Using the academic electronic health record to build clinical judgment skills in the classroom setting
Section snippets
Background
Using electronic health records (EHR) and electronic medical records (EMR) are important competencies in the nursing scope of practice in healthcare worldwide. Informatics education is essential for graduating nurses to meet entry-level professional nursing education requirements held by the American Association of Colleges of Nursing (American Association of Colleges of Nursing, 2021).
Informatics competencies are weaved throughout the Quality and Safety Education for Nurses (QSEN) initiative.
Framework
The framework that guided this learning strategy is the National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (CJMM). This evidence-based model was created to validate student's clinical judgment and is at the center of a current shift of the design of the NCLEX exam (National Council of State Boards of Nursing). The weekly class preparation was designed around the steps of the CJMM and used the same terminology: Recognize and Analyze Cues, Prioritize
Current Strategies to Build Clinical Judgment in Nursing Education
Simulation continues to gain popularity as clinical sites have become more difficult to obtain throughout the COVID-19 pandemic, including the use of the unfolding case studies. With the unfolding case study, students are given realistic, clinical scenarios which develop over time. These case studies have unpredictable problems and incomplete information provided, requiring students to use clinical forethought regarding potential decisions (Meiers, 2019). The instructor helps facilitate
Vision
The professor desired to design an engaging activity that would push students to connect with their textbook and other resources and build clinical judgment through class discussion. Knowing this would revolve around patient case studies, the professor had a vision to mock patient care in the classroom for a Foundations of Nursing course. The students are learning to care for patients, so the vision was to bring patient care into lecture as realistically as possible. The professor thought an
Implementation
The academic EHR was the center of a class preparation activity in unfolding case study style for a Foundations of Nursing class. Students followed a simulated patient through the EHR each week of the semester. The activity prompted students to review the EHR for cues related to current and past course content, with recommendations to read sections of the textbook and answer questions designed to build critical thinking skills. This was used in lieu of the traditional preclass reading
Student Feedback
The first couple of weeks of the semester, the students were directed simply to review the patient charts weekly for new notes and orders and come to class ready to discuss. Most students were able to attempt the activity, while others struggled to find the information and make the connections with material. Upon reflection that the students were brand new to nursing practice and terminology, as well as the technology, the professor then added the preclass assignment details to the LMS so
Faculty Experience
The EHR application was not designed to have cases unfold over several weeks in this manner, but the professor worked with the product support team to find the most effective way. The first weeks of implementing the activity the professor worked through technical issues, such as students not being able to view the updates and figuring out how to time updates. Each day in class was treated as a “shift,” meaning the case spanned about two weeks of patient care in the chart for a traditional
Implications for Nursing Education
Practicing clinical judgment in the classroom is essential to effectively prepare students for the next-generation NCLEX and clinical practice. Though the academic EHR has been integrated into simulation and lab activities, there is limited evidence discussing its use in the classroom for nursing programs. Programs that already use academic EHRs for lab or clinical activities can maximize the investment by extending its use to the classroom.
Evidence supports that faculty desire more training
Implications for Research
There is a gap in research surrounding the implementation of an EHR in the classroom setting. There are opportunities to gauge student and faculty perceptions of these activities and evaluate their effectiveness in various ways such as course grades, course evaluations, standardized exam performance, and more.
Conclusion
Implementing the academic EHR in the classroom is an innovative approach to building clinical judgment. Bringing the academic EHR into the class setting can complement its use in lab, simulation, and clinical and build student confidence in using similar products. Professors can be creative in designing activities that would be meaningful and relevant for their course content.
Conflicts of Interest
None.
References (12)
Incorporating electronic documentation into beginning nursing courses facilitates safe nursing practice
Teaching and Learning in Nursing
(2016)- et al.
The need for academic electronic health record systems in nurse education
Nurse Education Today
(2017) - et al.
Introduction of patient electronic medical records (EMR) into undergraduate nursing education: An integrated literature review
Nurse Education Today
(2020) - et al.
Electronic medical record use in nurse education curricula: A systematic review
Teaching and Learning in Nursing
(2021) The essentials: Core competencies for professional nursing education
(2021)- et al.
Learning and transfer effects of an unfolding case study in an adult health nursing course
Nursing Education Perspectives (National League for Nursing)
(2022)
Cited by (1)
Spreadsheet solutions: Documentation on a dime
2024, Teaching and Learning in Nursing
- #
Presented at Nurse Tim Annual Conference February 2022, Orlando, FL (Virtual poster).