An Investigation Into the Attitudes of Nursing Students Toward Technology

Abstract

Background: 

Attitudes toward technology may impact the levels of technology acceptance and training willingness among nursing students. Nurse acceptance and effective utilization of technology are critical to improving patient care and safety.

Purpose: 

The aims of this cross-sectional study were to measurethe attitude of nursing students toward technology and to determine if demographic characteristics affect their attitudinal measures. Furthermore, the amount of formal education provided on the use of technology applications is explored.

Methods: 

A convenience sample of nursing students attending a public university in Jordan was recruited, and a technology attitude scale designed to measure the attitude of nursing students toward technology was used. Scales designed to gather data on participant demographics, self-reported technology skills, and level of formal technology education were also used.

Results: 

The results showed that participants held a positive attitude toward technology. Students who reported a high level of technology skill had the most positive attitude toward technology. The impact years of formal education on the use of technology applications were low, whereas academic level had a significant impact on technology attitudes. Senior student participants had the highest level of technology education, likely because of their exposure to relatively more educational opportunities, and the most positive attitude toward technology.

Conclusions: 

Despite the positive attitude of nursing students toward technology, the problem of minimal technology education should be addressed in future nursing programs to further enhance positive attitudes toward technology.

Introduction

In our information technology (IT) era, healthcare institutions adopt policies and procedures that support the application of existing technology (^{Deltsidou, Gesouli-Voltyraki, Mastrogiannis, & Noula, 2010}). Therefore, nurses and other healthcare professionals are required to have essential skills and backgrounds in IT (^{Eley, Soar, Buikstra, Fallon, & Hegney, 2009}) to enable their use of IT skills in daily practice (^{Smedley, 2005}). IT skills gives nurses the capacity to enhance the quality of care provided to patients (^{Nkosi, Asah, & Pillay, 2011}); enhances the quality of healthcare data by providing a structured means to access, store, and interpret it (^{Ginneken, 2002}); enables professionals to collect reliable and accurate data on their patients (^{Thiru, Lusignan, Sullivan, Brew, & Cooper, 2003}); facilitates informed decision making; and enhances effective and timely patient care (^{Englebardt & Nelson, 2002}).

Nursing students are an intrinsic part of healthcare and IT use in the healthcare environment. Therefore, it is important that these students master basic technology skills. According to the Baccalaureate Education Essentials published by the American Association of Colleges of Nursing (²⁰⁰⁸, p. 18), baccalaureate graduates in nursing must gain “competence in using both patient care technologies and information management systems.” In addition, nursing students should acquire basic skills in technology upon admission to nursing schools (^{Maag, 2006}). Furthermore, ^{Deltsidou et al. (2010)} recommended that a basic-level technology skills test should be adopted to assess the technology competency of students at their entry to the nursing schools.

The incorporation of technology into the classrooms has been the most dramatic change in the education field (^{Deltsidou et al., 2010}). According to ^{Smedley (2005)}, nursing students should be able to use and apply basic technology skills to progress well in their educational programs. However, it has been shown that nursing students lack the basic skills necessary to use technology. Thus, further improvements are needed (^{Deltsidou et al., 2010}).

On the basis of the hypothesis that communication and information technologies facilitate the delivery of effective health services, some health and medical curricula have been modified to incorporate core technology proficiencies (^{Marini, 2000; Yee, 2002}). As part of this practice, nursing curricula in some countries now integrate technology topics (^{Bakken, Cimino, & Hripcsak, 2004; Desjardins, Cook, Jenkins, & Bakken, 2005; Rosenfeld, Salazar-Riera, & Vieira, 2002}).

However, this is not yet the norm in most countries. A Canadian study revealed that very few nursing colleges in Canada integrate information and communication technology (ICT) into their courses (^{Perry & King, 2009}). Even in the United States, the integration of ICT in nursing study is progressing slowly (^{Staggers, Gassert, & Curran, 2001}).

User acceptance of technology is a crucial determinant of successful uptake and use of technology. This determinant may be influenced by user attitudes. The adoption of any new technology depends on the attitudes of users (^{Dillon, Blankenship, & Crews, 2005; Gunawardena & Duphorne, 2000; Joo, Bong, & Choi, 2000}). The basic concepts of the theory of reasoned action (^{Ajzen & Madden, 1986}) provide the framework for the current work. This theory stresses the importance of behavioral intentions in the control of individual behavior. These intentions are determined by individuals’ attitudes toward a certain behavior and the subjective norms surrounding the conduct of that behavior. Under this theory, attitude is defined as the positive or negative feelings about performing a behavior. The attitude addressed in the current study is the feelings of like or dislike displayed by participants regarding the use of technology during class. On the basis of this theory, attitudes may be measured by assessing a person’s beliefs about the consequences of a behavior and evaluations about the desirability of these consequences. The beliefs of participants regarding the consequences of using technology during class and the likenesses of these consequences determined participant attitudes toward technology.

In this study, the term “technology” refers to the use of any type of technology application such as computers, databases, hardware, software, E-mail, and the Internet. In general, technology is a broad term used to describe software and hardware applications used to create, store, exchange, and use information (^{Nkosi et al., 2011}).

There is a paucity of research into nursing student attitudes toward technology. A review of the literature revealed that earlier works concentrated on nurse and nursing teacher attitudes toward technology (^{Maag, 2006}). Hence, this study examines the attitudes toward technology of nursing students in Jordan. No published research on nursing attitudes toward technology has been done in Jordan or in the broader Arab world. This makes this study important in terms of adding to the overall body of knowledge in the investigated area and expanding the scope of Jordanian and Arab literature.

Methods

The principal aim of this study was to examine the attitudes of nursing students toward the use of technology and the effect of demographic characteristics on these attitudes. Student self-reported formal education and training on certain technology applications was also explored.

Study Setting and Sample

A convenience sample at a university in northern Jordan was selected for this study. The nursing bachelor degree program in Jordan follows a four-year curriculum. The initial target population for this survey was composed of all 549 undergraduate nursing students (years one through four) enrolled in the target university at the time of data collection. However, first-year students were excluded from the final inclusion because they were enrolled in only basic science courses at the time of data collection. Thus, the final target population included 403 students in total.

Sample size was calculated using G-power software (^{Faul, Erdfelder, Lang, & Buchner, 2007}). A medium effect size (.30) was required for this study. The power level was set on .80, and the conventional α = .05 was specified. On the basis of this, the minimum required sample size for this study was set to 140 students.

Data Collection Procedures

This cross-sectional study used a survey design. After receiving ethical approval from the institution’s ethical committee, questionnaires were distributed to the tutor of each course. These tutors provided the student participants with the questionnaire at the end of a class session. Participants were given a concise written explanation of the study’s background and purposes and were requested to answer all questions. They were informed that their replies would be kept confidential and that, if they did not desire to participate, they could submit a blank questionnaire.

The participants returned completed questionnaires to the researcher’s office. Completing the survey was taken as a consent to participate. Questions were easy to understand, and the questionnaire required 10 minutes or less to complete. Participation was voluntary, and no course credits or other incentives were given for participation.

Instrument

The questionnaire contained three sections:

• (1) Demographic details: Demographic variables included the age, gender, and academic level of participants to identify factors that may affect overall group attitudes toward technology. Self-reported technology skill level was collected from participants by asking the question “how do you rate your skills in using technology?”, with a response on a 5-point Likert scale from 1 = very poor to 5 = very good.
• (2) Self-assessment of formal education on the use of technological applications: Participants were asked if they obtained formal education in any of the following topics during their study in the university: word processing, Internet use, E-mail use, use of software, use of hardware, Web-design programs, and databases. They indicated the presence of formal education by ticking a box for each given technology application. This information was collected to explore the amount of technology education gained by the students during their study. These topics address common prerequisite skills for nursing students (^{Maag, 2006}). Participants were requested to rate their technology skills and related knowledge of basic computer skills.
• (3) Technology Attitude Scale (TAS): The TAS (20 items) was designed by ^{McFarlane, Green, Hoffman, and Center (1997}) to examine teachers’ attitudes toward technology. The original scale is scored using a 7-point Likert rating (range: 1 = not true to 7 = very true). The scale was modified for use in examining students’ attitudes by eliminating terms intended for teachers. The modified version was composed of 15 items scored using a Likert-type scale ranging from 1 = strongly disagree to 5 = strongly agree (^{Maag, 2006}). For analysis purposes, all the negatively worded items were numerically reversed.

The developer of the original tool tested it with 86 foreign-language teachers before and after a training program and earned Cronbach’s alpha scores of .92 and .95, respectively (^{McFarlane et al., 1997}). The revised 15-item TAS was tested on a pilot group of students (N = 193) and earned a reliability coefficient of .88 (significant at the .05 level), demonstrating satisfactory reliability (^{Maag, 2006}).

Validity of the Translated Technology Attitude Scale

A panel of three doctoral degree holders competent in both Arabic and English was asked to translate and back-translate the original tool from English to Arabic. Any discrepancies between the original version and the translated version were discussed and resolved based on suggestions by the panel. The panel was asked to assess the face and content validity of the translated instrument by evaluating each item for clarity and validity as well as to provide suggestions for modification in a space provided under each item.

The 15 items of the TAS were subjected to exploratory factor analysis to assess construct validity. Principal component analysis was then performed, with an inspection of the screen plot revealing a clear break after the second component.

The two-component solution explained 58.70% of the total variance, which showed item intercorrelations. Component 1 contributed 41.60%, and component 2 contributed 17.10%. Both factors had eigenvalues greater than 1.00, with factor 1 having an eigenvalue of 6.25 and factor 2 having an eigenvalue of 2.57 (Table 1). Oblimin rotation was applied to help interpret these two components. The rotated solution discovered the presence of a simple structure, with both components showing a number of strong loadings and most variables loading substantially (14 items, load ≥ .70; only one factor, load = .55). Factor 1 had factor loadings that ranged from .70 to .82, and factor 2 had loadings that ranged from .55 to .82. This indicates that both factors adequately measure the aspect of the “attitude toward technology” construct.

TABLE 1: TAS Components

Table 1 shows the factor loadings after rotation. Nine items (1–9) that cluster on the same components suggest that component 1 represents the confidence in and the benefits of using technology as well as a positive attitude toward technology (i.e., affirming the utility of a technology and enjoyment in its use). On the other hand, the six items (10–15) that clustered on component 2 represent a lack of self-efficacy in the use of technology as well as a negative attitude toward technology (i.e., anxiety and unease). The interpretation of these two components is in harmony with a previous research done on the TAS scale (^{Maag, 2006}).

Reliability of the Translated Technology Attitude Scale

A Cronbach’s alpha of .89 (n = 186) was calculated for the internal consistency of the overall TAS, indicating that the factors within the variables are highly interrelated (^{LoBiondo-Wood & Haber, 2010}). Internal consistency reliability was estimated for the two components as well, with Cronbach’s alpha values reported as .90 and .86, respectively. Thus, the results indicate satisfactory internal consistency for the overall TAS and for its components.

Statistical Analysis

Data were entered and analyzed using SPSS 17.00 (SPSS, Inc., Chicago, IL, USA). Descriptive statistics were carried out on the questionnaire items, with tables of frequencies and percentages calculated. The mean score attained from the scale was used to measure the attitudes of participants. The independent-samples t test and one-way analysis of variance (ANOVA) test were used to examine differences among participants in terms of gender, age group, academic level, technology skill level, and mean TAS scores, with the statistical significance (α level) set at .05.

Results

Demographic Data

The results are based on a convenience sample of 223 participants who returned the questionnaires out of an accessible population of 403 students (response rate: 55.30%). Furthermore, 37 questionnaires were excluded because of unanswered items, leaving a total of 186 questionnaires for data analysis.

Most of the participants were women (71%, n = 132; Table 2), and participant mean age was 20.90 (SD = 1.83). Seniors (fourth-year students) comprised the largest participant subgroup (Table 2).

TABLE 2: Demographic Information (N = 186)

Attitudes Toward Technology

The overall mean TAS score of 3.96 (range: 1–5, SD = 0.52) is in the positive side of the continuum, indicating that participants held an overall positive attitude toward technology. As depicted in Table 1, most responses have similarly high mean scores, highlighting that participants agree that learning and knowledge about technology are important in academic and professional careers. Furthermore, 88.20% (n = 164) agree that technology facilitates the learning process, 86% (n = 160) agree that it is “important to know about technology for a future career,” and 86.60% (n = 153) like technology (Table 1).

Participant age was categorized into two groups: ≤22 years (88.20%, n = 164) and 22+ years (11.80%, n = 22). The respective attitude of the two groups toward technology was tested using an independent-samples t test. No significant difference was found, t (186) = 1.31, p = .19 (Table 3).

TABLE 3: Demographics and Attitudes (N = 186)

The same test was used to test whether gender affects students’ attitudes toward technology; no significant differences in results were observed (t(186) = 1.61, p = .11). A one-way ANOVA test found a significant difference between different academic levels and mean TAS score, F(2, 184) = 4.69, p = .01 (Table 3). However, although statistical significance was reached, the actual intergroup difference was quite small (Table 3). The effect size calculated using eta squared was 0.02, which is considered small in Cohen’s terms. Post hoc comparisons using Tukey Honest Significant Difference test indicate that the mean score for the second-year group (M = 3.50, SD = 0.59) was significantly different from both the third-year (M = 3.80, SD = 0.51) and fourth-year (M = 4.20, SD = 0.43) groups.

The hypothesis that the level of technology skills affects students’ attitude toward technology was tested using the one-way ANOVA test. Interestingly, a high significant difference was found between those who reported a very good level in technology skills and those reporting lower skills, F(3,182) = 11.52, p < .001 (Table 3). Again, the small effect size found (η² = 0.04) explained the small difference in the mean scores. Post hoc comparisons indicated that the mean score for those who reported “very good” skills (M = 4.20, SD = 0.47) was significantly different from those who reported “very poor” and “poor” skills (M = 3.30, SD = 0.65) as well as those who reported “fair” skills (M = 3.80, SD = 0.51). Moreover, there was a significant difference between those with “good” skills (M = 4.00, SD = 0.44) and those who have “very poor” and “poor” skills (M = 3.30, SD = 0.65).

Formal Education in Technology

The distribution of use of various technology applications by participant level of formal education is presented in Table 4.

TABLE 4: Self-Reported Technology Education (N = 186)

To further clarify participants’ level of formal education in technology (FET), an FET score was computed using ^{Maag’s (2006)} method. A score of 1 was assigned for each of the seven technology applications ticked on the questionnaire. Conversely, a score of 0 was assigned for each unticked technology application. The mean FET score was 3.10 (SD = 2.26, range = 0–7, N = 186). Twenty-one percent (n = 39) of the participants had received no FET during their study at the university. At the other end of the continuum, only 12 students (6.50%) had received education in all FET applications (n = 7). Forty percent earned an FET score of 0–2.

Most (56.40%, n = 22) of those who had received no FET were second-year students, whereas half (50%, n = 6) of those who had received education on all seven technology applications were fourth-year students.

A one-way ANOVA test revealed a highly significant difference between different academic levels and mean FET score, F(2, 182) = 10.10, p < .001. Again, a post hoc test found that the mean score for the second-year group (M = 2.10, SD = 2.22) differed significantly from both third-year (M = 2.90, SD = 2.26) and fourth-year (M = 3.8, SD = 2.01) students and that fourth-year students had the highest exposure of the three groups to FET at the university.

Discussion

The results of this study indicate that nursing students attending the target university in Jordan hold a positive attitude toward technology. Similar results have been reported in similar descriptive studies by ^{Maag (2006)} and ^{Nkosi et al. (2011)}.

Moreover, the results reveal no difference between male and female participant mean scores for attitude. In view of the fact that most participants were from the same age group, no significant difference in attitudes among different age categories was noted. A study on nurses by ^{Dillon et al. (2005)} found that the attitude of nurses toward interacting with electronic patient records was significantly affected by age (p = .05), with older nurses attaining higher mean attitudinal scores.

There was a significant difference in the attitude scores between participants at different academic levels. The fourth-year participants earned the highest mean score, most enjoyed technology, and generally agreed that they should know about technology in their future career. This could be because of greater exposure to technology applications during their study period and a desire to reflect this in their future hospital careers, because clinical practice necessitates some basic knowledge of technology.

Skill at using technology was associated positively with attitude (M = 4.20, n = 186; Table 3). This has implications for nurse educators. When these educators use technology in teaching and encourage students to utilize technology applications, students’ technology skills may improve and thus foster a more positive attitude toward ICT (^{Abbott, 1993}).

However, 40% of the participants reported “no-to-little” FET applications during their study at the university. These findings match with ^{Maag’s (2006)} results and disagree with those reported by ^{Edirippulige, Smith, Beattie, Davies, and Wootton (2007)}. In the latter study, most nursing students (82%, n = 46) recognized their computer skills as intermediate and advanced because of the formal training on computer applications as reported by most participants. However, the small sample size in this study could have affected the results.

The inadequacy of FET in Jordan is likely attributable to two factors: (a) the nursing curriculum is not supported with technology components, and (b) students choose not to take technology application courses. In the selected research site, only one computer course was offered as an elective. This underscores that the Jordanian educational system remains well behind Western European nations in terms of technology education (^{Internet World State, 2012}).

In fact, if more technology courses are made available to the students as mandatory courses, students might gain more familiarity with technology, which might reinforce their initial positive attitudes, particularly as this study’s findings prove that nursing students’ overall attitude toward technology is positive.

The lack of technology-related components in the nursing curricula may impact nursing students’ future careers. There is some evidence that registered nurses believe that their education in the nursing classroom fails to prepare them to utilize technology to guide clinical practice and patient care (^{Eley et al., 2009; Perry & King, 2009}). On the basis of these findings, nurse educators should integrate technology-related components into the nursing curricula to prepare students to work in today’s dynamic healthcare settings.

Data suggest that embedding IT-related topics in the nursing curriculum has positively affected nursing research, education, and practice (^{Nkosi et al., 2011}). Similarly, several other researchers have advocated the integration of technology in the nursing curriculum (^{Deltsidou et al., 2010; Jacso, 2005}).

The common belief that younger people tend to enjoy using their learned technology skills more than their older counterparts was not supported by the results of this study. Older (fourth-year) students showed significantly higher levels of IT enthusiasm and FET. This supports the results of ^{Maag (2006)}, which indicated that fourth-year students had obtained more FET during nursing study than new candidates. By the same token, ^{Deltsidou et al. (2010)} showed that the competencies of fourth-year students were superior.

Limitations

The use of a self-reported questionnaire is a limitation of this study because students subjectively rated their skills in technology use. Moreover, the use of a nonrandom convenience sample may threaten the external validity of findings. The response rate for this study was 55.30%, so nonresponders may affect any obtainable conclusion, as we are unaware of their attitudes toward technology. Furthermore, the current study excluded first-year students, who may have technology skills gained from their school education. However, including them was technically difficult, as they were taking basic science courses outside of the purvey of nursing. Finally, the selection of one research site in Jordan may limit the generalizability of findings.

Conclusions

Study findings show that Jordanian nursing students hold a generally positive attitude toward technology. Despite this positive attitude, participants reported that they received minimal FET during their study at the university. The positive attitude may suggest that students would welcome more technology-enhanced courses if made available in the curriculum. However, IT is of great value to all disciplines, which should be integrated at different levels and started as early as elementary school.

Implications for Practice and Research

Nursing educators should integrate technologies to improve students’ skills in the informatics field. As a minimum requirement, an introductory compulsory course in nursing informatics should be offered to all nursing students to bridge the gap between nursing students and technology. Today’s students are the nurses of the future, and it is recommended that nurses today must be able to utilize clinical IT effectively in patient care. Therefore, nursing educators must incorporate IT into the curricula so that students may easily adapt to the technology that they will use throughout their careers.

It is recommended that future research be conducted at the national level in Jordan. Moreover, as attitudes may change over time, a longitudinal approach should be conducted to identify differences in attitudes across time in future studies.