Understanding Nursing Student Needs Regarding Efficacy and Usability for a Simulated EHR
Event Type
Poster Presentation
TimeThursday, April 152:00pm - 3:00pm EDT
LocationEducation and Simulation
Description1. Goal: This presentation will bring together a learning scientist and a user experience researcher from a global health and analytics company that strives to deliver impactful digital solutions for nursing education. Together, they will focus on the significance of understanding learner/user needs in order to deliver efficacious and user-friendly educational technologies. They will anchor their conversation in the context of a simulated electronic health record (EHR), a tool designed to help nursing students practice clinical skills (e.g., assessing pain, charting vital signs). Participants will take away insights into the nature of feedback that is sought (i.e., what metrics add value to an EHR tool), and examples of findings from undergraduate nursing students (i.e., what do learners/users need, expect, and value in an EHR tool) from a research study conducted in Fall of 2020.

2. Background: According to the U. S. Bureau of Labor Statistics (2020), employment of registered nurses is projected to grow seven percent over the decade. Specifically, about 175,900 openings for registered nurses are projected each year on average from 2019 to 2029. This growth is faster than the average for all occupations. However, continuing instruction and training for nursing students (as with other students) has posed new challenges in the wake of a global pandemic (Dewart, Corcoran, Thirsk & Petrovic, 2020). Clinical nursing education in particular is most impacted, impeding opportunities for students to practice and acquire complex skills, such as the ability to make clinical judgments. Leaders in nursing education have urged the field to continue their commitment to quality research and education.
In recent years, nursing education has witnessed an upward momentum in the use of simulations because they afford students a safe environment for applying theory to practice. It is not surprising that in 2020, we witnessed an accelerated growth in the adoption of digital simulations across multiple sectors of education--medical and healthcare education in particular. This trend will continue, enabling digital simulations to become an integral and required component of clinical learning and skill development to ensure practice readiness. As such, there is a need for continued examination and discussion about how we can augment the value simulations offer in advancing clinical nursing education (Foronda, Fernandez-Burgos, Nadeau, Kelley & Henry, 2020).

3. Simulated Charting for Nursing (SCN, pseudonym): SCN is a digital electronic health record (EHR) system that combines practical, real-world experience in electronic documentation with fully integrated educator support to help incorporate EHR practice into nursing programs. It is important that we get continued feedback on Simulated Charting for Nursing (pseudonym) to ensure that the tool and the resulting experience satisfies and enhances nursing students’ needs.

From a learning science perspective, we are interested in understanding whether the overall activity (a) provides a good introduction to EHR, (b) prepares students with specific clinical skills (e.g., charting vital signs and assessing pain), (c) prepares them for clinical situations, (d) helps them learn about a topic (e.g., health assessment), and (e) provides a good balance between guidance and freedom of movement in the learning process.

From a usability and user experience perspective, we want to understand: (a) how user friendly the interface is for nursing students in an end-to-end workflow for a simulated EHR charting experience, (b) how easy or difficult key tasks are, and (c) what areas require improvements to better meet the expectations of students.

4. What do nursing students need in an EHR tool:
78 students using Simulated Charting for Nursing in a Health Assessment course reported wanting the following in an EHR tool as part of their feedback in a study conducted in Fall 2020:
a. Authenticity and Preparation for Clinical Situations: Students described this need by way of wanting exposure to realistic situations and conditions while learning how to chart/document patient information. Furthermore, students expressed the importance of practicing patient interaction and assessment to further hone their charting skills.
b. Theory-Practice Integration: It is no surprise that students expressed wanting opportunities to bridge theory and practice. They described this need as being exposed to a variety of ways of charting, and having opportunities to deepen procedural knowledge.
c. Pedagogical Characteristics: Good tools embody characteristics of good teachers. As such, students noted the need for guidance; albeit, with freedom to make and correct mistakes while learning to chart. Similarly, access to examples/models of good charting and interactivity (e.g., pictures, animations, sounds, quizzes, hands-on learning) with relevant information and relatable clinical situations were described as desired characteristics.
d. Initial Orientation: Students expressed a need for an introductory guide or overview of the EHR tool’s interface to alert them to important areas. In particular, students who were in their first semester, and typically at the very beginning of their nursing studies, cited this need since they were so new to understanding EHRs.
e. Ease of Use: Students expect and appreciate easy to use tools. They mentioned a few areas where usability could be enhanced in the EHR by giving them the opportunity to confirm their intent to submit a chart or an assignment in order to avoid premature submission. In addition, students indicated a desire to receive email notifications when their instructors had posted feedback on their assignments since this would save students time and avoid them having to check back at random.
f. Clear Navigation: Given the large number of charts contained within an EHR, students want clear navigation so they can quickly find the appropriate chart they need at any given point. Access to a Search functionality for quickly finding a specific chart was also suggested as being desirable.

We believe that our synergistic research approach (learning science + user experience) aligns well with the education and simulation track that focuses on the intersection between human factors and ergonomics and education technologies within the healthcare context (simulated EHR in this case). A cohesive and continuous approach to understanding nursing students' needs can lead to efficacious and user-friendly educational tools, and support larger goals of patient safety and care education.
Principal User Experience Researcher