Several studies show that nursing students are not comfortable using healthcare technology, and nurses in practice are not comfortable using EHRs (Fetter, 2009; Kelley, Brandon, & Docherty, 2011). About three quarters of nurses reported spending at least 50% of their time using the EHRs, which means less time for patient care (Johnson, et al., 2008). Another recent study reported that bedside nurses spend 4 hours per day documenting using EHRs (Penoyer, et al., 2014). The high number of hours spent using EHRs may be associated with non-user-friendly systems or nurses’ lack of competence with the electronic systems. It is imperative that the nursing students are able to use EHRs in their education so that they will be more prepared to enter the profession with strong technology skills for nursing documentation (Meyer, et al., 2011; Chung & Cho, 2017).
In 2016, the academic EHRs was adopted to Accelerated bachelor of Science (ABS) Program (N=9) at one university in the Eastern United States. In this study, the intentions of this study are two folds: (1) to examine the faculty’s and students’ perceptions of introducing academic EHRs system for teaching/learning nursing documentation and (2) to assess the outcomes of academic EHRs on changes in nursing students’ readiness of nursing documentation outcomes.
With this pilot study, a quantitative research design with supportive qualitative research will be used: (1) A qualitative descriptive research design will be applied to gather the information on both faculty and students’ perceptions of academic EHRs in terms of nursing documentation and (2) A two-group quasi-experimental pre/post design will be used to assess changes in nursing students’ readiness of nursing documentation. For qualitative data, a purposive sample of faculty (5-7 nursing faculty) will be invited for the interview. The inclusion criteria for faculty are to teach undergraduate nursing courses in Accelerated bachelor of Science (ABS) Program. All ABS students (N=9) will invited for the focus group discussion. For quantitative data, a convenience sample of BSN nursing students (including ABS nursing students) at one university in the Eastern United States will be invited. Student participants for quantitative data will be evaluated their readiness of the nursing documentation about patients using Docucare. “Pre-worksheet” will be given to students. Using Docucare, students will be asked to review the patient information. Pre-worksheet has two parts: (1) Roots and (2) Impression: (1) Roots: background & physiology, subjective findings, objective findings, recent lab results, and medications, and (2) Impression: A: What are the issues with this patient and P: What are your priorities when you enter the room, what your plan is. Students will conceptualize the patient information through the Docucare and students will be required to fill out the Pre-worksheet. Two evaluating nursing faculty will independently evaluate the Pre-worksheet for readiness of the nursing documentation and critical thinking through Docucare system.
For qualitative data, all interviews will be transcribed verbatim for analysis. The two researchers will be independently coded. The transcribed text will be carefully read and thematic segments will be identified. Data segments will be grouped based on commonalities. For quantitative data, changes in the accuracy of the students’ nursing documentation and communication ability will be assessed by comparing two groups. Specifically, the regression discontinuity method will be used, in order to overcome the statistical problem of endogeneity of an explanatory variable in observational data.
These findings will be very helpful to prepare students for the future of health information technology. Paper-based instruction may not be sufficient for teaching electronic nursing documentation. Faculty and nursing students should be familiar with EHRs, but also to teach/learn how to use academic EHRs meaningfully. Meaningful adoption of academic electronic health record systems will help in building the undergraduate nursing students’ competence in nursing documentation with electronic health record systems and improve patient care.