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Computer Competencies in a BSN Program

Lynne L. Ornes, PhD, RN; and Carole Gassert, PhD, RN, FACMI, FAAN

Beginning nurses need informatics skills to work efficiently in an environment that increasingly relies on information technology to promote patient safety. in addition, a federal order mandates that all americans have an electronic medical record by 2014. Nursing programs must integrate informatics content into their curricula to prepare nurses to use information technology. This article describes a baccalaureate (BsN) curriculum evaluation of nursing informatics content. Results can inform faculty about strategies that can strengthen informatics competencies. a research-based tool, based on the informatics competence work of staggers, Gassert, and curran, was developed to evaluate course syllabi. although evidence of learning experiences related to computer skills was present, students were not routinely exposed to computerized systems. No syllabi included evidence that addressed informatics knowledge competencies. We conclude that students received limited informatics exposure

AbstrAct

and may not be adequately prepared to use information technology. Recommendations for increasing nursing informatics experiences within a BsN curriculum are offered.

Received: December 29, 2004 Accepted: April 4, 2005 Dr. Ornes is Assistant Professor, Southern Utah University, Department of Nursing, Cedar City, and Dr. Gassert is Associate Professor and Associate Dean, Information and Technology, University of Utah, College of Nursing, Salt Lake City, Utah. Address correspondence to Lynne L. Ornes, PhD, RN, Assistant Professor, Southern Utah University, Department of Nursing, 351 West University Boulevard, GC005, Cedar City, UT, 84720; e-mail: ornesl@suu.edu.

ecent discussions about medication errors and patient safety are driving health care agencies to install information technology, such as information systems, as a strategy to reduce errors. such computerization of the health care industry requires that nurses be able to use the available technology to communicate among specialties and service areas and to safeguard personal health information (Zytkowski, 2003). The urgency of preparing nurses to use information technology is also being driven by an executive order issued by President Bush in 2004, mandating that all americans have an electronic medical record by 2014 (Bush, 2004). staggers, Gassert, and curran (2002) asserted that beginning nurses need fundamental information management and computer technology skills so they can use existing information systems and available information to manage their practice (p. 386). several other authors advise the integration of nursing informatics content into nursing education curricula to help nurses become competent (american association of colleges of Nursing, 1997, 1998; Gassert, 1998; Pew health Professions commission, 1998; saba & Riley, 1997). staggers, Gassert, and curran (2001) defined nursing informatics competencies as the integration of

knowledge, skills, and attitudes in the performance of various nursing informatics activities within the prescribed levels of nursing practices (p. 306). Levels of practicing nurses are defined as beginning nurse, experienced nurse, informatics nurse specialist, and informatics innovator. The authors categorized nursing informatics competencies into computer skills, informatics knowledge, and informatics skills. Of these categories, computer skills and informatics knowledge relate to the beginning-level nurse (staggers et al., 2001, 2002). in the current study, beginning-level nurses are equated to baccalaureate (BsN) prepared nurses. The categories of skills identified by staggers et al. (2001, 2002) are listed below, and examples are included in parentheses. computer skills include skills in administration (searching for patient information), communication (using e-mail), data access (using computerized data that relate to careplanning programs), documentation (documenting vital signs), patient education (using information technology in the process of patient education), patient monitoring (performing electrocardiography), basic desktop software (using word processing), and systems (using operating systems for functions such as copying and deleting). informatics knowledge includes data (recognizing the use and importance of nursing data for improving practice), impact (recognizing the time, effort, and skill required), privacy and security issues (using ethics), and systems (using networks). This article describes how one nursing program evaluated its BsN
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curriculum for the existence of nursing informatics content. after reviewing the literature on the need for computer competence education and computer literacy, we will outline the development of the tool and the method used for evaluating the curriculum. We then offer recommendations for increasing nursing informatics experiences within the BsN curriculum.

Literature review

The use of computerized patient documentation systems is important to patient operations and safety, but studies suggest that nurses may not use these systems to their benefit. for example, the use of computerized systems did not decrease the time nurses spent in documenting patient care services or increase the time they spent providing direct patient care; however, computerized patient records contained fewer errors (currell & Urquhart, 2004; hendrickson & Kovner, 1990). Repeatedly, nurses acceptance of the computerbased documentation system, acceptance of the nursing process, and confidence in using computers influenced the successful implementation and use of a computerized patient documentation system (ammenwerth, Mansmann, iller, & eichstdter, 2003; Darbyshire, 2004). Unsuccessful implementation of patient documentation systems may be related to nurses feelings that the computer applications did not reflect the patients condition, difficulty in retrieval of information (Darbyshire, 2004), lack of computer terminals to access and submit data (hendrickson & Kovner, 1990), and little or no training and support in using the system (currell & Urquhart, 2004). These findings support the need for early education of nurses in obtaining the knowledge, skills, and appreciation of information systems and informatics. although informatics is more than computer literacy or computer skills, these skills influence the acceptance of computer technology. computer skill level has been assessed in nursing students (Gassert & McDowell, 1995; hardy, 1995) and medical students (scott, schaad, Mandel, Brock, & Kim, 2000). Using the Level of computer
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experience tool to measure the literacy skills of nursing students in both an undergraduate course and a masters level informatics course, Gassert and McDowell (1995) found that both groups possessed low computer literacy skills. hardy (1995) found no differences in perceptions of actual and desired knowledge about computers and computer applications between prenursing students and RN-to-BsN students, meaning that working RNs did not feel better trained in computer use than did students beginning their education. in addition, scott et al. (2000) found that the opinions of academic deans and their medical students differed regarding when computer competence skills should be taught. in the same study, administrators questioned whether students self-reports of computer competencies were accurate. austin (1999) studied the degree of integration of computer literacy skills within nursing curricula. she found that only 3 (i.e., confidentiality issues of computerized medical information and records, literature searches, use of word-processor software) of the 60 skills were well integrated into the courses by 50% of the sample. McNeil et al. (2003) found that nursing programs more often address computer literacy than nursing informatics skills when they integrate information technology skills and knowledge into their curricula. To change what is taught, undergraduate curriculum committees must evaluate their content to determine whether nursing informatics competencies are present in their curricula. Then, faculty need to strategize how content leading to informatics competencies can be included in the curriculum. The current study builds on the previous work of staggers et al. (2001, 2002) in developing a tool for curriculum evaluation and seeking to determine the extent to which nursing informatics material is present in the courses in a BsN program.

nursing informatics material is present in the courses in a BsN program? The sample was all course syllabi for the 18 courses in a BsN program.
Instrument and Procedure

The tool created to evaluate the course syllabi (Figure) was based on the categories of informatics competencies for the Beginning Nurse described by staggers et al. (2001, 2002). four matrices were produced to represent each semester. Using this template, identifying information about each course and the categories of informatics competencies were placed in the first column of the matrix. identifying information about each course included the course number, title, prerequisite courses, total credits, class hours per week, laboratory hours per week, semesters offered, description, objectives, teaching methods, textbooks and software, and evaluation methods. The names of the nursing courses were then positioned in the remaining columns across the top row. space within each column allowed the investigators to write comments about the identifying information and evidence of the competencies present within the syllabus. The tool was designed to be completed by typing the comments into a word processor as the syllabi were being reviewed. The syllabus for each course was evaluated by one investigator (L.L.O.) to determine whether evidence of the competency was present.

results

The results are organized according to the nursing informatics competencies applicable to beginning-level nurses. all of the competencies were from the computer skills category (staggers et al., 2001, 2002). Missing from the syllabi was evidence related to the category of informatics knowledge.
Administration

Method
research Question and sample

The research question for this study was: What is the extent to which

This competency states that nurses use administrative applications for practice management and structured data entry, such as patient acuity
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systems. There was no evidence that content or practice related to this competency was presented in any of the courses within the program.
communication

Course number Course title Competencies Computer Skills: Administration Uses administrative applications for practice management (e.g., searches for patient information, retrieves demographics). Uses applications for structured data entry (e.g., patient acuity, classification applications). Computer skills: Communication (e.g., e-mail, Internet, telecommunications) Uses telecommunication devices (e.g., modems) to communicate with other systems (e.g., access data, upload and download data). Uses e-mail (e.g., create, send, reply, attach documents).

NXXX

NXXX

This competency states that nurses use telecommunication devices, such as modems, to communicate with other systems, e-mail, and the internet to locate and download patient care and nursing resources. courses that described using e-mail or WebcT were considered to include experiences in which students could gain this competency. Many nursing courses (n = 17, 94%) used the computer for communication purposes; e-mail was used in 9 (50%) of the nursing courses. students were encouraged to use the internet to locate patient care information in 13 (72%) courses.
Data Access

This competency states that nurses use computerized data related to practice and care, including generating computerized nursing care plans, performing documentation, and conducting online literature searches. Within two syllabi (11%) of the clinical courses, there was evidence that students use sources of data that relate to practice and care, access, enter, and retrieve data used for patient care, and use database applications to enter and retrieve information. There was no evidence that care plans were generated or patient-care documentation was performed using computers, although patient care planning was available by computer in two of the clinical settings. One third (n = 6, 33%) of the courses required online literature searches.
Documentation

Figure. Sample matrix of computer competencies in the curriculum.

tion. No syllabi contained evidence related to using technology for patient education.
Patient Monitoring

systems

This competency states that nurses use computerized patient monitoring systems. One syllabus (6%) from a clinical course required that students use a fetal monitor.
basic Desktop software

This competency states that nurses use an application to document patient care, perform discharge planning, and enter patient data, such as vital signs. course syllabi showed no requirements related to patient care documentation.
Patient Education

This competency states that nurses use technology for patient educaFebruary 2007, Vol. 46, No. 2

This competency states that nurses demonstrate keyboarding skills and use programs in multimedia presentations and word processing. it was assumed that students met the competency of demonstrating keyboarding skills if they were required to use e-mail or submit assignments using word processing (14 syllabi, 78%). Nine (50%) of the courses clearly stated that students were to complete assignments using a word-processing program.

This competency states that nurses use networks to navigate systems, operating systems, and peripheral devices. Three (17%) courses that used WebcT contained evidence that students were exposed to navigating systems. Two (11%) lecture-oriented courses used the e-mail, discussion board, downloading, and printing functions of the WebcT program. in one course (6%), students were required to attach documents to e-mail messages. in one (6%) clinical course, WebcT was used as a way to communicate with students. The functions of e-mail, discussion board, downloading, and printing on electronic reserve were used. Demonstrating basic technology skills and being able to capture patient data are also included in this competency. One (6%) course syllabi specified that students would be able
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to identify the electrocardiography monitor to capture patient data.

Implications for Nursing Education

of multimedia presentation, their understanding and use of systems, and their informatics knowledge through assessment of the course syllabi alone. in-depth interviews with faculty and students would add to the knowledge

The findings of this program evaluation support earlier reports that nursing faculty are the greatest block to incorporating technology into curricula (saba & Riley, 1997). in addition to increasing faculty skill and comfort in the use of available computerized systems, it is clear that there is a need to increase faculty knowledge and understanding of the nursing informatics competencies that relate to beginning nurses. in addition, it may be necessary to add criteria related to computer informatics practice to faculty evaluations. These measures may encourage faculty to change the way they teach. Workshops and mentoring programs can be used to incorporate different teaching methods and experiences into nursing courses. schools with graduate-level informatics programs can use graduate faculty and students as mentors to help BsN faculty gain computer skills. skills laboratories could collaborate with hospital information technology system departments to make computerized patient documentation systems available to allow faculty and students to practice care planning, entering vital signs, and other electronic patient care documentation activities. students could also be required to have personal digital assistants at the beginning of their educational programs to encourage them to use information technology in practice.

The findings of this program evaluation support earlier reports that nursing faculty are the greatest block to incorporating technology into curricula.

gained in this study to determine the extent to which the competencies are being taught and mastered in BsN curricula.

references

conclusions

a tool developed from the categories of informatics competencies identified by staggers et al. (2001, 2002) was used to identify the competencies included in the course syllabi of a BsN program. students in the BsN program had some exposure to informatics but limited exposure to technologies in the clinical setting. One limitation of this evaluation was that it was difficult to assess students exposure to the use
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print/20040427-4.html currell, R., & Urquhart, c. (2004). Nursing record systems: effects on nursing practice and health care outcomes (cochrane review). in The Cochrane Library, issue 1. chichester, UK: Wiley & sons. Darbyshire, P. (2004). Rage against the machine?: Nurses and midwives experiences of using computerized patient information systems for clinical information. Journal of Clinical Nursing, 13, 17-25. Gassert, c.a. (1998). The challenge of meeting patients needs with a national nursing informatics agenda. Journal of the American Medical Informatics Association, 5, 263-268. Gassert, c.a., & McDowell, D. (1995). evaluating graduate and undergraduate nursing students computer skills to determine the need to continue teaching computer literacy. Medinfo, 8(Pt. 2), 1370. hardy, J.L. (1995). assessment of the level of the actual and desirable levels of computer literacy, usage and expected knowledge of undergraduate students of nursing. Medinfo, 8(Pt. 2), 13261330. hendrickson, G., & Kovner, c.T. (1990). effects of computers on nursing resource use: Do computers save nurses time? Computers in Nursing, 8, 16-22. McNeil, B.J., elfrink, V.L., Bickford, c.J., Pierce, s.T., Beyea, s.c., averill, c., et al. (2003). Nursing information technology knowledge, skills, and preparation of student nurses, nursing faculty, and clinicians: a U.s. survey. Journal of Nursing Education, 42, 341-349. Pew health Professions commission. (1998). Recreating health professional practice for a new century: The fourth report of the Pew Health Professions Commission. san francisco: author. saba, V.K., & Riley, J.B. (1997). Nursing informatics in nursing education. Student Health & Technology Information, 46, 185-190. scott, c.s., schaad, D.c., Mandel, L.s., Brock, D.M., & Kim, s. (2000). information and informatics literacy: skills, timing, and estimates of competence. Teaching and Learning in Medicine, 12, 85-90. staggers, N., Gassert, c.a., & curran, c. (2001). informatics competencies for nurses at four levels of practice. Journal of Nursing Education, 40, 303-316. staggers, N., Gassert, c.a., & curran, c. (2002). a Delphi study to determine informatics competencies for nurses at four levels of practice. Nursing Research, 51, 383-390. Zytkowski, M.e. (2003). Nursing informatics: The key to unlocking contemporary nursing practice. AACN Clinical Issues, 14, 271-281.

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