Effect of Nursing Informatics' Training Program on Nurses' Proficiency in Remote Follow-Up for Liver Transplant Recipients

Background: Nursing informatics is expanding and developing with health information technology and becoming an essential component of all nursing practice areas particularly in monitoring of the organ transplanted recipients. Aim: To evaluate the effect of nursing informatics' training program on nurses' proficiency in remote follow-up for liver-transplant recipients. Research design: Quasi-experimental pretest-posttest design. Sitting: The present study was carried out at the Liver Transplantation follow-up Unit, National Liver Institute, Menoufia Governorate, Egypt. Sample: Convenient sample of all available nurses (50) divided random into intervention and control groups. Tools: Two tools were used; assessment questionnaire and Nursing Informatics Competency Assessment Tool (NICAT) . Results: All the 50 nurses completed the instructional program, but there was no clear differentiation between the interventional and control participants at the pretest phase in terms of the Nursing informatics competence and its elements (p = 0.54). However, in the post-test phase, the interventional nurses' Nursing informatics competence and its elements considerably improved with a big effect size in comparison to the control nurses (p=0.001), this distinction demonstrated the intervention nurses' competence in the post-test phase. The informatics literacy component had the biggest mean difference in the interventional group, whereas the informatics management skills element had the least overall mean difference. Conclusions : The intervention program obviously enhanced nursing informatics competence in all its dimension values, which suggested that it was helpful in raising the nursing informatics competence of nurses working in liver transplant unit. Recommendations: This program should be essentially applied in all health sectors for enhancing nurses' nursing informatics proficiency.


Aim of the study
This study aimed at evaluating the effect of nursing informatics' training program on nurses' proficiency in remote follow-up for livertransplant recipients.

Research Hypothesis
H1: Implementing nursing informatics' training program will improve nurses' proficiency in remote follow-up for liver-transplant recipients.

Research design:
A quasi-experimental pretest-posttest methodology was used in this research, comprising an intervention and control groups.

Study setting:
The current research was conducted at the Liver

Inclusion criteria
Nurses with a bachelor's degree, at least six months of experience working in liver transplant units, and no clinical shifts booked on the training days were required for enrollment.

Exclusion criteria
Being unavailable from one session and having an inadequate survey were the exclusion criteria. According to the inclusion criteria, none of the nurses were disqualified.

Tools and data collection procedure:
Two assessment questionnaires were made up for data collection in this research: by information management skills.

Scoring system:
Adjusting Likert scale system with a range of one to five, the NICAT is graded as follows:  Not competent (1 point), moderately competent (2 points), competent (3 points), proficient (4 points), and expert (5 points)  The tool's total range of scores is ranged between 30-150 with higher scores indicating more proficiency.
 A nurse who receives a total scoring of 30 is regarded to be a beginner;  A nurse who receives a rating upwards of 31 and 59 is an advanced beginner;  A nurse who receives a rating somewhere around 60 and 89 is competent;  A nurse who receives a rating between 90 and 119 is proficient; and  A nurse who receives a scoring between 120 and 150 is regarded to be a NI specialist.
With the assistance of an information technology professional, the investigators of the current study assessed the content's legitimacy. After describing the purpose of the investigation, all participants provided a written agreement to participate in the study, and they were guaranteed that all gathered data would be kept strictly secret and used solely for the purpose of the study.
Participation in the study was not obligatory and anonymous, according to the researchers.
Participants were also advised that refusing to participate in the study would not have any impact on their care or their health.

Validity of tools:
A jury of five academic medical surgical nursing staff and two healthcare informatics' experts attested to the accuracy of the adapted version of NICAT's material. By incorporating direct quotes from specialists, in-person conversations, and feedback, content legitimacy was increased.

Reliability of tools:
The reliability co-efficient regarding the first tool revealed (0.87). The investigators repeated the reliability co-efficient regarding the second tool, the Cronbach's alpha of the tool was showed (0.80) while for the nurse's proficiency the reliability co-efficient was equal to (0.847), which was adapted from (Rahman A., 2015). Hence, the study tools indicate good reliability for conducting the research study.
Additionally, 20 nurses took part in the questionnaire's pilot survey, and its reliability was evaluated using the Cronbach's alpha coefficient (α = 0.95).

Pilot study
Five nurses who participated in a pilot study (10%) were subsequently incorporated in the sampling because the study tools had not been changed. The goal of the pilot trial was to assess the instruments' usability and intelligibility, as well as to estimate how long it would take every nurse to fill in the demographic assessment questionnaire and the observational survey.

Contrast of the controls' improvements in NI competence
No discernible change in NI competence and its aspects was found in the control participants' pretesting and post-testing scores, which were both at the "competent" grade (t = -1.28, p = 0.14). What is more, a covariance analysis test was utilized in Table 3 to limit the effect of the pretesting on the nurses' NI competence.

Analysis of the interventional and controls' improvements in NI competence
Regarding the pre-testing effects, the findings showed a statistically significant distinction in the overall post-testing scores of NI competence and its aspects between the control and interventional samples. These outcomes concur with those in    Additionally, this assessment will assist the nurse manager in effectively understanding and planning for the training and development requirements of nurses.
 Finally, yet importantly, data collection took place a month after the operation. It is advised to conduct follow-ups every three to six months to ensure more reliable data, comparing the findings to ascertain the training's long-term effects, and evaluate the effectiveness of educational NI programs on nurses' competence.

Conclusions
The NI competence of liver transplant unit nurses and its aspects might be greatly enhanced by this initiative. The nursing staffs, as well as the national and global healthcare systems, have recently acknowledged the necessity to maintain NI competency development. It emphasizes the significance of proactive strategies to advance NI nursing skills across the board. Additionally, the preceding research's findings indicated that further interventional programs are required to boost NI competence and better satisfaction is the key competencies of the nursing field

Recommendations:
The findings of the current research indicated that in order to enhance nurses' NI competency, especially in the field of information management skills, professional nurses, decision-makers, healthcare assistants, and governments of healthcare situations should:  Developing training programs with the assistance of informatics' experts for nurses and other health workers can take inspiration from the training procedure employed in this program.
 Since nursing programs are in the ideal condition to foster NI competence in future nurses, it is crucial to improve collaboration and engagement between universities and healthcare settings for preparing future nurses to manage HIT and practical requirements efficiently by incorporating NI competence into nursing curriculum and employing integrated courses to enhance nursing students' NI competence.
 It is also advised to conduct more in-depth studies to examine NI competence in healthcare and assess the efficacy of various strategies and approaches to improve NI competence among nurses.