Running head: PRACTICUM SYNTHESIS PAPER

Practicum Synthesis Paper Nicole Cory Ferris State University

PRACTICUM SYNTHESIS PAPER Abstract This paper summarizes and analyzes the practicum experience completed during the spring semester, 2013. The clinical practicum is an opportunity for submersion into the role which allows for learning and understanding through experience. According to the ANA, within the informatics nurse specialist (INS) role the key responsibility is often implementation. Kurt Lewins change theory and the Health Information Management Systems Society (HIMSS) technology adoption framework were utilized as a framework for this experience. A clinical project was also performed and a brief description of this project is also included in this paper. An evaluation of the experience performed by the student and preceptor is also included. Key words: practicum, informatics nurse specialist

PRACTICUM SYNTHESIS PAPER Practicum Synthesis Paper The clinical practicum provides an opportunity for the student to gain knowledge and

skills that cannot be obtained through study and research. The experience requires the student to apply the knowledge gained during the program as he or she immerses herself in the role. It is also an opportunity for the student to apply theory to practice in the specialty role studied. This can be a difficult task and can be more easily performed while under the guidance of an experienced preceptor. I performed many different tasks during the practicum. I was involved in workflow analysis and the evaluation of a hybrid/electronic documentation method in preparation for the change to electronic documentation. I helped to create downtime forms for use when the electronic health record system (EHR) goes down. I assisted in the gap analysis of the old system as compared to the new electronic system. I helped to develop job aids for staff to use as guides after their training was completed. I also helped to coordinate training on the use of the electronic documentation module on restraints as well as assisting in training newly hired nurses. This paper will describe a practicum performed by this student at Pine Rest Christian Mental Health Services with Pam Hietbrink, RN-MSN, an experienced informatics nurse specialist (INS). The issues and challenges experienced along the way, as well as the methods utilized to address them are described in this paper. The application of theory to the practicum is discussed. A project was completed within this practicum experience which included the development of a project charter for the development of a mobile application for use in the Info Project. The info project at Pine Rest is an initiative that has been implemented to promote patient satisfaction and engage the clinical nurse leaders in interacting with the patients. These experiences will provide a solid foundation for this student as I begin my career as an INS.

PRACTICUM SYNTHESIS PAPER Description and analysis of clinical project During the practicum experience I completed a project charter which will be used in my scholarly project during the summer semester of 2013. As part of the standard of implementation and to improve my competency in the standard of knowledge and skills in human and organizational behavior, I employed project management techniques learned in my undergraduate studies, as well as from my preceptor. One such technique is the development of a project charter.

A project charter is a useful document that explains the purpose, objectives, schedule, and scope statement for the project. The scope statement describes the scope, constraints, assumptions, and deliverables of the project (Project Management Institute [PMI], 2008). The Project Management Institute (PMI) describes the scope statement as critical and defines it as being defined with specificity and hones throughout the project planning stage (PMI, 2008). The project scope can change through this process, but should contain concise assumptions, deliverables, and constraints related to a project. In my project the man hours required were a constraint for completing deliverables. Because the project I will be completing will involve the development of a mobile application, the charter contains a specific section on the actual technology to be utilized and the type of platform and description of any interface engine being used to send and receive data. The project goals for this project are not going to be specific related to improving patient satisfaction scores or patient outcomes because it is not yet determined exactly how the team wants to utilize the application. At one point it was planned to be used during patient rounds to simplify the process and reduce wasted steps and paper being used to collect the data at this time. The application may actually be utilized in

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some way related to patient satisfaction surveys. At this time we are leaving the overall goal as a general goal of developing the application. We will need to revisit the goals after we have a solid agreement on how the application will be utilized prior to actually beginning the project. See appendix A for this document. The project charter helps to keep a project on task and within a specific scope and is a valuable tool for a project manager. The INS frequently is responsible for managing large and small projects. It is imperative for a nurse in this specialty to understand project management techniques that are used to manage the scope and schedule. The project scope is the actual products, services, and results included in a project. The phenomenon of scope creep happens when changes are made to the project without considering their effect on the schedule and budget (PMI, 2008). The project charter developed during this practicum will be utilized to keep track of the deliverables for a project. It identifies project stakeholders and includes a timeline of the tasks that will be accomplished within the project when it is completed. It also includes project constraints, project assumptions, goals, and technical specifications. Development of a project charter, while participating in an implementation project, was a valuable experience because it gave me the opportunity to connect the two concepts. Without a project charter it is difficult to keep on task unless it is specifically identified in an official document such as a project plan or a project charter. The charter can also contain strategies for addressing requests for changes to the project which assists in maintaining the scope. Issues Concerns and Challenges There were several issues and challenges experienced during this practicum. The development of solutions that support clinical work is a concern for the INS. During the implementation process, it is also imperative for the INS to consider the potential for end-user

PRACTICUM SYNTHESIS PAPER resistance to the use of informatics solutions. Another issue that was encountered and address was the need to ensure compliance with regulatory standards when developing or implementing informatics solutions. Planning a project and keeping on schedule is also a major task of the INS, and during the process of evaluating and modifying electronic documentation modules for implementation, this topic was a concern. In preparation for the clinical practicum I performed research on topics related to implementation, change management, project management, and regulatory standards. I

specifically studied the regulatory standards related to restraint use. Throughout the experience I was able to utilize the knowledge gained from this research. Kurt Lewins change theory was utilized in this practicum. The change theory was utilize to anticipate and plan for resistance to the change from utilizing paper forms to document restraint use, to using electronic documentation modules within the electronic health record (EHR). The Health Information Management Systems Societys (HIMSS) Technology Acceptance Model was also used as a resource during the experience. This framework assists the project team in incorporating change management strategies within a project plan (HIMSS, n.d.). Development of Solutions that Support Clinical Work It is a major responsibility of the INS to develop and implement systems and solutions that can be used to improve patient care. The implementation of informatics solutions that can be utilized to automate processes and support clinical decision making can drastically improve patient outcomes (Amarasingham et al, 2009). A core competency of the INS role is to assist in the development of clinical processes that provide efficient, safe, patient care (Gardner et al., 2009).

PRACTICUM SYNTHESIS PAPER It is imperative for the INS to advocate for improved practice and monitor for problems caused by or exaggerated by informatics solutions. According to the Joint Commission, the over-reliance or under-reliance on information systems in healthcare can potentially cause harm to patients (Mitka, 2009). This is an issue that must be monitored and managed by the INS.

During the practicum, I contemplated the need for the EHR to remind nursing staff of every step required and every piece of documentation that is needed rather than allowing the nurse to use his or her knowledge and expertise as a guide. A major concern during the evaluation of the electronic documentation modules was that if a topic wasnt addressed specifically within the electronic form, then staff would forget to document it. Because of this concern, a paper checklist was modified and will be maintained with the new practices. It was discussed that the continuation of the use of paper checklists could also reduce usability of the solution and the efficiency of the process. Conversely, some of the documentation modules contained areas that did not need to be addressed by the staff responsible for completing that form and this also has potential for causing issues. Thus, the checklist remained a step in this process; it was important for me to see that sometimes the best thing is not always the new technology. It is necessary to be vigilant and consider the issue of usability and clinical decision support when developing and implementing informatics solutions. During the practicum, some issues that were brought to light on several topics seemed to stem from the lack of cohesiveness between the work being done and the technology in place. For instance, the electronic documentation modules contained some fields that did not need to be completed, and some fields were essential to be completed. Some steps within the electronic documentation were geared more toward acute care hospitals and would not necessarily apply to the patients at Pine Rest.

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It became apparent that being open-minded when evaluating work-arounds is necessary because it is often just the natural human response to something that isnt working right. A work-around occurs when a person develops ways to complete their work without utilizing the technology as it was intended. Nurses state they often have to develop work-arounds because using the technology as it is intended is inefficient or difficult (Gassert, 2009). Lack of userfriendliness has been identified as a major barrier to user acceptance of technology (TIGER, n.d. a). I tried to keep in mind the usability of solutions while evaluating for changes to the electronic documentation modules. A usable solution requires minimal effort, results in great user satisfaction, reduces errors, and improves patient safety (Boone, 2010). Often times the INS is not directly involved in the development of an informatics solution and this highlights the need for him or her to become an advocate for the end-user. Sometimes things cannot be changed due to the nature of how they are built within the system and the INS must be prepared to suggest alternate solutions. Sometimes technology is the key to improving the efficiency of work in healthcare and this is something I also realized during my practicum. During the analysis and discussion around the patient rounding process it became evident that technology could reduce the time it took to round and improve the consistency and speed of which the information was shared. It also will provide data more quickly in order for leadership to review for compliance with this practice which is an organizational goal. The use of EHR systems provides support for clinical decision making, improves access to critical patient information, and provides safety features such as medication interaction checking and when caregivers rely on this technology heavily in their day to day practice, a system downtime can result in serious issues (Nelson, 2007). Most organizations have downtime

PRACTICUM SYNTHESIS PAPER procedures, but they often can be overlooked overtime and become out of date (Nelson, 2007). Maintaining downtime forms can be an important role for the INS. During this practicum I was involved in updating downtime forms for use when the EHR became unavailable. Resistance to change

During the practicum experience I was involved in preparing for the implementation of a change from the use of paper forms to the electronic documentation of restraint initiation and continued assessment, as well as restraint discontinuation. The experience of planning for an implementation is very valuable, because implementation is a key responsibility of the INS (ANA, 2008). The implementation process provided an opportunity to utilize techniques to assist in the anticipation and prevention of resistance among end-users. The phenomenon of resistance to change is a common occurrence and is something that was considered during the practicum experience. Kurt Lewins change theory was utilized to plan for and prevent resistance to change, and the HIMSS technology adoption framework was used in my attempts to integrate project management with change management. Resistance to change is something that I have read about and tried to prepare myself for during the graduate program at Ferris State University. Resistance to the use of technology in healthcare has been known to slow, stall, or cause an implementation effort to fail (Kristonis, 2005). As the government pushes toward the use of EHRs in healthcare settings, implementation has become a large responsibility within the role of the INS (ANA, 2008). As I begin my career in the specialty of informatics, the strategies used to reduce or prevent resistance will be invaluable. Techniques utilized in the reduction or prevention of resistance to change included the involvement of the end-users in the identification of the need for change. Kurt Lewins change

PRACTICUM SYNTHESIS PAPER theory advocates for the involvement of staff members in this stage because it can assist in unfreezing which, according to the theory, is recognizing the need to move away from the status quo (Kirstonis, 2005). During several sessions the current workflow related to restraint documentation was analyzed with involvement of staff. The discussions during these sessions were used to impress the importance of the change and explain the benefits of changing to

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documenting in the electronic system. We also utilized the sessions as a venue for staff to voice their concerns and ask questions. According to Kotter (2008), the first major step to preventing resistance to change is to communicate the need for change to those who will be affected by the change. I also used this theory to identify the conditions that needed to change in order to move the staff from the status quo and help the staff to believe there is a need for change (Burnes, 2004). We discussed the current state of their work around the ordering, documentation, and reevaluation of the needs for restraints. Then we evaluated for potential areas that were cumbersome or inconsistently done, or done incorrectly. This was interesting because it highlighted not only the areas that needed to be changed, but also the areas lacking clear processes. We found that some were doing things one way and some individuals were doing something entirely different. The technology adoption framework supports identifying and addressing any latent issues that are found during analysis prior to the implementation stage (HIMSS, n.d.). It was agreed upon that the process would be better if standardized across the different areas. I also used the Project Management Body of Knowledge (PMBOK Guide) during this practicum experience. According to the Project Management Institute (2008), a project team needs to be involved early on in the project to participate in decision making and project

PRACTICUM SYNTHESIS PAPER planning. The team that would provide training to the end-users on the use of the electronic modules for restraint charting was developed and involved early on. We involved them in the

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workflow analysis and ongoing evaluation of the proposed modules that will be utilized in place of the paper forms. Because they were involved early on they will be more committed to the project (Project Management Institute, 2008). This is valuable because they will be taking this end-product to their peers and because of this commitment we are likely to have positive results. Compliance with Regulatory Standards The INS must be cognizant of regulatory standards when developing or implementing informatics solutions. The preparations for changing from paper to electronic documentation included the analysis of Joint Commission and State of Michigan regulations. Forms used at admission were also evaluated during the practicum experience. The Joint Commission requires that patients are screened for risks of violence, substance abuse, and history of psychological trauma (Joint Commission, 2012). Another major component is the identification of the patients strengths within the first three days of admission (Joint Commission, 2012). Another key admission component is the documentation of an individualized treatment plan as a requirement of the Michigan Mental Health Code. The Treatment plan means a written plan that specifies the goal-oriented treatment or training services, including rehabilitation services, that are to be developed with and provided for a recipient (Department of Mental Health, 2009). These key components were required to be included in the content of the electronic documentation. Another electronic documentation module being analyzed at Pine Rest dealt with restraint use and documentation which is a highly monitored and regulated issue. My lack of knowledge of inpatient behavioral medicine and unfamiliarity with the regulatory standards surrounding this work was a disadvantage for me and I had to quickly bring myself up to speed. It is a

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responsibility of the INS to develop or implement systems that are in compliance with regulatory standards (ANA, 2008). Throughout the analysis of the old process and evaluation of the proposed electronic module, these regulatory standards were considered and a plan was developed to address the change from paper documentation to electronic documentation. At one point there were questions regarding the actual areas that would need to be assessed by nurses to fulfill the requirements of assessing restrained patients every two hours. We were able to decide upon a standard for this item after reading and analyzing the requirements and utilizing clinical judgment. We were able to make a determination of the best areas to include in the module. I then submitted service requests to the corporate office for the modifications that were needed to ensure compliance with the standards. Service requests are an industry standard in information technology and are used to request changes and track changes to an information system. These requests provide a formalized method of collecting the information on what is being requested and why, and are then utilized to monitor what the status is for that change be it accepted and being worked on, or denied. Project Schedule and timeline According to the ANA (2008), project management is an essential skill for the INS, and the standard of implementation requires the INS to coordinate the project activities, facilitate change, and integrate technology to transform processes. A major activity within this standard is the coordination of activities that are essential to the achievement of the desired outcomes of a project (ANA, 2008). During the practicum I was involved in the preparations for training endusers on the use of the new documentation modules. We chose to coordinate these activities as part of the upcoming skills fair for all clinical staff. This required us to coordinate with other educational activities and vie for highly sought after computers and space. The fair takes place

PRACTICUM SYNTHESIS PAPER over a three day span that all nurses at Pine Rest must attend. We were able to secure a small space for the class and fifteen computers.

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The Health Information Management Systems Societys technology adoption framework also talks about defining team roles and responsibilities (HIMSS, n.d.). The authors state that when implementing a change one should coordinate all project activities with the user in mind. The change management portion of this framework really pinpoints the human aspect of change. They discuss EHR implementation and the need to move from the fear and resistance to trust and adoption (McCarthy & Eastman, 2010). They recommend repeatedly asking how each decision will impact the user and how it might impact patients. I think the question of how each decision might impact patients is something that we did not utilize in the practicum, but we could and should have. Evaluation of practicum The first goal I had set for the practicum was to understand and utilize the Unified Process project management methodology used to facilitate and coordinate project activities and goals. As I began to spend time at Pine Rest and became more familiar with the work being done there, I decided to seek out another source for project management. I evaluated the Unified Process and decided it was not geared towards a clinical or process related project, but more towards a software development project. In my searching I returned to the Project Management Institutes Project Management Body of Knowledge (PMOBK) and found the technology acceptance model on the HIMSS website. These seemed to contain information related to managing not only project timelines and deliverables, but also people and change. Another goal I had set for this practicum was to obtain experience and knowledge regarding the analysis of usability and efficiency of the electronic documentation modules at

PRACTICUM SYNTHESIS PAPER Pine Rest. I did complete a portion of this goal, however, usability was not as high of a

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consideration as I had hoped. More attention was paid to the capturing of data, and the inclusion of the right components in the electronic modules. Because we were only evaluating, not developing, the solution the testing of usability was considered more after the fact and was not as integral to the practicum as I had hoped. The third goal was to utilize change theory in bringing about change in the health care system. Once again, the goal was only partially met as I did not get to see the project through in its entirety. The project was initially stalled by the corporate office and will not be completed until after my practicum is over. I did utilize change theory by involving the end-user and discussing the need for change with them. This would be the unfreezing stage. An evaluation tool for the practicum experience is included in this proposal (see appendix B). The tool was developed using a Likert scale which is often used to assess an attitude or belief on a certain topic (Losby & Wetmore, 2012). The Likert scale uses a declarative statement that clearly supplies a negative or positive attitude which is used to elicit a definitive response. This tool utilizes a 5-point Likert scale with responses starting with strongly agree to strongly disagree providing the rater with equal opportunity to respond either positively or negatively (Losby & Wetmore, 2012). The TIGER initiative recommendations for informatics competencies were utilized in guiding the development of questions for this survey. The recommendations were developed in relation to the push for nurses to become adept at using technology to document and perform patient care tasks (TIGER, n.d. b). The recommendations stemmed from the knowledge that some nurses due to their age may not have received formal training in the use of computers and other technology, while other younger nurses have grown up with technology (Tiger, n.d. b).

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These competencies were developed to identify competencies for the various levels of education and experience among nurses from beginner to advanced practice. See appendix B for the evaluation tools completed by the student and the preceptor for the practicum. Conclusion During the practicum I gained experience with several of the competencies related to the practice of the INS. The hours I spent at Pine Rest with Ms. Hietbrink will provide a foundation for years of successful practice in this role. I will continue to learn and grow and expand upon the knowledge gained from working with my preceptor. It was a valuable experience as I became deeply involved in the day to day work performed by the INS. By assisting in the transition from paper to electronic documentation, I gained experience with the competency of implementation. Through my involvement in this process I became more comfortable with implementing informatics solutions that are closely related to compliance with regulatory standards. I was involved in workflow analysis, evaluation (including gap analysis), and submission of requests for changes to be made to the proposed electronic module. Using Kurt Lewins change theory as a guide we chose to involve the end users in the workflow analysis and brought them in to help evaluate the proposed electronic modules. The technology adoption framework was used as well to guide us through the steps to move from our current state to the future state of when the modules would be put into place. Through this experience I learned about the value of working with the end-user to develop a solution that is conducive to an efficient workflow. I truly believe it is my responsibility as the informatics nurse specialist to assist in the development of solutions that are minimally disruptive to the workflow of the clinician. Through the use of gained knowledge from theory and research I was able to successfully complete a practicum experience that will

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improve my practice as an INS, and this experience has prepared me to fulfill the role of the INS after graduating from Ferris State University.

PRACTICUM SYNTHESIS PAPER References Amarasingham, R., Plantinga, L, Diener-West, M., Gaskin, D., & Powe, N. (2009). Clinical

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information technologies and inpatient outcomes: a multiple hospital study. Archives of Internal Medicine, 169(2), 108-114. American Nurses Association (2008). Nursing Informatics Scope and Standards of Practice. Boone, E. (2010). EMR usability: Bridging the gap between nurse and computer. Nursing Management, 41(3), 14-16. Burnes, B. (2004). Kurt Lewin and the planned approach to change: a re-appraisal. The Journal of Management Studies, 41(6), 977-1002. DOI: 10.1111/j.1467-6486.2004.00463.x Gardner, R. M., Overhage, J. M., Steen, E. B., Munger, B. S., Holmes, J. H., . . .Detmer, D. E. (2009). Core content for the subspecialty of clinical informatics. Journal of the American Medical Informatics Association, 16, 153-157. doi:10.1197/jamia.M3045 Gassert, C. (2009). Technology targets studies: Technology solutions to make patient care safer and more efficient. American Academy of Nursing Workforce Commission. Retrieved from http://www.aannet.org/assets/PressReleaseLinks/2010/aan_workforce_monograph. pdf HIMSS (n.d.). Technology adoption framework. Health Information Management Systems Joint Commission (2013). Specifications manual for Joint Commission national quality measures. Retrieved from https://manual.jointcommission.org/releases/TJC2013A/ HospitalBasedInpatientPsychiatricServices.html Kotter, J. P. (2005). The Heart of Change Field Guide. Boston, Mass: Harvard Business School Publishing.

PRACTICUM SYNTHESIS PAPER Kristonis, A. (2005). Comparison of change theories. International Journal of Scholarly Academic Intellectual Diversity, 8(1). Retrieved from http://nationalforum.com/

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Electronic%20Journal%20Volumes/Kritsonis,%20Alicia%20Comparison%20of%20Cha nge%20Theories.pdf. Losby, J. & Wetmore, A. (2012). CDC coffee break: Using Likert scales in evaluation survey work. Retrieved from http://www.cdc.gov/dhdsp/pubs/docs/CB_February_14_2012.pdf. Mental Health Weekly (2012). Hospitals move closer to sharing HBIPS measure data with the public. Mental Health Weekly, 20(21), 1-3. Retrieved from Mitka, M. (2009). The Joint Commission offers warnings, advice on adoption new health care IT systems. Journal of the American Medical Association, 31(6), 587-588 Project Management Institute (2008). Project Management Book of Knowledge [PMBOK Guide]. Newtown Square, PA: Project Management Institute, Inc. TIGER (n.d. a) Designing usable clinical information systems: Recommendations from the TIGER usability and clinical application design collaborative team. Retrieved from http://www.tigersummit.com. TIGER (n.d. b) Informatics competencies for every practicing nurse: Recommendations form the TIGER collaborative. Retrieved from http://www.tigersummit.com/uploads/3.Tiger. Report_Competencies_final.pdf

PRACTICUM SYNTHESIS PAPER Appendix A Project charter

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1.1 Project Objectives

Complete application implementation by August 2013 Provide a simple mobile template for leadership to utilize during patient rounds Provide a real-time method of automatically transferring data from the clinical nurse leaders to the quality dashboard

1.2 Project Constraints Constraints: Limited budget Short project completion time frame (May to August 2013) Limited knowledge of application development. Privacy of patient information and the security of the application are also potential constraints. 1.3 Project Stakeholders Clinical Nurse Leaders at Pine Rest on each inpatient unit Kelly Domagala, Chief Nurse Executive of Hospital Based Services Sue Koons, Clinical Nurse Leader Pat Kennedy, Director of Quality , Hospital Based Services

Proposed Solution

Development of a mobile application for use on android systems at Pine Rest. The application will be utilized to collect the required data related to the info project. The app will be used from a smart phone and will interface with the quality dashboard. The application will be used to record the patients initials, room and bed number, clinical nurse leader name, which questions the patient was asked during rounds, and the patients answer. The application will improve

PRACTICUM SYNTHESIS PAPER efficiency and reduce paper usage during this process. The project is in alignment with LEAN principles in reducing wasted time and paper resources.

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2.1 Architecture

Functional Specifications The application will interface with the server at Pine Rest using Websockets and HTML5 messages to the server via a web hosting service. The user platform will be developed using basic java script and ruby programming language. The user interface will need to be edited to include unit-specific questions for different users on different units. The questions will change over time as different issues become a priority. This application will not be utilized on iPhones initially. An iOS applicaiton will be a phase 2 project.

Security Specifications If security is integral to the application being developed, then consider a specific section to document the security specifications relating to the application and supporting infrastructure. Investigate security further with the information technology department to ensure protection of patient privacy.

2.2 Development Utilizing a survey format we will: Develop access database to send information to form the application Complete by June 1 Write code for the entry model, view to display results, and survey entry controller Complete by June 14 Apply CSS and Ruby to format the user interface Complete by June 21 Create the database on the mobile platform Complete by July 1 Create web host on the hospital intranet or develop one-way interface to the server to receive data Complete by July 20

PRACTICUM SYNTHESIS PAPER 2.3 Testing

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The end-product will be tested with the clinical nurse leaders prior to roll-out for feedback and potential bug detection. Testing will be performed in a face to face environment, but issues will be tracked utilizing an issue sheet. Complete by August 1 Issue resolution will occur after testing phase 1 and before product deployment.

Calendar: May 21, 2013 start of project August 15, 2013 end of project

2.4

Deployment

Deployment will occur after successful testing has been completed. To be completed by August 5

PRACTICUM SYNTHESIS PAPER Appendix B

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PRACTICUM SYNTHESIS PAPER Evaluation for Clinical Practicum Experience Spring 2013 Student: Nicole Cory Preceptor: Pam Heitbrink Evaluation completed by __Nicole Cory______________________ 1= Strongly agree 2=Somewhat agree 3=neutral 4=somewhat disagree 5=strongly disagree

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1. This student demonstrates understanding of the importance of information management to clinical practice. 1 2 3 4 5

Comments: I was able to further my understanding of the different types of information management that is central to the role of the INS. During this experience I was able to see that the INS role is not always specific on technology, but of information management in general. 2. The student understands regulatory standards and guidelines and their relationship to information management. 1 2 3 4 5

Comments: I was at a disadvantage never having worked at an inpatient psychiatric facility before, I required extra guidance in what regulations would be impacted by the different solutions.

3. The student has knowledge of the different methods of information management and their clinical and/or administrative use. 1 2 Comments: 3 4 5

4. This student demonstrated understanding of the importance of privacy and security of information systems. 1 2 3 4 5

Comments: There were not very many opportunities to discuss the privacy and security of the system.

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5. The student applied project management principles during the practicum experience. 1 2 3 4 5

Comments: Project management is very obviously a large part of the INS role and I was able to observe and assist in coordination of project deliverables during the practicum.

6. The student demonstrated the ability to work with multidisciplinary teams to accomplish information management work. 1 2 Comments: 3 4 5

7. The student demonstrated the ability to utilize different technologies and systems to manage information. 1 2 3 4 5

Comments: I gained additional knowledge related to the use of business objects to develop reports. I also was able to utilize a new EHR during the experience and became proficient quickly.

8. The student demonstrated understanding of change management methodologies. 1 2 3 4 5

Comments: Change management is a difficult task and I will have to study, learn, and apply this in practice.

Reference Technology Informatics Guiding Education Reform (TIGER) (n.d.) Informatics competencies for every practicing nurse: Recommendations from the TIGER collaborative. Retrieved from http://www.tigersummit.com/uploads/3.Tiger.Report_Competencies_final.pdf