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Lessons Learned: Information Technology Meets Nursing Education

For years, nurses have been advocating for patient information at the point of care. Now, Helen Connors, RN, Ph.D., FAAN, executive director of the Center for Healthcare Informatics at the University of Kansas Medical Center, in Lawrence, Kansas, has introduced “information at the point of learning.”

At Johns Hopkins University School of Nursing, in Baltimore, Maryland, Patricia Abbott, RN, Ph.D., FAAN, assistant professor and co-director of the World Health Organization/Pan American Health Organization Center for Information Systems in Nursing Care, concluded that “it is a crime to graduate nursing students who don’t know how to interact in this complex and information intensive environment.”

In the wake of these realizations, working with their vendors, both the University of Kansas School of Nursing (KUSON) and the Johns Hopkins University School of Nursing (JHUSON), have integrated electronic health records into the nursing curriculum.

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Creating Partnerships

In 2001, the University of Kansas School of Nursing and Cerner Corporation announced a jointly funded partnership representing “a pioneering event for education and for the health care information technology industry.” According to Connors and her colleagues, the partnership marked “the first time that a live-production, clinical information system designed for care delivery is being used in a simulated way for teaching curriculum content to nursing students.”

In September 2004, Eclipsys Corporation issued a press release stating: “Underscoring the growing role that information technology plays in the delivery of healthcare, the Johns Hopkins University School of Nursing and Eclipsys Corporation have signed a letter of intent to launch a unique academic partnership. The goals of the partnership are to increase the healthcare information technology competence of nursing graduates and to design new ways of delivering safe and efficient healthcare utilizing healthcare information technology.” Implementation of this partnership will begin in summer 2005.

Integrating Electronic Health Records into the Curriculum

Both programs are embedding the electronic health record into their nursing curriculum. The emphasis is not the competency of using the technology, but rather “keeping the technology transparent and focusing on the learning,” Connors explained.

KUSON uses the recent Institute of Medicine reports on patient safety and education to guide curriculum development. Connors noted that nursing students will get a better understanding of the nursing process while they are learning to navigate an electronic health record, acquire information at point-of-learning, find evidence-based practices and create a plan of care based on data, information and knowledge. The integration is widespread throughout the nursing curriculum, including the research course in which nursing students learn how research fits into the plan of care.

KUSON has created a virtual health care delivery system including longitudinal records that allow nursing students to care for a patient in one setting during the first semester and encounter that same patient in another setting the following semester. Students interact with the electronic medical record in the various settings. This enhances the experience of having the electronic medical record embedded in the curriculum and builds a skill set required for clinical practice in the 21st century.

The use of the electronic health record during teaching is not just about learning to use the tool, but rather about how to “identify when a gap in understanding is present, how to find the information needed to fill the gap and how to critically evaluate the information to provide the optimal care for our patients,” Abbott explained.

“It also requires that we teach our students to support patient-centered care, which means having an informed patient who actively participates in healthcare decision making,” she added. “A patient who has been taught by a nurse to access online information and interpret data from a personal health record is a better patient.”

Abbott and colleagues have integrated informatics into nursing education in two significant ways: basic computer competencies and informatics competencies.

“Many people do not understand that these two things are vastly different,” Abbott said. “Basic computer competencies are focused upon actions like using databases and telecommunications--in other words, ‘Thy hands will touch the keyboard,’” she explained.

“Informatics competencies, on the other hand, are more complex and involve critical thinking and application of informatics tools, such as identifying best practices from compilations of data, using technology tools to plan patient care and using technology to help our patients reach and maintain a higher level of health.”

Faculty Reaction

Since 2001, the faculty at KUSON has been enthusiastic about the implementation of technology. After beginning with a pilot of five faculty and 34 students, most all undergraduate faculty were using the integrated teaching methods in 2002. Improvements, especially for the faculty, have come along, including the capability for the faculty to evaluate the students’ work online.

The introduction of new technology into a nursing curriculum represents a fundamental change in teaching methods. In many instances, the faculty will be using technology for teaching that was not available when they were practicing clinicians. This requires the faculty to “move out of the comfort zone,” Abbott explained.

Abbott added that it is challenging for faculty to teach what they themselves have just learned, especially as students move into increasingly automated clinical environments.

“What we have found at Hopkins is that the faculty has really risen to the occasion, and is actively incorporating informatics throughout our innovative and dynamic curriculum,” she said.

Student Reaction

When surveyed, the students at KUSON stated that they are “better prepared for the work environment” and that they had “better decision-making skills.” When asked if they would be able to document in a hospital that did not have an electronic health record, they said that they did learn those skills, however, they expressed a desire to work in a setting with electronic records.

The students at JHUSON welcome the upcoming change as well. Abbott reported that they need more practical hands-on experience. “Having 32 fully IT-outfitted simulation beds gives our students a wonderful opportunity to learn in a supportive environment,” she said.

What the Future Holds

The integration of the electronic health record is serving as an aid at integrating the medical school and nursing school curricula at KUSON. A virtual health care delivery system allows the medical students and nursing students to administer care to the same patients. It is envisioned that this will move into an integrated lab setting with medical students and nursing students simulating care together. Connors is now working with the allied health professionals, including the schools for occupational therapy and physical therapy, to further extend the care environment and the multi-disciplinary approach to patient care.

JHUSON involves the Fellows from the NIH-supported BioMedical Informatics training grant. “This means that we have physicians, librarians, nurses, computer scientists and public health professionals interacting in our simulation space. It makes for great study of team dynamics,” Abbott said.

Both Abbott and Connors agreed that there is a responsibility to teach the new generation of nurses practical computer skills so that with their mastery, computers serve nurses, rather than nurses serving the computers. This integrated training technique will prepare the students to take positions at hospitals, regardless of the presence or absence of an electronic health record or the specific vendor product.

Connors stated that the training these students receive will help transform their education to include the competencies required by the Institute of Medicine report on health professional education.

In looking at the impact on recruitment and retention, Abbott cited that “studies show that mismatch between educational preparation and clinical reality impacts on job satisfaction and retention rates.”

Take Away Message for Nurses

Connors advised: “Recognize that information technology is an area in which you have to focus. Understand the value of having this skill set.”

Abbott advised: “Teach the principles, but then apply them. For example, to play the piano you must touch the keyboard, not just read the book.”

Take Away Message for Nursing Students

Connors recommended: “Use the technology skill set you bring to nursing education and apply it to improve the quality, safety, efficiency and effectiveness of health care--you will make a difference.”

Abbott advised: “If you are not getting practical information in your training program, you need to demand it. Information technology in health care can no longer be avoided; it is not a matter of if, it’s a matter of when.”

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