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Volume 13, Issue 3 (2025)
Health Educ Health Promot 2025, 13(3): 555-563 |
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History
Received: 2025/07/2 | Accepted: 2025/08/11 | Published: 2025/08/22
Received: 2025/07/2 | Accepted: 2025/08/11 | Published: 2025/08/22
How to cite this article
Mallah Nokandeh F, Sabahi A, Baeradeh N, Garavand A, Khajouei R. Nursing Informatics in Iran Nurses’ Knowledge, Perspectives, and Barriers. Health Educ Health Promot 2025; 13 (3) :555-563
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1- Department of Health Information Technology, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
2- Department of Health Information Technology, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
3- Department of Public Health, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
4- Department of Health Information Technology, Faculty of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
5- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
2- Department of Health Information Technology, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
3- Department of Public Health, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
4- Department of Health Information Technology, Faculty of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
5- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Introduction
Health information technologies and systems are rapidly advancing, with increasing implementation and widespread usage observed in clinical settings worldwide [1]. Over the past 50 years, the evolution of health information technology has significantly impacted nurses, who constitute the largest group of healthcare professionals [2, 3]. To fully harness the advantages of health information technology, nurses are urged to actively engage in selecting, implementing, and optimizing health information systems, given their importance in nursing activities [4]. By enhancing their informatics skills, nurses can play a crucial role in these processes [5]. Utilizing health information technologies to collect, store, process, and modify nursing care data can streamline nursing services and enable efficient management of care and resources [6].
Considering the significant role of information technology in enhancing nursing care through improved decision-making, reduced errors and repetitive tasks, and decreased documentation time, nurses can effectively incorporate various clinical technologies in care settings and use health products to enhance efficiency [7, 8]. Nevertheless, the digitalization of healthcare services necessitates that nurses acquire new skills [9]. However, not all nurses are adequately prepared to leverage technology and informatics tools to fulfill their responsibilities [10].
Nurses are estimated to dedicate approximately 50% of their time to collecting, coordinating, and documenting information, which underscores the significance of nursing informatics [11]. This emerging field, relatively novel compared to other nursing specialties, aims to create innovative solutions for displaying, recording, managing, organizing, and processing healthcare information [12]. Nursing informatics now emphasizes the crucial role of information and its management in the nursing profession. It seeks to harness data to generate valuable insights and enhance nursing knowledge, ultimately improving patient care [13]. Moreover, this discipline is pivotal in integrating data, information, and knowledge to empower patients, nurses, and other healthcare providers to make informed decisions [14].
In addition to nursing education and computer-based learning, nursing informatics aims to facilitate distance learning and accurately document patients’ conditions and medical records [15]. Furthermore, this field is essential in supporting decision-making for nurses, patients, healthcare providers, and participants across all roles and organizations by utilizing information structures, processes, and technologies [16]. Consequently, nursing informatics holds immense potential to shape the future of healthcare by establishing connections between nurses and information technology, as well as the knowledge gained within these domains [17].
Numerous studies have highlighted the benefits and impact of nursing informatics in managing nursing information and enhancing nursing services. For instance, research conducted by Daniel & Oyetunde demonstrates the positive influence of nursing informatics on the nursing profession, including the prevention of medication errors through computer information systems, improved collaboration and sharing of patient information among healthcare providers, and enhanced efficiency and accuracy in nurses’ tasks [18]. Other studies have also indicated various advantages, such as increased accessibility to resources for nursing informatics specialists, improved continuity of care, and enhanced speed, timeliness, and accuracy of information recorded in patients’ medical records, leading to increased efficiency and safety [19-21].
Recognizing the immense significance of nursing informatics, the National Advisory Council on Nurse Education and Performance in the United States emphasizes its indispensable role in improving nurses’ overall performance and training [21]. Not only has the United States embraced this field, but countries such as England, Australia, Finland, Great Britain, the Netherlands, Canada, Brazil, and New Zealand have also actively incorporated information technology into their nursing curricula [22, 23]. Harerimana et al. confirme that integrating nursing informatics into master’s programs has resulted in a discernible enhancement in the quality of nursing clinical care [24].
In Iran, significant efforts have been made to advance the field of nursing informatics. The study conducted by Elahi et al. focuses on developing a master’s curriculum in nursing informatics [25]. This research assesses enhance the educational opportunities available to aspiring nursing informatics professionals. Furthermore, a team of medical informatics and nursing experts collaborates to design a comprehensive virtual nursing informatics course tailored to individuals at different proficiency levels, ranging from introductory to intermediate and advanced. Upon completing this course, participants are awarded a nursing informatics qualification certificate. This initiative has played a pivotal role in promoting the integration of informatics into nursing practice.
Sadeghi & Yaghmayi highlight the importance of establishing a dedicated nursing informatics field in Iran. With the expansion and specialization of the nursing profession, it has become imperative to leverage the expertise of nursing informatics specialists. By doing so, the quality of services provided by nurses in various areas, including education, research, clinical practice, and management, can be significantly enhanced [26]. Overall, these efforts underline the commitment of Iranian professionals to improve the field of nursing informatics. By investing in education, research, and specialized courses, Iran aims to empower nurses with the necessary knowledge and skills to deliver high-quality healthcare services in the digital era.
With the increasing application of nursing informatics in healthcare, education, and research, it has become imperative to recognize its significance in enhancing patient safety, improving care efficiency, and facilitating nursing management decision-making [27]. Furthermore, it is crucial to acknowledge that nurses comprise the largest group of health information technology users. Therefore, their informatics knowledge and skills, coupled with positive attitudes, play a pivotal role in the effectiveness of healthcare systems [28]. Consequently, exploring nurses’ perspectives on nursing informatics is essential for creating and developing nurse training programs, while also aiding policymakers and healthcare planners.
Despite the global growth in nursing informatics, its position in Iran remains unclear, as no prior studies have delved into this matter. Although there has been an increasing adoption of health information technologies, little is known about how nurses in Iran understand or engage with nursing informatics. Previous studies have mainly focused on curriculum development rather than assessing nurses’ readiness or perceptions. This study, therefore, addressed this gap by systematically evaluating both knowledge and attitudes among Iranian nurses at a national level.
Instrument and Methods
Study design and participants
This cross-sectional qualitative study, conducted in 2022, was conducted in two phases to assess nurses’ knowledge of nursing informatics and their perspectives on its establishment as a distinct discipline in Iran.
The first phase aimed to identify challenges and opportunities related to the implementation of nursing informatics in Iran. A total of 13 participants were included based on the principle of data saturation, whereby interviews continued until no new themes emerged. Purposive sampling was used to ensure representation from different hospital units and supervisory roles. Participants were selected according to the following inclusion criteria: a minimum educational qualification of a bachelor’s degree in nursing and at least one year of work experience in a hospital setting. Four hospitals in Mashhad were randomly selected, and the interviews were conducted over two weeks. The interview questions were developed based on a literature review and expert consultation. If permitted by the participants, interviews were audio-recorded; otherwise, detailed notes were taken. The qualitative data were then transcribed and analyzed using a thematic analysis approach to extract key themes regarding the perceived importance, challenges, and benefits of nursing informatics.
The second phase involved a nationwide cross-sectional survey to evaluate nurses’ knowledge of nursing informatics and their perspectives on its establishment. The study population included 1,440 nurses working in hospitals affiliated with medical science universities across Iran.
A convenience sampling approach was used to recruit participants. To maximize coverage and ensure broad participation, we disseminated the questionnaire through multiple dedicated nursing groups on virtual platforms widely used by Iranian nurses, including ETA, WhatsApp, and Telegram. These platforms were chosen because they host professional forums where a significant proportion of nurses engage in discussions and professional development.
Instrument
The questionnaire was developed systematically through a rigorous multi-stage process to ensure its validity and reliability. The development followed four main stages:
1) Item generation: Initial items were extracted from the qualitative findings obtained in phase one (interviews) and supported by a comprehensive review of national and international literature related to nursing informatics.
2) Expert review: The preliminary pool of items was reviewed by a panel of four medical informatics specialists to assess the clarity, relevance, and representativeness of each item. Based on expert feedback, items were revised, merged, or eliminated to enhance content validity.
3) Pilot testing: A pilot study was conducted with 165 nurses (excluded from the final sample) to evaluate the comprehensibility, wording, and time required to complete the questionnaire. Feedback from participants was used to refine ambiguous statements and remove redundant questions.
4) Psychometric evaluation: The internal consistency of the questionnaire was assessed using Cronbach’s alpha (α=0.94), confirming high reliability.
The final version of the questionnaire consisted of three sections. Demographic information included gender, age, education level, hospital affiliation, city of service, organizational position, employment status, and years of work experience; knowledge of nursing informatics included six items measuring nurses’ awareness and familiarity with nursing informatics concepts; and perspectives on nursing informatics contained 33 items examining attitudes toward the importance, implementation, and feasibility of establishing nursing informatics as an independent field.
This structured and evidence-based development process ensured that the final instrument possessed strong content validity, conceptual clarity, and internal reliability, making it suitable for assessing nurses’ knowledge and perspectives on nursing informatics at the national level.
Procedure
To minimize response bias, the questionnaire was distributed anonymously, and participants were assured that their responses would remain strictly confidential. Additionally, a pilot study involving 165 nurses was conducted to ensure the clarity and validity of the survey questions. To reduce social desirability bias, the questions were designed in a way that did not pressure respondents to provide socially expected answers. Furthermore, some questions incorporated reverse coding to assess response consistency and minimize acquiescence bias.
Given that the survey was distributed via online platforms, we acknowledge the potential for selection bias, as nurses active in virtual professional groups may have greater exposure to informatics-related topics. This limitation should be considered when interpreting the results, and future studies should aim for broader sampling approaches, including nurses who are not engaged in online communities.
This study received ethical approval from Mashhad University of Medical Sciences. Informed consent was obtained from all participants prior to their involvement. For the qualitative phase, both verbal and written consent were obtained before conducting interviews. In the survey phase, participation was voluntary and anonymous, with respondents explicitly consenting before completing the questionnaire.
Data analysis
The normality of data distribution was assessed using the Kolmogorov-Smirnov test. If the data followed a normal distribution, independent t-tests and one-way analysis of variance (ANOVA) were conducted for group comparisons. Conversely, if the data were not normally distributed, non-parametric tests, including the Mann-Whitney U test and the Kruskal-Wallis test, were applied.
To examine the association between awareness levels and demographic parameters, either parametric or non-parametric tests were employed based on the results of the normality assessment. All analyses were performed using SPSS version 27, with a significance level set at 0.05.
Findings
Interviews were conducted with 13 supervisors. Among them, four supervisors lacked knowledge of nursing informatics, while eleven acknowledged the importance of this field and its practical applications in healthcare. The challenges were classified into ten categories, while the opportunities were grouped into three categories. The most critical challenge identified was the insufficient availability of financial resources. Additionally, supervisors noted that nursing informatics could substantially benefit from the adoption of electronic health records and the increased use of information technology in nursing and medical practices (Table 1).
Table 1. Challenges and opportunities in establishing nursing informatics in Iran
![src=./files/hehp/images/HTML_Publish/81612/1.png]()
The supervisors in Iran considered several key benefits of implementing nursing informatics. These benefits included improved support for nursing documentation and record-keeping, assistance in managerial and statistical processes, and a notable reduction in nursing errors. However, the supervisors identified a significant drawback associated with the introduction of nursing informatics: the additional workload that accompanied its implementation (Table 2).
Table 2. Positive and negative points of setting up nursing informatics in Iran
![src=./files/hehp/images/HTML_Publish/81612/2.png]()
This study involved 1,440 nurses from across the country. Of these participants, 684 (47.5%) were women, while the remaining were men. Furthermore, most of the respondents were between the ages of 26 and 30 (Table 3).
Table 3. Demographic information of the participants
![src=./files/hehp/images/HTML_Publish/81612/3.png]()
Nurses demonstrated a moderate level of awareness of nursing informatics, with an average knowledge score of 43.42%.
In terms of attitudes, the average favorability score toward nursing informatics was 74.82%, indicating a generally positive perception. However, this did not necessarily translate into widespread acceptance, as some nurses supported the idea in principle but remained uncertain about its practical implications. When categorizing knowledge levels, 54% of nurses had a high level of knowledge, suggesting they were well-informed about nursing informatics. Conversely, 30% had a low level of knowledge, highlighting a significant gap in informatics education. Additionally, 16% of participants were undecided, which might indicate a lack of exposure to nursing informatics concepts.
Regarding challenges in establishing nursing informatics as a formal field, responses varied; 45% of nurses demonstrated a high level of awareness of these challenges. However, 34% had a low level of knowledge about these challenges. Furthermore, 21% of respondents did not express an opinion, possibly due to limited familiarity with the topic.
There was no significant correlation between nurses’ level of education and their overall perception of nursing informatics (p=0.24). However, a significant association was observed between educational attainment and knowledge of nursing informatics, with higher education levels corresponding to greater knowledge (p≤0.001). Additionally, while no significant relationship was found between nurses’ organizational position and their perspective on nursing informatics (p=0.69), a significant correlation was noted between organizational position and awareness level. Specifically, supervisors demonstrated a higher level of awareness compared to nurses, and supervisors exhibited greater awareness than managers (p=0.005).
Moreover, no significant association was identified between nurses’ employment status (p=0.4) or years of work experience (p=0.2) and their perspective on nursing informatics. However, a strong correlation was found between work experience and knowledge level. Nurses with over 20 years of experience exhibited the highest level of knowledge, whereas those with 16-20 years of experience reported the lowest awareness levels (p=0.001; Table 4).
Table 4. Correlation of demographic information with the mean level of awareness and views of nurses about the field of nursing informatics
![src=./files/hehp/images/HTML_Publish/81612/4.png]()
In general, 17% of nurses supported the impact of nursing informatics on improving the quality of services provided to patients, while 42% opposed it. Additionally, 41% of participants did not express an opinion on this matter.
Only 12% of nurses agreed with the positive effects brought about by nursing informatics in their daily workflow. A significant portion, 34%, voiced their disagreement, while an overwhelming majority of 54% expressed no definite stance.
Most nurses in Iran (54%) supported the potential establishment of nursing informatics. However, a notable percentage (24%) held an opposing view. Additionally, a significant portion (22%) of surveyed nurses did not provide a stated opinion.
Discussion
This study evaluated nurses’ knowledge of nursing informatics and their views on establishing it as an independent discipline. The most significant obstacle to establishing nursing informatics in Iran was the insufficient availability of financial resources. The shift toward electronic health records (EHRs) was identified as a key opportunity for advancing nursing informatics.
Insufficient funding posed a notable impediment to nursing informatics, as it restricted access to crucial resources, infrastructure, and support for nurses and other healthcare providers. This scarcity of funding adversely affected the quality and functionality of health information systems and compromised data maintenance and security [10]. Therefore, supporting adequate funding and resource allocation for nursing informatics initiatives was deemed essential.
The obstacles and challenges of setting up and adopting information technology varied greatly among different types of organizations and countries. They were influenced by cultural, social, organizational, i
Health information technologies and systems are rapidly advancing, with increasing implementation and widespread usage observed in clinical settings worldwide [1]. Over the past 50 years, the evolution of health information technology has significantly impacted nurses, who constitute the largest group of healthcare professionals [2, 3]. To fully harness the advantages of health information technology, nurses are urged to actively engage in selecting, implementing, and optimizing health information systems, given their importance in nursing activities [4]. By enhancing their informatics skills, nurses can play a crucial role in these processes [5]. Utilizing health information technologies to collect, store, process, and modify nursing care data can streamline nursing services and enable efficient management of care and resources [6].
Considering the significant role of information technology in enhancing nursing care through improved decision-making, reduced errors and repetitive tasks, and decreased documentation time, nurses can effectively incorporate various clinical technologies in care settings and use health products to enhance efficiency [7, 8]. Nevertheless, the digitalization of healthcare services necessitates that nurses acquire new skills [9]. However, not all nurses are adequately prepared to leverage technology and informatics tools to fulfill their responsibilities [10].
Nurses are estimated to dedicate approximately 50% of their time to collecting, coordinating, and documenting information, which underscores the significance of nursing informatics [11]. This emerging field, relatively novel compared to other nursing specialties, aims to create innovative solutions for displaying, recording, managing, organizing, and processing healthcare information [12]. Nursing informatics now emphasizes the crucial role of information and its management in the nursing profession. It seeks to harness data to generate valuable insights and enhance nursing knowledge, ultimately improving patient care [13]. Moreover, this discipline is pivotal in integrating data, information, and knowledge to empower patients, nurses, and other healthcare providers to make informed decisions [14].
In addition to nursing education and computer-based learning, nursing informatics aims to facilitate distance learning and accurately document patients’ conditions and medical records [15]. Furthermore, this field is essential in supporting decision-making for nurses, patients, healthcare providers, and participants across all roles and organizations by utilizing information structures, processes, and technologies [16]. Consequently, nursing informatics holds immense potential to shape the future of healthcare by establishing connections between nurses and information technology, as well as the knowledge gained within these domains [17].
Numerous studies have highlighted the benefits and impact of nursing informatics in managing nursing information and enhancing nursing services. For instance, research conducted by Daniel & Oyetunde demonstrates the positive influence of nursing informatics on the nursing profession, including the prevention of medication errors through computer information systems, improved collaboration and sharing of patient information among healthcare providers, and enhanced efficiency and accuracy in nurses’ tasks [18]. Other studies have also indicated various advantages, such as increased accessibility to resources for nursing informatics specialists, improved continuity of care, and enhanced speed, timeliness, and accuracy of information recorded in patients’ medical records, leading to increased efficiency and safety [19-21].
Recognizing the immense significance of nursing informatics, the National Advisory Council on Nurse Education and Performance in the United States emphasizes its indispensable role in improving nurses’ overall performance and training [21]. Not only has the United States embraced this field, but countries such as England, Australia, Finland, Great Britain, the Netherlands, Canada, Brazil, and New Zealand have also actively incorporated information technology into their nursing curricula [22, 23]. Harerimana et al. confirme that integrating nursing informatics into master’s programs has resulted in a discernible enhancement in the quality of nursing clinical care [24].
In Iran, significant efforts have been made to advance the field of nursing informatics. The study conducted by Elahi et al. focuses on developing a master’s curriculum in nursing informatics [25]. This research assesses enhance the educational opportunities available to aspiring nursing informatics professionals. Furthermore, a team of medical informatics and nursing experts collaborates to design a comprehensive virtual nursing informatics course tailored to individuals at different proficiency levels, ranging from introductory to intermediate and advanced. Upon completing this course, participants are awarded a nursing informatics qualification certificate. This initiative has played a pivotal role in promoting the integration of informatics into nursing practice.
Sadeghi & Yaghmayi highlight the importance of establishing a dedicated nursing informatics field in Iran. With the expansion and specialization of the nursing profession, it has become imperative to leverage the expertise of nursing informatics specialists. By doing so, the quality of services provided by nurses in various areas, including education, research, clinical practice, and management, can be significantly enhanced [26]. Overall, these efforts underline the commitment of Iranian professionals to improve the field of nursing informatics. By investing in education, research, and specialized courses, Iran aims to empower nurses with the necessary knowledge and skills to deliver high-quality healthcare services in the digital era.
With the increasing application of nursing informatics in healthcare, education, and research, it has become imperative to recognize its significance in enhancing patient safety, improving care efficiency, and facilitating nursing management decision-making [27]. Furthermore, it is crucial to acknowledge that nurses comprise the largest group of health information technology users. Therefore, their informatics knowledge and skills, coupled with positive attitudes, play a pivotal role in the effectiveness of healthcare systems [28]. Consequently, exploring nurses’ perspectives on nursing informatics is essential for creating and developing nurse training programs, while also aiding policymakers and healthcare planners.
Despite the global growth in nursing informatics, its position in Iran remains unclear, as no prior studies have delved into this matter. Although there has been an increasing adoption of health information technologies, little is known about how nurses in Iran understand or engage with nursing informatics. Previous studies have mainly focused on curriculum development rather than assessing nurses’ readiness or perceptions. This study, therefore, addressed this gap by systematically evaluating both knowledge and attitudes among Iranian nurses at a national level.
Instrument and Methods
Study design and participants
This cross-sectional qualitative study, conducted in 2022, was conducted in two phases to assess nurses’ knowledge of nursing informatics and their perspectives on its establishment as a distinct discipline in Iran.
The first phase aimed to identify challenges and opportunities related to the implementation of nursing informatics in Iran. A total of 13 participants were included based on the principle of data saturation, whereby interviews continued until no new themes emerged. Purposive sampling was used to ensure representation from different hospital units and supervisory roles. Participants were selected according to the following inclusion criteria: a minimum educational qualification of a bachelor’s degree in nursing and at least one year of work experience in a hospital setting. Four hospitals in Mashhad were randomly selected, and the interviews were conducted over two weeks. The interview questions were developed based on a literature review and expert consultation. If permitted by the participants, interviews were audio-recorded; otherwise, detailed notes were taken. The qualitative data were then transcribed and analyzed using a thematic analysis approach to extract key themes regarding the perceived importance, challenges, and benefits of nursing informatics.
The second phase involved a nationwide cross-sectional survey to evaluate nurses’ knowledge of nursing informatics and their perspectives on its establishment. The study population included 1,440 nurses working in hospitals affiliated with medical science universities across Iran.
A convenience sampling approach was used to recruit participants. To maximize coverage and ensure broad participation, we disseminated the questionnaire through multiple dedicated nursing groups on virtual platforms widely used by Iranian nurses, including ETA, WhatsApp, and Telegram. These platforms were chosen because they host professional forums where a significant proportion of nurses engage in discussions and professional development.
Instrument
The questionnaire was developed systematically through a rigorous multi-stage process to ensure its validity and reliability. The development followed four main stages:
1) Item generation: Initial items were extracted from the qualitative findings obtained in phase one (interviews) and supported by a comprehensive review of national and international literature related to nursing informatics.
2) Expert review: The preliminary pool of items was reviewed by a panel of four medical informatics specialists to assess the clarity, relevance, and representativeness of each item. Based on expert feedback, items were revised, merged, or eliminated to enhance content validity.
3) Pilot testing: A pilot study was conducted with 165 nurses (excluded from the final sample) to evaluate the comprehensibility, wording, and time required to complete the questionnaire. Feedback from participants was used to refine ambiguous statements and remove redundant questions.
4) Psychometric evaluation: The internal consistency of the questionnaire was assessed using Cronbach’s alpha (α=0.94), confirming high reliability.
The final version of the questionnaire consisted of three sections. Demographic information included gender, age, education level, hospital affiliation, city of service, organizational position, employment status, and years of work experience; knowledge of nursing informatics included six items measuring nurses’ awareness and familiarity with nursing informatics concepts; and perspectives on nursing informatics contained 33 items examining attitudes toward the importance, implementation, and feasibility of establishing nursing informatics as an independent field.
This structured and evidence-based development process ensured that the final instrument possessed strong content validity, conceptual clarity, and internal reliability, making it suitable for assessing nurses’ knowledge and perspectives on nursing informatics at the national level.
Procedure
To minimize response bias, the questionnaire was distributed anonymously, and participants were assured that their responses would remain strictly confidential. Additionally, a pilot study involving 165 nurses was conducted to ensure the clarity and validity of the survey questions. To reduce social desirability bias, the questions were designed in a way that did not pressure respondents to provide socially expected answers. Furthermore, some questions incorporated reverse coding to assess response consistency and minimize acquiescence bias.
Given that the survey was distributed via online platforms, we acknowledge the potential for selection bias, as nurses active in virtual professional groups may have greater exposure to informatics-related topics. This limitation should be considered when interpreting the results, and future studies should aim for broader sampling approaches, including nurses who are not engaged in online communities.
This study received ethical approval from Mashhad University of Medical Sciences. Informed consent was obtained from all participants prior to their involvement. For the qualitative phase, both verbal and written consent were obtained before conducting interviews. In the survey phase, participation was voluntary and anonymous, with respondents explicitly consenting before completing the questionnaire.
Data analysis
The normality of data distribution was assessed using the Kolmogorov-Smirnov test. If the data followed a normal distribution, independent t-tests and one-way analysis of variance (ANOVA) were conducted for group comparisons. Conversely, if the data were not normally distributed, non-parametric tests, including the Mann-Whitney U test and the Kruskal-Wallis test, were applied.
To examine the association between awareness levels and demographic parameters, either parametric or non-parametric tests were employed based on the results of the normality assessment. All analyses were performed using SPSS version 27, with a significance level set at 0.05.
Findings
Interviews were conducted with 13 supervisors. Among them, four supervisors lacked knowledge of nursing informatics, while eleven acknowledged the importance of this field and its practical applications in healthcare. The challenges were classified into ten categories, while the opportunities were grouped into three categories. The most critical challenge identified was the insufficient availability of financial resources. Additionally, supervisors noted that nursing informatics could substantially benefit from the adoption of electronic health records and the increased use of information technology in nursing and medical practices (Table 1).
Table 1. Challenges and opportunities in establishing nursing informatics in Iran
The supervisors in Iran considered several key benefits of implementing nursing informatics. These benefits included improved support for nursing documentation and record-keeping, assistance in managerial and statistical processes, and a notable reduction in nursing errors. However, the supervisors identified a significant drawback associated with the introduction of nursing informatics: the additional workload that accompanied its implementation (Table 2).
Table 2. Positive and negative points of setting up nursing informatics in Iran
This study involved 1,440 nurses from across the country. Of these participants, 684 (47.5%) were women, while the remaining were men. Furthermore, most of the respondents were between the ages of 26 and 30 (Table 3).
Table 3. Demographic information of the participants
Nurses demonstrated a moderate level of awareness of nursing informatics, with an average knowledge score of 43.42%.
In terms of attitudes, the average favorability score toward nursing informatics was 74.82%, indicating a generally positive perception. However, this did not necessarily translate into widespread acceptance, as some nurses supported the idea in principle but remained uncertain about its practical implications. When categorizing knowledge levels, 54% of nurses had a high level of knowledge, suggesting they were well-informed about nursing informatics. Conversely, 30% had a low level of knowledge, highlighting a significant gap in informatics education. Additionally, 16% of participants were undecided, which might indicate a lack of exposure to nursing informatics concepts.
Regarding challenges in establishing nursing informatics as a formal field, responses varied; 45% of nurses demonstrated a high level of awareness of these challenges. However, 34% had a low level of knowledge about these challenges. Furthermore, 21% of respondents did not express an opinion, possibly due to limited familiarity with the topic.
There was no significant correlation between nurses’ level of education and their overall perception of nursing informatics (p=0.24). However, a significant association was observed between educational attainment and knowledge of nursing informatics, with higher education levels corresponding to greater knowledge (p≤0.001). Additionally, while no significant relationship was found between nurses’ organizational position and their perspective on nursing informatics (p=0.69), a significant correlation was noted between organizational position and awareness level. Specifically, supervisors demonstrated a higher level of awareness compared to nurses, and supervisors exhibited greater awareness than managers (p=0.005).
Moreover, no significant association was identified between nurses’ employment status (p=0.4) or years of work experience (p=0.2) and their perspective on nursing informatics. However, a strong correlation was found between work experience and knowledge level. Nurses with over 20 years of experience exhibited the highest level of knowledge, whereas those with 16-20 years of experience reported the lowest awareness levels (p=0.001; Table 4).
Table 4. Correlation of demographic information with the mean level of awareness and views of nurses about the field of nursing informatics
In general, 17% of nurses supported the impact of nursing informatics on improving the quality of services provided to patients, while 42% opposed it. Additionally, 41% of participants did not express an opinion on this matter.
Only 12% of nurses agreed with the positive effects brought about by nursing informatics in their daily workflow. A significant portion, 34%, voiced their disagreement, while an overwhelming majority of 54% expressed no definite stance.
Most nurses in Iran (54%) supported the potential establishment of nursing informatics. However, a notable percentage (24%) held an opposing view. Additionally, a significant portion (22%) of surveyed nurses did not provide a stated opinion.
Discussion
This study evaluated nurses’ knowledge of nursing informatics and their views on establishing it as an independent discipline. The most significant obstacle to establishing nursing informatics in Iran was the insufficient availability of financial resources. The shift toward electronic health records (EHRs) was identified as a key opportunity for advancing nursing informatics.
Insufficient funding posed a notable impediment to nursing informatics, as it restricted access to crucial resources, infrastructure, and support for nurses and other healthcare providers. This scarcity of funding adversely affected the quality and functionality of health information systems and compromised data maintenance and security [10]. Therefore, supporting adequate funding and resource allocation for nursing informatics initiatives was deemed essential.
The obstacles and challenges of setting up and adopting information technology varied greatly among different types of organizations and countries. They were influenced by cultural, social, organizational, i