FEATURE ARTICLE
Perceptions and Experiences of Hospital Nurses During
Transition to an Electronic Handover Informatics System
Chia-Lun Lee, MSN, RN, Wei-Ting Lin, PhD, RN, Shu Yuan Lin, PhD, RN
An effective patient transfer, or handover, among healthcare
professionals can help prevent communication-related med-
ical errors, and a reliable electronic handover informatics
system can standardize the handoff process. Adapting to a
new handover system may cause stress for nurses. This de-
scriptive qualitative study aimed to explore the perceptions
and transition experiences of hospital nurses in adopting
and adapting to a new handover informatics system. Thirty-
eight nurses at a medical center in Taiwan participated
in the study from December 2016 to January 2017. The re-
searcher conducted five focus group interviews and analyzed
all responses using content analysis. Results showed three
major themes: “Perceptions of challenges and barriers related
to the transition to a new handover informatics system,”
“Perceptions of benefits and strategies to the transition to
a new handover informatics system,” and “Suggestions
for successful implementation of a new handover informat-
ics system.” Five subthemes emerged from the first theme,
and six subthemes emerged from the second theme. The re-
sults of this study could enhance our understanding of nurses'
perceptions and experiences with transition to a new hand-
over informatics system and could provide a reference for
hospitals to develop individualized strategies to facilitate
the implementation of a handover informatics system.
KEY WORDS: Informatics system, Shift handover, Transition
“I
mproving communication and safety for patient hand-
over” and “Promoting the effectiveness of communica-
tion among healthcare professionals” were declared as
national goals of patient safety by the Taiwan Joint Com-
mission on Hospital Accreditation (TJCHA) in 2006.1 A
good patient transfer, or handover, can help prevent com-
munication errors to ensure patient safety.2,3 Studies have
shown that handover via electronic technology can integrate
and disseminate patient information more efficiently and
Author Affiliations: Kaohsiung Medical University Hospital (Ms Lee and Dr S.Y. Lin) and School of
Nursing (Ms Lee and Drs W.T. Lin and S.Y. Lin), Kaohsiung Medical University, Kaohsiung, Taiwan.
The authors have disclosed that they have no significant relationships with, or financial interest
in, any commercial companies pertaining to this article.
This research work was supported by research grants from Kaohsiung Medical University Hospital
(KMUH104-M401), Taiwan.
Corresponding author: Shu-Yuan Lin, PhD, RN, Kaohsiung Medical University, No. 100, Shih-Chuan
1st Rd, Siamin District, Kaohsiung City 807, Taiwan (m845008@kmu.edu.tw).
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/CIN.0000000000000554
Volume 37 | Number 11
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
accurately.4–7 The development of electronic handover in-
formatics systems (HISs) has been slow compared to the im-
plementation of electronic medical records (EMRs) for diagnosis,
prescription, and laboratory tests in Taiwan hospitals. Only
10% of 10 medical centers had totally completed computer-
ized nursing handover information from 2009 to 2015.8 Ad-
vancing computer and informatics technology and legislation
regarding EMR use announced in Taiwan have accelerated
the use of EMR and HIS,9 although challenges and barriers
still exist for nurses during implementation in hospital set-
tings. In this study, we explored the perceptions of hospital
nurses when they experienced a transition to a new HIS,
and we present the current body of knowledge related to
handover and HIS issues.
Defining Common Handovers and Electronic Handover
Informatics Systems
Patient transfers are the most frequent occurrence among all
healthcare activities. It is defined as a transfer of responsibility
and accountability for patient care to another person or pro-
fessional team.10,11 Handovers frequently occur under circum-
stances such as nurses' shift transfer on each ward, nurse-to-nurse
interdepartmental transfers, and patient transfer between dif-
ferent professionals,12,13 and involve delivering patient care
information, providing education, building social relationships
with peers or colleagues, and demonstrating organizational
safe culture.14
The common methods of handover include oral commu-
nication, documented information, taped records, and elec-
tronic technology.15 The handover delivered through an
electronic informatics system that consists of minimum data
sets of patient medical information and a nursing plan is
called HIS.8 To promote safer handovers, the TJCHA called
for redesigned handover methods. Several projects have been
conducted to evaluate outcomes of HIS use in Taiwan hospi-
tals, and these projects have reported consistently that imple-
menting the HIS could reduce handover time per patient by
1.1 to 4.5 minutes and increase the handover completion rate
by 18.8% to 58.4% compared to the use of the oral handover
method.16–19 Other projects found nurses' satisfaction about
HIS had increased by 19.3% to 50.0% after replacing oral
and document-assisted handover.16,18,20 Implementing the
HIS could increase handover behaviors by 92.8% among
interdisciplinary professionals in the oral surgery ward and
CIN: Computers, Informatics, Nursing 591
FEATURE ARTICLE
increase the handover completion rate by 15.2% between
interdisciplinary transfers for emergent operation cases.21,22
Consequently, the evidence supports the idea that HIS could
promote effectiveness of handover procedures between nurses
or different professionals. However, the barriers and challenges
to effective handover procedures or using HIS have raised
further concerns.
Barriers and Challenges to the Implementation of
Electronic Handover Informatics Systems
Nurse- and computer-related problems in the implementa-
tion of HIS have been reported.23,24 When nurses have inad-
equate computer skills and technical assistance, they prefer to use
the traditional handover method rather than the HIS.2,7,23,25
Nurses also complain about time consumed by training, the bur-
den of dealing with electronic information, and the extra work-
load and responsibility during a transition to the new handover
method.26,27 Nurses report computer-related barriers including
slow speeds of devices and Internet service, time consumed
by logging on and off, difficulty finding information from
other disciplines, and having too much information on one
Web page. Furthermore, inadequate devices, the incomplete
informatics system, and unmet nurses' needs in HIS design
and function would decrease nurses' acceptance of HIS.13
Other barriers are worthy of concern. First, the lack of
standardized handover format or process manual may cause
breakdowns in communication and decrease staff acceptance
of HIS.9,26 Second, dual-handover methods used concurrently
might cause further staff burden and delay acceptance of the
new method.15 Third, nurses and physicians may rely on dif-
ferent sections of EMRs leading to communication problems
such as delivering overlapping information, ignoring pa-
tients' real conditions, and increasing communication er-
rors.28 Therefore, understanding nurses' perceptions and
barriers regarding adoption of HIS should be the first step
to promote acceptance of HIS.
Benefits and Strategies to the Implementation of
Electronic Handover Informatics Systems
A reliable HIS provides regular and timely patient information
that enables nurses to capture a patient's condition and improve
compliance with the plan of patient care.5,13 Taiwanese nurses
have reported five benefits of using HIS: “HIS assists me to
deliver a good handover,” “HIS enhances teamwork and capa-
bility for patient care,” “HIS makes the handover easy,” “HIS
saves handover time,” and “HIS enables me to learn from other
persons.”29 Other benefits of implementing HIS were to en-
hance the climate of team resource management, handover
consistency, and use of HIS among interdisciplinary profes-
sionals.20,22 Positive outcomes of implementing HIS included
an increased handover completion rate, an increase in nurses'
satisfaction, and a reduction of handover time.16–20,22
592 CIN: Computers, Informatics, Nursing
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Managers of nursing departments should apply strategies
to strengthen the computer competencies of nurses, provide
educational guidance, and meet staff needs regarding design
functions of computer systems and Internet speed to encour-
age successful HIS delivery.30,31 Developing a standardized
operating protocol, a framework for a minimum handover
data set, and standardized handover tools could all enhance
effective use of HIS.3,28,32 Training handouts and a compre-
hensive guidebook should be provided for learners and for
trainers before introducing a new HIS.23,33 When nurses feel
satisfied about high-speed Internet service, easy access to In-
ternet, and the setup of the HIS, they show positive attitudes
about using it.24,34
Using informatics and technology in handover delivery to
improve patient safety and care quality is a global focus.
However, introducing a new HIS could be a stressful event
for nurses in hospitals. Lack of a staff-centered implementa-
tion plan, ignorance of nurses' perceptions, and inadequate
support for informatics and technology can decrease or delay
nurses' acceptance of HIS. Consequently, this study aimed to
explore the perceptions and transition experiences of hospi-
tal nurses in adopting and adapting to a new HIS.
METHODS
Study Design, Settings, and Participants
This descriptive qualitative study describes and analyzes the
transition-related perceptions and experiences of nurses in a
medical hospital in Taiwan. To increase trustworthiness of
the study, criteria of credibility, dependability, transferabil-
ity, and confirmability were adhered to in design, sampling,
data collection, and analysis.35 To enrich the data and maxi-
mize sample representation, the convenience sampling method
and one inclusion criterion were used to recruit nurses in the
study. Participants were nurses who needed to deliver a hand-
over via HIS during shift changes. The researcher announced
recruitment information at the head nurses' meetings, and head
nurses introduced study information to staff nurses. Thirty-one
full-time nurses and seven head nurses from 32 units voluntarily
participated in the study. All participants were females with
ages ranging from 23 to 50 years with a mean of 12 years of
experience (Table 1). Participants worked at ICUs (23.7%),
medical-surgical units (39.5%), and other units. Nearly 82%
of participants were N2 and N3, which represented the distri-
bution of nursing clinical ladder in the study setting. Five focus
groups were held from December 2016 to January 2017. The
HIS used in this study was designed by the information tech-
nology (IT) department of the hospital in 2014, and it had
undergone several minor modifications.
Instrument
A semistructured interview guide was developed based on
literature review and research purpose. The adoption of
November 2019
Table 1. Characteristics of Participants the transcribed content word-by-word, revisiting the raw data
as many times as needed to gain insights and to note emerging
Items n % Mean ±SD Range
ideas on the transcribed paper. The themes, subthemes, and
Age (y) 35.5 ±7.8 23–50
extracted sentences were written in Mandarin; a person who
Working years 12.0 ±7.8 1–28
was proficient in Mandarin and English translated these.
Gender
Female 38 100.0
The two authors cross-checked these translations to ensure
Job title their correctness and appropriateness. To increase confirm-
Head nurse 7 18.4 ability, they further analyzed the data deductively by hand
RN 31 81.6 and formulated descriptive coding for content analysis
Working unit separately.38 Then, they applied the coding items to all
ICU 9 23.7 transcribed content and independently classified the cod-
Medical ward 8 21.1 ing items into major themes and subthemes; finally, they
Surgical ward 7 18.4 cross-checked the themes and recoded the transcribed
Others 14 36.8 contents with mutual agreement.37 The themes and the
Clinical ladder most representative sentences were chosen, and English
N 1 2.6 translations were finalized based on consensus of the two
N1 2 5.3 authors. Frequency analysis verified descriptive themes
N2 15 39.5 by counting and summing up the numbers of sentences
N3 16 42.1 representative of each subtheme appearing in contents.39
N4 4 10.5 To enhance transferability, analytic results were interpreted
with caution, and the characteristics of the study sample and
research setting were considered; limitations of generaliz-
an HIS is perceived as a stressor that may outweigh a
ability in the study were also stated.37
nurse's ability to cope, and this change will facilitate a
This study was approved by the institutional review board
transition process in which individual behavior and role
of the study hospital. Researchers informed all participants,
function adapt to new circumstances.34,36 The interview
and they signed a consent form prior to the focus group inter-
questions inquired about nurses' perceptions of and experi-
views. To protect the participants' privacy and confidentiality,
ences with their transition process and adaptation to HIS.
only the researchers could use the recorded information. All
Example questions are listed on Table 2.
transcribed content was assigned to aliases.37
Data Collection Procedures
Each focus group consisted of seven or eight nurses. Every RESULTS
nurse was interviewed once and assigned to one focus group Frequency and Major Findings of Themes
based on their work units. For example, nurses working in Three themes emerged from content analysis (Table 3). In
medical and surgical wards were assigned to the same group. Table 3, frequency indicates the number of times mentioned
Nurses from ICU or gynecological and pediatric wards par- by nurses across content relevant to themes and subthemes.
ticipated in another two groups. Each focus group interview The most frequently appearing theme was “perceptions of
was conducted for around 90 minutes without interruption. challenges and barriers related to the transition to a new
Focus group interviews were held in rooms with privacy and HIS.” There were five subthemes subordinate to it (Table 3),
low noise. One head nurse trained in qualitative methods with the major findings presented as follows.
and experienced in focus group techniques moderated the
five focus group interviews. Table 2. Interview Example Questions
Data Analysis Transition process Questions
To increase credibility, all interviews were voice-recorded, Perceptions of Example questions: Can you talk about your
and the recorded contents were transcribed verbatim to implementing HIS feeling or thought about the HIS? Can you
written documents. The first author facilitated focus group talk about the difficulties and challenges to
implement the HIS?
interviews, made observation notes during the process, and
Coping strategies Example questions: Can you describe the
checked the accuracy of the transcribed content using tapes strategies used to deal with difficulties and
and interview notes. We also invited the participants to pro- challenges while implementing the HIS?
vide feedback about the developed themes and interpretations Adaptation Example questions: Can you talk about your
of meanings to cross-validate the results.37 To enhance de- experience experience of adopting the HIS? What kinds
pendability, the first author and corresponding author read of support do you have?

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FEATURE ARTICLE

Table 3. Frequency of Themes and Subthemes

Themes/Subthemes Frequency Percent
Perceptions of challenges and barriers related to the transition to a new HIS 167 52.5
Mismatch between HIS design and nurses' needs and expectations 62 19.5
Changes in handover delivery method 34 10.7
Insufficient technical support 33 10.4
Nurses' emotional insecurity and emotional stress 21 6.6
Nurses' insufficient competency and training 17 5.3
Perceptions of benefits and strategies to the transition to a new HIS 138 43.4
Convenience of using the HIS 57 17.9
Comprehensiveness of an HIS 24 7.6
Tools to complete informatics handover 21 6.6
Policy compliance 14 4.4
Simultaneous use of the HIS and existing handover methods 13 4.1
A standardized handover delivery system 9 2.8
Suggestions for successful implementation of a new HIS 13 4.1

Perceptions of Challenges and Barriers Related to the
Transition to a New Handover Informatics System
Mismatch Between Handover Informatics System Design
and Nurses' Needs and Expectations
The content and design of the HIS were the most important
concerns of the study participants. At the beginning of the
HIS implementation, participants thought that the content
design of the HIS did not match their needs. F1 N1 (ie, focus
group 1, nurse 1) said, “We did not want to use the system be-
cause the content was not very comprehensive.” F1N2 said,
“We found the system was unfriendly to use or navigate.
Therefore, we were not willing to use it.” F5N1 said, “The de-
sign of the system should be compatible with the nurses'
needs and make it easier to use in clinical situations in or-
der to shorten the work time.”
Changes in Handover Delivery Methods
At the beginning of the HIS implementation, participants
expressed concern about stress related to changes in handover
methods. They reported that they had difficulties in following
the HIS format, which differed from writing up a report in
their own way. They also thought that the HIS was inconve-
nient and that a paper document was a more appropriate tool
for handover delivery. F1N5 said, “Originally, it was hard to
implement the system due to differences in logic and habits in
writing handover papers. Now I have to adjust my own logic
of organization in order to match the HIS format.” F2N6
said, “It was really different to change the handover method
from paper documents to the HIS in the beginning.” F4N2
said, “When we used paper documents to hand over informa-
tion between different shifts, we could flip through the docu-
ments and find the information we needed instantly. It was
more convenient.” F4N3 said, “It was very inconvenient to
select the right patient and wait until the right page came
up in the HIS.”
Insufficient Technical Support
Some participants noted that the computer equipment
and Internet speed did not adequately support the perfor-
mance of the HIS, especially for a large amount of patient
data. There was often a lag between the function pages.
F4N3 said, “Sometimes I feel like the system is really slow,
especially when there is a large amount of information
stored for patients with long hospital stays. I found it was
hard to use in the beginning.” F4N5 said, “It takes so
much time to switch between different function pages.”
F3N7 said, “Every time you change from one function page
to another, not only does it take a long time, but it can also
cause frequent crashes.” F2N3 said, “Computer crashing
is a big issue, especially considering how often it happens.”
F5N4 said, “Problems with the Internet connection really
bothered me.” Furthermore, support from the IT depart-
ment was insufficient. F5N2 said, “Sometimes it takes as long
as a week to have the system problem fixed.”
Nurses' Emotional Insecurity and Emotional Stress
The participants recalled many disagreements and negative
emotions at the beginning of the HIS implementation. Some
participants felt that it was unsafe to deliver handover infor-
mation through the HIS. F1N7 said, “I felt insecure about
the absence of the actual paper document.” Some nurses also
were concerned about information security and loss of patient
information. F4N3 said, “In the beginning, a lot of informa-
tion was lost during the handover between shifts.” F1N8 said,
“When the HIS was first implemented, the entire unit was op-
posed to it. We talked openly about our disagreement with

594 CIN: Computers, Informatics, Nursing November 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

its implementation because we really felt that abandoning
paper documents was neglecting patient safety.”
Nurses' Insufficient Competency and Training
The participants reported that they were not familiar with
the functions of the HIS and were unable to operate it cor-
rectly at the beginning when the HIS was first being imple-
mented. F1N3 said, “It is true that people did not make
maximal use of the HIS. Sometimes we didn't make full
use of this system because we were not aware of certain func-
tions.” Inconsistencies of handover demands between staff
and cross units were disturbing to nurses. F1N8 said, “Other
units would ask us to use paper documents for handover deliv-
ery. Some units still used the old methods for handover.” The
participants mentioned that the nursing department offered
courses and some trainers for the HIS, but trainers' roles
and functions did not play well. F5N3 said, “Every unit has
its own HIS trainer. However, they do not seem to function
properly. I don't think they have achieved their purpose.”
Perceptions of Benefits and Strategies to the Transition to
a New Handover Informatics System
The second most frequently addressed theme was “percep-
tions of benefits and strategies to the transition to a new
HIS.” Six subthemes were subordinate to it (Table 3).
Convenience of Using the Handover Informatics System
Participants realized the benefits of the HIS as they became
more familiar with it. Some participants agreed that the HIS
had become convenient and time-saving because it reduced
paperwork and time for preparing and delivering handover.
F5N6 said, “We used to spend a lot of time copying and
printing patient information on paper documents. In the
transition to the HIS, although it took some time to adjust,
we now spend much less time copying and printing patient
information.” F2N2 said, “The first thing my colleagues do
is to check the HIS when he or she comes to work, which
reduces the time for handovers.” F5N6 said, “One advan-
tage of the HIS is that you can see the prescription orders.
You do not need to wait for a paper copy.” F3N1 said, “In
the process of the handover, you can open different func-
tion screens at the same time. When you complete one
part, another part has been prepared. That can save a lot
of time.”
Comprehensiveness of a Handover Informatics System
The participants mentioned the HIS had undergone several
improvements and made it more comprehensive and efficient.
F1N1 said, “Compared to the original version of the HIS, the
structure and design of the current HIS version make it
much more comprehensive. I can find any information I
need in the HIS.” F2N6 said, “I am pretty confident with
Volume 37 | Number 11
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
the new HIS version. The system is operating much more
smoothly now, as it has been updated many times. The HIS
can directly link to patient information, such as diagnosis,
surgery, consultation, examination, and laboratory data. It
really decreases the workload for collecting information.”
F3N4 said, “The HIS shows patient information systemati-
cally from admission to physical assessment, including inter-
disciplinary information. The content is very complete.”
Tools to Complete Information Handover
Some units found additional uses of the HIS and developed
their strategies to complete information handover delivery.
F3N3 said, “We make good use of the HIS. There are some
spaces on the HIS screen where you can type anything you
have done or important patient information in the spaces.”
F4N2 said, “Initially, our unit added a handover supplement
tool that was to put a whiteboard in every patient room. We
wrote down information necessary for the next shift nurse.”
Policy Compliance
Participants recalled that the compliance policy forced them
to use the HIS. F2N1 said, “The way it works in our unit is
that, once the head of the department gives the order to act,
you can only follow it and must remove the paper document
from handover delivery immediately. You can only force
yourself to use the HIS.” F3N4 said, “This is really a matter
of changing habits. Therefore, I understand why the policy
change was so forceful.”
Simultaneous Use of the Handover Informatics System and
Existing Handover Methods
Participants used both the HIS and paper documents simul-
taneously to deliver handover information at the beginning of
transition. Although they still wrote some notes, they eventu-
ally transitioned to the sole use of the HIS. F2N2 said, “We
used the two methods simultaneously. We are still very depen-
dent on using paper documents.” F2N4 said, “Initially, we
still wrote handover notes by hand and transferred the in-
formation to the HIS afterward.”
A Standardized Handover Delivery System
The participants concluded that having a standardized
handover delivery method assisted them through the transi-
tion process. The benefits of the HIS are that it employs stan-
dardized handover content and uses common language
among the nurses. F5N2 said, “Everyone does handovers
based on the design of the HIS, which is a lot more standard-
ized.” F5N6 said, “With the HIS, we have a common lan-
guage. We have no need to repeat anything as we can
understand each other by looking at the same page on
the system.”
CIN: Computers, Informatics, Nursing 595
FEATURE ARTICLE
The HIS provides a communication platform for the units
and interdisciplinary professionals to communicate with each
other. F1N2 said, “The HIS really helped nursing staff with
these areas where they locate data, communicate for hand-
overs, or integrate information between departments.” F4N2
said, “I think there are a lot of benefits of the HIS. Following
the steps of the HIS, we won't make any mistakes related to
the handover information. Even when the nursing staff is really
tired or accidentally mishears information, the HIS will still
show the necessary information.”
Suggestions for Successful Implementation of a New
Handover Informatics System
The study participants also made some suggestions during
the interviews. The participants expressed that setting up
HIS trainers in units is a great idea, but the important con-
cern is how to determine their roles and functions. Partici-
pants also suggested that cross-unit and cross-staff learning
could be another effective method when implementing a
new HIS. F1N5 said, “I think that carefully selecting the
HIS trainer for a unit is really important. A good HIS trainer
can facilitate the implementation of the HIS in the units.”
F1N6 said, “Cross-unit training is helpful too. They can es-
sentially learn from each other about using the system.”
The participants suggested the institution should include
nurses (users) in designing the information system so that
users could help to develop content based on the users'
needs. Another suggestion was that the institution should
provide direct contact personnel who could respond to
nurses' questions and solve their problems.
DISCUSSION
This descriptive qualitative study explored the perceptions
and transition experiences of hospital nurses who were intro-
duced to a new HIS. The results presented two frequently
appearing themes, “perceptions of challenges and barriers
related to the transition to a new HIS” and “perceptions of
benefits and strategies to the transition to a new HIS.” These
findings showed most participants experienced many chal-
lenges at the beginning, and they perceived advantages of
HIS afterward that helped them to adopt HIS during the
transition. Ultimately, they used HIS with more confidence
and were able to offer suggestions as the third themes show.
The major challenge or barrier mentioned across focus
groups was “mismatch between HIS design and nurses' needs
and expectations.” Next common barriers were “changes in
handover delivery method” and “insufficient technical sup-
port.” These results echoed the literature in that the acceptance
of an HIS among nurses may be influenced by nurse-related
and computer-related factors.23,24 In our study, participants
emphasized more computer-related barriers than nurse-related
barriers at the beginning of implementing HIS, just as
596 CIN: Computers, Informatics, Nursing
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
the literature indicated that computer efficiency and the
integrity of patient information could influence nurses' willing-
ness and confidence in using an HIS.23,24 Therefore, strategies
to enhance a match between HIS design and nurses' needs
and expectations suggested by our study findings include an
involvement of users in HIS design process, an offer of contact
personnel for technical support, supply of adequate computer
equipment, and reliable Web services. The nurses cited two
nurse-related barriers: “nurses' emotional insecurity and emo-
tional stress” and “nurses' insufficient competency and training”
that were worthy to note in this study. Nurses' emotional inse-
curity and stress could appear because of their unfamiliarity
with a new system. This unfamiliarity may result in loss or igno-
rance of pertinent information that might endanger patients.40
Therefore, nurses feel safe by using documented reports to
complete HIS handover at the beginning. Our study results
were consistent with previous literature that showed when
users lack computer experience, have low informatics literacy
and inadequate training, and have difficulty in seeking help,
optimal use of the HIS is hindered.30,41 The participants in
this study also provided suggestions for successful implementa-
tion of an HIS. Particularly, hospitals should provide an HIS
guidebook or users' manual and offer training courses to assist
all nurses to become familiar with the comprehensive func-
tions of the HIS prior to its implementation.33 An additional
strategy is that administrators should provide continuing educa-
tion by cross-unit and cross-staff training to enhance nurses'
computer competency.23
The second most frequently reported theme was “percep-
tions of benefits and strategies for the transition to a new
HIS.” Two most frequently addressed benefits were “con-
venience of using an HIS” and “comprehensiveness of an
HIS.” After implementing the new system for a while, nurses
perceived the benefits related to an HIS such as its conve-
nience, efficiency, comprehensiveness, and accuracy that en-
couraged them to use HIS. This result is similar to previous
studies in which an effective HIS promoted good communi-
cations among nurses and made the handover delivery
much smoother.4,6,7
Other frequently mentioned strategies and benefits were
“tools to complete informatics handover,” “policy compli-
ance,” “simultaneous use of the HIS and existing handover
methods,” and “a standardized handover delivery system.”
Nurses initially developed their own strategies to compen-
sate for the disadvantages of HIS until the system gradually
met the users' needs. These coping strategies included mark-
ing down necessary information on supplemental tools or
additional space on HIS and nurses using written records
simultaneously to complete the HIS. Some nurses in this study
said that they had a strong motivation or willingness to use
the HIS; however, inconsistencies in the delivery demands
between nurses or units became an obstacle. Although HIS
November 2019
is designed to standardize the handover process,3 inconsis-
tencies in handover procedures between nurses or units were
common barriers found in our study. The nurses suggested that
hospitals unify HIS practices among nurses and across cross
units, and this is echoed in the literature.7,31
For compliance policy, the head nurses in some units
forced their staff to use the HIS immediately upon its imple-
mentation without an alternative choice, which shortened the
transition process. As the literature indicates, nurse managers
are the key persons who can strongly influence the adoption of
a new informatics system.42 According to these nurses' reports,
we found that it was difficult for nurses to integrate their indi-
vidual routines with the HIS at the beginning even if the pol-
icy forced them to use the HIS. Nurses would be more willing
to accept a new HIS if they had input in its design, sufficient
staff training, reliable computer equipment, a high-speed In-
ternet connection, and good cooperation between the nursing
and IT departments.23,24
Recommendations for Future Research
Future research could develop tools to assess nurses' percep-
tions, adaptation, computer competency, and education needs
before and after using a new HIS. Strategies for enhancing
nurses' adoption of HIS that should be tested based on our
findings were establishing a standardized handover delivery
procedure, setting up HIS trainers in units, and administer-
ing cross-unit and cross-staff training prior to implementa-
tion of HIS. The education plan is innovative for practice,
but determining trainers' roles and functions at the begin-
ning is especially recommended.
Limitations
Our study was limited in descriptive purpose and having
only female respondents, but the design and analysis were
conducted with rigor. Participants were recruited from dif-
ferent working units, but they all worked in the same hospi-
tal. Our findings are considered limited on transferability
due to the differences of culture and policy cross-healthcare
settings, particularly in different countries.
CONCLUSIONS
This study's findings provide a good reference for better un-
derstanding nurses' perceptions and adaptation strategies
during their transition to using a new HIS. The results reveal
important aspects of challenges, barriers, and benefits of
using the HIS and suggestions for the successful implementa-
tion of a new HIS. Our study suggests the implementation of
effective strategies to enhance a match between HIS design
and nurses' needs, increase nurses' competency and emo-
tional security, and establish a standardized handover de-
livery method to facilitate nurses' adoption of the HIS.
Volume 37 | Number 11
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
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