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Wednesday, October 31, 2007

Nursing Resource: PDAs for Nursing Students

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Nursing Resource: PDAs for Nursing Students: Technology at Your Fingertips Slide Transcript
Slide 1: PDAs for Nursing Students: Technology at Your Fingertips Stacy Garza Jerry Russell Rebecca Show Brenda Stalls Kelli Young

Slide 2: Identified Problem BCHS needs to continue being a leader in educating nursing students who have experience with the latest technologies that support the provision of evidence-based care for positive patient outcomes. Other schools of nursing require students to use PDAs in their undergraduate programs. We were interested in collecting information that could help BCHS administration & faculty decide whether to initiate a PDA requirement.

Slide 3: Triggers for the Study • Students need fast access to a variety of information at the point of care • Books & printed reference materials are out of date as quickly as they are printed • BCHS students are not keeping up with the competition

Slide 4: Significance to Nursing Practice • PDAs are portable • PDAs are timesavers • PDAs promote evidence-based decision- making by providing reliable, trustworthy information

Slide 5: Examples of Required PDA Software • Quick Drug References • Calculators • Diagnostic Tests • Clinical Reference • Dictionary George, L. E., & Davidson, L. J. (2005). PDA use in nursing education: Prepared for today, poised for tomorrow. Online Journal of Nursing Informatics, 9(2). Retrieved November 6, 2006, from

Slide 6: Quick Drug References • Latest drug updates • Many free programs • Adult & pediatric dosages • ePocrates: >3,300 brand and generic drugs, including dosing, interactions, black box warnings, safety & monitoring, adverse reactions, & pricing • MultiCheck multiple-drug interaction checker • Replace outdated unit medication manuals ePocrates

Slide 7: Calculators • Drug dosages • IV drip rates • Pediatric/adult conversions • BMI • Glasgow coma scale • Urine output • Mean arterial pressure • Pregnancy calculator • And more! MedCalc

Slide 8: Diagnostic Tests • Laboratory, imaging, & microbiology tests • Unbound Medicine’s Pocket Guide to Diagnostic Tests: – Which test is best to diagnose, screen, or follow a certain condition? – How do I interpret an abnormal diagnostic test? – How do I collect the appropriate specimen or prepare the patient for testing? – Where can I find more Unbound Medicine information on this test in the medical literature?

Slide 9: Clinical Reference • Look up diseases & diagnoses • Differential diagnosis information • Recommended diagnostic tests • Recommended treatments • Updated frequently Unbound Medicine with web resources

Slide 10: Dictionary • Definitions of medical terms • Cross-links to other content in dictionary • Pronunciations for some terms Unbound Medicine

Slide 11: Research Questions • What are the attitudes, opinions, & experiences of BCHS and UTHSC senior nursing students about PDAs? • How do the attitudes, opinions, & experiences of the two groups compare? • We hoped to obtain data that could assist BCHS administration & faculty to identify the need for & recognize possible issues associated with instituting a PDA requirement for nursing students.

Slide 12: Rationales for PDA Use in Nursing Schools The American Association of Colleges of Nursing, National League for Nursing, and the Institute of Medicine all recommend the incorporation of technology into the processes of nursing education.1 • Two distinct benefits:2 – Instant access to a tremendous amount of clinical information in one small mobile device – Gain technical skills from using the devices that can be used throughout their careers 1 George, L. E., & Davidson, L. J. (2005). PDA use in nursing education: Prepared for today, poised for tomorrow. Online Journal of Nursing Informatics, 9(2). Retrieved November 6, 2006, from White, A., Allen, P., Goodwin, L., Breckinridge, D., Dowell, J., & Garvey, R. (2005). 2 Infusing PDA technology into nursing education. Nurse Educator, 30, 150-154.

Slide 13: How Schools Implement PDAs in Nursing Programs • Selection of software & web-based programs most supportive of BSN program & clinical course objectives • Orientation of students & faculty to PDAs • Provision of support services to students & faculty • Evaluation of program Miller, J., Shaw-Kokot, J. R., Arnold, M. S., Boggin, T., Crowell, K. E., Allgri, F., et al. (2005). A study of personal digital assistants to enhance undergraduate clinical nursing education. Journal of Nursing Education, 44, 19-26.

Slide 14: Examples of Schools Currently Using PDAs in Nursing Education

Slide 15: Other Benefits & Challenges of Using PDAs in Nursing Education Programs • • Anywhere/anytime use Complying with HIPAA regulations • Increase student-faculty time • management in documenting Protecting patient clinical performance confidentiality • Encourages timely recording of • Encouraging consistent use by events from clinical setting faculty & students • Reduces paper use through • Troubleshooting wireless transmission synchronization problems • Breakage or inoperable units • Acquiring software beyond available freeware White, A., Allen, P., Goodwin, L., Breckinridge, D., Dowell, J., & Garvey, R. (2005). Infusing PDA technology into nursing education. Nurse Educator, 30, 150-154.

Slide 16: Gaps Found in the Literature • Sample sizes too small • Research needs to be broadened • More schools need to be included in research • Research needs to be more rigorous – Most studies used surveys – Most data based on personal opinions

Slide 17: Steps of the Research Project • Used an exploratory/descriptive survey approach • Data to be used to provide the basis for BCHS to explore instituting a PDA requirement for nursing students Advantages of Surveys Limitations of Surveys Obtain large amount of Obtain superficial information information from a variety of (breadth vs. depth) people Unable to clarify responses Easily administered

Slide 18: Survey Process & Sample COMMONALITIES • Senior graduating class • Anonymous • Everyone asked to respond • All questions pertained to PDAs • Yes/No, Likert-type scale, Open-ended BCHS UTHSC N=35 n=30, 86% N=31 n=11, 35% PDAs not required PDAs required In-class survey Online survey

Slide 19: Online Survey Process • Online survey program • No-cost My name is Jerry and I am a senior nursing • UTHSC students commonly student at Baptist College of Health Sciences. respond to surveys in this Like you, I will be graduating in December. I am in my last class and we are required to do a program project. Our group decided to do a survey on • Survey okayed by the PDAs in nursing school. I understand at UTHSC that you are required to purchase and use a Director of the Professional PDA. Please take a few minutes to answer the Entry Program few questions on our survey, located at The survey • Survey link distributed by the is anonymous. If you would, please help out your Assistant Director of the fellow nursing students by responding no later than 8am Monday, November 20. Thank you so Professional Entry Program much, in advance, for your help. • UTHSC faculty member entered questions in program & printed off final results for our group

Slide 20: Validity & Reliability Issues • • Diverse questions used yes/no because of the exploratory • Likert-type scale nature of the survey • open-ended • Questions were worded • What do you think about this differently because of the versus difference between the two • What was your experience groups • We primarily focused on taking • We enhanced the reliability of steps to enhance the validity of our study by using inter-rater our study, realizing this was an reliability procedures exploratory study whose results should be viewed as a first step Haber, J., & LoBiondo-Wood, G. (2006). Reliability and validity. In G. LoBiondo-Wood & J. Haber (Eds.), Nursing research: Methods and critical appraisal for evidence-based practice (6th ed., pp. 335-356). St. Louis, MO: Mosby.

Slide 21: Validity • Do the survey items • Does the survey adequately reflect the appear to needed breadth of appropriately explore students’ opinions, opinions, attitudes, & attitudes, & experiences with experiences with PDAs in an PDAs? understandable way? • Survey content • Survey items determined by: reviewed by: – Reviewing literature – Students – Consulting with faculty – Faculty experts in use experts in use of PDAs of PDAs

Slide 22: Inter-rater Reliability • Independent analysis of answers to open- ended questions • Comparison of our analysis • Discussion of rationales for coding where we disagreed • Arrive at consensus on the final coding

Slide 23: Survey Questions COMMONALITIES • Costs of PDA • Learning about PDA • Beneficial effects of PDA • Effect of PDA use on stress • Recommendations for future use • Advantages/Disadvantages of PDA BCHS UTHSC • Likelihood of attending • Other programs installed BCHS if PDA required on PDA • PDA ownership • Coverage of PDA costs • Observations of PDA use • Faculty encouragement

Slide 24: PDA Ownership Do you own a PDA? Did you own a PDA • Yes = 2 before coming to UTHSC? • No = 28 • Yes = 1 • No = 10 Use in clinical setting: • Yes = 1 • No = 1

Slide 25: Likelihood of Attending BCHS if PDA were Required 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% y y y e y el el el el ur lik li k lik li k ns un un ry l/U t ha Ve ry t t ra ha ew Ve eu ew m N So m So

Slide 26: Type of Person Observed Using PDA in Clinical Setting Nursing Administrator Student 4% 7% Faculty Physician 10% 37% Resident 17% 80% of respondents reported seeing others Nurse use PDAs in the 25% clinical setting.

Slide 27: Learning About PDAs 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% On my own One-on-one Small group Prior to class Integrated in class

Slide 28: Learning about PDAs 100% Very Helpful Somewhat Helpful Not at all Helpful 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% On my own One-on-one Small group Prior to class Integrated in Faculty Other students class

Slide 29: Advantages of PDA Use Responses: BCHS = 53 UTHSC = 39 140% BCHS UTHSC 120% 100% 80% 60% 40% 20% 0% Fast Access Medications Easy Labs Organization Compact Reliable Other

Slide 30: 0% 5% 10% 15% 20% 25% 30% 35% Ex pe ns e Lo sin g it O ve r-r el ia nc e O ut -o f- d at e Di s tra ct Te in g ch no lo gy gl it ch es Le ar ni ng He av y Fe ar O th er Un su re /N on e BCHS UTHSC Responses: BCHS = 39 UTHSC = 13 Disadvantages of PDA Use

Slide 31: Required & Other Programs on PDA • Games (4) • Mosby's 2006 Nursing Drug Reference • Medication program (2) • Mosby’s Nursing PDQ. • Medical dictionary (1) • Mosby's Diagnostic and • Spanish-English Laboratory Test dictionary (1) Reference (7th ed.). • Music (1) • Taber's Cyclopedic • Pictures (1) Medical Dictionary (20th ed.).

Slide 32: Perceptions of how Beneficial a PDA would have been in School 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% l l e l l ia ia ta ta ur fi c fi c en en ns ne ne m m l/U tri tri be be t ra de de ry t ha eu ry t Ve ha ew N Ve ew m m So So

Slide 33: Benefits of PDAs 100% Yes No 90% Unsure 80% 70% 60% 50% 40% 30% 20% 10% 0% Replaced reference books Helped in education Saved time Will continue using

Slide 34: Perceptions of Effects of PDA use on Stress Levels 100% BCHS 90% UTHSC 80% 70% 60% 50% 40% 30% 20% 10% 0% Greatly increase my Somewhat increase Neutral/Unsure Somewhat decrease Greatly decrease my stress my stress my stress stress

Slide 35: Maximum Amount to Pay for PDA Hardware & Software >$350 $251-$300 1% 13% $150-$200 50% $201-$250 36%

Slide 36: Actual Cost of PDA $251-$300 11% $150-$200 45% $201-$250 44%

Slide 37: Additional Costs 100% Hardware 90% Software 80% 70% 60% 50% 40% 30% 20% 10% 0% <$50 $51-$100 >$100

Slide 38: Recommend PDA for Future Nursing Students 100% BCHS 90% UTHSC 80% 70% 60% 50% 40% 30% 20% 10% 0% Yes No Unsure

Slide 39: Implications for Nursing Education • Coordinated effort to incorporate PDAs • Involve students, faculty, library, information technology, & administration • Develop PDA hardware & software requirements • Design PDA training – variety of methods • Identify PDA support system

Slide 40: Implications for Nursing Practice • All nurses on a unit use PDAs • Hospitals provide PDA hardware, software, & docking stations • PDA training provided by hospitals • PDA support groups developed across units • Develop PDA competencies • Administrator, nurse, & patient satisfaction & perception of usefulness

Slide 41: Evaluation • Does BCHS institute a PDA requirement? • Do faculty evaluations of students who use PDAs differ from those who do not? • Do student evaluations support the usefulness of PDAs? • Do students continue using PDAs after graduation?

Slide 42: Summary • Embrace the future: PDAs are here to stay – Several schools implementing PDA use – BCHS should explore implementing PDA use • Conduct further research on PDA use • Our findings showed: – Most students would have attended BCHS even with PDA requirement – Perception & experience of stress levels with PDA use – Other people observed using PDAs in clinical settings – There needs to be support for PDA use – Cost & financial aid are considerations

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