الفهرس 
Introduction and Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Change process for transition from traditional paper to electronic documentation is very difficult process and nursing staff face many challenges because change is experienced differently among nursing staff .Therefore change process require specific effort from nursing staff to change to electronic documentation. Orientation by challenges at phases of change process would be required to help nursing staff to recognize the challenges and plan for successfully pass, overcome failure and develop success transition to electronic documentation. Aim of the study:- The present study aimed to identify change process challenges facing nursing staff transition from traditional paper to electronic documentation. Setting:- The present study was conducted at all units of General Internal Medicine Hospital Tanta University. The study subject included all (180) nursing staff to achieve the aim of the study this tool was used. Tool:- Structured questionnaire schedule change process challenges facing nursing staff transition from traditional paper to electronic documentation. The questionnaire consisted of two parts. Part (1): included socio-demographic characteristics of nursing staff. Part (2): included data about change process challenges facing nursing staff transition from traditional paper to electronic documentation questionnaire. The questionnaire included three scales: A- Motivation challenges of nursing staff during unfreezing phase of change consisted of 2 subscales as follows:- Support nursing staff driving forces for implementation of electronic documentation included 10 items (from1 to10). Eliminate restraining forces subscale for implementation of electronic documentation included 7 items (from 11 to 17). B- Challenges of nursing staff during movement to change phase consisted of 3 subscales as follows:- Continuous communication subscale included 9 items ( from 18 to 26). Empowered action subscale included 2 items (from 27 to 28). Closely monitor for success of changes in nursing staff subscale included 5 items (from 29 to 33). C- Challenges of nursing staff during refreezing phase of change included 3 subscales as follows:- Proper leadership subscale included 5 items (from 34 to 38). Supervision subscale included 3 items (from 39 to 41). Ongoing support included 6 items (from 42 to 47). The subject responses were measured in a five points Likert Scale (5-1) ranging from (5) strongly agree to (1) strongly disagree. The scores were converted into percent scores to assess change process challenges facing nursing staff transition from traditional paper to electronic documentation. Pilot study was carried out on 10% of nursing staff. Necessary modification was done. Questionnaire was submitted to five experts in the area of specialty to check its content and face validity and internal consistency reliability. Results of present study revealed that: Nursing staff age range was 18-54 years old, with mean age 30.0±4.98 and, 48.3% of nursing staff located age group 36-43 years old . Most (81.7%) of nursing staff were females and 60% married. Above half (55.0%) of nursing staff had Technical Degree in Nursing , 25.6% of them had Bachelor Degree in Nursing 19.4%of them had Diploma Degree in Nursing .One third (33.9%) have ten years of experience with mean7.9±4.26 years. Nursing staff 11.7% were nurse manager and the rest (88.4%) were staff nurses. Nursing staff 66.7% attended a course training program and 63.3%of them still need to attend training program about the use of electronic documentation. About two third of nursing staff had high level of total change challenges at transition to electronic documentation. Below quarter of nursing staff had moderate level of challenges and few had low level of total change process challenges at transition to electronic documentation. The movement to change phase ranked first highest mean 61.72± 12.98 of nursing staff challenges. Followed by unfreezing ranked second mean 60.53± 11.20 and refreezing ranked third mean54.05± 9.95 of challenges for transition to electronic documentation . More than two third (67.8%) of nursing staff showed high level of motivation challenges of supportive driving forces for transition to electronic documentation, with mean 3.64±1.02. Equal (16.1%) of nursing staff showed moderate and low level of motivation challenges for supportive restraining forces. More than half (57.8%) of nursing staff showed high level of motivational challenges for eliminating restraining forces for transition to electronic documentation, with mean 3.44±1.07. While, less than one quarter (18.3%)of nursing staff showed moderate levels of motivation challenges for eliminating restraining forces for transition to electronic documentation. Support driving forces mean ranked first highest motivational challenges for unfreezing phase of change. About (74.4%,71.1%) of nursing staff had high level of challenges about continuous communication and closely monitor for success of changes in nursing staff. Nursing staff 58.3% and 23.3% respectively showed high and moderate levels of empowered action during movement to change phase of transition process. Range (18.3%-12.8%) of nursing staff had low level of challenges about empowered action, continuous communication and closely monitor for success of changes in nursing staff of movement to change phase of transition to electronic documentation. The closely monitor for success of change in nursing staff ranked first highest mean3.84±0.94 followed by continuous communication mean 3.82± 0.96 and the third mean 3.55± 1.00 for empowered action. Majority (77.8%,73.3%,65.6 %) of nursing staff showed high level of challenges about proper leadership, ongoing support and training and supervision. Range (8.3 %-6.7 %) had low level of challenges about proper leadership, supervision and ongoing support and training during refreezing phase. The proper leadership mean4.00±0.98 ranked first high mean followed by mean 3.83±0.88, and mean3.70 ± 0.83was the third mean for nursing staff challenged of refreezing phase of transition to electronic documentation among nursing staff. There was a positive significant relation between level of percent of nursing staff total change challenges and socio-demographic characteristics of nursing staff except sex. Nursing Staff showed significant high level of challenges during change process at (p<0.001) There was a positive statistical significant relation of nursing staff level of motivation challenge according to their socio-demographic characteristics except sex and marital status. Nursing staff showed significant high level of challenges during unfreezing phase of change process at (p<0.001). There was a positive statistical significant relation of nursing staff level of movement to change challenges according to their socio-demographic characteristics except (age, sex). Nursing staff showed significant high level of challenges during movement to change phase of change process at (p<0.001).As well as There was a positive statistical significant relation of nursing staff level of challenges during refreezing phase according to their socio-demographic characteristics except (age, sex). Nursing staff showed significant high level of challenges during refreezing phase of change process at (p<0.001. There was significant positive correlation between total change process challenges of nursing staff and challenges of every phase of change process (p<0.001). Based on the results of this study it was most recommended that: General Internal Medicine Hospital should updated and advertise of clear vision and mission towards the change process to electronic documentation. Nursing management should clearly disseminate information about electronic documentation and increase awareness about the purposes of change from traditional paper to electronic documentation and clearly defined performance standard towards electronic documentation. Head nurses should answer questions of nursing staff to maintain effective communication that helping nursing staff to manage their stress toward change and overcome challenges that occur due to change process. Nursing staff should focus on improving their computerization skills and knowledge acquisition.