Chapter 3 Final

Running head: CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY
The Impact of Clinical Nurse Educator Computer Competency Eric C. Jean, Joshua C. Lincoln, & Katie J. Tiesworth Ferris State University
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Chapter 1 On February 17, 2009, President Barak Obama signed the American Recovery and Reinvestment Act of 2009 (McCartney, 2011). As a part of this law, the Health Information Technology for Economic and Clinical Health Act was created, allocating 19.2 billion dollars to incentives to promote the adoption of health information technology (McCartney, 2011). This legislation has resulted in the necessity for nurses to possess and apply core informatics competencies. As the largest group of clinical information users, nurses are positioned to play a key role in the adoption of information technology (Mihalko, 2011). As technology increases, the nursing workforce may either benefit or hinder the future of health care via the use of computer technology. As technology in health care continues to expand, there are two vital areas needing
improvement to facilitate the adaptation to and utilization of technologies (Murphy, 2011). First is the willingness and adaptability of nurses to the new computer technologies to effectively integrate them into practice. Second, clinical educators must attain sufficient expertise and comfort with computer technologies to effectively impart that knowledge to learners (Murphy, 2011). Understanding these two variables may allow proper utilization of computer technology to the betterment of evidence based practice and efficiency. Nurses must be able to adapt to technological changes offering enhanced information access and ultimately improved patient care (Ozbolt & Saba, 2008). Yet, confidence and ability in using computer technologies varies greatly among nurses and may have a negative correlation with years of experience (Eley, Fallon, Soar, Buikstra, & Hegney, 2008). It is clear that nurses are more receptive to technologies when they make their jobs easier and more efficient, but are much less adaptable when the opposite is true (Murphy, 2011). Nurses cite various reasons for
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY dissatisfaction with computer use. Among them are work flow change, decreased charting quality, and negative impact on interpersonal relationships (Lee, 2008). The negative perceptions of these nurses may have been influenced by a lack of proper education. Computer technologies are providing educators with the opportunity to teach using methods previously unavailable, yet educators often lack the necessary skills to do so (Axley, 2009). As technology increases, educators and institutions must adapt to meet the needs of information age students (Coonan, 2008). The implementation of a technology fellowship program has demonstrated that educators can increase their comfort with technologies over time (Axley, 2009). However, it is not clearly understood if this enhanced computer competence leads to improved adaptation to and utilization of computers by the bedside nurse. Within nursing literature, research has been conducted regarding computer use by bedside nurses and by clinical educators; however, the literature lacks research on the relationship between these two phenomena. This relationship is highly relevant to the nursing specialty roles of administrator, educator, and informatics nurse specialist. For administrators, the technological competency of nursing staff has a great impact on the financial viability of the practice environment (Coonan, 2008). For educators, the importance of ascertaining the relationship between the technological competence of clinical instructors and that effect on the students adaptability to technologies is paramount. If a positive correlation exists, it must
become an imperative to increase the technological skills of clinical educators to the expert level. For informatics nurse specialists, the competence of those utilizing the various forms of technology is critical to the technologies' success. There needs to be a true cohesive and cooperative alignment between the development, implementation, and education on new technologies to positively affect practice.
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Abbreviated Literature Review In the United Kingdom and America, information technology is now an integral part of both nursing curriculums and practice (Nkosi, Asah, & Pillay, 2011). Nursing curriculum has made good progress towards outlining the needed computer literacy skills. The Technology Informatics Guiding Education Reform initiative has done work to outline the minimum
necessary computer skills for nurses (McCartney, 2011). These skills include: a) basic computer competencies, b) information literacy, and c) information management. Though these competencies have been identified, much of the literature focuses on how they apply to the educational setting rather than the workplace. Nurses need to know more than merely how to use a computer. They need to be able to apply this skill to their practice. It has become crucial that educational strategies be developed that increase nursing's competence in using technology, and educate nurses on how these competencies apply to the work setting (McCartney, 2011). According to Mihalko (2011), 50 % of electronic health record implementations fail. Conditions that can contribute to unsuccessful technology implementation include: a) nurse's feelings of inadequate reflection of the patient's condition by the technology, b) difficulty in information retrieval, c) lack of equipment, and d) inadequate training or support for the system (Ornes & Gassert, 2007). Though training and education can be time consuming, expensive, and difficult, it is one of the most important aspects of clinical transformation in which technology is utilized to improve patient care. The importance of education in transformation is also often overlooked (Sugrue, 2010). In a study conducted by Zuzelo, Hansell, and Thomas (2008), it was shown that lack of education regarding new technologies can lead to frustration amongst nurses. Emotions towards nursing technology can include fear, apprehension, uneasiness, and distrust of technology.
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Education, experience, exposure, age, gender, job title, and access to computers have all been shown to contribute to these attitudes and emotions (Nkosi et al., 2011). Nurses have expressed that they did not feel like real nurses until they were able to master technology (Zuzelo et al., 2008). Though referring to nursing educators as they relate to education institutions, Axley (2008) describes how many nurse educators who did not grow up with technology are now
facing challenges. Teaching with technology is not an intuitive skill, but rather one that must be learned by the educator (Axley, 2008). According to Ragneskog and Gerdnert (2006), a study done in Sweden concluded that although 92% of educators had internet access in their homes, only 48% felt they had information technology skills sufficient for their role as nurse educator. Nursing educators must work to gain the necessary knowledge to be able to advance students knowledge in information technology. Today it is clear that nurses need to acquire a certain level of skill with information technology in order to provide safe care. Nursing educators are in a key role to help nurses gain these skills and an appreciation for information technology. There is an ever-growing need for these educators to take a leading role and responsibility in ensuring that nurses are prepared (Ragneskog & Gerdnert, 2006). The types of computer competencies and literacy needed by today's nurses have been identified along with the need to educate nurses on new technologies being introduced to them. Many nurse educators lack the necessary computer skills to educate nurses. A gap in the literature exists regarding how the computer literacy skills of the educator can affect the nurses being educated. Research in this area may help guide both the necessary skills which are required by clinical educators, as well as possibly encourage current clinical educators to obtain the information technology skills necessary to properly educate today's nurses. Research results
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY may indicate for employers of clinical nurse educators to find resources for their employees to help them gain the necessary information technology skills. Research Problem The use of computer technologies in health care is not new; however, recent legislation including the American Recovery and Reinvestment Act of 2009 have rapidly accelerated the pace of technological change in healthcare today (McCartney, 2011). Computer use is a significant part of providing care for most nurses today. This accelerating use of technology, along with nursing knowledge emphasized by evidenced based practice, requires nurses to gain and apply core informatics competencies (Mihalko, 2011). It is no longer enough for nurses to have the same types of skill and knowledge as their predecessors. Nurses must now also be proficient in computer use.
This phenomenon, the increasing utilization of technology in health care, sets the context for this research proposal. Personal observation revealed that although technology is increasing, and nurses are demonstrating varying degrees of adaptability to the technology, the educators who frequently teach computer-based content often lack even basic computer skills. From this
point, a review of the literature did not provide research exploring the relationship between the technological competency of the clinical educator and the adaptation of the bedside nurse to computer technologies. This represents a gap in nursing research. Although studies show the positive impacts of health information technology (HIT), nurses have been slow to adopt it (Simpson, 2006). The nursing profession has not yet met the full potential in the utilization of evidence based practice (EBP). The time constraints of providing care and the culture of nursing are suggested as barriers to the adaptation to computer technology (Simpson, 2006). These technologies lead nurses to information and the potential of
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY improving patient care (Ozbolt & Saba, 2008). Nurses have voiced concerns regarding the implementation of technologies, including a perceived inadequacy regarding technology education (Zuzelo et al., 2008). Other research has shown that system interoperability and integration of systems may benefit patient care (Sensmeier, 2006). If nurses are ill prepared to use these systems, the benefits may not be realized. According to Axley (2008), clinical nurse educators today often teach traditional content
via computers, in addition to computer specific content such as documentation. These educators, although responsible for computer based content, often lack the technological proficiency necessary to teach it (Axley, 2008). A divide exists between many nurse educators and the information age learners of today (Coonan, 2008). A closer partnership between the practice environment and educators may help prepare nurses to meet the technological demands of health care today. The methods of education used in the past may be insufficient to meet the needs of todays learners (Coonan, 2008). Although nurse educators frequently use basic forms of computer technologies, they often feel ill prepared to meet the technological demands of teaching today (Ragneskog & Gerdnert, 2006). The purpose of this proposed research is to examine the relationship between these two phenomena prevalent in nursing today: (a) Clinical nurse educators use computers to teach nurses, yet they may often lack computer competence, and (b) nurses are having difficulty adapting to computer technologies. Nursing research has examined these two phenomena from various angles, yet a gap in the research exists as the relationship to each other has not been thoroughly explored. Therefore, this proposed research hopes to answer the following question: What is the relationship between a clinical nurse educators technological competency and the adaptation to computers in technologically novice bedside nurses in critical access hospitals?
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY This research proposal will outline a quantitative study resulting in statistical analysis to understand if the abilities and comfort of clinical educators have a statistically significant relationship to the technological adaptability and utilization of the bedside nurse. Theoretical Framework How people learn is of great concern to educators and students. However, a more pressing issue is how to ascertain when someone has achieved competence in a subject matter. There is a great deal of knowledge and research on how nurses achieve different levels of expertise as they progress in their careers both chronologically and experientially. Patricia Benners 1982 paper From Novice to Expert utilizes the Dreyfus Model (1981), which was an attempt to quantify and qualify how a person achieves expert status in a field. Benners
application to nursing is relevant in that it allows a categorization of certain aspects and methods of thinking that determine the level of expertise of a nurse. Benners research into the levels of skill attainment and proficiency are highly applicable to understanding how nursing educators can achieve expertise in the technological aspects of nursing and how they can instill that expertise to their pupils. As delineated in Benner (1982), nurses traverse through five levels of skill attainment to achieve the expert level. Novice is the first level, that is described as a nurse who is analyzing signs and symptoms without a true situational awareness and is constrained by strict guidelines without regard for individual circumstance. The advanced beginner displays satisfactory skills (Benner, 1982). According to English (1993), this level should be attained after a foundational program in nursing school. The third level in Benners model is competent. A competent nurse is becoming more self-actualized and less constrained by institutional guidelines (Benner, 1982).
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY This nurse is becoming aware of the intricacies of processes and is becoming more attuned to outcome based nursing. The proficient nurse is more aware of varying situations and focuses on the patient as a whole using a more holistic view of medicine (Benner, 1982; Benner, 1985; Benner, Sutphen Leonard & Day, 2010). This allows the nurse to modify care based on experience and make
decisions based on analytical processes and abstract abilities. The final level is the expert nurse. Expert nurses can base decisions on an intuitive grasp of situations without having to go through the minutia of the novice. They are thinking on a theoretical plane, using both mid-range and grand theory to practice. This attempt to qualify nursing excellence has led to changes in both clinical and didactic education. Benners approach has provided a tool set for educators to rethink how they teach. Based on analytical guidelines provided by Chinn and Kramer (2011), the importance of this theory is astounding. The basic assumptions about how people learn are based on highly accepted social learning theories wherein skills are communicated by example and are highly relevant to nursing (English, 1993, p. 388). The application of Benner (1982) necessitates that it be determined at what level a clinical educator is in their technological proficiency to properly teach novice nurses technological skills. This does not just pertain to student nurses, but also to practicing nurses who are unfamiliar or uncomfortable with technologies. If, as Benner (1982) postulates, to be a true educator a nurse must be an expert, then this applies to technologies as well. Nursing literature does not examine at that level a clinical educators technological expertise must be before a positive correlation exists with those being taught. Benners theory provides a
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY
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framework to gauge at what level the clinical educator and the student are as to technology; thus, it can be applied to this study to provide a framework and commonality among those being tested. In this proposal, to eliminate variability based on nursing experience, novice nurses will be questioned as to their comfort and adaptability to new technologies. Novice in this case refers to the level of computer skills the learner has not the nursing skills. The level of the nurse will be determined utilizing the theoretical framework provided by Benner, (1982) and Kaminski, (2010). Clinical educators level of technological expertise will also be determined using Benners and Kaminskis research. The determination of level of expertise will be used to ascertain if there is a statistical correlation between the competence and adaptability to new technologies of the novice nurses and the level of expertise of the clinical educator. Adaptability as per this study will be delineated as the ability for the novice nurses to implement the computer skills learned in an efficient manner. This adaptability includes an increase in comfort, competence, and decrease in resistance to new technologies. Figure 1 displays the relationship of Benners theory to the proposed research.
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NOVICE
Advanced Beginner
Rules are: context-free, independent of specific cases, and applied universally.
Has gained limited experience and begins to see some factual integration.
Rules are: context-free, independent of specific cases, and applied universally.
Lacks any adaptability or comfort with new skills and situations.
Can base actions only on situations previously exposed to.
Low adaptability and comfort with new situations.
Proficient
Competent
Can see situations as a whole and can change responses based on variables encountered.
Actions based on experience, abstractions and similarities of other situations.
Is very comfortable with new situations, but still follows guidelines.
Very adaptable to new situations.
Adaptability and Comfort are increased, however still depend on following an ordered process.
Can apply knowledge to new situations pulling from some experiences.
Expert
Increasing levels of Expertise in Computer Skills lead to:
No longer bases actions on procedures and guidelines. Thinks theoretically Adaptability Comfort Competence Acceptance
Extremely adaptable, competent and comfortable in any situation.
Fully capable of approaching all situations with an intuitive approach.
Increase efficiency and quality of care.
Increase efficiency of implementation of computer technologies.
Decrease resistance to new technology implementation .
Figure 1: Application of Benner's Stages of Skill Acquisition
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY The principle research of this proposal is to ascertain whether a correlation exists
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between experts in computer technologies teaching novices in computer technologies. Utilizing Benner (1982), determination of expertise of clinical educators in computer technologies should lead to an increase in the efficiency and improvement of evidence based care (Turisco & Rhoads, 2008). When nurses feel more comfortable with computers and other technologies, they have greater job satisfaction and demonstrate better communication and efficiency in their jobs (Turisco & Rhoads, 2008). This leads to greater patient satisfaction and lower overhead for hospital management (Turisco & Rhoads, 2008). A recent study demonstrated that as nurses become more adaptable and comfortable with computer technologies, they are more likely to accept and integrate these technologies into their daily routines. This may streamline technological transitory periods and reduce resistance of nurses not as comfortable with change (Bickford et al., 2008). Research Question Today, nurses are required to be competent in technology and must be able to apply these skills in order to be successful (Schleyer, Burch, & Schoessler, 2011). Training and education of these skills can be time consuming, expensive, and difficult; however, it is one of the most important aspects of clinical transformation (Sugrue, 2010). Though the importance of education in the use of technology for nurses is understood, one study found that nearly half the nurse educators they queried reported not having technology skills sufficient for their role (Ragneskog & Gerdnert, 2006). Much research has been conducted looking into nurses and their ability to use computers, as well as nurse educators and their comfort level and ability to use computers. However, no research has looked at the relationship between these two variables. The mentioned variables have been studied independent of each other, but the relationship between them has
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY never been evaluated. A Level II research question must be used to evaluate this relationship (Wood & Ross-Kerr, 2011). With this in mind, the following research question will be considered: What is the relationship between a clinical nurse educators technological
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competency and the adaptation to computers in technologically novice bedside nurses in critical access hospitals? Chapter 1 Summary Recent government regulations including the American Recovery and Reinvestment Act of 2009 have rapidly accelerated the pace of technological change in healthcare today (McCartney, 2011). This acceleration of technological change presents the context for the two phenomena introduced by this research: a) Clinical nurse educators use computers to teach nurses, yet they may often lack computer competence, and b) nurses are having difficulty adapting to computer technologies. A brief summary of the literature has been provided regarding these phenomena. The body of literature does not examine the relationship of the computer skills of the clinical nurse educator in relation to those of the nurse. The identification of this gap in nursing research has led to the proposal of a new study that examines the relationship between two phenomena prevalent in nursing today. The proposed research hopes to answer the question: What is the relationship between a clinical nurse educators technological competency and the adaptation to computers in technologically novice bedside nurses in critical access hospitals? Benners novice to expert model has been introduced as the theoretical framework for this quantitative research. Chapter 1 of this research proposal has created the foundation for this research. Chapter 2 provides more detailed support for the use of Benners theoretical foundation as well as a more complete examination of nursing literature to further explore the major concepts associated with the proposed research.
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Chapter II
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An in depth literature review presents support for concepts of information and computer technological competence of both clinicians and students. Many articles reviewed address one or both of those issues, but none have attempted to determine a dependency between them. This chapter is a literature review focusing on two major categories, the nurse educators computer and information technology (IT) competence and the clinical nurses computer and IT competence. It also describes the reasoning for using Patricia Benners From Novice to Expert, (1982) as a theoretical model for this proposal. Theoretical Framework Patricia Benners From Novice to Expert (1982) is an application of The Dreyfus Model (1980) which attempts to quantify how persons achieve intuitive expertise in a field of study. Dreyfus and Dreyfus originally studied airline pilots, chess players, and other fields to try to understand at what point a person is deemed an expert and what it means to be one. Benner applied this to her groundbreaking work to determine how nurses achieve expertise. She determined that nurses traverse through levels of expertise as they practice and quantified some of the qualities that determine the transition to new levels. She also provides a general timeline for each level acquisition. Benners model postulates that professionals pass through five levels of proficiency: novice, advanced beginner, competent, proficient, and expert (Benner, 1982, p. 402). Determining the level of expertise of any teacher or learner is paramount to this proposal as it is trying to ascertain a dependent relationship of the level of competence of the instructors teaching computer technologies and its relationship to the level of competence of the students after instruction. In other words, do students who learn from experts in computers increase their level of computer competence more than those who learn from less competent instructors?
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Benner and Context The concepts outlined by Benners research suggest a timeline for the acquisition of expertise. It is important to note that in using the descriptive guidelines of Benners From Novice to Expert (1982), one must apply them to the contextual format of the research being performed. In a 2001 study by Janet Hargreaves, the relevance of context associated with
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Benners theory is illustrated as an expert nurse is exposed to an unfamiliar clinical focus. The nurse being studied is a pediatric nurse who has achieved expert status per Benners levels of skill acquisition. Although these levels are not easily quantifiable, they are nonetheless important in assessing levels of expertise. The context wherein Benners theory is applied is extremely important (Hargreaves, 2001). In the Hargreaves (2001) study, the subject, Delya, feels like a novice when asked to fulfill a role with which she has less experience than in her clinical role. Delya lacked confidence as the environment and skills she was asked to utilize were more foreign, basic tasks became difficult and confusing (Hargreaves, 2001). This illustrates how an expert clinical nurse, when faced with new material outside their normal field, can be unable to perform at the same level they are accustom to and how their perceptions of their abilities will make them resistant and antagonistic to change. This is very evident in the implementation of information technologies, and specifically computers, as expert nurses are continually asked to adapt to the ever-changing technological requirements of their jobs (Axley, 2008). As new computer software is introduced, nurses constantly feel like novices and may resist the change. The nurse in Hargreaves (2001) received mentorship and was deemed to be an expert within a six-week period. This may seem as if it contradicts Benners timeline for achieving expert status, but it actually lends credibility to the idea that expertise is adaptable because it is a way of thinking. In Hargreaves (2001), the nurse
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began to feel and act as an expert and was able to derive knowledge and skills from a basic skill set and thus only needed to learn and integrate the new material into practice. This is an important concept, as many nurses do not have the basic technological skill sets to pull from when being introduced to computer and technological advancements; thus learning new software leaves them at the novice stage for a long period of time (Pease, 2011). Delya also was able to utilize Benners model to be self-aware and was aided her in the knowledge of personal deficiencies. Willingness to learn, and knowledge of personal clinical expertise in one area, lead to greater achievement in the new role. The importance of Benners research in this study is apparent; but also illustrates that the model does not require linear application, but must be utilized within context. Thus, an educational philosophy which is based purely on the concept of linear progression towards expertise, does not take into account the mobilization of the individual nurses abilities has to be incomplete (Hargreaves, 2001, p. 393). This is important in the area of computer competence. In order to accurately measure levels of competence, one must first understand the context or perceptions the subject has about their existing levels of competence. Benner and Competence The relationship between competency and performance is the subject of a 2008 study by Stobinski in which he wrote competency is what a nurse is capable of doing, and is manifested in measurable actions and behaviors (Stobinski, 2008, p. 417). It follows that to perform tasks with expertise one must first be competent. It is an important aspect of Benners model that experience is needed for one to achieve expertise, and that a majority of that happens within the clinical environment (Stobinski, 2008). Both Stobinski (2008) and Hargreaves (2001) note that competency and expertise are not static, but change based on experiences, settings, and
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY perceptions. Within this context, it is easy to demonstrate why so many nurses are or feel
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incompetent in regards to computer technologies. There is little education done with regards to technologies. As Axley (2008) writes, many nurse educators do not have the requisite knowledge to teach students computer based technologies, thus students are not prepared for the clinical environment in regards to computer use. It is also apparent that the perception of nurses regarding their competence in a subject greatly affects their ability to perform (Hargreaves, 2001; Stobinski, 2008). If students are not being taught computer technologies, or are being taught by educators who are neither competent nor comfortable with teaching them, it may lead to them feeling as novices with computers in their clinical environment. In Stobinkis (2008) study, the author notes that transitions through levels of competence are directly related to education by specialists within the sub-specialty. The application of this study is to clinical nursing, but computer technologies are so prevalent in nursing they have almost become a sub-specialty of their own. Most institutions and schools do not have educators with expertise in the use and application of computer technologies. Thus, it is unrealistic to expect clinical nurses to truly learn computers and their application to their specialty roles without experts in computers to teach them. Stobinski (2008) believes Benner is correct in her assertion that learning basic skills is the foundation for progressing to more advanced expertise. The competence, or lack thereof, of the education process is integral in the development of expertise of students. It is imperative then, that this study specifically tests the dependence of the level of competence of the learner on the level of competence of the educator in regards to computer utilization and implementation.
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Correlations of Expertise and Competence One study examines how Benners Novice to Expert model affects the implementation of information technologies (Courtney, Alexander & Demris, 2008). It shows that the level of nursing clinical expertise can change how they learn new technological implementations. Novice and advanced beginners are more receptive to support systems and mentors, and a positive correlation has been seen in their adaptability to new technologies. However, more competent, proficient, and expert nurses are not as open to new technologies unless they can see how it will improve patient care and the nurses efficiency (Courtney et al., 2008). Using the theoretical framework by Benner allowed the researchers to determine what level of expertise nurses were at so that this could be applied to their study to determine any correlations to level of expertise and information technology adaptation. [Benners] levels of clinical practice mark four major shifts in clinical practice through progression of the different levels and are useful in understanding how nurses use and generate data and information (Courtney et al., 2008). In this study, the researchers correlate the level of expertise and the effectiveness of clinical decision support systems. Each level of expertise (utilizing Benner) had a different perspective on what information technologies should be implemented and how it should be done. In this research proposal, it is important that Benners model is utilized to ensure the data being gathered is meaningful and truly demonstrates a dependent relationship between educators and students. In 2007, Ericsson, Whyte, and Ward studied expertise within the nursing profession. Through an overview of relevant literature and utilizing Benners model the study determined that to truly get a measurable difference between levels of expertise the situations needed to be extreme and wholly attributable to education (Ericsson et al., 2007). The education in question
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may not come from school, books, or teachers,but must arise from experience and intuition based on same. According to Ericsson et al. learning and improvement of performance is not a passive accumulation of experience but mediated by active engagement in deliberate practice, where aspiring experts acquire mental representations to monitor, control, and refine their performance (Ericsson et al., 2007, p. 67). Nurses do not become experts in the Benner model without being taught or seeking out instruction. They need to be actively utilizing new materials and tools in order to truly understand them. This can be assumed to be true of technologies as well, and to learn these technologies, nurses must be instructed by a teacher with expertise in them. Criticisms of Benner There are criticisms of Benners theory that need to be pointed out. Benners 1982 theory accounts for the subject it is intending in that it recognizes the valid application of The Dreyfus Model to nursing practice. It does not however, completely explain how a nurse will obtain each level of expertise. This is clearly delineated by English (1993), in that Benners lack of explanation of the expert role does not meet the scientific constructivist approach that is testable with limitation of independent variability. English (1993) writes, According to this model it is unclear at what stage one becomes an expert, and if there are better experts than others, i.e. are there stages of expertise or is expert a unique and final state?(p. 389). This is an important question because it is not simply a matter of semantics. Benner is attempting to describe what an expert is by using peers to determine expertise. This could be interpreted as self-serving, but it is at the very least non-methodological. This misses the point which Benner describes attributes that peers would recognize as being at different levels of expertise and not using a strict constructivist methodology to determine exactly what an expert is. This is what makes Benners
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theory useful in this research proposal, as it will help quantify what is normally qualitative data, such as perception of competence. Review of Literature This literature review explores concepts in two primary areas of focus: a) nursing & technology, and b) education & technology. Within the focus of nursing and technology, three concepts are identified: a) nurse technological competence, b) nurses lack technological preparation, c) consequences of poor preparation. Nurses today must be competent in the use of healthcare technology (Degroot, 2009; McCartney, 2011; Pease, 2011; Fetter, 2009). However, literature today indicates that nurses, nursing students, and nursing faculty may all have low levels of skill regarding health information technology (HIT) (Fetter, 2009). These concepts must be kept in mind when considering the research question: What is the relationship between a clinical nurse educators technological competency and the adaptation to computers in technologically novice bedside nurses in critical access hospitals? Todays nurses must be competent in: a) basic computer use, b) information literacy, and c) information management (McCartney, 2011). However, it has been suggested that clinical educators do not possess the skills we are expecting todays nurses to obtain (Fetter, 2009). It has been presumed that if nurse educators are not competent in technology, this lack of competence may affect their ability to pass the appropriate technology skills to their students. When nurses are poorly prepared in the use of healthcare technology, negative consequences may occur. Poor education on how to use information technology can lead to frustration amongst nurses (Zuzelo et al., 2008) and increase the likelihood of technology implementation failure (Poon et al., 2006). A lack of understanding in the use of HIT can also lead to safety risks (Pease, 2011). For these reasons, it is important to understand how best to
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prepare todays nurses to use HIT. This includes understanding what effect the nurse educators technology competence has on the ability of the nurse learner to use technology. Nurse Technological Competence Much nursing literature is available describing the need for todays nurses to be competent in healthcare technology (Degroot, 2009; Fetter, 2009; McCartney, 2011; Pease, 2011). In 21st century healthcare, nurses must be competent in information technology, as well as: a) patient centered care, b) working with multidisciplinary teams, c) evidenced based practice, and d) quality improvement (Degroot, 2009). The minimum information technology skills needed by nurses, as outlined by the Technology Informatics Guiding Education Reform (TIGER) initiative, include: a) basic computer competencies, b) information literacy, and c) information management (McCartney, 2011). According to Pease (2011), nurses must have basic computer skills, including the ability to use word processing and the ability to do internet searches. Nurses must also have information literacy skills; defined as the ability to locate, gather, and interpret information appropriately (Pease, 2011). Along with this, both the American Nurses Association (ANA) and the American Association of College of Nursing have recognized the ability to use information technology as an essential skill for todays nurses. The relevance of these skills is demonstrated by the processes they enable including: a) evidenced based practice, b) innovativeness, c) research, d) information acquisition, and e) professional education and development (Fetter, 2009). A study conducted by McCannon and ONeil (2003) surveyed nurse administrators to determine which computer skills were considered the most important for new nurses. The results showed that nurse administrators desire nurses to not only have basic computer skills, but also specialized computer skills such as the ability to use electronic bedside charting. From this,
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McCannon and ONeil determined that nurses may need more than a general computer course as part of their undergraduate work. Similarly, a literature review conducted by Fetter (2009), showed that the clinical setting may be a more appropriate setting for nurses to learn more complex information technology skills. In conjunction, employers have higher expectations of new nurses computer skills than nurse educators (Fetter,2009) and orientation periods today are less lengthy than desired as a result of the nursing shortage (McCannon & ONeal, 2003). Due to this, nurses must be competent in the initial job skills required before they begin working (McCannon & O'Neal, 2003). Nurses Lack Technological Preparation Today, nurses must be skilled in managing and communicating information. Nurses today are the primary processors and users of healthcare information and have been recognized as such for over 40 years (ANA, 2008). The ANA (2008) describes four related concepts: a) data, b) information, c) knowledge, and d) wisdom. Data, which consists of objectively described entities, turns into information once it has been interpreted and organized. That information then becomes knowledge once relationships amongst the information have been identified. Last, wisdom occurs when knowledge is applied critically to solve problems. An information system is a good tool to help support the collection of both data and information (ANA, 2008). In 2006, a study conducted by the National League of Nursing showed 60% of nursing schools require their graduates to be computer literate (Pease, 2011). However, most of the literature available describes how to apply information technology skills in the educational setting rather than how these skills will apply in the workplace. Educators should provide examples to students of how the learned information technology skills could apply in a hospital
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or work setting (McCartney, 2011). Along with this, it has been suggested by Fetter (2009) that todays educators may not have the technology skills to effectively teach these competencies. In fact, todays employers may expect nurses to have a higher level of skill with technology than their educators possess (Fetter, 2009). Although many nursing schools have developed core curriculum to encourage informatics competencies, many of todays nurses have not been in a formal education program for many years. These nurses may not have had the opportunity to learn technology skills like todays graduates (Hart, 2008). According to Hart (2008), many of todays nurses are not ready for evidenced based practice due to a lack in computer and information literacy skills. This lack in computer and information literacy amongst nurses could be related to the nursing professions slow progression towards the use of technology. With the current promotion of technology in healthcare through the American Recovery and Reinvestment Act of 2009, technology in healthcare is quickly advancing (Mihalko, 2011). It is imperative that work is done now to give nurses the necessary technology skills before this process becomes overwhelming (Hart, 2008). A study conducted in Australia by Eley, Fallon, Soar, Buikstra, and Hegney (2008) showed that less than 25% of the nurses surveyed felt very confident in any software program. Though more senior level nurses tended to be more comfortable with programs directed towards management, nurses who were younger or who had less experience in nursing tended to be more confident in the use of technology. This may also be related to a higher acceptance of information technology in healthcare by younger or less experienced nurses. Though the study found that younger nurses tended to be more confident with technology, they still found that very few participants labeled themselves as very confident in the use of technology (Eley et al., 2008). It has been suggested that technology in healthcare is growing faster than nurses can develop the
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competencies to keep up with the changes (Hart, 2008). With this in mind, one may assume that nurse educators must work to find ways to better prepare not only more senior nurses who are less confident with technology, but also new graduate nurses. Consequences of Poor Preparation Not appropriately preparing nurses to use healthcare technology may lead to negative consequences. It has been shown that more than 50% of electronic health record implementations fail (Mihalko, 2011). The cost of implementation and the risk of failure are barriers which limit HIT implementations. Lack of funding to properly educate nurses on how to use technology can increase the likelihood of failure (Poon et al., 2006). A study conducted by Zuzelo et al. (2008) showed that inadequately educated nurses are likely to become frustrated with new technology. The participants in this study also expressed concerns with using new technologies incorrectly, leading to adverse consequences for patients or colleagues (Zuzelo et al., 2008). When nurses are not appropriately prepared to use healthcare technology, safety concerns may arise. According to Pease (2011), nurses will tend to create workarounds when using technology that is not fully understood. A workaround could be considered beneficial if it is necessary to reach an intended goal. However, a workaround in a healthcare setting can lead to negative consequences. If a nurse creates a workaround, this will not address the root of the problem, leaving the situation open to further workarounds. Even if a nurse is computer literate, poorly implemented technology can still cause confusion which can lend itself to a safety risk (Pease, 2011). With nurses playing a key role in the success of healthcare technology (Mihalko, 2011), it may be assumed that an emphasis should be placed on appropriately preparing nurses to avoid the creation of unnecessary workarounds caused by poor understanding.
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY The use of technology in healthcare has been shown to directly reduce medical errors (Hart, 2008). An example of technology which may directly reduce medical errors is an electronic medical record. Electronic medical records can both increases access to patient
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information and increase communication of patient information (American Society of Registered Nurses, 2009). However, the attitude of a nurse utilizing health care technology can predict whether or not that nurse intends to adopt an information system (Hart, 2008) and affect the ability of that nurse to use technology to its fullest capacity (American Society of Registered Nurses, 2008). Prevalent attitudes towards computers in nursing include: a) anxiety, b) computer liking, and c) computer confidence. Along with this, emotions nurses feel towards technology can include: a) fear, b) apprehension, c) uneasiness, and d) distrust towards the technology. Education, amongst other factors, has been shown to contribute to these attitudes and emotions (Nkosi, Asah, & Pillay, 2011). Though many nurses today are not completely opposed to the use of technology in healthcare, it is unclear if nurses will accept and use the available technologies to their fullest potential (Mihalko, 2011). With education as a contributing factor to a nurses attitude toward the use of healthcare technology, we may assume that proper education on the use technology may lead to an improved attitude towards same. Computer Competence of the Educator This research proposal considers the relationship of the technological competence of the educator to the adaptation to technology by the nurse learner. The review of the literature provides the concept of nurse competence in HIT and demonstrates that consequences to health care may occur when a lack of competence is present. This concept of HIT competence also extends to the nurse educator; however, transformation of nursing education may also facilitate the adaptation of nurses to technology.
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Various authors address the technological competency of the nurse educator (Axley,
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2008; Schulte & Sherwill-Navarro, 2009; Skiba & Barton, 2006). It is presumed that if educators possess a high degree of technological competence that this will translate to the education of nurses today, yet this has not been tested. The lack of technological skills among nursing faculty presents both current and future concerns for the nursing profession (Axley, 2008). Nurse educators must possess the ability to find research that is applicable to their practice and to meet the needs of nursing students (Schulte & Sherwill-Navarro, 2009). The educator must be an expert in the technology to teach a student how to effectively implement and utilize it (Skiba & Barton, 2006). It is ironic that the need for educator technological competence is so closely related to EBP, yet the basis for these claims has not been directly tested. The ever-changing field of health care and the diversity of the nursing workforce, present challenges to nursing education. These challenges may require the transformation of educational processes. According to Coonan (2008), nurses entering the workforce often lack the skills necessary to perform the role. Education must adapt to meet the technological demands of the clinical environment and to accommodate todays generation of learners (Coonan, 2008). As much as 50% of the nursing workforce does not possess the technological competence to engage in EBP or perform the basic functions of the job (Patterson, Carter-Templeton, & Russell, 2009). The need for preparation within education is further highlighted when one considers that nursing includes four generations, with various technical baselines, practicing at the same time (Sherman, 2006). The revolutionary change in HIT brought forth by meaningful use presents both an opportunity and a necessity for nursing education to adapt to meet this challenge (Walker, 2010). Leaders within nursing must realize the necessity to seamlessly integrate informatics and
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technology within the essential constructs of the nursing profession (Walker, 2010). Educational transformation which emphasizes computer and informatics competency may ensure that nursing meets the demands of the current HIT agenda and is well positioned to lead HIT initiatives in the future. Educator Technological Competence Within nursing literature, various authors examine the technological competency of the nurse educator (Axley, 2008; Schulte & Sherwill-Navarro, 2009; Skiba & Barton, 2006), yet the literature does not test the relationship between the skills of the educator to the technological adaptation of the learner. Many institutions are currently experiencing nursing faculty shortages and the advent of new technologies on the ever-aging workforce may only exacerbate the problem. In the article titled The Integration of Technology into Nursing Curricula: Supporting
Faculty via the Technology fellowship Program, Axley (2008) addresses a significant challenge for the nursing profession; the lack of technological competency of nursing faculty. Many schools have begun implementing course work to increase the technological expertise of students, yet nursing faculty may not be competent to teach this course work (Axley, 2008). To address this situation, Axley (2008) implemented a study involving volunteer faculty to participate in multiple different strategies to increase their level of competence and comfort with new technologies. Some of the strategies used were: a) developing online educational materials, b) managing computer examinations, c) preparing online and web based seminars, and d) simulation training. Volunteer faculty members were provided with mentoring to help them learn and become more comfortable with new technologies. Most of the volunteer faculty were at the novice to advanced beginner level of technological advancement and were quite challenged by the project (Axley, 2008).
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY The evaluation of the success of this test project was done by self-evaluation and interview processes to determine if faculty felt more comfortable with technologies and could integrate them into the school of nursing (Axley, 2008). The success of the participants was
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based on their ability to organize and upload course materials and initiate electronic discussions with students. Students also reported on the perceived success of the teachers abilities to utilize the technology. Nurse educators within the study recognized the need to become more technologically proficient. With mentorship, educators are more likely to become more comfortable and proficient with technologies; thus, be more likely to implement them into curricula (Axley, 2008). Although this study shows that a technology fellowship program may increase the comfort and proficiency of the educator, it does not address how this will affect the nurse learner. Although this study demonstrates favorable results from the program, it may lack scientific merit as Axley (2008) does not appear to control the variables that may inhibit the competency of the educator. Axley (2008) assumes what this research proposal intends to examine; that when educators possess technological competence, this benefits the learner. Skiba and Barton (2006) examine the impediments and adaptations educators must embrace to teach net generation students through an examination of current literature. Net generation students are deemed as those born after 1980. These learners tend to be very comfortable with technologies (Skiba & Barton, 2006). Educators must adapt and become experts in computer based technologies not only in their functions, but in their relevance to care. Net generation students want to know how the technologies will apply in the clinical setting. Technologies which encourage nurses to function as knowledge workers may both engage net generation students and transform patient care (Skiba & Barton, 2006).
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It is a logical inference that students will learn technologies better from teachers who are not only field experts, but experts in utilizing and integrating these technologies. As written in Benner (1982), the expert is one who thinks abstractly and theoretically. They are not bound by algorithmic mentalities and can extrapolate from previous experience. This demonstrates the expert level of competence needed by clinical educators to teach technologies to nurse learners. Further support for the need of nurse educators to possess technological competency is provided by Schulte and Sherwill-Navarro (2009). Although many nurse educators often view themselves as possessing a high degree of computer literacy, they often lack abilities which research librarians see as basic. A particular technological weakness among nurse educators may be information literacy, which supports the utilization of information to enable EBP. Research librarians may play a role in instructing faculty as well as students regarding information literacy, yet according to Schulte and Sherwill-Navarro (2009) many nurse educators are reluctant to include librarians in information literacy instruction sessions. These authors recommend that both students and educators may benefit from librarian taught IL curriculum to utilize EBP (Schulte & Sherwill-Navarro, 2009). With the prevalence of EBP methods in nursing today, the technological proficiency of the educator is paramount. Education Transformation Coonan (2008) addresses the challenges associated with meeting the technological demands of preparing nurses today. New graduate nurses are entering the workforce ill prepared to fill the expectations of the role. This article presents the need for several basic areas of change in nursing education. First, it describes the need for a much more significant level of collaboration between educational institutions and practice environments. Next, educational methods must be adapted to accommodate information age learners (Coonan, 2008).
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According to Coonan (2008), the needs of these learners require educators to change the way they are teaching. Learners must be engaged in an active learning process. Technology allows for interactive self-directed learning to accommodate these learners. Coonan suggests that practice environments are putting technologies into place faster than academics can currently teach them. A significant generational and technological gap often exists between learner and educator (Coonan, 2008). Innovative ways to close this divide are needed. Coonan (2008) provides support for the idea that educators and the education system need to change to meet the needs of information age learners. One key item proposed is that these learners do not even consider computers technology. This point may serve to illustrate the distance between nurses entering the workforce and those currently in nursing. Many nurses today were nurses before computers were used significantly in hospitals, yet many new nurses have never known life without computers. Sherman (2006) proposes that differences among the various generations within the nursing workforce present both challenges and opportunities to nursing leaders. Developing the skills necessary to adapt to the four generations within nursing will help nurse leaders to maximize the potential of the workforce. The four generations described by Sherman (2006) are: a) Veterans born (1925-1945), b) Baby Boomers born (1946-1964), c) Generation X born (19631980), and d) Millenial Generation born (1980-2000). These four generations span from the time when the average person had never seen a computer (Veterans), to a generation that has never been without hand held computing devices. This knowledge illustrates the challenge in educating nurses related to the use of computer technologies. Millennial nurses for whom technological competence may be second nature have higher expectations regarding coaching
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY than any other generation (Sherman, 2006), yet the educators charged with teaching computer skills to these nurses are often from a generation with lower technological competence. Various authors within nursing literature examine the prevalence of computer skills within nursing curriculum (Thompson & Skiba, 2008) or attempts at academic reform to meet
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the technological demands of nursing (Bembridge, Levett-Jones & Jong, 2011; Patterson, CarterTempleton & Russell, 2009; Ternus & Shuster, 2008; Walker, 2010). Patterson et al. (2009) describe experiences from the Learning Information Seeking and Technology for Evidencebased Nursing Practice (LISTEN) project designed to improve information literacy in both student and workforce nurses. The authors recognize that although nursing education has placed new emphasis on information literacy and HIT competencies, the development of a standardized model has been hindered by inconsistency and ill equipped educators. LISTEN project uses web based training to support nurses use of information literacy, HIT and EBP Information literacy is the ability to recognize a need for, access, retrieve, critically appraise, and apply information (Patterson et al., 2009). Information literacy is the foundation to lifelong learning and EBP. Information technology includes proficiency with computers,
databases, and software (Patterson et al., 2009). This concept is closely related to the concept of computer literacy frequently found in nursing literature. To emphasize the importance of these skills, Patterson et al. (2009) state that 50% of nurses do not have the ability to access EBP information and lack the computer skills necessary for their jobs. In addition, these key definitions support for the need for the research proposed by this proposal. Ternus and Shuster (2008) conducted research over seven years to examine which computer competencies need further support within a nursing program. The study also examined how computer literacy varies in successive class years. This study utilizes a strong sample with
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY 401 senior level nursing students over a seven year period. One finding of this study is that students possessed a higher overall level of computer literacy with each successive year. In
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addition, computer literacy is shown to be higher in students who own personal computers than their counterparts who do not (Ternus & Shuster, 2008). Data inquiry is shown to score the lowest of the computer literacy subsets which the research examined (Ternus & Shuster, 2008). Several elements included within data inquiry are: a) use of electronic library catalogs, b) use of electronic clinical information systems, c) general database searches, and d) specific database searches. The article includes a discussion on potential strategies for remediation of computer skills and supports the need for education reform. The authors further address the need to evaluate the computer literacy of the student; however, this discussion does not question the computer literacy of the educator. According to Walker (2010), the TIGER initiative has developed in response to the increasing prevalence of technology within health care. Informatics competencies should be considered essential components of nursing competencies. The TIGER initiative began informally in 2004, after President George W. Bush called for every American to have an electronic health record by 2014 (Walker, 2010). In 2006 the name TIGER was formally adopted. The initial goals of TIGER included using informatics to improve health care and to seamlessly integrate technology into nursing curricula. The early action plan for TIGER included the facilitation of partnerships among informatics, research, practice institutions, and education (Walker, 2010). Phase 2 TIGER includes the components of faculty and learning environment development as two of nine collaboratives (Walker, 2010). Now in phase 3, TIGER remains aligned with the goals set forth by meaningful use. A key strategy within TIGER phase 3, is the
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY TIGER 3 Virtual Learning Environment (VLE) that addresses the need for improved access to
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informatics training for nurses. The TIGER initiative includes a long term vision for informatics competencies in nursing that allows for flexibility as innovations arise. The VLE is the TIGER strategic platform to address change (Walker, 2010). This article provides further support for the concept of educational transformation. Bembridge et al. (2011), explore the transferability of information and communication technology (ICT) skills learned in the university setting to the nursing profession. This qualitative study involves a small group of eight new graduates entering into nursing in a semimetropolitan healthcare facility. Data is gathered by semi-structured in-depth audio taped interviews. A thematic data analysis was conducted with the interview data. Although this research is conducted using a small sample size it does provide a critical review of the literature that supports the need for ICT skills to be obtained in the educational setting. The literature review revealed a conceptual frame work which helped to divide the findings into three phases: a) pre transfer, b) transition, and c) post transfer. Each phase includes different concepts which could influence the transferability of ICT from a university setting to the work place (Bembridge et al., 2011), the technological competency of the educator is not among them. Thompson and Skiba (2008) suggest that nurses must be prepared to meet the technological demands of health care today. These authors examine the findings of a 2005 National League of Nursing task group which reviewed literature and surveyed nursing faculty and administrators to determine the prevalence of informatics competencies in nursing curriculum. Communication with 1,557 nursing faculty and 540 administrators occurred via email giving this research a strong sample. Respondents showed low standards for technology requirements of their respective programs with fewer than 16% of programs requiring students to
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY own laptop computers. One very telling statistic is that fewer than 7% of programs required students to have a hand held computer of any kind. Computer literacy is reported as a
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requirement for approximately 60% of administrators and faculty; however, information literacy is reported as a requirement in less than 40% of each group (Thompson & Skiba, 2008). BSN or masters programs are more likely to have a higher degree of informatics integration into the curriculum and were more likely to have separate informatics courses (Thompson & Skiba, 2008). Although informatics is shown to be integrated into curriculum, few programs include informatics as a terminal objective. Administrators listed several reasons for not including informatics in nursing curricula including: a) no room for informatics content, b) lack of faculty preparation, c) informatics not a priority, d) budgetary restraints, and e) not applicable to clinical sites. This research may serve as an example of the rate of technology implementation in health care as few clinical sites today have no information technology integration. According to Thompson and Skiba (2008) 37% of nursing faculty rated themselves as competent using a novice to expert scale, with 26% providing an advanced beginner rating. Additionally only 3% viewed themselves as informatics experts. This literature review clearly demonstrates a gap in nursing literature. The literature addresses the need for technological competency of nurses, and establishes that nurses lack technological competence. The ramifications of this lack of competence are put forth. The literature also supports the need for technological competence for nurse educators and the need for a transformation within nursing education. Yet, the technological competence of the nurse educator in relation to the adaptation to technology by the nurse has not been tested. A major assumption in all of the literature included in this review is that a higher level of technological competence of the educator will result in greater adaptation by the nurse learner.
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Chapter 2 Summary Chapter 2 of this research proposal provides further support for the use of Benners
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(1982) novice to expert model as the theoretical framework for the proposed research. A review of nursing and relevant literature explores concepts in two primary areas of focus: a) nursing and technology and b) education and technology. Within the focus of nursing and technology, three concepts are identified: a) nurse technological competence, b) nurses lack technological preparation, c) consequences of poor preparation. Within the focus of education and technology the concepts of educator technological competence and education transformation are identified. The technological competence of the nurse educator in relation to the adaptation to technology by the nurse is demonstrated to be a gap in nursing literature. Chapter 3 of this research proposal will include the research design and methodology for the proposed research. Chapter III Chapters one and two of this research proposal have established the relevance of the proposed research and built support for the main concepts that are included. In addition, Benners (1982) theoretical framework has been detailed as the foundation for the research. Chapter three will now provide details of the design and methodology of the proposed research. The details for a quantitative descriptive survey design are provided. The sample and setting include all eligible technologically novice nurses within critical access hospitals in the state of Michigan. The details of the method include the use of Likert scales to generate data. Support is provided for the use of the Spearmans rho correlation index as the data analysis method. The measures to ensure reliability and validity are provided. Finally the limitations and ethical considerations regarding the proposed research are addressed.
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Research Design According to Polit and Beck (2012), there are two broad categories of research designs, experimental and non-experimental. The research design for the proposed study is nonexperimental because it does not intend to manipulate either the dependent or the independent
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variable. The educators will conduct teaching as they normally do. No attempt will be made to manipulate the educators technological competency or teaching methods. The competency of the educators will be assessed after the teaching has occurred. Only educators at the beginner and expert levels according to Benners (1982) model will be included in the research. Nor will any manipulation occur regarding the nurses. The competency of the nurses will be measured via self-evaluation before and after education has occurred. An experimental design would be ethically inappropriate for use in the proposed study. Because nurses will be assessed before and after teaching has occurred, this would represent a prospective design according to Polit and Beck (2012). Prospective designs examine variables at a given point and then move forward to determine the cause and effect relationship (Polit & Beck, 2012). Neither the educator nor the nurse will be aware of the purpose of the research making this a double blind study as described by Polit and Beck (2012). This type of blinding may help reduce bias in the proposed research. This research proposal has put forth a level two research question as described by Wood and Ross-Kerr (2011). The proposed question is: What is the relationship between a clinical nurse educators technological competency and the adaptation to computers in technologically novice bedside nurses in critical access hospitals? The setting for the proposed research is all critical access hospitals within the state of Michigan. The literature review in chapter two has demonstrated the level of knowledge regarding both the independent and dependent variables.
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY The literature discusses these variables independently but does not examine the relationship
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between them. According to Wood and Ross-Kerr (2011), when considering level two questions with known variables but unpredictable relationships, a non-experimental descriptive survey design may be used. At level 2 research questions designs using correlational and comparative surveys are often used (Wood & Ross-Kerr, 2011). A correlational survey design may be appropriate for considering the proposed research question. Since the relationship among the variables cannot be determined prior to the onset of the study, this method begins with a conceptual base and aim to determine both the direction and the strength of the relationship among the variables (Wood & Ross-Kerr, 2011). In summary, this research proposes a non-experimental double blind method to conduct a prospective correlational study using descriptive surveys to determine both the direction and strength of the relationship among the variables. Setting and Sample According to Polit and Beck (2012), sampling methods fall into two general categories, probability and non-probability. Non-probability sampling methods are also known as nonrandom samples. Consecutive sampling is a form of non-probability sampling which considers all eligible participants within the desired population (Polit & Beck, 2012). Non-probability samples are less likely to produce a representative sample than random samples; therefore a large sample will increase the strength of the sample (Polit & Beck, 2012).
Within the state of Michigan there are 36 critical access hospitals (MHA, 2011). This study proposes a sample which includes all eligible nurses working in critical access hospitals within the state of Michigan. The eligibility criteria for this study are as follows: (a) active registered nurse licensed in the State of Michigan in good standing, (b) active employment in a
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY critical access hospital within the state of Michigan, and (c) pre-education technological competence self rating at novice level.
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Sample bias in this research will be minimized by including all eligible registered nurses within the setting. Because the sample considers all novice nurses within the state of Michigan, this sample would reflect a high degree of generalizability to technologically novice nurses in critical access hospitals. Further research could examine a representative sample in other types of facilities. Critical access hospitals are the chosen setting for this research because they present an opportunity to examine all eligible nurses within this type of facility in an entire state. In addition, it has been shown that critical access hospitals are often in the early stages of technological adoption (Bahensky et al., 2009). This research has the potential to greatly impact education initiatives during technology adoption. Method According to Polit and Beck (2012), when developing a data collection plan, researchers must first determine what type of data needs to be collected. The research being proposed looks to test the research question: What is the relationship between a clinical nurse educators technological competency and the adaptation to computers in technologically novice bedside nurses in critical access hospitals? When testing a research question, all key variables should be tested (Polit & Beck, 2012). The variables from the research question above include the independent variable, or the clinical nurse educators technological competency, and the dependent variable, or the ability of technologically novice bedside nurses to adapt to technology. With these two variables in mind, instruments will be used which test both the competence of the clinical nurse educator, as well as the novice nurses adaptation to technology.
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY The next step in developing a data collection plan includes selecting a data collection method (Polit & Beck, 2012). To answer the research question above, two different self
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administered questionnaires will be utilized. A questionnaire will be utilized for various reasons. First, compared to direct interviews, questionnaires are: (a) relatively inexpensive, (b) offer a higher level of anonymity, and (c) could possibly reduce the risk of bias. Though there are benefits to the use of questionnaires, there are some consequences as well. The use of a questionnaire over a direct interview increases the risk of confusion and creates the risk of incomplete answers (Polit & Beck, 2012). According to Polit and Beck (2012), it is not recommended for researchers to create new instruments, but rather, researchers should check to see if there is an instrument available which would be compatible with their study, or investigate if there is an instrument available which can be adapted to appropriately fit their research. For this reason, research was conducted to investigate if appropriate instruments had been previously created which would meet the needs of this study. After searching the literature, an appropriate instrument was not found. However, the concepts behind an instrument created by Ali et al. (2005) were utilized to develop the instruments for this research. For the instrument created by Ali et al. (2005), the questionnaire was constructed using a five point Likert scale that was adapted from Benners five stages of proficiency. With this questionnaire, the five responses available on the Likert scale included: (a) 1 for novice, (b) 2 for advanced beginner, (c) 3 for competent, (d) 4 for proficient, and (e) 5 for expert. As part of the questionnaire created by Ali et al. (2005), a series of components or tasks were listed and those completing the survey were asked to respond to each element by ranking themselves according to the five point scale above.
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY For the first instrument, which will measure the nurses self described level of competence as to the use of a PDA, a similar concept as described by Ali et al. (2005) will be used. Each nurses will be asked to rate themselves on a list of PDA related tasks and activities
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on the five point Likert scale described above, utilizing Benners five stages of proficiency. The questionnaire will consist of 15 items (see Appendix A). For the instrument which will assess the educators competence with the use of technology, the same type of Likert type scale will be used. However, the instrument will only ask the educator to evaluate their current level of competence with technology as a whole (see Appendix B). When creating both instruments, care was taken to ensure the questions were stated clearly. To assist with this, jargon was avoided and questionnaire items were stated as simply as possibly. To avoid bias and encourage honesty, leading statements and personal language were avoided (Polit & Beck, 2012). After the instruments were created, each was presented to a sample of 20 nurses who critiqued the instruments for clarity and usability. The two instruments were then presented to panels of experts, as suggested by Polit and Beck (2012). The questionnaire assessing the nurses competence as related to the use of a PDA was presented to a panel of experts who work closely with the technology. The questionnaire which assesses the clinical educators technology competence was presented to a panel of experts who specialize in technology education in some way. These experts tested the content validity for both the items presented and the scales used. In order to assess the novice nurses ability to adapt to the presented technology, the questionnaire will be presented to them at two points. The questionnaire will be administered to these novice nurses prior to the educational experience provided to them by the various educators, and will again be administered to them after the education is complete. By utilizing
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY this pre-test post-test method, the novice nurses pre education competence can be compared with their post education competence, allowing for an assessment of any change which has occurred (Polit & Beck, 2012). On the day of the educational experience, the nurses will be
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instructed to arrive to the class 30 minutes prior to the beginning of class. These 30 minutes will be utilized to distribute the pre-education questionnaire to the nurses who attend class, allow time for the nurses to complete the questionnaire, and then allow time for the questionnaires to be collected. The questionnaires will be distributed to the nurses by the clinical educator and will be collected by having the nurses place their survey in a manila envelope. After the education is complete, the same questionnaire will again be distributed following the same procedure described above. After the educational experience is complete, the clinical nurse educators will then receive the above described questionnaire which will assess their level of computer competence. The clinical nurse educators will be mailed their questionnaire one day after they have completed their teaching. The educator will be asked to mail their survey back to the researchers using the pre post marked envelope sent with the questionnaire within ten days. Due to the relative low response rate which accompanies mailed questionnaires, a reminder letter will be sent to the educators if a reply has not been received after ten days, along with an additional survey incase those respondents have misplaced their original survey (Polit & Beck, 2012). Data Analysis To analyze the data from this study, the Spearmens rank correlation coefficient, also known as Spearmans rho, will be used. This is appropriate for a level II study using nonparametric data (Polit & Beck, 2012). The basic principle behind this correlation is if the independent variable increases then so does the dependent variable (Triola, 2011). In the case of
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this proposal, there is one independent variable which is the level of competence of the educator. The independent variable will be the students increase in PDA competence after being educated by either an expert or novice in PDAs. Thus there will be two categories of educators being tested; a self described novice and a self described expert. However, these two variables will be tested independently of the independent variables, or the learners. In other words, each group of students tested will only be exposed to one dependent variable, or level of teacher. This proposal will collect the data reported by the students who have indicated they are at the novice level. Those nurses who have either a total score of 15 on the first survey taken, or who have indicated no prior experience with a PDA will be considered at the novice level. The Spearmen calculations will be determined by using the said Likert scale ranking of novice to expert with novice being 1 and expert being 5. This will be collected before and after education. Separate calculations will be done for the students who are taught by novices and those by experts. According to Jeremy Hauser, math department head at Baker College of Cadillac Michigan, an alpha value of 0.10 would be appropriate for this level of research (personal communication, April 15, 2012). This alpha will be applied to the data collected on students being taught by experts in PDAs. An alpha of 0.50 will be applied to data collected on students who have been taught by novices. If the rho value of the data collected on students that have been instructed by an expert in PDA use is above 0.90 it will suggest there is a definite positive correlation between being taught by an expert versus being taught by a novice. Conversely, if the rho value of the students taught by novices is below 0.50 it will suggest the students do not learn as well from a novice teacher. The reason for the difference in alphas used for each category to be tested is to determine the statistical significance of the differences between the rho values (personal communication, April 15, 2012).
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Validity and Reliability There are two main sub-categories of validity in relation to this research proposal.
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Internal validity is an expression to what degree of certainty the conclusions drawn from the data can be attributed to the independent variable (Wood & Ross-Kerr, 2011). In this proposal internal validity is met by limiting the dependent variables to an expert and novice teacher. According to Polit and Beck (2012), the use of the Likert scale helps eliminate any bias by the observer and it is also a double blind test in that the participants are not aware of the purpose for the test. This proposal is an attempt to determine a positive dependent relationship between the level of expertise of the teacher and the effect it has on the students level of competence with PDAs. It is not limited to any specific sex or population to eliminate possible independent variability related to background or generational inequities. This proposal will test any student who rates themselves pre-education as a novice which may seem as if there is little attempt to limit the independent variability, however limiting participation based on sex, race, age or nursing expertise can overcomplicate the confounding variables thus limiting the confidence in the validity of the rho coefficient. The use of questionnaires will ensure each participant is responding to the same questions with ordinal values assigned to each. This also eliminates any bias or undue influence by interpretation by the researchers (Polit & Beck, 2012). According to Polit and Beck (2012), internal validity represents the likelihood that results are directly related to the independent variable. Internal validity in the proposed research is enhanced by the inclusion of all eligible nurses within the chosen setting. Additionally, study participants will be unaware of the purpose of the study. Selection bias will be minimized by testing the nurses technological competence before and after education has occurred. External validity refers to the degree to which the relationship among the variables will remain similar
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among other people (Polit and Beck, 2012). To enhance external validity this study will include 36 critical access hospital settings which possess similar size and scope of practice within one geographic area. This will enhance the potential for replication of the proposed research. The limits of the external validity of this study are that it is not subject to demographic review. Sex, age, and nursing experience will not be ascertained, thus the analysis of the data can draw no conclusions as to those parameters. The purpose is simply to ascertain if there is a dependent relationship between the level of expertise of the educator and the level of expertise of the students after being instructed by said educator. Since this is limited to critical access hospitals, it will not be clear if the defining variable in this study is the location and demographics of the hospital workforce. To determine this, a similar study should be repeated at all non-critical access hospitals within Michigan. To increase its external validity, this study need also be repeated over a five year period to ensure validity. Reliability is essential to validity in that for research to be valid it must also be reliable (Polit & Beck, 2012). This is a reliable study as the methodology is easily repeatable. Likert scales are a common measuring tool used to assign numeric and ordinal values to normally unquantifiable data (Wood & Ross-Kerr, 2011). This research can and should be repeated at all critical access hospitals across the country to determine if the rho values are consistent. If it is proven to be the case, more in depth analysis and testing could yield data that can greater explain the correlation. The proposal is reliable in that it does not allow for interpreted or observed bias. The Likert tests being given are scaled from 1-5 with 1 being novice and 5 being expert. There is no room for observational discrepancies as the data is ordinal and numeric. This test/proposal can be repeated at any hospital with any qualified subjects to determine if its reliability and validity are consistent. The testing procedures are easily followed and the statistical analysis is
45
accurate and appropriate for the level of data attained. Further research may indeed indicate the need for elimination of certain independent variability, but it would be imprudent to assume those variables at this time. Limitations The planned research which has been detailed in this proposal may not be without limitations. The proposed research includes a non-experimental design. The research proposes the strongest methods to study the variables that are reasonably achievable. Although a highly controlled experimental design could provide data at a stronger level of measure, this type of research would be unreasonable to examine the phenomenon of interest. Ethical considerations would prohibit an experimental design which could potentially harm patients. The setting of the research takes place in critical access hospitals within the state of Michigan. Nurses from these hospitals comprise the sample for several reasons. Critical access hospitals within the state of Michigan represent an opportunity to examine all novice nurses from one type of hospital within a large geographic area. Studying critical access hospital nurses allows for the examination of a very strong sample for this type of hospital. Few other hospital types would be reasonable for a study to examine all eligible nurses within that type of hospital. Although this proposed research may provide insight into the adaptation to technology by nurses in critical access hospitals, the generalizability to other types of hospitals may require additional research. Critical access hospitals often have fewer technical resources than other types of hospitals (Bahensky et al., 2011). For example, a critical access hospital may have no onsite IT personnel. When technologies break down, the support available at other institutions may not be available in critical access hospitals. The effect of this lack of support on nurses in critical access hospitals is unknown. Therefore the generalizability of this proposed research
46
must be carefully considered. Further research could examine novice nurses in another hospital category or technical competence level. The method of this proposed research includes self-evaluation by both the nurse educators and the bedside nurse. The nurse educators provide self-evaluation based on their perceived level of expertise. The bedside nurses provide self-evaluation using Likert scales to determine their perceived adaptation to technology. Although this method provides data at the ordinal level which can be statistically analyzed (Polit & Beck, 2012), the foundation of the data is subjective. A stronger method would be one that tested educators and nurses thus resulting in ratio level data (Polit & Beck, 2012) rather than rely on self-evaluation. This method was considered during the development of this proposal but would be highly difficult and possibly prohibitive to the research. The data analysis method for the proposed research is the use of Spearmans rho correlation index to show the strength of the relationship among the variables. One limitation of this data analysis method is that the type of variables being examined can change the value of the data (Polit & Beck, 2012). Due to the subjective nature of self-evaluation via Likert scales, the results will require careful and precise discussion to provide clear interpretation of the strength of the relationships among variables. As stated previously the purpose of this study is to simply determine if there is a higher positive correlation when being taught by an expert as compared to a novice. Ethical Considerations When considering the design and methodology of this research, there are multiple ethical concerns which have been considered. These considerations include the (a) right to self-
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY determination, (b) right to fair treatment, (c) right to full disclosure, and (d) right to privacy. Though not all of these rights can be fulfilled, all have been considered.
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First, to maintain the participants right to self determination, each must be given the right to not participate in the research and must also be willing to participate in the study without coercion (Polit & Beck, 2012). This right applies to all participants, including both the nurses and the clinical nurse educators. The nurses have the right to refuse to complete both the pre education and the post education questionnaire. The clinical nurse educators have the right to refuse to participate in the completion of the questionnaire which will evaluate their competence in the use of technology. The right of the participants to self determination also leads to the right of the participants to fair treatment. Even if a nurse or clinical nurse educator refuses to participate in the research, the participant must still be treated fairly (Polit & Beck, 2012). All participants also have the right to privacy. This right will ensure the study participants information will be collected in confidence and will be kept confidential. First, to help ensure as much privacy as possible, the participants will be asked for minimally intrusive personal information (Polit & Beck, 2012). The nurse participants will be asked for their name and date of birth for tracking purposes only. The nurses will also be asked for the full name of the educator who provided the education as to allow for appropriate correlation. When the questionnaires are sent to the clinical nurse educators, they will be asked to provide their full name, as well as the location of where they provided the education. To further help protect privacy, when the data from the various questionnaires are collated for analysis, all participants will be assigned an identification number, rather than using their personal information. Last, the participants right to full disclosure should be considered. Due to the double blind nature of this study, it will not be possible to give full disclosure to the participants.
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY However, because this study will not be creating any risk to the participants greater than what may be encountered naturally, this research causes minimal risk to the participants. For this reason, it will not be considered unethical to withhold this information (Polit & Beck, 2012). Chapter 3 Summary Chapter 3 has provided the details of the design and methodology of this proposed
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research. A quantitative descriptive survey design is proposed and supported as the best method for the study. The sample and setting include all eligible technologically novice nurses within critical access hospitals in the state of Michigan. Detail regarding the use of Likert scales to evaluate educator and nurse technological competence along with support for these methods are provided. Spearmans rho correlation index is shown to be the appropriate data analysis method. The measures to ensure reliability and validity are provided. Finally, the limitations and measures to enhance the ethics of the research are addressed. Chapter 4 will include analysis of the data and the associated findings along with a discussion of the implications of the research.
CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY References
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Ali, N. S., Hodson-Carlton, K., Ryan, M., Flowers, J., Rose, M. A., & Wayda, V. (2005). Online education: Needs assessment for faculty development. The Journal of Continuing Education in Nursing, 36(1). 32-38.
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Bahensky, J. A., Ward, M., Nyarko, K., & Li, P. (2011). HIT implementation in critical access hospitals: Extent of implementation and business strategies supporting IT use. Journal of Medical Systems, 34(4). 599-607. doi: 10.1007/s10916-009-9397-
Bembridge, E., Levett-Jones, T., & Jeong, S. (2011). The transferability of information and communication technology skills from university to the workplace: A qualitative descriptive study. Nurse Education Today, 31(3), 245-252. doi:10.1016/j.nedt.2010.10.020 Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407.
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Benner, P. (1985). From Novice to Expert, Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass. Bickford, C., Smith, K., Ball, M., Frantz, G., Pannier, T., Newbold, S., . . .Cortes-Cormerer, N. (2005). Evaluation of a nursing informatics training program shows significant changes in nurses perception of their knowledge of information technology. Health Informatics Journal, 11, 225. doi: 10.1177/1460458205055689 Chinn, P., & Kramer, M. (2011). Integrated theory and knowledge development in nursing. (8th ed.). St. Louis, MO: Mosby. Coonan, P. R. (2008). Educational innovation: Nursings leadership challenge. Nursing Economics, 26(2), 117-121. Retrieved from http://www.ovid.com Courtney, K. L., Alexander, G. L., & Demiris, G. (2008). Information technology from novice to expert: Implementation implications. Journal of Nursing Management, 16, 692-699. doi:10.1111/j.1365-2834.2007.00829.x De Groot, H. (2009). Overview and summary nursing technologies: Innovation and implementation. The Online Journal of Issues in Nursing, 14(2). doi: 10.3912/OJIN.Vol14No02ManOS Dreyfus, H. L., & Dreyfus, S. (1980). A five stage model of the mental activities involved in directed skill acquisition. Unpublished study, University of California, Berkeley. Eley, R., Fallon, T., Soar, J., Buikstra, E., & Hegney, D. (2008). Nurses' confidence and experience in using information technology. Australian Journal of Advanced Nursing, 25(3), 23-35.
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Fetter, M. (2009). Improving information technology competencies: Implications for psychiatric mental health nursing. Issues in Mental Health Nursing, 30(1), 3-13. doi:10.1080/01612840802555208. Hargreaves, J., & Lane, D. (2001). Delyas story: From expert to notice, a critique of Benners concept of context in the development of expert nursing practice. International Journal of Nursing Studies, 38, 389-394. Hart, M. D. (2008). Informatics competency and development within the US nursing population workforce: A systematic literature review. Computers, Informatics, Nursing, 26(6), 320329. Kaminski, J. (2010). Theory applied to informatics: Novice to expert. Canadian Journal of Nursing Informatics, 5(4), Editorial. Retrieved from http://cjni.net Lee, T. (2008). Nursing information: Users experiences of a system in Taiwan one year after its implementation. Journal of Clinical Nursing, 17, 763-771. doi: 10.1111/j.13652702.02041.x McCannon, M., & O'Neal, P. (2003). Results of a national survey indicating information technology skills needed by nurses at time of entry into the work force. Journal of Nursing Education, 42(8), 337-340.
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McCartney, P. R. (2011). Health information technology: Integrating informatics competencies into practice. MCN: The American Journal of Maternal Child Nursing, 36(4), 267. doi:10.1097/NMC.0b013e31821c9194
Michigan Hospital Association (MHA). (2011). Michigan Critical Access Hospitals, Retrieved from http://www.mha.org
Mihalko, M. (2011). Cognitive informatics and nursing: Considerations for increasing electronic health records adoption rates. Journal of Pediatric Nursing, 26(3), 264-266. doi:10.1016/j.pedn.2011.02.00 Murphy, J. (2011). The nursing informatics workforce: Who are they and what do they do? Nursing Economics, 29(3), 150-152. Retrieved from http://www.medscape.com Nkosi, Z. Z., Asah, F. F., & Pillay, P. P. (2011). Post-basic nursing students' access to and attitudes toward the use of information technology in practice: A descriptive analysis. Journal of Nursing Management, 19(7), 876-882. doi:10.1111/j.1365-2834.2011.01303.x Ornes, L., & Gassert, C. (2007). Computer competencies in a BSN program. Journal of Nursing Education, 46(2), 75-78. Ozbolt, J. G., & Saba, V. K. (2008). A brief history of nursing informatics in the United States of America. Nursing Outlook, 56(5), 199-205. doi:10.1013/joutlook.2008.06.008 Patterson, R., Carter-Templeton, H., & Russell, C. (2009). Information literacy: Using LISTEN project strategies to equip nurses worldwide. Connecting Health and Humans, 146, 652656. doi: 10.3233/978-1-60750-024-7-652 Pease, J. (2011). Nurses and health information technology: Working with and around technology. N C Medical Journal, 72(4), 317-319.
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Peterson, S., & Bredow, T. (2009). Middle range theories: Application to nursing research. (2nd ed.). Philadelphia: Lippincott, Williams, & Wilkins.
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Poon, E., Jha, A., Christino, M., Honour, M., Fernandopulle, R., Middleton, B., . . . Kaushal, R. (2006). Assessing the level of healthcare information technology adoption in the United States: A snapshot. Medical Informatics and Decision Making, 6(1). doi:10.1186/14726947-6-1 Ragneskog, H., & Gerdner, L. (2006). Competence in nursing informatics among nursing students and staff at a nursing institute in Sweden. Health Information & Libraries Journal, 23(2), 126-132. Schleyer, R. H., Burch, C. K., & Schoessler, M. T. (2011). Defining and integrating informatics competencies into a hospital nursing department. CIN: Computers, Informatics, Nursing, 29(3), 167-173. doi:10.1097/NCN.0b013e3181f9db8c Schulte, S. J., & Sherwill-Navarro, P. J. (2009). Nursing educators perceptions of collaboration with librarians. Journal of the Medical Library Association, 97(1), 56-59. doi: 10.3163/1536-5050.97.1.013 Sensmeier, J. (2008). Deep impact: Informatics and nursing practice the goal? Use IT to increase efficiency, safety, and efficacy. IT Solutions, 39(5), 2-6. Sherman, R. ( 2006). Leading a multigenerational nursing workforce: Issues, challenges and strategies. The Online Journal of Issues in Nursing, 11(2). Retrieved from www.nursingworld.org/ojin/topic30/tpc30_2.htm
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Ternus, M. P., & Shuster, G. F. (2008). Computer literacy in a traditional nursing program: A 7year study to identify computer-based skills needed for success. MERLOT Journal of Online Learning and Teaching, 4(1), 24-36. Thompson, B. W., & Skiba, D. J. (2008). Informatics in the nursing curriculum: A national survey of nursing informatics requirements in nursing curricula. Nursing Education Perspectives, 29(5), 312-317.
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CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Wood, M. J., & Ross-Kerr, J. C. (2011). Basic steps in planning nursing research: From question to proposal. (7th ed.) Sudbury, MA: Jones and Bartlett. Zuzelo, P., Gettis, C., Hansell, A., & Thomas, L. (2008). Describing the influence of technologies on registered nurses' work. Clinical Nurse Specialist: The Journal of Advanced Nursing Practice, 22(3), 132-142.
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CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Appendix A PDA Competence Assessment
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Below are listed several tasks associated with or features available on the Personal Digital Assistant (PDA) which has been or will be presented today. Please indicate below your current level of competence with each feature or task listed. Please indicate your level of competence according to the following criteria: 1. 2. 3. 4. 5. Novice Advanced Beginner Competent Proficient Expert
PDA Features 1. Powering the PDA on and off 2. Charging the battery of the PDA 3. Monitoring the battery life of the PDA 4. Increasing or decreasing the volume on the PDA 5. Increasing or decreasing the brightness of the PDA screen 6. Opening Microsoft Word on the PDA 7. Compose a document through Microsoft Word on the PDA 8. Accessing the web browser on the PDA 9. Searching the internet through the web browser on the PDA
Novice
Advanced Competent Beginner
Proficient
Expert

10. Accessing the applications on the PDA 11. Accessing the drug guide on the PDA 12. Searching for a medication in the drug guide on the PDA 13. Accessing an e mail account through Outlook on the PDA 14. Composing and e mail through Outlook on the PDA 15. Deleting an e mail through Outlook on the PDA
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No
Yes
Have you ever used a PDA prior to today?
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Appendix B Educator Technology Competence Assessment
Please indicate below what you feel your current level of competence with technology as a whole is. Please indicate your level of competence according to the following criteria: 1. 2. 3. 4. 5. Novice Advanced Beginner Competent Proficient Expert
Novice
Advanced Beginner
Competent
Proficient
Expert

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Running head: CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

Rules are: context-free, independent of specific cases, and applied universally.

Rules are: context-free, independent of specific cases, and applied universally.

Lacks any adaptability or comfort with new skills and situations.

Can base actions only on situations previously exposed to.

Low adaptability and comfort with new situations.

Actions based on experience, abstractions and similarities of other situations.

Is very comfortable with new situations, but still follows guidelines.

Very adaptable to new situations.

Can apply knowledge to new situations pulling from some experiences.

Increasing levels of Expertise in Computer Skills lead to:

Extremely adaptable, competent and comfortable in any situation.

Fully capable of approaching all situations with an intuitive approach.

Increase efficiency and quality of care.

Increase efficiency of implementation of computer technologies.

Decrease resistance to new technology implementation .

Figure 1: Application of Benner's Stages of Skill Acquisition

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Chapter II

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY References

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY Appendix A PDA Competence Assessment

Advanced Competent Beginner

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

Have you ever used a PDA prior to today?

CLINICAL NURSE EDUCATOR COMPUTER COMPETENCY

Appendix B Educator Technology Competence Assessment

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