e r e n t f r o m y o u r i n i t i a l e x p e r i e n c e ? (3) I f d i f f e r e n t , do y o u r e c a l l a t u r n i n g p o i n t ? (4) T e l l me a b o u t d. Was l e a r n i n g t o u s e a c o m p u t e r a t y p i c a l e x p e r i e n c e f o r you? (1) What was t y p i c a l ? (2) What was u n u s u a l ? (3) T e l l me more I ' d l i k e t o move on t o t h e n e x t q u e s t i o n  learning  216 QUESTION 2 You a r e a n u r s i n g s t u d e n t a t C a r i b o o C o l l e g e , a n d y o u r n u r s i n g p r o g r a m i s p r e p a r i n g y o u t o work i n a h o s p i t a l setting. I ' d l i k e y o u t o t a k e some t i m e t o t h i n k a b o u t t h e h o s p i t a l s e t t i n g a s y o u know i t t o b e f r o m y o u r c l i n i c a l e x p e r i e n c e as a s t u d e n t n u r s e , and as you u n d e r s t a n d i t t o be from your r e a d i n g . Think o f y o u r s e l f as a nurse w o r k i n g i n a h o s p i t a l today. I ' d l i k e t o know..... a. What do y o u t h i n k c o m p u t e r s a r e d o i n g f o r y o u , i n y o u r j o b as a n u r s e , w o r k i n g i n a h o s p i t a l ? (1) What a r e t h e b e n e f i t s ? (2) What a r e t h e l i m i t a t i o n s ? (3) T e l l me more b. How do y o u t h i n k y o u r r o l e a s a n u r s e , w o r k i n g i n a h o s p i t a l , i s e f f e c t e d by computers? (1) I s i t p o s i t i v e ? (2) I s i t n e g a t i v e ? (3) D e s c r i b e more a b o u t I'd  l i k e t o move on t o t h e l a s t q u e s t i o n  QUESTION 3 Take a s much t i m e a s y o u n e e d f o r t h i s l a s t q u e s t i o n . I ' d l i k e you t o p r o j e c t i n t o t h e f u t u r e . T h i n k about y o u r s e l f , employed as a nurse i n a h o s p i t a l f i v e y e a r s a f t e r you graduate. T h a t w o u l d be ( y e a r 1 - 1995, y e a r 2 - 1994, y e a r 3 - 1 9 9 3 ) . a. What do y o u your j o b as (1) How w i l l (2) What do (3) What do (4) T e l l me  t h i n k c o m p u t e r s w i l l be d o i n g f o r y o u t h e n , i n a nurse i n a h o s p i t a l ? i t d i f f e r from t h e p r e s e n t ? you t h i n k t h e b e n e f i t s w i l l be? you t h i n k t h e l i m i t a t i o n s w i l l be? more a b o u t  b . How do y o u t h i n k y o u r r o l e a s a n u r s e w o r k i n g i n a h o s p i t a l w i l l be a f f e c t e d b y c o m p u t e r s i n t h e y e a r (1) How w i l l i t d i f f e r f r o m t h e p r e s e n t ? (2) W i l l i t b e p o s i t i v e ? (3) W i l l i t b e n e g a t i v e ? (4) D e s c r i b e more a b o u t I'd l i k e t o c o n c l u d e t h i s i n t e r v i e w w i t h a few g e n e r a l questions. I s t h a t a l l r i g h t w i t h you?  ?  217 RESPONDENT PROFILE DEMOGRAPHICS 1.  Sex:  Male  2.  Age:  18-24 25-29 30-39 40-49 _50-59 65+  Female  3. What was your e d u c a t i o n a l experience n u r s i n g program?  p r i o r t o entering the  High School Degree Other(specify)  4. Have you had education  s p e c i f i c t o computing?  Yes Please  No describe  COMPUTER USAGE 5. Do you c u r r e n t l y have ready access t o a computer? (a)  at home?  Yes  No  Yes  No  I f yes, what type? (b)  i n t h e community? I f yes, what type?  218 6. I f y o u c u r r e n t l y u s e a c o m p u t e r s y s t e m , how d i d y o u t o use i t ?  learn  s e l f taught c o m p u t e r company r e p on t h e j o b t r a i n i n g other (specify)  7. Does y o u r s p o u s e / s i g n i f i c a n t Yes 8. I f y e s , how  o t h e r use a computer? No  often?  e v e r y day o n c e a week o n c e a month less often 9. Do y o u h a v e  children?  Yes I f s o , how Are  No  many?  any o f them c o m p u t e r u s e r s Yes  (excluding  arcade  No  I f y e s , where? _school home other 10. F e e l  THANK  f r e e t o make any a d d i t i o n a l comments.  YOU!  games)?  220 APPENDIX H: THEMES Themes from Interviews 1 - 35  CAREGIVING ROLE  ARTICULATE NEEDS  DIVISION OF LABOUR  HUMAN ERROR  TIME MANAGEMENT  WORKLOAD  ACCURACY  INFORMATION TAMPERING  AVAILABILITYYACCESSIBILITY  LEARNING TO USE  SOPHISTICATION OF SOFTWARE  STAFFING  COMPETENCE  DOWNTIME  OF NURSE  COST  PATIENT FEELINGS  EFFICIENCY  CURRENT INFORMATION  SPACE  COMPUTER DEPENDENCY  TYPING ABILITY  NATURE OF WORK  TEACHING  DEPERSONALIZATION  COMMUNICATION  QUALITY OF PATIENT CARE  SPECIALIZATION  MODERNIZATION  LEGALITIES  PROMPTING NURSE  CONFIDENTIALITY  ACCOUNTABILITY  RESPONSIBILITY  ETHICAL DILEMMAS  RESISTANCE TO CHANGE  TECHNICIAN  FEELINGS ABOUT JOB  NURSE'S PRIORITIES  DECISION MAKERS AGENDA  CLERICAL  STEREOTYPING PATIENTS  INDIVIDUALIZED CARE  MACHINE ORIENTED  221 APPENDIX I: CATEGORIES GROUPED IMAGE  PATIENT CARE  - Caregiver  - Accuracy  - D i v i s i o n Of Labour  - Competence Of Nurse  - Specialization  -  Teaching  - Machine o r i e n t e d  -  Communication  - Nature Of Work  - R e s i s t a n c e To Change  - Depersonalization  - F e e l i n g s About  - Modernization  - Stereotyping Patients  - Technician  - Patient Feelings  - Nurse's P r i o r i t i e s  - Current  - Clerical  - Computer Dependency  Job  Information  - Prompting Nurse - I n d i v i d u a l i z e d Care WORKLOAD  - Q u a l i t y Of P a t i e n t Care  - Time Management - Availability\Accessibility  PROFESSIONALISM  - S o p h i s t i c a t i o n Of Software  - Responsibility  - Cost  - Articulate  - Efficiency  - Human E r r o r  - Space  - Information  - Typing  Ability  needs  Tampering  - Accountability  - D e c i s i o n makers Agenda  - E t h i c a l Dilemmas  - Learning To Use  - Legalities  - Staffing  - Confidentiality  - Downtime  222 • APPENDIX J COMPUTER USE BY NURSES  NURSING  B. COMMUNICATION  teaching t o o l - patients - staff physiological  monitoring  documentation - charting - p a t i e n t care - flow sheets  notes  n u r s i n g care p l a n s - assessment - problem statement r e f e r e n c e source - drug i n f o r m a t i o n - calculations - compatabilities - policies and procedures - past h i s t o r i e s - o l d charts - lab results - admissions  nurses - d a i l y assignments - s h i f t report - Kardex doctors - orders h o s p i t a l departments - order drugs - order s u p p l i e s - schedule t e s t s - dietary other h o s p i t a l s  C. ADMINISTRATION scheduling - staffing\P.C.U's - rotations - O.R. bookings - O.P.D. bookings finance - payroll - billing - inventory control statistics - bed a v a i l a b i l i t y  

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