International Journal of Medical Informatics (2005) 74, 1021—1030
Nursing informatics knowledge and competencies: A national survey of nursing education programs in the United States Barbara J. McNeil a,∗, Victoria L. Elfrink b, Susan T. Pierce c, Suzanne C. Beyea d, Carol J. Bickford e, Carolyn Averill f a
Division of Nursing and Health Sciences, Lewis-Clark State College, 500 8th Avenue, Lewiston, ID 83501, USA b Ohio State University, OH, USA c College of Nursing, Northwestern State University, LA, USA d Dartmouth-Hitchcock Medical Center, NH, USA e American Nurses Association, DC, USA f St. Luke’s Regional Medical Center, ID, USA Received 19 January 2005; accepted 15 May 2005 KEYWORDS Nursing informatics; Education; Nursing education; Health informatics; Nursing curricula
∗
Summary An online survey of deans/directors of 266 baccalaureate and higher nursing programs in the U.S. was developed by informatics expert nurses. Participants (1) identified nursing informatics (NI) competencies and knowledge of undergraduate and/or graduate students in their nursing programs; (2) determined faculty preparedness to teach NI and to use informatics tools; and (3) provided perceptions of NI requirements of local practicing nurses. Frequency data and qualitative responses were analyzed. Approximately half of undergraduate nursing programs were teaching information literacy skills and required students to enter with wordprocessing and email skills. Least visible informatics content at all levels included the use of information system data standards, the Nursing Information and Data Set Evaluation Center criteria, the unified medical language system (UMLS), and the nurse’s role in the life cycle of an information system. Almost 50% of respondents perceived faculty as ‘‘novice’’ and ‘‘advanced beginners’’ in teaching and using NI applications. Participants reported no future plans to offer NI training in their region. Findings have major implications for nurse faculty, staff developers, and program administrators who are planning continuing education opportunities and designing nursing curricula that prepare nurses for use of the electronic health record and 21st century professional practice. © 2005 Elsevier Ireland Ltd. All rights reserved.
Corresponding author. Tel.: +1 208 792 2406; fax: +1 208 792 2062. E-mail address:
[email protected] (B.J. McNeil).
1386-5056/$ — see front matter © 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2005.05.010
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1. Introduction The uses of new and emerging technologies are being considered key to decreasing medical errors and easing the burden of paperwork for the nurse. As healthcare increasingly focuses on timely information to drive decision-making and to support the electronic health record, the use of informatics to support practice must be integrated into nursing education program curricula to prepare graduates for the workforce of which informatics is increasingly an integral part.
1.1. Literature review The importance of including informatics knowledge and skills within nursing curricula is well supported in nursing literature and by major professional organizations [1—4]. In 1997, the Division of Nursing of the Health Resources and Services Administration (HRSA) convened the National Nursing Informatics Work Group (NNIWG) comprised of 19 experts in the country to advise the National Advisory Council on Nurse Education and Practice (NACNEP) about priorities for nursing informatics education and practice in the U.S. From these recommendations, the National Informatics Agenda for Nursing Education and Practice was generated as well as recommendations for including core computing and nursing informatics (NI) concepts in nursing curricula [5]. The American Nurses Association recently revised the Scope and Standards for Nursing Informatics Practice [6]. Within these standards, computer literacy skills, information literacy skills and overall informatics competencies are delineated for the beginning nurse, experienced nurse and the Informatics Nurse Specialist. Computer literacy skills include use of word processor, database, and spreadsheet software, and using email and other informatics applications to document care. Information literacy is a skill set that enables the nurse to locate, access and evaluate information. Access includes the ability to conduct bibliographic retrievals and to locate, retrieve, and evaluate information from the Internet. Overall informatics competencies are those that relate to the care of patients such as interpreting patient and nurse information, using informatics applications for nursing and addressing privacy, confidentiality and security of information in nursing practice. A complete review of the last 15 years of empirical studies addressing the integration of information technology competencies and the progression of information technology in nursing education can
B.J. McNeil et al. be found in the article by Staggers, Gassert and Curran [7]. They concluded that the integration of information technology knowledge and skills into nursing education curricula has been a slow process and that no consistent curricula for nursing information technology exist in nursing education programs. The work of Staggers, Gassert, and Curran has been the most recent work in promoting information technology in nursing education. Using a review of the literature from 1986 to 1998, and input from a panel of NI experts, these authors have developed 304 nursing informatics competencies for four levels of practicing nurses: beginning nurse, experienced nurse, informatics nurse specialist and informatics innovator. The broad categories of competencies and accompanying specific competencies should guide nurse educators in designing curricula to prepare nurses for all levels of professional practice.
2. Methods The current study builds on previous research and is guided by three research questions.
2.1. Research questions This article reports findings of a study examining the perceived scope of nursing informatics knowledge and skill competencies of nurse faculty, practicing nurses and baccalaureate and masters prepared student nurses in the U.S. The major research questions were: 1. What specific informatics knowledge and skills currently are being taught in baccalaureate and masters-level nursing education programs across the U.S.? 2. To what extent are faculty members prepared to teach this knowledge and these skills? 3. What are the perceived current and future uses of informatics tools used by practicing nurses across the U.S.?
2.2. Instrument The principal investigator secured a small faculty development grant from a regional college in Idaho to partially fund the development of an online survey. The Information Technology Education in Nursing Curricula Survey (ITENCS) was developed on paper and then refined for submission to an online service that reformatted the survey and managed survey responses.
Nursing informatics knowledge and competencies Table 1 Survey questions corresponding to 11 broad content categories on the Information Technology Education in Nursing Curricula Survey (ITENCS) Survey question number(s) 1—4 5—11
12
13—16
17
18—19
20
21—26
27—29
30
31—37
Broad content category Demographic data from respondents Availability of informatics/ information technology courses or training by region Informatics/information technology skills and knowledge of nurses in the region Informatics/information technology skills and knowledge required of undergraduate and graduate students at entrance/exit from these programs Program’s current continuing education or staff development requirements for informatics/ information technology Informatics/information technology skills taught/should be taught by nurse faculty Method of validating students’ informatics/information technology skill Regional use of informatics/ information technology tools by nurses Perception of faculty’s informatics/ information technology skills Plans for future informatics/information technology training in the region Perceived need (current and future) for nurses trained in informatics/information technology
Survey questions were developed from the nursing informatics literature and content validity was established through review by nursing informatics experts serving on the American Nurses Association’s (ANA) Committee on Nursing Practice Information Infrastructure and the ANA’s Nursing Information and Data Set Evaluation Center (NIDSEC). The initial paper survey contained 11 broad categories of questions (see Table 1) that resulted in the online survey version containing a total of 37 discrete questions. Broad informatics core content domains and related specific content areas are displayed in Table 2.
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2.3. Sample and procedure After obtaining human subject approval for the survey from the college Institutional Review Board (IRB), the primary investigator created mailing labels obtained from the American Association of Colleges of Nursing (AACN) for all 672 member and non-member baccalaureate and higher nursing programs in the U.S., including the territory of Puerto Rico. A letter was mailed to each dean/director of the nursing program outlining the purpose of the research, assigning a pass code for the online survey, indicating a deadline for submittal and contact information for further questions. A statement was also included explaining that completing the survey constituted consent to participate. Program deans and directors were encouraged to complete the survey or to assign the task to an appropriate member of their program. Data, including date submitted and pass code number for each participating program, were tracked on a weekly and then monthly basis by the online service agency. This service, blinded to respondents, managed the data collection. E-mail reminders included a link to the survey and the deadline for participating in the study. These reminders were sent to those who had not responded after the first 6 weeks of the study. A second e-mail was sent notifying programs that data collection was extended for 2 months until the end of July, 2001. A Web search was made to obtain names and email addresses for programs whose e-mail returned (n = 33). Twelve of 33 email addresses were not found. Some respondents indicated reasons for not submitting the survey: no longer in director position (n = 10); on vacation/sabbatical leave or out of the country (n = 9); not knowledgeable about the content (n = 8), unable to access the survey (n = 10). Attempts were then made to identify the appropriate person to complete the survey at programs that did not initially respond. Seven schools reported difficulty with link activation. Support from the online survey vendor was solicited to help participants who reported that they were ‘‘unable’’ to access the survey. In most cases, investigation revealed the inability to access the survey was due to configuration of the school’s computer system. Seven requests for a faxed version of the survey were filled. The survey collected quantitative and qualitative data. Data analysis included frequencies using the statistical package for the social sciences (SPSS). Spradley’s [8] ethnographic method was used to analyze data for the survey questions with a qualitative component. In those instances, subjects were asked to explain a rationale for
1024 Table 2
B.J. McNeil et al. Informatics core content domains related to specific content areas in the ITENCS
No.
Informatics core content domain
Twenty-five specific content areas in survey
1
Informatics/information technology
Definitions Historical development State of the science: informatics theory Expected informatics nurse competencies
2
Computer technology
Types/functions of hardware and software Networks (configurations and usage)
3
Information processing
Accessing electronic resources General Systems Theory Information processing frameworks and research Adoption of innovation and change theories
4
Information systems for nursing practice, education, management, and research
Types and applications of information systems Computer-based patient record Standardized language and classification systems The Unified Medical Language System National health databases
5
Life cycle of information systems
Roles of healthcare members Planning, designing, implementing, evaluating, and upgrading a system Ergonomics (human factors research) ASTM, ANSI, HL7, and other data standards NIDSEC standards for systems
6
Telehealth/telemedicine
Types and applications to practice Legislative issues (e.g., HIPAA) Legal issues in telehealth
7
Professional issues
Ethical use of information and information systems: privacy, confidentiality and security Evidence-based practice
their quantitative response or provide illustrative examples using free-text answers. The submitted responses were examined in their native form. Specifically, each open-ended question was treated as a separate organizing framework and the answers were transcribed verbatim and compared with the other open-ended responses for that question. The responses were grouped in larger taxonomic domains by virtue of some similarity. The first element of the structure of a domain is a ‘‘cover term’’. For example, using an example from the survey, the cover term ‘‘mobile computing’’ was identified as a symbol of a larger unit of knowledge, representing the views of the population of nurse faculty for the semantic relationship of ‘‘the types of technology tool competencies used in the future’’.
3. Results A total of 266 nursing programs out of 672 (return rate = 40%) submitted the survey. Of this sample,
65% (n = 172) were nursing program administrators, directors, managers or deans and less than 28% (n = 74) were nurse educators. Respondents represented programs from all states within the U.S. and the territory of Puerto Rico with the largest regional responses from the South Atlantic area (District of Columbia, Delaware, Florida, Georgia, Maryland, North/South Carolina, Virginia, and West Virginia.) and the Eastern North Central Region (Illinois, Indiana, Ohio, Michigan, and Wisconsin). Almost half of the respondents served urban settings, less than a third served rural areas, and one-fifth reported serving a combination of urban and rural constituencies. A total of 357 deans/directors did not respond to the survey and did not provide reasons for not participating.
3.1. Undergraduate nursing programs 3.1.1. Informatics knowledge and skills For 50% of the sample (n = 132), the informatics content reported most frequently (see Table 3) was
Nursing informatics knowledge and competencies Table 3
1025
Perceived frequencies of informatics content taught in undergraduate nursing programs in the U.S
Twenty-five specific informatics content areas
Percentages (%) and number (n) of programs reporting informatics content is taught in undergraduate nursing curricula
Accessing electronic resources Computer-based patient record Ethical use of information systems Informatics nurse competencies Informatics definitions Hardware and software Evidence-based practice Information systems in nursing practice, education, management, research National Health Data Databases Nursing standardized languages Adoption of innovation and change theory Informatics theory Informatics historical development Information processing frameworks/research General systems theory Types of telehealth applications Use of computer networks Legal issues for telehealth Roles of health care members in info system life cycle Legislative issues in telehealth e.g., HIPAA) Planning, designing, implementing, evaluating, and upgrading an information system Ergonomics with information systems Unified Medical Language System Data standards: ASTM, ANSI, HL7, ‘. NIDSEC standards for information systems
50 (132)a 46 (121)a 45 (121)a 40 (105)a 39 (104)a 38 (102)a 37 (98)a 37 (98)a
a b
31 (83) 30.5 (81) 30 (79) 29 (77) 27 (73) 26 (69) 25 (67) 23 (60) 21 (56) 20 (52)b 19 (51)b 16 (43)b 12 (33)b 12 (33)b 11.3 (30)b 6 (15)b 5 (14)b
Highest (>35% of undergraduate programs) informatics content areas reported as taught. Lowest (≤20% of undergraduate programs) informatics content areas reported as taught.
‘‘accessing electronic resources’’. Slightly less than half of responding programs reported the ethical use of information systems and the computer-based patient record were taught in undergraduate nursing programs. Slightly greater than one-third of programs (37%, n = 98) reported ‘‘evidence-based practice’’ was a component of the undergraduate curriculum. Less than half of the respondents (40%, n = 105) selected ‘‘informatics nurse competencies’’ as content within undergraduate programs. Specific informatics content areas determined to be the least visible are shown in Table 3 and included data/information system standards such as the American Society for Testing and Materials (ASTM), health level 7, and the American National Standards Institute (ANSI); and the Nursing Information and Data Set Evaluation Center (NIDSEC) criteria. Less than 20% of programs reported teaching information system life cycle activities.
3.1.2. Informatics skills required for undergraduate program entrance and exit It is remarkable that only about half of U.S. baccalaureate nursing programs require undergraduate nursing students to enter with basic wordprocessing and e-mail skills (see Table 4). Only 25% (n = 67) of those responding expected students to enter with information literacy skills such as bibliographic retrieval skills via the library and/or the Internet. About 40% (n = 98) of programs required students to be proficient in accessing the Internet/WWW upon entering the undergraduate nursing programs. As expected, almost 80% of nursing undergraduate programs expected students exiting from their programs to demonstrate computer literacy skills (word-processing and e-mail) and information literacy skills (bibliographic retrieval and use of the Internet/WWW). Prior to graduation, competency in using databases and spreadsheets was expected
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B.J. McNeil et al.
Table 4
Informatics skills reported as required for entering undergraduate and graduate nursing programs
Informatics skill
Percentages (%) and numbers (n) of undergraduate programs reporting informatics skill is required upon entry into program
Percentages (%) and numbers (n) of graduate programs reporting informatics skill is required upon entry into program
Word-processing Use of Email Use of the Internet/WWW Bibliographic retrieval via use of library-based resources Bibliographic retrieval via use of the Internet Use of presentation graphics software Database applications Spreadsheet applications
51 47 37 25
41 39 34 29
(135) (124) (98) (67)
22 (59)
26 (69)
9 (24) 8 (22) 8 (21)
15 (41) 15 (41) 12 (32)
in only one-third of undergraduate programs. A majority of programs reported that validation of computer literacy skills occurs indirectly through integrated course assignments. Others reported
Table 5
(108) (103) (91) (76)
central validation strategies for students upon exit from the program that included demonstration of competencies, completion of a computer course or computer literacy exam.
Perceived frequencies of informatics content taught in graduate nursing programs
Twenty-five Specific informatics content areas
Percentages (%) and number (n) of programs reporting informatics content is taught in graduate nursing curricula
Accessing electronic resources Ethical use of information systems Evidence-based practice Information systems in nursing practice, education, management, research Informatics nurse competencies Adoption of innovation and change theory Computer-based patient record National Health Data Databases Informatics definitions General systems theory Nursing standardized languages Informatics theory Types of telehealth applications Hardware and software Information processing frameworks/research Legal issues for telehealth Informatics historical development Roles of health care members in info system life cycle Legislative issues in telehealth, e.g., HIPAA Use of computer networks Planning, designing, implementing, evaluating, and upgrading an information system Ergonomics with information systems Unified medical language system Data standards: ASTM, ANSI, HL7, etc. NIDSEC standards for information systems
38 36 34 34
(102)a (96)a (91)a (89)
33 31 31 30 30 29 29 29 28 28 28 27 24 24 23 22 20
(88)a (82)a (81)a (80)a (79)a (77) (77) (77) (75) (75) (74) (73) (63) (65) (60) (58) (53)b
18 17 14 12
(47)b (44)b (36)b (32)b
a b
Highest informatics content areas taught as reported by ≥30% of graduate nursing programs. Lowest informatics content areas taught as reported by ≤20% of graduate nursing programs.
Nursing informatics knowledge and competencies
3.2. Graduate nursing programs 3.2.1. Informatics knowledge and skills Although the percentages are low, the informatics content areas most frequently taught in graduate nursing programs in the U.S. are listed in Table 5. It was disappointing that only 34% (n = 91) of programs reported including ‘‘evidence-based practice’’ in the graduate nursing curriculum. The lowest reported informatics content areas taught in graduate programs (see Tables 3 and 5) are identical to those reported as lowest in undergraduate programs. 3.2.2. Informatics skills required for graduate program entrance As shown in Table 4, less than half of the respondents required graduate students to enter with skill in using email and word-processing. A lower percentage of respondents required information literacy skills (bibliographic retrieval skills and accessing the Internet/WWW). The lowest reported informatics expectations for nurses entering graduate programs were in spreadsheet applications, databases, and use of presentation graphics software.
3.3. Faculty 3.3.1. Informatics skills taught Approximately one-third of programs (see Table 6) reported that nurse faculty members are teaching computer literacy skills: e-mail, spreadsheets, and databases. Over half of nursing programs surveyed indicated nurse faculty are teaching information literacy skills (bibliographic retrieval from both the Internet/WWW and library sources). 3.3.2. Average level of nurse faculty NI competency Using Benner’s from novice to expert framework [9], only two programs rated their nurse faculty
Table 6
1027 as ‘‘experts’’ in teaching and using information technology. The greatest percentage of nursing programs (39%, n = 103) rated faculty at the ‘‘advanced beginner level’’. A combined percentage of 86% (n = 229) of programs rated faculty as ‘‘novice’’, ‘‘advanced beginner’’, or ‘‘competent’’. Significantly, 18% (n = 48) of programs reported faculty as ‘‘novices’’ in this area. Less than one-third (29%, n = 78) of nursing programs reported faculty members at the ‘‘competent level’’. Nearly half (46%, n = 122) of programs reported either no future plans or did not know of any plans to offer informatics education or training in their region. 3.3.3. Evidence of a champion of nursing informatics Over three-fourths of nursing programs indicated there was a champion informatics user in their nursing program. This finding reflects potentially widespread support among nursing programs for informatics education in the curriculum.
3.4. Practicing nurses 3.4.1. Informatics tools currently used by practicing nurses Respondents indicated the most frequent use of informatics tools used by practicing nurses included: (1) remote monitoring devices (e.g., machines that monitor a single function such as electrocardiograms and temperature, pulse and respirations); (2) online consumer health tools including that serve to access and evaluate online health care resources; (3) handheld computers to document care or retrieve health information at the point of care. When asked to predict 5 years into the future, respondents identified similar informatics tools will be used predominantly by nurses.
Respondent’s perceptions of informatics skills taught by nurse faculty
Informatics skill
Percentage (%) and number (n) of programs reporting nurse faculty are teaching the informatics skill
Bibliographic retrieval via use of the Internet Bibliographic retrieval via library-based resources Use of Internet/WWW Use of presentation graphics software E-mail Database applications Spreadsheet applications Word-processing
57 54 50 42 35 31 27 23
(150) (144) (132) (113) (94) (82) (73) (62)
1028 Table 7
B.J. McNeil et al. NI positions reported as most needed in the future (n = 134 responses)
Cover terms (n)
Native terms (role description by respondent)
Systems analyst (23)
Involved in the planning, design, selecting, implementation, and evaluation of computer systems; CIO; process improvement; mediators between staff and technology Engage in telehealth; use of computers at bedside; electronic health record; management. Trainers; software troubleshooters, upgrade/implementation designers Nurses who work with insurance; database developers; quality assurance people; data mining and outcomes evaluation workers We need three people at our hospital; Local hospital hires one informatics nurse for every six units; At the local hospital, we have 21 positions; vendors hire locally I don’t understand the question; we are far behind; don’t have the background to answer this
Clinical use (10) On-site educators (6) Quality Improvement Nurses (11) Specific positions needed or already in place (13) Don’t know (48)
3.4.2. Need for informatics-prepared nurses Almost three quarters (n = 194) of respondents indicated that nurses in their regions were currently performing informatics work. Over half of those surveyed reported a moderate to high need for nurses prepared for informatics positions in healthcare. In the next 3 years, 81% (n = 213) of nursing programs projected that the need for informatics nurses will increase greatly (41%, n = 108) or increase somewhat (40%, n = 105). Reflecting a common theme among many regions, the greatest percentage of programs per region perceiving a moderate to high need for informatics nurses currently were from the East South Central, East North Central, Pacific, or South Atlantic regions of the U.S. Compared to other regions, the East South Central and Pacific region respondents most frequently projected the need for informatics-prepared nurses will ‘‘increase greatly’’ in the future. Representing a rural location, nursing programs from the Mountain region represented the lowest percentile in planning for informatics training or education for practicing nurses, faculty or students in the next year. As shown in Table 7, respondents projected that within the next 3 years there will be an increased need for system analysts for nursing informatics positions.
4. Discussion 4.1. Research question 1 In examining findings that answer the first research question, the data indicate that current baccalaureate nursing programs are beginning to emphasize ‘‘information literacy skills’’. However, faculty reportedly continue to teach computer literacy
skills. Expectations for informatics skills are low for students entering both undergraduate and graduate nursing programs. There are many gaps in informatics content taught at both levels of nursing preparation.
4.2. Research question 2 The findings regarding research question #2, the extent of faculty preparation for teaching informatics knowledge and skills, are unclear with respect to the breadth and depth of the informatics skills possessed by nurse faculty. Many respondents noted that information technology experiences such as the use of databases and spreadsheets were included in the nursing curriculum, but did not tie the use of these applications to clinical practice. Although informatics content and skills may be present in nursing curricula, it is not evident if it is the nurse faculty who were teaching informatics content and computer skills. The data indicate that there is a gap in the knowledge needed by faculty to prepare nurses to be skilled in information technology and its’ use to manage clinical information in daily clinical practice. According to Connors et al. [10], educators who teach with advanced technologies need to ‘‘develop new skill sets and reengineer their pedagogical approach so that technology itself remains transparent to the learning process’’ (p. 233). McCannon and O’Neal [11] reported that searching medical databases for information is a critical skill for new nurses.
4.3. Research question 3 The findings from research question #3 describe the program directors’ perceptions about the current
Nursing informatics knowledge and competencies and future uses of informatics tools by practicing nurses and underscore the need for nurse generalists and specialists to be knowledgeable and skillful in using informatics tools. The findings provide further support for more nurse informatics specialists and faculty with informatics expertise. Overall, the faculty do perceive the need for curricula that include evidence-based practice, technology skills and information literacy skills for data management and information processing.
5. Conclusion This study provides the empirical evidence of the critical need to include informatics concepts, informatics skills and the use of informatics tools in professional nursing practice within nursing curricula across the U.S. The schools of nursing deans/directors perceive a growing need for informatics specialists and nurse educators who are prepared to lead change related to informatics. Noticeably, the data indicate that informatics competencies and tools used most by practicing nurses (e.g., remote monitoring devices, handheld computers, and accessing online health care resources) are not currently identified as expected outcomes from graduates within the U.S. It would be useful to know the extent to which informatics tools are being incorporated into present curricula to prepare students for practice. Although the majority of nurse educators are primarily at the novice or advanced beginner level with the use of informatics tools and informatics skills, the need for faculty to be knowledgeable and skilled in informatics is paramount. If faculty in the U.S. have had insufficient opportunities to gain expertise with informatics tools used in daily nursing practice, this gap will transfer to existing nursing students. Instead, findings from successful models of collaboration with information technology partners such as in the E-Health Delivery System (SEEDS) project [10] must be analyzed and widely replicated across all geographic regions of the U.S. In this project, curriculum content includes virtual case studies that assist students to ‘‘think in a data-driven mode that, in turn, provides the foundation for evidence-based practice’’ [10, p. 230]. The nursing program utilizes Cerner’s clinical information system software for order entry, data repository, clinical documentation and clinical decision support tools in a ‘‘live-production’’ environment. The finding that 75% of programs reported a champion informatics person is very positive and reflects a pool of faculty who are interested in
1029 promoting the integration of informatics concepts and skills in nursing program curricula. Although the majority of programs reported a champion, sufficient funding of continuing education offerings to assist faculty to achieve the necessary level of competency remains a challenge for nursing deans/directors. It was interesting to find that the programs indicating that there were no current opportunities for informatics training also indicated they were unaware of or there were no future plans to offer nursing informatics education/training in their region. This finding underscores the need for further education of nursing directors and faculty that specifically addresses the importance of informatics for supporting evidence-based health care. How can graduates of nursing programs be prepared to deliver evidence-based best practice within the ever-changing world of informatics as it relates to nursing if nurse educators have a knowledge gap and the programs do not include basic informatics content? Nursing programs and professional organizations should actively pursue efforts to establish a state-of-the-art national nursing informatics curriculum. Such an undertaking can assist the nursing profession in narrowing the ever-widening gap between nursing informatics education and practice.
Acknowledgments We appreciate Lewis-Clark State College for providing the resources that enabled us to accomplish this research. A special thanks to the expert input of members of the current American Nurses Association Committee on Nursing Practice Information Infrastructure and the Nursing Information and Data Set Evaluation Center Committee. We are grateful to the staff from iTelehealth Inc. for the quality of their online services.
References [1] B.J. McNeil, S.K. Sodom, Nursing informatics education in the United States: Proposed undergraduate curriculum, Health Info. J. 6 (2000) 32—38. [2] B. Carty, P. Rosenfield, From computer technology to information technology. Findings from a nation study of nursing informatics, Comput. Nurs. 11 (1998) 122—126. [3] J.S. Ronald, D.J. Skiba, Guidelines for Basic Computer Education in Nursing, National League for Nursing, New York, 1987. [4] S. Bakken, An informatics infrastructure is essential for evidence-based practice, JAMIA 8 (2001) 199—201. [5] National Advisory Council on Nurse Education and Practice. Report to the Secretary of the Department of Health and Human Services: a national informatics agenda
1030 for nursing education and practice, Washington, DC, 1997. [6] American Nurses Association, Scope and standards of nursing informatics practice, American Nurses Publishing, Washington, DC, 2001. [7] N. Staggers, C.A. Gassert, C. Curran, Informatics competencies for nurses at four levels of practice, JNE 40 (2001) 303—316. [8] J.P. Spradley, The Ethnographic Interview, Holt, Rinehart and Winston, New York, 1979.
B.J. McNeil et al. [9] P. Benner, From Novice to Expert: Excellence and Power in Clinical Nursing Practice, Addison-Wesley Publishing Company, Menlo Park, CA, 1984. [10] H.R. Connors, C. Weaver, J. Warren, K.L. Miller, An academic-business partnership for advancing clinical informatics, Nurs. Educ. Perspec. 23 (2002) 222—233. [11] M. McCannon, P.V. O’Neal, Results of a national survey indicating information technology skills needed by nurses at time of entry into the work force, J. Nurs. Educ. 42 (2004) 337—340.
