Using the academic electronic health record to build clinical judgment skills in the classroom setting

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Highlights

  • The academic EHR usage in undergraduate nursing education is limited mostly to the lab or clinical setting, but it can help build clinical judgment in the didactic setting as well.

  • The academic EHR was used in an unfolding case study exercise throughout the semester of a Foundations of Nursing course to complement preclass reading assignments.

  • Students found the activities engaging and important in increasing their comfort with the clinical setting EHR. Faculty found the activity effective in practicing clinical judgment and a minimal time commitment each week.

Abstract

Nursing faculty used an academic electronic health record to promote clinical judgment skills in a prelicensure Foundations of Nursing course. Students reviewed weekly patient charts for class preparation. During class, students and faculty discussed the findings, trends, nursing interventions, and rationales that pertained to the weekly course content. Students reported that the activities helped prepare them for clinical patient care. Faculty found that students came to class more prepared and able to engage in discussion. Faculty learned lessons by trial and error throughout the semester to make the workflow and creative process easier in the future.

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.

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