By: Dr. Shawn Foley

The purpose of this study was to explore the effect of a learning environment using an Electronic Health Record (EHR) on undergraduate nursing students’ behavioral intention (BI) to use an EHR.  BI is defined by Davis (1989) in the Technology Acceptance Model (TAM) as the degree to which a person has formulated conscious plans to perform or not perform some specified future behavior.  BI is determined by measuring the perceived usefulness (PU) and perceived ease of use (PEOU) of a particular technology or information system.

The study employed 56 undergraduate nursing students, both juniors and seniors, from three (3) accredited Schools of Nursing in a survey research approach that uses a cross-sectional between-subjects design.  One-on-one interviews also were used to document undergraduate nursing students’ perceived behavioral intention of an EHR in the learning environment on clinical rotations and on practice.

Participants were recruited using sampling procedures during the fall 2010 and spring 2011 semesters.  They were either enrolled at (1) Schools of Nursing that bring an authentic EHR experience into the curricula in order to teach nursing practice or; (2) a School of Nursing that uses a paper-based approach to teach nursing practice.   In both environments students also had experience with an EHR on clinical rotations.

Participants were asked to complete a self-administered questionnaire that has items to assess the perceived usefulness (PU) and the perceived ease of use (PEOU) of an EHR.  They were also given the option to participate in a follow-up interview.  During the interview, they were asked to share their perceptions of their behavioral intention to use an EHR on their clinical rotations and in practice.

The mean scores for all the survey responses and the mean score for individual items on the questionnaire and their standard deviations were consistent across both learning models.  The data did not predict behavioral intention for either factor PU or PEOU.  There was a significant difference between the BI to use an EHR between junior and senior students’ educated in a learning environment using an EHR with senior students reporting a higher BI score.

Regarding the interviews, there was a reported impact to PU and PEOU for the majority of the participants interviewed.  In general, participants reported a positive impact on their behavioral intention to use an EHR.  All participants agreed that there was value in having an Electronic Health Record (EHR) to teach nursing practice integrated within the school curricula (classroom, skills lab, and simulation lab).

The conclusions of this study can be offered as suggestions for improving the education of nursing students in the United States.  Based on the results and the findings presented in this study, faculty members at schools of nursing should consider implementing an EHR in the classroom, skills lab, and simulation lab in order to positively impact students’ behavioral intention to use an EHR.  Additionally, EHR implementation in the classroom, skills lab, or simulation lab will likely lead to an increase in understanding of the technology and how it relates to nursing practice, an increase in knowledge and skill set, an increase in competence, an increase in comfort level with technology, a decrease in stress and anxiety when using an EHR on clinical rotation, and will ultimately serve to better prepare nursing students for nursing practice.  Limitations of this study and recommendations for future research are also shared.

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