Development and Validation of Information Technology Scale in Nursing

Abstract

Background  The implementation of information technology (IT) in patient care is on the rise. The nursing workforce should be prepared for using such technology to support the delivery of patient-centered care. The integration of informatics into nursing practice has been progressing at a slower rate than the development of advancements and in which areas nurses use IT is still not clear.

Objective  Our objective was to develop a new instrument to determine the usage of IT in nursing practice.

Methods  A methodological study was conducted with factor analyses. A total of 498 registered nurses in a university hospital ( n  = 374) and primary care centers ( n  = 124) participated in the study. A questionnaire consisting demographic characteristics and an item pool with 50 statements were used to collect data. The validity and reliability of the instrument were statistically tested by computing the Keiser–Meier–Olkin (KMO) and Bartlett tests, an exploratory factor analysis, descriptive statistics, Cronbach's α, and a confirmatory factor analysis.

Results  The instrument extracted eight factors comprising 39 items that explained 55% of the variance: professional autonomy(α = 0.82), data sharing/communication(α = 0.80), data management (α = 0.79), professional development (α = 0.71), administration (α = 0.76), research (α = 0.76), informing (α = 0.68), and classification of interventions (α = 0.75). Total reliability was 0.936. KMO index and a measure of sampling adequacy were high (0.936); the Bartlett test of sphericity was significant ( p  < 0.005).

Conclusion  Study provided the evidence for the factor structure, internal consistency, reliability, and responsiveness of the 39-item “The Information Technology Scale in Nursing.” Further testing of the developed instrument with a larger number of nurses from various backgrounds and different settings is recommended.

Introduction

Information technology (IT) is the use of computer systems or equipment and software to manage, process, save, and exchange data. 1 In the care setting, the implementation of IT is on the rise, as applying this technology to health care improves patient safety and quality of care, saves time, and reduces health care costs. 2 Increasing numbers of people with chronic diseases are challenging to health care costs. These people have many needs related to their diagnoses such as routine checks, medicine, knowledge about their disease, and being in touch with health care professionals. In addition, the complexity of diagnostic information has made the clinical decision-making process more difficult. Medical transaction charges are greater than they have ever been before, but IT has the potential to facilitate health care delivery by increasing the time spent on individual treatment or care and promoting the reduction of all medical costs. Thus, it has an important role to play in approaching many problems, such as in minimizing time spent on paper documentation. 3

Nowadays, computers, electronic health systems, and equipment are indispensable for health care professionals in the context of patient care. Using these systems also improves the clinical skills of nurses by emphasizing evidence-based practice and quality improvement approaches when it comes to providing safe and effective patient care, 4 thereby making the nursing workforce stronger. As the use of technological systems in nursing implementation increases, an important role has emerged for nurses with specialized informatics knowledge and skills for managing health care information also increase. Informatics is a science that includes the interaction between humans and IT, and nurses should be aware of the development stages of IT and informatics. Integrating technology into nursing practice and health care will be vital in enhancing the quality of medical interventions. 4 Indeed, the most important point in IT studies is to adopt a proactive approach; it has clearly been asserted in such studies that the nursing workforce should be prepared to work with IT to provide evidence-based nursing care. 4 5 Moreover they should be proficient and knowledgeable in informatics. At the same time, as the literature has shown, IT still cannot be used effectively in all nursing interventions and by nurses of all ages and specialties. 4 6 7

Previous studies that related to informatics have been limited to nurses' competency and focused on competency in using e-health devices, applied computer skills, and knowledge, 8 9 10 11 12 13 14 15 16 17 18 19 20 perceptions and attitudes of nurses, and so forth; however, no study has focused specifically on the utilization of IT. 21 22 23 24 25 26 27 The literature reviews cited above outlined the most important and widely discussed factors. Although competency and attitudes of nurses have been determined in this regard, evidence on the usage of IT in the nursing profession is scarce. It could be said that a valid and reliable tool used to reveal the utilization of IT in nursing practice has yet to be developed. Thus, it is clear that there is a need in this regard. In contrast with the literature, in this paper, we plan to reveal the areas of nursing practice in which IT is frequently used.

The aim of this paper is to create an instrument to determine the use of IT in nursing practice. With the current scale, areas in which nurses use IT less often can be identified, and suggestions, along with training programs, can be developed to address this problem in our country (Turkey). The scale can be disseminated by conducting validity and reliability studies in the languages of different countries and making it available for international use. The survey instrument is also intended to be used to influence nursing practice. This is the originality of our study that distinguishes it from the others which previously reported. Since no measurement tools with features similar to the current scale could be found in either national or international literature, no evidence regarding the research results could be observed.

Methods

Study Design and Participants

The present study has a prospective instrument validation and methodological research design. Of 500 targeted participants, 498 nurses participated in the main group for the application of the final version of the instrument. Nurses working in a university hospital and primary care centers in a province in Turkey were included. The location in which the study was conducted was the center of a province in the east of Turkey. With its up-to-date equipment and expert team in the region and surrounding provinces where it is located, the hospital was a health organization providing services in all branches of medicine, especially surgery and internal sciences, basic medical sciences, and diagnostics and imaging; the care centers were primary care examination centers where first interventions and diagnostic procedures are performed to protect individuals' health and diagnose their diseases. Participants were informed about the study process, purpose, and potential risks and benefits of the research, and issues of confidentiality, and their consent was obtained online.

Data Collection

Data were collected with an online questionnaire from January 10 to March 13, 2022. The questionnaire consisted of questions on descriptive characteristics, such as age, sex, marital status, education, the institution at which the participant worked, and an item pool with 50 statements about IT in nursing practice. Further details about the items are given in Table 1 . The reason such questions were asked is that existing studies have encouraged the idea that IT is related to a participant's sex, age, education, and institution. 26 27 28 In the existing literature, the number of samples in the studies of instrument development should be 5 or 10 times the number of statements in the item pool created. 28 29 30 31 Thus, the target sample was 500 nurses.

Table 1. 50 items of the instrument.

I use information technology…	Mean	SD	r	Cronbach's α if item deleted
1. To save personnel data of individuals	1.56	0.59	0.446	0.941
2. To access data of individuals	1.56	0.58	0.491	0.941
3. To archive personnel data of individuals	1.61	0.72	0.379	0.942
4. To provide secure data to individuals	1.61	0.60	0.512	0.941
5. To perform statistical analysis of data of individuals	1.63	0.64	0.550	0.941
6. To learn up-to-date information about my profession	1.53	0.57	0.456	0.941
7. To recall information about professional practices	1.52	0.53	0.373	0.942
8. To convey my professional knowledge to my colleagues	1.56	0.77	0.336	0.942
9. To learn up-to-date information peculiar to my profession	1.54	0.55	0.423	0.942
10.To provide individuals with up-to-date information	1.59	0.59	0.498	0.941
11.To provide individuals reliable information	1.61	0.57	0.460	0.941
12.To ensure that the education of sick and healthy individuals is understandable	1.63	0.58	0.476	0.941
13.in order for in-service training related to my profession to be effective	1.60	0.59	0.449	0.941
14.To increase the learning motivation of my colleagues in clinical training (by using visual equipment such as videos, photographs, etc.)	1.62	0.61	0.531	0.941
15.To receive education at international standards	1.67	0.65	0.478	0.941
16.To communicate with my national and international colleagues	1.76	0.68	0.487	0.941
17.To communicate with other members of the healthcare team	1.56	0.58	0.525	0.941
18.To enhance communication with individuals in the society	1.69	0.64	0.511	0.941
19. To increase communication between clinician and academician nurses	1.64	0.63	0.507	0.941
20.To provide documentary for research	1.63	0.61	0.588	0.941
21.for the use of individual data in scientific research	1.66	0.63	0.529	0.941
22.To collect data for research	1.63	0.58	0.549	0.941
23.To analyze collected data	1.62	0.61	0.596	0.941
24.To issue the results of research to the community	1.64	0.62	0.525	0.941
25.To share case presentations	1.68	0.64	0.595	0.941
26.To carry out the nursing process with evidence-based practices	1.63	0.60	0.575	0.941
27.To increase scientific data sharing	1.62	0.62	0.604	0.941
28.To plan individual care	1.65	0.61	0.558	0.941
29.To effectively use the International Nursing Initiatives Classification (NIC)	1.87	0.76	0.516	0.941
30.To effectively use the International Nursing Care Outcome Classification (NOC)	1.86	0.72	0.452	0.942
31.To increase the visibility of nursing care	1.62	0.60	0.546	0.941
32.because it provides increasing professional self-confidence in nursing interventions with evidence-based data	1.68	0.63	0.531	0.941
33.To increase application skills	1.66	0.64	0.533	0.941
34.To provide care for individuals by saving time	1.73	0.69	0.258	0.944
35. To establish a legal basis for the diagnosis and treatment process	1.66	0.58	0.482	0.941
36. To use the data of individuals ethically	1.65	0.58	0.552	0.941
37. To facilitate the process of providing information about treatment and care	1.70	0.62	0.529	0.941
38. To increase autonomy in my profession	1.68	0.60	0.500	0.941
39. To improve decision-making skills in my profession	1.66	0.61	0.506	0.941
40. To facilitate the management of nursing practice	1.63	0.61	0.492	0.941
41. To share the workload equally among my colleagues	1.72	0.65	0.469	0.941
42. To make shift plans fairly	1.75	0.73	0.452	0.942
43.To quickly assign my colleagues to relevant departments/units	1.73	0.69	0.481	0.941
44.To increase professionalism in the management of nursing services	1.68	0.63	0.448	0.941
45.To make use of educational opportunities in my profession	1.65	0.63	0.516	0.941
46.To promote academic career	1.72	0.84	0.434	0.942
47.To get promotion	1.72	0.71	0.525	0.941
48.To improve the mission and vision of nursing profession	1.67	0.65	0.518	0.941
49.To promote professional career	1.61	0.58	0.463	0.941
50. To support scientific data sharing				excluded

Conceptual Framework and Literature Review

The steps of the study design were conducted with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guide. 32 The purpose of this guide is to clarify the characteristics, terminology, and definitions of an instrument by reaching consensus among field experts on the desired subject, to standardize them and to classify appropriate measurement features to evaluate their results. 32 The COSMIN guide defines the approaches to be followed to develop an instrument that will measure a particular feature. We followed these approaches with a view of developing the present instrument. The American Association of Critical Care Nurses Essentials, Quality and Safety Education for Nurses, and Technology Informatics Guiding Education Reform-based measurement of nursing informatics competency, as well as the Guide of IT Considerations, were used as the framework to map out IT and to describe the components involved with implementing IT, the types of these systems, and the functional capabilities of a comprehensive health IT system. 33 34 35 The initial structure of the tool examined in this study was based on a framework of IT use by the nursing profession, and a nursing informatics instrument was chosen because this study sought to focus on IT usage that was specific to the nursing practice 34 35 36 37 and the advanced roles of nurses that were expected. The framework of the study was also created based on the advanced practice nursing roles that are defined in the literature, and it was expanded by adapting it to IT terminology. 38 A literature review was performed to assess recent instruments acknowledged as IT measurement tools to obtain a comprehensive viewpoint for developing the current assessment tools. Eligibility was based on the literature published in the past 15 years that focused on nursing informatics and IT. Of the initial 300 citations identified, 50 that were related to IT in nursing practice were deemed eligible. The PubMed, Web of Science, Google Scholar, and HealthSTAR electronic databases were searched to identify literature, including research articles, clinical trials, observational studies, and all other available articles without limitation on article type. National databases were also included in the search. The keywords used were as follows: nursing informatics, nursing information, informatics, informatics competency, and IT in nursing practice.

After searching the literature, the components of nursing informatics were identified. Then, an initial item selection was conducted to address major facets of the subject that have been found to be related to nursing practice. This approach produced an initial pool of 50 items rated using a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). This Likert scale was used by the 10 experts as they evaluated the items.

Field Testing of the Instrument

The items were disseminated to the experts (who held Ph.D. degrees) with different professional specialties, such as instrument development, public health, epidemiology, and statistics for recommendation. Ten experts evaluated a list of items derived from the literature review. The purpose of obtaining expert recommendations was to achieve a consensus regarding the construction of the instrument. The items were evaluated according to the four following options”: 1—not appropriate; 2—somewhat appropriate/the statement needs revision, 3—quite appropriate but minor corrections are required; and 4—very appropriate.” Then, the content validity ratios and content validity indexes (CVIs) of the instrument items were calculated.

To test the intelligibility of the items, a pilot study was conducted with 75 nurses in another hospital. This confirmed the accuracy, readability, and ambiguity of the preliminary questionnaire. The finalized instrument was applied to the original sample group, and the applicability of the instrument was tested using validity and reliability analyses.

Validating the Instrument

The compliance of the items was examined for factor analysis. The results supported that conducting factor analysis should be performed based on the results of the Kaiser–Meyer–Olkin (0.936) and Bartlett sphericity tests (×21485 = 9228.739; p  < 0.05). The “alpha internal consistency coefficient” test was used to test the reliability of the scale.

Principal component analysis (PCA), exploratory factor analysis, and confirmatory factor analysis (CFA) with varimax rotation were performed to test the validity of the instrument. The fitness index for the model fit test was confirmed. Standardized factor loading was used, and the significance of each item was checked for the extraction. After the data analysis obtained from the preliminary application of the draft scale, and application of the results, the instrument consisted of 39 items.

Ethics Committee Process

The present study was approved by the ethics committee board of Ataturk University Medical Faculty (Approval No. 04.03.21-41). The aim and concept of the study were explained to the participants, and data were collected from individuals who voluntarily agreed to participate. Once a prospective participant selected “I agree” on the consent form, it was possible for them to participate in the study. In addition, permission to conduct the study was obtained from the hospital management and provincial health department.

Results

Before conducting factor analyses the minimum value of the CVI for the 10 experts was clarified for 50 items. This value was presented in the literature as 0.62, 32 33 and based on this information, an item with a score of less than this was removed from the instrument construction. In addition, some experts suggested the exclusion of a relevant item because it was similar in meaning to another item. Based on this point, the phrase “to support scientific data sharing” was excluded from the study. With the contraction of the scale, it consisted of 49 items.

The content validity analysis resulted in a value of 0.80. In other words, the developed instrument measures 80% of the conceptual structure.

The mean, standard deviation, skewness, and kurtosis of each item were checked to determine the discriminatory power of each item. In the study, the KMO index and a measure of sampling adequacy was high (0.936); the Bartlett test of sphericity was significant ( p  < 0.005). With this result, it was identified that the draft instrument was suitable for factor analysis. This analysis was conducted on 49 items.

A procedure was followed to ensure that the factors were stable across the extraction and rotation methods. The results of validity and reliability testing indicated that five items (items 28, 33, 26, 12, 13) were not valid, with an item-total correlation ≤ 0.40. Two items (items 6 and 7) were not reliable with a value of 0.624. Finally, items: 21, 25, and 34 have created a dimension on their own. These 10 items were subsequently removed from the instrument. As a result of the factor analysis, the 39 items were associated with 8 factors and the factors explained 55% of the total variance. All loadings of the remaining items were above the traditional cut-off value of 0.40. They ranged between 0.46 and 0.81, and the exact ranges were as follows: factor 1, 0.560–0.645; factor 2, 0.575–0.638; factor 3, 0.627–0.759, factor 4, 0.520–0.625; factor 5, 0.648–0.710; factor 6, 0.644–0.699; factor 7, 0.458–0.738; and factor 8, 0.753–0.814.

In our study, the fit indexes of the scale are presented in Table 2 . Accordingly, all of the fit index values of the scale indicate that the scale has a good fit. These analyses show that the scale is a valid measurement tool.

Table 2. The acceptable and calculated fit indexes of the scale.

Acceptable fit indexes	Calculated fit indexes
χ 2 /SD < 5	1.793
GFI > 0.90	0.919
AGFI > 0.90	0.927
CFI > 0.90	0.916
TLI > 0.90	0.911
RMSEA < 0.08	0.071
RMR < 0.08	0.070

Abbreviations: SD, standard deviation; GFI, goodness of Fit Index; AGFI, adjusted goodness of fit index; CFI, comparative fit index; TLI, Tucker Lewis Index; RMSA, root mean square error of approximation; RAR, robust alternating regressions.

Cronbach's α reliability for the scale was acceptable for each factor. For professional autonomy, it was 0.826; for data sharing/communication, it was 0.806; for data management, it was 0.794; for professional improvement, it was 0.715; for administration, it was 0.760; for research, it was 0.765; for informing, it was 0.680; and for intervention classifications, it was 0.759. The total reliability of the scale was 0.936.

The results of the analyses revealed that the validity and reliability levels of the scores obtained by the application of the final version of the scale to the participants were high. The final version of the instrument with the 49-items resulted in an 8-factor, 39-item instrument.

Eight items (items 31, 32, 35, 36, 37, 38, 39, and 40) consistently defined were factor 1, called “professional autonomy” using both principal components analyses and maximum likelihood extraction methods, as well as varimax (orthogonal) rotations. Seven items (items 14,15,16,17,18,19, and 27) were defined as factor 2: “data sharing/communication,” the remaining factors were labeled as factors 3 (items 1,2, 3,4, and 5): “data management”; factor 4 (items 45, 46, 47, 48, and 49): “professional improvement”; factor 5 (items 41, 42, 43, and 44): “administration”; factor 6 (items 20, 22, 23, and 24): “research”; factor 7 (items 8, 9, 10, and 11): “informing”; and factor 8 (items 29 and 30): “intervention classifications.” These eight factors explained 55% of the total variance of the scale. Table 3 provides further details.

Table 3. Description of the factors of the instrument.

Factors	The number of the items	Items	Cronbach's α
Professional autonomy	8	31, 32, 35, 36, 37, 38, 39, 40	0.826
Data sharing/communication	7	14, 15, 16, 17, 18, 19, 27	0.806
Data management	5	1,2,3,4,5	0.794
Professional improvement	5	45,46,47,48,49	0.715
Administration	4	41,42,43,44	0.760
Research	4	20,22,23,24	0.765
Informing	4	8,9,10,11	0.680
Intervention classifications	2	29,30	0.759
Total scale	39	1–39	0.936

The factor structure compatibility of the scale was also tested using CFA. Descriptions of the 39 items are given in Table 4 along with their factor loading obtained from a PCA.

Table 4. Distribution of weight matrix of scale items data.

I use information technology …	Factors
	1	2	3	4	5	6	7	8
36. To use the data of individuals ethically	0.630
32. because it provides increasing professional self-confidence in nursing interventions with evidence-based data	0.619
38. To increase autonomy in my profession	0.607
39. To improve decision-making skills in my profession	0.596
37. To facilitate the process of providing information about treatment and care	0.585
40. To facilitate the management of nursing practice	0.581
31. To increase the visibility of nursing care	0.510
35. To establish a legal basis for the diagnosis and treatment process	0.490
15. To receive education at international standards		0.741
16. To communicate with my national and international colleagues		0.721
19. To increase communication between clinician and academician nurses		0.564
14. To increase the learning motivation of my colleagues in clinical training (by using visual equipment such as videos, photographs, etc.)		0.549
17. To communicate with other members of the healthcare team		0.485
18. To enhance communication with individuals in the society		0.475
27. To increase scientific data sharing		0.419
1. To access data of individuals			0.746
2. To archive personnel data of individuals			0.733
3. To provide secure data to individuals			0.689
1. To save personnel data of individuals			0.629
4. To perform statistical analysis of data of individuals			0.578
47. To get promotion				0.644
49. To promote professional career				0.622
48. To improve the mission and vision of nursing profession				0.541
46. To promote academic career				0.503
45. To make use of educational opportunities in my profession				0.470
42. To make shift plans fairly					0.745
41. To share the workload equally among my colleagues					0.686
43. To quickly assign my colleagues to relevant departments/units					0.628
44. To increase professionalism in the management of nursing services					0.581
10. To provide individuals with up-to-date information						0.713
9. To learn up-to-date information peculiar to my profession						0.652
11. To provide individuals reliable information						0.649
8. To convey my professional knowledge to my colleagues						0.579
24. To issue the results of research to the community							0.693
22. To collect data for research							0.678
23. To analyze collected data							0.555
20.To provide documentary for research							0.431
29. To effectively use the International Nursing Initiatives Classification								0.792
30. To effectively use the International Nursing Care Outcome Classification								0.787

Identification of Scale Factors

Professional autonomy: The usage for IT in increasing the visibility of nursing care and improving professional self-confidence and decision-making skills.

Data sharing/communication: The usage of IT for sharing scientific data and communicating with other members of the health care team, patients and healthy individuals, clinicians, or academicians.

Data management: The usage of IT in the recording, archiving, protection, and statistical analysis of the data of health care and caregivers.

Professional improvement: Whether nurses use IT for professional development and academic careers.

Administration: Whether nurses benefit from IT in management, such as task sharing, shift planning, and assignment.

Research: The usage of IT by nurses for data collection, research, analysis, and delivery information to society.

Informing: Whether nurses use IT to inform their colleagues, or other individuals on health-related issues or in education.

Intervention classifications: The usage of IT for the international Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) in health care.

Description and the Analysis of the Instrument

None of the scale items were reverse scored. The total scale and the factors were scored as arithmetical means. A cut-off value was not identified. Increasing scores (the scores higher than the mean) indicated that the usage of IT was high. In correlation analyses, a significant, negative, and weak correlations between “age” and “professional autonomy” ( r  = −0.098*, p  = 0.030), “data management” ( r  = −0.103*, p  = 0.022), and “research” ( r  = −0.090*, p  = 0.045) were detected ( p  < 0.05).

Findings Related to the Correlation Between the Scale and Demographic Characteristics

In our study, 374 (75.1%) nurses were working in the hospital and 124 (24.9%) were working in primary care centers, and 305 (61.2%) were female. The average age was approximately 31.45 ± 5.93 years. Most nurses ( n  = 323, 64.9%) held a bachelor's degree, and 273 (54.8%) were married. According to the correlation analyses, there was a significant difference between “sex” and “professional autonomy” ( t  = −2,059; p  = 0.040). Male nurses had higher scores. A statistically significant difference between “marital status” and “professional autonomy” was found. Based on this finding, married nurses had lower scores ( t  = −2.045; p  = 0.041) compared with single nurses. There was a statistically significant difference between the mean scores of the subdimensions and “education” ( p  < 0.05), except “management.” Postgraduates had higher scores. The mean score for “intervention classification” ( t  = 4.165, p  = 0.000) and “institution” showed a statistically significant difference. Nurses working in hospitals had higher scores.

Discussion

The aim of the current study was to create an instrument to determine the usage of IT in the nursing profession. The sample was consisted of nurses who had different specialties. In the study, the highest reliability levels were found for “professional autonomy” (0.826) and “data sharing/communication” (0.806), while the lowest was found for “informing” (0.680). This may have been to the fact that respondents could not reconcile the concept of benefiting from informatics and informing; on the contrary, they found the concepts of professional autonomy, data sharing/communication and IT to be related. The potential reason for this finding could be the lack of understanding of the content of the “informing factor.” This may have resulted in less use of this technology, when providing up-to-date and reliable information to individuals and conveying the knowledge to colleagues.

Furthermore, the high consistency and reliability levels of the statements in the whole instrument and in the sub-dimensions may have stemmed from the comprehensibility of the items and statements, as well as the overlapping of the concepts of IT and nursing.

The correlation analyses, revealed that age affected the usage of IT. Especially, there was an inverse relationship between age and IT usage. In the correlation analyses, male nurses, single nurses, postgraduates, and those working in the hospital used IT more than others did. In some of studies regarding the use of IT among nurses, age and education have been identified as effective factors, as they were in the present study. 36 37 39 At the same time, Eley et al stated that age can never be an obstacle to the use of technology. 40

In our study, nurses working in primary care centers used NIC and NOC initiatives less. As described in other studies, nurses working in hospitals and in private units, such as intensive care, use IT more. 41 42 This finding of our study was consistent with the findings reported in the literature.

In present study, men used IT more than women did for professional autonomy, decision-making, and for raising the visibility of care. Single nurses used IT more in career decisions, and postgraduates used it more than others did. In contrast with these findings, in a previous study, Akyol et al indicated that sex did not affect the use of informatics. 43 This difference in results may have stemmed from differences in the units in which the studies were conducted.

In our study, some of the information gleaned from the survey was novel. For example, as expected, intervention classifications related to NIC and NOC initiatives were more frequently used in hospital; however, what was unexpected was that male nurses used IT more in clinical practice than female nurses did. It was noteworthy that, in nursing, which has been a female-dominated profession for many years in our country, male nurses were more prominent compared with female nurses when it came to increasing the visibility of the profession. Utilizing IT as a tool and understanding its clinical implications are essential aspects of nursing practice.

Limitations

Despite its strengths, this study had some limitations. The study participants were restricted to one state university and primary care centers in the east of Turkey, which may limit the generalizability of the findings. The use of IT was measured using nurses' self-reporting, not their actual knowledge, skills, or behaviors. Therefore, the actual use of IT by nurses' may be lower due to over-reporting because of the tendency for them to describe only their desirable attributes. In addition, the findings of the study might not be representative of the broader population of nurses across the country or nurses in different cultural or regional contexts.

Since the developed instrument is new and specific to the country, its validity and reliability in other cultural or geographical settings have not yet been tested. Furthermore, the study relied on online data collection, which might have introduced selection bias. Nurses without access to the online platform or those who are not tech-savvy might be underrepresented and the study's findings are based on self-reported data. There is potential for recall bias, social desirability bias, or misinterpretation of questions by participants. In addition, we chose to measure the use of IT (5-point Likert scale method) according to the suggestions of experts to whom items were sent to be evaluated. This might also be noted as a limitation for our study.

Conclusion

The findings of the study showed that the “Information Technology Scale in the Nursing Profession” is valid and reliable. As a project, this study revealed how often and in which units or areas nurses do and do not use IT. According to the results, it is possible to carry out interventions in these areas, such as education programs in college schedules or clinics. Further testing of this newly developed instrument with a larger number of nurses from various backgrounds and different settings is recommended.

Clinical Relevance Statement

This study used a newly developed instrument with the aim of clarifying areas in which nurses use IT.

Multiple-Choice Questions

1. What equipment is indispensable for health care professionals in patient care?

   1. Computers

   2. An electronic health system

   3. Equipment related to information technology

   4. All of the above

   Correct Answer: The correct answer is option d. Health care environments are increasingly implementing IT, and professionals must be competent to use IT and it's all its equipment to increase the quality of care.

2. What is the first step in developing a measurement tool first?

   1. Literature search for the theoretical stage

   2. Validity testing

   3. Reliability testing

   4. Producing an initial pool of related items

   Correct Answer: The correct answer is option a. It is essential to have knowledge related to the main purpose of a study before developing an instrument. A literature search is the first step in gaining knowledge about the basis of the study.