Enhancing Nursing Informatics Education and Faculty Development: An Integrative Review

1. An Integrative Review of Education and Faculty Development in Nursing InformaticsTracia M. Forman, PhD, RN-BC, CNEAssistant Professor, The University of Texas Rio Grande ValleyDavid A. Armor, MSN, RNNurse Educator/Resource Specialist, Valley Baptist Medical CenterAva S. Miller, EdD, PhD, RN-BC, AHN-BC, CNEProfessor Emeritus, The University of Texas Rio Grande Valley Texas Society of Allied Health Professions 41st Annual Conference -“Preparing for the 21st Century Workforce” September 21, 2018 San Antonio, TX

2. Objectives

3. Background • Staggers et al. (2001) identified nursing informatics roles: • Beginning nurse • Experienced nurse • Informatics nurse specialist • Informatics innovator • American Nurses Association (2015) stated the roles of the informatics nurse specialist, are now considered basic informatics competencies required of all nurses.

4. Definition(s) of Nursing Informatics

5. Purpose The study purpose was to determine the state of the science related to clinical informatics competencies of the registered nurse to determine best practices in educational strategies for both nursing students and faculty.

6. Research Questions

7. Method-Integrative Review Whittemore & Knafl’s (2005) Integrative Review Method

8. Method-Screening Process

9. Clinical Informatics Articles by Country of Origin

10. Method-Interesting Findings • Hand journaling produced an amazing 1,092 articles to sort through that were not identified by the databases. • Web-based and Boolean search patterns uncovered valuable pieces of grey literature which included dissertations, a toolkit, a thesis, a TIGER-based e-repository document and an article on clinical informatics that was translated from Portuguese to English. • A high number of articles were excluded due to their focus on the experienced practicing nurse instead of the nursing student. Our focus was to reveal what competencies the nursing student and faculty needs to best prepare the nursing student for real world clinical experiences.

11. Results-TIGER • The most common method to measure clinical informatics in peer-reviewed articles is the Technology Informatics Guiding Education Reform (TIGER). • Developed in 2006 as a resource initiative • Designed to improve patient care through current technology • This model is considered a foundation of informatics • What sets this tool apart is the tool develops knowledge and skills of the student and faculty

12. Results-TIGER Framework European Computer Driving License-(ECDL) This program tests individuals in three basic competencies levels. The base module evaluates an individual’s basic computer skills, online essentials, and the ability to use word processing and spreadsheet applications. This module is aimed at users of patient information systems, such as physicians, nurses and other ancillary staff and support staff. The goal of this program is to provide an easy to use set of instructions for all end users no matter what level of education or experience.

13. Results-TIGER Framework HITCOMP E-Repository • Competencies tools have been created as a result of TIGER • TIGER has 33 core competencies outlined in its curriculum as defined by the HITCOMP e-repository http://hitcomp.org/competencies/ • This tool is based on Blooms taxonomy and has five grades of experience that are color coded for ease of use. • The five grades of experience are baseline, basic, intermediate, advanced and expert.

14. Results-The Electronic Healthcare record (EHR) • Using the EHR at the healthcare facility is another popular training method • The student nurse learns to document real-time nursing interventions on actual patients • The interventions include assessments, plans of care, medications, patient activities, wound care, safety precautions and teaching • The more exposure to the EHR the greater the student confidence. Students should have the opportunity to view different types of patients EHR and should be part of the BSN curriculum • One study indicated that students who practiced with the EMR >5 times had a more positive perception of the EMR

15. Results-The Electronic Healthcare record (EHR) • The EHR allows a smooth transition to real practice, but sometimes has barriers to overcome • Faculty may not have complete buy in to the process or may not be experienced with the healthcare EHR • Faculty should be engaged and have a passion for healthcare informatics • Healthcare companies may limit or block student access to the EHR to the point where they are unable to learn the system • Universities should work with the hospital educators to remedy access issues

16. Results-QSEN • The Quality and Safety Education for Nurses (QSEN) is designed to guide nursing programs in informatics. It measures the students actual ability to use technology. QSEN Definition of Informatics: Use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Objective: Students will utilize technology and equipment in the clinical unit while maintaining the Health Insurance Portability and Accountability Act (HIPPA).

17. Results-ICT Tool • The Information and Communication Technologies (ICT) tool was developed in 2011 by the Canadian Association Schools of Nursing (CASN). • Tool was developed for needs of the student and faculty • Main goal was to address the knowledge nursing students needed at the time of graduation • A taskforce of healthcare professionals across Canada created 3 primary competencies with 19 indicators

18. Results-ICT Tool • The (ICT) tool focuses on clinical skills, documentation, quality, safety and best outcomes. • Creates a more alert clinician who understands system limitations and reduces bedside errors • Supports universities across Canada to include the tool into undergraduate nursing curriculum • Supports faculty through an increase of informatics awareness and supports instructors who may not be fully prepared through the integration of the indicators in the ICT tool. The indicators incorporate the use of the Tardif framework with the ICT tool. This framework assists instructors greatly because Tardif is familiar curriculum that is widely used across Canada for other clinical purposes

19. Results-Other Competency Tools • Several healthcare facilities built their own competency tools based on Staggers, Gassert & Curran’s original work in 2001. The three domains are computer skills, informatics knowledge, and informatics skills. • One DNP program built their own 86 item informatics set with 18 competency areas. • This study found that both BSN and MSN students felt they had low competence in areas such as decision support systems, searching and retrieving literature sources, statistical analysis, extracting data sets and nursing research. • A nursing study in South Korea built an informatics competencies questionnaire that involved 230 nurses included a total of 112 items with 53 competencies for beginning nurses and 59 competencies for the experienced nurse. • The study found that nurses in manager roles or individuals who had informatics education or background had higher competencies. This result reinforces the idea that a formal informatics is a necessary component to include future nursing programs.

20. Discussion-Strengths

21. Discussion-Weaknesses No clear best practice for teaching clinical informatics competencies. Minimal research related to nursing faculty competencies. Research tools were self-assessments. Lack of diversity in sample populations.

22. Conclusion

23. Acknowledgement This research was funded by a grant received from the National League for Nursing.

24. Questions

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