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

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.

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Students need fast access to a variety of information at the point of care Books & printed reference materials are out of date as quickly as they are printed BCHS students are not keeping up with the competition

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Books & printed reference materials are out of date as quickly as they are printed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

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

PDAs are portable

PDAs are timesavers

PDAs promote evidence-based decision-making by providing reliable, trustworthy information

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 http://eaa-knowledge.com/ojni/ni/9_2/george.htm

Quick Drug References

Calculators

Diagnostic Tests

Clinical Reference

Dictionary

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box warnings, safety & monitoring, adverse reactions, & pricing MultiCheck multiple-drug interaction checker Replace outdated unit medication manuals ePocrates

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Replace outdated unit medication manuals

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

Drug dosages

IV drip rates

Pediatric/adult conversions

BMI

Glasgow coma scale

Urine output

Mean arterial pressure

Pregnancy calculator

And more!

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 information on this test in the medical literature? Unbound Medicine

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 information on this test in the medical literature?

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

Look up diseases & diagnoses

Differential diagnosis information

Recommended diagnostic tests

Recommended treatments

Updated frequently with web resources

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

Definitions of medical terms

Cross-links to other content in dictionary

Pronunciations for some terms

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.

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.

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 http://eaa-knowledge.com/ojni/ni/9_2/george.htm 2 White, A., Allen, P., Goodwin, L., Breckinridge, D., Dowell, J., & Garvey, R. (2005). Infusing PDA technology into nursing education. Nurse Educator, 30 , 150-154.

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

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.

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

Examples of Schools Currently Using PDAs in Nursing Education

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

Anywhere/anytime use

Increase student-faculty time management in documenting clinical performance

Encourages timely recording of events from clinical setting

Reduces paper use through wireless transmission

Complying with HIPAA regulations

Protecting patient confidentiality

Encouraging consistent use by faculty & students

Troubleshooting synchronization problems

Breakage or inoperable units

Acquiring software beyond available freeware

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

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

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 Limitations of Surveys Obtain superficial information (breadth vs. depth) Unable to clarify responses Advantages of Surveys Obtain large amount of information from a variety of people Easily administered

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

Limitations of Surveys

Obtain superficial information (breadth vs. depth)

Unable to clarify responses

Advantages of Surveys

Obtain large amount of information from a variety of people

Easily administered

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

Senior graduating class

Anonymous

Everyone asked to respond

All questions pertained to PDAs

Yes/No, Likert-type scale, Open-ended

Online Survey Process Online survey program No-cost UTHSC students commonly respond to surveys in this program Survey okayed by the Director of the Professional Entry Program Survey link distributed by the Assistant Director of the Professional Entry Program UTHSC faculty member entered questions in program & printed off final results for our group My name is Jerry and I am a senior nursing student at Baptist College of Health Sciences. Like you, I will be graduating in December. I am in my last class and we are required to do a project. Our group decided to do a survey on PDAs in nursing school. I understand at UTHSC that you are required to purchase and use a PDA. Please take a few minutes to answer the few questions on our survey, located at http://CTLSilhouette.wsu.edu/surveys/ZS56802 . The survey is anonymous. If you would, please help out your fellow nursing students by responding no later than 8am Monday, November 20. Thank you so much, in advance, for your help.

Online survey program

No-cost

UTHSC students commonly respond to surveys in this program

Survey okayed by the Director of the Professional Entry Program

Survey link distributed by the Assistant Director of the Professional Entry Program

UTHSC faculty member entered questions in program & printed off final results for our group

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

Diverse questions used because of the exploratory nature of the survey

Questions were worded differently because of the difference between the two groups

We primarily focused on taking steps to enhance the validity of our study, realizing this was an exploratory study whose results should be viewed as a first step

yes/no

Likert-type scale

open-ended

What do you think about this

versus

What was your experience

We enhanced the reliability of our study by using inter-rater reliability procedures

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

Do the survey items adequately reflect the needed breadth of students’ opinions, attitudes, & experiences with PDAs?

Survey content determined by:

Reviewing literature

Consulting with faculty experts in use of PDAs

Does the survey appear to appropriately explore opinions, attitudes, & experiences with PDAs in an understandable way?

Survey items reviewed by:

Students

Faculty experts in use of PDAs

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

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

Survey Questions 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 COMMONALITIES Likelihood of attending BCHS if PDA required PDA ownership Observations of PDA use Other programs installed on PDA Coverage of PDA costs Faculty encouragement

Costs of PDA

Learning about PDA

Beneficial effects of PDA

Effect of PDA use on stress

Recommendations for future use

Advantages/Disadvantages of PDA

Likelihood of attending BCHS if PDA required

PDA ownership

Observations of PDA use

Other programs installed on PDA

Coverage of PDA costs

Faculty encouragement

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

Do you own a PDA?

Yes = 2

No = 28

Use in clinical setting:

Yes = 1

No = 1

Did you own a PDA

before coming to UTHSC?

Yes = 1

No = 10

Likelihood of Attending BCHS if PDA were Required

Type of Person Observed Using PDA in Clinical Setting 80% of respondents reported seeing others use PDAs in the clinical setting.

Learning About PDAs

Learning about PDAs

Advantages of PDA Use Responses: BCHS = 53 UTHSC = 39

Disadvantages of PDA Use Responses: BCHS = 39 UTHSC = 13

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

Mosby's 2006 Nursing Drug Reference

Mosby’s Nursing PDQ.

Mosby's Diagnostic and Laboratory Test Reference (7th ed.).

Taber's Cyclopedic Medical Dictionary (20th ed.).

Games (4)

Medication program (2)

Medical dictionary (1)

Spanish-English dictionary (1)

Music (1)

Pictures (1)

Perceptions of how Beneficial a PDA would have been in School

Benefits of PDAs

Perceptions of Effects of PDA use on Stress Levels

Maximum Amount to Pay for PDA Hardware & Software

Actual Cost of PDA

Additional Costs

Recommend PDA for Future Nursing Students

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

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

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

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

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?

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?

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

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