Analysis of Factors Influencing the Adoption of Electronic Nursing Documentation: A SEM-PLS Approach
DOI:
https://doi.org/10.31674/mjmr.2026.v010i04.02Abstract
Background: The Indonesian Ministry of Health mandates the use of electronic medical records (EMRs) across all healthcare facilities, impacting hospitals nationwide, including those in Pekanbaru. In response, hospitals in Pekanbaru have integrated digital applications into healthcare services, including nursing care. Nursing documentation is now conducted using Electronic Nursing Documentation (END). Despite its implementation, no formal evaluation of END usage has been conducted, even though service effectiveness remains a key performance indicator. Objectives: This study aims to analyze factors influencing the adoption of END using a Structural Equation Modelling–Partial Least Squares (SEM-PLS) approach. Methods: This quantitative study employed a cross-sectional design and utilized a structured questionnaire. A total of 287 inpatient nurses from three hospitals in Pekanbaru were selected through purposive sampling. Data were analyzed using SEM-PLS techniques. Result: The structural model showed that perceived usefulness (POU) significantly influenced attitude toward using (ATU) (β = 0.749, p < 0.001) and behavioral intention to use (BITU) (β = 0.415, p < 0.001). Perceived ease of use (PEOU) significantly influenced ATU (β = 0.168, p = 0.010) and POU (β = 0.831, p < 0.001). ATU significantly influenced BITU (β = 0.490, p < 0.001) and actual usage behavior (AUB) (β = 0.464, p < 0.001), while BITU significantly influenced AUB (β = 0.479, p < 0.001). The model explained 82.7% of the variance in AUB. IPMA showed that POU had the highest importance for AUB (0.722), whereas PEOU had the highest performance (72.115). These results suggest that enhancing system usability and demonstrating its practical benefits can strengthen adoption intentions. Conclusion: The TAM creates significantly influenced END adoption, with POU being the strongest predictor of AUB and PEOU showing the highest performance. Future longitudinal studies applying objective usage measures are needed to authenticate these associations and explore additional determinants of adoption.
Keywords:
Adoption, Electronic Nursing Documentation, Nurses, PLS, Structural Equation Modelling Approach.Downloads
References
Abuadas, M., & Albikawi, Z. (2025). Predicting nursing students’ behavioral intentions to use AI: the interplay of ethical awareness, digital literacy, moral sensitivity, attitude, self-efficacy, anxiety, and social influence. Journal of Human Behavior in the Social Environment, 36(7), 579-599. https://doi.org/10.1080/10911359.2025.2472852
Chand, S., & Sarin, J. (2019). Impact of Electronic Nursing Documentation ( End ) In Terms Of Quality of Nursing Documentation. IOSR Journal of Nursing and Health Science. 8(3), 25–32. https://doi.org/10.9790/1959-0803032532
Davis, F. D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 13(3), 319–340. https://doi.org/10.2307/249008
Davis, F. D., & Granić, A. (2024). Revolution of TAM. In: The Technology Acceptance Model. Human–Computer Interaction Series (eds). Springer, Cham; pp. (59–101). Springer International Publishing. https://doi.org/10.1007/978-3-030-45274-2_3
Hair, J. F., Hult, G. T. M., Ringle, C. M., Sarstedt, M., Danks, N. P., & Ray, S. (2021). Partial least squares structural equation modeling (PLS-SEM) using R: A workbook. Springer. https://doi.org/10.1007/978-3-030-80519-7
Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31(1), 2–24. https://doi.org/10.1108/EBR-11-2018-0203
Hair, Joseph F, J., Hult, G. T. M., Ringle, C. M., & Sarstedt, M. (2022). A Primer on Partial Least Squares Structural Equation Modeling (PLS-SEM). (p. 355). SAGE.
Iseni, J., Swoboda, W., Houben, D., & Hilla, R. (2026). Acceptance of digital technology among nursing staff in geriatric long-term care: Systematic review. JMIR Nursing, 9, e82223. https://doi.org/10.2196/82223
Jacques, D., Will, J., Dauterman, D., Evanovich, K., Delmore, B., Doty, G. R., Brien, K. O., & Groom, L. (2025). Evaluating Nurses ’ Perceptions of Documentation in the Electronic Health Record : Multimethod Analysis. JMIR Nursing, 8, e69651. https://doi.org/10.2196/69651
Kementerian Kesehatan Republik Indonesia. (2025). Selamat datang di situs resmi Kementerian Kesehatan Republik Indonesia [Welcome to the official website of the Ministry of Health of the Republic of Indonesia]. Retrieved October 14, 2026. https://kemkes.go.id/id
Kristiana, E., Dedi, B., & Nurhayati, S. (2023). Implementation of technology acceptance model (TAM) in electronic documentation of nursing care: Phenomenology explorative. JHeS (Journal of Health Studies), 7(1), 46–57. https://doi.org/10.31101/jhes.3052
Lee, A. T., Ramasamy, R. K., & Subbarao, A. (2025). Understanding Psychosocial Barriers to Healthcare Technology Adoption : A Review of TAM Technology Acceptance Model and Unified Theory of Acceptance and Use of Technology and UTAUT Frameworks. Healthcare, 13(3), 250. https://doi.org/10.3390/healthcare13030250
McCarthy, B., Fitzgerald, S., O’Shea, M., Condon, C., Hartnett-Collins, G., Clancy, M., Sheehy, A., Denieffe, S., Bergin, M., & Savage, E. (2019). Electronic nursing documentation interventions to promote or improve patient safety and quality care: A systematic review. Journal of Nursing Management, 27(3), 491–501. https://doi.org/10.1111/jonm.12727
Németh, G. (2025). Impact of digital tools on patient assessment and documentation accuracy in nursing practice. Journal of Patient Care and Nursing Practice, 2(1), 40–44. https://doi.org/10.33545/30789087.2025.v2.i1.A.11
Rahayu, E. P., & Ariyanti, R. (2025). Evaluasi penerapan rekam medis elektronik pada fasilitas pelayanan kesehatan di Indonesia: A systematic review [Evaluation of the implementation of electronic medical records in health care facilities in Indonesia: A systematic review]. Jurnal Manajemen Pelayanan Kesehatan, 28(4), 131–138. https://doi.org/10.22146/jmpk.v28i04.20034
Reierson, I. Å., Mofossbakke, R. G., & Solli, H. (2025). Nursing students ’ perspectives on learning electronic health record documentation in an academic setting and during clinical placement : A qualitative study. BMC Nursing, 24(764), 1–11. https://doi.org/10.1186/s12912-025-03320-5
Saraswasta, I. W. G., & Hariyati, R. T. S. (2018). The implementation of electronic-based nursing care documentation on quality of nursing care: A literature review. International Journal of Nursing and Health Services (IJNHS), 1(2), 19-31. https://doi.org/10.35654/ijnhs.v1i2.23
Shafiee, M., Shanbehzadeh, M., Nassari, Z., & Kazemi-Arpanahi, H. (2022). Development and evaluation of an electronic nursing documentation system. BMC Nursing, 21(1), 15. https://doi.org/10.1186/s12912-021-00790-1
Wahyuni, E., Nursalam, N., Dewi, Y. S., Arifin, H., & Benjamin, L. (2024). Electronic nursing documentation for patient safety, quality of nursing care, and documentation: a systematic review . JPMA. The Journal of the Pakistan Medical Association, 74(9), 1669–1677. https://doi.org/10.47391/jpma.9996
Wang, N. (2021). Electronic nursing documentation. In D. Gu & M. E. Dupre (Eds.), Encyclopedia of gerontology and population aging (pp. 1614–1618). Springer. https://doi.org/10.1007/978-3-030-22009-9_443
Zaharany, T. A., & Hariyati, R. (2020). Developments in Electronic Nursing Logbooks in Health Service Areas: Literatur Review. 4, 38–44. https://doi.org/10.31983/jnj.v4i1.5415
Zaman, N., Goldberg, D. M., Kelly, S., Russell, R. S., & Drye, S. L. (2021). The relationship between nurses’ training and perceptions of electronic documentation systems. Nursing Reports, 11(1), 12–27. https://doi.org/10.3390/nursrep11010002
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Malaysian Journal of Medical Research (MJMR)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
