Journal of Nursing Education

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Guest Editorial 

The Challenges of Technology

Marilyn S. Brady, PhD, RN

Abstract

No one will argue that technology has made our lives easier, both personally and professionally. However, nurse educators must acknowledge that the benefits of technology are accompanied by challenges, which are apparent in both the clinical and classroom settings and boil down to issues of training and access.

Electronic charting presents the first challenge. Each health care system seems to adopt different electronic charting packages. When there are multiple health care systems in one area, instructors may assign students to rotate through as many systems as possible so students may experience practice settings as diverse as a large medical center and a small, corporate, community hospital. However, instructors may need to examine this practice, as each electronic charting system requires 4 to 6 hours of training before students can document patient care. If students continue to rotate through clinical facilities, a solution may be for students to bypass electronic charting and continue to use paper documentation, which the nurses assigned to the patients then enter into the system. Unfortunately, this solution changes both students’ experience and accountability.

Another issue that accompanies electronic charting is access. Students are typically given access, but instructors are increasingly being required to cosign students’ documentation. In these situations, instructors must clarify what cosigning indicates. If instructors cosign, is it assumed that they have personally assessed each patient?

Technology also surrounds the administration of medications. No one will disagree that systems must be implemented to decrease medication errors, but these systems do come with the same challenges of training and access. Training may be straightforward and involve only the instructors. However, access poses a greater challenge because the instructors generally have the code students must use to retrieve and administer medications. The instructor then becomes a dispenser of medication. If an instructor has eight students who each provide total care for two patients on a busy medical-surgical unit, medication administration can consume a major portion of the instructor’s day, leaving little time for other clinical teaching strategies necessary to develop students’ ability to think critically about patient care.

One solution may be to decrease the number of times students are responsible for administering medications. Decreasing the number of patients for whom students provide care or restricting the hours during which students administer medications are two ways to accomplish this goal. For example, students could be responsible for administering the 10:00 a.m. medications only. However, limiting the number of times students administer medications does have implications for their success on the NCLEX-RN®: 13% to 19% of the items on the test plan that go into effect this month will be in the area of pharmacological and parenteral therapies, defined as “providing care related to the administration of medications and parenteral therapies” (National Council of State Boards of Nursing, 2003, p. 7).

Finally, the use of PowerPoint for classroom presentations brings with it the challenge of access. In this case, students may insist on access to these presentations to simplify their note-taking, or render it completely unnecessary. Students know their instructors can easily provide these presentations, and instructors often do make them available. However, what is lost is students’ ability to think critically about the information provided. Access to PowerPoint presentations encourages students to become consumers, rather than processors of information, thus losing their ability to sift through information and select what is essential. Instructors can model this ability for students. Technology may be beneficial here, as the “hybrid” or “blended” course can be used to provide information outside of the classroom setting, saving class time for active learning strategies that promote thinking and processing.

While the articles…

No one will argue that technology has made our lives easier, both personally and professionally. However, nurse educators must acknowledge that the benefits of technology are accompanied by challenges, which are apparent in both the clinical and classroom settings and boil down to issues of training and access.

Electronic Charting

Electronic charting presents the first challenge. Each health care system seems to adopt different electronic charting packages. When there are multiple health care systems in one area, instructors may assign students to rotate through as many systems as possible so students may experience practice settings as diverse as a large medical center and a small, corporate, community hospital. However, instructors may need to examine this practice, as each electronic charting system requires 4 to 6 hours of training before students can document patient care. If students continue to rotate through clinical facilities, a solution may be for students to bypass electronic charting and continue to use paper documentation, which the nurses assigned to the patients then enter into the system. Unfortunately, this solution changes both students’ experience and accountability.

Another issue that accompanies electronic charting is access. Students are typically given access, but instructors are increasingly being required to cosign students’ documentation. In these situations, instructors must clarify what cosigning indicates. If instructors cosign, is it assumed that they have personally assessed each patient?

Medication Administration

Technology also surrounds the administration of medications. No one will disagree that systems must be implemented to decrease medication errors, but these systems do come with the same challenges of training and access. Training may be straightforward and involve only the instructors. However, access poses a greater challenge because the instructors generally have the code students must use to retrieve and administer medications. The instructor then becomes a dispenser of medication. If an instructor has eight students who each provide total care for two patients on a busy medical-surgical unit, medication administration can consume a major portion of the instructor’s day, leaving little time for other clinical teaching strategies necessary to develop students’ ability to think critically about patient care.

One solution may be to decrease the number of times students are responsible for administering medications. Decreasing the number of patients for whom students provide care or restricting the hours during which students administer medications are two ways to accomplish this goal. For example, students could be responsible for administering the 10:00 a.m. medications only. However, limiting the number of times students administer medications does have implications for their success on the NCLEX-RN®: 13% to 19% of the items on the test plan that go into effect this month will be in the area of pharmacological and parenteral therapies, defined as “providing care related to the administration of medications and parenteral therapies” (National Council of State Boards of Nursing, 2003, p. 7).

Powerpoint Presentations

Finally, the use of PowerPoint for classroom presentations brings with it the challenge of access. In this case, students may insist on access to these presentations to simplify their note-taking, or render it completely unnecessary. Students know their instructors can easily provide these presentations, and instructors often do make them available. However, what is lost is students’ ability to think critically about the information provided. Access to PowerPoint presentations encourages students to become consumers, rather than processors of information, thus losing their ability to sift through information and select what is essential. Instructors can model this ability for students. Technology may be beneficial here, as the “hybrid” or “blended” course can be used to provide information outside of the classroom setting, saving class time for active learning strategies that promote thinking and processing.

Conclusion

While the articles in this issue of the Journal of Nursing Education focus on the benefits of technology in nursing education, the challenges must also be addressed. Solutions to these challenges will likely involve increased collaboration between service and education. Ultimately, addressing these challenges will create even greater benefits.

Marilyn S. Brady, PhD, RN

Department Head, Nursing Programs

Trident Technical College

Charleston, South Carolina

Reference

  • National Council of State Boards of Nursing. (2003). Test plan for the National Council Licensure Examination for Registered Nurses. Chicago: Author.

10.3928/01484834-20040401-07

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