Utilization of Electronic Health Record Software in a Nursing Program
Health informatics, knowledge and the use evidenced based practice are essential components in the provision of quality and safe services in the nursing profession. Most nursing schools have persistently continued to educate the student using the traditional methods without consideration of the changes that are experienced both within and outside the healthcare system (Button, Harrington, & Belan, 2014). The remaining small portion then continues to struggle with various advancements including determination of the five core competencies for the healthcare personnel as stated by the Institution of Medicine (IOM), use of the electronic health records software in preparing their students on critical thinking as well as decision making, focusing on the use of evidence-based literature to guide the nursing practices as well as integration of the high fidelity simulations.
With only a handful number of nurses being equipped with the knowledge on these essential aspects of professional development, it forms a prerequisite for stagnation concerning change hence influencing the manner unto which such nurses will undertake their practices. This proposal addresses the nursing programs that are not utilizing the electronic health records software in their program which is viewed to originate from the influence of the nursing students towards its adoption.
Over an extended period, one of the challenges that healthcare providers especially nurses has been facing is the effective implementation of the electronic health records systems in the real world area of practice. For effective execution to take place, there is a need for regular system update as well as user education which entails the gap that this article addresses. With the incorporation of the system in the education curriculum, the students will find easy time in practicing what they learnt.
Recent internal organizational trends leading up to the gap.
The education requirements are changing to get along with the advances that occur with technology and knowledge. The curriculum then has to review these current changes and adapt to the transforming surrounding in assisting the students to meet their needs and match the practices in the health sector. Reluctance and sluggish review of these changes have led to the gap with the result being most nursing programs not embracing the EHR software.
With the revolution in the healthcare system regarding technology use, most of the student nurses need to embrace the introduction of the new technology into the nursing curriculum to fit into the system. The change of learning methods from the old system to one that integrates the new software forces the students to undergo transition. A good number have difficulties hence develop resistance despite the fact that it is mandatory for them to have the knowledge and skills inherent to the electronic health records (Button, Harrington, & Belan, 2014).
Other events leading to the gap entails the coming of software such as the SimChart and the SimEMR which are significant in training on the EHR education yet majority on the nursing schools have not developed them or such equivalents (Hunt, 2017). The system also demands the need for an expert to train the nurse educators to master its use before they pass it to their students. This transition is slow to impair the implementation of the incorporation of the software into the nursing program.
Organizational background causes of the gap.
The teaching criteria whereby the nursing students are only allowed to access the educational EHR only during the classroom sessions or in the laboratory act as distractors to facilitate these learning of the new system. The gap gets in when the students are not given opportunities to learn at their own pace. The distraction extends even to make them not take the practice seriously.
The gap is also caused by the frustrations students encounter with some EHR functions in both the academic and the clinical setting. It is such experience that such students develop the negative perceptions of the system being complex hence resist its adoption.
Various surveys show a broad institutional variation concerning the use of EHR in education. The differences result from varying local interpretation concerning the use of EHR by the Medicare guidelines. The gap is further created by the increasing instances of nursing students training in the ambulatory practice settings with the faculty being voluntary. To meet the additional cost of EHRS licenses turns to be a problem hence such institutions have challenges in incorporating the software into their program (Matson et al., 2014).
Target audience
Nursing students form a particular target for the project since the incorporation of the software into the nursing education affects them directly. The students will be of bachelor level including the ones who have had direct entry into the level as well as those who are upgrading from associate degrees. They will receive the proposal in their nursing schools during the conventional school meetings. Through the project, the resistance from the students can be overcome by exposure, training and guidance in line with the new system before the implementation of the incorporation. The proposal will change their attitude towards the introduction of the technology software since they will be able to learn various advantages to them, for instance, being technologically equipped increasing their levels of being employed as well as the entire nursing profession as it will lead to better care to the patients.
Proposed solutions
Change of program requirements to enable the use of only educational EHR software in the curriculum is also vital. The modification will allow the use and incorporation of a system that can be used for learning purposes and not the commercial EHRs. The educational EHR allows for the learning of the system as opposed to the navigation that is usually the case of the commercial ones.
There is a need for educational sessions for the nursing students that addresses the purpose of the introduction of the software into the nursing program, the advantages that such interventions will come about with and the limitations that are expected (Leapaldt, 2015). During such sessions, the concerns of the students will be addressed as more light will be shed on the entire issues of new curriculum. For the students to be comfortable and get more acquainted with the software, students’ handbooks and worksheets ought to be given. It assists them to explore the software thoroughly to increase its acceptance.
Nursing students need to access the educational EHR all times, and this can be achieved by having a system that can be accessed not only in the classrooms and the laboratories but also in the portable electronic devices. In conjunction with the full access of the system, there is need to have a scaling feature that acts to restrict the access of different features for the student depending on their level of training((Kushniruk et al., 2014).
Creation of a positive environment that is conducive to learning through the availability of competent mentors, computer laboratories, portable electronic devices and classrooms that are adequate for all nursing students can bridge the gap. In such a surrounding, the training on the new software will be facilitated with much ease to make significant effects on the system.
There is also need to build an integrated system of experience that will be embraced by the students based on its relevance and simplicity. Such as system will entail case studies that challenge the nursing students to document their care and come up with clinical judgments in various phases of care, simulations that assist nursing students to build and edit the records of their patient as well as incorporating the records into the simulations and their practical simulation laboratories. Also, the system needs to encompass the records on the clinical rotations to enable them document the care provided to their patients during their clinical experiences.
The EHRs can be integrated into the classroom teaching to foster its development and give it a new understanding. The integration can also be extended to the hands-on experiences to make its incorporation into the nursing program more meaningful. The students will then be able to have a comprehensive approach to meet their learning objectives in both the educational EHRs and the academic studies.
Expected Outcomes
The modification made to the program requirements will allow the students to acquire skills and knowledge on the use of the system since it is flexible, unlike the commercial ones that are fixed. This will make them competent enough to be able to manipulate other systems. In the long run, the learning of such system will enhance and promote their use of the software for their learning purposes.
The full access to the educational EHR allows continuous learning among the students hence accommodating different types of learners including those that may be slowly catching up with the system. Majority of the students will also be at par with their mentors hence making them take the practice serious thus enabling the promotion and adoption of the new software.
The use of the integrated approach to spearhead the incorporation should make the learners equipped with various scenarios from case studies, clinical experiences and simulation. The students will then be motivated and adopt the incorporated software with minimal resistance (Kowitlawakul et al., 2015). In the long haul, will have a prior experience to care of patients and use of the system both in the clinical environment as well as simulated environment hence the confidence to practice the same will be high upon graduating.
Evidence summary
According to Leapaldt, (2015), the health informatics professionals are in high demand and cannot focus on the educational EHRs. This then shifts the burden to the universities and the nursing schools to hire one of the professionals to make them an educational system that can be used by their students in learning.
Creation of a positive learning environment is integral in keeping the nursing students focused on concentrating on the electronic software. They experience less destruction that might set in and make the use of the technology less productive or useful.
In an open system where various student users get access to the data and various features, there is a likelihood of the users being frustrated hence impeding their feeling to embrace the adoption. Unscaled EHRs exposed to first, second and third-year students leads to varying views concerning complexity. As far as this may be beneficial to the advanced nursing students, the inexperienced student nurses develop a negative attitude towards the software as they perceive it to be complicated. This calls for scaling of the features to fit various levels of training (Kushniruk et al., 2014).
Curley recognizes the increased demand for the advanced trained nurses (2015). This translated to the fact that the impact incorporation of electronic health records software to such levels of nurses. With reduced resistance, more students are likely to be competent with the technology systems hence increasing their demand. The article recognizes the need for changes in the curriculum to improve the competencies of nursing students. Development of a simulation laboratory where students can practice the nursing informatics enhance reception and incorporation of the software (Kowitlawakul et al., 2015)
Understanding the interface of the technology and its application is improved with the integration of the software into the classroom programs (Stephenson et al., 2014). This stimulates the awareness and the acceptance by the nursing students before they commence their clinical rotation. They get to apply the theories and principles learned in the classroom to the real patients in similar ways they did to the virtual patients.
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Implementation plan
The implementation of the software will be guided by the Technology Informatics Guiding education Reforms (TIGER) initiative that outlines the activities that need to be undertaken while integrating technology into the nursing education (Hübner et al., 2016). This action will assist in ensuring schools that have not incorporated the EHR software into their nursing programs create a virtual learning environment where nursing students will be able to learn the developed system (Borycki et al., 2015). The faculty will input dummy data into the educational EHR that will act as a simulated chart for the student use. The necessary information taken in the history of the patient will be incorporated. These encompass the demographic data, laboratory results, vital signs, the administered drugs, reports from imaging tests, patients’ notes and the treatment progress. The EHR will then be modified to meet its full potential and according to the level of the students using it to meet their needs.
To use the educational EHRs correctly, a saved bank of the virtual patients will be created with the students being able to choose the patient whose information they want to access. These cases will then be saved for use in future. They have to be rich in information to simulate the real working environment where the nursing students will encounter the overwhelming amount of data of the patients seeking treatment in the care centres. For the higher level students, will act as a demonstration of the need to find the information they require from patients since there are cases with only diagnostic data while others will have large data.
A scaling feature will be included in the EHRs to fit both advanced students and the inexperienced students. The wealth of information in the software will be useful for the advanced nurses with scaling feature used to turn off or curb other features from being viewed by other students until they are required to do so. The curriculum will then entail a scaled standards of grading having the first year nursing students identifying omissions and errors for the history and physical examination of the patient. The second-year students will come up with the list of problems that patient have and determining their diagnosis from the test results. The third-year students will then apply the evidence-based practice guidelines to care for their patients.
A timeline
The installation of the computer laboratory and creating of the virtual learning environment to be planned and achieved within one month. This will be followed by six months of training and availing of the environment for exploration and conduction of trials by nursing students for six months. The software can then be incorporated into the curriculum upon being accredited by the concerned regulatory bodies. The program will be launched by assigning each system to the students in each semester so that as they get trained for the electronic health record, they work on other systems that may be encountered in various clinical areas. Throughout the nursing training period, the students will be exposed to computerized documentation systems in their general nursing programs to enhance their experience hence supporting the implementation of the software into their curriculum.
Needed resources and personnel
The TIGER Virtual Learning Environment will provide the health information technology modules and other associated software which are critical resources in the incorporation of the EHR software into the nursing program. Nursing schools will require a computer center where the learning environment will be accessed for both trialability, training as well as learning purposes (Hübner et al., 2016). There will also be a need to live and on-demand webinars that may act as tutorials to get the students ready for the incorporation of the software.
Proposed change theory.
With the incorporation of the electronic health records software involving various stakeholders including nurse educators, nursing students, clinical agencies, practising nurses as well as the information technology department among others, its implementation needs to take care of all these parties especially the students as they form the recipients for the change being brought about. The resistance that the adoption of the new software into the nursing program face can be related to nursing students perceiving it to be complicated and having no significant impact on the nursing profession. They may also feel that the system may complicate their learning process since their focus of training is on the care provision to the patient rather than the logistics involved in the entire management.
Since the entire move is adoption of new software that was not there earlier on, I suggest the use of the Everett Rogers model of innovative-diffusion to guide and make the software be embraced into the nursing programs (Doyle, Garrett, & Currie, 2014). This model determines the feeling that individuals develop while adopting new technology hence provides various qualities—relative advantage, compatibility with existing values and practices, simplicity, trialability and observable results, that ought to prepare the nursing students in embracing the incorporation of the technology software into their program and facilitate its implementation.
Relative advantage
Relative advantage refers to the manner into which the innovation has to be seen as an improvement when compared to the old one so as the change to be adopted by an individual (Miller, 2015). With the commitment of the student nurses in the learning responsibility, they tend to resist change that interferes with these usual activities in their daily living. According to Rogers, face to face communication with the students is essential in that it allows the students together with other stakeholders to share the information and feelings that come with the transition in the learning program. With this in mind, the implementation will take the form of creating implementation teams through which the advantages of the system will be displayed.
The advantages to be provided to the audience will entail equipping the nursing students with knowledge and skills that fit the technological competencies in the clinical markets to meet the use of the electronic health records which has not been achieved using the old methods of training. To the students, the incorporation of the software will enable them to have both necessary computer skills and knowledge on various systems that can fit the clinical agencies hence they will be highly marketable upon completion of their courses. Also, the incorporation of the software into the nursing program will not only be used in the nursing schools but also in the clinical areas that have not adopted the electron health records systems into their facilities. With all these critical advantages, the nursing students will be able to embrace the incorporation of the software in their learning program.
Through the meetings and series of educational sessions, the students will be provided with additional awareness, knowledge and skills before the incorporation of the software to the program. This will allow resolution of some negative feelings that they may have developed to promote positive attitudes that will enable the use of the software in training.
Compatibility with existing values and practices.
Nursing students can promote the adoption of the new software into their program when they understand the manner unto which the existing values and practices in the nursing training get along and are compatible with the new method of teaching and learning at large. Effective communication is vital to this understanding. According to McGonigle and Mastrian (2015), an adoption process like the incorporation of the EHR software can work if the nursing flow is incorporated in the designs and the resources already available in the nursing curriculum. With this effected, the nursing students will be dealing with relatively familiar processes in the nursing curriculum.
The implementation plan will entail informing the students that the incorporation of the software, procedures entailed in its training, teaching processes as well as policies surrounding it involved fellow student nurses. Besides, it will be of great need to make the super users, and expert trainers of the software available to the student nurses to handle difficulties and questions regarding the incorporation as well as training the learners using the new software in the nursing schools.
Simplicity.
Resistance and failure to incorporate the software into the nursing programs come with difficulty. The simpler the incorporation of the software the more willing the nursing students will be able to adopt it and embrace its integration. Before the establishment, there is need to commence computer literacy classes to serve the students and equip them with the basic computer knowledge. After that, both the students who might be a novice to computers or the system have their fears eased making them to view the incorporation and use of the electronic health records software a more straightforward issue.
In addition to the training in making the issues further simpler, the creation of a buddy system where there is assigning of expert users of the software among the student nurses to those who are not will be vital. Both the provision of extra training and development of a buddy system can increase the skills and knowledge of student nurses hence reduce the fear of unknown making it easier to incorporate the software and make its implementation a success.
Trial ability.
Those who can explore the new software before its incorporation are less resistant and more willing to be part of its incorporation (Miller, 2015). After the training sessions to the students, they will be given access to various software incorporated by other institutions to allow them to explore and get familiar with the software. At the same time, the computer laboratories created in these nursing schools will have the software running for some time to allow both the students to navigate and be able to master it. During such periods, the individuals will be ready to go through the software at their own pace hence easing the anxiety and difficulty that usually engulfs both the students and their teachers as they curbed by their busy schedules.
Observable results.
Observable results provide the adopter with evidence demonstrating the manner unto which the incorporation of the new software has been successful both in equipping nursing students as well as impacting the overall nursing education. There is need to provide evidence-based outcomes to the nursing students. These include impacts and research studies pertaining the high employability for the nursing graduates with the technical skills as well as the overall revolution advantage of the having nurses with electronic health records system competencies, e.g. increased implementation of the system with such nurses on the practice and the improved care and safety of nursing services. All these will demonstrate to them the manner unto which the incorporation of the system, has worked for other institution and impacting the entire nursing profession. Besides, it will promote the theory since the strategy will display the positive outcome of the software hence reduce resisters and increase the number of adopters among the nursing school that will lead to widespread incorporation of the software to the nursing program.
Barriers to implementation.
The incorporation of the electronic health records software to the nursing program is vulnerable to challenges such as the resistance by the nursing leadership. This is so because they are usually uncertain of the process of integrating information technology into the nursing curriculum hence may not be familiar with what it entails. The staff anxiety which is a crucial barrier can be allayed by formal training and clear procedures to be used by students. The students can also resist the change due to the negative attitude towards the curriculum development especially when the mentors do not properly demonstrate the use of the EHRs software making it complex to the learners (Gonen, Sharon, & Lev-Ari, 2016).
Limited funding and cost can also thwart the incorporation of the software. This is so because the purchasing of the computers, portable electronic devices and installation of a modern computer laboratory that can create a virtual learning environment is costly. The incorporation of the software also translates to the employment of additional staffs by these nursing schools. All these require sufficient funding that may not be met by all nursing schools.
Another barrier is the existence of various software of electronic health records used by different hospitals. This makes it difficult to come up with software that will be fitting each hospital needs. This can be encountered by harmonizing the technology software and develop an educational EHR to be able to provide the basic and relatively standardized competencies.
Conclusion.
Indeed, the radical transformation of the nursing profession marks the rapidly changing contexts of the healthcare environment. All the changes that occur in science, technology as well as the healthcare system are exceeding expectations that nurses are looked up to for safe and quality healthcare provision. For the nursing field to meet the continuously changing expectations, the nursing education needs to be moved from the old methods of teaching and get transformed to incorporate the new software that meets the standards of the job market. All these can only be achieved when there is a faculty committee in the integration of the informatics and the electronic health records system in the entire nursing program for the better preparation of the graduates to meet the needs of the healthcare users.
The incorporation of the electronic health records software ought to have been driven from various directions with different professional organizations, it is through such moves that the integration will be stable, and the students will have opportunities to navigate the technology, do documentation of patient care in a simulated environment as well as aiding in the development of critical thinking skills that are key in nursing care provision
The implementation plan needs to take the form of utilizing the already available recourses as well as the addition of other essential resources. With the Everett Rogers theory of innovative adoption model, the nursing students can be moved from resisters to adopters hence a realization of a smooth transition in the incorporation process.
