Introduction: As information technology (IT) becomes more prevalent in our everyday lives, the profession of nursing is not immune from this progression. Nurses, being one of the largest professions of healthcare workers, are utilizing computers more often to assist in their daily work. Some examples of this are: administering medications, charting patient assessments and education, reporting outcomes and measurements from databases, and as an aid in guiding clinical decisions. This practice of fusing nursing skills with information technology to provide patient care has been called nursing informatics has by Graves and Corcoran (1989), who define nursing informatics as "a combination of computer science, information science, nursing science designed to assist in the management and processing of nursing data, information, and knowledge to support the practice of nursing and the delivery of nursing care" (p. 227). Recent passage of legislation that mandates and rewards early IT adoption in the healthcare setting will accelerate its adoption, making it the stethoscope of the 21st century (Murray, 2007). As nurses are confronted with this new reality it will be imperative that they have exposure and knowledge in order to play a meaningful and effective role in the multidisciplinary care team, as well as take part in system development and implementations. Recent literature and recommendations from influential nursing bodies such as the Institute of Medicine, the National League for Nursing, and the American Association of Colleges of Nursing, have all placed great emphasis on increasing the prevalence of nursing informatics as a key component in all levels of nursing education (Institute of Medicine (IOM), 2003; NLN Board of Govenors, 2008; American Association of Colleges of Nursing, 2008). The aim of this literature review is to determine the degree of computer technology and informatics knowledge that baccalaureate nursing students have been exposed to prior to graduation in the United States.
Search strategy: A comprehensive review of qualitative and quantitative research articles was performed in PubMed, OVID CINAHL, OVID Nursing Database, and Ovid Medline databases. The following MeSH search terms used in this review were: Computer Literacy; Nursing, Education, Baccalaureate; Nursing Education Research; Nursing Informatics/Education; and Students, Nurses. Articles prior to 2007 that did not include baccalaureate nursing students, with samples of schools located outside of the United States, conference proceedings/abstracts, and those lacking a peer review were excluded. In the initial search, 24 potential articles were identified; after applying the exclusion criteria, four journals were selected as applicable to utilize in this article (see Table 1).
Table 1.First Author Focus Data Collection Tool Samplealphabetical Used Size(date)Elder (2009) Descriptive, The Computer 109 correlational study Competencies Survey students to compare student and Computer ratings of their Competencies computer competency Assessment to theirs skills on a computer-graded assessmentFetter Student evaluation Investigator adapted 42(2009) using established based one The students informatics Staggers Gassert, and competencies to Curran (2001) tool benchmark graduate performance.McNeil Analysis of The IT Education in 266(2006) qualitative data from Nursing Curricula programs a national online Survey survey of BSN education programs describing the current level of integration of computer literacy and information literacy skills and competencies of nursing faculty, clinicians, and students.Ornes (2007) BSN curriculum Based on Categories 18 BSN evaluation of nursing of Informatics required informatics content. Competencies for the course Beginning Nurse by syllabi Staggers, Gassert, and Curran (2001)
Review of the Literature: Elder and Koehn (2009) conducted a two-part evaluation of 109 baccalaureate nursing students in the mid-western United States to determine how students rated their skills in word-processing, spreadsheets, databases, and basic as well as advanced computer skills. This self-survey was followed up with a computer-based evaluation, where students were required to perform some of these activities to compare their perceptions with actual performance. The authors found that students perceived their skills in some of the tested areas to be near expert, yet their assessments revealed that many performed at marginal levels required to pass a class. Students in this study did perform well in the internet portion of the assessment, although 20% reported that government agencies controlled the information online to ensure its accuracy. The study authors recommended that nursing education needs to utilize computer-based tested assessments of incoming students' skills to provide immediate feedback and allow for remedial education in the specified areas.
Fetter (2009) utilized a modified version of the Staggers, Gassert, and Current (2001) tool to assess graduating seniors in a baccalaureate nursing program. The students completed the self-assessment on each of the 43 novice nurse IT competencies, which were based on the ANA's Nursing Informatics: Scope and Standards of Practice. The competencies included such areas as: theory and clinical courses, hardware and software requirements and skills, and general comments. The students' top ranked competencies were: using internet sources, word-processing, networks, operating systems, and the keyboard. The lowest ranking items on the assessment were: using applications to document, creating a care plan, valuing informatics knowledge for practice and skill development, and using applications for data entry.
To survey baccalaureate deans and directors perceptions of nursing informatics in their programs, McNeil et al (2006) created the IT Education in Nursing Curricula Survey. Survey results showed that many current programs place greater importance on computer literacy skills rather than informatics literacy skills. Additionally, half of the respondents reported not having any informatics education in their region and many were unable to add informatics curriculum due to lack of qualified teaching faculty and non-supportive environments. Half of the respondents felt that the current and future demand for nurse informaticists was low.
To evaluate course syllabi in a baccalaureate program for nursing informatics competencies, Ornes and Gassert (2007) created a tool based upon the Categories of Informatics Competencies for the Beginning Nurse by Staggers, Gassert, and Curran (2001). The informatics competencies utilized for this study were: administration, communication, data access, documentation, patient education, patient monitoring, basic desktop software, and systems. The authors found no evidence of administration, documentation, and patient education in any of the 18 reviewed syllabi and concluded that students receive limited informatics exposure and furthermore that they may not be sufficiently prepared to use information technology.
Synthesis: Two prevailing themes are apparent in the literature reviewed: 1) Definitions of nursing informatics vary amongst academic settings and 2) Student nurses do not possess adequate computer and informatics skills to enter the healthcare environment today with adequate nursing informatics skills. Although government agencies have implemented policies requiring the use of technology and informatics in the healthcare workplace, nursing schools have come up short in adapting their curriculum to this change.
Staggers, Gassert and Curran (2001) defined the computer and informatics skills of a beginning-level nurse, which has been equated to a BSN prepared nurse, and their definition could serve as a consistent standard among academic settings. These competencies are listed in Table 2 and have been utilized to aid the integration of nursing informatics into the baccalaureate education (Ornes & Gassert, 2007). The combination of nurses lacking adequate computer and informatics skills in conjunction with nursing educational institutions failing to provide technology education has the potential to produce nurses who are clinically competent yet unable to function in today's healthcare environment. Baccalaureate nursing education is running out of time to embrace this historical change in healthcare.
Table 2.
Computer Skills and Informatics Knowledge Competencies of the Beginning Level Nurse Staggers, Gassert, and Curran (2001)
* Computer Skills
* Administration (searching for patient information)
* Communication (using e-mail)
* Data Access (using computerized data that relates to care-planning 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)
* Systems (using operating systems for functions such as copying and deleting)
Informatics Knowledge
* Data (recognizing the use and importance of nursing data for improving practice)
* Impact (recognizing the time, effort, and skill required)
* Privacy and security (using ethics)
* Systems (using networks)
Implications for practice: Baccalaureate nursing students are graduating to a reality of obsolete paper charts, clinical reference materials a click away and federal mandates for electronic medical records by 2014. More than ten years after the published recommendations of The National Agenda for Nursing Education and Practice progress has been slow to penetrate educational institutions and the nursing profession. The report, A National Informatics Agenda for Nursing Education and Practice. Report to the Secretary of the Department of Health & Human Services, recommends educating nursing students and practicing nurses in core informatics content, preparing nurses with specialized skills in informatics, enhancing nursing practice and education through informatics projects, preparing faculty in informatics, and increasing the collaborative efforts of nursing informatics (National Advisory Council on Nurse Education and Practice, 1997). These five goals are an ideal starting point to begin formulating a consistent informatics agenda in baccalaureate programs. Schools of nursing should make computer courses a recognized portion of pre-requisite coursework, assess student computer and informatics skills on admission, and integrate computer and informatics skills throughout all levels of required coursework for students. Deans and directors should consider making informatics education a core component of faculty education and professional development. The creation of learning partnerships with informatics departments at hospitals in which their students perform clinical rotations, as well as nursing informatics professional organizations can provide expert knowledge and further resources. Although implementing these recommendations may sound like a daunting task, national nursing organizations (see Table 3) have made toolkits available to assist in this curriculum addition. As the healthcare environment changes, nursing students and nursing education must adapt to meet these changes in order to adequately prepare nurses for the ever-changing and ever-increasing technologic environment that awaits them.
References
American Association of Colleges of Nursing. (2008, October 20). The Essentials of Baccalaureate Education for Professional Nursing Practice and Faculty Tool Kit. Retrieved March 15, 2011, from American Association for Colleges of Nursing: www.aacn.nche.edu/education/pdf/BaccEssentials08.pdf
Elder, B. L., & Koehn, M. L. (2009). Assessment tool for nursing student computer competencies. Nursing Education Perspectives, 30 (3), 148-152.
Fetter, M. S. (2009). Graduating nurses' self-evaluation of information technology competencies. 48 (2), 86-90.
Graves, J., & Corcoran, S. (1989). The study of nursing informatics. IMAGE: Journal of Nursing Scholarship, 21227-31.
Institute of Medicine (IOM). (2003). Health Professions Education: A Bridge to Quality. Washington, DC: The National Academies Press.
National Advisory Council on Nurse Education and Practice. (1997, December). A national informatics agenda for nursing education and practice. Report to the Secretary of the Department of Health & Human Services. Retrieved March 26, 2011, from ERIC: Education Resources Information Center: http://www.eric.ed.gov/PDFS/ED449700.pdf
NLN Board of Govenors. (2008, May 9). Informatics education toolkit: Getting started. Retrieved March 15, 2011, from National League of Nursing: http://www.nln.org/aboutnln/PositionStatements/informat-ics_052808.pdf
Murray, P. J. (2007). Nursing Informatics 2020: Towards defining our own future-Proceedings of NI2006 post congress conference (Vol. 128). Amsterdam: IOS Press.
McNeil, B. J., Elfrink, V., Beyea, S. C., Pierce, S. T., & Bickford, C. J. (2006). Computer literacy study: Report of qualitative findings. Journal of Professional Nursing, 22 (1), 52-59.
Ornes, L. L., & Gassert, C. (2007). Computer competencies in a BSN program. Journal of Nursing Education, 46 (2), 75-78.
Table 3.
Available Tools for Nursing Informatics Education
TIGER- http://www.thetigerinitiative.org/
AACN- www.aacn.nche.edu/education/pdf/BaccEssentials08.pdf/
NLN- http://www.nln.org/facultydevelopment/facultyresources/index.htm
Daniel Gracie, MSN, RN
