Informatics Competencies, Article Critique Example

Outline

Research Problem/Purpose

Review of the Literature

Theoretical Framework

Variables/Hypotheses/Questions/Assumptions

Methodology

Data Analysis

Summary/Conclusions, Implications & Recommendations

Research Problem/Purpose

It became imperative after a goal was set being part of the Affordable Care Act indicating that all health care organizations by 2014 establish electronic health record (EHR) systems. The problem, however, is that historically, nursing education curricula did not account for informatics competencies as a subject. Consequently, contemporary nursing managers, administrators and executives have not been appropriately prepared to neither apply nor guide change towards implementation of electronic health records(EHR) in their organizations (Westra& Delaney, 2008).

In identifying this foundation irregularity within both the implementation and application processes healthcare organizations have undertaken emphasizing informatics competencies relevant to specific leadership roles to improve functionality of the system. As such, the American Organization of Nurse Executives (AONE) took action including informatics in their recent updateof competencies required for efficient nursing executive functioning. Again some difficulty surfaced since these competenciesnot definitive enough to effect adequate changes. They were too broadly stated for translation into clinical practice. Therefore, the purpose of this study ‘the purpose of this study was to develop informatics competencies for nursing leaders’ (Westra & Delaney, 2008, p. 804). Certainly, this study is expected to provide guidance on a very health care sensitive issue. The investigators have placed this study problem within the context of existing knowledge since competencies are emergent concepts in the science as it pertains to obtaining most favorable outcomes.

Review of the Literature 

Concepts explored in the literature review included informatics competencies; combined competencies; computer skills; informatics knowledge; informatics skills; nursing leader; documenting, bedside and portableapparatus; ergonometrics of work station and level of management. Most of the references were current ranging from1984 to 2008. Waltz, Strickland and Lenz. (1984).Measurement in Nursing Research. Philadelphia: F.A. Davis Company was the oldest reference used in the study. Perhaps, the researchers could not find a more profound source from current literature to express the importance of measurement in nursing research.

Theoretical Framework

The Delphi approach was used by researchers for arriving at a consensus concerning competencies being explored. For the purposes of scientific research theDelphi approach cannot be considered a theoretical framework, but rather a method. Analysts contend that it actually consist of a structured communication technique that emerges from a distinct systematic, interactive forecasting methodology that depends solely on a responses by a panel of experts on a particular subject. These experts answer questionnaires in two or more rounds as was described in the study being reviewed (Rowe & Wright, 2001).

Scientifically, a theoretical framework is not an approach, but a precise collection of interrelated concepts that guideresearchers into determining aspects of the study that can be measured measure as well as valid statistical inferences, which can be made (Botha, 2009). It can be concluded that since there has been no clear theoretical framework in this study, but a subtle implication that one might exist theoretical concepts were not defined and none offered that were related to the research. Consequently, thisresearch did not reference any specific nursing theory neither ones from other disciplines. However, the AONE nursing executive competences were applied when creating nursing informatics competencies since these ought to be relevant to the science.

Atheoryapplicable for this resear is Benner’s Stages of Clinical Competence since ‘the purpose of this study was to develop informatics competencies for nursing leaders’(Westra & Delaney, 2008, p. 804). The five stages are considered useful since nursing leaders could be viewed as novices regarding nursing informatics skills. In designing competences it is inevitable that nursing leaders observe these stages before any competency declaration is made. It takes one through from novice to advanced beginner; competent; proficient and expert (Benner, 2004)

Variables/Hypotheses/Questions/Assumptions

The obvious identifiable independentvariableis informatics competencies and nursing leaders and dependent variable. Independent variables act as predictors or explanatory elements. Essentially, they are the factors, which describe variations in the dependent variable. They were not defined exclusively, but collectively in the methods section of this study. For example, informatics competencies were described as computer skills; informatics skills and informatics knowledge. In operationalizing these concepts researchers applied AONE nursing executive competencies to measure each concept and correlated expert opinion using Delphi approach(Westra & Delaney, 2008). No specific research question or the hypothesis could have been identified. However, an implication for developing competencies was declared in the statement, ‘the purpose of developing informatics competencies was to identify those areas related to nursing leadership, which included front line managers to the nursing executive’(Westra &Delaney, 2008). While not asking a question neither stated in the form of a hypothesis it reinforces then original purpose.

Methodology

These researchers appeared have adapted a mixeddesign inclusive of both quantitative and qualitative elements. Quantitative designs embrace statistical interpretations and explanations of data.For example, a content validity index was calculated, which is a statistical measurement used for aligning informatics competencies developed with AONE nursing executive competencies. Apart from this measurement along with calculation of percentages there were no other strong statistical data presentations (Westra & Delaney, 2008).

Consequently, it can be concluded that these researchers took a stronger qualitative approach. Qualitative studies use words rather than figures during interpretation and explanation of data. There has been a distinct exploratory diction in the analysis,which has been demonstrated throughout the discussion. Examples are how the Delphi process was described according to data retrieved from each round of the intervention. Tables displaying concepts did not calculate means neither medians nor strand deviations. Concepts were simply verbalized(Westra & Delaney, 2008).

Inductive reasoning was predominantly used during the analysis and discussion sections of this study.This is my opinion from the premise that inductive reasoning unlike deductive does not try to prove truth, but suggest it. The researchers did not conclude that the informatics competences developed through this study were the only ways leaders demonstrate their informatics skills. Rather they suggested further investigations in this area of study. While they were eager to provide evidence based interventions it was not presented as absolute proof. Alternatively, deductive reasoning aims to provide evidence based on truth. This is why many researchers adapt qualitative approaches since it is believed that figures are more authentic in establishing truth. As was mentioned earlier these researchers choose to dwell less on statistics, but applied inductive reasoning in developing the competencies which they feel are applicable to twenty-first century nursing leaders facing an informatics incompetency difficulty (Westra & Delaney, 2008).

The sample size and study population, sampling method and study setting embraced selecting a purposive sample consisting of‘13 nursing leaders, informaticians, and researchers’ (Westra & Delaney, 2008, p. 804). This selection was obtained from a population of ‘American Medical Informatics Association Nursing Informatics Working Group, the Minnesota Organization of Nursing Leaders, and the University of Minnesota School Of Nursing’(Westra & Delaney, 2008, p 804).

The researchers choose a non-probability sampling technique involving a purposive method whereby researchers choose the sample from the premise of participants/subjects they believe are best suitable for the study. This method is employed, especially, in cases where there are few participants/subjects meeting the requirement to be included in the study. In this scenario researchers were looking for persons with a specific type of expertise in informatics (Westra & Delaney, 2008).

Data was collected through reviewing relevant literature along with application of Delphi method. Informatics competencies were retrieved from the literature perused. They were further categorized as either informatics knowledge or computer skills in alignment with a framework developed by Staggers, Gassert, andCurran. Thereafter, the competencies were re-evaluated for redundancies and subsequently reworded. After compiling the initial list they were compared to the AONE’s Nursing Executive competencies. Some items were found to be inappropriate and were deleted while others reworded again and subcategories reorganized. Internal and external reliability and the validity of the measurement tools were AONE’s Nursing Executive competencies;content validity index; a list of the Informatics Competencies for Nursing Leaders developed by investigators andDelphi approach. Ethical considerations encompassed securing consent for nursing leaders/experts’ participation in the project (Westra & Delaney, 2008).

Data Analysis

A content validity index (CVI) was used to calculate the proportion of ratings for a quite relevant competency. Further, an 80% agreement threshold was established for consensus determination on competencies reviewed. Every response was transferred into Excel. a percent agreement calculated for each competency afterwards. Competencies showing an 80% agreement rating were retained. However, wording changes of the reorganized competencies were recommended through participants’ responses (Westra & Delaney, 2008).

Investigators then examined relevance of competencies with ratings less than 80% in relation to AONE Nursing Executive Competencies for additional appropriateness. All competencies carrying less than 80% agreement were discarded. Results were presented using three tables. Table 1 displayed computer skills (Basic and Advanced). Table 2 showed informatics knowledge from the management concept perspective and table 3displayed informatics skills as they relate to requirement and system selection; financing, implementation, ethical and legal considerations as well as analysis. One finding was that ‘informatics competencies for nursing leaders should emphasize knowledge and skills for planning, coordinating, supporting, directing, and evaluating informatics initiatives rather than doing’ (Westra & Delaney, 2008, p. 804).

Summary/Conclusions, Implications & Recommendations

The strengths and limitations of this study are implicit in the design itself. Qualitative research findings are often presented using inductive reasoning. As such, the element of subjectivity is greater than quantitative study methods when statistics are used to provide evidence. A major strength is that the reader can more easily understand explorations offered in a qualitative display of data than those demanding statistical interpretations. The audience the researchers hope to reach this is the most appropriate approach to have taken in designing informatics competencies(Westra & Delaney, 2008, p. 804).

Researchers admitted that informatics knowledge and skills determined the study’s uniqueness. Consequently, it was imperative that competencies pertaining to nursing leadership roles and responsibilities be further evaluated before generalizations to adjacent populations. Additional validation was necessary since the study focused on nursing leadership roles in a specific health care setting. Findings and conclusions are significance for nursing practice even through the scientific evidence may be questionable since there were no statistical interpretations of data. However, it serves as a valuable guide for nurse managers in health care settings where informatics competencies are not being used (Westra & Delaney, 2008).

References

Benner, P. (2004).From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison

Botha, M. (2009).Theory Development in Perspective. The Role of Conceptual Frameworks and Models in Theory Development.Journal of Advanced Nursing, 14(1), 49–55.

Rowe, G., & Wright, V. (2001). Expert Opinions in Forecasting. Role of the Delphi Technique. Boston: Kluwer Academic Publishers.

Westra, B., & Delaney, C. (2008). Informatics Competencies for Nursing and Healthcare Leaders.AMIA Annu Symp Proc, 13(1); 804–808