I strongly suspect this issue does not get enough attention…
Student placement and the use of digital systems
Aug 29, 2022 | Aged care, Community Chats, Community of Practice, Data, Digital Health, eHealth, Innovation, Nursing & Midwifery Informatics
Sally Duncan
Chief Nursing & Midwifery Information Officer, Northern Sydney Local Health District
Before digital health, things were much simpler for both the student nurse, and midwife, in relation to learning how to document assessments, medications, observations, and care. Back in the early eighties, when I trained in both areas, we had a very hands-on integrated approach to learning how to document, compared to today’s world, with basic observational charts, fluid balance charts, medication charts and what was known as a ‘Nursing/Midwifery Kardex’ to document care and plans. What we learnt around nursing and midwifery documentation in the classroom, was then emulated on our placements under the supervision of the registered nurses/midwives and tutors. At the end of each placement, we mastered the art of caring for and documenting our patient’s/woman’s/baby care assessments, goals, treatments and interventions, for that specialty/area.
Today, it has become much more complex. There is not only paper documentation but more often than not there is a digital health record and other digital health technologies to learn. Do the current nursing and midwifery undergraduate students have the same experience in preparing them for their placements? With the fairly rapid rise in digital health, it seems university education around preparing students for digital health systems has lagged. In 2013, Baillie et al. [1] conducted a survey that investigated student nurse and midwife experiences of using the electronic medical record (EMR) in practice. The results indicated that there needed to be more opportunities to enable students to be more competent in using EMRs prior to placement, with a request for more hands-on practice in a simulated environment. Following the published paper, a collaboration between the university and its affiliated health organisations established governance around onboarding and guidelines around usage, and also provided formalised EMR training for their students.
A recent qualitative study by Peacock, Slade & Wilson [2] around nursing and midwifery students’ perspectives on the use of digital systems during placements revealed that moving between paper and digital records was quite taxing. Whilst they recognised the benefits of documenting digitally, the participants considered paper much easier to use and documenting digitally at the bedside proved onerous for many. Again, for many, a lack of preparation and access granted to them to use the system was often challenging and frustrating. The study summarised that the students felt that being able to practice in a simulation centre with the ability to have interactive modules prior to placement would make them more confident in using the systems to review and document patient care.
In addition to learning how to document in an EMR, a student also has to work with other digital technologies, such as smart intravenous pumps, wearables, virtual care, and cybersecurity, to name a few. They are also required to understand nursing and midwifery data terminology, and the use of clinical technologies is only looking to expand in the future [3-4]. Within Australia we have had an explosion of digital health maturity – Queensland Health has adopted a single digital record strategy [5], NSW is in the process of finding a vendor to consolidate the domains of its digital records and pathology into one single digital health platform [6], and both Western Australia and Tasmania have announced budget and planning for a single digital health platform [7-8].
Where does this leave our student nurses and midwives today? Some great work has already been achieved to assist not only students but the general nursing and midwifery workforce, with the development and publication of a National Nursing and Midwifery Digital Health Capability Framework [3], and free competency-based learning modules hosted by the Australian College of Nurses [9]. According to the Australian College of Nursing, “interactive online resource has been developed specifically for Australian nurses, midwives and nursing and midwifery students to support the development of their knowledge and skills in relation to digital health technologies. The content of the resource has been informed by the National Digital Health Strategy, the development of which was led by the Australian Digital Health Agency (ADHA) in collaboration with key stakeholder groups including, amongst others, the Australian College of Nursing” [10].
Most students are frequent internet and social media users [10]. But for them to gain confidence in using digital health systems, there is a need for more digital health training [10-13], particularly around learning the concepts of digitally documenting, and a standardised approach, given there appears to be so much variability currently across university curricula. Foundational nursing and midwifery studies need to provide more digital health literacy interventions [10].
More here:
https://digitalhealth.org.au/blog/student-placement-and-the-use-of-digital-systems/
The increasing use of Digital Health technology is becoming more and more routine these days with the use of Electronic Health Records and other documentation systems – in nursing and elsewhere – becoming routine.
The issue in all this is just how well Digital Health skills and understand are being delivered to current cohorts of trainees and just how well those who were trained over the last 40 years are bought up to speed.
The ADHA appears to be aware of the problem but does not seem to be really pushing hard to dramatically improve things being much more focused on their “products”. See here:
The AIDH is similarly aware of the problem and runs courses (CHIA) for digital health experts and sees the need for workforce growth but does not appear to be seized of the need to get down to the grass roots of front-line workers.
Maybe a conference on how the skills of those on the front line can be improved and some wider research on just where things stand and where the gaps are could be pretty useful. Action would surely problem – as will the action follow after the regular coronial findings of software problems in the sector.
A recent reminder came to notice on the topic last week. See here:
https://medicalrepublic.com.au/whos-to-blame-when-the-software-gets-it-wrong/75863
While all this stuff is not as exciting as other Digital Health issues to most we need to research and plan properly to safely and comprehensively in this vital domain or much of the more exciting efforts won’t really get all that far.
Time for the ADHA, the States, Colleges and the AIDH to develop, fund and implement a coordinated national approach to Health Workforce Digital Health knowledge and literacy!
David
6 comments:
I think it will be important those teaching learn and learn fast. There is also the question of time, and just what is important to know? Like other tools you do not need to now the supply chain and manufacturing processes to use something.
"Today, it has become much more complex. There is not only paper documentation but more often than not there is a digital health record and other digital health technologies to learn."
Seems that technology has been implemented without any assessment of all the other things that need to be in place to make it work - like more time, more money, more training, more management, more risk, more security.
And that's assuming the technology can actually deliver some benefit.
The whole digital health push is drowning in unintended consequences. Except for the technologists who will walk away with their pockets full of cash leaving the rest of the world, including patients, to deal with the mess they have left.
Insanity - doing the same thing over and over again and expecting different results.
First the pathetic MyHR.
Then mygov, then the trusted ID system, then COVIDSafe, then the lack of of a visa processing system and then the miserable failure of the Digital Passenger Declaration:
‘Big dollars’ are needed to fix visa processing systems: O’Neil
https://www.innovationaus.com/big-dollars-are-needed-to-fix-visa-processing-system-oneil/
When will the government and the public service understand their systemic inability to build large scale IT systems. The ones that do work (and there are quite a few) have been developed over many years and many enhancements, usually by people with good skills and much experience - but they've all left after years of mismanagement and "whole of government IT outsourcing" and never been replaced.
Starting from scratch and using the hollowed out the public services IT sector (mostly project managers and bureaucrats) only delivers IT system failures - see above.
It's easy to trash public services IT, it's much harder to rebuild it. Good luck, you'll need it.
The first thing to do is recognise the problem, otherwise - just more insanity.
Under the banner of Insanity reference is made @9:24AM to some hugely costly Federal government IT failures.
Yet, for some inexplicable reason the MyHR continues on - receiving hundreds of millions of dollars each year - avoiding any meaningful scrutiny. And in an industry - health - which could benefit enormously were the hundreds of millions of dollars to be redirected into patient care.
There's a job advert for Director Enterprise Architecture at the ADHA on LinkedIn
https://www.linkedin.com/jobs/view/3247190610/
The job description looks like it's been written by a bureaucrat who doesn't know the first thing about Enterprise Architecture but who has been told to go and hire one.
Anyway on the LinkedIn page that describes the ADHA
https://www.linkedin.com/company/australian-digital-health-agency/
it says that the median tenure is 2 years.
Looking at the NSW Agency for Clinical Innovation
https://www.linkedin.com/company/nswaci/
the median tenure is 3.4 years
ACT Health
https://www.linkedin.com/company/act-health/
the median tenure is 4.9 years
My experience of looking for a job is that it is always much easier to get a job at a company with a high turnover. The trouble is you wouldn't want to work there, people keep leaving.
Considering 80% of enterprise architecture focuses on well the enterprise, and the APS is a very rigid and brittle structure of hierarchies, processes and norms I can’t see much for the “enterprise” architect. Still at least they have given up on healthcare outcomes.
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