TECHNOLOGICAL DYNAMICS IN NURSING AND THEIR CHALLENGES ON NURSE PRACTICING SKILLS IN KENYATTA NATIONAL HOSPITAL SHARON MINA OKEYO H56/76095/2014 A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR AWARD OF THE DEGREE OF MASTER OF SCIENCE IN NURSING OF THE UNIVERSITY OF NAIROBI OCTOBER, 2016 DECLARATION This research project is my original work and has not been presented for a degree in any other university. Signed Date Name: Sharon M. Okeyo MScN (University of Nairobi) Registration Number: H56/76095/2014 ii CERTIFICATE OF APPROVAL This research project has been submitted for examination with my approval as the University Supervisor. First Supervisor Prof. Anna Karani, PhD Professor of Nursing & Nursing education School of Nursing University of Nairobi Signed Date Second Supervisor Dr. Emmah Matheka, PhD Lecturer School of Nursing University of Nairobi Signed Date iii DEDICATION To my family: My husband Joshua Mboga Oliech, my son Ethan Geno Oliech, my daughter Natalie Gweth Oliech and my parents Jane and Philip Okeyo. To all nurses in Kenya iv ACKNOWLEDGEMENTS This research project has been made possible by a number of people to whom I am very grateful. Special thanks to my supervisors Prof. Anna Karani and Dr. Emmah Matheka who supported and encouraged me all through the period. Thank you so much for your continuous guidance, advice and invaluable help throughout the period. Special thanks to my family: My husband Joshua Oliech, my son Ethan Geno Oliech, my daughter Natalie Gweth Oliech and my parents Jane and Philip Okeyo. Thank you so much for being there for me, for your prayers, support and encouragement. Special thanks to my friends too with whom we consulted and encouraged each other throughout the project. My utmost gratitude goes to the almighty God who gave me wisdom, strength, ability and all that was needed to complete this project. v LIST OF ABBREVIATIONS AND ACRONYMS ACNO Assistant Chief Nursing Officer AMREF African Medical and Research Foundation ART Assisted Reproductive Technology CBD Central Business District EHR Electronic Health Record EMAR Electronic Medication Administration ICT Information Communication and Technology IT Information Technology KEMRI Kenya Medical Research Institute KMTC Kenya medical Training College KNH Kenyatta National Hospital KNH/ERC Kenyatta National Hospital/ Ethics Research Committee MEAK Medical and Educational Aid to Kenya MOH Ministry of Health NACC National AIDS Control Council NASCOP National AIDS and STDs Control Program NBTS National Blood Transfusion Services NCK Nursing Council of Kenya NO Nursing Officer PRIDE Poverty Reduction through Information and Digital Employment SACNO Senior Assistant Chief Nursing Officer SNO Senior Nursing Officer vi SPSS Statistical Package for Social Sciences UK United Kingdom USA United States of America VVF Vesico Vaginal Fistula vii DEFINITION OF TERMS Technological dynamics of Nursing are the changing aspects of nursing as a result of incorporation of technological innovations in nursing care. Practicing skills are the skills that the nurse uses in carrying out their function and which enhance professionalism of the practice. Nurse practitioners refer to the qualified professional nurses who are carrying out the nursing functions. Technological skills are the skills that enable one to use technological equipment and to apply the use of ICT in their work. Digital divide is the gap between those who have and those who do not have access to online information. Patient acquired information is the information that the patients have about their health condition which they have sought for by themselves from any source including online sources. Biometrics the science of identifying people through physical characteristics such as fingerprints, handprints, retinal scans, palm vein prints, voice recognition, facial structure, and dynamic signatures, is often suggested as a solution to the information access problem CPOE-Computerized Physician/Provider Order Entry is a clinical software application designed specifically for providers to write patient orders electronically rather than on paper viii Clinical decision support system is a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery ix TABLE OF CONTENTS DECLARATION .......................................................................................................................................... ii CERTIFICATE OF APPROVAL ................................................................................................................ iii DEDICATION ............................................................................................................................................. iv ACKNOWLEDGEMENTS .......................................................................................................................... v LIST OF ABBREVIATIONS AND ACRONYMS ..................................................................................... vi DEFINITION OF TERMS ........................................................................................................................ viii TABLE OF CONTENTS .............................................................................................................................. x LIST OF TABLES ..................................................................................................................................... xiii LIST OF FIGURES ................................................................................................................................... xiv EXECUTIVE SUMMARY ........................................................................................................................ xv CHAPTER ONE: INTRODUCTION ....................................................................................................... 1 1.1 Background Information ......................................................................................................................... 1 1.2 Problem statement ................................................................................................................................... 5 1.3 Research Questions ................................................................................................................................. 6 1.4 Objectives of the study ............................................................................................................................ 6 1.4.1 General Objective ................................................................................................................................ 6 1.4.2 Specific Objectives .............................................................................................................................. 6 1.5 Study Hypothesis .................................................................................................................................... 7 1.6 Justification of the study ......................................................................................................................... 7 1.7 Scope of the study ................................................................................................................................... 8 1.8 Limitations of the study .......................................................................................................................... 8 CHAPTER TWO: LITERATURE REVIEW .......................................................................................... 9 2.1 Overview of technology in nursing practice ........................................................................................... 9 2.2 Development of Technology in nursing ................................................................................................ 10 2.3 Technology application in Nursing ....................................................................................................... 12 2.4 Information access by patients on the internet and other sources ......................................................... 15 2.5 Challenges of handling patients who have acquired information from other sources .......................... 18 2.6 Challenges faced and coping strategies used by nurses in handling technological trends in nursing practice ........................................................................................................................................................ 22 2.7 Theoretical Framework ......................................................................................................................... 24 2.7.1 Philosophy of science and caring by Jean Watson............................................................................. 24 2.7.2 Change Management Theory by Kurt Lewin (1890-1947) ................................................................ 26 x 2.8 Conceptual Framework ......................................................................................................................... 27 CHAPTER THREE: RESEARCH METHODOLOGY........................................................................ 30 3.1 Research Design .................................................................................................................................... 30 3.2 Site Description, .................................................................................................................................... 31 3.3 The Study