Emerging Technologies in Undergraduate Education Electronic Charting in Nursing Education within Simulation Developing Undergraduate Simulation Exercises to Incorporate Electronic Health Record (EHR) Documentation Using the PC-CCC© System Veronica D. Feeg PhD, RN, FAAN Jennifer E. Mannino PhD(c), MS, MA, RN Geraldine L. Cornell, MS, RN

Introduction The PC-CCC, designed as a Microsoft Access® application of the Sabacare Clinical Care Classification (CCC) system, is an evidenced based electronic documentation system available via free download from the internet.

Implementing a Cost-Efficient System in the Learning Environment Nursing curricula needs informatics integration and application early Most clinical experiences are centered around medication administration units Nursing documentation should begin with the learning experiences Students learn in clinical and simulation labs – need to learn documentation Simulation is possible but documentation is $$$$$ Phase 1: Developed the PC-CCC Phase 2: Tested the PC version – Randomized Trial Phase 3: Field Tested with Baccalaureate Nursing Students

Results of Randomized Trial– Evaluation of Documentation Performance (EDP) There was a significant difference in the students who used the PC CCS Microsoft Access© system. Evaluation of care plans of students who used the DATA-BASED CCCS were significantly higher than care plans by students who used the TEXT-BASED CCCS

Purpose of the Emerging Technologies Grant To develop and integrate an electronic health record (EHR) documentation exercise in conjunction with clinical simulation in an undergraduate Nursing course (NUR 209).

Method Developed level appropriate simulation scenarios that incorporate electronic documentation Developed audio-visual tutorials using BlueBerry Flashback software Pilot tested scenarios and electronic documentation with one course section Expanded use to other course sections

Scenarios Developed five level appropriate scenarios according to NLN guidelines Scenarios designed to focus on patient safety and enhance physical assessment skills Cardiac Peripheral Vascular Respiratory Gastrointestinal Neurological

Tutorials: Via Tablet Introduction to PC-CCC Using the PC-CCC

The CCC Terminology Applied to the Nursing Process Assessment Diagnosis Outcome Planning Implementation Evaluation 21 Care Components 182 Nursing Diagnoses 3 Expected Outcomes (Improve, Stabilize, Deteriorate) 198 Nursing Interventions 4 Action Types (Assess, Perform, Teach, Manage) 3 Actual Outcomes (Improved, Stabilized, Deteriorated) (V. Saba) http://sabacare.com

I’m going to walk you through the program and show you how it works This screen is known as the “switchboard” Click on Patient Data

The students enters the patients general Demographical or Biographical data Fictitious names are used *Emphasis is placed on identifying support services and including family members in care, as well as, identifying barriers to learning such as “not being able to comprehend or communicate in English”

Once the patient data is entered it’s time to create the plan of care Once the patient data is entered it’s time to create the plan of care. Click “enter CCCS”

Through patient Assessment the students identifies a “Care Component” Through patient Assessment the students identifies a “Care Component” . The “Care Component” links the six steps of the Nursing Process. Also provides the standardized framework to document & track the care provide by the student nurse “Diagnosis” : Nursing Diagnosis used to identify the “problem” evidenced by the signs and symptoms presented. The students uses the free text space to support the chosen diagnosis. “Expected Outcome”. Outcome Identification. Based on the interventions you will provide, do you expect the patient to Improve, Stabilize or Deteriorate . “Action”. Or Nursing intervention. Specifically what action will bring about the expected outcome, care provided is broken down into 4 categories: Assess, Care, Teach, Manage. The provide eveidence of the tuype of care needed to bring about a specific outcome. Simple example- when you are administering medications to a patient you are carring out at least three of the four actions. Assessing the patients ability to receive the medication, providing the “Care” or actually administering the medication, and finally you are “Teaching”. You are teaching your patient about the mediation, what to expect, how to identify or manage side effects. Emphasis on care as a continuum not just independent skills is crucial for Nursing students. “Interventions”: Nursing Interventions or Planning stage of the Nursing process. Level of service identified to plan and implement care. The student uses the free text space to identify specific interventions (with rationales) they have performed for each intervention. Lastly, “Actual Outcome” the Evaluation stage of the Nursing Process. The student will reenter the database, click on the problem and identify whether or not the patient Improved, Stabilized or Deteriorated. The “actual outcome” for this patient was not determined due to the limited encounter the student had with the patient. The CCC automatically creates a problem list for each patient. One can click on display to see detailed information and/or note an actual outcome then resolve a problem. I explained this page as it applies to nursing but the language is not specific to “nursing” it can be used by multiple disciplines. Meeting 2nd Objective 2. Provide a unique approach to teaching nursing students the Nursing Process Foster the students’ understanding of the steps recognized as essential for nurses Foster the students’ understanding of and ability to prioritize Nursing Diagnoses & Nursing Interventions Foster the students’ understanding of and ability to create Nursing care plans Encourages critical thinking without memorization Next the student clicks on “report” 8. Clicking on “report”

Report generates and “Individual Care Record” Meeting 2nd Objective 2. Provide a unique approach to teaching nursing students the Nursing Process Foster the students’ understanding of the steps recognized as essential for nurses Foster the students’ understanding of and ability to prioritize Nursing Diagnoses & Nursing Interventions Foster the students’ understanding of and ability to create Nursing care plans Encourages critical thinking without memorization This record can be printed or saved as a PDF and email to the instructor.

Meeting 3rd objective 3. Monitor, track, and evaluate student experiences at multiple clinical sites Allows for the documentation, storage, analysis and retrieval of information Aggregate and analyze nursing interventions by type and frequency Further statistical analyses allow the instructor the ability to evaluate student experiences meaningfully (see in next slide) Frequency of Interventions See what types of patients the students are caring for and what types of interventions each individual student is doing Make recommendations to clinical instructors You see in interventions by type: How the nursing students spent their time. Assessments and Teaching 28% Care 26% (performing the task) Manage 18% (identifying need for a referral)

Sample (n=77) First semester Sophomore Level Baccalaureate Degree Nursing Students Enrolled in Nursing 209: Foundations of Humanistic Nursing Practice. Large Nursing Program – Small Campus

Summary: Student Reported Usability of the PC-CCC (n=77) PC–CCC Usability Items Strongly Agree/Agree Disagree/Strongly Disagree This program aided my ability to understand and prioritize Nursing Diagnosis 92% 7% This program aided my ability to understand and prioritize Nursing Interventions 8% Using this program aided my ability to understand Nursing Care Plans 94% 6% Using this program aided my ability to create Nursing Care Plans 91% 9% I would recommend future Nursing 209 students use this program 88% 12% I would like to continue using this program for all nursing courses that require the development of Nursing care plans The screen design was organized and clear 97% 3% The format was easy to follow 90% 10% The information was easy to understand The system allowed me to chart my care plan 96% 4% The system was efficient to enter the data I enjoyed the method of entering the data 87% 13% I would recommend using this program at the bedside

Conclusion Why? Independent College Over 1,200 undergraduate nursing students Placements in over 50 clinical areas throughout NYC and LI