Andra

TUGAS SISTEM INFORMASI KEPERAWATAN
“5 JURNAL SISTEM INFORMASI KEPERAWATAN”
DISUSUN OLEH:
WISPA HANYDAAYNI,SST P01720423
Dosen Pembimbing: Ns.Andra saferi Wijaya,M.Kep
KEMENTERIAN KESEHATAN REPUBLIK INDONESIA
POLTEKKES KEMENKES BENGKULU
PRODI PENDIDIKAN PROFESI NERS
JURUSAN KEPERAWATAN
TAHUN AJARAN 2022/2023
JURNAL ILMU KOMPUTER

(COMPUTER SCIENCE JOURNAL)
http://jik.htp.ac.id
SISTEM INFORMASI MANAJEMEN E-RECRUITMENT
KEPERAWATAN BERBASIS WEB PADA RUMAH SAKIT
SANSANI PEKANBARU
1 2 3
Suherman , Nurhayati , Sairata Rajes Sari
1,2
Program Studi Sistem Informasi, STMIK Hang Tuah Pekanbaru
Email :
suhermansohorgani63@gmail.com
Abstract
The Hospital Sansani a Private Hospital located in at Soekarno Hatta (Arengka Up) Subdistrict Sidomulyo West. Know where this
Sansasi Hospital , has branches still in Riau Pekanbaru city . Similarly, what happened to the Hospitas Sansani Pekanbaru, the
number of employees of each division requests that require the skilled workforce and professional in his work . E-Recruitment is a
method of recruitment of new candidates for employment with the company through all the stages which have been provided by the
company and the use of modern electronic communication media such as the Internet , so that recruitment can be carried out quickly
and precisely in order to obtain employment in accordance with needs of the company . To obtain the necessary data for the study ,
the methodology used , the stages are: analysis , design , coding and testing , implementation , and maintenance . And through
activities including: collecting data by interview , observation , and literature . The data obtained were then analyzed and described
using object -oriented modeling method. The results of this study in the form of e - recruitment applications that can provide ease in
the process of hiring and gettingthe appropriate man power criteria.
Keywords: E-Recrutement, Information System, PHP, MySql, SIM.
Abstrak
Rumah Sakit Sansani merupakan rumah sakit swasta berkedudukan di Jl. Soekarno Hatta (Arengka Atas) Kecamatan Sidomulyo
Barat, di mana Rumah Sakit Sansasi ini, memiliki beberapa cabang yang masih berada di kota Pekanbaru. Rumah Sakit Sansani, pada
dasarnya banyak membutuhkan para tenaga kerja yang terampil dan profesional dalam pekerjaannya. E-Recruitment merupakan
sebuah metode perekrutan para calon tenaga kerja baru di Rumah Sakit Sansani dengan melewati segala tahapan-tahapan yang
telah diberikan oleh Rumah Sakit tersebut dan menggunakan media komunikasi elektronik modern seperti internet, sehingga
perekrutan dapat dilaksanakan secara cepat dan tepat guna mendapatkan tenaga kerja yang sesuai dengan kebutuhan Rumah Sakit.
Untuk memperoleh data-data yang diperlukan selama penelitian, Dalam melakukan penelitian metodologi yang digunakan adalah
waterfall. Selain metoda waterfal dilakukan juga kegiatan lain seperti : pengumpulan data dengan wawancara, observasi, dan studi
pustaka. Data yang diperoleh kemudian dianalisis dan digambarkan dengan menggunakan metode pemodelan yang berorientasi
Iptek. Hasil dari penelitian ini dalam bentuk aplikasi E-Recruitment yang dapat memberikan kemudahan dalam proses perekrutan
karyawan untuk mendapatkan tenaga kerja sesuai kriteria yang diinginkan.
Keywords: E-Recrutement , Sistem Informasi, PHP, MySql, SIM.

https://doi.org/10.33060/JIK/2022/Vol11.Iss1.250
E-ISSN : 2579 - 3918 | P-ISSN : 2302 - 710X

26
JIK, Vol. 11, No. 1
April 2022
PENDAHULUAN PHP (Hypertext Prepocessor). Menurut Bunafit Nugroho

(2004), PHP adalah kombinasi antara bahasa pemrograman dan
Rumah Sakit Sansani Pekanbaru didirikan atas dasar aplikasi server. PHP merupakan server - side Scripting yang
kepedulian terhadap nilai kesehatan masyarakat. Bermula dari digunakan untuk membuat dan menjalankan aplikasi web server
Praktek Pribadi tahun 2002 kemudian berkembang menjadi yang dinamis, interaktif dan mempunyai performansi tinggi.
balai pengobatan tahun 2005. Selanjutnya tahun 2007 mulai Adobe Dreamweaver, Adobe Dreamweaver adalah aplikasi
mencoba menyewa tempat dengan bergabung di Yayasan Al desain dan pengembangan web yang menyediakan editor
Birra tahun 2007 hingga 2010.
Sebagai institusi pelayanan kesehatan masyarakat yang

memiliki latar belakang dan permasalahan yang ada di Rumah
Sakit Sansani , terutama pada pengelolaan sumber daya
manusia, dimana rumah sakit ini masih mendapat kritikan atau
saran atas ketidak puasan masyarakat, terutama pada kualitas
tenaga kesehatan. Dalam hai ini, perawat sebagai salah satu
ujung tombak pelaku pemberi pelayanan kesehatan kepada
pasien di rumah sakit, karena berhubungan lansung dengan
pasien. (Grace, 2004).
Permasalahan yang selalu dihadapi Rumah Sakit Sansani

adalah jumlah tenaga keperawatan yang melamar melebih
kapasitas perekrutan yang diinginkan, sehingga membutuhkan
banyak waktu dalam prosedur pelaksanaanya, dampak lainnya
akan ada banyak kertas (surat lamaran) yang menumpuk dan
sulit mencari kandidat yang diinginkan Rumah sakit.
Berdasarkan hal-hal tersebut diatas, maka peneliti

mengangkat permasalah penelitian tersebut sebagai bahan
yang dirangkum dalam sebuah judul yaitu Sistem Informasi
Manajemen E-Recruitment Keperawatan Berbasis Web Pada
Rumah Sakit Sansani Pekanbaru. Sistem informasi ini akan
dirancang dengan menggunakan alat bantu perancangan,
diantaranya :
Data Flow Diagram
Menurut Tata Sutabri (2005) “Data Flow Diagram (DFD)

adalah suatu network yang menggambarkan suatu sistem
komputerisasi, manualisasi atau gabungan dari keduanya yang
penggambarannya disusun dalam bentuk kumpulan komponen
sistem yang saling berhubungan sesuai dengan aturan
mainnya”. Data flow diagram digunakan untuk
menggambarkan sistem yang akan dirancang secara
keseluruhan. Flowchart adalah suatu bagan dengan simbol-
simbol tertentu yang menggambarkan urutan proses dan
hubungan antara suatu proses dengan proses lainnya dalam
suatu program. Sistem Informasi Manajemen E- Recruitment
pada rumah sakit sansani akan di implementasikan dengan
menggunakan alat bantu pemrograman diantaranya :
WYSIWYG visual (bahasa sehari-hari yang disebut sebagai adalah model klasik yang bersifat sistematis, berurutan dalam
Design view) dan kode editor dengan fitur standar seperti membangun software. Model ini sering disebut dengan “classic
syntax highlighting, code completion, dan code collapsing life cyle” atau
serta fitur lebih canggih seperti real-time syntax checking
dan code introspection untuk menghasilkan petunjuk kode
untuk membantu pengguna dalam menulis kode.
Desain Sistem Menurut George M.Scott yang di
sadur Jogiyanto (2005:209) Desain Sistem di defi niskan
sebagai penggambaran, perencanaan dan pembuatan
sketsa atau pengaturan dari beberapa elemen terpisah
kedalam satu kesatuan yang utuh dan berfungsi. Rekrukment
Menurut Rachmawati Ike Kusdyah (2008,84) Rekrutmen juga
merupakan serangkaian mencari dan memikat pelamar kerja
dengan motivasi, kemampuan, kemampuan dan keahlian
yang diperlukan untuk menutupi kekurangan yang
diidentifikasi dalam perencanaan kepegawaian. Maksud dan
tujuan rekrutmen adalah untuk mendapatkan persediaan
sebanyak mungkin calon-calon pelamar sehingga organisasi
akan mempunyai kesempatan yang lebih besar untuk
melakukan pemilihan terhadap calon pekerja yang dianggap
memenuhi standar kualifikasi organisasi. Proses rekrutmen
berlangsung mulai dari saat mencari pelamar hingga
pengajuan lamaran oleh pelamar. Proses rekrutmen perlu
dikaitkan dalam dua hal . Pertama, para pencari tenaga
kerja baru perlu mengkaitkan identifikasi lowongan dengan
informasi tentang analisis pekerjaan, karena informasi
tersebut mengandung hal- hal penting tentang tugas apa
yang akan dilakukan oleh para tenaga kerja baru yang
berhasil di cari, di temukan, di seleksi dan dipekerjakan.
Kedua, komentar para manajer yang kelak akan membawahi
tenaga kerja baru itu harus diperhatikan, bahkan
dipertimbangkan dengan matang. E-Recruitment
Menurut Chapman & Webster, (2003) E-Recruitment

merupakan sebuah metode perekrutan para calon tenaga
kerja baru pada perusahaan dengan melewati segala tahapan-
tahapan yang telah diberikan oleh Instasi ataupun perusahaan
dalam menggunakan media komunikasi elektronik modern
seperti internet, sehingga perekrutan dapat dilaksanakan
dengan lebih menghemat waktu dan tenaga guna
mendapatkan tenaga kerja yang sesuai dengan kebutuhan.
Tujuan dari penelitian ini adalah untuk Agar mendapatkan

tenaga keperawatan yang professional, Dengan dirancangnya
sistem E-Recruitment keperawatan dapat membantu dalam
proses perekrutan keperawatan pada Rumah Sakit Sansani
secara cepat dan tepat, Dengan adanya sistem E-Recruitment,
dapat mengurangi penggunaan kertas yang berlebihan.
METODE PENELITIAN
Dalam penelitian ini penulis menggunakan model
waterfall. Menurut Bennet dkk (2002: 51) Model waterfall
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Suherman, et al Sistem Informasi Manajemen E-Recruitment Keperawatan Berbasis Web Pada Rumah Sakit Sansani Pekanbaru
model waterfall, Disebut dengan model waterfall karena tahap

demi tahap yang dilalui harus menunggu selesainya tahap
sebelumnya dan berjalan berurutan.
Gambar 1. Fase-fase dalam Waterfall.
Metode waterfall mempunyai langkah-langkah sebagai berikut :
Keahlian Teknik SistemSeorang yang ahli membuat sistem

informasi harus mempunyai kemampuan spesifikasi
arsitektur tingkat tinggi dibidang perangkat lunak dan Gambar 2. Aliran sistem yang sedang berjalan di Rumah Sakit
perangkat keras. Analisis Kebutuhan Semua sistem Sansani Pekanbaru.
membutuhkan antar muka (interface) yang harus didefinisikan
Pelamar
secara benar dan disesuaikan dengan kondisi organisasi yang
mempunyai sistem tersebut. Desain Hasil dari analisa sistem Pada sistem yang sedang berjalan, pelamar mengajukan
akan digunakan untuk mendesain sistem Pembuatan Setelah surat dan mengikuti ujian kompetensi. Yang mana nantinya
semua rancangan yang dibuat telah jadi, kini hasil rancangan pelamar juga akan mendapat informasi mengenai hasil tes
tersebut di terjemankan kedalam kode program. Tergantung ujian yang telah dilaksanakan.
pada bagaimana fase di sain telah lengkap. Pengujian,
Pengujian sistem dilakukan untuk memastikan kepuasan Receptionist Receptionist
terhadap ketepatan kebutuhan yang telah dibuat pada tahap bertugas menerima lamaran yang diajukan Oleh
awal. Dan kelengkapannya. Pemasangan, Setelah didapatkan
hasil pengujian sistem yang memuaskan pelanggan maka pelamar, dan mendistribusikannya pada bagian HRD (Human
langkah selanjutnya adalah pemasangan sistem untuk Resources Of Development) HRD (Human Resources Of
digunakan sistem harus dapat mengelola secara hati-hati Development) Surat lamaran diproses oleh HRD (Human
terhadap hal- hal yang ti dak dibutuhkan dan dapat Resources Of Development) untuk melakukan proses seleksi
meminimalkan risiko perubahan yang terjadi. Perawatan, pelamar atau ujian kompetensi, HRD (Human Resources Of
Perawatan sistem harus dilakukan dengan berkesinam bungan, Development) membuat laporan peserta ujian kompetensi
terutama sekali terhadap perubahan-perubahan untuk untuk diberikan pada pimpinan. Dari hasil ujian kompetensi
kelansungan hidup sistem. lalu HRD (Human Resources Of Development) melakukan
penilaian dan menentukan pelamar yang lulus sebagai
HASIL DAN PEMBAHASAN karyawan. HRD (Human Resources Of Development) juga
memberikan informasi pada pelamar yang lulus dan membuat
Analisa Sistem Berjalan. laporan karyawan baru untuk pimpinan, Pimpinan menerima
ujian kompetensi dan laporan karyawan baru.
Aliran sistem yang sedang berjalan pada Rumah Sakit
Sansani pekanbaru Sistem Yang Diusulkan.
Berikut merupakan gambaran sistem yang
diusulkan
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JIK, Vol. 11, No. 1
April 2022
Data Flow Diagram (DFD)
Gambar 4. Context Diagram
Gambar 3. Sistem yang diusulkan.
Sistem E-Recruitment Rumah Sakit Sansani telah memiliki

database yang mampu menampung dan mencetak laporan
yang dibutuhkan. Sistem ini memudahkan pelamar untuk
melamar dan mengikuti ujian kompetensi serta membantu
HRD (Human Resources Of Development) dalam proses
rekruitmen karyawan baru dan pembuatan laporan.
Perancangan Sistem Secara Umum.
Perancangan sistem ini dibuat dengan diagram arus data

(Data Flow Diagram). Data Flow Diagram adalah diagram yang
menggambarkan proses dari data flow diagram yang
memberikan gambaran yang menyeluruh mengenai sistem.
Context Diagram
Context Diagram Sistem E-Rekruitmen Rumah Sakit

Sansani adalah sebagai berikut:
Gambar 5. Data Flow Diagram
Flowchart
Berikut merupakan flowchart pada sistem informasi yang

diusulkan :
Gambar 6.
Flowchart
29
Suherman, et al Sistem Informasi Manajemen E-Recruitment Keperawatan Berbasis Web Pada Rumah Sakit Sansani Pekanbaru
Gambar 7 Rancangan tampilan Menu Utama.
Gambar 8 Rancangan tampilan Form Pendaftaran.
Gambar. 9. Rancangan tampilan Login
Gambar 11 Tampilan Menu Utama Sistem E-Recruitment
SIMPULAN DAN SARAN

Simpulan dan Saran.
Berdasarkan penelitian yang telah dilakukan maka, penulis dapat mengambil kesimpulan bahwa : Dengan adanya
Sistem E- Recruitment ini dapat membantu mempermudah kinerja dari HRD (Human Resources Of Development) dalam
melakukan proses perekrutan keperawatan dan mengelola data pelamar. Sistem ini juga memberikan kemudahan bagi
HRD (Human Resources Of Development) rumah sakit yang bertindak sebagai admintrator dalam memonitoring. Sistem
ini melakukan proses pengumpulan data pelamar dimulai dari penginputan data pribadi, pengiriman lamaran serta
penilaian ujian pelamar.
Sistem Informasi E-Recruitment dirancangan dengan menggunakan bahasa pemograman PHP berbasis web.
Dengan adanya Sistem E-Recruitment ini rumah sakit dan pelamar menjadi satu kesatuan sehingga proses perekrutan
pegawai menjadi lebih efisien dan efektif. E-Recruitment ini bisa dikembangkan dengan menambahkan modul-modul
seperti ujian secara online dan lain-lain. Sesuai dengan kebutuhan fungsional dari rumah sakit itu sendiri, sehingga
waktu dan biaya yang digunakan untuk proses perekrutan menjadi lebih kecil. E- Recruitment ini menggunakan
teknologi internet dan alangkah baiknya sitem E-recruitment ini menggunakan sistem keamanan data yang lebih baik.
DAFTAR PUSTAKA
Bennett, dkk, 2002. Object Oriented System Analysis And Design Using Uml, Inggris: McGrawhill.
Bunafit Nugroho,2005, Database Relasional Dengan MySQL, Yogyakarta: Andi Yogyakarta.
Grace Ginting Muthe, 2004, Analisa Proses Perekrutmen dan seleksi Tenaga Keperawatan I RS Duren Sawit,
Tesis FKM: Universitas Indonesia.
Ike Kusdyah Rachmawati, Manajemen Sumber Daya Manusia, Yogyakarta : ANDI, 2008, hlm. 84.
Jogiyanto H.M. 2005. Analisis dan Desain Sistem Informasi: Pendekatan terstruktur teori dan praktik aplikasi
bisnis, Yogyakarta: CV. Andi Offset.
Sutabri, Tata, 2005. Sistem Informasi Manajemen, Yogyakarta: Andi Yog
Shafiee et al. BMC Nursing (2022) 21:15
https://doi.org/10.1186/s12912-021-00790-1
RESEARCHOpen Access
Development and evaluation of an

electronic nursing documentation system
Mohsen Shafiee1 , Mostafa Shanbehzadeh2 , Zeinab Nassari1 and Hadi Kazemi-Arpanahi3,4*
Abstract
Background: Nursing documentation is a critical aspect of the nursing care workflow. There is a varying degree in how
detailed nursing reports are described in scientific literature and care practice, and no uniform structured documentation
is provided. This study aimed to describe the process of designing and evaluating the content of an electronic clinical
nursing documentation system (ECNDS) to provide consistent and unified reporting in this context.
Methods: A four-step sequential methodological approach was utilized. The Minimum Data Set (MDS) development
process consisted of two phases, as follows: First, a literature review was performed to attain an exhaustive overview of
the relevant elements of nursing and map the available evidence underpinning the development of the MDS. Then, the
data included from the literature review were analyzed using a two-round Delphi study with content validation by an
expert panel. Afterward, the ECNDS was developed according to the finalized MDS, and eventually, its performance
was evaluated by involving the end-users.
Results: The proposed MDS was divided into administrative and clinical sections; including nursing assessment and the
nursing diagnosis process. Then, a web-based system with modular and layered architecture was developed based on
the derived MDS. Finally, to evaluate the developed system, a survey of 150 registered nurses (RNs) was conducted to
identify the positive and negative impacts of the system.
Conclusions: The developed system is suitable for the documentation of patient care in nursing care plans within a
legal, ethical, and professional framework. However, nurses need further training in documenting patient care according
to the nursing process, and in using the standard reporting templates to increase patient safety and improve
documentation.
Keywords: Nursing records, Nursing process, Electronic health record, Electronic medical records, Hospital information
system
B Clinical documentation and access to reliable informa-

tion are crucial facets of nursing decision-making in care
a practice [1]. Nurses and other caregivers aim to ex-
c change information about patients and administrative
k
g
* Correspondence: h.kazemi@abadanums.ac.ir
r
o Department of Health Information Technology, Abadan University of Medical
3
Sciences, Abadan, Iran

u Department of Student Research Committee, Abadan University of Medical
4
n Sciences, Abadan, Iran
d Full list of author information is available at the end of the article

activities with high quality standards such as and comprehensive documentation of nursing
precision, timeliness, concurrency, conciseness, interven- tions is essential for several other reasons. It
comprehensive- ness, organization, and improves patients’ outcomes, increases the quality
confidentiality [2]. Nursing documentation is and safety of healthcare services, ensures practice
defined as written evidence demonstrating that the accountability, and facilitates communication
nurse’s authorized and moral responsibilities were between various involved
met in order for care to be assessed [3]. Accurate
© The Author(s). 2022 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other
third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the
material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a
credit line to the data.
Shafiee et al. BMC Nursing (2022) 21:15 Page 2 of 12
interoperability across health information systems. Sev-

eral terminologies exist that support nursing practice,
health care stakeholders [4]. Accordingly, the nursing but none have been broadly leveraged in Iran’s E-health
documentation framework needs to be standardized, system [17]. To comply with data standards, nursing
reasonably organized, and structured to mirror the specialists must decide which data items should be in-
phases of the nursing process, i.e., the assessment, cluded in the context of patient care, and what required
diagnosis, planning, implementation, and evaluation data could be documented by other healthcare staff
of patient conditions [5]. Despite the importance of [18, 19]. Therefore, to overcome the limitations of
clinical documentation, currently, there are above- mentioned paper-based nursing documentation,
undesirable situations of care recordings and a lack some considerations must be addressed from a data
of an appropriate framework for documenting nursing
care [6]. Studies in Iran have revealed that the
nursing documentation is not compliant with the
standards. Several studies compared international
standards with those reported in Iranian studies
showed that nurses in other countries were more
diligent in following documentation principles and
standards [7]. Currently, the clinical nursing reporting
in most hospitals in Iran is paper-based which may be
similar to writing a story with a varied and in-
consistent format. In most cases, there is no legislative
defense for the nursing staff because of the gradual
fading and illegibility of manual records [8, 9].
Writing a nursing report is a routine event that that
should be performed several times during a nurse’s
daily work, therefore, nurses spend about 37% of
their entire working time writing reports [10–12].
One-half of all nurses must stay at work for 1–2 h after
the end of their shifts, mainly to complete nursing
records [13]. This approach has several drawbacks
including wasted time, disruption in patient care,
medical errors, endangering patients’ safety, fading
and illegibility of the paperwork, high staff turnover
rates, legal problems, and, other similar factors [14,
15]. Due to the fast developments in information
technology, the health industry actively attempts to
em- ploy electronic medical records (EMRs) for clinical
practice, research, education, and supervision
purposes. The Nursing information system (NIS), as a
module of EMR, control nursing care or services and
manages the nursing activities through which data
are assembled, ex- changed, stored, extracted,
presented, and transferred [16]. It has been revealed
that employing an EMR and electronic clinical nursing
documentation leads to higher quality, more
complete, and more patient-centric documentation
than manual nursing documentation. Na- tional
Health information technology officials suggested the
use of standard terminologies and data sets to enable
Inclusion criteria were (1) - availability of the full text
of the journal articles, (2) - language (English or
management standpoint [20, 21]. Thus, the Persian), and (3) - publication date (from 2011 or
purpose of this study was to design, develop, and later). Figure 1 shows the search strategy for
evaluate of an electronic clinical nursing identifying the relevant articles. The first part (Part A)
documentation System (ECNDS) and determine its included terms used for reporting templates. In the
core data elements and the validity of their second part (Part B), the keywords related to
corresponding values. digitalization were used. The third part (Part C)
contained terms about studies on information
system data architecture. The results of these three
parts were combined using the Boolean operator
M “AND, OR”. The search was supplemented via
e checking the bibliographies of the identified articles.
t Furthermore, previously developed relevant
h classification systems were systematically screened
o to collect information on clinical nursing report data
elements, including the nursing diagnosis
d classification of the North American Nursing
s Diagnosis Association Inter- national (NANDA-I), and
the Nursing Outcome Classifi- cation (NOC), Nursing
Study design Intervention Classification (NIC) and International
Classification of Nursing Practice
A four-step sequential methodological approach was
utilized. The minimum data set (MDS)
development process consisted of two phases, as
follows: First, a literature review was performed to
attain an exhaustive overview of the relevant
elements of nursing and map the available
evidence underpinning the development of MDS.
Then, the data included from the literature review
were analyzed using a two-round Delphi study with
content validation by an expert panel. Afterward, a
web- based system with modular and layered
architecture was designed based on the derived
MDS. Finally, to evaluate the developed system, a
survey of 150 registered nurses (RNs) was conducted
and the positive and negative impacts of the
system were identified.
Literature review
We performed a literature review to define the MDS-

nursing report parameters. To conduct the study,
first, an extensive literature review was performed in
internet databases such as Web of Science, PubMed,
ProQuest, Scopus, Magiran, and SID to identify the
electronic nursing documentation system’s potential
data elements. Thus, this step comprises all the
elements associated with clinical nursing report
templates and, it is necessary to incorporate and
collect all elements related to nursing practices
including diagnosis, assessment, and intervention.
Fig. 1 Search strategy
(ICNP). Finally, data fields were extracted from the re- gender
lated retrieved resources and entered into a
checklist with two administrative and clinical sections.
Delphi phase
The initial MDS content was validated by the Delphi

technique using two rounds as bellow:
Participants
Using purposive sampling, we convened nursing

professionals working as university faculty members
of nursing in Iran’s Universities of Medical Sciences.
Table 1 shows the demographic characteristics of
these experts.
Questionnaire development
The preliminary literature review provided the

framework for developing a questionnaire to seek
Table 1 Demographic characteristics of Delphi participants
Variables frequency percentage

female 43 53.75
experts’ individual views regarding the important ele-
male 37 46.25
ments to be included in the MDS. The participants
were asked to assess all items’ importance in the
Educational preliminary data list extracted from the literature
review. Item importance was assessed based on a
PhD nursing (RN) 74 92.5 three-point Likert scale, which included three
options: “yes”, “no”, and “unsure”. “yes” indicated
Master nurse (RN) 6 7.5
the high importance of an element, and “no”
Age meant the low importance of the element for
inclusion. A blank row was provided at the end of
30–40 19 23.75 the questionnaire for the experts to add the
necessary data elements. The content validity of the
40–50 48 60
questionnaire was assessed by an expert panel,
> 50 13 16.25 including 80 nurses. Moreover, a test-retest was used
to evaluate the reliability of the questionnaire. A
Work experience in clinical field (years) consensus was reached based on experts’
agreement level regarding data elements to select
< 10 12 15
items with ≥70% agreement (on an item’s
10–15 28 35
importance) [22, 23].
15–20 24 30
20–25 8 10 Delphi survey rounds
> 25 8 10 After the initial ranking, items with less than 60%
agreement were deleted, those with more than 75%
Total 80 100 agreement were excluded from the second
round, and those with 60 to 75% agreement were
Demographic characteristics of Delphi participants
surveyed in the second round. The checklists were
individually presented to the experts who were
blind to the scores of the other experts, and if there
was 75% consensus over a subject, it was included in
the final MDS.
Statistical analysis
Data were analyzed using the statistical package for

social sciences (SPSS) software version 25 (Chicago,
USA) via a few descriptive and analytical tests (chi-
square, t-test, and paired t-test). The software was
used to summarize respondents’ characteristics and
demographic details. For each item outcome, the
median, mean, and proportion ratings were
calculated. To rank the scores, the median for each
item outcome was calculated. The statistical
significance was considered at p < 0.05.
section of the questionnaire included 12 items for

evaluating the ‘quality of the system, which is defined
Nursing documentation software development tools as the assessment of the quality of the system, its
outputs, and its responsiveness. The last section of the
Using Visual Studio 2019 a web-based nursing docu-
survey had 11 questions on ‘user satisfaction with
mentation system was designed. We used this
ENDS’, which is defined as the extent to which nurses
platform because of its numerous benefits (e.g., cost-
believe the system is important in improving their
effective, scalable and accessible, user-friendly, fast
work [26].
and conveni- ent, possessing the ability to custom
search, improved Intellicode, having a clipboard, and
refactoring attri- butes) [24]. The developed system
was implemented with the cascading style sheets Ethical considerations
(CSS) technology as a web-based program. CSS, along
with the hypertext markup language (HTML), was The director of the research facility of the university ap-
used to describe the presentation of documents and proved the research protocol (approval ID: IR.ABADA-
set the document syntax, layout, display format, and NUMS.REC.1400.065; date: 14/05/2021). All the
visual effects (e.g., font type, color, spacing, and sizes). participants were required to sign a confidentiality
The code was written in Java- Script language to agreement and study participation consent form before
design the website. Finally, Structured Query joining the expert panel.
Language (SQL) was employed to develop the re-
lational database (RDB). SQL provides efficient and
systematic storage of data with high performance,
availability, scalability, flexibility, management, and
security [25].
Evaluation of the developed ECNDS
A pilot study was designed to assess clinical nurses’

views on working with the system. A total of 150 RNs
participated in this survey, who worked in a variety of
clinical wards, including; the emergency department,
critical care wards, and other medical-surgical wards.
The instrument used in this survey was a
questionnaire containing 35 items which was
employed to evaluate system quality, system
usefulness, and user satisfaction of the ECNDS
prototype system [26]. A five-point Likert scale was
used to rate responses ranging from ‘never/almost
never/not at all’, to ‘always/almost always/very
great’ for each item. In the first section of the survey,
respondents listed their credentials, primary work
settings, job classification(s), and years of experience
as a nurse.
The second section of the questionnaire contained

12 questions for assessing the ‘system usefulness ‘,
which is defined as the frequency of using the system
to complete patient care-related tasks. The third
This section has 19 items in our study. The items were
delivered by the Delphi survey for nursing
They were cognizant of the objectives of the study. professionals. In the first round of Delphi, all the items
They were also informed that their participation was of this section were confirmed (Table 2).
optional, and they had the liberty to withdraw from
the study at any time.
Nursing assessment information
R This section has a total of 875 data items, which are

divided into nine categories. These categories
e include (Table 2):
s
u
l A. Cardiovascular system:
The cardiovascular system had 140 data items.
t Items 1 to 60 (95.63% agreement), items 61 to
s 100
Phase 1: literature review (89.87% agreement), items and 101 to 130

(88.6% agreement) were accepted in the first
Searching the online databases resulted in retrieving stage of Delphi; items 131 to 140 (85.46%
3520 articles from PubMed, Embase, Scopus, Science agreement) are accepted in the second stage of
Direct, and Cochrane databases after removing the Delphi, and finally, all 140 cardiovascular items
duplicates. Initial screening of the titles and abstracts were accepted. Each item had a percentage of
resulted in 145 articles, of which 113 were excluded acceptance, and the items whose acceptance
because they did not address reporting template percentage was close to each other are listed in
items in relation to nursing practices. Three more a column.
articles were identified through checking the
bibliographies, leading to a total of 35 articles for
full-text review (Fig. 2).
Phase 2: Delphi stage
In this study, after searching in scientific databases

and according to the processes provided by NANDA,
CCC, and ICNP nursing classifications, we extracted a
set of data elements and validated them via a
two-round Del- phi survey for inclusion in the final
MDS of nursing documentation. We divided this
dataset into three general categories, including the
administrative category, nursing assessment, and
nursing diagnoses. The number of participants in the
Delphi stage was 80 subjects, including 74
individuals with a nursing Ph.D. degree, and six
nurses with an MSC nursing degree. About 43% of
the participants were female, 88% of them had
more than 10 years of clinical experience, and all
participants had an RN degree (Table 1).
Administrative information
Fig. 2 Search flow diagram
C. Genitourinary (GU) system

The GU system had 85 data items. Items 1 to
B. Muscle and skeletal system 30 (98.1% agreement), items 31 to 56
The muscle and skeletal system had 80 data (96.23%
items. Items 1 to 40 (98.32% agreement), items
41 to 68 agreement), and items 57 to 82 (97% agreement)
were accepted in the first stage of Delphi. Items 83
(92.87% agreement), and items 69 to 78 to 85 (65.66% agreement) were removed in the
(90.56% agreement) were accepted in the first second stage of Delphi and finally, 82 GU items
stage of Delphi. Items 79 to 80 (65.36% were accepted. Each item had a percentage of
agreement) were removed in the second stage acceptance and the items whose acceptance
of Delphi and finally, 77 muscle and skeletal percentage was close to each other are listed in a
items were accepted. Each item had a column.
percentage of acceptance that those items
whose acceptance percentage was close to
each and the listed in a column.
D. Renal system
The renal system had 50 data items. Items 1
to 36 (89.1% agreement), items 37 to 45
(90.39%
agreement), items 46 to 50 (98.85%

agreement) were accepted in the first stage of
Delphi, and therefore, all 50 renal items were
accepted. Each item had a percentage of
acceptance and the items whose acceptance
percentage was close to each other are listed
in a column.
E. Neurological system
The neurological system had 110 data items.
Items 1 to 48 (99% agreement), items 49 to 88
(91.41%
agreement), items 89 to 100 (95% agreement),

and
items 101 to 108 (88.64% agreement) were

accepted in the first stage of Delphi. Items 109
to 110 (69.75% agreement) were removed in
the second stage of Delphi and finally, 108
neurological items were accepted. Each item
had a percentage of acceptance and the items
whose acceptance percentage was close to
each other are listed in a column.
Table 2 Administrative and Nursing assessment information
patient demographic information Round 1 Round 2 Final Decision
Agree
Dis agree Unsure Agree Dis agree Unsure
N (%)
N (%) N (%) N (%) N (%) N (%)
Patient name, age, gender, educational level, Marital Status, Employment status,
admitted date, admitted time, admitting nurse, Admitting physician 100 0 0 kept
Physician, Ward, Bed, Hospital name, Phone, Insurance, Source of history 100 0 0 kept
Past medical history 85.62% 8.4% 5.98% kept

Items related to the nursing assessment
Body systems Item numbers Item numbers Round 1 Round 2 Final Decision
(total)
Agree Agree
Dis agree Unsure Dis agree Unsure
N (%) N (%) N (%) N (%) N (%) N (%)
Cardiovascular system 140 1–60 95.63% 2.4% 1.97% kept
61–100 89.87% 6% 4.13% kept
101–130 88.6% 10.7% 0.7% kept
131–140 69.43% 29.11% 1.46% 85.46% 14.54% 0 kept
Muscle and Skeletal system 80 1–40 98.32% 0 1.68% kept
41–68 92.87% 7.13% 0 kept
69–78 90.56% 7.4% 2.04% kept
79–80 62% 36% 2% 65.36% 34.64% 0 remove
GU system 85 1–30 98.1% 0 1.9% kept
31–56 96.23% 0 3.77% kept
57–82 97% 0 3% kept
83–85 70.25% 29.75% 0 65.66% 34.34% 0 remove
Renal system 50 1–36 89% 10% 1% kept
37–45 90.39% 0 9.61% kept
46–50 98.85% 0 1.15% kept
Neurological system 110 1–48 99% 0.5% 0.5% kept
49–88 91.41% 2.36% 6.23% kept

89–100 95% 4% 1% kept
101–108 88.64% 11.36% 0 kept
109–110 67% 30% 3% 69.75% 30.25% 0 remove
Psychological and social 65 1–42 98.12% 1.88% 0 kept
43–58 96.55% 2.32% 1.13% Kept
59–65 100% 0 0 Kept
Skin system 55 1–49 100% 0 0 kept
50–55 96% 0 4% kept
General appearance 150 1–36 100% 0 0 kept
37–88 94.96% 5.04% 0 kept
89–95 98% 2% 0 kept
96–106 96% 3% 1% kept
107–120 86.76% 0 13.24% kept
121–134 79.23% 20.77% 0 kept
135–145 89% 11% 0 kept
146–150 88% 12% 0 kept

Table 2 Administrative and Nursing assessment information (Continued)

Respiratory system 140 1–55 89.51% 9.39% 1.1% kept
56–78 98.23% 1.77% 0 Kept
79–100 96.37% 3.2% 0.43% Kept
101–125 95% 0 5% Kept
126–140 70.26% 21.36% 8.38% 79.80% 20.2% 0 kept
35–40 89% 10% 1% kept
Administrative and Nursing assessment information
F. Psychological and social category (86.76% agreement), items 121 to 134 (79.23%
The psychological and social category had 65
data items. Items 1 to 42 (98.12% agreement), agreement), items 135 to 145 (89% agreement),
items 43 and
to 58 (96.55% agreement), and items 59 to 65 items 146 to 150 (88% agreement) were accepted
(100% agreement) were accepted in the first in the first stage of Delphi, and therefore, all 150
stage of Delphi, and therefore, all 65 general appearance items were accepted. Each
psychological and social items were accepted. Each item had a percentage of acceptance and the
item had a percentage of acceptance and the items whose acceptance percentage was close to
items whose acceptance percentage was close to each other are listed in a column.
each other are listed in a column.
I. Respiratory system
G. Skin system The respiratory system had 140 data items. Items 1
The skin system had 55 data items. Items 1 to to 55 (89.51% agreement), items 56 to 78 (98.23%
49 (100% agreement) and items 50 to 55 (96%
agreement were accepted in the first stage of agreement), items 79 to 100 (96.37% agreement),
Delphi, and therefore, all 55 skin items were and items 101 to 125 (95% agreement) were
accepted. Each item had a percentage of accepted in the first stage of Delphi, and items 126
acceptance and the items whose acceptance to 140 (79.80% agreement) were accepted in the
percentage was close to each other are listed in second stage of Delphi and therefore, all 140
a column. respiratory items were accepted. Each item had a
H. General appearance percentage of acceptance and the items whose
The general appearance had 150 data items. acceptance percentage was close to each other
Items 1 to 36 (100% agreement), items 37 to 88 are listed in a column.
(94.96%
agreement), items 89 to 95 (98% agreement),

items
96 to 106 (96% agreement), items 107 to 120

Due to the large amount of information, we had legal issues (65%). The developed ECNDS is utilized
to provide, only Table 3, which is an example of a used at bedside (93%),
platform developed for cardiovascular nursing
assessment.
Source of nursing diagnoses
In this study, we conducted a Delphi survey to

determine the source for writing nursing
diagnoses. For this purpose, the main sources for
nursing diagnoses (NANDA, ANA, ICNP, CCC, and
CINA) were selected and sent to the participants.
One-hundred percent of the survey returned, and
the NANDA classification was accepted with 98%
approval. Nursing diagnoses were written based
on NANDA and included in the final MDS of the
nursing reporting system (Table 4).
System evaluation
After developing the ECNDS Fig. 3, it was

experimen- tally used by the end-users (nurses),
and a pilot study was performed on user
satisfaction. This study was conducted on 150
clinical nurses. The majority of the participants
were female (74.66%), and the average age was
36.4 (SD ± 6.4). About 45.33% of them were

employed in the internal medicine-surgical wards,
35.33% worked in critical wards, 12.66% were
employed in emergency wards, and 6.68% worked
in other medical wards. The average work
experience was 15.66 years (SD ± 4.5) (Table 5).
The extracted data are classified into three

categories. Figures 4 and 5 identify the positive and
negative impacts of the developed ECNDS by
nurses, respectively, after implementing the
system at the Abadan hospitals.
The ECNDS can improve the communication

between departments (89% of the nurses who
responded to the question on communication
agreed that the system functioned well and
nurses were satisfied with it). This system can
also improve the quality of patient care (92%). By
using it, the retrieval and entry of patient in-
formation become simple and accurate (80%). In
addition, the system is easy to access (91%), and
can be used by nurses in different wards (89%). It
also reduces documentation errors (85%); and
Table 3 A sample of final nursing reporting MDS: the cardiovascular system assessment data elements
Data elements Data values
HR
BP Invasive
Non-invasive
Iv line Peripheral Angio cat

Scalp
Central Triple lumen

Double lumen
Port
Cat down
Site of Iv line Peripheral Hand

Leg
Jugular
Central Subclavian
Jugular
Limb
Serum Dose / Ml/hr. / Gtt/min
Type of serum Isotonic/ Hypertonic/ Hypotonic

The patient needs blood products No
Yes (if yes,) FFP, Cryoprecipitate, Cryopoor Plasma (CPP), whole blood, platelet concentration, washed
red blood cells, Low leukocyte red blood, Radiated red blood cells, Frozen red
blood cells
Quality of pulse (power) +, ++, +++, ++++
Symptoms of dyspnea PND (paroxysmal natural dyspnea), Orthopnea, dyspnea during exercise, dyspnea during rest,
chest pain yes Onset, Site Radiation, Quality of pain, Pain aggravating factors, Pain Reduction Factors, no
Capillary Refill time Brisk (> 2 s), Sluggish (< 2)

Time to start the pain
CVP (central vein pressure) Normal, abnormal

Rhythm normal
arrhythmia Irregular Atrium arrhythmia, Early Stimulation Syndromes, AV arrhythmia & blocks, Branch
blocks, Ventricular arrhythmia,
Regular SA node arrhythmia
patient needs a pacemaker yes Internal, External
no
Set up of pacemaker Mode, Output, Rate

Does the patient need a monitor? Yes, no
Does the patient need an IABP? Yes, no setup
Edema yes Localize, general

no
Edema yes Pitting, Not pitting

no
CPCR yes onset start, duration, end time of CPCR, Time to announce resuscitation code, Drug
are used, Type of rhythm, shock,
no
CPR successful yes post-CPR care

no
ventilate the patient during CPR ETT, LMA, AMBO bag
A sample of final clinical nursing reporting MDS: the Cardiovascular system assessment data elements
Table 4 Source of nursing diagnoses
Nursing Delphi survey rounds Final

classification Round 1 Round 2 Decision
systems
Agree N (%) Dis agree N
(%) Unsure N (%) Agree N (%) Dis agree N (%) Unsure N (%)
NANDA 98 0 2 accepted
ANA 35.6 64.4 0
ICNP 33.1 66.9
CCC 45.2 54.8
CINA 40.3 59.7
Source of nursing diagnoses
D
facilitates exchanging information from shift to shift i
(79%), and boosts the productivity (87%) (Fig. 4).
s
The second section of the survey is shown in c
Fig.
u
5 and describes the negative impacts of the s
ECNDS as follows: the loss of confidentiality (35% of
the nurses answering the question on the
s
confidentiality issue agreed that the ECNDS requires i
increased confidentiality); the ECNDS is dependent o
on utilities (35% of nurses agreed); the hospital is
still using a paper system in some departments n
(89%); using the ECNDS is time consuming (28%
The field of information technology is developing and
agreed), and the system is works very slowly (60%).
with its progress, it can help the advancement of other
Moreover, 17% of the participants disagreed with
sciences such as nursing science. In Iran, nursing docu-
the validity of coding the nursing diagnosis and
mentation is still conducted in a traditional and paper-
15% of them disagreed with the validity of the
based manner [8]. Electronic clinical nursing documen-
coding of the nursing assessment.
tation needs the data to be stored according to a
uniform and structured framework. This study aimed
to design an electronic clinical documentation system
for unified recording of nursing activities using
standardized data elements which improve data
quality, data interoperability, and decision-making,
and pave the way for formulating global standards for
nursing care. In this study, we conducted a systematic
review study along with a two-round Delphi survey to
prepare a formal and organized data structure and standard platform. This
Fig. 3 Clinical nursing documentation system home pages

exchanging information from one shift to another shift

were 93 and 79%, respectively [12]. In other words,
Table 5 Descriptive demographics of clinical nurses in the survey filling or
Variables Frequency percentage
Gender
female 112 74.66
male 38 23.34
ward
ER 19 12.66
Critical care 53 35.33
Medical and surgical 68 45.33
Other 10 6.68
mean SD
Age 36.4 ± 6.4
Work experience in clinical field (years) 15.66 ± 4.5
Descriptive demographics of clinical nurses in the survey
MDS could be applied to develop more patient-

oriented, evidence-based, safe and high-quality
nursing care. The developed MDS also helps to
support decision-making. After the survey, the system
was found that it prevents 65% of the legal issues,
reduces 85% of documentation errors, and does not
have the problems of the paper documentation
process. After using the system, 92% of the nursing
staff were satisfied with the increase in the quality of
care, which is in line with a study in Oman [27]. In
Iran, nursing documentation is a paper-based
approach, and nurses spend about one to two hours
completing nursing reports [28]. However, in this
survey, 82% of the nurses stated that their time was
saved by utilizing the system developed in this study.
In our study, nurses’ satisfaction with filling nursing
report documentation at the patients’ bedside, and
sidered to solve the major problems of EMR. Unlike
other studies, our work has a formal and organized
documentation of the clinical nursing report at the structure according to the nursing process, which has
patients’ bedside and exchanging patient been shown to improve legislative compliance and
information across shifts are two important completeness nursing documentation completeness
features of a nursing report that were taken into [27, 30]. Our software indicated that with the
account in our designed system. The ability of advancement of EMR in nursing practice, many
software to keep the information confidential is paper-based reporting problems such as; wasted time,
one of the most fundamental features of this tool. disruption in design and clinical care the patients,
Due to the team’s support for its security, the medical errors, endangering patients’ safety, fading
system designed in our study received 65% and illegibility of manual documentation, legal
satisfaction from nurses. problems, and, other similar issues. Are resolved [8,
9]. The electronic system developed in this study
We discovered the benefits and drawbacks of EMR
allows the nurses to fill out the pre-designed standard
systems, from reviewed studies, e.g., equipment
platform at the patient’s bedside, eliminating the
shortages and breakdowns, writing on paper and
need to write on paper and transfer the
transferring to EMR [29], user-friendliness and
information to the system. One of the time-consuming
interoperability, hardware and software problems,
and non- user-friendly problems of EMR systems is
increased documentation load, lack of formal
recording reports on paper and transferring them to
structure, inability to use at bedside, and other
the system [29], which was solved in our software.
factors [30]. Therefore, in the system developed in
On the other hand,
our study, the following features have been con-
Fig. 4 Positive impact of the

ECNDS
Fig. 5 Negative impact of the

ECNDS
this process is recorded at the patients’ bedside, and Limitations

therefore, the patient’s information is not missed.
More- over, our software shows a graph of the This study should have been used in more hospitals
progression of a patient’s clinical conditions such as with more nurses; on the other hand, nurses were
the patient’s heart rate in different shifts. The because of the heavy workload of nurses in clinical
mentioned features are among the strongest aspects wards and their lack of spare time, it was difficult for
of this system, which have been stated in a survey of them to participate in this study. In addition, nurses
clinical nurses. The simplicity and fluency of the needed training use this system, took great effort. The
designed platform as well as the existence of infrastructure of some hospitals was not suitable for
scientific and approved abbreviations in this platform the components of this design and it was very
are another advantage of this software noted in the challenging to build the necessary infrastructure.
survey by the nurses. Another key feature of this sys-
tem is that it can be used in general and specialized
clinical wards such as CCU. In the survey, nurses em-
phasized the software security factor in maintaining
patient information and the support team of this
system, which is a very important aspect in any
software. Finally, we must mention that our designed
software has the following features; (1) the existence
of an official structure and approval by nursing
professors; (2) it can be used in all hospitals and
different wards;(3) it can be easily used in the
bedside; (4) it has the ability to report nursing
information from shift to shift; (5) after a survey of
nurses working in the wards of Aba- dan hospitals,
it was concluded that our system is user friendly,
easy to learn and easy to used.
Funding
C
o There was no funding for this research project.
n
c Availability of data and materials
l The datasets used and/or analyzed during the current study are available from the
corresponding author on reasonable request.
u
s
i
o
n
s
The primary purpose of the nursing
documentation MDS was to scientifically reduce
the amount of clinical nursing report data
collected and documented by nurses during the
patient care process, while also enhancing the
enjoyment of nursing due to a reduction in
documentation burden. Involvement of the
system end-users in a meaningful way during the
development process resulted in an easier
conversion from paper-based to computerized
documentation, higher approval from nurses who
use the electronic nursing documentation system,
and minimal complaints regarding its content in
the practice setting.
Abbreviations
EMR: electronic medical record; RN: register nurse; CSS: cascading style sheets;
HTML: Hypertext Markup Language; NIS: Nursing information system; NANDA:
North American Nursing Diagnosis Association International;
NOC: Nursing Outcome Classification; NIC: Nursing Intervention Classification;

ICNP: International Classification of Nursing Practice; ECNDS: electronic clinical
nursing documentation system; MDS: minimal data sets
Acknowledgments
We thank the Research Deputy of the Abadan University of Medical Sciences for
financially supporting this project. We also would like to thank all experts who
participated in this study.
Authors’ contributions
M SH (1) and H AP performed a literature review to define the MDS-nursing

reporting parameters. M SH (2), Z N performed Delphi survey. H AP and M SH
(2) development electronic nursing report. Z N and M SH (1) performed
evaluation of the developed system. M SH (1), H KA and M SH (2) contrib- uted
to the interpretation of the results. H KA, M SH (2) and M SH (1) took the lead in
writing the manuscript. All authors provided critical feedback and helped shape
the research, analysis and manuscript. All authors read and approved the final
manuscript.
Shafiee et al. BMC Nursing (2022) 21:15 Page 377 of
Declarations
Ethics approval and consent to participate
The study protocol was approved before the initiation of this study by the Ethics Committee of Abadan university of medical sciences (approval
ID: IR.ABADANUMS.REC.1400.104 ). The study was performed in compliance with this institutional guideline, ethical guidelines for clinical research of the Iran government, and the
Declaration of Helsinki. The questionnaire was anonymous (demographic questions were asked but did not include identification details), and confidentiality of information was
assured.
All methods were performed in accordance with the relevant guidelines and regulations by the Declaration of Helsinki. All participants were required to sign a privacy agreement and
study participation consent form before joining the expert panel.
Informed Consent: Informed consent was provided by the mailed letter to all subjects prior to their enrollment. Filling out the questionnaire reflected consent to participate.
Consent for publication
All participants included in this research gave written informed consent to publish the data contained within this study.
Competing interests
Author(s): Mohsen Shafiee, Mostafa Shanbehzadeh, Zeinab Nassari, Hadi Kazemi-Arpanahi.
We declare that we have no significant competing for financial, professional, or personal interests that might have influenced the performance or presentation of the work described
in this manuscript. We have described our potential competing financial, professional, and/or personal interests in the space.
Author details
1
Department of Nursing, Abadan University of Medical Sciences, Abadan, Iran. 2Department of Health Information Technology, School of Paramedical, Ilam University of Medical
Sciences, Ilam, Iran. 3Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran. 4Department of Student Research Committee, Abadan
University of Medical Sciences, Abadan, Iran.
Received: 14 September 2021 Accepted: 21 December 2021
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Original Article
Information Processing in Nursing

Information Systems: An Evaluation Study
Abstract from a Developing Country
Background: In recent years, information technology has been introduced in the nursing departments
of many hospitals to support their daily tasks. Nurses are the largest end user group in Hospital
Information Systems (HISs). This study was designed to evaluate data processing in the Nursing
Information Systems (NISs) utilized in many university hospitals in Iran. Methods andoMaterials: This
was a cross‑sectional study. The population comprised all nurse managers and NIS users of the five
n
training hospitals in Khorramabad city (N = 71). The nursing subset of HIS‑Monitor questionnaire was
used to collect the data. Data were analyzed by the descriptive‑analytical method and the inductive
The
content analysis. Results: The results indicated that the useparticipating
nurses of health in information
the study did not systems
take a
desirable advantage of paper (2.02) and computerized (2.34)has
(HIS) information
spread processing
to modern tools to perform
health care
nursing tasks. Moreover, the less work experience nurses have, the further
organizations, [1,2] they
withutilizemany
computer tools
health
for processing patient discharge information. The “readability of patient information”
care organizations utilizing and “repetitive
information
and time‑consuming documentation” were stated as the most important expectations and problems
technologies to provide quality services
regarding the HIS by the participating nurses, respectively. Conclusions: The [1] nurses participating in the
present study used to utilize paper and computerized to their patients.
information Nursing
processing care to
tools together is
perform nursing practices. Therefore, it is recommended one that
of the
the nursing
most process
important health
redesign care
coincides
with NIS implementation in the health care centers. services. The central coordinating role
[3]
of nurses in the patient care team has

made
Keywords: Information processing, Hospital information them
system, to beinformation
Nursing recognizedsystem,
as one of the
Evaluation, Iran most important groups of patient record
registrar[4] and the main users of HIS. [5] Low
quality of nursing documentation
represents deficiencies in care programs.[6]
Hence, in recent years, information

technology in the nursing departments of
many hospitals has been introduced to
support their daily tasks. [7] These duties are
quite diverse and the main tasks include
planning, execution, and documenting
nursing care based on care process. Other
tasks performed by nurses comprise
This is an open access article distributed under the terms of the

Creative Commons Attribution-NonCommercial-ShareAlike 3.0
License, which allows others to remix, tweak, and build upon
the work non-commercially, as long as the author is credited and
the new creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

I
entering orders, dispensing
n and monitoring medication
t usage, managing the ward,
documenting, and
r communicating with other
o specialists.[8]
d Computer-based Nursing
u Information System (NIS) is
part of HIS that deals
c with nursing aspects and is
t used to better support
nurses in their daily tasks.
i
[9]
The introduction and development of
Mahnaz Samadbeik1, Nafiseh
this system affects the overall processing of
Shahrokhi1, Marzieh Saremian2,
information in hospitals.[6] NISs help
Ali Garavand3, Mahdi Birjandi4
nurses to provide better care to patients
and the possibility of assessment and 1
Student Research Committee, Lorestan University
exchange of clinical information with other of Medical Sciences, Khorramabad, Iran, 2Social
health care providers. Thus, the proper Determinants of Health Research Center, Lorestan
University of Medical Sciences,
functioning of NIS improves clinical data
integrity and satisfies user needs.[10] This Khorramabad, Iran, 3School of Allied Medical
system results in easier access to health Sciences, Shahid Beheshti University of Medical
care information, readability of nursing Sciences, Tehran,
documents, avoidance of repetition in the Iran, 4Department of Statistics and Epidemiology,

documenting process, better support of School of Health and Nutrition, Lorestan University
workflow, and greater respect for the legal of Medical Sciences, Khorramabad, Iran
rules and principles.[6]
How to cite this article: Samadbeik M, Shahrokhi N,

Saremian M, Garavand A, Birjandi M. Information
processing in nursing information systems: An
evaluation study from a developing country. Iranian J
Nursing Midwifery Res 2017;22:377-82.
Received: October, 2016. Accepted: February, 2017.
Address for correspondence:
Nafiseh Shahrokhi,
Student Research Committee, Lorestan University of

Medical Sciences, Khorramabad, Iran. E-mail:
mahbeik@yahoo.com
Access this article online
Website: www.ijnmrjournal.net
DOI:
10.4103/ijnmr.IJNMR_201_16
Quick Response Code:
© 2017 Iranian Journal of Nursing and Midwifery Research | Published by Wolters Kluwer - Medknow 377
Samadbeik, et al.: The quality of information processing in nursing information systems
The emergence of new information technologies has made i

some changes in the nursing documentation, the most
important of which is the shift from traditional paper-based a
records to electronic documentation system in a number of l
health care centers. Information technology solutions have
freed health care providers from specific and important
s
problems of paper documentation and have improved the
quality of nursing documentation.[4,11,12]
a
Any changes in the HIS should be evaluated on a regular n
basis.[13] Assessment of information and communication
technology systems in health care organizations is essential
d
to determine their side effects. In addition, evaluation
of these systems can provide the necessary information
M
to improve knowledge, create better health information
systems in the future, and guarantee the existence of e
efficient information systems.[14] As nurses constitute the t
largest end user group of HISs, evaluation of HISs should
begin with the assessment of nursing subsystems. h
However, despite the increasing number of NISs, their o
evaluation has not been often done thoroughly and
sufficiently.[9,15] In addition, no comprehensive theoretical d
and practical tools, methods, and guides exist for this type s
of evaluation.[16]
A cross-sectional study method was used in this study
The studies conducted in this regard have mostly
carried out in the training hospitals of Lorestan University
emphasized on specific evaluation criteria such as the
of Medical Sciences in 2016. The HISs used in these
impact on nursing documentation,[15,17,18] the time
hospitals, developed by five HIS software vendors, are
required to perform the nursing duties,[19] information
applied in many university hospitals with thousands of
quality requirements of users,[18,20] and challenges to and
active clinical users in Iran. Based upon the census sampling
facilitators of the nurses’ uses of the NIS.[9,21]
method, the study population comprised all nurse
Furthermore, in Iran, few studies have been done to managers (including matrons, supervisors, and head nurses)
address issues such as the state of NIS in Iran,[22] the and NIS users of the all five training hospitals in
structural needs of nursing data classification in the Khorramabad city (N = 71).
computer system,[23] and nurses’ experiences of the impact
The questionnaire utilized in this study was based upon the
of NIS on the efficiency of nursing service, [24] whereas none
reliable and valid HIS-Monitor questionnaire developed
of them studied the changes in the nursing information
processing after the introduction of computer-based NIS.
Nevertheless, achieving a full picture of NISs requires
taking into account the different evaluation criteria, which
encompass all nursing activities.[6] Therefore, this study
aimed to evaluate the processing of data in the NISs utilized
in many university hospitals in Iran from nurses’
viewpoint.
M
a
t
e
r
Iranian Journal of Nursing and Midwifery Research ¦ Volume 22 ¦ Issue 5 ¦ September-October 2017 37
by Ammenwerth et al. [6,15]

The HIS-Monitor comprises The data analysis was performed using the computerized
107 specific questions and 12 general questions, focusing Statistical Software Package for Social Science (SPSS)
on how a HIS efficiently supports clinical and version 17 developed by the Institute of Business
administrative tasks. It offers a quantitative score of HIS Management (IBM). To investigate the association
quality from the viewpoints of the professional groups. between the use of paper and computer information
The questionnaire not only considers information processing tools by the nurses to perform their tasks,
technology aspects but also puts emphasis on the
information processing tools used in various situations.
[15]
Thus, it serves as a useful tool for assessing HISs at
the centers where computerized and paper systems are
employed in parallel.
The adapted version of self-administrated HIS-Monitor

questionnaire comprised personal characteristics (work
ward, work experience, age, gender, education, and
organizational position) as well as 41 specific and general
questions, focusing on the quality of information
processing in nursing. These questions were divided into
the six major specific sections, including 7 questions on
nursing admission, 18 questions regarding access to
available patient-related information, 6 questions on
creation and updation of a nursing care plan, 2 questions
on nursing care, 6 questions on the documentation of
nursing care, and 2 questions on patient discharge.[6] At
the end of the questionnaire, there were 2 open-ended
questions regarding the fulfilled expectations and
problems of nurses about the nursing documentation and
tasks. To assess nurses’ views about the quality of
information processing, a 4-point scale of Likert from very
bad (very low) to very good (very high) was applied.
The mean values were calculated by attributing the code
“1” for the most negative answer to the code “4” for the
most positive answer, thus higher values indicate a
“better” quality of information processing.
The reliability and validity of this tool have been

approved by the previous researchers.[6,15] To confirm
the validity of the translation into the Persian language,
WHO forward/backward translation protocol was used.
The English version was first translated into Persian
by a qualified translator. Next, the Persian version was
examined for any inconsistencies by a panel of experts.
Then, the instrument was translated back to English by an
independent translator, whose mother tongue was English
and had no knowledge of the questionnaire. The backward
translated version was forwarded to a board of experts to
identify any poorly translated items or expressions and the
necessary modifications were made. The validity of the
content of this tool to be used in Iran was approved
by 5 faculty members of the nursing department. In
addition, the average internal reliability of the
questionnaire was high,  = 0.89.
a paired t-test was used. Moreover, the relationships bachelor’s degree. Approximately, 68% of the respondents
between personal characteristics of nurses and the use were under 40 years of age, and most of them (52%) had a
of the data processing tools (computer and paper) work experience of less than 12 years.
applied to carry out the nursing responsibilities in the
training hospitals were assessed by using multivariate
analysis iof variance (MANOVA).
The open-ended questions were analyzed using

inductive content analysis and MAXQDA 12 qualitative
analysis software. In the first stage of analysis, the nurses’
responses to those questions were read several times to
ensure that the analyst had a clear grasp of the overall
content. Then, the contents were reduced by changing
the nurses’ basic statements into simple statements. The
statements with similar meanings (semantic similarities)
were clustered together and recorded in the frequency
table. It should be noted that grouping of the statements
was done independently by two researchers, whereas a
third researcher was consulted if a consensus was not
reached.
Ethical considerations
Before starting the interview, written consent
for filling evaluation questionnaires was obtained from all
participants.
R
e
s
u
l
t
s
The studied hospitals had 753 active beds and 706 nurses.
The NIS was implemented at all the hospitals concurrent
with the establishment of the HIS, and all the nursing
stations were equipped with computers and covered
by a Local Area Network (LAN). The paper-based nursing
documentation system in the hospitals included forms of
physician order, nursing reports, nursing considerations at
the time of patient’s admission, patient’s training, and vital
signs measurement, vital signs chart, and absorption and
excretion of fluids.
Questionnaires were completed and returned by

50 nurses (70.4% response rate). The findings of this study
showed that 76% of the respondents were females and
the rest were males, most of the respondents (94%) had a
The findings of the present study [Table 1] showed no significant relationship was found between these
that all the respondents (100%) used both paper and two tools (paper and computer) in the task taking of
computer information processing tools together to nursing admission and access to available patient-related
perform their nursing duties. Based on the scores assigned information (P > 0.05). The results of the current
to the answers, the total mean scores of these tools study [Table 2] revealed that all the participating groups
revealed that the nurses participating in the study did not further used the computer tool to perform their nursing
favorably take the advantages of using paper (2.02) and tasks.
computer-based (2.34) information processing tools to
perform their nursing tasks; moreover, the information The results of the MANOVA [Table 3] showed that there was
processing with any of the investigated tools was not no significant relationship between gender, organizational
satisfactory. The nurses’ least and most uses of computer position, and age with the information processing tool
tools to perform their tasks were related to nursing used for all studied nursing tasks (P > 0.05). Further, work
admission 1.57(0.49) and documentation of nursing care experience only had an effect on the information
2.63(0.73). However, paper tool showed the most and processing tools (computer and paper) used for the task of
least uses for the access to available patient-related patient discharge (3). Furthermore, the work experience
information (2.11) and nursing care (1.89), respectively. groups of nurses participating in the study had significant
differences at least in one of the tools used to carry
As shown in Table 1, significantly positive relationships out the nursing task of patient discharge (P = 0.04).
were observed between the uses of paper and computer
tools in the tasks of creation and updation of nursing care By separately comparing each tool in terms of work
plan (P = 0.006, r = 0.38), nursing care (P = 0.013, r = 0.34), experience, it was seen that there was a significant
documentation of nursing care (P = 0.021, r = 0.33), difference between the two groups based on the
and patient discharge (P = 0.026, r = 0.31). However, computer
Table 1: Assessment of the support of the nurses’ tasks by the information processing tools in the
study hospitals
Tasks of nursing Information processing tool (Mean (SD)) Correlation coefficient
Paper-based Computer-based
Nursing admission 2.01 (0.69) 1.57 (0.49) 0.19
Access to available patient-related information 2.11 (0.64) 2.46 (0.64) 0.11
Creation and update of a nursing care plan 2.01 (0.65) 2.46 (0.72) 0.38*
Nursing care 1.89 (0.86) 2.52 (0.99) 0.34*
Documentation or nursing care 2.10 (0.76) 2.63 (0.73) 0.33*
Patient discharge 1.99 (0.85) 2.42 (0.93) 0.31*
Total 2.02 (0.74) 2.34 (0.75)
*P≤0/05 was considered as the significant level
nurses with less than or equal to 12 years of work

experience in the use of computer tools for the information
processing of patient discharge (2.73 (0.85)) compared to
Table 2: Participants’ views about the the corresponding group of more than 12 years of
processing tools used for nursing tasks work experience (2.08 (0.90)), it can be concluded that the
according to personal nurses with less work experience took a further
advantage of computer tools for processing patient
characteristics discharge information.
Participants’ information Information processing The met expectations and the most important problems
of the nurses in the HIS were grouped in 3 and 4 categories
tool (Mean (SD)) using a content analysis method, respectively [Table 4].
Paper Computer The content analysis of the responses to the open-ended
questionnaire indicated that the readability of patient
Gender
information was raised as the expectations met in the NIS
Female 2.05 (0.57) 2.42 (0.62) by the most nurses (N = 43). In addition, the majority
of the nurses (N = 48) pointed out the repetitive and
Male 2.09 (0.63) 2.52 (0.30) time-consuming documentation as the HIS problem.
Age
D
=<40 2.02 (0.54) 2.39 (0.52) i
>40 2.13 (0.67) 2.57 (0.62) s
Work experience (years)
c
u
=<12 2 (0.53) 2.5 (0.49)
s
<12 2.12 (0.63) 2.39 (0.63)
s
i
o
Table 3: MANOVA of the variables of n
information processing tools used in the
nursing task of patient The nurses participating in the present study used to use
paper and computer information processing tools
discharge for the two groups of work experience together to perform nursing duties, although they did not
desirably take advantages of any of the mentioned tools.
Test name Value Hypothesis df Error df Significant The results of other studies conducted in Iran have also
shown that the NISs are not in a good condition and do
not comply with
Pillai’s Trace 0.12 3.33 2 0.04*
Wilks’ Lambda 0.88 3.33 2 0.04*
Hotelling’s Trace 0.14 3.33 2 0.04*
Roy’s Largest Root 0.14 3.33 2 0.04*
tool used for the discharge duty (P = 0.01), but not

based on the paper processing information tool (P = 0.46).
Therefore, because of the higher average score of the
the duties and areas of nursing work,[22,24] though based One limitation of the study is related to the difference
on the studies performed in other countries, the between the hospitals in the time period that the HIS
quality of information processing significantly improved has been in operation, that is likely to affect the
after the introduction of computer-based information nurses’ viewpoint. Another notable limitation is the
systems.[6,25,26] The reason for this paradox can be the
continuation of using dual processing tools in Iranian
hospitals after learning and trusting the information
systems, which leads to an enhancement of the nurses’
workloads and inappropriate application of NIS.
No significant relationships were found between gender,

age, and organizational position and the information
processing tool employed for all nursing tasks,
however, the nurses with less work experience would take
more benefit of computer tools for processing the
information of patient discharge. Similarly, in their study,
Kahouyi and Babamohamadi reached the conclusion that
older nurses with less computer skills would be more likely
to spend more time on the use of information technology.
[24]
The findings of the study by Mann also showed that
those nurses and midwives who had good experiences of
clinical information systems would be more willing to use
this system.[27]
Repetitive and time-consuming documentation as well

as the limited coverage of nursing tasks were of the most
important problems mentioned in the information
systems used in the hospitals under study. Research
studies have pointed to different findings in this regard.
Some have stated the use of NIS saves time, accelerates
nursing tasks, and provides more time for patient care,
[24,28,29]
and others have known it to impose more time for
documentation and less time for patient care.[6,9,20,25]
Therefore, it seems that if the NIS does not comply with
the clinical care and nursing tasks, the documentation
time will increase. In addition, a further time- saving will
be possible by designing the information systems in a
manner that provides facilities such as a coverage for all
the nursing tasks, full description of nursing care, and a
possibility of recording nursing data at the patient
bedside. In the research conducted in this area, some
other problems have been mentioned including the
existing design flaws in the system content, hardware
shortages, system down times, inadequate training of
users, concerns about security, increase in nurses’
workloads, low number of portable computers, repetition
in recording information, and poor communication with
other HIS subsystems.[6,20,24,30] Improved readability of
documents was of the most important expectations of
the nurses fulfilled by the NIS in this study, which was
in agreement with the other relevant studies indicating
improvement of the documentation quality as one of the
key benefits of the system.[9,17,24,25]
Table 4: Nurses’ fulfilled expectations and problems in the fields of documentation and nursing
tasks in the
HIS (N=71)
Which one of your expectations has the HIS fulfilled in the What problems does the HIS have in the fields of documentation
fields of documentation and nursing tasks?
and nursing tasks?
Category Number* Typical example of a response Category Number Typical example of a response
Readability of 43 “Electronic nursing Repetitive and 48 “Parallel uses of computer and manual
patient information documentation has caused me time-consuming systems have caused a repetitive
to be able to easily read all my documentation documentation in the patient records
colleagues’ handwritings and the and system, thus more time is needed
nursing reports to be readable to for documentation and less time
all the authorized people.” remains for patient care.”
Improvement of the 39 “The HIS has caused the Limited coverage of 35 “The information system designed
quality of nursing information relevant to patient nursing duties does not fully comply with the nurses’
documentation care to be fully standardized tasks and fields of profession in the
and accurately and continuously hospital and only some of the nurses’
recorded, as well as the occupational tasks can be performed
incomplete documentation of through the system.”
care data provided for patients Incomplete access 23 “All the information needed for
to be prevented.” to the required patient care such as the doctor’s
information orders does not exist in the HIS and
the patient’s paper records must be
checked as well to achieve all the
required information.”
Improvement of 26 “The use of this system has Not having access 7 “The system has not been able to
interdepartmental improved communications to the required data provide direct access to patient
communications with other clinical departments at the patient’s data at his/her bedside, because
and units, such as laboratory, bedside documentation must be done at the
radiology, and operating nursing stations and laptops or other
room. It can also transfer the mobile technologies are not used for
information easier and faster to documenting and accessing the patient
the applicants.” data at the his/her bedside.”
*The number of nurses who responded the related statement in the open questions
small number of respondents (71), limiting the ability to

generalize the findings of the present study.
Acknowledgment
Research project from Student Research Committee at
C
Lorestan University of Medical Sciences (research project
o number: 1887). The authors would also like to thankthe all
n the nurse managers and NIS users participated in this
study.
c
l Financial support and sponsorship Lorestan
u University of Medical Sciences. Conflicts of

s interest
i
There are no conflicts of interest.
o
n R
Based on the results obtained, it is suggested that
e
the nursing process redesign coincides with the NIS f
introduction in health care centers. If nurses are e
involved in the design and development of the system from
the early stages to be able to transfer their expectations r
and needs to the system development team, they will find e
positive attitudes towards the new system and show less
resistance to it. n
c
Furthermore, it is recommended that the statistics and
information technology office of ministry of health and e
medical education, HIS supplier companies, analysts, s
developers of NISs, and nursing profession communities
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Open access Original research
Nurses’ perceptions of the

clinical information system in primary
healthcare centres in Qatar: a cross-
sectional survey
Monaa Hussain Mansoori,1,2 Kathleen Benjamin,2 Emmanuel Ngwakongnwi,2 Samya Al

Abdulla3
To cite: Mansoori MH, Benjamin

K, Ngwakongnwi E, et al. A
Nurses’ perceptions of the clinical
information system in primary B
healthcare centres in Qatar: a
cross-sectional survey. BMJ S
Health Care Inform
T
2019;26:e100030. doi:10.1136/
R
bmjhci-2019-100030 A
C
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY- T
NC. No commercial re-use. See rights and permissions. Published by
BMJ. Background Qatar is one of the fastest growing countries in the
Received 07 May 2019
Arabic region. Primary Health Care Corporation (PHCC) is the
Nursing, Primary Health Care Corporation, Doha, Qatar University of
1 2
Revised 23 July 2019 Calgary, Doha, Qatar

main provider of primary health services in Qatar and employs
1600 nurses. In 2014, PHCC started to migrate from paper to
Accepted 24 July 2019 Primary Health Care Corporation, Doha, Qatar
3 electronic documentation of patient records using a clinical
information system (CIS). Since implementation, the use of CIS and
perception of users have not been assessed.
Objective This study measured nurses’ perceptions regarding the

Correspondence to Monaa Hussain Mansoori;
mmansoori@phcc.gov.qa utilisation, quality and user satisfaction with the CIS in PHCC.
Methods Using a pre-existing survey, a cross-section of

nurses from six health centres in Qatar were systematically
selected and invited to participate in the
study. Eighty-nine surveys were completed (response rate: 98.8%)

and descriptive analyses were performed.
Results Nurses’ perceptions regarding the utilisation, quality

and user satisfaction with the CIS were positive. Nurses
indicated that the CIS is a resource for clear, accurate and up-
to-date data and that their performance improved due to the CIS.
Yet responses to an open-ended question in the survey revealed
some concerns related to the CIS, such as patient confidentiality,
system downtime and time constraints.
Conclusion Ensuring that the CIS is facilitating nurses’ work is

crucial to guarantee high-quality care to the community. The
findings provide foundational data to help PHCC to understand
nurses’ perceptions and to take

steps to overcome challenges
that nurses face related to the
CIS in their daily practice. This
work could also provide S
direction for future
research. u
m
m
a
Qatar is a r
peninsular Arab y
country located in
Western Asia.1
During the past 20
years, Qatar has
What is already known?
experienced
significant social and ► Nurses have reported both positive (eg, increased
economic 2017 the population increased to 2 639 211. 4 satisfaction) and negative (eg, breach of patient
transformations due Thus, there was a critical need for an confidentiality) aspects related to clinical information
in part to the system (CIS) in prior studies.
advanced technology system to capture
discovery of oil.2 this increasing amount of data. ► Nurses have concerns related to confidentiality of
These changes patients’ records with CIS use.
resulted in rapid Qatar initiated the first steps in
urbanisation, which developing a primary healthcare system in What does this paper add?
consequently 1954, and in 1978 the Ministry of Health
increased the launched healthcare services in nine ► Overall, nurses’ perceptions regarding the utilisation,
centres. Currently, there are 23 primary quality and user satisfaction with the CIS were positive.
burden of non-
communicable healthcare centres distributed ► Nurses indicated that the CIS is a resource for clear,
diseases.3 This accurate and up-to-date data and that their perfor-
epidemiological mance improved due to the CIS.
transforma- tion and
► However, responses to an open-ended question in the
the growth of survey revealed some concerns related to the CIS, such
Qatar’s population as patient confidentiality, system downtime and time
have increased the constraints.
volume of data. In
1997, there were How might it impact on clinical practice in
the foreseeable future?
513 455 people in
Qatar, and in ► The findings of this study can be used to minimise the
challenges that nurses face in their daily practice
related to the CIS.
► The findings can help decision makers to establish

support systems (eg, educational sessions) to overcome
the challenges nurses face with the CIS.
Mansoori MH, et al. BMJ Health Care Inform 2019;26:e100030. doi:10.1136/bmjhci- 1

2019-100030
Open access
across three regions: Central, Western and Northern. M

These centres are considered the first entry point for
patients into the healthcare system. E
T
Nurses play a key role in Primary Health Care Corpo-
ration (PHCC). They are the first point of contact for H
patients entering health centres, and they make up the O
largest component of the workforce. In 2014, PHCC
launched a new clinical information system (CIS) and D
provided training prior to implementation. Changes in S
the way nurses document their work have a significant
impact on their practice. 5 Hence, gaining a better A cross-sectional survey was conducted in 6 of the 23
understanding about nurses’ perceptions related to health centres distributed across three regions (ie, 9 in
their use, the quality and their level of satisfaction with the Northern region and 7 in the Central and Western
the CIS system in PHCC is important. This may regions). Two health centres from each region were
ultimately help PHCC to make necessary changes to selected to obtain a representative sample. Driving
improve nurses’ use and satisfaction with the CIS, distance and time to the first author’s home influenced
which in turn may improve patient care. The objective the choice of health centres selected for data collection.
of this study was to measure PHCC nurses’ perceptions
regarding the utilisation, quality and user satisfaction Systematic sampling was used to obtain a study sample.
with the CIS. In systematic sampling, individuals from a population of
interest are sampled at regular intervals, such as taking
A review of literature (2006–2017) was conducted using every fifth person.16 A list of nurses in each PHCC was used
Cumulative Index to Nursing and Allied Health Litera- as a sampling frame. Numbers were assigned in sequence
ture, PubMed, Web of Science and PsycINFO including the to the names on each list. Starting from the third subject,
following keywords: clinical information system, Elec- tronic every subject with an odd number was enlisted for
health record, primary health care, nurs*, perception. Ten the
relevant articles were included in this review. 6–15 All
studies were conducted in non-Arab countries using
qualitative, quantitative or mixed-methods approaches.
There was considerable variability across the studies in
terms of nurse characteristics, inclusion of other health-
care professionals in the sample and type of information
system evaluated. The results in all studies combined
both positive aspects of CIS (eg, change in
attitude/knowledge, increased satisfaction and nurses’
strong intentions to adopt the electronic health record)
and negative aspects (eg, gaps in knowledge and research
related to electronic medical record (EMR), lack of
proper staff training prior to EMR implementation and
confidentiality concerns). Four of the ten studies focused
on nurses’ perceptions alone,8 9 11 12 whereas the
remaining six studies combined nurses’ perceptions with
patients, physicians and other healthcare professionals in
primary care.
study until a total of 15 subjects per site were computer-based patient information systems) was
selected. If a nurse was not on duty, they were replaced by ‘CIS/Clinical Information System’; (3)
excluded and another participant with the next odd ‘hospital’ was replaced by ‘Practice area in PHCC’; and (4)
number was selected. A contact person who did not ‘nurse care worksheets’ was replaced by ‘Ambulatory
have any supervisory relationship with the nurses intake form/ nurses’ notes’.
assisted the researcher with data collection.
Data were entered by the first author into Excel
Inclusion criteria were (1) male or female nurse application (V.2016) for Windows, and then the Excel
working at a primary healthcare centre in Qatar who file was transferred to SPSS (V.24) for analyses.
completed the PHCC CIS training programme, (2) Descriptive analyses (frequencies, means, SD and
nurses who had worked with the CIS for at least 6 percentages) were performed.
months,
(3) self-reported ability to read and understand English,

(4) provides direct patient care and (5) willing to
participate in the study.
In 2016, there were 1600 nurses across 23 health
centres. A study involving all 23 health centres will
require a sample of 341 nurses, assuming a 95%
confidence level for estimates (p=0.05). Study sample
was adjusted to 89 (341/23*6) in accordance with the
design that envis- aged recruitment from only 6 out of
23 sites. A systematic sampling was employed to select
subjects from the list of nurses provided per site.
The tool used in the study was ‘Degree of

computer- ization and use of computer-based patient
information systems in Japanese’. 17 This questionnaire
includes 34 items divided into three sections: (1) extent
of use of EMR systems (12 items), (2) quality of EMR
systems (13 items) and (3) user satisfaction (9 items).
Response options for sections 1 and 2 were
‘never/almost never’, ‘seldom’, ‘about half the time’,
‘most of the time’ and ‘always/ almost always’.
Response options for section 3 were ‘not at all’, ‘very
little’, ‘some’, ‘great’ and ‘very great’. Partici- pants
were given the option of selecting ‘N/A’ (not appli-
cable) for sections 1 and 2, whereas ‘don’t know’ was
the option in section 3.
The reliability and validity of this tool were examined

in a study of 1666 nurses in 42 hospitals in Japan. 17 The
reliability for each subscale was assessed. Cronbach’s
alpha across these subscales ranged from 0.79 to
0.94. Content validity was assessed based on previous
surveys and a review of the tool by a panel of expert
nurses in informatics. Construct validity was
examined through factor analysis and correlational
analyses. Reliability levels for each subscale were
determined.
A few modifications to the original tool were made to

render it more specific to PHCC. Permission to
modify the tool was obtained from the authors of
this tool. The following were the modifications: (1)
‘bedside’ was replaced by ‘health center’; (2) CBPIS (for
2 Mansoori MH, et al. BMJ Health Care Inform 2019;26:e100030. doi:10.1136/bmjhci-2019-100030
Open access
Table 1 Sociodemographic data
Demographic features Percentages
Gender
Female 80.9
Male 19.1
Education
Diploma 18.0
Bachelor’s degree 77.5
Master’s degree 4.5
PhD –
Age groups (years)
<30 24.7
30–40 47.2
>40 27.0
Years worked at PHCC (years)
1–2 18.0
3–5 28.1
6–10 27.0
>10 25.8
Marital status
Single 20.0
Married 78.7
Divorced –
Widowed –
Birthplace
Qatar 3.4
Other 96.6
Mean score
(SD)
Items
1. Review the patient’s problems. 4.37 (0.817)

Missing data: for age=0.10%; for years worked at PHCC=0.10%; and
marital status=0.30%. 2. Obtain information on investigation or treatment 4.56 (0.753)
procedures.
PHCC, Primary Health Care Corporation.
3. Obtain the results from new tests or 4.45 (0.754)
investigations.
4. Enter daily nursing care notes. 4.69 (0.535)

R
E 5. Capturing patient observations at the health 4.21 (1.113)
center
S
U 6. Answer questions concerning general medical 4.15 (1.061)
knowledge (concerning treatment, symptoms,
L complications etc).
T 7. Obtain results of test and investigations. 4.56 (0.783)
S
8. To check drug information (such as allergy and 4.56 (0.811)
Ninety participants were recruited and 89 returned interactions).
their surveys (98.8% response rate). The mean age of the
9. Write nursing care plans. 4.18 (1.293)
participants was 37 years (SD ±8.7), 80.9% were female,
78.7% were married, 96.6% were born outside Qatar, and 10. Write nurse care worksheets (Ambulatory 4.49 (0.990)
77.5% had a bachelor’s degree. Nearly three-quarters intake form).
(73.1%) of the respondents have worked in a health
centre for less than 10 years. A summary of the 11. Collect patients’ info for discharge reports. 4.11 (1.570)
sociodemographic data is presented in table 1.
12. Document physical assessment of 4.57 (0.916)
The mean scores of most items were above 4 out of patients.
5. This suggests that overall the nurses have positive
perceptions related to CIS, used the system in their 13. How often does the system provide the precise 4.44 (0.690)
practice and are relatively satisfied with the system. information you need?
The mean scores are presented in table 2.
14. How often does the information content meet 4.42 (0.580)
your needs?
Table 3 illustrates participants’ responses to the six
possible response options. Generally speaking, a higher 15. How often does the system provide reports that 4.34 (0.656)
percentage of participants selected the response seem to be just exactly what you need?
options ‘most of the time or always/almost always’.
16. How often does the system provide sufficient 4.38 (0.649)
Although the percentage of N/A responses were rela- information?
tively low, there were three questions that had a
higher N/A response rate. These were the following: 17. How often is the system accurate? 4.34 (0.673)
(1) ‘Obtain
18. How often are you satisfied with the accuracy 4.29 (0.710)
of the system?
19. How often do you think the output is presented 4.25 (0.758)
in a useful format?
20. How often is the information clear? 4.27 (0.780)

Continued
Mansoori MH, et al. BMJ Health Care Inform 2019;26:e100030. doi:10.1136/bmjhci-2019-100030 3
Open access
had mixed
Table perceptions related to CIS utilisation and patient confidentiality. Concerns related to patients’
2 Continued
confidentiality were similarly found in another study. 10 Currently, PHCC has policies to ensure the confidentiality of
patient data. One possible strategy that may help to minimise nurses’ concerns regarding confidentiality of patient
data would be to provide inservice educationMean to raise
scoreawareness of existing policies. There are other strategies that
organisations can adopt to protect the confi-(SD) dentiality of patient data. One study18 stated that patients’ health data
areItems
at risk of disclosure by mistakes or by theft. The authors stated that it is the responsibility of leaders in healthcare
sectors to consider the ethical issues related to electronic health records (EHRs) and frame proper policies to
maintain patients’
28. Do you privacy
feel the quality andwork
of your confidentiality.
has 4.51 They
(0.676)suggested measures such as firewalls and antivirus software
improved?to help maintain patients’ confidentiality, and they also suggested that staff must not share their
programs
password with others and to log off the computer
29. Do you feel CIS is worth the time and 4.39 (0.806)
effort
CIS, required
clinical to usesystem.
information it? studies would be to include a statement in the
instructions to participants advising them that there are
30. Do you feel quality of information has 4.51 (0.740)
no ‘right’ or ‘wrong’ answers and that they should select
improved?
results of test and investigations’ (item 7, (4.5%), (2) ‘Write the ‘best’ response option for them.
31. Do you
Nursing feelplans’
care the CIS(item
has been a success
9, 9%), and in(3) ‘Collect
4.58 (0.636)
patients’
your health center? Although the satisfaction rate was high, the responses to
info for discharge reports’ (item 11, 19.1%).
one open-ended question showed that some
32. Do you feel participants
Twenty-six CIS is an important systemprovided
(23.1%) for 4.62 (0.699)
comments participants
to one open-ended question (ie, any other
comments) at the end of the survey. Five categories
(themes) were identified: (1) confidentiality concerns: for
instance, some participants said that the use of the CIS
improved patient privacy, while others believed that
there was a lack of confidentiality; (2) functionality of the
system: some participants mentioned that the system
was slow, that there were internet connectivity
problems and the system automat- ically logged off at
times, and many complained of the difficulty to deal
with the clients’ anger during downtime; (3) value for
the time: some participants stated that the use of CIS
saved their time, whereas others believed that the
system’s downtime, logging in and documenting were
time-consuming; (4) improvement in patient care: some
participants said that the CIS improved workflow,
improved documentation process and enhanced the
accessibility to patients’ data; and (5) staff satisfaction:
some participants described the CIS as very useful,
nice, supportive, helpful and a good method.
DISCUSSION
The positive findings in this study are similar to the results
of existing studies.6–9 11 12 14
The high mean scores may suggest the possibility of

acquiescence bias. One possible strategy to help minimise
the risk of this type of bias in future quantitative
when leaving the room. related to their satisfaction/dissatisfaction with the CIS
system.
Downtime can be defined as a time during which
authorised users will not be able to access and use Fahrenholz and colleagues19 suggested that there
the applications to perform their routine tasks. 19 The must be downtime training courses for all new employees
authors stated that there are two types of downtimes: and that regular refresher training should be provided to
scheduled and unscheduled. Although participants’ all staff. Moreover, the authors stated that another
responses to the survey item related to the CIS ‘saving effective way to prepare staff for downtime and evaluate
time’ were positive, comments to the open-ended their read- iness is downtime drill, which will truly reflect
question indicated that some participants found that staff’s knowledge and skills to deal with downtime. 19
the system’s downtime, logging in and documenting Currently PHCC has a regular downtime drill every 3–6
were all time-consuming, which made patients months to ensure that all PHCC staff are skilled in dealing
dissatisfied. Participants did not give enough details in with unexpected downtimes. As part of the drill,
the open- ended question to understand how healthcare managers of each healthcare centre must
downtime, logging in and documenting were time- ensure that all hard copy forms, such as blood
consuming. These findings have implications for investigation request forms, referral slips and medication
future research. Future studies could use a mixed- prescription sheets, are available and located in the
method approach that will allow for a deeper prearranged location in the event of a system
understanding of issues related to ‘time’ and the CIS downtime. Future focus group interviews could help to
within the context of PHCC in Qatar. Addition- ally, better understand the challenges that nurses and other
future research could capture patients’ perceptions healthcare professionals experience related to downtime.
Mansoori MH, et al. BMJ Health Care Inform 2019;26:e100030. doi:10.1136/bmjhci-2019-100030
Table 3 Participant responses to survey items
Never/ Almost Always/

never Almost
About half Most of the
Items (%) Seldom (%) the time (%) time (%) always (%) N/A (%)
1. Review the patient’s problems. – 5.6 4.5 37.1 52.8 –
2. Obtain information on investigation or treatment procedures. 1.1 1.1 4.5 28.1 64.0 1.1
3. Obtain the results from new tests or investigations. – 3.4 5.6 33.7 57.3 –
4. Enter daily nursing care notes. – – 3.4 24.7 71.9 –
5. Capturing patient observations at the health center. 3.4 6.7 10.1 27.0 50.6 2.2
6. Answer questions concerning general medical knowledge (concerning treatment, 1.1 7.9 15.7 29.2 42.7 3.4
symptoms, complications etc).
7. Obtain results of test and investigations. – 2.2 6.7 28.1 58.4 4.5
8. To check drug information (such as allergy and interactions). 1.1 3.4 3.4 22.5 69.7 –
9. Write nursing care plans. 2.2 13.5 12.4 16.9 46.1 9.0
10. Write nurse care worksheets (Ambulatory intake form). 4.5 2.2 2.2 21.3 69.7 –
11. Collect patients’ info for discharge reports. 9.0 12.4 6.7 21.3 31.5 19.1
12. Document physical assessment of patients. 3.4 1.1 2.2 24.7 65.2 3.4
13. How often does the system provide the precise information you need? – 2.2 3.4 43.8 49.4 1.1
Open access
14. How often does the information content meet your needs? – – 4.5 49.4 46.1 –
15. How often does the system provide reports that seem to be just exactly what you need? – – 10.1 46.1 43.8 –
5
16. How often does the system provide sufficient information? – 1.1 5.6 47.2 46.1 –
17. How often is the system accurate? – 2.2 4.5 50.6 42.7 –
18. How often are you satisfied with the accuracy of the system? – 2.2 7.9 48.3 41.6 –
19. How often do you think the output is presented in a useful format? – 2.2 12.4 43.8 41.6 –
20. How often is the information clear? – 3.4 9.0 46.1 40.4 1.1
21. How often is the system user-friendly? 2.2 2.2 13.5 42.7 39.3 –
22. How often do you get the information you need in time? – 1.1 11.2 40.4 47.2 –
23. How often does the system provide up-to-date information? – 1.1 10.1 48.3 39.3 1.1
24. How often can you count on the system to be up and available? – 5.6 7.9 55.0 30.3 1.1
25. How often is the system subject to frequent system problems and crashes? 1.1 31.5 14.6 34.8 18.0 –
26. Do you feel CIS are useful? – 1.1 3.4 32.6 62.9 –
27. Do you feel your performance has improved due to CIS? – – 9.0 25.8 65.2 –
28. Do you feel the quality of your work has improved? – – 10.1 29.2 60.7 –
29. Do you feel CIS is worth the time and effort required to use it? 1.1 – 12.4 32.6 52.8 1.1
Continued
Open access
Although one reviewed study measured the impact

of the CIS on patient outcome, 20 no studies in Qatar
N/A (%) have measured the impact of CIS on patients’ outcomes.
1.1
1.1
1.1
Future research could measure outcomes such as
patient safety and satisfaction with CIS within the
context of Qatar.
Five of the ten studies reviewed measured the

always (%)
perceptions of nurses and other healthcare providers,

Always/
but the studies did not present individual scores for

Most of the Almost
each category of provider.6 10 13–15 Although nurses are

57.3
62.9
66.3
58.4
members of the interprofessional healthcare team in

PHCC, they have unique roles and responsibilities. For
time (%)
instance, as mentioned before, nurses are the first

point of contact for clients and provide direct patient
36.0
29.2
29.2
care. There is a need for future research that explores

the unique perceptions of nurses, or studies that
Seldom (%) the time (%)
About half
present the results for each healthcare professional

individually.
Most of the participants in this study were female,

which is similar to the findings of other studies. 6–8 11
3.4
6.7
1.1
4.5
Since the vast majority of nurses are women

worldwide, the male perspective will typically be
under-represented in most surveys. It would be
interesting to conduct gender-specific focus groups to
1.1
2.2
1.1
determine if gender-specified perceptions regarding

CIS exist.
Although minor modifications were done to the

–
–
Almost never
tool to improve clarity for nurses working at PHCC,

there is a need for further refinement that better aligns
with the role of nurses in PHCC in Qatar. 1 For example,
Never/
items could include nurses’ roles related to home-care

(%)
1.1
1.1
patients, school health and women’s health.

–
A sampling frame was used, which helped to avoid

unin- tended selection bias and allowed everybody in
the sites to have an equal chance of being selected.
The use of the list of nurses greatly facilitated
recruitment process. For future studies, this sampling
approach can be used since the study sites maintain a
current list of all their nursing staff. Overall,
s been a success in your health center?
important system for your health center?
recruitment did not pose any challenges. In this study

only 15 participants were selected from each of the six
study sites. A study with a larger sample size involving
all 23 PHCC sites would allow opportunities for more
information has improved?
nurses to participate.
atient has improved?
As mentioned previously, three items had relatively

high ‘N/A’ responses. The question with the highest N/A
i
safet
response rate (19.1%) asked nurses if they ‘Collect

patients’ info for discharge reports’. This rate may partly be
related to the fact that the word ‘discharge’ is not a
familiar word in PHCC. For future research in Qatar, this
question could be deleted. The second highest N/A rate
(9.0%) asked nurses if they use the CIS to ‘Write Nursing
care plans’. This rate may be partly related to the fact
that PHCC nurses do not ‘write nursing care plans’.
However, they do write plans for ongoing treatments,
such as weekly dressing change. Therefore, the term
‘writing nurses care plans’ could be replaced with ‘writing
nursing treatment plans’. Lastly, the third highest N/A
response rate (4.5%) asked nurses if they used the CIS to
‘Obtain results of test and investigations’. This rate may
be partly related to the fact that, although nurses in
PHCC have access to patients’ tests and investigations,
they usually do not obtain the results,
Open access
since physicians concentrate more on this activity. Hence, tive perceptions related to CIS system. However, some
this item could be deleted in future studies. challenges were reported in the open-ended question
related to patient confidentiality and downtime.
L Findings of this study have implications for practice
policy and future research. The findings can help
i decision makers in PHCC to establish support systems to
m overcome the challenges nurses face with the CIS. For
i instance, PHCC can provide educational sessions for
nurses to overcome the challenges of downtime. These
t findings can also support decision makers in PHCC to
a raise awareness of the current policies related to
patient confidentiality which may help minimise nurses’
t concerns related to breaches in patient confidentiality.
i Lastly, future studies could use a qualitative approach
that will allow for a deeper understanding of issues
o related to ‘time’ and the CIS within the context of PHCC
n in Qatar. Additionally, future research could capture
patients’ perceptions related to their satis-
s faction/dissatisfaction with the CIS system.
The sample size was relatively small; thus, the results
cannot be generalised at this point of time. The original
response options (ie, not at all, very little, some, great, Acknowledgements The authors would like to acknowledge the authors Ochieng George
very great and don’t know) for section 3 (items 26–34) Otieno, Hinako Toyama, Motohiro Asonuma, Masako Kanai-Pak and Keiko Naitoh, who
permitted the use of their survey tool in this study.
were missed when the survey tool was formatted.
There- fore, the same response options (ie, Contributors MHM made substantial contributions to the conception and design, writing of
never/almost never, seldom, about half the time, most the manuscript, acquisition of data, analysis and interpretation of
of the time, always/ almost always and N/A) were used
data, provided the final approval of the version to be published, and agrees to be accountable
throughout the survey. Hence, the results for section 3 for all aspects of the work. KB made substantial contributions to the conception and design,
should not be compared with other similar studies that interpretation of data, involved in the drafting and revising of the manuscript critically for
content, provided the final approval of the version to be published, and agrees to be
have used the original response options.
accountable for all aspects of the work. EN made substantial contributions to conception and
design, data analysis and interpretation, and approved the final version for publication. SAA
provided input on study design, interpreted the results, was involved in revising the
manuscript critically for important intellectual content and approved the final version for
publication.
C
Funding The authors have not declared a specific grant for this research from any funding
O agency in the public, commercial or not-for-profit sectors.
N Competing interests None declared.

C Patient consent for publication Not required.
L
Ethics approval This study received ethical approval from the Conjoint Health Research
U Ethics Board (CHREB) in Calgary and the PHCC in Qatar. The study
S
I
O
N
This study evaluated 89 nurses’ perceptions related to CIS
in six health centres in Qatar. Overall, nurses had posi-
purpose and ethical considerations (eg, confidentiality of the data) were explained to the 14 Secginli S, Erdogan S, Monsen KA. Attitudes of health professionals
participants. They were asked to complete a survey, place it in a sealed envelope and give towards electronic health records in primary health care settings: a
it back to the contact person. questionnaire survey. Inform Health Soc Care 2014;39:15–32.
15 Terry AL, Stewart M, Fortin M, et al. Gaps in primary healthcare electronic
medical record research and knowledge: findings of a pan- Canadian study.
Provenance and peer review Not commissioned; internally peer reviewed. Healthcare Policy 2014;10:46.
16 Sarma BB, Kumar VV, Lalitha SV. Modified estimator for population
Data availability statement No data are available. mean in systematic sampling using known coefficient of variation. J Phy
Conf Series 2018;1000.
17 Otieno OG, Toyama H, Asonuma M, et al. Nurses? views on the use,
Open access This is an open access article distributed in accordance with the Creative
quality and user satisfaction with electronic medical records:
Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to questionnaire development. J Adv Nurs 2007;60:209–19.
distribute, remix, adapt, build upon this work non-commercially, and license their 18 Ozair FF, Jamshed N, Sharma A, et al. Ethical issues in electronic
derivative works on different terms, provided the original work is properly cited, health records: a general overview. Perspect Clin Res 2015;6:73.
appropriate credit is given, any changes made indicated, and the use is non-commercial. 19 Fahrenholz CG, Smith LJ, Tucker K, et al. Plan B. A practical
See: http://creativecommons.org/licenses/by-nc/4.0/. approach to downtime planning in medical practices. J Ahima
2009;80:34–8.
20 Ward MM, Vartak S, Schwichtenberg T, et al. Nurses perceptions of how
clinical information system implementation affects workflow and patient
care. CIN 2011;29:502–11.
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1 Central Intelligence Agency. The world fact book. Available: https://
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(EMR) demonstrations change attitudes, knowledge, skills or needs?
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nurses' use of electronic devices in a home care setting. Can J Nurs Res
2013;45:54–73.
8 Galimany-Masclans J, Garrido-Aguilar E, Girbau-García MR, et al. New
technologies and nursing: use and perception of primary healthcare nurses
about electronic health record in Catalonia, Spain. Telemedicine and e-
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9 Leblanc G, Gagnon MP, Sanderson D. Determinants of primary care
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Mansoori MH, et al. BMJ Health Care Inform 2019;26:e100030. doi:10.1136/bmjhci-2019-100030

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TUGAS SISTEM INFORMASI KEPERAWATAN

“5 JURNAL SISTEM INFORMASI KEPERAWATAN”

WISPA HANYDAAYNI,SST P01720423

Dosen Pembimbing: Ns.Andra saferi Wijaya,M.Kep

KEMENTERIAN KESEHATAN REPUBLIK INDONESIA

POLTEKKES KEMENKES BENGKULU

PRODI PENDIDIKAN PROFESI NERS

TAHUN AJARAN 2022/2023

JURNAL ILMU KOMPUTER

Keywords: E-Recrutement, Information System, PHP, MySql, SIM.

Keywords: E-Recrutement , Sistem Informasi, PHP, MySql, SIM.

E-ISSN : 2579 - 3918 | P-ISSN : 2302 - 710X

PENDAHULUAN PHP (Hypertext Prepocessor). Menurut Bunafit Nugroho

Sebagai institusi pelayanan kesehatan masyarakat yang

Permasalahan yang selalu dihadapi Rumah Sakit Sansani

Berdasarkan hal-hal tersebut diatas, maka peneliti

Data Flow Diagram

Menurut Tata Sutabri (2005) “Data Flow Diagram (DFD)

dipertimbangkan dengan matang. E-Recruitment

Menurut Chapman & Webster, (2003) E-Recruitment

Tujuan dari penelitian ini adalah untuk Agar mendapatkan

model waterfall, Disebut dengan model waterfall karena tahap

Gambar 1. Fase-fase dalam Waterfall.

Metode waterfall mempunyai langkah-langkah sebagai berikut :

Keahlian Teknik SistemSeorang yang ahli membuat sistem

Data Flow Diagram (DFD)

Gambar 4. Context Diagram

Gambar 3. Sistem yang diusulkan.

Sistem E-Recruitment Rumah Sakit Sansani telah memiliki

Perancangan sistem ini dibuat dengan diagram arus data

Context Diagram Sistem E-Rekruitmen Rumah Sakit

Berikut merupakan ﬂowchart pada sistem informasi yang

Gambar 8 Rancangan tampilan Form Pendaftaran.

Gambar. 9. Rancangan tampilan Login

Gambar 11 Tampilan Menu Utama Sistem E-Recruitment

SIMPULAN DAN SARAN

Bunafit Nugroho,2005, Database Relasional Dengan MySQL, Yogyakarta: Andi Yogyakarta.

Sutabri, Tata, 2005. Sistem Informasi Manajemen, Yogyakarta: Andi Yog

Shafiee et al. BMC Nursing (2022) 21:15

Development and evaluation of an

B Clinical documentation and access to reliable informa-

Sciences, Abadan, Iran

n Sciences, Abadan, Iran

d Full list of author information is available at the end of the article

interoperability across health information systems. Sev-

We performed a literature review to define the MDS-

Fig. 1 Search strategy

The initial MDS content was validated by the Delphi

Using purposive sampling, we convened nursing

The preliminary literature review provided the

Table 1 Demographic characteristics of Delphi participants

Variables frequency percentage

20–25 8 10 Delphi survey rounds

Data were analyzed using the statistical package for

section of the ques- tionnaire included 12 items for

Evaluation of the developed ECNDS

A pilot study was designed to assess clinical nurses’

The second section of the questionnaire contained

Nursing assessment information

R This section has a total of 875 data items, which are

Phase 1: literature review (89.87% agreement), items and 101 to 130

Phase 2: Delphi stage

In this study, after searching in scientific databases