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Abstract
he world is in the midst of an informatics revolution. Informatics is reconfiguring our world view
from linear, hierarchical, and separate structured
realities to overlapping, interacting concepts and disciplines (Nelson & Staggers, 2008). Recognizing this revolution, the federal government first called for an Electronic
Health Care Record for the majority of Americans by 2014
(Raymond, 2004). President Obamas stimulus package,
the American Recovery and Reinvestment Act of 2009, addresses the improvement of health care services by specifically targeting health information technology (Title XIII)
and the development and implementation of electronic
health record systems (EHRS). All three major professional nursing associations, as well as a national nursing
informatics coalition, have published policy statements
that support competency in nursing informatics for all
practicing nurses, as well as nursing students (American
Association of Colleges of Nursing [AACN], 2008; American Nurses Association [ANA], 2008; National League for
Nursing [NLN], 2008; Technology Informatics Guiding
Education Reform [TIGER], 2009). The NLN identified
the importance of preparing the next generation of nurses
to practice in a technology-rich environment and called on
faculty, deans, administrators, and the NLN itself to advocate that all students graduate with up-to-date knowledge
and skills in each of three critical areas: computer literacy,
information literacy, and informatics (NLN, 2008).
The Institute of Medicines (IOM) Quality Chasm series
identified that the quality of patient care would improve
when safety is assured. To that end, the faculty members
of the Quality and Safety Education for Nurses (QSEN)
panel adapted the IOMs competencies for nursing by proposing definitions that described essential features of respected and competent nursing (Cronenwett et al., 2007).
Knowledge, skills, and attitudes (KSAs) for each defined
competency were developed for prelicensure nursing education programs. Of the six competencies identified by
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Method
Because this was an exploratory study, the qualitative
constant comparative method (CCM) was used to analyze
the data and identify significant patterns across individuals and among groups. This process was repeated until the
researchers assessed the saturation point of data clustering and recurring patterns of theme identification. The
research team chose the CCM because it is an analytic
procedure for generating theory in a systematic way. The
constant comparison of incidents on the basis of as many
of their similarities and differences as possible brings
out underlying uniformities and diversities and accounts
for differences with single, higher level concepts (Glaser,
1965, p. 444). The goals of the CCM are to discern conceptual similarities, to refine the discriminative power of categories, and to discover patterns. In this way, researchers
can develop a theory inductively by categorizing, coding,
delineating categories, and connecting those categories
(Boeije, 2002).
The process of CCM is both descriptive and explanatory. CCM internal validity occurs when data categories
are understood within context (Dye, Schatz, Rosenberg, &
Coleman, 2000), and internal validity of findings increases when comparisons are highly regarded (Boeije, 2002).
External validity is achieved when data are understood
through comparison (Dye et al., 2000). Sampling that has
been conducted in a reasonably homogeneous sample provides the basis for generalizing the concepts and relationships between them to units that may be absent from the
sample but which represent the same phenomenon (Boeije, 2002, p. 393).
As a team, all three researchers reviewed the transcripts, noted responses across each open-ended survey
item within each interview, and coded categories of responses to determine the core message or the storyline.
The team then compared each response to open-ended
items on the interview guide across interviews and coded
categories of responses to determine patterns and themes.
Categories were compared until saturated and delimited
to achieve parsimony of variables and a more applicable
scope of the theory.
Results
Four major themes emerged based on direct quotes,
codes, categories, and clusters (Table).
Theme 1: Teaching Strategies
Without exception, every faculty participant identified
teaching documentation skills through a demonstrationreturn demonstration method. Through both group and
one-on-one instruction, faculty reviewed some examples of
nursing notes using textbooks or samples from the medical
record such as I first review the hospitals documentation
system then I orient students to the hospitals documentation requirements. Students write a draft note for their
assigned patient that faculty correct and edit, and then co617
Table
Summary of Major Themes
Major Theme
Teaching strategies
Learning from
experts
Cluster
Teaching/learning
Discovering ways of
knowing
Role identity/
perception
Categories
Codes
Providing illustrations,
examples
Group learning exercises
One-on-one instruction
Enhancing skills
Learning from role models
Stimulating critical thinking
Unlearning/learning
Role-modeling through
critique
Teaching, learning,
teaching
Knowledge to application
domain
Critical thinking
Legal/ethical/
institutional issues
Protection
assurance
Visibility/invisibility
Encountering barriers
Protection/nondisclosure
Patient specific
Institutional and policy
issues
Legal and liability
Ethical
sign after the student entered the information into the clinical documentation system. Continuing group discussion
of documentation principles along with individual editing
of students notes were identified as leading to successful
note writing by students. Rationale for this group as well as
one-on-one teaching-learning strategy was to enhance documentation skills and stimulate critical thinking. Faculty
felt strongly about the value of this method, even though
the recurring sentiment was: Its very time consuming to
check through ten student notes twicetheir initial note
and then corrected copy and then countersign. But I feel
this is the best way. From participants general comments
about documentation, almost all faculty wondered if and
how much documentation was taught in lecture, as well
as in the college laboratory, and believed they taught the
bulk of clinical documentation in the clinical areas. For example, Sometimes documentation material is not covered
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Illustrative
Respondent Quotes
Faculty reviews note,
student documents and
faculty counter signs note
in chart.
Review paper and
electronic documentation;
provides sample.
Emulated staff RN notes.
Discussed concepts
and reviewed individual
documentation.
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