The purpose of this study was to determine the attitudes of nursing students towards the nursing process software. The mean score of students' attitudes toward the nursing process software was 80.70 ± 5.58. Based on the three-part range, students’ attitude scores were considered desirable. In this study, the majority of students scored good or very good the majority of items evaluating the nursing process software. Also most nursing students did not evaluate any of the 21 items as weak or very weak. Most students had a moderate attitude in 5 or less items evaluating the nursing process software.
Similar to this study, the attitude of health care providers in other studies conducted in the field of comprehensive software of the nursing process (including all stages of the nursing process) was positive, which indicates the efficiency and effectiveness of such software both in the field of learning and care. According to the study by Hariyati et al. , nurses had a positive attitude about using Nursing Management Information System at the Public Health Service in Indonesia, and the nurses satisfaction rating in the area of simplicity and completeness of nursing process increased after using Nursing Management Information System. According to some studies, students were satisfied with the use of nursing process software in clinical practice and its efficiency in promoting clinical care [10, 34]. According to the students’ attitudes in the study by Sayadi and Rokhafroz , their knowledge and skills about the nursing process improved after using the software, and 86% of the students said their satisfaction from using software was high or very high. Based on the study of Mazlom and rajabpoor , 81.3% of the participants rated the nursing process software as good or very good and also efficiency of software in patient care was very high, so that the mean score of nursing students’ opinions was 84.3 ± 5.83 and for nurses was 73.2 ± 1.13 from total score of 100 and the use of the nursing process software was cited as a facilitator of clinical practice.
Based on the literature review, no negative attitudes about comprehensive nursing process software (including all nursing process stages) were found in the studies. Furthermore, in most studies using non-comprehensive software heath care providers reported lower positive attitudes of the efficiency of the software [38,39,40,41]. However in some studies, negative attitudes of the participants about nursing information technology programs were identified [28, 35]. The results of the study by BabaMohamadi et al.  showed that more than half of the nurses did not understand the benefits or the impact of the nursing computer program on the patient care process and from their point of view the computer program influenced a limited number of patient care processes. According to the findings of this study, computer programs prevalent in the clinical nursing environment didn’t have complete capability because they couldn’t process information in all or most aspects of care . Also, in a study by Topaz et al. , they reported low satisfaction and multi-level concerns with electronic health records in Finland. in this study poor system usability, non-integrated systems, lack of standards; and limited functionality, failure to meet nursing clinical needs, non-nursing-specific systems and a lack of user training were among the main concerns of study participants. It should be noted that in these studies, it was the attitude of health care providers towards the efficacy of nursing electronic records that was assessed and there wasn’t an integrated approach to patients’ assessment and related needs that included care planning and nursing intervention documentation. Similarly, in many studies, the nursing process has been defined as a separate pathway that does not cover all stages and the most unconsidered stage was the evaluation stage [23, 26, 42].
The scientific productions analysis designed to identify the characteristics and requirements of similar systems and software in the area of Nursing care evidenced the importance of the development of Nursing assistance systems to support clinical decisions. These systems considered all the stages of Nursing process . Furthermore, though the nursing process has been divided into parts, they do not occur in isolation but are interdependent and recurring [44, 45]. Expert opinion, appears to agree that the core of the Nursing Process-Clinical Decision Support System should be based on the Advanced Nursing Process as it is research-based. Considering the Nursing diagnoses and true linkages between diagnoses, evidence based interventions, and patient outcomes . In other studies, the use of creative learning models in other areas and the use of different and interconnected phases of the nursing process was mentioned . Therefore, in this study the nursing process software design was based on all interrelated stages of the nursing process as recommended in nursing theory text books. So, it seems obvious that nursing students’ attitudes were significantly positive regarding comprehensive and theoretically based- nursing process software.
In this study, the nursing student’s highest rated attitude was respectively related to the “Effectiveness of software in prioritizing patient care and problems”, “Completeness of patient's electronic information compared to handwritten mode” and “Software’s effectiveness in saving your time”.
Consistent with the findings of the current study and based on the study of Mazlom and Rajabpoor , the most important benefits of software from 90% of nurses’ attitudes were being effective in prioritizing diagnoses, accuracy of electronic information compared to handwriting, and helping to organize patient’s problems. Also, in this study, the least frequent measure of satisfaction among 10% of nurses and students participating was related to the accuracy of electronic information compared to handwriting and the effectiveness of the software in saving time  which are not consistent with the findings of present study. This may be due to the different software and research community in these studies. Like the present study, the study of Lima et al.  showed that the computerized nursing process is useful in developing the nursing process, facilitating data collection, diagnostic reasoning, and identifying the clinical signs of newborn in neonatal units.
Most nurses have a positive idea on the use of the nursing process, but have little interest in using it because of it being time consuming . The reduction in the time taken for completing the nursing documents, without decreasing the quality of collected data is an important advantage of information technology. This results in increased nursing time to stay with patients . It should be noted that the time it takes to use a computerized system is inversely related to the resources of the information technology system . So, using advanced software programs is a time management strategy that facilitates and accelerates the implementation of the nursing process because software programs allow nurses to enter assessment information quickly .
The growth of information technology and systems has been improving nursing care. Significantly. Using indicators of quality care, we find that information systems and software in nursing care help to organize and manage the increasing volume of information and data required by the nurse to develop their actions, saving time by recording the technical and scientific documents electronically. It also provides databases that can be used for research . In this study, in addition to having the above features, we found that software that prioritizes problems based on the nursing assessment contributed to the positive results. Also using various valid and up to date nursing textbooks to develop the content of the software and finally the user friendly design of software had a direct impact on the student’s attitude towards using the software. “Fast implementation”, “data mining algorithms” and “forecasting techniques” are important features of new software and should be considered in the field of health care information technology [50, 51].
In the present study, the lowest level of students' attitudes towards the software was respectively related to the “feeling of fairness in labor division based on the software”, “the effectiveness of the software in determining your workload” and “the feeling of satisfaction in labor division based on the software”.
Regarding the cases with lowest level of student’s attitude towards the software, it should be noted that based on a review of extensive texts, in any of the studies issues such as observing the fairness of software-based division of work, the effectiveness of the software in determining workload and nursing students' satisfaction with software based work division has not been studied. However, it seems that since the clinical education system used in this study every student was responsible for all the care of the particular patient. The patients are transferred to the students based on the student’s academic knowledge and ability related to their semesters. However, proper division of tasks or assignment of student’s workload by their clinical instructors using the nursing process software has not been considered. So it is suggested that nurse educators evaluate students in terms of the amount of activities and clinical learning software data especially in the areas of diagnosis, nursing intervention and implementation.
Nursing students’ attitudes toward computers play a significant role in the successful implementation of information technology . Education has an important effect on healthcare providers attitudes towards the nursing process [53,54,55]. Furthermore, nursing education has a major part to play in improving the use of the nursing process and thus promoting the overall quality of nursing care . However, the lack of technology training during college courses, short and inadequate training time, lack of retraining and lack of tools  together with a Lack of reference information  are the main challenges for nurse education. Considering the tendency of today’s generation of nursing students to have a positive attitude toward technology and using the web supported learning methods will improve the quality of nursing education . So in this study it was important to assess the nursing student’s attitude toward using the nursing process software as an educational tool for delivering patient care. Along with the numerous benefits of computer programs, some challenges of information technology were noted. Altering the routine care process and practices, deviating from direct patient care had a negative effect on decision making and patients outcome  that may impact on using information technology of nursing process. Other factors that may influence nurses’ attitudes toward computer software include the existence of a minimum set of nursing data and standard nursing terms in computer software . It should be noted that in the current study, the Software’s comprehensiveness and the use of NANDA contribute to the validity of our findings. While the use of International Nursing Diagnosis and up-to-date content using standard nursing text books and applicability and simplicity of software contributed in removing the limitations of the information technology related to the nursing process. Therefore, according to our findings nursing managers and nursing education authorities should try to remove these existing barriers and provide the appropriate facilities to enhance the implementation of the computerized nursing process. Furthermore, the surest way to increase acceptance and positive attitudes, and thus ensure improvements in patient care, is to engage nurses as full stakeholders in implementing and improving these technologies .
In general, from the student’s response, the implementation of the computerized nursing process allows improved diagnosis accuracy, systematic and complete care and documentation. Although the implementation of a computer system is expensive and requires a great deal of planning and training, such systems can significantly improve patient safety by enhancing the quality of appropriate care .
In this study, female students had a significantly more positive attitude toward the nursing process software than male students. Also, the attitude scores of the younger students were significantly higher. In other studies a positive attitude of female nurses or nursing students toward the traditional nursing process is reported [14, 62]. It should be noted that in these studies, student’s attitudes towards computerized nursing process software have not been addressed, so this needs to be investigated in future studies. However, it appears that in most of the studies, including the current study, most of the study's participants were women, influenced by the traditional and feminine nature of the nursing profession and that this can have an effect on the results. Similar to this study, Singh and Masango  found that younger healthcare practitioners were more interested in using nursing information systems. But in the study of BabaMohamadi et al. , younger nurses had somewhat negative attitudes toward the impact of computerized nursing programs for patient care compared to older nurses. This may be affected by the low efficacy of one-step software used in this study for learning and providing care by young nursing students. It seems that nowadays younger students are more willing and satisfied using nursing process software than older students because of their familiarity with the world of technology and informatics and the greater attractiveness of such technologies. It is also likely that students who are more experienced in the professional and educational fields will be more aware of the disadvantages of establishing different care giving practices based on the computerized nursing process program.
The advantages/disadvantage of this study
The advantages of this study
Promoting the use of the nursing process in patient care.
Improving the awareness and knowledge of nursing students about the nursing process.
More accurate and more efficient implementation of the nursing process by clinical health care providers.
Outline the need to establish computer-based equipment and infrastructure to implement the nursing process.
The disadvantage of this study
Possibility of students relying on the software contents and functions.
Possibility of reducing critical thinking and independent management of nursing students considering the relationship between the data in the different stages of the nursing process (patient assessment, nursing diagnoses, planning, implementation and evaluation) when using the nursing process software.