Perspectives on the implementation of health informatics curricula frameworks.

BACKGROUND: The COVID-19 pandemic highlighted the necessity of equipping health professionals with knowledge and skills to effectively use digital technology for healthcare delivery. However, questions persist about the best approach to effectively educate future health professionals for this. A workshop at the 15th Nursing Informatics International Congress explored this issue. OBJECTIVE: To report findings from an international participatory workshop exploring pre-registration informatics implementation experiences. METHODS: A virtual workshop was held using whole and small group interactive methods aiming to 1) showcase international examples of incorporating health informatics into pre-registration education; 2) highlight essential elements and considerations for integrating health informatics into curricula; 3) identify integration models of health informatics; 4) identify core learning objectives, resources, and faculty capabilities for teaching informatics; and 5) propose curriculum evaluation strategies. The facilitators' recorded data and written notes were content analysed. RESULTS: Fourteen participants represented seven countries and a range of educational experiences. Four themes emerged: 1) Design: scaffolding digital health and technology capabilities; 2) Development: interprofessional experience of and engagement with digital health technology capabilities; 3) implementation strategies; and 4) Evaluation: multifaceted, multi-stakeholder evaluation of curricula. These themes were used to propose an implementation framework. DISCUSSION: Workshop findings emphasise global challenges in integrating health informatics into curricula. While course development approaches may appear linear, the learner-centred implementation framework based on workshop findings, advocates for a more cyclical approach. Iterative evaluation involving stakeholders, such as health services, will ensure that health professional education is progressive and innovative. CONCLUSIONS: The proposed implementation framework serves as a roadmap for successful health informatics implementation into health professional curricula. Prioritising engagement with health services and digital health industry is essential to ensure the relevance of implemented informatics curricula for the future workforce, acknowledging the variability in placement experiences and their influence on informatics exposure, experience, and learning.

Baseline evaluation of nursing students' informatics competency for digital health practice: A descriptive exploratory study.

Introduction: The healthcare system is increasingly technology-dependent and proficiency in informatics skills is essential for health professionals to efficiently operate in the contemporary clinical environment. Nurses are major users of digital health technologies and graduates need to be well-prepared and confident to use the different available clinical systems competently as they transition from education to practice. Aim: To explore undergraduate nursing students' self-perceptions of informatics competence, set within a larger research project. Method: Descriptive, exploratory cross-sectional research design, with online self-assessment survey of undergraduate nursing students (n = 142). Data were analysed with descriptive, correlation and comparative statistics. Results: Participants' perceived overall mean informatics competency was at the level of somewhat competent, with only 40.84% (n = 58) at the level of competent. The highest mean value was in foundational information and communication skills and the lowest in information and knowledge management. Formal informatics education within curriculum was limited and lacked uniformity, as was prior exposure to important simulated informatics tools in preparation for practice. Factors including academic year level, computer experience and previous experience using clinical systems had a significant impact on participants' perceived informatics competency. Conclusion: Even though informatics competence is vital for clinical practice, with technology becoming pervasive within healthcare, nursing students' preparedness for digital health was sub-optimal. There were gaps in students' critical informatics practice knowledge with implications for work readiness of future graduates and nurse education practice.

Factors in integrating academic electronic medical records in nursing curricula: A qualitative multiple case studies approach.

BACKGROUND: Academic electronic medical records are useful simulation-based educational tools that assist health professional students develop their skill sets for digital health practice. Despite this, their utilisation in pre-registration nursing curricula is uncommon in Australia and New Zealand. AIM: To explore factors surrounding integration of academic electronic medical records into pre-registration nursing curricula in Australia and New Zealand. DESIGN: Exploratory qualitative multiple case studies approach with purposive sampling set within a larger research project. METHODS: Semi-structured interviews conducted with course leaders from six nursing schools. Data were analysed in an iterative content-driven deductive and inductive process using open-coding and categories. Case analysis involved within case and cross-case analysis. RESULTS: Findings revealed different factors that impacted the utilisation of academic electronic medical records in nursing curricula including factors influencing adoption, barriers and challenges with implementation, enablers for integration and perceived benefits for students' clinical practice preparation. Reasons for not using academic electronic medical records, barriers for implementation, and preparation of students for clinical practice in the absence of these simulation tools were also highlighted. CONCLUSION: Our findings suggest that use of academic electronic medical records in nursing curricula is still evolving and that their adoption and application within programs is not straightforward. While there are many factors unique to the schools using such resources, factors including decisions around curriculum incorporation, optimising available resources to support students' learning, and developing faculty capability to teach with academic electronic medical records were common considerations. Lack of funding and access to local educational tools were ongoing barriers for adoption. Further research examining curriculum timing and preparation, possibilities of partnerships to share resources, and evaluation in meeting students' needs is necessary.

Informatics Competency Measurement Instruments for Nursing Students: A Rapid Review.

Digital transformation in healthcare impacts curricula preparation and work readiness of future health professionals. Informatics capabilities are essential practice attributes. Therefore, measurement of these competencies is important as students transition from education to practice. This rapid review, conducted according to Cochrane and World Health Organization guidelines, examined validity and reliability measurements of existing instruments used to self-assess nursing informatics competencies. MEDLINE, CINAHL, EMBASE, and PubMed databases were searched. Empirical studies with the primary aim of measuring informatics competencies reporting psychometric assessment were included. Methodological quality appraisal involved predetermined criteria based on COnsensus-based Standards for the selection of health Measurement INstruments taxonomy. Data extraction and critical appraisal of six studies from four countries identified five instruments. Study characteristics, constructs measured, population, instrument type, and psychometric properties of interest were examined. There were some similarities and differences with instrumentation. Two important measurement properties, content validity and reliability, were underreported. Gaps in key measurement properties were identified, which require further research. Selection of a practical evaluative instrument to implement should also consider the constructs measured, and practicality and feasibility of the instrument for its suitability in different settings. A larger investigation comparing more informatics competency assessment instruments is necessary for an exhaustive analysis.

Use of academic electronic medical records in nurse education: A scoping review.

BACKGROUND: Use of academic electronic medical records is internationally recognised as a means for preparing health professional students for the digital healthcare environment. Reported practice benefits include skills for electronic documentation, health informatics, point-of-care clinical decision support systems, as well as preparation for information technology-enabled clinical settings, while challenges include lack of access to simulation software, faculty-related barriers, limited finances and educational software costs. However, little is known about best practices related to its use within pre-licensure or entry-to-practice nursing curricula and impact on clinical practice outcomes. OBJECTIVE: This review sought to explore how academic electronic medical records are used in entry-to-practice nursing curricula. DESIGN: A scoping review guided by the Joanna Briggs Institute three-step search strategy, exploring existing publications and grey literature. INCLUSION CRITERIA: Quantitative and qualitative studies related to use of academic electronic medical records in pre-licensure nurse education. INFORMATION SOURCES: A range of databases were searched including CINAHL, Medline, Proquest Central, ERIC, ScienceDirect, PubMed, IOS Press, as well as grey literature, reference lists and handsearching. REVIEW METHODS: The search yielded 580 articles, from which inductive thematic analysis of 34 included studies was conducted. RESULTS: Included articles were nine qualitative, 21 quantitative and five mixed methods studies. Most originated from the USA. Academic electronic medical records are mainly used to teach documentation, safe use of health technology, and for clinical preparation. Most are used for fundamental or junior levels courses, with problem-based learning and simulation embedded. Institution's technology resources and faculty capability are essential to implementation. CONCLUSIONS: There is a need for more research that examines optimal timing and duration of use of academic electronic medical records in curricula, and their impact on critical thinking and clinical performance. Finally, there is a need to explore greater academic-clinical partnerships in the education process.

Takayasu arteritis presenting as postpartum cardiomyopathy.

A case of Takayasu arteritis (TA) presenting as postpartum cardiomyopathy in a puerperal 26-year-old Hispanic female patient is presented. TA is a large-vessel vasculitis affecting young to middle-aged women. TA can result in cardiomyopathy as a direct result of myocardial involvement. The patient had classical clinical and radiographic findings of TA that were previously undiagnosed. She had rapid functional improvement with corticosteroids. The importance of a thorough physical examination of peripheral pulses is stressed in all patients, especially in those with cardiomyopathy.

Pioglitazone and the risk of myocardial infarction and other major adverse cardiac events: a meta-analysis of randomized, controlled trials.

A recent meta-analysis suggested that the use of rosiglitazone increases the risk of myocardial infarction (MI) in patients with type 2 diabetes mellitus. It is unclear whether this is a class effect of thiazolidinediones (TZD). We did a meta-analysis to evaluate cardiovascular outcomes with the use of pioglitazone. Randomized, controlled trials in which pioglitazone was compared with placebo or other hypoglycemic agents were considered for analysis. Studies were included if the data for MI were available. Studies were identified with use of relevant search words in Medline, Pubmed, EMBASE, CINAHL, and Cochrane databases. Data abstraction was done by 2 individual authors using a standardized protocol. The relative risk across all study groups was computed by the Mantel-Haenszel method, and interstudy heterogeneity was assessed by the chi method. All results were computed according to 95% confidence intervals. Five trials (N = 9965) met the inclusion criteria for analysis. The relative risk for MI was 0.86 (0.69-1.07; P = 0.17). The relative risks for stroke and revascularization were 0.79 (0.61-1.02; P = 0.07) and 0.40 (0.13-1.23; P = 0.11), respectively. Pioglitazone does not increase the risk for MI and may decrease the risk for stroke and revascularization.

Lemierre syndrome complicating a subcutaneous neck abscess.

Lemierre syndrome is septic thrombophlebitis of the internal jugular vein caused typically by an oropharyngeal infection. We report a case of Lemierre syndrome complicating a subcutaneous neck abscess. Lemierre syndrome should be considered in the differential diagnosis of septic emboli and sepsis, especially in a patient with tenderness along the sternomastoid muscle.

Paradoxical bronchospasm: a potentially life threatening adverse effect of albuterol.

We report a case of paradoxical bronchospasm to both levalbuterol and albuterol. While the exact mechanism for this known adverse effect of albuterol is not known, awareness of this adverse effect can be life saving to the patient. To our knowledge, this is the first reported case of paradoxical bronchospasm to levalbuterol inhalation solution.