Informatics competencies pre-and post-implementation of a Palm-based student clinical log and informatics for evidence-based practice curriculum.

Informatics Competencies Pre- and Post-Implementation of a Palm-based Student Clinical Log and Informatics for Evidence-based Practice Curriculum Suzanne Bakken, RN, DNSc,1,2 Sarah Sheets Cook, RN, MEd, 1 Lesly Curtis, RN, MS,1 Michael Soupios, MS, MA, 3 Christine Curran, RN, PhD 4 1 School of Nursing and 2 Department of Medical Informatics, 3 Center for New Media Teaching and Learning, Columbia University, New York, NY, 4 Ohio State University, Columbus, OH ABSTRACT The purpose of this paper is to describe the implementation and evaluation of a two-part approach to achieving informatics competencies: 1) Palm-based student clinical log for documentation of patient encounters; and 2) informatics for evidencebased practice curriculum. Using a repeatedmeasures, non-equivalent control group design, selfreported informatics competencies were rated using a survey instrument based upon published informatics competencies for beginning nurses. For the class of 2002, scores increased significantly in all competencies from admission to graduation. Using a minimum score of 3 on a scale of 1=not competent and 5=expert to indicate competence, the only area in which it was not achieved was Computer Skills: Education. For 2001 graduates, Computer Skills: Decision Support was also below 3. There were no significant differences in competency scores between 2001 and 2002 graduates. Computer Skills: Decision Support neared significance. Subsequently, the approaches were refined for implementation in the class of 2003. INTRODUCTION Within the context of improving patient safety and enabling evidence-based nursing practice, the Columbia School of Nursing has initiated curricular changes to enhance the informatics competencies of its students and graduates. A number of activities have been undertaken across the Entry-to-Practice (ETP) and Master’s advanced practice nurse curricula.1,2 The purpose of this paper is to describe the implementation and evaluation of a two-part approach to achieving informatics competencies: 1) Palm-based ETP student clinical log for documentation of patient encounters; and 2) informatics for evidence-based practice (EBP) curriculum. BACKGROUND Informatics Competencies Professional clinical societies, educational accreditation organizations, and informatics associations have initiated activities and in some instances, guidelines or criteria for informatics competencies for clinicians, informatics specialists, and informatics innovators.3-7 Moreover, reports such as that of the Pew Health Professions Commission have identified effective and appropriate use of information and communication technologies as an essential competency for all health care professionals.8 Beyond its explicit role in improving patient safety and enabling evidence-based practice, 9 some have argued that information technology is a critical component to managing the severe nursing shortage.,10 Consequently, although research related to informatics competencies in nursing has been conducted for more than a decade,11-14 there is now heightened interest in ensuring that graduates of nursing programs have sufficient informatics competencies to meet the demands of the variety of health care settings in which they will assume positions. Most recently, Staggers et al published a set of informatics competencies for nurses at four levels of practice: beginning nurse, experienced nurse, informatics specialist, and informatics innovator.14 Investigators developed and initially validated the competencies through literature review and expert consensus. Building upon this work and others, the American Nurses Association (ANA) published the Scope and Standards of Nursing Informatics Practice.3 The document not only delineates informatics nurse specialist practice, but also describes informatics competencies for beginning and experienced nurses. The beginning nurse competencies focus on fundamental information management and computer literacy skills and the use of existing informatics solutions and available information to manage their practice. The competencies for beginning nurses as published by Staggers et al. served as the basis for the informatics competency evaluation in this study. 14 Entry-to-Practice Program The ETP Program at Columbia University School of Nursing is designed to prepare students AMIA 2003 Symposium Proceedings − Page 41 with bachelor’s degrees in other fields for the first step in a career as an advanced practice nurse. Phase I (ETP-BS) prepares the student for basic practice as a registered nurse (RN) and Phase II (MS) focuses on preparation for an advanced practice role (nurse practitioner, nurse anesthetist, nurse midwife). Phase I, which is the focus of the activities described in this paper, includes instruction in the biological and behavioral sciences and incorporates clinical and didactic learning in nursing science necessary for the first professional degree. Clinical education receives major emphasis, with patient experiences beginning early in the first term. Theory and clinical practice are related to the promotion of health and prevention of illness, as well as to the care of the sick and their restoration to optimal health. Students work with patients in a variety of settings, such as clinics, hospitals, community centers, and home. The curriculum is built on the integrated health model. The initial focus is on promotion of health and prevention of illness. Student Clinical Log The ETP student clinical log was designed to support student documentation of patient encounters and benchmarking of practice over time and to provide an educational record of their experiences. It served as a primary tool in assisting students to understand “what nurses do” and to recognize their role in building evidence from their practice. The student clinical log was completed in addition to the clinical documentation required in each clinical setting. Electronic Electronic Electronic Input Electronic Input Input Devices Devices Input Devices Devices Input Buffer Repository Data scrubbing and transformation is accomplished though a set of manual procedures and SQL queries that move the scrubbed data into the repository. A number of reports based on queries against the repository have been developed to permit faculty and students to interpret the collected data. The Palm-based clinical log application was developed using the Satellite Forms Palm OS development tool suite. Students entered a subset of de-identified data (i.e., no patient names, medical record numbers, or other identifiers were used, simply a two or three letter “code” of the students’ choosing) from patient encounters (Figure 2). Figure 2. Patient Demographic Screen Where possible, standardized terminologies were used to represent the data elements; in other instances, custom terminologies were developed. The primary standardized terminology implemented was the Home Health Care Classification16 that was used for nurs (...truncated)