Abstract
Introduction: Electronic health records (EHRs) have transformed healthcare documentation, yet their impact on nursing practices in resource-limited settings remains underexplored. In Palestine, where governmental hospitals face infrastructure challenges, EHR adoption may enhance efficiency but also introduce disruptions affecting nurse morale.
Aim: To assess the dual role of electronic health information systems in nursing practice: perceived benefits and challenges for workflow and job satisfaction in Palestine
Methods: This quantitative cross-sectional study surveyed 190 nurses from medical and surgical wards in eight Palestinian governmental hospitals using a structured questionnaire. Data collection occurred from March to April 2025. The instrument assessed demographics, work environment factors, workflow efficiency (9-item Likert scale), and job satisfaction (adapted Nursing Workplace Satisfaction Questionnaire, 10 items). Sample size was calculated via G*Power for regression analysis (n=190 minimum). Descriptive statistics, normality tests, and multiple linear regression were performed using SPSS version 29, with significance at p<0.05.
Results: Response rate was 90.48 %. Nurses (mean age 32.64 years; 51.6 % male) reported moderate workflow efficiency (mean=3.59/5) and job satisfaction (mean=3.57/5). Over 70 % perceived high EHR-related efficiency, with 52.1 % satisfied overall. Regression identified EHR user-friendliness (β=0.261, p<0.001), training (β=0.243, p=0.024), technical support (β=0.184, p=0.005), and age (β=0.223, p=0.037) as predictors of efficiency. Similar factors predicted satisfaction: user-friendliness (β=0.274, p<0.001), training (β=0.274, p=0.020), technical support (β=0.148, p=0.012), and age (β=0.194, p=0.045).
Conclusion: EHRs positively influence nursing productivity and moderately boost fulfillment in Palestinian public hospitals, contingent on training and support. Findings inform policy for optimizing digital tools in low-resource contexts to improve care quality and reduce burnout.
References
1. Dubale AT, Mengestie ND, Tilahun B, Walle AD. User Satisfaction of Using Electronic Medical Record System and Its Associated Factors among Healthcare Professionals in Ethiopia: A Cross‐Sectional Study. Khani Jeihooni A, editor. BioMed Res Int. 2023 Jan;2023(1):4148211. doi:10.1155/2023/4148211
2. Ramoo V, Kamaruddin A, Nawawi WNFW, Malaysia D of NS Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Chin Che C, Kavitha R. Nurses’ Perception and Satisfaction Toward Electronic Medical Record System. Florence Nightingale J Nurs. 2022 Dec 1. doi:10.5152/FNJN.2022.22061
3. Qtait M. Nurses’ Knowledge, Attitudes, and Implementation of Evidence-Based Practice Comparative Study. Sage Open Nurs. 2025 Dec;11:23779608251343611. doi:10.1177/23779608251343611
4. Abu Raddaha AH. Nurses’ perceptions about and confidence in using an electronic medical record system. Proc Singap Healthc. 2018 Jun;27(2):110–7. doi:10.1177/2010105817732585
5. Yasin YM, Alomari A, Al-Hamad A, Kehyayan V. The impact of COVID-19 on nurses’ job satisfaction: a systematic review and meta-analysis. Front Public Health. 2024 Jan 11;11:1285101. doi:10.3389/fpubh.2023.1285101
6. Moore EC, Tolley CL, Bates DW, Slight SP. A systematic review of the impact of health information technology on nurses’ time. J Am Med Inform Assoc. 2020 May 1;27(5):798–807. doi:10.1093/jamia/ocz231
7. Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis. 2011 Sep;11(9):692–701. doi:10.1016/S1473-3099(11)70054-8
8. Hariyati RTS, Hamid AY, Eryando T, Hasibuan ZA. Usability and satisfaction of using electronic nursing documentation, lesson-learned from new system implementation at a hospital in Indonesia. Int J Healthc Manag. 2020 Jan 2;13(1):45–52. doi:10.1080/20479700.2018.1504387
9. Lee SJ, Lee YM, Seo EJ, Son YJ. Impact of Hospital Nurses’ Perception on Clinical Alarms and Patient Safety Culture on Alarm Management Practice. Int J Environ Res Public Health. 2021 Apr 12;18(8):4018. doi:10.3390/ijerph18084018 PubMed PMID: 33921203; PubMed Central PMCID: PMC8069512.
10. Owoc J, Mańczak M, Tombarkiewicz M, Olszewski R. Burnout, well-being and self-reported medical errors among physicians. Pol Arch Intern Med. 2021 Jun 16. doi:10.20452/pamw.16033
11. Melnick ER, West CP, Nath B, Cipriano PF, Peterson C, Satele DV, et al. The association between perceived electronic health record usability and professional burnout among US nurses. J Am Med Inform Assoc. 2021 Jul 30;28(8):1632–41. doi:10.1093/jamia/ocab059
12. Berihun B, Atnafu DD, Sitotaw G. Willingness to Use Electronic Medical Record (EMR) System in Healthcare Facilities of Bahir Dar City, Northwest Ethiopia. Xu G, editor. BioMed Res Int. 2020 Jan;2020(1):3827328. doi:10.1155/2020/3827328
13. Fadel MA, Elfallah EAO, Elghriani A. An Evaluation of the Attitudes of Healthcare Nurses Towards New Technologies. In: Proceedings of the 6th International Conference on Engineering & MIS 2020 [Internet]. Almaty Kazakhstan: ACM; 2020 [cited 2025 May 7]. p. 1–6. Available from: https://dl.acm.org/doi/10.1145/3410352.3410731 doi:10.1145/3410352.3410731
14. Alsulaiman MA, Alsulaiman IA, Almansour TM, Alsulaiman HA, Qorad HSA, Almatif AY, et al. Satisfaction of Health Care Workers from the Electronic Health Recording System in Najran General Hospital, Southern Saudi Arabia. Haya Saudi J Life Sci. 2022 Dec 18;7(12):336–43. doi:10.36348/sjls.2022.v07i12.002
15. Arruum D, Setyowati, Handiyani H, Artono Koestoer R. Nurses’ Job Satisfaction Regarding the Use of Health Technology: A Survey Study. J Keperawatan Indones. 2024 Mar 31;27(1):47–58. doi:10.7454/jki.v27i1.1076
16. Venkatesh V, Morris MG, Davis GB, Davis FD. User Acceptance of Information Technology: Toward A Unified View1. MIS Q. 2003 Sep 1;27(3):425–78. doi:10.2307/30036540
17. Alqaissi N, Qtait M, Jaradat Y, Farajalla F, Mesk Z, Awwad K. Post-Traumatic Stress Symptoms and Quality of Life Among West Bank Nursing Students Following the October 7th Gaza War: A Cross-Sectional Study. SAGE Open Nurs. 2025 Sep 22;11. doi:10.1177/23779608251381664
18. Farajalla F, Alqaissi N, Qtait M, Mesk ZM, Awwad K. Prevalence of violence and quality of life among nursing students during the 7th of October War in Palestine. BMC Nurs. 2025 Jul 5;24(1). doi:10.1186/s12912-025-03544-5
19. Sbaih K, Qtait M, Alqaissi N, Farajalla F. Perceptions of the nursing profession among first-year health profession students: A cross-sectional study in Palestine. Alfuqaha OA, editor. PLOS One. 2025 Oct 24;20(10):e0334933. doi:10.1371/journal.pone.0334933
20. Farajalla F. Nurses’ Work Satisfaction With Electronic Medical Record Use and Associated Facilitators and Barriers in Palestine. Sage Open Nurs. 2026 Jan;12:23779608261418586. doi:10.1177/23779608261418586
21. Park S, Marquard J, Austin RR, Pieczkiewicz D, Jantraporn R, Delaney CW. A Systematic Review of Nurses’ Perceptions of Electronic Health Record Usability Based on the Human Factor Goals of Satisfaction, Performance, and Safety. CIN Comput Inform Nurs. 2024 Mar;42(3):168–75. doi:10.1097/CIN.0000000000001084
22. Farajalla F. Military checkpoint exposure and predictive factors of quality of life among nurses during the 7th of October war in Palestine: a cross-sectional observational study. Confl Health. 2025 Nov 3;19(1):79. doi:10.1186/s13031-025-00721-w
23. Farajalla F, Farajallah M, Alqaissi N, Qtait M. Critical Care Nurses’ Practices in Clinical Alarm Management: Barriers and Predictors From a Mixed‐Methods Study in the Southern West Bank, Palestine. Grypdonck MHF, editor. Nurs Res Pract. 2026 Jan;2026(1):4564347. doi:10.1155/nrp/4564347
24. Alqaissi N, Farajalla F, Qtait M, Darabee IM, Khallaf DS, Daghamin KR, et al. Factors Influencing Cardiopulmonary Resuscitation Quality in Palestinian Emergency Settings. Disaster Med Public Health Prep. 2025;19:e264. doi:10.1017/dmp.2025.10203
25. Jedwab RM, Manias E, Redley B, Dobroff N, Hutchinson AM. Impacts of technology implementation on nurses’ work motivation, engagement, satisfaction and well‐being: A realist review. J Clin Nurs. 2023 Sep;32(17–18):6037–60. doi:10.1111/jocn.16730
26. Naamneh R, Bodas M. The effect of electronic medical records on medication errors, workload, and medical information availability among qualified nurses in Israel– a cross sectional study. BMC Nurs. 2024 Apr 24;23(1):270. doi:10.1186/s12912-024-01936-7
27. Farajalla F, Batran A, Malak MZ, Ayed A. Clinical Alarm Management in Terms of Knowledge and Practices Among Palestinian Critical Care Nurses in the West Bank. Sage Open Nurs. 2026 Jan;12:23779608251410070. doi:10.1177/23779608251410070
28. Qtait M, Amro N, Alqaissi N, Awwad K, Farajalla F, Mesk Z, et al. Challenges Faced by Nurses in Disaster Management in Palestine: A Systematic Review. Sage Open Nurs. 2026 Jan;12:23779608261434445. doi:10.1177/23779608261434445
29. Pinevich Y, Clark KJ, Harrison AM, Pickering BW, Herasevich V. Interaction Time with Electronic Health Records: A Systematic Review. Appl Clin Inform. 2021 Aug;12(04):788–99. doi:10.1055/s-0041-1733909
30. Farajalla F, Farajallah M, Alqaissi N, Qtait M, Mesk ZM. Impact of electronic health records on nursing workflow efficiency and predictive factors in Palestinian hospitals. Xu JL, editor. PLOS Digit Health. 2026 Mar 20;5(3):e0001318. doi:10.1371/journal.pdig.0001318
31. Lefchak B, Bostwick S, Rossetti S, Shen K, Ancker J, Cato K, et al. Assessing Usability and Ambulatory Clinical Staff Satisfaction with Two Electronic Health Records. Appl Clin Inform. 2023 May;14(03):494–502. doi:10.1055/a-2074-1665
32. Farajalla F, Salameh A, Halahla A alrahman, Talahmmeh M, Al-Allama M, Rasras M. Determinants of quality of life in type 1 and type 2 diabetes patients in Palestine: a comparative cross-sectional study. BMC Prim Care. 2026 Apr 14. doi:10.1186/s12875-026-03319-0
33. Mesk Z, Alqaissi N, Amro A, Abdul Manaf R, Farajalla F, Abu Rmaileh S, et al. Academic Stress and Its Effect on the Psychological, Emotional, and Behavioral Health of Nursing Students. Int J Body Mind Cult. 2025;12(7):147–56. doi:10.61838/ijbmc.v12i7.917
34. Qtait M, Alqaissi N, Farajalla F, Jaradat Y, Awwad K. Impact of the October 7 Gaza war on post-traumatic stress symptoms and quality of life in Palestinian nursing. Sci Rep. 2025 Oct 3;15(1):34575. doi:10.1038/s41598-025-18039-1
35. Aris Winata IMN, Hariyati RrTS. Nurse satisfaction level using electronic nursing documentation. Enferm Clínica. 2021 Apr;31:S109–12. doi:10.1016/j.enfcli.2020.12.002
36. Ju JK, Jeong HW. Effect of a Practice-Oriented Electronic Medical Record Education Program for New Nurses. Healthcare. 2025 Feb 8;13(4):365. doi:10.3390/healthcare13040365
37. Topaz M, Ronquillo C, Peltonen LM, Pruinelli L, Sarmiento RF, Badger MK, et al. Nurse Informaticians Report Low Satisfaction and Multi-level Concerns with Electronic Health Records: Results from an International Survey. AMIA Annu Symp Proc AMIA Symp. 2016;2016:2016–25. PubMed PMID: 28269961; PubMed Central PMCID: PMC5333337.
38. Qtait M, Farajalla F, Alqaissi N, Awwad K, Amro N, Jaradat Y. Antibiotic self-medication behaviours and contributing factors among adults in the Southern West Bank, Palestine. JAC-Antimicrob Resist. 2026 Mar 9;8(2):dlag028. doi:10.1093/jacamr/dlag028
39. Qtait M, Farajalla F, Alqaissi N, Jaradat Y. Implementation and Impact of Tele‐Intensive Care Unit (Tele‐ ICU ) Models on Critical Care Outcomes: A Systematic Review. Nurs Crit Care. 2026 Mar;31(2):e70401. doi:10.1111/nicc.70401
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Copyright (c) 2026 Hamza Ghanayem, Fuad Farajalla, Mousa Farajallah (Author)