Content area
Background
Telemedicine and health informatics are a common aspect of patient care delivery in the United States. Graduate-level nursing students must be knowledgeable of telehealth and health informatics prior to entering the workforce as an advanced practice nurse. Nursing educators must provide educational opportunities within the curriculum that focus on telehealth and health informatics concepts that align with competencies. The Essentials: Core Competencies for Professional Nursing Education includes a new Domain #8 called, “Informatics and Healthcare Technologies,” where five key subdomains of this competency are defined.
Method
This article describes the college's approach to incorporating telehealth and health informatics into the graduate-level curriculum and the associated alignment to the 2022 Essentials.
Results
Faculty professional development and course revision strategies improved the infrastructure for teaching telehealth and health informatics.
Conclusion
The new Domain, #8, Informatics and Healthcare Technologies, can be successfully infused into the DNP curriculum with student engagement. [J Nurs Educ. 2025;64(3):196–199.]
Full text
Telehealth and health informatics courses should bridge the gap in providing advanced-level nursing students with a solid foundation in innovative emerging technologies in health care delivery. Before the coronavirus disease 2019 (COVID-19) pandemic, many advanced-level nursing curricula did not include telehealth or health informatics, leaving nursing students and future nursing leaders without foundational health informatics training. For graduate-level nurses and future nursing leaders, health informatics and telehealth must be studied to assist with restructuring patient interaction with nursing professionals, access to health care delivery, and the nurse-patient relationship (Wu, 2021).
Telehealth is defined by the U.S. Health Resources and Services Administration and includes video visits, phone calls, online communication, and storing patient data, and it may include using email or sharing lab results in a secure patient portal. Although it has been in common practice since the mid-1990s, the potential use of tele-health extends beyond COVID-19 services (Health Resources and Services Administration, 2022). Health informatics is defined by the Health Information Management Systems Society as the discipline that researches, formulates, designs, develops, implements, and evaluates information-related concepts, methods, and tools (e.g., information and communication technology) to support clinical care, research, health services administration, and education (Franberg, 2020).
Discussions among nursing educators regarding the inclusion of telehealth and health informatics in the advanced nursing curriculum have been ongoing for years. Many articles and discussions have focused on identifying competencies, utilizing frameworks, and the need for faculty educational resources. This article will focus on a practical approach to integrating a telehealth course and incorporating the soft and hard skill sets within an advanced-level nursing program's currently offered health informatics course.
The Problem
This College of Nursing (CON) is located in the world-renowned Texas Medical Center in Houston. It has over 100 years of educating nursing students, entry-level (Bachelor of Science in Nursing) to advanced-level (Doctor of Nursing Practice [DNP]). Within the advanced-level nursing program course offerings, courses are offered face-to-face, hybrid, and online. Core courses focus on leadership, health care policy, and evidence-based practices; however, providing didactic training in health informatics and offering a tele-health elective course needed to be improved. The problems the CON graduate nursing faculty identified included a lack of faculty expertise in health informatics and telehealth and not offering the telehealth elective course. The CON also needed to enhance the current required health informatics course taught in the DNP program with soft and hard skills.
Since the graduate program's inception, the CON has hired an outside person to teach this health informatics course. With the increasing change in including health informatics and telehealth in the curricula, the college realized the need to have an in-house faculty more prepared in the areas of health informatics and telehealth. The faculty also realized that the current course only offered didactic activities and needed to infuse skill sets. In addition, the telehealth elective course was developed and placed in the curriculum inventory but was never offered.
Approach
The CON used four steps to address the problems and to plan the process of incorporating soft and hard skills into the health informatics course and telehealth into the DNP curriculum (American Association of Colleges of Nursing, 2021; Davies et al., 2020; Eckhoff et al., 2022; Forman et al., 2020). A Title III grant supported DNP faculty development and curriculum changes to improve the program's infrastructure for offering quality improvement, health informatics, and telehealth in the curriculum. Steps included the following:
Step 1: Faculty development. Chike-Harris et al. (2021) described the immediate need for graduate nursing students to be prepared for the use and benefits of telehealth; however, barriers to implementing telehealth courses must be addressed. Barriers may include faculty knowledge deficits, the need for telehealth resources, or decreased telehealth opportunities. The CON faculty's knowledge and perception of revising the health informatics course and offering the telehealth course were assessed through multiple discussions. Faculty were then offered paid opportunities to attend health informatics and telehealth workshops to increase their knowledge. Some faculty attended the Arizona telehealth program courses and the National Organization of Nurse Practitioner Faculties' Telehealth Webinar Series. One faculty member completed a telehealth and health informatics course and received a certificate. Within the course-work, the faculty member gained knowledge on competencies, the Nursing Education for Healthcare Informatics model, tele-health and health informatics resources, course development, and course evaluation. The faculty member was tasked with creating a telehealth course, which may be offered interprofessionally, and adding hard and soft skill sets to the currently offered health informatics course. Additionally, two to three faculty will be completing the telehealth certification course that the Center for Telehealth, Innovation, Education and Research offers.
Step 2: Competencies identified. The Essentials: Core Competencies for Professional Nursing Education's Domain #8: Informatics and Healthcare Technologies (Table 1) was reviewed, and information was gathered prior to development of the telehealth course and revision of the health informatics course content. The competencies listed in The Essentials document help promote the need of nursing practice and educational experiences for competent advanced practice practitioners. This task was completed to ensure that the course-work developed aligns with specified curriculum requirements designated by the National Organization of Nurse Practitioner Faculties and the American Association of Colleges of Nursing.
| Domain | Competency |
|---|---|
| 8.1 | Describe the various information and communication technology tools used in the care of patients, communities, and populations |
| 8.2 | Use information and communication technology to gather data, create information, and generate knowledge |
| 8.3 | Use information and communication technologies and informatics processes to deliver safe nursing care to diverse populations in a variety of settings |
| 8.4 | Use information and communication technology to support documentation of care and communication among providers, patients, and all system levels |
| 8.5 | Use information and communication technologies in accordance with ethical, legal, professional, and regulatory standards and workplace policies in the delivery of care |
Step 3: Curriculum revision and course enhancement. Educational strategies should include both hard and soft technological skills. Those skill sets should include decision support systems, aids for clinical decision making, accessing and extracting data from clinical datasets, literature search processes, using RefWorks, and statistical data evaluation. Informatics content can be incorporated into nursing curriculum with clear learning outcomes or taught in an independent study course. When offering an independent study course, content should be manageable and easier to develop after identifying the major informatics concepts for nursing or health care professionals (Kupferschmid et al., 2020; Rutledge et al., 2021).
The CON offers a core health informatics course for the advanced-level nursing students. The course allows students to explore health information technology from a systems perspective and as a disruptive technology. Course content includes health informatics standards and vocabularies, evidence-based clinical decision making and clinical decision support, and transforming clinical workflow processes. The course was revised to incorporate soft and hard skills to encourage student engagement and promote the application of those skills. Course assignments developed included understanding the importance of run charts in presenting health care information, utilizing the Microsoft Excel spreadsheet add-in Analysis Toolpak to analyze health care data, and creating a mobile app that encourages patient engagement. The revised health informatics course was offered as a 10-week summer course.
The telehealth course was offered as a 16-week fall elective. This course educated the students about the Tietze Tele-health Framework (Figure 1). It focused on using telehealth technologies to deliver health care and services to clients in rural and underserved areas with limited nursing resources.
Figure 1. - Tietze Telehealth Framework. Note. ICU = intensive care unit; NICU = neonatal intensive care unit; ECHO = extension for community health care outcomes; ED = emergency department. Reprinted from McBride & Tietze (2022) with permission of Springer Publisher. ©Mari Tietze.
The Tietze Telehealth Framework assists students with understanding the various delivery methods for telehealth encounters and levels of engagement. Listed first on the framework, Level 1 diagnostics in nature is telemedicine. It involves a stationary or “clinic-based” encounter with the provider being away from the patient. Next, at Level 2, monitoring patient health trends is remote/monitoring management. Remote/monitoring management focuses on “home-based or facility-based” encounters instead of traditional face-to-face clinical visits. This method allows patient health information to be shared electronically with the health care provider. Third on the framework is mHealth/mobile health, which is Level 3. This Level allows the patient to be mobile and engaged in everyday activity. This method also allows health care providers to receive patient information remotely (McBride & Tietze, 2022). Course assignments included completion of a simulated telehealth activity and exam.
Step 4. Course implementations. The curriculum changes for the health informatics course and the telehealth elective course offerings were approved by the CON faculty. In addition, the telehealth course was approved by the graduate council and placed back into the curriculum course inventory. The student learning outcomes and syllabi were revised for both courses.
The health informatics course was a 10-week course taught in the summer of 2022. There were six students enrolled in the course. Course assignments/modules for the health informatics course included:
Run chart activity: This activity focuses on developing run charts and interpretation of data. Excel add-in for data analysis: This activity focuses on developing hard skills needed to analyze data using an Excel spreadsheet. Creation of a mobile application: This activity focuses on developing the hard skills to promote health within the communities in which students practice.
The telehealth course was taught in the fall as a 16-week course. Three students enrolled in this course. Course modules/assignments included:
Discussion boards: Topics were COVID and telehealth, patient safety and telehealth usage, and health informatics technology national standards used within health care facilities. Simulated telehealth activity and exam: The exam evaluates knowledge acquired during a simulated telehealth experience and required coursework.
Outcomes/Evaluation
An evaluation that concentrates on student learning outcomes can be used to gather data on the effectiveness of the coursework. The student learning outcome for both courses was to use information systems technology to improve health care quality and transformation of health care. Upon completing each course, students were asked to complete a course evaluation. Student feedback (n = 6) related to one assignment is shared in the next paragraph. The assignment involved the following: 1) creating and deploying a mobile application using Excel spreadsheets and Google Docs, and 2) writing a reflection paper documenting their experience with this assignment. The data show weaknesses in using Google Sheets for mobile application creation and deployment. The student needed help to deploy the mobile application successfully.
Feedback regarding the mobile application creation and deployment course assignment was retrieved from the students' reflective journaling assignment. Some examples of feedback received are as follows:
Significance of assignment to community—
“Helps patients to monitor their own health conditions (blood pressure readings and medication tracking) and share information with provider.” “Providers should make an effort to properly incorporate mobile technology into their treatment plans.” Student self-efficacy— “Thought assignment was going to be difficult; however, was simpler than anticipated.” “Thought could only be completed by computer software geniuses before assignment.” “Helped to alleviate the anxiety of creating a mobile app.” Ease of execution of assignment “Watched YouTube video and followed the instructions provided. I was able to complete the assignment successfully.” “I had no clue on how simple it was to make a mobile app until I completed this assignment.”
Conclusion
For future nursing leaders to truly understand telehealth and health informatics, nursing educators must revise and plan current curriculum offerings to provide students with competency-based coursework. This article describes how one college improved the infrastructure for teaching telehealth and health informatics in the DNP curriculum. Course development strategies will assist nursing educators with planning and implementing telehealth and health informatics courses into graduate-level nursing curricula.
American Association of Colleges of Nursing. (2021). The essentials. https://www.aacnnursing.org/Essentials
Chike-Harris, K. E., Garber, K., & Derouin, A. (2021). Telehealth educational resources for graduate nurse faculty. Nurse Educator, 46(5), 295–299. 10.1097/NNE.0000000000001055 PMID: 34238795
Davies, A., Mueller, J., & Moulton, G. (2020). Core competencies for clinical informaticians:Asystematic review. International Journal of Medical Informatics, 141, 104237. 10.1016/j.ijmedinf.2020.104237 PMID: 32771960
Eckhoff, D. O., Guido-Sanz, F., & Anderson, M. (2022). Telehealth across nursing education: Findings fromanational study. Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing, 42, 308–314. 10.1016/j.profnurs.2022.07.013
Forman, T. M., Armor, D. A., & Miller, A. S. (2020).Areview of clinical informatics competencies in nursing to inform best practices in education and nurse faculty development. Nursing Education Perspectives, 41(1), E3–E7. 10.1097/01.NEP.0000000000000588 PMID: 31860501
Franberg, H. (2020). HIMSS TIGER interprofessional community: Global informatics definitions, version 4.(Report No. 4). HIMSS. org. https://www.himss.org/resources/tiger-informatics-definitions
Health Resources and Services Administration. (2022). Getting started with telehealth. Telehealth. Retrieved January 3, 2023, from https://telehealth.hhs.gov/providers/getting-started/
Kupferschmid, B., Creech, C., Lesley, M., & Schoville, R. (2020). Informatics experience can help predict doctor of nursing practice student mastery of informatics competencies. Computers, Informatics, Nursing: CIN, 38(11), 590–596. 10.1097/CIN.0000000000000656
McBride, S., & Tietze, M. (2022). Nursing informatics for the advanced practice nurse: Patient safety, quality, outcomes, and inter-professionalism(3rd ed.). Springer Publishing Company. 10.1891/9780826185266
Rutledge, C. M., O'Rourke, J., Mason, A. M., Chike-Harris, K., Behnke, L., Melhado, L., Downes, L., & Gustin, T. (2021). Telehealth competencies for nursing education and practice: The four p's of telehealth. Nurse Educator, 46(5), 300–305. 10.1097/NNE.0000000000000988 PMID: 33481494
Wu, Y. (2021, October 10). Utilization of telehealth and the advancement of nursing informatics during COVID-19 pandemic. International Journal of Nursing Sciences, 8(4), 367–369. 10.1016/j.ijnss.2021.09.004 PMID: 34552807
Sharisse Hebert, DNP, APRN, FNP-BC, is an Assistant Professor, Prairie View A&M University College of Nursing. Mari Tietze, PhD, RN-BC, FHIMSS, FAAN, is a Professor, College of Nursing and Health Innovation, University of Texas at Arlington. Chloe Gaines, PhD, APRN, FNP-BC, is a Professor, Prairie View A&M University College of Nursing.
Grant: This work was partially supported by the Prairie View A&M University's Title III B: Strengthening Historically Black Graduate Institutions Grant (2019–2024) from the U.S. Department of Education, paid to Prairie View A&M University.
Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.
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