Malaysian Nurse Warrior: 05/24/12

Chapter 1

1.1 Introduction

The internet is a worldwide collection of computer networks, cooperating with each other to exchange data through telephone wires and satellite links. Internet users are people with access to worldwide network. Internet users can share varies information topic such as economic, entertainment and health. World Bank Report (2011) cited by Trading Economic (2012), stated that the internet users in Malaysia was last reported at 15705762.40 in 2010. According to Grandinettii (2000), more than 70,000 websites provide health information and consumer use of the internet for health information is large and growing. According to Nielson Net Index Study (2011) cited in Yahoo! Advertising Southeast Asia (2010), from 19 major search engines in the internet, health information was ranked fourth most searched item by Malaysian.

With the existence of many health related websites, it provides many benefits to consumers, especially nurses. Prendiville, Sauders, & Fitzsimons, (2009), stated that research shows that health professional’s use of the internet to obtained health and medical information has increased. Health professional’s defines as a doctors, nurses, pharmacies and others which who deal direct to the patient and health.

According to Contillo (2012), American Academic of Nurses Practitioners Survey stated that more than 98 percent of nurses responded that they use the internet. In that survey, they found that nurses used the website of health information in the internet for several reasons such as for online Nursing Continuing Education for license, Podcasts for update information in health, blogs for sharing detail nursing practice issues, patients stories, fears, triumphs or even family and leisure activities, information sites for clarify for example unfamiliar terms or check spelling to make sure the medication order are correct, mobile medicine for traveler to assess their medical risk, support groups for patients online community, consults for home care nurse, job search for sharing work-related issue and creating nursing community for its ability to be used for mentoring and creating a sense of share purpose.

Although nurses have many benefits from the use of the health information Internet but there are barriers that make the nurse cannot use these facilities maximally. In general, nurses report the following barrier to obtaining information which are lack of time, lack of access to information and lack of searching skills (Dee & Standley, 2005). Although a detailed analysis of a fact is beyond the scope of this view, demographics of the nursing works force and the number of year’s exposure to the online resources are undoubtedly factors in how comfortable a nurse is likely to fell with searching for online information ( Tannery, Wessel, Epstein, & Gadd, 2007).

Now, let's go back to our Malaysian nurses. So far, very difficult to get an article that touches on how the behavior or the barriers faced by Malaysian nurses in search of health information using the internet. According to McKnight (2006), in nursing, the majority of published studied concentrate on academic nursing students and are usually very library centric, concentrating on what resources are being used. However, it does not mean that nurses do not use the internet in Malaysia in search of health information or do not have a serious problem in search of health information. Based on the experience and observation of researcher for 13 years as a clinical nurse and 2 years as nursing tutor, nurses do not use the internet in clinical areas because of several factors. The main factor is the lack of internet access in the ward, followed by lack of time, lack of skill and lack of knowledge of searching specific web sites related to nursing and medical such as journals. Besides the lack of motivation, no mentoring and guidance from the top also cause nurses are not aware of the need to search for health-related information via the internet.

Base on the phenomenon, researcher plan to conduct a research on barrier toward health information-seeking on the Internet among Malaysian nurses. This study will explore on the attitude of nurses on health information-seeking on the internet and the barrier toward health information-seeking on the Internet among Malaysian nurses. At the end of this study will hopefully be able to make improvements related to the appropriate methods to reduce barriers to nursing institutions can be beneficial to nurses themselves, patients, organizations and subsequent nursing institutions in particular.

1.2 Statement of the problem

According to Sulaiman (2003), researchers need a problem statement. Problems in the research necessary for researchers to discuss moves to benefit from it. In this study, problem statement has been identified through researcher experience along 13 years as a nurse, and by observation of the attitude of nurses around the situation.

Experience and observation as a clinical nurse and nursing tutor

Throughout his career as a nurse researcher who had worked in the ward situation, in critical areas, in the clinic and the technical support Unit, the internet is very important to find health information.

However, internet facilities are only available in certain places in the hospital such as in doctors room, nurse manager's room and library. With the busy routine nursing care, nurses do not have time to go to the library to use the internet. Wi-fi line was expanded in all areas of the hospital but almost 99% of nurses do not carry a laptop to work place. For nurses who have a cell phone internet, they will share the gadget with friends who need help in finding the meaning of such a word, looking for information about the disease or medication. Usually the nurse will find information at home. However, the information is always retained search for nurses who do not have internet access at home.

Lack of knowledge and skills in searching for health information using the internet is one of the obstacles. Through conversation and daily activities with other nurses, nurses are only looking for health information using Google or Yahoo page. Nurses do not know the use of various search engines and web sites in search of materials such as journals such as Pubmed, Ovid, Sage and others. Some nurses just learn on the internet for finding information when they are student nurse and there is no course that allows nurses to sharpen these skills.

For students, they viewed adept at using the internet in search of health information. They can surf the internet at libraries and through the laptop. However, the attitudes of students who only use the internet if they have a task assigned by the tutor is very regrettable.

For nurses in the field of education, use of the internet to find health information is excellence. However, since not many websites or journal that can be accessed for free, it can sometimes reduce the sense of novice teachers to use the internet and find comfort with the material through the book.

1.3 Purpose of the study

The determination of specific goals and objective of the study to be conducted is a very important step. Clear objective of the study will help researchers determine the hypothesis or research question (Mohamed Izham, 2004).

1.3.1 General Objective

In this research will be identify the barrier toward health information seeking on the internet among Malaysian nurses

1.3.2 Specific Objective

At the end of this research, researchers will be able to : -

1. Identify the barrier toward health information seeking on the internet among Malaysian nurses

2. Identify the impact of the barrier toward health information seeking on the internet among Malaysian nurses

3. Identify demographic relations with the barrier toward health information seeking on the internet among Malaysian nurses

1.4 Research question

A research question is a concise question which expresses what the research project aims to find out. It is crucial to have a clearly defined research question before starting to collect your data, as it will give the structure and focus necessary to get meaningful and useful results (Ripfa, 2002)

1.4.1 The research topic

Barrier toward health information-seeking on the internet among Malaysian nurses

1.4.2 Research question

What are the barriers toward health information-seeking on the internet among Malaysian nurses ?

1.5 Significance of the study

According to Mohamed Izham (2004), the significance of the study explains why the study should be done.

1.5.1 Nurses

This study will identify barriers toward health information-seeking on the internet among Malaysian nurses, identify the impact of these barriers and identify the demographic factors related to the barriers. After identified the barriers faced by nurses, improvement measures will be made to reduce these barriers. By knowing the impact of these barriers, it is hoped the nurse and the management involved, such as hospital management takes a serious view of this problem and find the best solution to solve the problem which it will benefit to nurses, patients, hospitals and nursing organizations.

1.5.2 Patient

This study is related to the barrier toward health information-seeking on the internet. If the nurse was on duty in the clinical area, by identifying these barriers and improvements can be done, patients will get quick information on the disease with the latest and persuasive if the nurse to include evidence from past studies on nursing care. This will increase the patient satisfaction to the nurses in term of the knowledge and initiative of nurses to answer their questions.

1.5.3 Hospital and nursing organization

This study will identify barriers toward health information-seeking on the internet among Malaysian nurses, identify the impact of these barriers and identify the demographic factors related to the barriers. After the improvements made, it will have an impact on nurses and customer satisfaction will enhance the image of the organization and the value of the nurse.

1.6 Delimitation of the study

Delimitations are restrictions or bounds that researchers impose prior to the inception of the study to narrow the scope of a study. Delimitations and limitations are discussed to analyze possible threats to the study's validity and to acknowledge existing flaws to the research design. Delimitations are choices made by the researcher which should be mentioned (Drake, 2001).

The delimitation of this study is the researcher chooses to look only at health information seeking barrier among the Malaysian nurses

1.7 Definition of terms

Definition of terms is a very brief section consisting of a series of definitions of the key terms or concepts found in the proposal (Drake, 2001).

Health information

Health information will refer to clinical knowledge such as drug information, nursing assessments, articles and nursing best practice guidelines and resources to seek better understand in health situation and plan of care.

Health information seeking

The three main ways of accessing online health information are searching for health information, participating in support groups and interacting with health professionals. Nurses may use the computer to search drug databases, libraries and best practice resources to obtain important information related to the diagnosis and care or find health education information for you.

The health information can be find using the tools such as MedlinePlus, Healthfinder, Cancer.gov , Centers for Disease Control and Prevention, familydoctor.org, Healthfinder, HIV InSite, Kidshealth, MayoClinic, MedlinePlus and NOAH: New York Online Access to Health. Health Insight which are content of a health information site for consumers.

Internet

The Internet is a worldwide collection of computer networks, cooperating with each other to exchange data using a common software standard. Through telephone wires and satellite links, Internet users can share information in a variety of forms.

For nurses, the use of computer technology provides quick access to important information about your health or illness. Nurses may also use a small hand held computer known as Personal Digital Assistants or PDAs.

Malaysian Nurses

Malaysian nurses referring to clinical nurses. Quoting from former Malaysian first lady, Toh Puan Sri Siti Hasmah Hj Mohamad Ali (2003), asserts that nurses need to be skilled in the use of internet-enabled progress as citizens of developing countries. With the skills and knowledge in technology, it can improve the image of nursing profesion.

CHAPTER II

LITERATURE REVIEW

2.0 Introduction

Literature review is a process of reading, analyzing, evaluating, and summarizing scholarly materials about a specific topic (Fink, 2009). After doing a literature review and see some examples of research related barrier toward health information-seeking, some information has been obtained.

Quoting his Secretary General Ministry of Energy, Water and Communications Dato’ Dr. Halim Man, Malaysia is on the move in the modern and sophisticated technology. The government has provided infrastructure facilities to provide ICT facilities and encourage Malaysians use the internet in their daily work. The Government has allocated RM 12.9 billion in the RMK-9 to realize the project and programs related to the ICT state. Effort to promote information and communication technology is expected to have a positive impact to the community and further develop the country’s human capital up to a global level (Rancangan Pembangunan IC T Negara, 2010)

There are clear message from government to enhance the quality of Malaysian citizen in using the Internet. The nurses also should take advantage of the abundance of this facility so that the image of nursing staff on par with other sectors and not be left behind. Nursing Malaysia using the Internet in daily business, but no evidence of widespread Internet use among Malaysian nurses.

2.1 Previous studies

2.1.1 Health information-seeking on the internet

Research shows that health professionals’ use of the internet to obtain health and medical information has also increased (Tang &Ng, 2006). The wealth of information available means that ‘healthcare professionals are increasingly finding that they have more information available than they can handle with confidence in their busy time schedules’ and ‘the hardest task now is to actually locate the information required from the flood of information received’ (Davies, 2007).

Jones, Katherine, and Pesut (2011) found in their research that the primary reasons clinical nurses conducted web-based information searches included direct patient request, colleague requests, building patient materials collections, patients’ family requests, routine teaching, personel development and staff development. According to Contillo (2012), American Academic of Nurses Practitioners Survey stated that more than 98 percent of nurses responded that they use the internet. In that survey, they found that nurses used the website of health information in the internet for several reasons such as for online Nursing Continuing Education for license, Podcasts for update information in health, blogs for sharing detail nursing practice issues, patients stories, fears, triumphs or even family and leisure activities, information sites for clarify for example unfamiliar terms or check spelling to make sure the medication order are correct, mobile medicine for traveler to assess their medical risk, support groups for patients online community, consults for home care nurse, job search for sharing work-related issue and creating nursing community for its ability to be used for mentoring and creating a sense of share purpose.

2.1.2 Barrier toward health information-seeking on the internet

While there is an increasing interest in, and use of, the internet by health professionals to obtain information, there are still a number of barriers evident.

Common barriers to nurses’ information seeking on clinical unit are lack of access to the most relevant resources, search results that are too large to be useful, search results that retrieve information that is incomplete, inaccurate, inconsistent and non-evidences based and information that is to difficult to read or understand.

In study by Dee & Stanley (2005), nursing students are shown to use some online resources more often than clinical nurse which are 96% compared to 4 % of clinical nurse in one study. 76% of clinical nurses in the study felt that their lack of database searching skills was holding them back compared to students 8%. Access to a physical computer at work remains an issues which are 75% of the nursing student had access and only 50% of the clinical staff were in the same fortunate position. In Jones, Katherine, and Pesut (2011) study also found that lack of knowledge about specific resources or the technologies required to use them, as well as previous negative experience with specific resources, were also important factors that hampered effective information searching and retrieval in clinical practice. Their finding stated that the clinical nurse were not particularly comfortable or confident or comfortable with their web searching skills. The specific characteristics of information resources also posed barriers to effective use. Browser-based search engines, for example, maximize search results, leading to long, un diffentiated list of both appropriate and inappropriate information resources.

Cogdill (2003) stated that for clinical nurse, the perceived urgency of situation is also seen to have a negative effect on the potential of information seeking via online. Similar with study by Jones, Katherine, and Pesut (2011) that found time requirement were identified as the primary barrier to effective use of web-based recourses. Clinical nurses simply do not time to search for materials and filter the information during working hours especially when patients of family members are waiting for information.

Organizational barrier commonly cited among participating nurses concerned hospital policies and procedures that dictated preference of intranet packages. Policies limited access to certain websites, and in some cases, discourage the use of the web from clinical units (Jones, Katherine, and Pesut, 2011). Dee and Stanley (2005) found that the other barrier is perception of nurses that library was only for physicians.

Some nurses believe they do not have the necessary skills to appraise the information critically (Koivunan, Valimaki & Hatonen, 2010). Jones, Katherine, and Pesut (2011) support that finding which in their research found nurses participants who used Google or other searching engines were, on average, willing to browse through eight documents before giving up. Participants were also unwilling to dig deeply into a recourse before abandoning it.

Demographics of the nursing workforce and number of years’ exposure to online resources are undoubtedly factors in how comfortable a nurse is likely to feel with searching or online information (Tannery, et al. 2007 ; Andrews, et al, 2005; Winter, et al, 2007; Doney, Barlow & West, 2005). Renahy and Chauvin (2006) noted that numerous studies examined what users demographic traits were associated with health information seeking on the Internet. Nearly all quantitative studies reported more women were searching for health information on the Internet than men. The other two most studied demographic variables were education level and income, where higher levels of each were associated with health information seeking.

2.1.3 Solution to barrier toward health information-seeking on the internet

Some authors propose a clinical librarian role as a solution to the difficulty of accessing information (Coumou &Meijman, 2006). In areas that are geographically remote, outreach librarians may help, particularly if they establish a personal relationship with their users. (Bryant, S.L.(2004). An improvement in search ability amongst many professionals following training intervention from a librarian is noted (Brown, 2007). Both academic health sciences librarians and hospital can assist with clinical nurses time constraints by offering training classes on trusted, up-to-date health care information resources and basic computer skills to prepare nurses for database searching (Dee & Stanley, 2005).

2.1.4 Limitation of the study on Internet –base information-seeking behavior

Although the internet on general information-seeking behavior is vast, and forms part of the curricula of several library schools, relatively little recent investigation has been carried out into how medical and health care professionals search for internet-based online information(Younger, 2010). Some recent study studies have examined the broader landscape of health information in general (Curtis, Weller & Hurd, 1997, cited by Younger, 2010). There is a lack of studies examining the Internet searching information behavior of clinical and healthcare staff.

2.2 Theoretical framework

Information seeking Model (Figure 1) illustrates the relationships between the concepts of user, need, uses and user behavior. The model suggests that the user perceives a need in the context of the user's environment. That is, in a given environment or event (e.g. university course) the user will perceive an information need (research a paper). The perceived need will lead the user to search for information, making demands upon a variety of information sources.

Information seeking behavior may lead to either a success or a failure. If successful, information is located which will be used. This may result in the satisfaction or non-satisfaction of the original perceived need. Satisfaction occurs when the located information has been analyzed and satisfies the original need. Non-satisfaction occurs when the information does not satisfy the original need. Each of the steps that one uses while going through the information seeking behavior process, as outline in the model, may be referred to as strategies. Some information seeking behavior may require only one strategy such as using the librarian for help or make tutorial. When all the needed information is found, which results in satisfaction of the user's information need, the search process is ended. Some information seeking behavior may require many strategies with the user calling upon a variety of information sources because the information need is not thoroughly satisfied (Hayden, 2012).

Figure 1: Information Seeking Model - Adapted from Wilson and Krieklas (1983)

CHAPTER III

METHODS

3.1 Research design

The research design is defined as, it is the plan for collecting and utilizing data so that desired information can be obtained (Chua, 2003).

In this study, a descriptive survey design will adopted, using a mailed questionnaire to collect qualitative and quantitative data.

3.2 Sampling

In research, terms a sample is a group of people, objects, or items that are taken from a larger population for measurement. The sample should be representative of the population to ensure that we can generalize the findings from the research sample to the population as a whole. (Chua, 2003).

3.2.1 Study population (N=100)

In this study, the study population is a clinical Malaysian nurses.

3.2.2 Sampling Population

In this study, the sampling population is a clinical nurses who are still in service until 2013.

3.2.2.1 Inclusion Criteria

(i) Clinical nurses who are still in service until 2013.

3.2.2.2 Exclusion Criteria

(i) New graduate nurses least then 6 month in service.

3.2.2.3 Sampling Method

Convenience sampling method.

3.2.2.4 Sample Size

According to formulae (Kirkwood,1988);

N=P (100-P)/e²

Where,

N= Number of respondent

P = Prevalence of HDL-C level from previous study (Knutsson A.,et al,2001)

e = Standard error

For clinical nurse:

N= 26.7(100-26.7)/5²

N ~ 78 respondents

+20% to encounter the defaulters~ 16

=94 respondents

The estimated total respondents that involved in this study were 94 respondents.

3.3 Instrumentation

According to Polit, Beck & Hungler (2004), instruments are tools used by researchers to collect data, such as adopt a questionnaire - questionnaires, schedules, observations, or adopt a measuring scale.

In this study, the author will get the permission from An Australian Nursing Federation for using their questionnaire of “Nurses and Information Technology Survey”. (Appendix 1)

The questionnaire consisted of 78 questions divided into the categories of :

i. Background

ii. Access and use of computers

iii. Uses of information technology

iv. Access to the internet

v. Knowledge of health information technology initiatives

vi. Position requirements for information technology

vii. Training and education in information technology

viii. Barriers to use

ix. Technical support

x. Management attitudes and support

xi. Security and confidentiality

xii. Professional organization support

xiii. Free comment about information technology in the workplace.

3.3.1 Validity and reliability of the instrument

Validity is the ability of an instrument used to measure what is supposed to be measured in the study (Polit & Beck, Hungler, 2004).

Validity of the instrument will be recovered by a panel of experts in the field of nursing which are Nurse Manager and Head of the Department of Nursing. Both panels were selected based on their experience with health information search system.

Reliability of the instrument was not done because the researchers used the original questionnaire were identified.

3.4 Data collection procedure

3.4.1 Step of data collection

In this study, author decided to use mail survey because the author consider the busy time of nursing routine. When the respondents receive the questionnaire, its allow respondents to fill it out at their own convenience and any potential interviewer bias may be reduced due to lack of contact with the interviewer.

Researchers determined that the distribution and data collection within 2 months.

In the first week, the questionnaires will posted to a convenience sample of clinical nurse. After 3 weeks, the researchers expect response from all respondents. A reminder letter will sent to all respondents approximately 1 month after the original mailing to encourage replies from non-responders.

3.4.2 Confidentiality and anonymous

Some studies have shown that response rate is affected by the anonymity/confidentiality policy of a study. Others have reported that responses became more distorted when subjects felt threatened that their identities would become known. Others have found that anonymity and confidentiality issues do not affect response rates or responses (StatPac Inc, 2012).

In this study, it is difficult to conduct an anonymous questionnaire through the mail because of the need to follow-up on non-responders. The only way to do a follow-up is to mail another survey or reminder postcard to the entire sample. However, it is possible to guarantee confidentiality, where author promise not to reveal the information to anyone. For the purpose of follow-up, identifying numbers on questionnaires are generally preferred to using respondents' names. It is important, however, to explain why the number is there and what it will be used for.

3.4.3 Ethic committee

According to Burns (2005), states that ethics is needed in research to show or produce practical knowledge. Thus researchers will comply with the ethics of research until the end. It also is one of the research procedures related to professional bodies, legal, social responsibility in the study. The main purpose is to ensure that no person who assaulted or experiencing unwanted effects from research activities.

In this study, researchers do not need to apply for an approval of an organization for doing research because the questionnaire will be sent directly to the respondents home address.

3.5 Frameworks for data analysis

Analysis was undertaken using SPSS on an item-by-item basis using descriptive and inferential statistical tools as appropriate to the scale of measurement.

3.5.1 Quantitative data

Dichotomous and categorical variables were described using frequencies and proportions.

As stated earlier, the sample was stratified according to geographic location. Because of this, some analyses involving other variables in the design required pooling of data to create sufficient power. Detection of significant differences in proportions between two dichotomous or categorical variables was achieved by the use of cross-tabulations using the X2 test of significance and Fisher's exact test of significance if expected cell frequencies in a 2 x 2 matrix were less than five. Numbers in some analyses were quite large and as a result there was a propensity in the data for many comparisons to be significant despite quite small effect sizes.

The Phi-coefficient or Cramer's V (in the case where one or both variables have more than two levels) provides an indication of thestrength of the relationship between two categorical variables. It was decided that a main effectwould only be reported if: p=<0.05 and the Phi coefficient or Cramer's V was 0.10 or greater. In this and all other reported analyses, Bonferroni adjustments to alpha levels were made to control for family-wise error rates in any post-hoc comparisons conducted. Comparisons between dichotomous or categorical variables and continuous variables were achieved through the use of univariate analysis of variance (ANOVA).

To ensure that reported differences were meaningful, an F statistic was considered significant if: p=<0.05 and the associated partial n2, an indication of the amount of variance explained by the relationship between the variables in the analysis, was 0.01 or greater.If both variables being compared were continuous in nature, a Pearson correlation coefficient was used to describe the strength of the relationship. Consistent with other analyses, a relationship wasconsidered meaningful if p=<0.05 and Pearson's r=>0.10.

3.5.2 Qualitative data

A number of questions were designed to collect qualitative data. Question 75 asked members to identify the nursing organization/s of which they were members and Q76 offered respondents the opportunity to identify what their professional organization could do for them with respect to information technology. Answers from these questions were collated and sent without further analysis to all the professional organizations to which respondents identified themselves as being members.

For the qualitative question (Q78: Are there any other comments that you wish to make about information technology in your workplace?) a thematic analysis was undertaken following standard methodology. Qualitative data from the surveys were transcribed verbatim and emerging themes and patterns of meaning were identified. Data were analysed using six cycles: content analysis, coding of texts, comparison through the process of indexing, re-analysis through text search, re-interpretation of the data, and re-confirming preliminary analysis. To increase the reliability of the emergent themes using the above analytical procedure, two experienced research staff conducted separate data analyses and compared the findings. The two research staff came to a consensus as to the emergent theme.

4.0 Research Schedule

Good research has a clear long term plan. A schedule establishes the timeline of tasks and responsibility. To achieve all the objectives that have been built, a plan was made. Plan contains a list of all the activities undertaken and the date of the tenure of an activity. The researcher build the Gantt chart as a time guidance. This study will take about 6 month to complete. The Gantt chart below will show the research schedule:-

Research title:	Barrier toward health information-seeking on the internet among Malaysian Nurses
m	Jan 2013				Feb 2013				March 2013				April 2013				May 2013
WEEKS	1	2	3	4	1	2	3	4	1	2	3	4	1	2	3	4	1	2
Preparing the research proposal
Application from ethic committee
Pilot study
Data Collection					5/2/
Data analysis								2
Writing research finding
Submission of project report book														13
Research presentation																23

(Total words : 4940)

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Malaysian Nurse Warrior

Thursday, May 24, 2012

KERJAYA JURURAWAT - HEMODIALISIS NURSE

MY UNDERGRADE ACTIVITIES- NURSING MANAGEMENT LEARNING MX TOUR TO VARIOUS HOSPITAL IN LEMBAH KLANG

my activities as a undergrade student in UM - lawatan ke KATSU

assignmnet to share 4- information seeking behaviour on the internet among malaysian nurses

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