Designing the Plane While Flying It: A Case Study on Nursing Faculty Development during Academic Electronic Health Records Integration in a Small Liberal Arts College

phenomenon (cognitive abilities) (Suskie, 2010). nurse educator: includes all RN faculty and RNs working at the college to educate students that currently may not be working in a “faculty” position. This would include part time lab staff RNs or administrators. nursing faculty: RNs working in positions labeled as “faculty”. Employees considered ELECTRONIC HEALTH RECORDS IN NURSING EDUCATION 22 faculty include tenured, nontenured, assistant, associate, adjunct, visiting, and clinical associates. nursing informatics: nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information, and knowledge to support patients, nurses, and other providers in their decision making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology (American Nurses Association, 2008). nursing practice: nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations (American Nurses Association, 2012). meaningful use: means providers need to show they're using certified EHR technology in ways that can be measured significantly for quality. The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use a) the use of a certified EHR in a meaningful manner, such as e-prescribing, b) the use of certified EHR technology for electronic exchange of health information to improve quality of health care and c) the use of certified EHR technology to submit clinical quality and other measures ( H.R. 1--111th Congress, 2009). ELECTRONIC HEALTH RECORDS IN NURSING EDUCATION 23 personal health record (PHR): an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual (Bell & Bradford, 2008). skills: are the proficient manual, verbal or mental manipulation of data or things that allow for the execution of well-specified tasks (psycho-motor abilities) (Suskie, 2010). usability: the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use (Healthcare Information and Management Systems Society, 2011). ELECTRONIC HEALTH RECORDS IN NURSING EDUCATION 24 Chapter Two The Literature “Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has. ” -Margaret Mead The purpose of this case study is to explore and describe, with the nursing faculty and nurse educators of a small liberal arts college, their knowledge, skills, and attitudes (KSAs) as they participate in an action research framed curriculum development program for implementation of applied informatics using an academic EHR platform. Specifically, the question this researcher wants to answer is What is the experience of nursing educators and nursing faculty members involved in the integration of an AEHR project framed in the Learning by Developing model at a small liberal arts college school of nursing? To carry out the study, it was necessary to complete a critical review of current literature in order to provide framework for the study. This review was ongoing throughout the data collection, data analysis, and synthesis phases of the study. This chapter explores the current knowledge about integration of EHR technology and concepts within academic settings in an attempt to discover successful strategies as well as barriers that affect this process, as well as identify gaps. In light of this, the discussion includes two major areas of literature: computerized health records integration in academic settings, and faculty development on informatics. Nursing faculty development regarding informatics was reviewed because nursing faculty members are a vital element in the success or failure of curriculum development. A clear understanding of nursing faculty and nurse educators’ knowledge, development of skills, and attitudes regarding informatics, and during the integration of an EHR provides direction and ELECTRONIC HEALTH RECORDS IN NURSING EDUCATION 25 structure for a successful integration process. Theoretical frameworks on integrative approaches to faculty development were explored to provide structure for the study. To conduct this selected literature review, multiple resources were used including books, dissertations, Internet resources, professional journals, and periodicals published since 2000. These sources were accessed through ERIC ® , ProQuest ® , EBSCO ® , PubMed ® , CINAHL ® , and Google Scholar ® . Search terms included the keywords “Computerized Patient Records”, “Electronic Medical Record”, and “Electronic Health Record” with the same keywords plus “faculty nursing”, “ nurse educator”, “faculty learning”, “education, nursing”, “nursing education”, and “education, nursing, baccalaureate. ” In addition, review of annotated bibliographies from the Quality & Safety Education for Nurses (QSEN) and Technology Informatics Guiding Educational Reform (TIGER) websites. EHR Implementation Processes in Schools of Nursing EHR implementation processes in schools of nursing began as requirements for student EHR skills increased. This came about in order to ensure quality and safety of patients during clinical immersion experiences with students in clinical sites in the community. Students must be prepared to perform, as graduate and practicing nurses do, by first practicing clinical skills in a low stakes environment. With the recent immersion of EHR systems into healthcare facilities, this includes information management and documentation in the clinical site electronic health record system. EHR systems are specialized to particular healthcare facilities therefore to ensure student preparation, all nurse educators and nursing students are required to attend special training sessions on ELECTRONIC HEALTH RECORDS IN NURSING EDUCATION 26 documentation processes in the EHR for that particular facility prior to scheduled clinical courses. These sessions are many times shorter in length and intensity than the training for nurse employees due to the short-term nature and limited access restrictions imposed by the clinical facility during student experiences at the clinical site(s). Because, content delivery for student training sessions is varied, student preparation for working in EHR systems is inconsistent and minimal. A few nursing schools across the country sought to improve this practice to better prepare students for clinical experiences. In order to get a better understanding of the process of integrating EHR platforms into nursing school curriculum for the purposes of education, it is necessary to look at how the process occurs in nursing schools across the country. The literature revealed two different models of EHR integration; one is clinical facility/school of nursing (SON) partnerships, and the second is use of a specially designed academic electronic health record (AEHR) platform, not affiliated with any particular healthcare site. This review begins with further elaboration on partnership models.