Learning Objectives for the Electronic Medical
Records
"The EMR
represents the structure for the documentation of healthcare. This documentation provides the basis for
patient care decisions. Clinical
practitioners regularly contribute a great deal of information and data to the
record to complete a multitude of tasks" (Penoyer et al.,
2014).
When implementing a new
Electronic Medical Record (EMR), the Informatics Nurse may use various learning
tools to assist in the learning process.
This may include incorporating Bloom's Taxonomy in order to assist in developing
the required learning skills that support nurses as they become familiar with information
technology.
"Bloom's taxonomy
contains six categories of cognitive skills ranging from lower-order skills
that require less cognitive processing to higher-order skills that require
deeper learning and a greater degree of cognitive learning" (Adams,
2015).
The six categories of cognitive skills that range from
lower-order skills to higher-order skills are remembering, understanding, applying,
analyzing, evaluating, and creating.
Three learning
objectives that demonstrates successful training of the EMR by the staff nurse
are:
- the staff nurse will be able to explain the
purpose of meaningful use and how it impacts healthcare
- the staff nurse will be able to manipulate
the system to access and apply data in the EMR
- the staff nurse will be able to evaluate
patient data in the EMR to develop care plans that promote patient
education and provide positive patient care outcomes.
References:
Penoyer, D. A., Cortelyou-Ward, K. H., Noblin, A.
M., Bullard, T., Talbert, S., Wilson, J., & ... Briscoe, J. G. (2014). Use
of electronic health record documentation by healthcare workers in an acute
care hospital system. Journal Of Healthcare Management / American College
Of Healthcare Executives, 59(2), 130-144.
Adams, N. E. (2015). Bloom's taxonomy of cognitive
learning objectives. Journal Of The Medical Library Association, 103(3),
152-153. doi:10.3163/1536-5050.103.3.010
CPOE
Application Training
The Kurt Lewin Change Management Model was selected
for the application of a change theory used to train physicians to using a CPOE
system that was implemented into a healthcare facility. The Kurt Lewin Change Management Model is a
three stage theory of change that is composed of the unfreeze,
change/transition, and refreeze.
The change that occurs is considered a process of
learning. Lewin uses this theory to
transition one from a unlearned phase to a learned phase of development. "Change
is better defined as learning, why
cultures change through enlarging and broadening, not through destruction of
elements, and why the involvement of the learner is so crucial to any kind of
planned change or, as we might better conceptualize it -- managed learning" (Schein, 1999).
To train physicians to use a new CPOE system in the
EMR the following should take place in each phase:
Unfreezing
Stage
In this stage of learning the physician needs to be
educated on why change is necessary.
This could be done through open forums where discussions could be held
with Informaticists and Information Technology teams as well as Administration
to give physicians all the necessary information to explain where the system is
currently without change to where the system will be once implementation of the
new CPOE system. In this phase, demonstrations
should be shown to simplify the process or to give practical examples of how
the system will operate to give a visual guidance of the CPOE. This would help to decrease any anxiety and
misinterpretation of how the CPOE system will function.
Change/Transition
Stage
In the change/transition Stage, physicians should be
given individual training on usage of the CPOE.
Simplified demonstrations of physician ordering should be demonstrated
with a return demonstration by physicians.
This will capture what learning the needs are of the physicians so that further
education in those specific areas can be provided. Training should be individualized or in
groups of one to three. This should be a
repetitive process until the physician can independently navigate the CPOE and
manipulate functions efficiently.
Refreezing
Stage
In the refreezing stage, physicians should be given
final assessments with open discussion to the learning process. This would allow physicians to express any
learning deficits that they may have with the CPOE system. In addition, further educational needs can be
assessed, as well as any clarifications of the CPOE functions.
"Change is vital to progress, yet the nursing
literature identifies numerous complexities associated with transforming plans
into action, and attempts at change often fail because change agents take an
unstructured approach to implementation.
It is important, therefore, that managers, or change agents, identify an
appropriate change theory or model to provide a framework for implementing, managing
and evaluating change" (Mitchell, 2013).
References:
Schein, E. H. (1999). Kurt Lewin's Change Theory in
the Field and in the Classroom: Notes Toward a Model of Managed Learning. Reflections, 1(1),
59-74. doi:10.1162/152417399570287
Mitchell, G. (2013). Selecting the best theory to
implement planned change. Nursing Management - UK, 20(1), 32-37.
