Learning Objectives and Change Theories

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

https://www.google.com/search?q=images+for+bloom%27s+taxonomy

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:

https://www.google.com/search?q=kurt+lewin+theory+of+change+images&rlz

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.