FEATURE ARTICLE
The Relationship Between Nursing Informatics
Competency and Clinical Decision-Making Among Nurses
in West Bank, Palestine
Ahmad Batran, PhD, RN, Saed Mohammad Al-Humran, MSHI, Malakeh Z. Malak, PhD, RN, Ahmad Ayed, PhD, RN
This study aimed to examine the relationship between nurs-
ing informatics competencies and clinical decision-making
by taking into account nurses' individual characteristics
and job-related characteristics. A cross-sectional design was
used. The cluster random sampling method was adopted to
select 14 governmental hospitals in West Bank, Palestine, in
which all nurses in these hospitals were invited to participate
in this study. Results found that the total mean (SD) score
for the nursing informatics competency scale was 2.6
(0.88), which indicates that the nurses had lower nursing in-
formatics competency, and the informatics skills subscale
had the lowest mean score (mean [SD], 2.4 [1.00]). Con-
cerning clinical decision-making, the total mean (SD) score
was 2.59 (0.38), which indicates that the nurses had lower
clinical decision-making. Regarding clinical decision-making
subscales, searching for information and unbiased assimila-
tion of new information had the highest mean score (mean
[SD], 2.64 [0.39]); on the contrary, the canvassing of objec-
tives and values subscale had the lowest mean score (mean
[SD], 2.53 [0.38]). Nursing informatics competency had a
positive relationship with clinical decision-making. Thus, it
is necessary to enhance nurses' informatics competency,
especially informatics skills and clinical decision-making,
by developing training programs about this technology di-
rected to nurses.
KEY WORDS: Decision-making, Nursing informatics,
Palestine
ursing is one of the world's careers that faces many
N challenges to offer quality care for patients.1 Unsur-
prisingly, nurses consume up to half of their time in
documentation; therefore, they need computerization and
information technology (IT) to fill this gap.2 This technology
Author Affiliations: Pediatric Health Nursing, Faculty of Nursing, Faculty of Allied Medical Sci-
ences, Department of Nursing, Palestine Ahliya University, Palestine (Dr Batran); Pediatric Health
Nursing, Faculty of Nursing (Dr Ayed), and Deanship of Admission and Registration (Mr
Al-Humran), Arab American University, Jenin, Palestine; and Community Health Nursing, Faculty
of Nursing, Al-Zaytoonah University of Jordan (Dr Malak), Amman.
The authors have disclosed that they have no significant relationships with, or financial interest
in, any commercial companies pertaining to this article.
Corresponding author: Malakeh Z. Malak, PhD, RN, Faculty of Nursing, Al-Zaytoonah University of
Jordan, PO Box 130, Amman 11733, Jordan (malakeh.m@zuj.edu.jo; malakehmalak@yahoo.com).
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/CIN.0000000000000890
Volume 40 | Number 8
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
has grown quickly in the past 4 decades and has become a cru-
cial portion of healthcare. As a result, nurses confronted rapid
changes in IT and increased usage of computers in their work-
place; therefore, they have participated in establishing nursing
informatics and planning and carrying out IT to provide
healthcare for their clients.2 Nursing informatics is an innova-
tive and evolving field that has been acknowledged by nursing
as a profession. It is a specialty that incorporates computer, in-
formation, and nursing science to deal with and communicate
data, knowledge, and information in nursing clinical practice.3,4
It also simplifies the combination of data, knowledge, and infor-
mation to assist nurses and healthcare professionals in all roles
and areas in their clinical decisions.5
Nurses should understand the benefits of adopting this
technology. Previous studies indicated that nursing informat-
ics combines the best practices into patients' care6 and rein-
forces evidence-based practice.7 Nursing informatics has
positive influences on healthcare and nursing practices, in-
cluding improving patient safety, enhancing the quality of
patients' healthcare, and minimizing healthcare costs and
workload.5,8 Also, it assists exchange of information between
patients and nurses and enhances their relationship.8 It helps
patients, nurses, and other healthcare workers to make proper
decisions2,3 and to attain affirmative outcomes.3
Clinical decision-making is defined as a conscious, cogni-
tive impression of how one goes about making decisions.9 Al-
though critical clinical thinking and decision-making are
learned and developed in the clinical practice environment,
there is no alternative for handling patient observations and
interactions for nurses who are equipped to work individu-
ally as part of a collaborative healthcare team. Health ITs
will improve the provision of preventive healthcare, provide
guidance for decision-making, and reduce clinical errors.10
Current nursing competencies are designed not only to
address the knowledge, behavior, and skills required by pro-
fessional nurses but also to address advanced nursing practices
in accordance with advanced technology.11 Nurses should
have nursing informatics competency, which refers to the inte-
gration of knowledge, skills, and attitudes in the performance
of various nursing informatics activities within four prescribed
levels of nursing practice: beginning nurse, experienced nurse,
informatics nurse specialist, and informatics innovator.12
CIN: Computers, Informatics, Nursing 547
FEATURE ARTICLE
Nurses require information without harm to patients. To
get a clear understanding of a patient's medical status, they
need to screen health records, treatment notes, laboratory
and examination reports, and physician/interdisciplinary
team notes. They use this information to effectively make de-
cisions to develop implications for patient care.13
Nursing informatics are innovative methods to catch the
attention of nurses, enhance their critical thinking and profes-
sional decision-making capabilities, and improve general prac-
tical function. Unsurprisingly, clinical practice lacks the area of
research on the use of nursing informatics to improve clinical
decision-making skills among nurses. However, there are some
studies that documented the relationship between EHRs and
nursing informatics and decision-making among nurses.14–16
Research and evaluation are required to set the value of
nursing informatics and assist in the implementation of nurs-
ing informatics in clinical nursing courses. Hospitals across
the country, have moved from traditional paper-based
health records to EHRs. As a result of this change, nurses
should be knowledgeable and competent in nursing infor-
matics to assist in developing decision-making processes.
CONCEPTUAL FRAMEWORK OF THE STUDY
The conceptual framework (Figure 1) was developed by the
authors based on the literature review and the model of
Staggers et al.17 This framework is based on the relationship
between the nurse's individual characteristics (age, nursing
experience, and educational level) and job-related characteris-
tics (department, shift-work, and time spent on EHRs during
a shift) as controlling factors and nursing informatics compe-
tencies that consist of informatics knowledge, computer skills,
and informatics skills, in addition to clinical decision-making.
The competency of nursing informatics is determined by
studying three categories: firstly, computer skills competencies
(eg, searching, patient demographic data collection, patient
FIGURE 1. Proposed conceptual model of nursing informatics competency and clinical decision-making.
548 CIN: Computers, Informatics, Nursing
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
care documentation, use of ITs to enhance nursing care, use
of telecommunication devices, and safe use of networks and
computer technology); secondly, informatics competencies,
which are the identification of the use or significance of nurs-
ing data to improve practice, and the perception that the
computer can only assist nursing care and that human func-
tions cannot be performed by computers; and, thirdly, infor-
matics competencies tech skills (eg, understanding the infor-
mation flow within an organization, constructing process in-
formation flowcharts for all facets of clinical systems, and
designing criteria and database structures to promote educa-
tion, administration, clinical care, or research).18 An earlier
study carried out by Green et al14 found that nursing infor-
matics competencies influence decision-making satisfaction.
This conceptual model proposed that clinical decision-
making could be influenced by nursing informatics competen-
cies, which could be affected by a nurse's individual character-
istics and job-related characteristics (Figure 1). It illustrates
that a nurse's individual characteristics and job-related char-
acteristics had an influence on nursing informatics competen-
cies, which had a direct effect on clinical decision-making.
Thus, this study aimed to analyze the relationship between
nursing informatics competencies and clinical decision-making
by taking into account nurses' individual characteristics and
job-related characteristics. Hence, the following hypothesis
was formulated: there is a positive relationship between nurs-
ing informatics competencies and clinical decision-making
among nurses in the hospitals in West Bank.
METHODS
Design, Setting, and Sampling
A cross-sectional, descriptive-correlational design was used
to conduct this study. The study included governmental hos-
pitals in West Bank, Palestine. There were 82 hospitals in
Palestine in 2018, including 52 in West Bank, involving East
August 2022
Jerusalem, which accounted for 63.4% of the total number
of hospitals in Palestine.19 Nursing informatics were inte-
grated in these hospitals and are considered as a part of
nurses' work, especially EHRs.
The cluster random sampling method was adopted to se-
lect 14 hospitals from different areas in West Bank, in which
the hospitals with high capacity and occupancy, in addition
to adopting EHRs in their healthcare system for more than
5 years, were selected, and then a simple random method
was adopted to select these hospitals. A power analysis was
used to calculate the sample size using G*Power 3.1 software
(Heinrich Heine University, Dusseldorf, Germany), in which
effect size = 0.11, power = 0.90, and α = 0.05. A sample size
of 722 participants was needed to attend to the study. All
nurses in these hospitals were invited to participate in this
study, in which the total number of nurses in the selected
hospitals was 951. The two of the authors distributed ques-
tionnaires to all nurses in order to allow for missing data or
incomplete questionnaire. The inclusion criteria were all
nurses who are working in the selected hospitals in all depart-
ments and using nursing informatics in their work.
Instruments
A self-reported questionnaire was used to collect data from
the study participants.This questionnaire consists of the fol-
lowing parts: socio-demographic data, nursing informatics
competency, and clinical decision-making. Socio-demographic
data that were developed by the researcher consist of personal
and job-related characteristics of the nurses that could affect
their informatics competencies and clinical decision-making
skills (eg, age, nursing experience, educational level, shift-
work, work department, and time spent on EHRs during
a shift).
Nursing informatics competency was assessed using the
Self-Assessment of Nursing Informatics Competencies Scale
developed by Yoon et al.20 This scale consists of 30 items
rated on a 5-point Likert scale (1, not competent, to 5, expert).
The subscales of the Self-Assessment of Nursing Informatics
Competencies Scale include basic computer knowledge and
skills, wireless device skills, clinical informatics role, clinical
informatics attitudes, and applied computer skills: clinical in-
formatics.20 The Self-Assessment of Nursing Informatics
Competencies Scale was scored, in which a mean score of
3 or more for each subscale and for the total scale indicates
high nursing informatics competency level, and a mean score
of less than 3 indicates a low nursing informatics competency
level. These subscales were valid and reliable, in which inter-
nal consistency reliability using Cronbach's α was as follows:
clinical informatics role = 0.91, basic computer knowledge
and skills = 0.94, applied computer skills: clinical informat-
ics = 0.89, nursing informatics attitudes = 0.94, and wireless
device skills = 0.90.
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Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Clinical decision-making was measured using the Clinical
Decision-Making in Nursing Scale developed by Jenkins.21
This scale describes the perception of nurses in clinical
decision-making based on self-expression.22 The initial Clin-
ical Decision-Making in Nursing Scale was composed of 40
items and four subscales. These subscales included the search
for alternatives or options, canvassing of objectives and
values, evaluation and re-evaluation of consequences, and
search for information and unbiased assimilation of new in-
formation. Each subscale is composed of 10 items, in which
each item is assessed using a 5-point Likert scale: (5) always,
(4) frequently, (3) occasionally, (2) seldom, and (1) never.21
Minimum and maximum points to be taken are 40 and 200,
respectively, in the whole scale and 10 and 50, respectively, in
the subscales, where higher scores indicate higher perception
in clinical decision-making. The scale is evaluated through the
scores obtained from each subscale and the total scale.21,22 This
scale is scored according to the total mean score for the scale
and subscales and categorized as follows: a mean score of
≥3.00 indicates high clinical decision-making, and a mean
score of <3.00 indicates low decision-making.
Because Arabic is the native language, to overcome any
language difficulties and preserve the validity of the content,
the instruments were translated following the translation
protocol of the World Health Organization. The instru-
ments were translated into Arabic and back-translated into
English. Also, the validity of the instruments was tested, in
which an Arabic copy of the instruments was sent to five bi-
lingual panels of experts in nursing education. The experts
had no comments. Then, a pilot study was carried out on
nurses (N = 50) directly after obtaining ethical approval.
The pilot study found that the participants had no trouble
in interpreting or clarifying the contents of the instruments,
and the required time to complete the questionnaire was
10-20 minutes. Additionally, reliability was evaluated using
internal consistency reliability with Cronbach's α. The Cronbach's
αs for the Self-Assessment of Nursing Informatics Competen-
cies Scale and the Clinical Decision-Making in Nursing Scale
were 0.92 and 0.89, respectively.
Data Collection
After obtaining approval from the Arab American University
Palestine and Palestinian Ministry of Health, the researchers
contacted each nursing administrator in the targeted hospi-
tals, and the study purposes and instructions were clarified
to them. Then, a list of the nurses was obtained from those ad-
ministrators. The questionnaires, enclosed in an envelope,
were given to the head nurses in each department in the se-
lected hospitals, who took the responsibility of distributing
the questionnaires to the eligible nurses and collecting these
questionnaires. After 1 week, the researchers collected these
envelopes from the head nurses in the participating hospitals.
CIN: Computers, Informatics, Nursing 549
FEATURE ARTICLE

Ethical Considerations Table 1. Distribution of Socio-demographic Variables

Ethical permission was obtained from the (Arab American of the Study Participants (N = 824)
University at Palestine). Consent forms were delivered to
Characteristics Mean (SD) n (%)
and later obtained from the nurses who expressed interest
Personal characteristics
to participate in the study. Consent encompassed details
Age, y 35 and less 33.20 (7.4) 550 (66.8)
about the purpose of the study, a concise description and in-
36–49 250 (30.3)
structions, and clarification that there are no harms or risks
50 and above 24 (2.9)
in participation. The participation was voluntary, and the
Sex Male 534 (64.8)
nurses were informed that they could withdraw from the Female 290 (35.2)
study at any time and that there would be no penalty or loss Educational Diploma 191 (23.2)
of benefits upon withdrawal. Confidentiality was maintained level Bachelor 539 (65.4)
during all stages of the study, in which the participants were Master 94 (11.4)
informed in the first page of the questionnaire to avoid writ- Nursing <5 163 (19.8)
ing any personal information related to them. Also, the ques- experience, y 5–10 301 (36.5)
tionnaires were distributed and collected by the head nurses. 11–25 318 (38.6)
The collected data were entered on a computerized >25 42 (5.1)
datasheet that were coded and secured. Job-related Day (8 or 12 h) 226 (27.4)
characteristics Evening/night 130 (15.8)
Data Analysis (8 or 12 h)
Data were analyzed using the IBM SPSS Statistics version Shift-work Day or 468 (56.8)
25 (IBM Inc., Armonk, NY, USA). Descriptive statistics (fre- evening/night
quencies, percentages, means, and standard deviations) were Department Medical/surgical 306 (37.1)
performed for all parameters. Multiple linear regression was Critical care 243 (29.5)
conducted to verify whether the competency of nursing infor- Maternity and 168 (20.4)
pediatric
matics predicted clinical decision-making without controlling
Operation and 107 (13.0)
for any possible confounders. The researcher then tested emergency
whether the model with competency in nursing informatics Time spent on <5 195 (23.7)
as an independent variable still predicted clinical decision- EHRs during 5–10 445 (54.0)
making after adjusting personal and job-related characteris- working hours, h >10 184 (23.3)
tics. The findings were significant at P ≤ .05.

RESULTS score (mean [SD], 2.4 [1.00]). Concerning clinical decision-

A total of 951 questionnaires were distributed to the nurses
who agreed to participate in the study. However, 824 ques-
tionnaires were returned, with a response rate of 86.6%.
Concerning participants' characteristics, the findings re-
vealed that the mean (SD) age of nurses was 33.2 (7.4) years,
and 66.8% of participants were <35 years old. The majority
of the nurses (64.8%) were males. A total of 65.4% had a
bachelor's degree, and 38.6% had 11-25 years of nursing ex-
perience. The majority of participants (56.8%) reported work-
ing either day or evening shifts. More than one-third (37.1%)
of the nurses were from medical/surgical departments. The
majority of the participants (54.0%) spent 5-10 hours on doc-
umentation using EHRs during working hours according to
shift-work (Table 1).
As shown in Table 2, the total mean (SD) score for the
nursing informatics competency scale was 2.6 (0.88), which
indicates that the nurses had lower nursing informatics com-
petency. Concerning the subscales of nursing informatics
competency, the three subscales had lower mean scores;
however, the informatics skills subscale had the lowest mean
making, the total mean (SD) score was 2.59 (0.38), which in-
dicates that the nurses had lower clinical decision-making.
Regarding clinical decision-making subscales, searching for
information and unbiased assimilation of new information
had the highest mean score (mean [SD], 2.64 [0.39]); on
the contrary, the canvassing of objectives and values subscale
had the lowest mean score (mean [SD], 2.53 [0.38]).
Table 3 shows the relationship between nursing informat-
ics competency and clinical decision-making before and after
controlling for personal and job-related characteristics. All
assumptions were met for multiple regression. Results from
regression analysis found that when nursing informatics
competency was included in the model (Model 1), it had a
significant relationship with clinical decision-making (β = 0.280,
P < .001) and explained a significant proportion of variance
in clinical decision-making scores (R2 = 0.079, F = 70.161,
P < .001). When personal and job-related characteristics were
included in the model (Model 2), nursing informatics compe-
tency significantly correlated with clinical decision-making
(β = 0.281, P < .001) and explained a significant proportion

550 CIN: Computers, Informatics, Nursing August 2022

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Table 2. Levels of Nursing Informatics Competency skills among nurses in Palestinian hospitals. Our findings show
and Clinical Decision-Making (N = 824) that the Palestinian nurses had low levels of nursing informat-
ics competency, particularly in informatics skills. Frazandipour
Competencies Mean (SD)
et al23 found that more than half of nurses had little skill in
Nursing informatics competency informatics competency and the least in informatics skills.
Computer skills Basic computer 2.7 (0.98)
Additionally, Yang et al24 found that the informatics compe-
knowledge and skills
tency of nurse managers was at a moderate level, and their
Wireless device skills 2.5 (1.1)
Computer skills subscale: total mean score 2.6 (1.04)
skills in computers and informatics were lower than their in-
Informatics Clinical informatics role 2.4 (0.99)
formatics knowledge. This study result could point to the fact
knowledge Clinical informatics 2.8 (1.0) that nursing informatics is a developing area, in which the
attitude nurses meet ever challenging and changing practice situa-
Informatics knowledge subscale: total mean score 2.6 (1.0) tions. Even though some would find new technology a chal-
Informatics skills Applied computer skills: 2.4 (1.0) lenge, informatics will improve nursing clinical practice.
clinical informatics Nurses would have better entry in patient records, increase
Nursing informatics 2.6 (0.88) their total efficacy, and reduce probable errors.25 Thus, nurses
competency scale: should improve their skills through training and informatics
total mean score
educational courses.
Clinical decision-making
Our findings show that the Palestinian nurses had a low
Searching for 2.58 (0.37)
alternatives or options level of clinical decision-making. Previous studies documented
Canvassing of 2.53 (0.38) that clinical decision-making is a complicated process that
objectives and values could affect the quality of patients' care and patients' condi-
Evaluation and 2.60 (0.38) tions.26 The low level of decision-making could be related to
re-evaluation of low organizational support, insufficient nurses' skills in nursing
consequences informatics,27 lack of commitment, poor communication, over-
Searching for 2.64 (0.39)
load, and lack of continuous nursing development.27
information and
unbiased assimilation Initial application of technology to knowledge may help to
of new information recognize potential problems. For instance, detecting changes in
Clinical decision-making: total mean score 2.59 (3.77) patient condition will quickly occur with electronic documen-
tation, since the information is accessible. The nurse should
utilize the knowledge to validate an effective plan of action.28
of variance in clinical decision-making scores (R2 = 0.085, Nibbelink et al15 found that EHRs and clinical data may pro-
F = 10.86, P < .001). R2 accounted for 7.9% of the vide important support in decision-making for critical care
decision-making variance in Model 1, which expanded by an- nurses; nursing informatics competency implies to support
other 0.6%, making the overall variance reach 8.5%. their clinical decision-making skills.
The current study revealed that nursing informatics compe-
DISCUSSION tency had a relationship with clinical decision-making, which
The current study aimed to examine the relationship between means that nursing informatics competency can enhance the
nursing informatics competency and clinical decision-making capability of nurses to engage in clinical decision-making.

Table 3. Relationship Between Nursing Informatics Competency and Clinical Decision-Making

Model Variable B SE β t P Confidence Interval
1 Informatics competency 8.614 1.028 0.280 8.376 .000 6.596–10.633
R = 0.280, R2 = 0.079, adjusted R2 = 0.078, F = 70.161, df = 1, P = .000
2 Informatics competency 8.621 1.045 0.281 8.254 .000 6.571–10.672
Age (years) 0.047 0.174 0.013 0.267 .790 −0.296 to 0.389
Educational level −0.136 1.600 −0.003 −0.085 .932 −3.276 to 3.005
Nursing experience 0.562 1.536 0.017 0.366 .714 −2.452 to 3.577
Department 0.102 0.835 0.004 0.123 .902 −1.537 to 1.741
Shift-work 0.748 1.090 0.024 0.686 .493 −1.391 to 2.887
Time spent on EHRs during shifts (hours) 2.646 1.387 0.066 1.907 .057 −0.077 to 5.369
R = 0.292, R2 = 0.085, adjusted R2 = 0.077, F = 10.860, df = 7, P = .000

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Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

FEATURE ARTICLE
Using predictive clinical decision-making in nursing practice
can enable making individualized therapeutic decisions and
providing assistance for effective use of limited healthcare re-
sources to improve the quality and effectiveness of patients'
care.16 The current results were affirmed by Green et al,16
who found that nursing informatics competencies influence
decision-making satisfaction. Furthermore, Nibbelink et al15
indicated that informatics provides useful support for nurses'
decision-making by integrating patient information with evi-
dence. In addition, decisions must be made based on evidence
of the best outcomes, especially for the complicated and time-
limited care of patients with critical illness. Therefore, EHRs
and clinical data are important ITs that can facilitate the inte-
gration of evidence into nursing practice.29
The results revealed that age and department were not
correlated with developing clinical decision-making. These
results were inconsistent with a previous study conducted
by Alaseeri et al30 who found that age and department had
a significant influence on nurses' clinical decision-making.
Also, Kosicka and colleagues31 found that expanded use of
intuitive models of clinical decision-making was correlated
with age and working in hospital units. The present study re-
sults could be interpreted as the age mean for the study partic-
ipants was in the beginning of 30s and the majority of them
had experience of more than 5 years, which mean that they
have the capacities for making a decision in terms of their ex-
periences. Also, the participants were working in the depart-
ments that need for nurses who have decision-making skills
and problem-solving abilities to provide high-quality care.
With regard to nursing educational level and experience,
our findings revealed that nurses' educational level and expe-
rience had no relationship with nurses' clinical decision-
making. However, other studies found that educational level
influenced decision-making positively. Wu et al32 found that
nurses' educational level and experience had a significant
correlation with nurses' clinical decision-making. Also, Farčić
and colleagues33 demonstrated a positive association between
nurses' experience and decision-making. Keshk et al34 found
that critical care nurses with more than 6 years of experience
had abilities to make advanced clinical decisions. Moreover,
Ludin35 reported that age and working experience signifi-
cantly influenced clinical decision-making among critical
care nurses. The present study results could be related to
characteristics of the sample, in which the majority of the
participants had a bachelor's degree and higher, which could
be explained that these nurses were exposed to decision-making
skills and capacities in their nursing curriculum during their
study. Additionally, more than 80% of the participants had
more than 5 years of work experience in hospitals, which in-
dicated that they have decision-making skills.
The study results revealed that time spent on EHRs per
shift had no association with clinical decision-making among
552 CIN: Computers, Informatics, Nursing
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
nurses, which is consistent with a previous study.36 Tower
et al37 found that increasing time spent on EHRs per shift en-
hances nurses' usage of patient information and clinical signs in
a number of different ways to create a mental map of the
patient's condition that helped develop their decision-making.
Understanding the patient's status is a critical and complex
aspect of nurses' decision-making. This understanding re-
quires the nurses to spend time, gather physiological cues,
identify important cues, frequently interact with technology,
and ascertain how to act as a part of their decision-making
process to the collected information.38
IMPLICATIONS FOR PRACTICE
In general, this study has positive and important implications
for nursing practitioners and decision-makers in health insti-
tutions to restructure healthcare delivery systems based on
IT. It is necessary to enhance nurses' informatics compe-
tency, especially informatics skills and clinical decision-
making, by developing educational and training programs
about this technology directed to nurses in all departments
and adopting practices that ultimately lead to providing
the best healthcare services. Additionally, it is necessary to in-
tegrate health informatics in the nursing curriculum in uni-
versities to provide nursing students with the necessary infor-
matics knowledge and skills. Gonen and colleagues39 found
that the integration of informatics abilities in teaching can
enhance nurses' education and facilitate the integration of
communication and information technologies into health
and information management.
Despite the sufficient findings of this study, a few limitations
should be taken into consideration. The study is cross-sectional,
which does not reflect the direct influence of nursing infor-
matics competency on clinical decision-making. Also, the data
were collected using a self-reported questionnaire, which was
based on the nurses' perceptions and opinions.
CONCLUSION
This study confirmed low levels of nursing informatics compe-
tency and clinical decision-making. Also, nursing informatics
competency had a positive relationship with clinical decision-
making. The use of health informatics helps nurses to make their
clinical decisions while providing patients' care. Thus, nurses
need ongoing training to adopt nursing informatics in their prac-
tice while providing daily healthcare services for patients.
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