Assessing Nurse Educator Student Informatics Competencies

Citation
Bove, L., and Sauer, P. (Fall 2022). Assessing nurse educator student informatics competencies. Online Journal of Nursing Informatics (OJNI), 26 (2), https://www.himss.org/resources/online-journal-nursing-informatics

Abstract

Informatics is essential to nursing practice. The nurse educator student must be proficient at informatics to prepare students to enter the profession.

Purpose: This study examined nurse educator students’ informatics knowledge using the SANICS instrument.

Methods: Participants enrolled in a graduate-level nurse educator course on informatics were surveyed using the SANICS instrument. The Institutional Review Board determined the study was exempt and survey results were anonymous.

Results: There were 152 participants, with 94.1% (N=-143) females and 57.2% (N=87) less than 40 years old. Participant years of experience was well distributed with 35.1% (N=53) having 0-5 years; 26.5% (N=40) 6-10 years, and 38.4% (N=58) more than 10 years of experience. Participants scored near the proficient level of SANICS basic computer knowledge (M= 2.9), above the proficient level for SANICS role subscale (M= 3.22), and at the competent level for SANICS applied computer skills (M=2.42). Age and years of experience had a strong association (c2 (2) = 57.022, p<.001), with 31.3% of those who are older having 10 or more years of experience.

Significance: Informatics needs to be taught and developed throughout all levels of nursing education. Nurse educator students should be at the proficient or expert level to teach the next generation of nurses.

Today’s healthcare system is constantly advancing with nurses using more technology to care for patients than ever before. This requires nurses to be proficient with informatics and information management. Education about how to use informatics to perform patient care begins in prelicensure education and continues in advanced degree programs. Various definitions of informatics exist, however, and no one tool assesses all the skills needed. The purpose of this article is to describe graduate nurse educator (NE) students’ level of informatics competency.

Background and Significance

Healthcare information and communication technologies (HICTs) assist nurses and other healthcare providers to give the best possible care (Hoover, 2017). HICTs consist of applications such as the electronic health record, bar-coded medication administration, electronic documentation, and decision support. When used correctly, HICTs can help improve care and outcomes. Informatics competencies and the quality of information processing have been found to be positively correlated and to enhance decision-making (Al-Hawamdih et al., 2018). With these technologies, nurses can use informatics to make better evidence-based decisions.

To use HICTs competently, nurses need some understanding of informatics, which have many definitions. The American Nurses Association’s (ANA) Nursing Informatics: Scope and Standards of Practice defined nursing informatics as the “specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge and wisdom in nursing practice” (ANA, 2015, p. 10). The Healthcare Informatics and Management Systems Society (HIMSS) has also adopted this definition. The American Medical Informatics Association (AMIA) broadened the definition to “the intersection between the work of stakeholders across the health and healthcare delivery system who seek to improve outcomes, lower costs, increase safety and promote the use of high-quality services” (AMIA, 2022, para 2). Per the American Association of Colleges of Nursing (AACN), “informatics processes and technologies are used to manage and improve the delivery of safe, high quality, and effective healthcare” (AACN, 2021, p 47). AACN goes on to say that the use of technologies changes the way people and processes interact.

As with the definition of informatics, there are a number of instruments used to measure competency. Farzandipour and colleagues (2021) developed a 48-item questionnaire with three categories: basic knowledge, informatics knowledge, and informatics skills. The Technology Informatics Guiding Education Reform Initiative (TIGER) was implemented to address skills that all nurses will need in the 21st century. TIGER developed an instrument to measure nursing informatics competencies based on similar competency areas: basic computer, information literacy, and clinical information management (Hunter et al., 2015). Yoon and colleagues (2015) refined their original instrument into an 18-item instrument but categorized these items into different categories: basic skills, role, and applied computer skills: clinical informatics. Yoon’s instrument more closely supports new and experienced nurses.

The purpose of this study was to explore the level of informatics competency of students enrolled in a graduate nursing education program.

Methods

This study examined the informatics competencies of graduate nurse educator (NE) students who were enrolled in a required informatics course at a university in the southeastern United States.

Target Population

All graduate NE students who were enrolled in the informatics course were required to complete the survey for course credit. They could also consent to share the information with researchers. Data were collected using an online survey between the fall of 2020 and the fall of 2021. The university IRB determined this study was exempt from IRB approval.

Procedures for Data Collection

The survey contained 24 items: six demographic questions requesting information about gender, race, age, work experience and computer experience and 18 items from the revised Self-Assessment of Informatics Competency Scale for Health Professionals (SANICS) (Yoon, 2015). The SANICS items were scaled with a 5-point Likert scale, where 0=not competent, 1=somewhat competent, 2=competent, 3=proficient, and 4=expert. The 18 items were grouped into three categories with 1) basic computer skills, having four items, 2) role, having two items, and 3) applied computer skills, having 12 items. The SANICS instrument has been used to measure the skills that are required for nurses to practice in health care settings (Forman et al., 2020; Yoon et al., 2015). In this study, the SANICS Cronbach’s alpha was 0.91.

Results

Data were analyzed using IBM SPSS Statistics version 25 (IBM Inc., Armonk, NY, USA). Data analysis included descriptive statistics, and mean scores were compared using t-tests and ANOVAs. Items from the SANICS instrument were analyzed by item, category and aggregate score.

152 graduate NE students participated in the survey, all but one student enrolled during the time period. The vast majority (94.1%, n=143) of students were female, and 75.1% (n=114) identified as White, non-Hispanic. Fifty-seven percent (n=87) of students were less than 40 years of age and had various levels of experience (Table 1). Some of the variables were not evenly distributed; gender was not used in analysis, race was condensed to two variables, age was categorized as below 40 years of age or 40 and above, and years of experience was consolidated to three categories. Age and years of experience had a strong association (c2 (2) = 57.022, p<.001) with 31.3% of those who are older having 10 or more years of experience.

The scores for the SANICS were reported for each measure as shown in Table 2. When examining the three subscales, participants scored near the proficient level for the SANICS basic computer knowledge subscale (M=2.9, SD=.559) and above the proficient level for the SANICS role subscale (M=3.228, SD=.662). The lowest score was the SANICS applied computer skills category, which scored at the competent level (M=2.42, SD=.662). The lowest item in this subscale was for “incorporate structured languages into practice” (M=1.24 SD=1.15).

A chi square test of independence was performed to examine the relation between age and experience. The relationship between these variables was significant, X2(2, N=150) = 57.02, p=<.001). A one-way ANOVA compared the impact of age, race or years of experiences on the SANICS subscale scores and total scores (Table 3). A one-way ANOVA revealed that there was a statistically significant difference in the mean role subscale between those who were less than 40 years of age and those who were 40 years or older (F (1,148) = [5.082], p=.026). A one-way ANOVA revealed that there was a statistically significant difference in the mean total score between those who were less than 40 years old and those that were 40 years or older (F (1,146) = [4.175], p=.043). A one-way ANOVA revealed that there was a statistically significant difference in mean role score between those who were White, non-Hispanic and other races (F (1,149) = [5.523], p=.02). A one-way ANOVA also revealed that there was a statistically significant difference in mean role (F (2,147) = [5.466], p=.005) and total scores (F (2,145) = [3.345], p=.038) between those with different levels of experience.

Discussion

This study aimed to understand graduate NE student informatics competencies using the SANICS instrument. This population was examined since these students aspire to be future educators and will need to incorporate informatics into their teaching in academic or practice settings. If educators do not have sufficient informatics knowledge, they will not be able to teach the concepts to future nurses. Most graduate nursing students already have some experience with healthcare technology and informatics in their clinical practice. They have also seen various roles within facilities and practices, and this experience may account for role competencies scoring above the proficient level.

In this study, older and more experienced participants scored higher on total score and near proficient on the basic subscale. The original SANICS instrument was used to assess faculty and administrators’ informatics competence, and while almost all respondents in the study were administrators, a minimum of proficiency was reported in all three subscales (Lilly et al., 2015). Choi and Zucker (2013) and Kupferschmid et al, (2017), found that doctorate of nurse practitioner students, who had more experience than master’s students, had higher scores in self-assessed competencies. Choi and De Martins (2013) found similar results when using the original SANICS instrument.

Kleib and colleagues (2019) determined that the full benefits of HICT systems to improve care and patient outcomes required informatics competence. There is, however, a wide variation as to what constitutes nursing informatics competencies and how academics define informatics. Based on the literature used in their scoping review, Kleib et al., (2019), identified three consistent basic competencies: computer literacy, information management, and information literacy. Khezri and Abdekhoda (2019) used a self-made instrument to measure Bachelor’s degree nurses’ informatics competencies. This instrument measured three categories of informatics: 1) informatics skills that included internet and network use and understanding of data sets, 2) computer skills that included computers and applications such as Microsoft Office, and 3) informatics knowledge that included nurses’ role in system implementations. Khezri and Abdekhoda’s (2019) informatics skill competencies are most similar to the SANICS applied computer skills: clinical informatics, computer skills competencies with SANICS basics computer skills, and informatics knowledge with SANICS role. These studies found that experience with healthcare computer systems was positively correlated with higher overall competency scores, but age was negatively correlated. These findings may differ from others due to the use of a different competency instrument.

In another study measuring informatics competencies in nurses in Finland, Kinnunen and colleagues (2019) found that more experience and higher levels of education were associated with higher proficiency. These researchers found that more training on the electronic health record (EHR) was associated with higher competency levels, although one-third of the nurses in their study reported insufficient training. There were limited differences in competency by EHR system used, although emergency department and ICU nurses reported higher competency. Unlike the United States, Finland has implemented a nationwide EHR and has since developed a national nursing curriculum. Kinnunen et al., (2019), found that informatics competency facilitates ease of use of the EHR and has a positive effect on data quality.

Applying data to patient care decisions requires not only technology, but also the use of the data generated by technology. Healthcare technology and informatics can improve patient safety by using evidence-based tools and decision-making algorithms (Agency for Healthcare Research and Quality (AHRQ), 2020). The four areas that healthcare technology has most recently impacted are 1) reducing adverse drug events, 2) minimizing diagnostic errors, 3) improving transfusing safety, and 4) greater adherence to evidence-based care (AHRQ, 2020). The focus is now on creating interoperable systems that present the right information to the right user so they can apply the data generated, and creating these systems requires informatics competency. Applying predictive analytics to population and public health data also requires informatics competency; these analytics can help detect problems early and provide care that considers patient gender, race and socioeconomic status (University of South Florida (USFHealth), 2021).

Increased informatics competency has also been associated with lower levels of stress in less-experienced nurses (Kaihlanen et al., 2021). This lessened stress was not true, however, with more experienced nurses in this study. Lower levels of nursing stress are important to patient safety. Melnyk and colleagues (2018) found that nurses with suboptimal mental and physical health were associated with a higher likelihood of medical errors. While the current generation of nurse graduates are digital natives and use technology every day, experienced nurses may not have as much comfort with technology in general. Without comfort with technology, nurses may have a harder time feeling confident with informatics in healthcare. Improving informatics competencies can help to lower stress and may help to reduce medical errors.

While gender did not show any differences in SANICS scores in this study, White non-Hispanic participants scored higher on the role subscale than their minority counterparts. Although great strides have been taken to reduce the racial and socioeconomic digital divide, it still exists. Those with limited access to HICT have reported computers and the data they produce as difficult or unfriendly (Ball et al., 2019). Diversity in the workforce, however, has been found to improve performance and outcome, and having more diversity in informatics positions can help improve comfort with computers (Gomez & Bernet, 2019).

Foster and Sethares (2017) completed an integrative review to find what strategies were used to implement informatics in curriculum, as well as to describe what helped or hindered faculty when implementing informatics in their courses. They identified two strategies that are in use in many programs today: using a learning management system even for classroom-based courses and using a realistic EHR during simulation experiences. The literature also supported providing faculty training on informatics and working with informatics.
Phillips and colleagues (2019) focused on developing a curriculum to implement the Quality and Safety Education for Nurses (QSEN) informatics competencies to improve practice. QSEN addresses the knowledge, skills and attitudes that nurses need to continuously improve quality and safety (QSEN, 2020). Phillips and colleagues reviewed informatics teaching strategies and included challenges, benefits, and costs to each strategy. They then developed “key actions” to help faculty teach informatics competencies that included 1) providing digitally enhanced case studies, 2) collaborating with informatics specialists to develop templates within the EHR that demonstrate that safe and quality care has been carried out, 3) employing technology that promotes active learning in staff development programming, 4) formally sharing what is and what is not working, and 5) offering staff development opportunities that teach and review EHR and technology basics (Phillips et al., 2019, p 395). Including key actions such as these in the curriculum can help new NEs to develop courses that help their students gain informatics competency.

Limitations

The sample in this study was limited to graduate NE students who were enrolled in a required informatics course. Students elected to have their data analyzed and may not be representative of graduate nursing students. Self-ranked competencies may not be reflective of actual competencies.

Implications for Practice

Informatics needs to be taught and developed throughout all levels of nursing education to help new nurses understand the technology and data to provide optimal patient care. Basic informatics competency education must be part of undergraduate education while more advanced competencies are included in graduate- and doctoral-level education. Graduates of nurse education programs need to have at least a proficient competency in informatics to teach the next generation of nurses. In previous studies, educators did not have a sufficient level of informatics competency, this insufficiency may have limited them from providing adequate education (Bove & Sauer, 2022; Forman et al., 2020). This problem can be addressed by focusing on improving graduate NE students’ knowledge and proficiency in informatics so they can teach future generations. Educators need to learn the best ways to provide education on informatics at all levels of nursing education. Adding content about informatics to NE programs will help better prepare them to educate future nurses.