A Statement on "Computer Competency: An Energy Need" was issued by the College Board in early May 1983 in addressing academic preparation for higher education (Chronicle of Higher Education, 1983). The meaning of the statement is acute and evocative. In anticipation for the time that all high school graduates are "computer competent," we in nursing must prepare to be on top of the new technology so as not to lose our comparative advantage. And, there is no doubt that nursing is preparing. In a recent report of results of a 1983 survey of 342 schools, the CV. Mosby Company indicated that in the United States:
Almost 50% of the baccalaureate nursing programs currently own or have access to at least one microcomputer. Several schools own or have access to more than one microcomputer and a few programs own or have access to as many as 25 units.
About 50% of the schools have APPLE hardware. The remaining half is divided among many manufacturers' hardware (IBM-PC, TRS-80, COMMODORE).
Among the schools who have micros, about 50% indicated that their hardware is new and they are just learning to use it. Another 35% of the schools have developed applications for teaching, research, administrative work and word-processing. The remaining 15% are using the microcomputer exclusively at this time for administrative/word processing functions.
This article deals with the experiences of two nursing deans (The University of Iowa and University of Texas, Austin) and the considerations involved in preparing their nursing schools for the future of information technology.
Information technology is defined as equipment and techniques involving electronic communication, includes telephones, computers, word processors and onice systems, television, radio, and telecommunications. Typewriters, conventional copiers, file cabinets, books and card catalogs are excluded from this definition. The annual costs of equipment and staffing for information technology in many universities approach $15 million or more, and in our universities average slightly over five percent of the budget. The total capital investment may be approximately $35 million, and annual growth in these expenditures is predicted to be 25% to 35%. Moreover, because equipment costs are falling, increases in expenditures represent much greater increases in information technology use, perhaps 50% to 70% annually. Consistent with business trends, the bulk of the growth has occurred in colleges and departments, while universities' established technology centers have experienced more modest increases.
On both our campuses there are established computing centers offering a variety of computing faculties and services. There are centers for Academic Research and Instructional Computing, centralized Administrative Data Processing and Library computer services. At Iowa there is also a Hospital Information System. Generally, each university center has its own staff and computing equipment. There are no formal ties between the centers nor is there any physical interconnection of computing facilities. Coordination and information exchange are informal and occur primarily at upper management levels. In addition, Iowa has a telecommunications/video conferencing system and offers Telecourses as part of the off-campus study program. The University academic research and instructional computing centers accommodate several program languages and statistica! packages to offer a variety of computing facilities and services upon which we rely: assistance to faculty and services such as general technical and statistical consulting, short courses, data analysis and interpretation, and mainframe computer assistance which allow users to do all of the following: enter and analyze research data; enter, edit, and format text; visualize and modify a variety of graphic information; monitor ongoing experiments; construct and utilize large-scale data bases; link with other computer systems; interact with instructional programs; and output numerical, text, and graphic materials on sophisticated printers and typesetters. At both universities, through the Computing Center, there is an allocation of funds to each department to pay for instructional and research use of any of the mainframes by students and faculty. Other funds are available from Graduate College accounts or special grants. Matriculated undergraduate or graduate students can open an account with the Centers to pay for computing time used for individual educational purposes.
The satellite computer groupings, another aspect of each university's institutional array, provide instructional terminal clusters in departments, colleges, bureaus and dormitories across the campus and in both schools of nursing. Departments furnish space, student assistants, and partial costs. The academic computing centers furnish terminals and partially share maintenance costs. Each cluster is available to any member of the University community.
In both universities free, noncredit, short courses on the use of computer services and software are offered by computer center staff, who also provide walk-in and telephone consultation services, and other services such as keypunching, documentation and equipment maintenance. Library special services available to students and faculty for nominal fees include computerized document retrieval systems for bibliographic references. Faculty may charge reasonable numbers of such searches to the Nursing accounts. Librarians work with faculty and student clients to access any of the over 200 databases available.
At both universities centralized data processing is available on a monthly rental basis. This is a transaction-oriented facility and provides daily ledgers and monthly accounting statements, personnel information, student records and grant tracking. Each school of nursing rents a system using a computer terminal and teleprinter which is connected to the central data processing facility. This system allows the school's business office to access data for bookkeeping and accounting purposes, to coincide with University processing and ease in reconciliation of statements. We also access information such as class rosters, advisors and student record data and other types of enrollment data, and program mailing labels from the student records for mass mailings. Student grade data cannot be manipulated or altered through the school terminal.
A departure at Iowa is the availability of a computer equipment discount program to assist university faculty and staff in purchasing computing equipment. Under the program, faculty and staff can purchase selected personal computers, terminals, printers and communications equipment at 20%-30% discount. Iowa's Office of Information Technology has selected various brands and models of computing equipment according to functions, prices, and compatibility with existing University computing systems. New equipment is continually being evaluated for inclusion in the program. Vendors submitted quotes for quantity purchases and one vendor was selected for each equipment type, based upon price, service and delivery, among other things. To qualify for the program and the discounts, UI faculty and staff can visit the Center where much of the equipment is available for inspection. There, staff assist in the selection of equipment based on individual needs and are provided the necessary forms by which orders can be placed with selected vendors.
Information Technology in the Two Schools
Computer activities in both schools of nursing encompass instructional use, developmental, research, and administrative applications.
Both schools have had access to the University's mainframe computer for several years for research purposes. During the past three years Iowa's College of Nursing acquired two Texas Instrument portable computers, six CPT word processing office systems, a satellite computer cluster with 10 terminals, four different microcomputers, DEC writers and printing terminals, a letter quality printer, an administrative data processing system, and for student clinical experience and faculty research, access to patient data through the Hospital Information System. All Iowa nursing students must complete computer literacy requirements before graduation. Computer literacy means the student can identify the benefits and limitations of computer technology for the health professional and the consumer of health care; use the language of computer technology; apply computerized information technology to the discipline of professional nursing; is able to use different types of computers and computer software; and can use a computer-based hospital information system to input and retrieve patient data. Computer literacy course work requires both graduate and undergraduate students to use computer software packages.
Besides the availability of hardware, in Iowa's college are resources for using computers to teach with and teach about computers by means of computer technology learning packages for students and faculty; CAI packages; research and statistical packages; data searches; and, a design team to support faculty to use, evaluate and develop software. The design team consists of an instructional designer, a graphics/media specialist, a computer programmer to test and implement computer programs, and a systems analyst to plan and design entire systems of programs and procedures for administrative, faculty and student used.
At Austin the first computer equipment was purchased for the school's Research Center in 1977. Presently there are eleven Apple computers, four Cathode ray terminals, and six Compucorps word processors in use in the Nursing Building. The school's Learning Center utilizes one of the database management systems available on the CYBER mainframe to catalog and update information about film rentals, film reviews, software holdings, and subject headings. One of the services soon to be available in the Learning Center is a computer-assisted learning program. When the system is completed, five microcomputers in a network with a CORVUS hard disk drive will enable students to learn basic skills and theory at their own pace. Videotape and printer links will be available as well. Staff members on a federally funded Computer-Assisted Instruction project are developing an authoring system which faculty members will use to create instructional modules on the steps of the nursing process. Microcomputers and an interdisciplinary team combines nursing content with instructional design. Faculty evaluations are the basis of ongoing system refinement.
Nursing at Texas selected Compucorp equipment for inhouse administrative word processing in the school of nursing because of its available and adaptable software. For the same reasons Nursing at Iowa selected CPT word processors. Both use the systems for record keeping, multiple mailings, and biographical and other information on the status of prospective, current, and terminated employees. In both schools, word processing is used for the more complex typing jobs, such as reports, speeches, newsletters, handbooks, faculty scholarship, and merging mailing lists with letters, or to be printed on labels to facilitate the dissemination of information. Other general uses of word processing include maintaining rosters and yearly calendars of school events, recording and projecting budgets and budget changes for instant balances, letter writing, committee minutes and for sending and receiving electronic mail, and masterlists for mass mailing purposes, with the capability of screening for certain information.
In both schools computer-assisted instruction is used for teaching, tutorials, drill, and to learn varying practice concepts. At Austin, supported by the federally funded project, computer simulation models are being prepared for forecasting patient outcomes, assessing community health status, and identifying patients at high risk.
Moreover, both schools have computer educational and training workshop series designed to teach faculty and students who need it how computers work, how computers can be productively used, familiarity with machines and systems, specific applications in nursing, and provide for interactive experience for learners to use microcomputers, minicomputers and the mainframe computer. Time for the workshop series ranges from several hours to one day. The constraint of hardware access and limited interactive computer time is greatly alleviated by the availability of access to computer terminals for up to 16 hours daily. Instructional strategies consist of lectures, demonstrations and "hands on" teaching.
The Dean's Perspective
Major Considerations: A dean's forecasting ability meets its greatest test in planning for informtion technology. Beyond decisions about hardware, software and resource allocation, there are major issues to be addressed. Although many are university-wide concerns, the nursing dean will need to influence policy decisions, bargain with central administrators for collegiate initiatives, and disseminate and interpret information about impending decisions and new developments.
There are major questions with which the dean must grapple. Will the new technology be used for straight computational purposes? for administrative record keeping? for interconnection with other systems? for storage of large databases? for information management of large databases? as a teaching device? as a locus for scholarship? as a combination of all or part of these possible functions? What will it all cost?
In considering the decision (and it is hardly an option any longer) to include use of computer technology in the nursing program, the availability of funds and the amount of the budget to be allocated for computer technology is pivotal. Administrators must plan to have money in the budget to add new equipment and software as it becomes available, and there must also be funds to replace broken and obsolete equipment and software. The UTA School of Nursing experience indicates that microcomputers must be replaced every five years.
Consideration in developing computer technology in the colleges involves faculty interest in becoming computer literate and the availability of necessary resources and support services for faculty to become computer literate. It is a faculty decision to increase the use of technology in nursing education. In those schools where technology is little used, the reasons for the lack of use are lack of money, of course; and because, on the average, teachers do not like technology, do not welcome it, and do not want anything that will change or usurp even part of their jobs. The literature contends that we are not likely to think of economies until our jobs or incomes depend on it. There are also contentions that teacher acceptance is the greatest challenge to increased use of technology. It was also suggested that teachers may lack motivation as well as time and ability to produce software.
In both colleges, faculty development techniques consist of having authorities on the subject speak to faculty about the use of computers and the provision of computers for faculty to use. The interest in learning is there. It contributed to both deans making major investments in the use of the mainframe computer and microcomputers as teaching devices for computer assisted instruction, for student and faculty scholarship, for structuring environmental needs for successful implementation of information technology, teaching, scholarship and administration and in illustrating cost effectiveness.
Costs: Without any doubt the use of computer systems places a burden on the colleges using them. The management of the data and information used and produced by the various systems require close control and constant monitoring. Moreover, the expense involved can be formidable. Capital outlay for computer hardware purchases (terminals and printers), installation charges, word processing equipment and printers, and furniture, and initial software and manuals totaled approximately $50,000. We calculate annual maintenance costs at 10% of equipment costs. Total operating costs in 1981 dollars were $103,400 at Iowa and $142,302 at Austin.
Sources for funding are derived from federal grants, gift monies, and general university allocations. Both colleges use strategies for planning in six major areas: Capitol outlay for equipment installation, peripherals, accessories and furnishings; operating costs; faculty development (including courses, books, periodicals, home study materials, seminars, workshops, authoring systems); replacement costs for breakage, updates, enhancements and modifications; office automation; and computer-assisted-instruction. Operating costs include use of the university hardware, software and software development, maintenance contracts and warranties, expendables such as paper, diskettes, fans, information sources such as subscriptions for periodicals, trade publications, manuals, books, etc.; security monitors; dedicated space; human factors considerations and ergonomie aspects such as anti-static carpet, humidity control, lighting, assuring privacy, etc.; personnel to manage the system and for consulting and other faculty and student support; and rentals for such things as terminals and printers for administrative data processing. Office automation uses include word processing and text editing, electronic filing; electronic mail; electronic scheduling; data processing; subscriber databases; answering machines; and tools for instructors such as electronic gradebooks and test item generators.
Ttends (1981-1983): In both schools, in the past two years, we have observed increased numbers of computer projects; increase in on-line dollars spent for graduate student research; increase in student use of computers and computer time; increase in on-line connect time for all uses (including administrative); increased research development, use of technical consultation and use of computers in research; expanding computer access across campuses and 24-hour computer center availability.
In addition, faculty are acquiring their own microcomputers. The trend in computer use at both universities is toward purchase of microcomputers for word and text processing, small record management, bibliography maintenance and graphics such as "drawing pictures," among other things. The advantage of the microcomputer is that it is a "highly interactive computer," allowing for flexibility in interaction between user and computer. A future trend will be toward use of computers for communication with a significant increase in electronic mailing systems and connections to other universities.
The Pitture: In the modern world of nursing administration and technology, the basic cycle of input, process, output and storage has not changed, however, the method of input, the speed of processing and the variety of output devices has greatly altered the way we do things.
The ways in which computer and other information technologies can be used in nursing programs are only limited by the knowledge and imagination of the user. In this paper the authors have described systems in use in two public universities in diverse geographic areas. We believe that each program must make plans for computer usage to meet its needs after looking at the reasons for computer use and the human and material resources available to initiate the program of use. Our progress in determining the various uses, cost of programs, and process of establishment of computer usage in these two nursing programs may be useful as you plan to introduce use of technology in your program.
Nursing must provide graduates who have basic literacy in science and technology. Though computers have great potential for use in nursing education, educators have not fully explored that potential. Too frequently, computers are being used as a supplemental device - an addition to the traditional educational environment. There has been little consideration given to rethinking the entire educational process and the way the new technologies can contribute to the educational process.
In both schools our planning is based on the following premises: (a) Technology and human qualities are not antiethical. Technology will allow us to be more intelligently human and to use our human qualities more effectively; (b) Technology cannot be seen as ends in itself, but part of a careful strategy; (c) Constant attention must be given to attenuating those aspects of our systems which are inhumane and to align individual needs with the schools mission and goals; and (d) High tech and personalized educational style are goals to aim for.
As deans we believe we have a mission. Naisbitt in Megatrends (1982), calls nursing one of the information occupations. We are among the 60% of people in this country who spend our time creating, processing or distributing information. This is our job and what we do shapes society as we bring our knowledge and skills to bear on society. Information technology is beginning to free us up to reconceptualize what we are doing and how we do it, how and where we spend our time, how we allocate resources, how scholarship productivity is possible, how we can be more creative. In nursing, limitations of good software and our own sophistication are holding us back for now in maximizing use of computers in our enterprises. However, better software will eventually sell more hardware which in turn will attract more software.
We are simultaneously attending to the parallel growth of hightech/hightouch through attention to ergonomie aspects (human factors), assignments of personnel, expectations for how and where people spend their time, and dignifying the development of computer programs and their accessibility in the public domain as scholarship. Networking information technologies will accelerate our sharing ideas, information, contacts and resources because we will need to move from the concept of local ownership to the concept of access. Networking appeals to many of us because it is egalitarian. Information is the great equalizer (Naisbitt, 1982).
Information technology will help us exercise more of our options, provide more and more opportunities for us to use our more human skills, force révaluation of the contributions of our jobs and our skills (as evidenced by the fact we are being sought out by book publishers and computer societies; faculty scholarship is resulting from the proliferation of personal computing equipment among faculty; there is more encouragement of innovation; we foresee fewer clerical personnel and less labor intensive activity). Computers will assume the place in our existence comparable to the sphygmomanometer, the thermometer, and the acquisition of physical assessment skills. These are just tools we use in nursing. What we are finding however, is that there is only one thing more important than excellence. Maintaining it.
- Naisbitt, J. (1982). Megatrends, ten new directions transforming our lives. New York: Warner Books, Inc.
- Statement on "Computer Competency" (1983, May 18). The Chronicle of Higher Education, 26(12), 15.