Nurse Education in Practice (2004) 4, 190–199

NurseEducation

www.elsevierhealth.com/journals/nepr

in Practice

FOCUS

Computer and information literacy inpost-qualifying education

Ian J. Colea,*, Amanda Kelseyb

a Lecturer in Information and Communication Technology, Department of Health Sciences, University ofYork, C Block, Alcuin College, Heslington, York YO10 5DD, UKb Senior Lecturer in Primary Care/Public Health, School of Healthcare Studies, University of Leeds, BainesWing, P.O. Box 214, Leeds LS2 9UT, UK

Accepted 31 July 2003

Summary Computer literacy and information retrieval techniques are bothskills that are required to undertake further educational study effectively. In thesummer of 2000, a group of post-registered nurses and midwives on undergrad-uate courses in one university department, completed a self-assessmentquestionnaire to examine their knowledge and competence of computer andinformation literacy. This paper describes the method and results of this studywith the results indicating that these students had deficits in both computer andinformation literacy. The study also outlines the structural and functionaldifficulties that need to be resolved around the area of using computers ineducation for nurses and midwifes.

�c 2003 Elsevier Ltd. All rights reserved.

KEYWORDSComputer;Information;Literacy;Post registration;Post qualified;Student;Nurses;Midwives;ECDL;FITness;Quantitative;Survey

Introduction

The implementation of evidence-based practicerequires nurses and nursing students to be com-puter literate. The ability to locate relevant in-formation by electronic means as well astraditional information retrieval methods is of vi-tally importance to the modern nursing profes-sional. Retrieving information electronicallyrequires nurses and nursing students to be skilled inthe use of computers.

* Corresponding author. Fax: 44-1904-321623.E-mail addresses: ijc4@york.ac.uk; a.kelsey@leeds.ac.uk.

1471-5953/$ - see front matter �c 2003 Elsevier Ltd. All rights reserdoi:10.1016/S1471-5953(03)00065-9

Many post-registration students attend part-time courses and may be precluded from attendingthe computer skills courses offered by their uni-versities by the demands of practice.

The achievement of the European ComputerDriving Licence (ECDL, 2000) has been chosen asthe reference standard for basic IT skills for NHSstaff (Benjamin and Davies, 2001 and Millen, 2000).The ECDL is discussed, and the equivalent USstandard is also examined, to provide some com-parison. This exploration of the standard of skillsought by the National Health Service (NHS) pro-vides background for the nurses’ own assessment oftheir ability to use computer and informationtechnology.

ved.

191Computer and information literacy 191

A group of 346 post-registration students in oneuniversity were asked to evaluate their own com-puter skills to assess the extent of their difficulties.

This paper has two sections. In the first sec-tion, the definitions of computer and informationliteracy are discussed. The skills and abilities re-quired for using information technology are thenexamined. The level of skill necessary is thenconsidered.

In the second section, the examination ofquestionnaires completed by students in computerskills ability is undertaken. This questionnaire wasdesigned to elicit the student assessment of theirlevel of skill in the use of computer technology.The methodology, results and conclusions arediscussed.

Background

Nurses have been found to have insufficient skills toexploit information technology in a series of stud-ies, dating back to the late 1980s (Carter and Ax-ford, 1993; Grobe, 1988; Hillan et al., 1998).However, both registered practitioners and stu-dents were usually found to have a “positive atti-tude” to the use of computers (Hillan et al., 1998).In past decades, this enthusiasm may have beeninhibited by a lack of computer training integrationinto nursing courses. Armstrong (1989) conducted anational study of nurse educators about the use ofcomputers in nurse education and found that fewnursing institutions were providing students withcomputer courses. In the following year, Chambersand Coates (1990) concluded that a nationalstrategy was needed to provide education in com-puter skills for nurses. These problems continuedthroughout the 1990’s and similar difficulties havebeen recorded elsewhere, particularly in Singapore(Kiat and Chia, 1999). All these studies have fo-cused on computer literacy and less has beenwritten about information literacy, it is clear thatboth types of skill are needed and the differencebetween these two types of literacy is exploredbelow.

The teaching of computer skills is usually con-sidered to be the responsibility of the establish-ment providing nurse education, in collaborationwith employers. (Anthony, 1997; Ballard, 1999;Blythe and Royle, 1993; Kiat and Chia, 1999; Sar-ento and Leino-Kilpi, 1997). However, Graveley etal. (1999) consider that the teaching of computerskills is not the responsibility of nurse education,believing that most future students will have de-veloped such skills at school. This may be true in

the future but in the present environment, nurseeducation institutions continue to attempt to pro-vide a broad level of computer skills training.

Definitions of computer and informationliteracy

The existing literature provides only a limitednumber of definitions for these terms, and theyoften appear dated. One commonly used definitionof computer literacy is that of Mackey (1992) whichcharacterises computer literacy as the use ofcomputing outside of specialist computer sciencework and relied heavily on Bork’s (1985) definition.

Computer literacy can be considered to mean the mini-mum knowledge, know-how, familiarity, capabilitiesand abilities about computers. (Bork, 1985, p33).

More helpful to nurses are the comments byHunter (1983) that

Computer literacy skills will vary from person to personand from time to time but that computer literacy is what-ever a person needs to be able to do with (and know)about computers (p9).

This implies that computer literacy is influencedby the context in which computers are used. In-formation literacy is a broader concept, which in-cludes computer literacy and the ability to useinformation.

Behrens (1994) provides a simple definition ofinformation literacy, which is:

The ability to use information, or possibly the possessionof a knowledge of information (p309)

An older definition of information literacy byBreivik (1991) is more comprehensive. It includesthe ability to identify a lack of information, andwhat information is needed as well as the ability toevaluate and organise the available information.

In Breivik’s (1991) definition, it is a fundamentalskill:

Information literacy is, in fact, the first component onthe continuum of critical thinking skills (p226)

She considers that computer literacy is insuffi-cient, and that information literacy also includes aknowledgeable use of print and media resources.Burnham (1994) also identifies the ability to accessorganise and evaluate information as essential toinformation literacy. Burnham also gives some de-tailed objectives for nursing students at each stageof their professional preparation.

The NHS has chosen the European ComputerDriving Licence (ECDL) as being the qualification in

192 I.J. Cole, A. Kelsey

computer and information literacy recommendedfor all staff in the service (Benjamin and Davies,2001 and Millen, 2000). The ECDL is a seven-modulecourse which is “an information technology cer-tificate for all citizens” (ECDL, 2001).

The modules are:

• Basic concepts of information technology (in-cluding the physical make-up of a personal com-puter (PC) and basic information about use)

• Using the computer and managing files• Word processing• Spreadsheets• Database (including designing a database and re-

trieving information from databases, but not lit-erature searching)

• Presentation (using graphics and charts)• Information and communication (including web

searches, and use of email).

These seven modules cover skills, which are usefulto nurses and have been adapted to have a healthfocus (NHS ECDL, 2003) although there are stillareas for development. For example, nurses needcomprehensive literature searching skills and theseare not explicitly covered by the ECDL.

Despite some difficulties in the balance of theECDL for nurses, the overwhelming difficulty is theincorporation of a seven-module computer skillscourse within existing part-time, post-registrationcourses.

Education policy-makers in the US take a dif-ferent approach, emphasising the understanding oftechnology as well as specific skills. The NationalResearch Council Computer Science and Telecom-munications Board (1999) describes the concept of“Fluency with Information Technology” or FITness.“Fluency” is defined thus:

Fluency with information technology. . .entails a processof lifelong learning in which individuals continually applywhat they know to adapt to change and acquire moreknowledge to be more effective at applying informationtechnology to their work and personal lives (p2)

FITness requires three types of knowledge:contemporary skills, foundational concepts andintellectual capabilities. Contemporary skills in-clude the ability to use software applications.Foundational concepts are the underpinning prin-ciples of the functioning of computers, networksand information. The intellectual capabilities ofFITness include the ability to apply informationtechnology in complex and sustained situations,the manipulation of information and abstractthought about related issues. Achieving fluencyequips people to use computing and information

technology with ease and to overcome many of theproblems that they may encounter independently.It appears to be a more flexible approach than thattaken by the ECDL and would allow nurses to pri-oritise the development of relevant skills and omitless important aspects. Given the other pressuresof nursing curricula, perhaps achieving FITness maynot be possible, but it may be useful in mappingprogress towards a goal.

Both the ECDL and the contemporary skills ele-ment of FITness includes the ability to set up apersonal computer and to use applications such asword processing, graphics and databases. In facteven these contemporary skills exceed the capa-bilities of many nursing students on entry and itwas considered necessary to define computer lit-eracy and information literacy for the purposes ofthis study at a level appropriate to the Britishstudents recruited to the study.

Information literacy was defined for this study asthe ability to use computerised databases, the In-ternet and electronic library catalogues to locateinformation and the ability to use email. Computerliteracy was considered to be the skills requiredfor information literacy, including mouse control,word processing and file management.

Study outline

A quantitative survey of post-registration nursingstudents in one university department was under-taken in 2000. The study sought information aboutthe students’ assessment of their own competen-cies in both computer and information literacyskills. It was considered that by discovering thelevel of computer skills the students felt they hadalready gained that an informed decision could betaken as to whether (or not) it was necessary toconsider future resources in the form of the pos-sible provision of taught computer courses, self-directed workbooks or self-directed software. Thisconsideration was confirmed by Noyes and Baber(1999, p112) when they stated that ‘questionnairesare a useful measure’ when considering the opin-ions, attitudes and utilisation of computers in largepopulation studies.

At the time of the study there were 497 studentsundertaking Post-registration courses with the de-partment of which 463 were part-time and 34 werefull-time students. The survey questionnaire wasadministered to all these students whereby 346responded. The students were overwhelmingly fe-male (92%) and the age range was 24–61 years witha mean age of 38 years.

193Computer and information literacy 193

Method

The questionnaire was devised after consultingeach of the following design questionnaire meth-ods: The questionnaire for User Interface Satis-faction (QUIS) by Chin et al. (1988), the ComputerUser Satisfaction Inventory (CUSI) by Kirakowskiand Corbett (1988), the Software Usability Mea-surement (SUMI) Kirakowski and Corbett (1993) andthe 12 stages of questionnaire development asdefined by Oppenheim (1992).

Based on these questionnaire methodologies, itwas decided that a five-point Likert-type scale withscale descriptors: excellent, good, adequate, poorand very poor should be used. The use of the five-point scale made it possible for students to choosea median response, although it was considered thatthe students’ concerns about computer and infor-mation literacy were such that to provide “Poor”alone as a descriptor might result in some studentsfailing to answer the question because their ownassessment would be inadequately expressed bysuch a category. Thus “Very Poor” was also pro-vided, although in the analysis “Poor” and “VeryPoor” were considered together as both less than“Adequate”. Likewise the use of excellent andgood were considered together to be aboveadequate.

Prior to distribution, the questionnaire was pi-loted to 10 respondents who were not included inthe final study. The feedback from the pilot led tothe modification and clarification of some of thequestions. It was decided to distribute the ques-tionnaire throughout the month of June 2000 be-cause all post-registration courses were takingplace. Questionnaires were distributed and col-lected by lecturers within teaching sessions, whichgave the high response rate of 69% (n ¼ 346).

There was one misunderstanding with one groupof 15 students who were asked to return thequestionnaire directly to one of us. Only four stu-dents did so but despite this misunderstanding theresponse rate and results were considered repre-sentative of the student body.

Only students who did not want to participate orwere missing from the teaching sessions when thequestionnaires were distributed made up the 31%(n ¼ 151) non-respondents and since the question-naire was anonymous we were unable to contactnon-respondents.

The questionnaires were tagged to identifywhich course the students were taking, the ratio-nale for this was that the results from each specificcourse could be collated and this data sent to eachcourse leader for examination. Data was analysed

using the SPSS (version 9) statistical softwarepackage (SPSS, 2003).

Results

The results were analysed in the two main cate-gories of computer literacy and information liter-acy. The computer literacy category wasconcerned with the ability to use computers; theinformation literacy category was concerned withthe ability to search and access information, andthe ability to perform advanced searching. Theresults for each of these categories are describedin turn.

Computer literacy

“Computer literacy” described the skills neces-sary for accessing and using information includingthe use of the mouse or keyboard, managingfiles, understanding disk drives, navigating anoperating system (Windows), word processing andknowledge of what a CD-ROM is. Students wereasked to assess their own ability to use each ofthese components using one of the scale de-scriptors (excellent, good, adequate, poor orvery poor). The percentage of students selectingeach of these descriptors is recorded for allquestions about computer literacy, in Fig. 1.Fig. 1 also shows the total percentage of stu-dents selecting less than adequate scores.

Information literacy

Results in this section are reported in three subsections, those about the use of the electronic li-brary catalogue and their ability to access journalsand other materials (Fig. 2a and b), questionsabout the students’ knowledge and use of data-bases (Figs. 3 and 4) and finally questions about theuse of the Internet and email (Fig. 5).

There were a large group of students who in-dicated that they were unable to search for booksand journals using the electronic library catalogue(51.2%) (Fig. 2a Q8), suggesting that further ex-perience of using information technology would behelpful. Many students also considered that theirability to use electronic information services(bibliographical databases and on-line journals)was less than adequate. The following Fig. 3summarises the students’ responses to questionsasking them to rate their understanding of what abibliographical database is, and their ability to useone.

Figure 1 Computer literacy.

194 I.J. Cole, A. Kelsey

Given the difficulty found by these students inusing the library catalogue and databases, it wasexpected that using the Internet would also beproblematic. In fact, these students were moreconfident with the Internet (Fig. 5) than with a li-brary catalogue or an electronic bibliographicaldatabase.

A further group of questions about more com-plex searching were asked (Fig. 4). A group of17.3% (N ¼ 60) of the students knew what keywordmapping is, but only 12.2% rated their under-standing of it as adequate or better. When askedhow they understanding of Boolean searching isonly 6.9% considered it to be adequate or better.Four students did not respond to the questionabout Boolean searching. While 93.6% of studentsstated that they knew what the Internet is (Fig. 5),71.7% said that they used it at some time and 65.9%had used it to access information.

A smaller group of nearly half of the studentsused e-mail (49.1%), while only 10.4% of studentsrated their ability to use e-mail as less then ade-quate, 45.1% of students gave the same assessmentof their knowledge of the Internet.

Space was allocated on each questionnaire foradditional comments and one student felt com-pelled to write:

Everyone expects you to have IT skills knowledge al-ready!!! It has made my course twice as difficult, and Ifeel more inadequate when everyone else seems to haveIT skills.

This student felt very inadequate when using acomputer and the perception that the course is

made harder by a lack of computer experience is areal concern. One possible problem with self-evaluation questionnaires is that the students maybe fairly competent in the use of computers andwhat they are really lacking in is confidence.Whether the problem is a lack of confidence or areal lack of computer skills is not the issue. Theimportant factor as the quote from the studentshows is that a large number of these students‘perceive’ themselves as being unskilled in the useof computers and it is that issue that needs to beaddressed.

Discussion

There are clearly deficits in both the computer andinformation literacy of this student group, withboth structural and functional difficulties for thesestudents to overcome before they would be able toimproving their computer and information literacy.The structural difficulty is that, while universitiesmay provide a training in computer and informationskills, the courses are usually at the beginning ofthe academic year and are only repeated at fixedtime throughout the year. Post-registration coursesmay start at any time during the year, so studentsmay miss the provided courses. Courses may alsobe held at times when part-time students, areunable to attend. These matters can clearly beaddressed by more flexible provision.

The functional difficulties are less easily over-come. The first of these is age related. Although

Figure 2 (a) and (b) Library skills.

195Computer and information literacy 195

there was a wide age range in the group (24 to 61),not all of these students would have used com-puters at school and fewer would have been taughtinformation literacy. Both this lack of computerexperience and age-related cognitive changes werefound by Mead et al. (2000) to inhibit the learningof older adults. In a study of midwives, oldermidwives were found to have more negative atti-tudes to computers than younger ones (Hillanet al., 1998).

A second functional problem was the number ofyears spent out of formal education. Graveley

et al. (1999) found that this influenced the level ofinstructional support needed to establish computerand information literacy. While we did not inquireabout the years since leaving formal education, itis likely that post-registration nursing studentshave been outside a formal educational situationfor more years than many other university stu-dents, this is especially true for those nurses whotrained before Project 2000 was implemented.However, nursing students have one importantadvantage drawn from their ability to base theirlearning in practice. Topp and Kinn (1999) found

Figure 3 Bibliographical database literacy.

Figure 4 Advanced database literacy.

196 I.J. Cole, A. Kelsey

that learning computer skills could be made moreeffective by using real and relevant situations asexamples. Clearly nurses, unlike other mixedgroups of university students have a common ex-perience, which can be used to provide real ex-amples and enhance learning.

The final functional issue was that of gender. Thestudents completing the questionnaire were over-whelmingly female (92%) and women have beenfound to be less confident and more anxious thanmen in using computers (Siann et al., 1990; Templeand Lips, 1989). This problem was outlined by

Nielsen et al. (1998) when they suggested that fe-male students (in Australia) are significantly af-fected by the way they perceive computing. . .as amasculine area. This is echoed by Schuster (2001),president of the American Association of UniversityWomen Educational Foundation (AAVE) who argues:

There is clear evidence that girls and women lag in inter-est and participation in the use of technology. (Schuster,2001).

Dyck (1996) also noted gender differences whenobserving attitudes towards computers, with fe-

Figure 5 Internet and E-mail literacy.

197Computer and information literacy 197

males having a less positive attitude then males.One explanation of this problem could be how thedifferent sexes view spatial orientation and visu-alisation. Contreras and Colom (2001) undertooktests of 602 University graduates of both sexes byusing a computer simulation program and althoughboth males and female were equally educated andcomputer literate, spatial performance was stillhigher in males. These issues need to be consideredin any nurse education computer and informationliteracy curriculum.

Conclusion

The students’ own assessments of their skills inboth computer and information literacy showedimportant deficits. There were both structural andfunctional difficulties to overcome in planning tomeet the needs of these students.

Student attitudes to computers and informationtechnology are paramount to overcoming thesedifficulties.

Marasovic et al. (1997) commented that nursesneed a positive attitude when dealing with infor-mation technology if a strategy is to succeed and incomparison Scott (2001) undertook a small ques-tionnaire study of nurses and found that 90% of herrecipients viewed computer training to be an es-sential requirement but only 15% felt comfortableusing a computer.

With the NHS Information Authority roll out offree training and testing for the ECDL to all NHS

staff (NHS IA, 2002), it is hoped that these com-puter literacy problems within the NHS will gradu-ally decline although it’s important to point outthat there is no ‘quick fix’ to these problems and itwill take a number of years to resolve.

The implementation of the NHS ECDL portal,when it was launched in March 2003 is hoped toalleviate some of the excessive workload issues forthe NHS’s IT trainers (ECDL NHS, 2003a). The portalis designed to give all NHS staff on-line resources toundertake the ECDL qualification. So far there are13,600 registered users on the portal with 13,000people actively using the learning materials Theproject is due to run for 3 years and has a target oftraining 450,000 NHS staff over the period (ECDLNHS, 2003a).

If this project is successful in delivering thenumbers of computer literate staff within thetimescale set, then the Department of Health’svision of a NHS with safe, fast modern IT systemsfor health professions to support them in their workmay come true (DoH, 2001).

Schools of nursing within universities need tocontinue working along side the NHS on dealingwith computer literacy problems. Universities needto offer the same level of computer literacy sup-port to all students regardless of weather or not astudent has completed previous computer literacytraining. They can overcome the structural prob-lems by offering suitable introductory computingand information courses at more regular intervals.In a university-wide computer literacy course onlya few examples from nursing are likely to be used,and as relevance is an important dimension in

198 I.J. Cole, A. Kelsey

learning, if the student body is large enough, uni-disciplinary courses could be considered.

The functional problems for universities needcareful consideration. In particular, the provisionmade for more diverse groups of students may notbe suitable for post-registration nurses. The stu-dents surveyed were largely female, some mayhave been resuming education after a gap of sev-eral years and many were older than traditionaluniversity student. Offering the university-wideprogramme on a more regular basis may be insuf-ficient to meet the needs of this group of students.

Nursing students certainly need an introductorycourse, but on-going learning support is also re-quired, as students need to develop their skills astheir courses progress. One possible solution is toprovide an introductory course and an accompa-nying workbook and access to computer-basedlearning packages, which would allow students whoneed the support, to review the materials at con-venient times to them. Ideally such materialswould be tailored to the needs of nursing students,who would benefit from the use of examples, whichare real and relevant to their practice and theirlearning.

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