TOWARDS AN INFORMATICS COMPETENT NURSING PROFESSION:

VALIDATION OF THE
SELF-ASSESSMENT OF NURSING INFORMATICS COMPETENCY SCALE (SANICS)
BEFORE AND AFTER ONLINE INFORMATICS TRAINING

A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THE

UNIVERSITY OF HAWAI‘I AT MĀNOA IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF

DOCTOR OF PHILOSOPHY

IN

NURSING

May 2015

By

Judi A. Godsey

Dissertation Committee:

Debra Mark, Chairperson

Estelle Codier
Lorrie Wong
Sunmoo Yoon
Curtis Ho

Keywords: Informatics, competency, SANICS, psychometrics, training

 Copyright

2015

Judi Allyn Godsey

i
 Acknowledgements

I wish to express sincere appreciation to my advisor and chair, Dr. Debra Mark, who has

been a model mentor and a highly competent guide on my journey to a PhD. Many thanks to the

members of my dissertation committee, Drs. Codier, Ho, and Wong, and a special thanks to Dr.

Yoon, who created and graciously shared the SANICS instrument as the topic for my

dissertation, along with much expertise and guidance on psychometrics. A special thanks to my

friend and statistical coach, Greg Grady, who patiently guided and instructed me on all things

psychometric.

This dissertation is dedicated to my loving and supportive parents, Bob and Erna Godsey,

who always believed in and nurtured my potential. To my sisters, Debbie, Pam and Tonja, who

are my cheerleaders, and lifelong best friends. To my extended family members, including my

forever friends Debbie and Phyllis, who have remained steadfastly positioned as a source of

support, prior to and during the years leading up to this degree. My deepest appreciation to Dr.

Debra Breneman, who long ago coaxed, urged, and ultimately persuaded a relatively new

Associate Degree RN to leap outside of her comfort zone and relentlessly seek higher ways of

knowing. And to my wonderful children, Amy and Allen (and my brand new granddaughter,

Allyn), who inspire me to be more than I am. And finally, I extend my warmest gratitude to my

dedicated husband and life partner, Buddy, who consistently sees exciting opportunities instead

of insurmountable barriers.

I would not be here without the people acknowledged on this page, and I am deeply and

infinitely grateful for your influence and presence in my life.

ii
 Abstract

Nurses should be involved in healthcare initiatives that incorporate informatics as an

essential tool for improving health outcomes (IOM, 2010). However, nurses frequently report

lack of competency to perform the most basic computer functions, outside of those required

within their work environment (Hwang, 2011). Without educational or training interventions,

nurses are limited in their ability to effectively use information technology in practice (Greiner,

2003). This study explored the psychometric performance of the Self-Assessment of Nursing

Informatics Competencies Scale (SANICS) when used to measure informatics competency in a

population of entry-level nursing students. Data collected before and after an online informatics

training intervention (SOLO-IT) confirmed the factor structure and internal consistency

reliability of the SANICS. Statistically significant increases (p < 0.001) were reported by

participants (n = 496) on 27 of 30 items measuring self-perceptions of informatics competencies.

Significant differences (p < 0.001) in each sub-scale mean score before and after completion of

SOLO-IT confirmed the construct validity of the SANICS. Results of this study support the

SANICS as a psychometrically sound instrument for measuring perceived informatics

competencies in entry level nursing students. Diffusion of informatics competency throughout

the nursing workforce could depend upon the availability of on-demand training resources and

valid instruments which support nurses as competent users of informatics in an era of ubiquitous

health information technology. Findings from this study provide preliminary evidence that

SOLO-IT may be an effective tool for improving perceptions of informatics competencies

among entry level nursing students. Future studies are recommended using paired samples of

nurses and nursing students from diverse populations, as well as studies which correlate

perceived competencies with actual demonstrated skills.

iii
 Table of Contents

Chapter I: Introduction ................................................................................................................1

Background ......................................................................................................................................2
American Association of Colleges of Nursing ...........................................................................2
Technology and informatics Guiding Educational Reform ........................................................4
The National League of Nursing.................................................................................................6
Nursing Informatics and the Affordable and Accountable Care Act ..........................................6
Institute of Medicine ...................................................................................................................7
Significance......................................................................................................................................8
Purpose...........................................................................................................................................10
Research Questions ........................................................................................................................11
Methods..........................................................................................................................................12
Summary ........................................................................................................................................12

Chapter II: Review of the Literature ........................................................................................14

Theoretical Framework ..................................................................................................................14

Theoretical Model- Principal Components of Scale: Developing Psychometrically Sound
Instruments .....................................................................................................................................14
Psychometrics ................................................................................................................................16
Principal Component Analysis .................................................................................................16
Internal Consistency Reliability................................................................................................17
Construct Validity .....................................................................................................................17
Responsiveness .........................................................................................................................18
Studies Describing Informatics Competencies .............................................................................19
Instruments to Measure Informatics Competencies ......................................................................22
Graduating Nurses’ Self-Evaluation of IT Competencies .......................................................23
Computer Literacy Scale for Newly Enrolled College Students ..............................................24
Assessment Tool for Nursing Student Computer Competencies ..............................................24
The eNNI Project ......................................................................................................................25
Computer Competencies in the Curriculum .............................................................................25
Survey of Beginning Nurse Competencies ...............................................................................26
Computer Competencies Survey and Assessment Tool ...........................................................26
Gassert/McDowell Computer Literacy Survey .........................................................................27
TIGER Initiative Informatics Competencies ............................................................................27
Informatics Competency Questionnaire ...................................................................................28
Technology Skills Assessment Survey .....................................................................................29
Competency Assessment Tool ..................................................................................................29

iv
 The Self-Assessment of Nursing Informatics Competency Scale ............................................29
Choi ......................................................................................................................................31
Choi and De Martinas ..........................................................................................................31
Choi and Bakken ..................................................................................................................32
Informatics Training and Assessment ............................................................................................42
European Computer Driver’s License (ECDL) Certification ...................................................43
TIGER Virtual Demonstration Center .....................................................................................44
Nursing Resources: A Self-Paced Tutorial ...............................................................................45
IC3 Training and Certification Program ...................................................................................46
The Passport Project for Nursing Success ................................................................................46
Computer Competency Tutorial ...............................................................................................48
Information Literacy Tutorial ...................................................................................................48
Pre-test for Attitudes Toward Computers in Healthcare...........................................................49
Summary .......................................................................................................................................53

Chapter III: Research Methodology .........................................................................................55

Introduction ....................................................................................................................................55
Research Questions ..................................................................................................................55
Research Design ............................................................................................................................56
Conceptual Definitions ..................................................................................................................56
Informatics ................................................................................................................................56
Informatics Competency ...........................................................................................................57
Informatics Knowledge ........................................................................................................57
Computer Skills ...................................................................................................................58
Operational Definitions ..................................................................................................................61
Entry Level Nursing Student ...................................................................................................61
Blackboard ................................................................................................................................61
Informatics Curricular Instruction ...........................................................................................61
Informatics Training ................................................................................................................61
Competency on the SANICS ....................................................................................................62
Instrumentation ..............................................................................................................................62
Method to Test the SANICS Instrument ...................................................................................64
Sample..................................................................................................................................65
SANICS and SOLO-IT ..................................................................................................................65
Instructional Design of SOLO-IT .............................................................................................66
Self-Directed Learning ........................................................................................................66
SOLO’s Web Based Modules ...................................................................................................67
Plan for Data Collection and Analysis ..........................................................................................73
Process to Determine Feasibility ..............................................................................................73

v
 Data Analysis Plan ...................................................................................................................74
Statistical Power ..................................................................................................................75
Plan for Statistical Analysis .................................................................................................76
Ethical Considerations ............................................................................................................ 76
University of Hawaii IRB Approval ....................................................................................76
Xavier University IRB Approval .........................................................................................78
Limitations of the Design..........................................................................................................79
Summary ........................................................................................................................................80

Chapter IV: Results ....................................................................................................................81

Research Design………………………………………………………………………………….81
Setting and Sample ...................................................................................................................81
Profile of Respondents ..............................................................................................................83
Presentation of Data for Research Question One ..........................................................................84
Principal Component Analysis .................................................................................................84
Parallel Analysis .......................................................................................................................86
Psychometric Analysis: Comparisons with Original SANICS Study.......................................86
Presentation of Data for Research Question Two ..........................................................................89
Value of SOLO-IT .........................................................................................................................91
Summary ........................................................................................................................................93

Chapter V: Discussion ................................................................................................................94

Discussion ......................................................................................................................................94
Sample Size and Return Rates ..................................................................................................94
Study Participants .....................................................................................................................94
Research Question One ..................................................................................................................94
Research Question Two .................................................................................................................95
Value of SOLO-IT .........................................................................................................................96
Limitations .....................................................................................................................................97
Implications for Future Research ...................................................................................................99
Summary ......................................................................................................................................100
References ...................................................................................................................................114

List of Tables

Table 1: Informatics Competency Instruments ...........................................................................33

Table 2: Non-Curricular Informatics Training Resources ..........................................................50
Table 3: BSN Demographics ......................................................................................................83

vi
Table 4: Factor Structure Matrix Pre-and Post-SOLO-IT ..........................................................85
Table 5: Factor Structure Compared to Original SANICS Study ...............................................87
Table 6: Average Scores for Each SANICS Sub-Scale Pre/Post SOLO-IT ...............................90
Table 7: SANICS Scores Post SOLO-IT Compared to Original SANICS Study ......................91
Table 8: Value of SOLO-IT ........................................................................................................92

List of Figures:

Figure 1: Theoretical Model: Principal Components of Scale for Developing Psychometrically

Sound Instruments ........................................................................................................................18
Figure 2: SOLO-IT and SANICS: Participation and Return Rates ..............................................82
Figure 3: Parallel Analysis ............................................................................................................86

List of Appendices

Appendix A: SANICS Instrument ..............................................................................................102

Appendix B: SOLO-IT Course Overview and Grading Criteria ................................................104
Appendix C: Power Analysis Using the G Power Program .......................................................111
Appendix D: University of Hawaii IRB Approval ....................................................................112
Appendix E: Xavier University IRB Approval ...........................................................................113

vii
 Chapter I
Introduction

Numbering more than three million, licensed Registered Nurses (RNs) make up the

largest group of healthcare professionals in the United States (Health Resources Services

Administration, 2010). Advances in healthcare have created a nursing workforce increasingly

dependent upon technology to deliver innovative therapies at the bedside, and to interpret

massive amounts of quality-related outcomes data in the executive boardroom. The information

age is producing data at rates that exceed the ability to use it. The Economist estimates medical

centers are home to almost one billion terabytes of data, “equivalent to almost two trillion file

cabinets worth of information” (2010, pg. 3).

Nursing informatics is “a specialty that integrates nursing science, computer science,

and information science to manage and communicate data, information, and knowledge in

nursing practice” (American Nurses Association [ANA], 2001, p.17). Nurses capable of

integrating informatics solutions into an automated healthcare environment will be essential to

the future of nursing and the promotion of health that spans “time and place” and “wellness and

health maintenance activities” (Health Information and Management System Society [HIMSS],

2012, p. 3). For more than a decade, nursing researchers have recognized that evidence based

practice (EBP) would be dependent upon nursing’s ability to demonstrate expert knowledge in

patients’ individual and collective decision making processes (McCormack, Kitson, Harvey,

Rycraft-Malone, Titchen & Seers, 2002). Such expert knowledge in practice is based on a

foundational ability to use information technology effectively and manage electronic sources of

information, which assumes at least a basic education in informatics (Courey, Benson-Soros,

Deemer, & Zeller, 2006; IOM, 2003).

1
 Background

As the largest group of clinical health information technology users, nurses must

possess a minimum set of technical competencies needed for the electronic medical record

(EMR), including basic computer skills and information literacy (Ball, Douglas & Hinton-

Walker, 2011). Basic computer literacy (competency) is defined as “the use of personal

computers, including the use of software tools such as word processing, spreadsheets, databases,

presentation graphics, and e-mail” (Hebda & Czar 2013, p. 8). Information literacy is the ability

to access, process, and use information and is an essential component of nursing informatics

competency (IOM, 2011). The IOM has identified information literacy as the recommended

standard for nursing and nursing students (2011).

Significant contributions concerning the role of nursing informatics have been made

during the past decade. Staggers and colleagues defined and described informatics

competencies, skills, knowledge, and abilities based on educational preparation and expertise:

beginning nurse, experienced nurse, informatics nurse specialist, and informatics innovator

(Staggers, Gassert, & Curran, 2001, 2002). Their seminal research has informed the

development of informatics competency measurements for the nursing profession and has

influenced many of the standards commonly used by leading professional nursing organizations.

These organizations include the American Association of Colleges of Nursing (AACN, 2008),

the TIGER Initiative (2010) and the National League of Nursing (2008).

American Association of Colleges of Nursing (AACN)

The AACN’s “Essentials of a Baccalaureate Education for Professional Practice,”

provides guidelines for nursing practice (2008). In 2008, the AACN included the mandate that

informatics be included as an “essential element” of a baccalaureate nursing degree, since

2
“computer and information literacy are crucial to the future of nursing” and provide a bridge

between the “preparation-practice” gap (p. 17).

The 2008 guidelines include “Information Management and Application of Patient

Care Technology” as one of the nine “Essentials” for a professional nursing education (p. 17).

Standards outlined under the technology “Essential” include:

1. Demonstrate skills in using patient care technologies, information systems, and

communication devices that support safe nursing practice.

2. Use telecommunication technologies to assist in effective communication in a variety of

healthcare settings.

3. Apply safeguards and decision making support tools embedded in patient care

technologies and information systems to support a safe practice environment for both

patients and healthcare workers.

4. Understand the use of computerized information systems to document interventions

related to achieving nurse sensitive outcomes.

5. Use standardized terminology in a care environment that reflects nursing’s unique

contribution to patient outcomes.

6. Evaluate data from all relevant sources, including technology, to inform the delivery of

care.

7. Recognize the role of information technology in improving patient care outcomes and

creating a safe care environment.

8. Uphold ethical standards related to data security, regulatory requirements, confidentiality,

and clients’ right to privacy.

3
 9. Apply patient-care technologies as appropriate to address the needs of a diverse patient

population.

10. Advocate for the use of new patient care technologies for safe, quality care.

11. Recognize that redesign ofworkflow and care processes should precede implementation

of care technology to facilitate nursing practice.

12. Participate in evaluation of information systems in practice settings through policy and pr

ocedure development (p. 17).

The implementation of informatics as an essential component of accreditation

standards is an important step in the process of transforming nursing education in a manner that

prepares graduates to practice competently. Such skills are critical in a technology driven

healthcare environment (Ball, Douglas & Hinton-Walker, 2011).

Technology and informatics Guiding Educational Reform (TIGER)

Technology and Informatics Guiding Educational Reform (the TIGER Initiative) is an

independent, grassroots nursing initiative whose primary focus is educational reform in nursing

informatics (Ball, et. al, 2011). The TIGER Initiative began in 2006 in response to the growing

need for an informatics competent nursing workforce. The TIGER Initiative catalyzed the

formation of the Alliance for Nursing Informatics (ANI), a coalition of 20 nursing informatics

professional societies, and major nursing organizations such as the ANA, Association of Nurse

Executives (AONE), the American Association of Colleges of Nursing (AACN) (TIGER, 2008).

The ANI also includes an additional 170 diverse organizations which seek to make informatics

“nursing’s stethoscope by the 21st century” (Ball, et al, 2011, p. 19; TIGER, 2008, 2010). The

TIGER Initiative focuses on “the need to engage nurses in all settings in the national effort to

4
prepare the healthcare workforce toward effective adoption of electronic health records” (p. 10).

The following recommendations emerged from the TIGER Summit (2010):

 Institute a national marketing campaign to promote the value of technology in a multi-

disciplinary way that supports an accepting culture.

 Include Health Information Technology (HIT) in every strategic plan, mission, and

vision statement; use of HIT is embraced by executives, deans, all point of care

clinicians and students with goal of high quality care and safety.

 Establish multidisciplinary teams that embrace a shared vision and operate cohesively to

push for broad technology integration within/across entire organizations.

 Develop mutual respect between/among clinicians who may bring different skills and

knowledge (p.14).

The TIGER Initiative developed a TIGER Informatics Competencies Collaborative

(TICC). This group of informatics and nursing experts was charged with the establishment of a

minimum set of informatics competencies (Ball, et al, 2011). The TICC also outlined

basic computer and information literacy skills for nurses and nursing students. Recommended

information literacy and computer skills are described below (Gugerty & Delaney, 2009):

Information literacy skills identified by TIGER.

1. Determine the nature and extent of the information needed

2. Access needed information effectively and efficiently

3. Evaluate information and its sources critically and incorporates selected information

into his or her knowledge base and value system

4. Individually or as a member of a group, use information effectively to accomplish a

specific purpose

5
 5. Evaluate outcomes of the use of information (p.5).

Computer skills identified by TIGER.

1. Concepts of Information and Communication Technology (ICT)

2. Using the Computer and Managing Files

3. Word Processing

4. Spreadsheets

5. Using Databases

6. Presentation

7. Web Browsing and Communication (p. 3).

The National League of Nursing

The National League of Nursing (NLN) has called for the development of innovative

educational programs which improve informatics competencies and enable competent use of

information technologies (2008). For more than a decade, the nursing literature has reported that

nursing schools lack standardization as to the type and complexity of computer skills required for

nursing students (Sinclair & Gardner, 1999) The ability for nursing education to integrate

computer competency and information literacy “will require nursing curriculum reform and an

infusion of technologies for learning” (p. 40).

Nursing Informatics and the Affordable and Accountable Care Act

Nurses should be involved in healthcare initiatives that incorporate informatics as an

essential tool for improving health outcomes (IOM, 2010). As a result of the Affordable Care

Act (ACA) of 2010, healthcare delivery is transitioning to electronic health records for

meaningful use and exchange of information (Department of Health and Human Resources

[HHS], 2010). The ACA includes broad application of informatics competencies to support the

6
meaningful use of information supporting quality patient outcomes. However, a chasm between

knowledge and practice prevails due to incomplete adoption of healthcare innovations (IOM,

2001; Glanz, Rimer &Viswanath, 2008). Nurses deficient in basic informatics competencies

have limited ability to use and apply communication and information technology in their practice

(IOM, 2003, p. 85). Nurses are the largest group of clinical users of health information

technologies and must master a minimum set of competencies needed for the electronic medical

record (EMR), including basic computer skills and information literacy (Ball, et al, 2011).

Employing agencies may understandably assume that requisite computer skills are being taught

during a student’s undergraduate college education. However, nurses frequently lack the

minimum level of competency to work efficiently or effectively with computerized information

systems (Thede & Sewell, 2004; Wilbright, et. al, 2006). Inexperience with technology is one of

the most common factors impeding the adoption of Electronic Medical Records (EMR) (Mcginn,

et al. 2012). Effective use of electronic health systems depend on competence with the complete

system, including advanced tools for charting and data management (Saba & McCormick, 2011).

Institute of Medicine (IOM)

Ongoing advances in health informatics require the preparation of a nursing

workforce competent in computer based applications. In a groundbreaking report, The Future of

Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) called for nurses

to be involved in healthcare initiatives that incorporate informatics as an essential tool for

improving health outcomes (2010). The Institute of Medicine defines information literacy as the

ability to access, process, and use information (2011). A key component of informatics

competency is information literacy, which is the ability to find, retrieve, and analyze information

7
(American Library Association, 2012). Information literacy is considered an essential

competency and is the recommended standard for all nurses and nursing students (IOM, 2011).

Significance

Informatics competency is readily accepted as basic technology skills that nurses must

have to perform their duties (McNeil, Elfrink, Pierce, Beyea, Bickford, & Averill 2005; Staggers,

Gassert & Curran, 2001; Yoon, Yen, & Bakken, 2009). Effective and efficient use of electronic

health systems rely on competence with the complete system, including the ability to use

advanced tools designed for charting and data management (Saba & McCormick, 1996). Expert

testimony provided to the Office of the National Coordinator (ONC) revealed significant

challenges for nurses when locating pertinent data “in the sea of available electronic information

in the EMR” (Staggers, 2011, p. 542). Inexperience with technology has been identified as one

of the most common factors impeding the adoption of the EMR (Mcginn, et al. 2012).

For the past 30 years, nurses have been encouraged to acquire and build upon

informatics competencies to perform their role optimally (Ball & Hannah,1984; Graves &

Chocoran, 1989; Herbert, 1999; Saba & McCormick, 1996; Scholes & Barber, 1980; Staggers,

Thompson, Happ & Bartz, 1998; Turley, 1996). Still, nurses consistently self-report a lack of

competency to perform even the most basic computer functions, outside of those required within

their work environment (Ball, Douglas, Hinton-Walker, 2011; Hwang & Park, 2011; Thede &

Sewell, 2009).

A gap exists in the literature regarding informatics competency training resources for

nurses and the availability of valid, reliable tools to measure their effectiveness. These findings

are surprising given persistent recommendations from professional nursing organizations calling

for a deliberate, systematic approach to improving the basic computer skills and information

8
literacy of the nursing profession (ANA, 2001; IOM, 2011; TIGER, 2008). Despite this call, the

integration of informatics into the nursing curriculum and development of informatics

competencies among nurses is still lacking (Hunter, McGonigle, Dee, Hebda, 2013; Virgona,

2013).

The TIGER Initiative focuses on “helping the nursing profession to adopt informatics

tools, principles, theories, and practices that make healthcare safer and more effective, efficient,

patient-centered, and equitable for all stakeholders” (p. 3). The TIGER Initiative’s Executive

Summary (2010) identified the concern of “informatics illiteracy in nursing education” and

included the imperative for nurses to become competent in the use of technology tools to support

decision making in clinical practice (p. 2). In a recent study (2013), students enrolled in the first

semester of a Doctor of Nursing Practice (DNP) Program were not competent in any of three

categories of computer skills, informatics knowledge, and informatics skills. Despite ubiquitous

use of technology in daily life, the incorporation of basic computer skills and informatics into

nursing curricula is still considered an “essential” need (Virgona, 2013, p. 61). A common

misperception is that younger students enter traditional BSN programs with requisite computer

and information literacy skills. However, recent research suggests that RN to BSN and

Accelerated BSN students may be more competent in informatics than younger Pre-Licensure

students (Choi, 2012). Even though use of technology has been expanded in K-12 education,

“findings indicate that (nursing) students’ computer competencies may be lower than

anticipated” (Elder & Koehn, 2009).

Broad adoption of essential nursing informatics competencies would be advantageous

for the nursing profession (Ball, et al., 2011). The TIGER Initiative calls for competency based

training resources which can help prepare the nursing workforce to improve healthcare delivery

9
using informatics (Ball, et al, 2011). However, informatics competency training resources for

nurses remain insufficient and frequently do not provide validity and reliability data for the

instrument, or lack formalized assessments altogether (2011).

Evidence exists that “without a basic education in informatics, nurses and other

healthcare professionals are limited in their ability to make effective use of communication and

information technology in their practice” (IOM, 2003, p. 85). Educational interventions aimed

directly at informatics competencies of nursing students have proven effective (Choi, 2012;

Flood, Gasiewicz & Delpier, 2010; Tarrant, Dodgson, & Law, 2008, Yoon, et al., 2009).

However, nursing education programs have been slow to support the development of informatics

competencies or to provide the training and resources necessary for nurses to enter the

professional world with adequate technology or information literacy skills (Westra & Delaney,

2008).

Purpose

The TIGER Collaborative issued a Call to Action identifying the need for educational

interventions which foster information technology innovation and adoption by nurses (2008). In

2011, the TIGER Initiative called for competency based training resources which improve basic

informatics competencies (computer skill and information literacy) and prepare the nursing

workforce to improve healthcare delivery using informatics (Ball, et al). While numerous

instruments have been utilized to measure the informatics competencies of nurses, relatively few

research reports provide psychometric data to support the reliability and validity of the

instruments (Lin, 2011). Issues related to computer competency and information literacy have

long been described by researchers, yet few training resources exist and “little attention has been

paid to the validity of scales used” (Lin, 2011, p. 306).

10
 This purpose of this study is to evaluate the psychometric performance of the Self-

Assessment of Nursing Informatics Competency Scale (SANICS) before and after completion of

informatics training. Principal component analysis will be used to examine the factor structure

of the SANICS. Internal consistency reliability will be used to examine the psychometric

properties of the SANICS among a sample of BSN entry-level nursing students. Responsive of

the SANICS over time will be examined following completion of Successful Online Learning

and Orientation Informatics Training (SOLO-IT) modules. Construct validity of the SANICS

will be assessed using a known group approach to compare differences in means for each

SANICS subscale (construct) before and after completion of Successful Online Learning and

Orientation Informatics Training (SOLO-IT) modules.

Research Questions

The literature supports an ongoing lack of informatics competencies among the nursing

profession, as well as a lack of valid tools in which to measure them. Additionally, the literature

acknowledges a lack of empirically sound informatics training resources. Research questions to

be answered by this study are as follows:

1) What are the psychometric properties of the SANICS among a population of BSN

entry-level students?

2) Is the SANICS responsive over time when used to measure informatics competencies

following completion of Successful Online Learning and Orientation (SOLO)

Informatics Training (IT) modules?

 Hypothesis: There will be a significant difference in SANICS scores between

pre-SOLO and post-SOLO.

11
 Methods

Essential informatics concepts will provide the foundational underpinnings for this

research. Authoritative definitions derived from research studies, professional nursing

organizations and national health collaboratives were used to inform the study’s design. A

thorough review of current and historical literature supported the lack of requisite computer

competency and information literacy skills essential for an informatics competent nursing

workforce. The literature also described a persistent lack of reliable and valid tools to measure

those competencies.

National professional nursing organizations recommend web based informatics training

for nurses, as well as rigorous assessment tools and strategies to validate their effectiveness

(Ball, et al., 2011). However, a comprehensive literature search identified a lack of web based

training resources and accompanying instruments used to measure the outcomes of informatics

training. Due to the small number of empirical studies available, the search for training

resources was expanded to include both nursing and educational tools which measure

competencies before and/or after informatics training. Review of curriculum based informatics

instruction and/or health record simulation training sites was excluded from this search.

Summary

Researchers have developed measurement scales which define and quantify the

informatics competency (IC) levels needed for nurses and nursing students (Staggers, Gassert, &

Curran, 2002; Yoon, et al., 2009). Competency levels outlined by these instruments are

comprehensive and span from the “beginning nurse” to “informatics innovator” (Staggers, et al.,

2002). While nursing informatics competencies have been described for more than a decade, a

comprehensive review of the literature revealed a surprising lack of research studies describing

12
training interventions to address the problem of insufficient informatics competencies among

nursing professionals. Additionally, published literature describing valid, reliable assessment

tools to measure the effect of informatics competency training among nurses or nursing students

was relatively sparse.

13
 Chapter II

Review of the Literature

Theoretical Framework

This quantitative study will use a post-positivist theoretical perspective grounded in

objectivist epistemology. In post-positivism, objectivity is the “regulatory ideal” but may not be

achievable due to the research process which allows claims to be refined or abandoned altogether

(Guba & Lincoln, 1994, p. 205). The post-positivist approach does not seek to prove a

hypothesis (as with positivism), but rather to indicate a failure to reject the hypothesis (Phillips &

Burbules, 2000). Human knowledge can be challenged and assumptions withdrawn, when

warranted, for further investigation (2000). Quantitative research is defined as “a means for

testing objective theories by examining the relationship among variables” (Creswell, 2009, p. 4).

Quantitative inquiry allows theories to be tested deductively, “building in protections against

bias, controlling for alternative explanations, and being able to generalize and replicate findings”

(Creswell, 2009, p. 4).

Theoretical Model: Principal Components of Scale Theory

Scientific inquiry is dependent upon the adequacy of its measures (Foster and Cone,

1995). Figure 1 illustrates the importance of using psychometrically sound instruments to

accurately measure the informatics competencies necessary for nursing practice in a technology-

driven healthcare environment. This model is built upon the Principal Components of Scale

Theory (Guttman, 1941), which involves a vector of numerical weights or scores with

corresponding principal components. In this system “each numerical score…is proportional to

the sum of the weights for the item response” in such a manner that maximizes the “correlation

ratio” (p. 327). The resulting scoring weights support item reliability by factoring a matrix of

14
inter-item correlations. Principal components are considered correlated with the scores when the

weighted items maximize the coefficient alpha (Lord, 1958).

Validated measurement tools support the development of on-demand training resources

for self-directed learners who work in fast paced healthcare environments. The need for an

informatics competent workforce is mandated by professional nursing standards (AACN), scope

of nursing practice (ANA), and recommendations of authoritative bodies (IOM, NLN). The

model shows the relationship between easily accessed tools for self-directed learning and the

achievement of information technology skills consistent with a technologically competent

nursing workforce prepared for evidence based practice.

Figure 1: Theoretical Model

Principal Components of Scale Theory: Developing Instruments to Support Informatics Training

and Evidence Based Practice

15
 Psychometrics

This study will measure the items contained within the Self-Assessment of Nursing

Informatics Competencies Scale (SANICS) and will analyze their psychometric properties.

Psychometric evaluation is concerned with an instrument’s reliability and validity (Carmines &

Zeller, 1979). An instrument is a device used by researchers to measure variables (Neale &

Liebert, 1986). Commonly, research instruments include questionnaires, rating scales, and

physiological or observational measurements (1986). Reliability is established when a measure,

repeated on a different population, remains consistent (Cortina, 1993). The degree to which

evidence supports the interpretation of a test is referred to as validity (Guilford, 1946).

This study will evaluate the psychometric properties of the SANICS instrument using: 1)

principal component analysis, 2) internal consistency reliability, and 3) responsiveness.

Principal Component Analysis

Principal component analysis with oblique (promax) rotation will be used to determine

the factor structure of the SANICS instrument. Principal component analysis is the preferred

method for factor extraction since, unlike factor analysis, it allows for all sources of variability

(unique, shared, or error) to be analyzed (Mertler & Vannatta, 2010). The goal in principal

component analysis is to “extract the maximum variance from the data set, resulting in a few

orthogonal (uncorrelated) components” (2010, p. 234). Parallel analysis will be used to

determine which factors should be retained. In parallel analysis, “eigenvalues from research

data prior to rotation are compared with those from a random matrix of identical dimensionality

to the research data set. Component PCA eigenvalues which are greater than their respective

component parallel analysis eigenvalues from the random data would be retained” (Franklin,

Gibson, Robertson, Pohlmann & Fralish, 1995, p. 100). An eigenvalue is “the amount of total

16
variance explained by each factor, with the total amount of variability in the analysis equal to the

number of original variables in the analysis (i.e. each variable contributes one unit of variability

to the total amount)” (Mertler & Vannatta, 2010, p. 234). Parallel analysis is “considered more

replicable than using eigenvalues or Scree plot to determine the cut-off for retention” (Yoon, et

al, 2009, pg. 548). Factor loadings and promax rotation with Kaiser normalization will be used

to examine and confirm correlations among factors (Tabachnick & Fidell, 2007). Factorial

validity involves the measurement of reference factors to determine if a test theoretically

measures what it was intended to measure (Guilford, 1946). Rotation is “a process by which a

factor solution is made more interpretable without altering the underlying mathematical

structure” (Mertler & Vannatta, 2010, p. 238). Promax rotation is an oblique rotation of factors

to determine their relationship with one another (2010).

Internal Consistency Reliability

Internal consistency reliability of the SANICS instrument will be determined using

Cronbach’s alpha to assess the total scale and each subscale. Cronbach’s alpha (Cronbach, 1951)

is one of the most popular reliability statistics and is used to determine “the internal consistency

or average correlation of items in a survey instrument to gauge its reliability” (Reynaldo &

Santos, 1999, p.2). An acceptable reliability coefficient of 0.7 has been identified as reliable,

though lower thresholds have been used (Nunnally & Bernstein, 1994). A scale which fails to

show variables with high correlation would be considered to have poor reliability (1994).

Construct Validity

Construct validity refers to an instrument’s ability to measure constructs adequately

(Shuttleworth, 2014). Construct validity is frequently measured using intervention studies, where

groups with low scores on the construct being measured are taught the construct, then re-

17
measured. The presence of statistically significant differences between pre and post-test scores

establishes good construct validity (Shuttleworth, 2014).

Construct validity of the SANICS will be assessed using a known group approach to

compare differences in means (averages) for each SANICS subscale (construct) before and after

completion of Successful Online Learning and Orientation: Informatics Training (SOLO-IT)

modules. In a known group approach, “the instrument is administered to two groups known to

be high and low on the measured concept (Burns & Grove, 2010). This study will also determine

if self-perceptions of informatics competencies increased following completion of SOLO-IT’s

online training modules. Competency is indicated by a minimum SANICS score of 3 (Yoon et

al., 2009). If the SANICS is sensitive to individual differences in means (averages) before and

after completion of SOLO-IT, then the mean performance between each group should be

significantly different (Waltz, et al. 2005).

Responsiveness

Responsiveness is an index used to measure an instrument’s ability to detect change over

time between baseline and post-test (Middel & Van Sonderen, 2002). Responsiveness, or effect

size (ES), of the SANICS will be determined using a standardized response mean (SRM) which

is commonly used to measure responsiveness (2002). The SRM will be calculated as the

difference between scores before and after completing SOLO-IT, divided by the standard

deviation of the difference. Effects sizes of < 0.20 are commonly accepted as trivial

responsiveness; ES ≥ 0.20 < 0.50 small; ES ≥ 0.50 < 0.80 moderate; and ES ≥ 0.80 large (Cohen,

1977). Responsiveness of the scale over time will be assessed using independent sample t-tests.

18
 Studies Describing Informatics Competencies

Staggers and colleagues established the standards for measuring informatics

competencies largely in use today (2001, 2002). This seminal work has served as the foundation

for studies which have followed, resulting in expanded competency descriptions for specific

populations. Despite the significant contributions by Staggers and colleagues which have

resulted in comprehensive competency descriptions, most nursing informatics research reports

still fail to define this concept (Hunter, McGonigle, & Hebda, 2013).

In a recent study (2011) of 350 nurses, more than two-thirds (69.2%) reported below

average informatics competency and over half (58.9%) rated computer skills as below average

(Hwang & Park). The ability to search databases and use nursing-specific software, both critical

information technology skills, were also reported as lacking by survey participants (2011). This

study positively correlated the presence of basic computer skills and formal informatics

education with informatics competency. Hwang and Park concluded accessibility to informatics

education, as well as training opportunities to improve basic computer skills, are needed in

nursing practice to improve the competencies necessary for managing and using healthcare

information, and improving patient safety (2011). Furthermore, the researchers recommended

that priority be given to groups possessing low computer proficiency (2011).

Another study exploring common practices employed by RNs when accessing data to

support evidence based practice (EBP) indicated a preference for information obtained from

colleagues rather than a review of scholarly literature (Dee & Stanley, 2005). The reason cited

for this preference was unfamiliarity with navigational skills necessary to access electronic

databases (2005). Opportunities to infuse technology into nursing education include access of

real-time linkages to expansive and widely available global information networks. Nursing

19
programs frequently focus on the use of technology as a means to support educational

programming rather than an essential tool to prepare students for technology enhanced nursing

practice (McNeil, Elfrink, Pierce, Beyea, Bickford, & Averill, 2005).

In further research conducted by McNeil and colleagues, college deans and directors

from 266 baccalaureate and higher nursing programs ranked their faculty’s ability to teach and

use nursing informatics as “novice” or “advanced beginner” (McNeil, et al., 2005). The study

revealed that United States (U.S.) nursing programs inconsistently taught information literacy

skills, standardized nursing language, and technology supported evidence based practice. Their

research examined informatics knowledge and skills taught in baccalaureate and master's level

nursing education programs in the U.S.. Findings from this study showed that only about half of

U.S. baccalaureate nursing programs (n=135) taught information literacy skills or required basic

word processing and e-mail skills for entering students. Only 25% (n=67) expected students to

enter their nursing program with information literacy skills and only 9% (n=24) expected

students to have the ability to use presentation software. The informatics content taught most

frequently included “accessing electronic resources” (50%), followed by “computer based

patient record” (46%), “ethical use of information systems” (45%), “informatics nurse

competencies” (40%), and “informatics definitions” (39%). Only 37% of respondents reported

teaching informatics content which supported evidence-based practice. Graduate programs were

found to have even less informatics related content areas than undergraduate programs. The

researchers also examined the perceptions of faculty members’ informatics competency and their

use of informatics tools. Almost half of respondents ranked nursing faculty abilities as “novice”

or “advanced beginners” with using nursing informatics applications. This study determined that

a critical need exists to “include informatics concepts, informatics skills, and the use of

20
informatics tools in professional nursing practice within nursing curricula across the US” and to

prepare faculty who are qualified to teach these skills (p. 1029). These findings have

implications for nursing education since the ability to access and translate informatics knowledge

is essential for evidence based nursing practice (IOM, 2011). Much work is needed to prepare

current and future generations of nurses to function as competent users of the information

technologies that support evidence based practice (Desjardins, Cook, Jenkins, Bakken, 2005;

Waters, Rochester, McMillan, 2012).

Frequently, a substantial amount of time passes between an initial nursing degree and a

return to higher education. This delay between nursing programs of study exacerbates the

problem of informatics deficiencies for nurses since technological changes in the educational

setting further illuminate a lack of understanding of informatics (Spratley, et al., 2000).

Many high functioning students (top 10% of incoming college freshman) capable of

performing internet based literature searches lack the ability to 1) access scholarly sources, 2)

think critically about the information attained, and 3) lack awareness of legal and ethical issues

relating to information technology (Gross & Latham, 2009). Consensus exists among deans and

directors of nursing programs across the nation that nursing students should graduate with basic

information literacy skills, though such skills are frequently not taught in undergraduate

programs (McDowell & Ma, 2007). Additionally, nurse educators frequently possess only basic

skills in the area of applied informatics (Skiba, Connors, Jeffries, 2008). Informatics training,

therefore, shifts to the employing institution and to nursing administrators who are left to manage

the lack of informatics training and the inadequate technological preparation of nurses (Westra &

Delaney, 2008). Because graduating nurses are prepared insufficiently with technology skills,

21
formalized informatics training which should have been provided during the post-secondary

educational process, is necessarily absorbed by the workplace, or is entirely absent (2008).

Information literacy (the ability to access, process, and use information) is the

recommended standard for nursing and nursing students (IOM, 2011). Nurse information

literacy skills must be highly efficacious to manage vast amounts of new information (Majid,

Foo, Luyt, Zhang, Theng, Chang, and Mokhtar, 2011). However, despite groundbreaking

technological advances in healthcare, nurses frequently lack basic informatics competencies

outside of their own work environment (Thede & Sewell, 2009). A survey of nurse executives

revealed the existence of a “preparation-practice” gap regarding technical readiness among

nursing graduates (Nurse Executive Center Nursing School Curriculum Survey [NECNSC],

2008). Only 10.4% of respondents felt that nursing graduates are being sufficiently prepared for

practice in the area of technical skills. This finding was followed with agreement by almost 90%

of the 362 nursing school leaders surveyed (2007).

Instruments Measuring Informatics Competencies

Since the arrival of computer systems to the healthcare setting, nurses have been urged to

obtain competency with using technology in all practice settings (Ball, Douglas, Hinton Walker,

2011). Experts and leading professional nursing organization have provided perspectives

regarding the need for all nurses to use and apply information technology in their practice (ANA,

2001; IOM, 2011; TIGER, 2008).

Nursing experts and professional organizations have called for a nursing workforce

capable of demonstrating informatics competencies. However, integration of informatics into

the nursing curriculum and development of informatics competencies among nurses is still

lacking (Hunter, McGonigle, Dee, Hebda, 2013; Virgona, 2013). While numerous informatics

22
competency instruments have been utilized, relatively few research reports provide psychometric

data to support the reliability and validity of the instruments (Lin, 2011). Issues related to

computer competency and information literacy have long been described by researchers, yet

“little attention has been paid to the validity of scales used” (Lin, 2011, p. 306).

The following discussion summarizes research reports describing informatics

competencies using a variety of instruments over the past decade. An outline of what is

currently known about instruments measuring nursing informatics competencies follows

(including their psychometric properties, when available). This information is also summarized

chronologically in Table 2, with studies using the SANICS instrument highlighted separately

toward the end of the table.

Graduating Nurses’ Self-Evaluation of Information Technology Competencies

The 43 informatics novice nurse competency items developed as part of the seminal work

by Staggers, Gassert, and Curran (2001) served as the foundation for the Graduating Nurses’

Self-Evaluation of Information Technology Competencies survey instrument (Fetter, 2009). In a

pilot study, informatics competencies were ranked by 42 graduating seniors. The majority of the

program’s graduating students rated themselves as having moderate ability on novice nurse

standardized competencies. Students self-reported strongest skills in computer based

communication and desktop software, and lowest competencies in the use of documentation

systems and valuing informatics knowledge (2009). Recommendations included integrating

information technology into all courses and establishing minimum performance standards for

each course. The project “lacked the rigor of formal research” since reliability data on how it

performed were not collected (2009).

23
Computer Literacy Scale for Newly Enrolled Nursing College Students

Lin (2011) described the reliability and validity of computer competency and computer

literacy scales used in nursing. Of the five survey tools included in the background evaluation,

only three included any basic reliability/validity data, and this information was limited (Bataineh

& Baniabdelrahman, 2006; Cole & Kelsey, 2004; Elder & Koehn, 2009; Lupo & Erlich, 2001;

McNeil, Elfrink, Beyea, Pierce, & Bickford, 2006). The researcher described the computer

literacy of Taiwanese nursing students using the Computer Literacy Scale for Newly Enrolled

Nursing College Students (2011). This assessment scale was developed based on the Ministry of

Education (MOE) guidelines. The resource was designed for technical schools and included

computer hardware, software, networks, computer problem solving and IT society (Hinkin,

1998). The content validity index (CVI) was tested using eleven experts who rated content

relevance (2011). Principal component analysis with varimax rotation was used to estimate total

variance, and Eigenvalues greater than one guided the total number of factors used. Exploratory

factor analysis confirmed the content validity and internal consistency of the instrument. The

researcher concluded the instrument had good content validity, reliability, convergent validity,

and discriminant validity, and was an “excellent computer literacy assessment for newly enrolled

nursing students” (p. 315).

Assessment Tool for Nursing Student Computer Competencies

The Assessment Tool for Nursing Student Computer Competencies is comprised of 40

self-ranking statements, designed by the researchers, to measure perceptions of computer

competency (Elder & Koehn, 2009). Students were offered a voluntary tutoring session on

computer skills as an incentive to participate in this study. The researchers compared computer

competency self-ratings of 79 first and second semester nursing students and 8 RN-BSN

24
completion students. Ratings were then compared with the actual performance of those skills on

a computer graded assessment. Reliability was computed using Kuder-Richardson 20 coefficient

of reliability, resulting in in an alpha of 0.65. Content validity, questions, and skills were derived

from concepts taught in a basic computer course. Correlation coefficients were computed for

survey and actual assessment scores which showed a low but significant correlation (r=0.282,

p<0.05). Results suggested that students self-rated computer skills higher than actual ability to

perform them (2009).

The eNNI Project

The Electronic National Nursing Informatics (eNNI) Project measured the electronic

documentation competencies of nurses and nurse educators before and after an educational

intervention designed to improve information and communication technology (ICT) skills

(Rajalahti & Saranto, 2012). A total of 158 Finnish nurse educators and novice-to-experienced

RNs took part in this study. An e-questionnaire was developed and used based on the

foundational work of Staggers, et al. (2002) and Saronto (1997) which itemized requisite

computer competency and information literacy skills. The psychometric properties of the e-

questionnaire instrument were not evaluated during this project. The researcher concluded that

informatics competencies of the nurse participants and educators did not improve as a result of

this project (2012).

Computer Competencies in the Curriculum

Ornes and Gassert (2007) used the beginning nurse competency items from Staggers’

(2001) earlier work to develop an informatics competency tool for beginning nurses. This tool

was used to evaluate baccalaureate nursing students’ information technology skills by

determining how informatics content was represented in the curriculum. Researchers determined

25
students were not routinely exposed to computerized systems in the class room and may not be

prepared to use IT. No syllabi addressed informatics knowledge competencies. Researchers

concluded that students received insufficient exposure to informatics and were at risk for being

insufficiently prepared to use information technology. Recommendations included increasing

exposure to nursing informatics within the BSN curriculum. No reliability/validity data was

provided for the instrument used in this study (Ornes & Gassert, 2007).

Survey of Beginning Nurse Competencies

Desjardins, Cook, Jenkins & Bakken (2005) evaluated the effect of an informatics

curriculum on nursing informatics competencies among undergraduate students using a modified

version of the tool developed by Staggers, et al (2001, 2002). The researchers used a repeated-

measures, non-equivalent comparison group design to measure differences in self-rated

informatics competencies before and after a curriculum on Informatics for Evidence Based

Practice (IEBP). Students were not competent in information literacy at the beginning of the

BS/MS Program, despite having a bachelor’s degree in another field. Significant increases were

reported from admission to graduation in most or all of the cohorts studied. Findings suggested

incorporating informatics into the curriculum was successful. However, all data was self-

reported, and information concerning the validity or reliability of the survey tool was not

provided (Desjardins, et al., 2005).

Computer Competencies Survey and Assessment Tool

Elder and Koehn (2009) observed undergraduate nursing students may perceive computer

skills to be higher than ability to perform them, suggesting that actual competencies may be even

lower than reported. The researchers compared the self-rated computer competencies among

incoming nursing students’ (n=87) with their ability to perform those skills on assessment. The

26
Computer Competencies Survey tool was developed by the researchers and included Likert-type

scale items asking students to rate themselves from expert to no experience. The survey was

followed by completion of the Computer Competencies Assessment, a 40 question computer-

graded assessment also created by the researchers. Correlation coefficients showed a low, but

significant correlation for the survey and assessment (r=0.282; p<0.05). No psychometric data

describing the reliability and validity of either tool was provided. Findings from this study

suggested that students frequently “did not have an adequate grasp of basic computer

knowledge”, as demonstrated by high self-ratings and low performance scores (Elder & Koehn,

2009).

Gassert/McDowell Computer Literacy Survey

McDowell and Ma (2007) surveyed 411 students on admission and 429 upon graduation

from a baccalaureate nursing program to compare differences in computer experience between

program entrance and exit. Significant increases in experience were noted with word processing,

e-mail, and Internet experience, but little improvement was noted in information literacy, or

advanced skills, such as spreadsheets and use of data bases. Results suggested that “nursing

education programs currently may not be providing beginning nurses with the tools needed to

effectively and efficiently work in the technology-rich healthcare arena” (2007, pg. 30). No

reliability or validity data was provided for the research instrument.

TIGER Initiative Informatics Competencies

The TIGER Initiative Informatics Competencies instrument was developed to measure

self-perceptions of nursing informatics competency (Hunter, McGonigle & Hebda, 2013). The

231 items on the instrument were selected from three other instruments already in existence

following three rounds of reviews by content experts. The basic-computer-skills items (108)

27
came from European Computer Driver License computer literacy course ( 2012). The

information literacy items (47) were adapted from the American Library Association's

Information-Literacy Standards (2012). The source of items for clinical information

management (76) came from the Health Level Seven electronic health-record-system functional

model (2004). Content Validity Index (CVI) was calculated on each subset of NI competencies

and demonstrated moderate validity: Information Literacy=1.0; Clinical information

Management=1.0; Basic Computer Skills=1.0. The instrument was piloted with 184 participants

ranging in age from 26-70 years (161 of the respondents were RNs). The majority of

participants ranked themselves as expert on most of items on the survey, with lesser confidence

on information literacy related items. Limited reliability/validity data was provided, as this

report focused on instrument development. The researchers stated an analysis of each item will

be forthcoming and reported in a future article (Hunter, McGonigle & Hebda, 2013).

Informatics Competency Questionnaire

Hwang & Park (2011) conducted a cross-sectional study among nurses in Seoul, Korea.

The 292 item questionnaire measured self-perceptions of informatics competency, basic

computer skills, attitudes toward computers and population. Informatics competency positively

correlated with basic computer skills and formal informatics education. The majority of nurses

(69.2%) rated informatics competencies below average and more than half (58.9%) rated

computer skills as below average. Content validity was examined by three informatics experts.

Principal component factor analysis with varimax rotation revealed factor loadings ranging from

.41 to .81. Based on principal component analysis, factors were considered to be in the

developmental stage. Study recommendations included enhancement of nursing curriculum with

informatics content which includes basic computer skills (Hwang & Park, 2011).

28
Technology Skills Assessment Survey

The Technology Skills Assessment Survey in an instrument developed by the researcher

to assess the self-perceptions of technology skills among graduate Registered Nursing students

(n=19) enrolled in their first semester of course work (Virgona, 2012). The survey tool included

two qualitative and ten quantitative items measuring nurses’ perceptions of current technology

skills and the barriers to using and learning new technologies. Students generally rated

themselves as novices with technologies (Word, Excel, HTML, Javascript, and online bill

payment) other than social media and smart phones. Technology skills were not seen as critical

when entering nursing, but critical for promotion. The major theme emerging from the

qualitative data was the lack of in-house technology training resources, and the perception that

certain technology skills were not valued by organizations (Virgona, 2012). Reliability and

validity data were not included in this research report.

Competency Assessment Tool

Choi and Zucker (2013) compared the informatics competencies of Doctor of Nursing

Practice (DNP) students enrolled in the post-BS track (n=68) with students enrolled in the post-

MS (n=64) using the Competency Assessment Tool. This 86 item instrument assessed 18 areas

of informatics competency in the categories of computer skills, informatics knowledge, and

informatics skills. The instrument was based on Staggers and colleagues competency statements

for the beginning and experienced nurse (2001, 2002) with additional items added on

information literacy (Bakken, et al, 2004 and Curran, 2003). The internal consistency

reliabilities of the instrument were high, with a Cronbach's alpha for all items of .98. The

Cronbach’s alpha for the three competency categories was: computer skills .97, informatics

knowledge .95, and informatics skills .93. Overall, students in the post-BS and post-MS tracks

29
were not competent in any of the three categories of informatics competency at the beginning of

their first semester in the DNP Program. However, statistically significant improvement was

observed in perceived informatics competencies in all three categories following a 14 week

online informatics course (p<.05). Recommendations included offering an informatics

curriculum to improve the informatics knowledge and competency skills of DNP students,

particularly computer skills for decision support (Choi & Zucker, 2013).

The SANICS

The Self-Assessment of Nursing Informatics Competencies Scale (SANICS) is the

instrument chosen for this study. The internal consistency reliabilities of the instrument are high.

The SANICS was developed to assess the informatics competencies of nursing students and

practicing nurses using a valid, reliable means of measurement. This instrument is primarily

based on the informatics competencies developed by Staggers and colleagues, for beginning and

novice level informatics users (Staggers, Gassert, & Curran, 2002). Additional items were added

to the SANICS to include standardized terminologies, evidence-based practice, and wireless

communications. The SANICS contains 30 items designed to measure informatics competencies

with descriptors ranging from 1 (not competent) to 5 (expert) (2009). The instrument was

initially tested on a sample of 336 students completing the baccalaureate portion of a combined

BS to MS Nursing program following an informatics curriculum. Exploratory principal

components analysis with oblique promax rotation extracted a five-factor structure which

explained 63.7% of the variance. Those factors were as follows: Basic Computer Knowledge

and Skills (Cronbach’s alpha = 0.94), Applied Computer Skills: Clinical Informatics (Cronbach’s

alpha = 0.89), Clinical Informatics Role (Cronbach’s alpha =0.91, Clinical Informatics Attitudes

(Cronbach’s alpha = 0.94), and Wireless Device Skills (Cronbach’s alpha = 0.90).

30
Responsiveness of the SANICS was supported by significantly improved scores following

completion of an informatics course.

The studies summarized below describe how the SANICS was used to measure

informatics competencies in nursing student populations. Data describing the psychometric

performance of the SANICS is included, where available.

Choi

The SANICS was the chosen instrument in a study to compare informatics competencies

of 131 nursing students in three undergraduate tracks: Traditional Pre-Licensure, RN to BSN,

and Accelerated BSN (Choi, 2012). Students from each group were found to differ significantly

in overall informatics competency (F(2, 92)=4.31, p=.02). The RN to BSN students were

significantly more competent (mean=3.21) than Traditional Pre-Licensure students (mean=2.82)

(p=.02). The SANICS showed high internal consistency reliabilities. Cronbach’s alpha for the

total scale was .95. Subscale alphas ranged from .93 for “Basic computer knowledge and skills”

to .89 for “Clinical informatics role” and “Wireless Device Skills”. The researcher recommends

future research to identify factors affecting informatics competency, such as age, gender, basic

computer skills, level of nursing experience, or formal informatics education (Choi, 2012).

Choi & De Martinas

The informatics competencies of 289 undergraduate and graduate students were

examined using the SANICS (Choi & De Martinas, 2013). The internal consistency reliabilities

of the instrument were high. The Cronbach’s alpha for each subscale was calculated for each of

the five factors, as follows: Basic Computer Knowledge and Skills (0.94); Applied Computer

Skills (0.90) Clinical Informatics Role (0.89); Clinical Informatics Attitudes (0.90); and Wireless

Device Skills (0.87). Overall, students were found to be competent in informatics: Graduate

31
students reported a higher informatics competency mean (3.23, SD = 0.70) than undergraduate

students (3.01, SD = 0.72) (t = 2.35, p = 0.02). Study findings indicate that students in both

programs were most confident in their basic computer skills and informatics attitudes. However,

students from both programs perceived themselves to be less competent in the areas of applied

computer skills and clinical informatics role.

Choi & Bakken

The psychometric properties of the SANICS were examined in nursing students attending

an undergraduate (n=131) and graduate (n=171) program. The five-factor structure of the

instrument was valid, and accounted for 69.38% of the variance. The Cronbach’s alpha was 0.96

for the total scale with subscales ranging from 0.94 for basic computer knowledge and skills to

0.84 for data/information management skills. The SANICS showed good responsiveness

(standardized response mean =0.99). Significant improvement in competency scores among

students with diverse demographic and educational backgrounds was demonstrated following

completion of an informatics course. Construct validity using a known group approach was

supported by significantly higher mean scores for graduate compared to undergraduate students.

Researchers concluded the SANICS is a psychometrically sound for nursing students with

diverse demographic and educational backgrounds.

32
Table 1

Informatics Competency Instruments

Education or
Name and Source of Researcher # of Psychometric Training Findings
Population
Items and Year Items Characteristics Intervention

Survey of Beginning Students were not

Nurse Competencies competent in
information
Based on 43 literacy at the
beginning nurse 39-44 beginning of the
informatics Desjardins, items, 274 nursing No validity/ BS/MS Program,
No
competencies Cook, Jenkins varied students reliability data despite having a
Intervention
Staggers, et al & Bakken by completing bachelor’s degree
(2001, 2002). (2005) survey year one of a in another field.
version BS/MS Significant
Additional EBP Program increases reported
items added based on from admission to
a survey of directors graduation in most
at Columbia or all of cohorts
University studied
Bakken, et al. (2004)
Statistically
840 significant
Gassert/ admitted and Matriculating increases were
McDowell Computer graduated or completion reported in
Literacy Survey McDowell & 11 nursing No validity/ of nursing experience and
Ma (2007) students over reliability data program computer
McDowell & Ma an eight year curriculum ownership during
(2007) period the eight year
study period

33
 Students were not
Computer routinely
Competencies in the exposed to
Curriculum Tool computerized
Matrix developed to systems and may
Ornes & Not evaluate not be prepared to
Based on Categories Gassert Provid- informatics No validity/ Not use IT.
of Informatics (2007) ed competencie reliability data Applicable No syllabi
Competency for the s within addressed
Beginning Nurse syllabi of 18 informatics
(Staggers, et al. courses. knowledge
(2001, 2002). competencies
Graduating Nurses'
Self-Evaluation of Majority of
Computer “Lacked the rigor graduating
Competencies 42 No
Fetter (2009) 43 graduating of formal research Intervention students self-rated
Survey since reliability data as having
seniors
were not collected” moderate ability
Based on Staggers, et on novice nurse
al. (2001) novice No validity/ standardized
nurse competencies reliability data competencies

34
 Content validity,
questions, and skills
tested were derived Results suggested
from textual that students rated
Computer concepts used in a their skills higher
Competencies basic computer Pre-test to than their actual
61 first and
Survey
second course. self-assess performance of
and
semester current computer skills.
Computer Correlation computer
Elder & 40 nursing
Competency coefficients were competency
Koehn (2009) students and
Assessment Tool computed for followed by Limited reliability/
RN-BSN
completion survey and computer validity studies
Both tools developed
students assessment scores assessment of
by the researchers
and showed a low ability to
Elder & Koehn (2009)
but significant perform skills
correlation (r =
0.282, p < 0.05).

Used context Participants earned

Computer Literacy validity index the highest scores
Scale for Newly (CVI) to test the for the network
Enrolled Nursing content validity of domain
Students Lin (2011) 24 270 first year computer literacy No and the lowest
undergrads measurement items. Intervention score for the
Based on Ministry of Confirmatory factor hardware domain
Education (MOE) analysis showed the
course guidelines and scale possessed Appears to be an
relevant literature on good content excellent computer
computer literacy and validity, reliability, literacy
competency convergentvalidity, assessment for
(2008) and discriminant newly enrolled
validity. nursing students

35
 More than two-
thirds felt they had
Cronbach alpha insufficient
coefficient = .79; informatics
Informatics Principal competency and
Competency component factor more than half
Questionnaire analysis with rated computer
Hwang & 292 hospital varimax rotation skills below
Park (2011) 40 nurses revealed factor No average.
Designed by the loadings ranging intervention
researchers from .41 to .81. Based on principal
(Hwang & Park, Content Validity component
2011) was examined by analysis, factors
three informatics were considered to
experts. be in the
developmental
stage.
Education
provided on
The eNNI Project 136 nurse electronic The NI skills of
educators, nursing the participants
e-questionnaire based novice and documenta- and educators did
on Saranto (1997) and Rajalahti, experienced No validity/ tion and not improve
Staggers, Gassert & Saranto 158 RNs, other reliability data information during the project
Curran's (2002) (2012) nurse communica-
informatics professionals tion No reliability/
competencies research in Finland technology validity studies
(ICT)

36
 Students perceived
technology skills
as not critical
19 graduate when entering
Technology Skills Registered
No validity/ No nursing but critical
Assessment Survey Virgona 12 Nursing
(2012) students reliability data intervention for promotion.
Developed by the enrolled in Lack of training
researcher first semester resources were
Virgona (2012) of course identified as a
work barrier

Students were not

informatics
Competency competent at the
Assessment Tool Cronbach's alpha beginning of their
for all items was first semester.
Based on Staggers
.98. Statistically
and colleagues
68 post-BS 14 week significant
competency
Choi, Zucker 86 compared to The Cronbach’s online improvement in all
statements for the
2013 64 post-MS alpha for the three informatics categories reported
beginning and
competency course after completion of
experienced nurse
categories was: informatics course.
(2001, 2002) with
computer skills .97,
additional items
informatics The internal
added on information
knowledge .95, and consistency
literacy (Bakken, et
informatics skills reliabilities of the
al, 2004; Curran,
.93. instrument were
2003)
high.

37
 TIGER Initiative
Competencies

Basic computer skills

(108) came from
European Computer Limited reliability/
Driver License validity studies
(ECDL, 2012). Focused on
Information literacy Hunter, 231 184 ranging Content Validity No instrument
items (47) were McGonigle & in age from Index (CVI) was Intervention development.
adapted from the Hebda (2013) 26-70 years calculated on each
American Library subset of NI Analysis of
Association's competencies: each item
Information Literacy Information to be reported
Standards (2012). Literacy = 1.0; in future article.
Source for clinical Clinical
information information
management (76) Management = 1.0;
came from Health Basic Computer
Level Seven Skills = 1.0.
electronic health
record system
functional model
(2004).

38
 Self-Assessment of Nursing Informatics Competency Scale (SANICS)

Principal component
analysis with oblique
Self- Assessment of
promax rotation
Nursing Informatics
extracted five
Competencies Scale
factors: clinical Informatics Preliminary
(SANICS)
informatics role curriculum evidence exists for
Yoon, Yen & 93 Combined
(α = .91), basic which the reliability and
Yoon, Yen & Bakken Bakken BS/MS
computer knowledge emphasized validity of the
(2009) (2009) nursing
and skills (α =.94), informatics SANICS
students in
applied computer tools to
Primary source was 2006-07
skills: clinical support Sample
Staggers, et al., (2001, (N=336)
informatics (α =.89), patient safety dependent-
2002) beginning and
nursing informatics mindfulness young with a high
experienced nurse
attitudes (α =.94), modeling and level of basic
informatics
and wireless device monitoring computer
competencies
skills knowledge and
(α =.90). skills

RN to BSN
students were
131 nursing Cronbach’s alpha for significantly more
students the total scale was competent
from three .95. Subscale alphas (mean=3.21) than
SANICS tracks: ranged from .93 for Traditional Pre-
Choi (2012) 30 Traditional “Basic computer No Licensure students
Yoon, Yen & Bakken Pre- knowledge and intervention (mean=2.82)
(2009) Licensure, skills” to .89 for (p=.02).
RN to BSN, “Clinical informatics
and role” and “Wireless The SANICS had
Accelerated device skills” high internal
BSN consistency
reliabilities

39
 Construct
validity using a
Cronbach’s alpha of known group
0.96 for the total approach
scale with was supported by
subscales ranging significantly
from 0.94 for basic higher mean
Choi & 131 computer scores
14-week
Bakken 30 undergrads knowledge/skills to for graduate
online
(2013) 171 post- 0.84 for students compared
informatics
SANICS graduates data/information to undergraduate
course
management skills. students.
Yoon, Yen & Bakken
(2009) The SRM was large The SANICS is
(0.99) indicating the psychometrically
SANICS was sound for nursing
responsive students with
diverse
demographic and
educational
backgrounds

40
 Students were
Cronbach’s alpha for competent in
each subscale is informatics.
below: Graduate students
Total (= 0.96) reported a higher
Basic computer informatics
knowledge and skills competency mean
SANICS Choi & De ( 0.94); Applied (3.23, SD = 0.70)
Martinas 30 289 computer skills No than
Yoon, Yen & Bakken (2013) undergrad (0.90) Clinical intervention undergraduate
(2009) and graduate informatics role students (3.01, SD
students (0.89); Clinical = 0.72) (t = 2.35, p
informatics attitude = 0.02).
(0.90); Wireless
device skills (0.87) The internal
consistency
reliabilities of the
instrument were
high

41
 Informatics Training and Assessment

The Technology Informatics Guiding Educational Reform (TIGER) Collaborative issued

a Call to Action requesting education and training interventions which foster information

technology innovation and adoption by nurses (2008). Essential skills for clinicians were

identified as basic computer competencies and information literacy (2008). While the need for

improved informatics competencies has been well established for more than 25 years (Ball,

1984; Graves, 1989; Herbert, 1999; Saba & McCormick, 1996; Scholes & Barber, 1980;

Staggers, Thompson, Happ & Bartz, 1998; Turley, 1996), there remains a lack of training

resources for nurses (Ball, et. al, 2011). Informatics competency is also essential for students

enrolled in web based and web enhanced coursework commonly used to deliver nursing

education (Virgona, 2013). Education and training interventions described in the literature are

typically limited to informatics content modification for a single course (Bakken, Sheets, Cook,

Curtis, Soupios, Curran, 2003), or curricular revisions which measure informatics competency

from program entry to program exit (McDowell & Ma, 2007). Research has consistently

supported the effectiveness of courses which address the lack of informatics competencies of

nursing students (Choi & Bakken, 2013; Desjardins, Cook, Jenkins & Bakken, 2005; Shorten,

Wallace & Crookes, 2001; Tarrant, et al, 2008; and Wallace, Shorten, Crookes, McGurk, &

Brewer, 1999). Unfortunately, only half of nursing programs teach information literacy skills

(McNeil, et al., 2005; Pilarski, 2011).

Nurses work in complex, fast paced environments where they must quickly process data

and form clinical judgments which ultimately guide patient care (Kossman, Bonney & Kim,

2014). Universal adoption of informatics competencies will require access to on-demand

training resources available “at any time and from any site” (Ball, et al., 2011, p. 445).

42
Educational strategies limited to the occasional informatics course, or initiative which require

matriculation through an entire nursing program are insufficient and inadequate to meet the

growing informatics competency needs of busy nurses in practice, or a technologically

dependent nursing profession as a whole (Ball, et al., 2011).

A comprehensive review of the literature was conducted for training interventions which

used instruments to measure informatics competencies (computer skills and/or information

literacy) following a training intervention. This review identified a lack of web based training

resources and accompanying instruments to measure outcomes resulting from the delivery of

informatics training. Due to the paucity of empirical studies, the search for informatics training

resources for nurses with valid/reliable instruments was expanded to include 1) works published

since 1995, and 2) published resources/tools used in general education to measure computer

competency or information literacy before and/or after informatics training. These results

yielded only eight such informatics training resources in the scholarly literature or via public

access. Of these resources, only two included measurement tools. Review of curriculum-based

informatics instruction and/or health record simulation training sites was excluded from this

search. Training resources identified by this review are described in the following discussion,

and summarized in Table 2.

European Computer Driver’s License (ECDL) Certification

The Task Force of the Council of European Professional Informatics Societies (1997-

2014) developed the European Computer Driver’s License (ECDL) Certification Program as a

way to promote standardization of information technology skills within the IT industry and for

the general population. The subscription based ECDL online modules include computer

essentials, online essentials, word processing and spreadsheets. Additional training options (fee

43
based) include presentations, using databases, web editing, image editing, project planning, IT

security, online collaboration, and heath information storage. The TIGER Informatics

Competencies Team offered their endorsement of the ECDL and recommends training for nurses

using the Basic Computer Competencies Modules. The ECDL is the world’s largest end-user

computer skills certification program, has been used by more than 7 million users, and has “a

very well developed and mature training program, work book, and testing process” (TIGER,

2008). The ECDL’s Basic Computer Competency training is comprised of the seven modules

outlined below:

 Module 1 – Concepts of Information Technology (IT)

 Module 2 – Using the Computer and Managing Files

 Module 3 – Word Processing

 Module 4 – Spreadsheets

 Module 5 – Database

 Module 6 – Presentation

 Module 7 – Information and Communication

While ECDL training is endorsed by the TIGER Collaborative, its modules are

generalized for use in a wide range of industries and do not address essential computer skills

required in healthcare, or the unique challenges of the healthcare setting (eg. HIPAA, meaningful

use, interoperability, etc.). Validity and reliability measurements for the tools used for ECDL

assessments are not available online, and were refused upon request of this researcher.

TIGER Virtual Demonstration Center

As mentioned above, the TIGER Collaborative has recommended the ECDL program as

a computer competency training option for nurses (2008). However, a new subscription based,

44
Virtual Demonstration Center (2013) sponsored by the TIGER Collaborative, was recently

launched as a virtual conference, simulation and training site for nurses. The Demonstration

Center contains web based informatics resources, including links to clinical simulations, as well

as observable and interactive demonstrations. Links are embedded within the Center’s web

pages allowing users to navigate to other sites which support the development of informatics

competencies. Access to the Center also includes webinars and educational sessions covering

electronic health records, usability, clinical decision support, meaningful use, health information

exchange, and interoperability. The vision of the TIGER Virtual Demonstration Center is to

provide “highly effective and efficient, technology-enabled, solutions of exemplary healthcare

delivery systems of the next three to ten years” (2013). An online instrument, (The TIGER

Online Self-Assessment Tool) has been designed and piloted which measures self-perceptions of

informatics competencies. This instrument has demonstrated moderate content validity (Hunter,

McGonigle & Hebda, 2013).

Nursing Resources: A Self-Paced Tutorial and Refresher

An online training resource entitled “Nursing Resources: A Self-Paced Tutorial and

Refresher” is available via open source through New York University’s (NYU’s) Library

(Jacobs, 2014). The site includes four self-paced online modules covering the following topics:

 Beginner’s Research Guide – Literature search, locating articles, background questions,

Search strategies, citing, and locating full text articles.

 Evidence Based Nursing- Locating the best evidence, developing the research question,

expanding the search for evidence, specialized databases, and clinical guidelines.

 Web Resources – Searching the web, search engines, web directories, consumer health

information, and evaluating the web.

45
  Tools – Saving search histories

Learners move through the site using navigational arrows at the bottom of each page.

The site is not interactive and skill demonstrations, or the use of assessments or evaluation

tools, are not options on this site.

IC³ Training and Certification Program

The IC³ Training and Certification Program is available online through Pearson Vue

Business (2000). The site targets incoming college students who may need computer

remediation or employers who may wish to use its assessment capabilities as a screening tool for

new job candidates. Certification comprises individual examinations for computing

fundamentals, key applications (word processing, spreadsheet and presentation software), and

living online (internet and networking). A convenience feature found on this site is the “IC³ Fast

Track” which allows literacy skills to be quickly assessed. This resource is only available

commercially, with an option to purchase bulk user licenses. Certification is achieved through

successful completion of a “one time test. Approximately 175,000 examinations are

administered monthly in 148 countries and in 27 languages. Benefits of IC³ certification are

described as a means to “validate digital literacy skills”, although no published data regarding

the site’s effectiveness, or the psychometric properties of instrument could be located. Pearson

Vue denied requests by this researcher to provide data describing the performance of the training

site or assessment tool.

The Passport Project for Nursing Success

The purpose of the Passport Project for Nursing Success was to “assess the skills,

knowledge, and informatics comfort level of students, while providing computer training and

teaching for beginning nursing students in an undergraduate nursing program” (Edwards &

46
O’Connor, 2011). A survey was created by the researchers since “no tools with measured

reliability and validity were available upon a review of the literature” (p. 5). The survey was

administered to incoming students’ (n=90) to measure self-perceived informatics competencies

and learning needs. Following this initial assessment, students completed seven self-paced

online learning modules housed in the Blackboard LMS. On-line tutorials with questionnaires

and demonstration assignments were incorporated into the modules to facilitate learning needs of

the students. These modules included:

 Module 1: Basic Computing

 Module 2: Nursing Program Handbook

 Module 3: College Orientation & Resources

 Module 4: Netiquette

 Module 5: Managing Documents

 Module 6: Research & APA

 Module 7: On-line Testing

Evaluation of learning was based on the ability to perform various functions, including

complete an interactive evaluation, construct and download a document, and using the quiz

function within Blackboard. Five qualitative program evaluation questions yielded themes of

appreciation for the training, and improved understanding of informatics and Blackboard. No

reliability/validity data was available for any of the quantitative assessments used by the

researchers. While the Passport Project was described in the literature by the authors, the actual

site was not available for review.

47
Computer Competencies Tutorial

St. Edward University’s Computer Competencies Tutorial (1995-2007) is a web based,

computer skills remediation tool for all incoming freshmen. Completion of this training was

required during the years 1995-2007, but became optional during the years 2008-2011.

Descriptions of this online computer training resource are provided here for completeness only,

as the Tutorial was removed as an active training site in 2013. No assessment instrument was

used to measure the effect of training. The Computer Competency Tutorial consisted of five

modules covering the following content:

1.) Introduction to Computers

2.) World Wide Web

3.) Introduction to Word Processing

4.) Introduction to Spreadsheets

5.) Multimedia

Information Literacy Tutorial

The open source Information Literacy Tutorial, sponsored by Rutgers University, is a

web based training site for nursing students (2008). This tutorial consists of three sections

covering animated and/or video recorded content intended to improve information literacy. The

Tutorial’s content includes: formulate a research question, navigate CINAHL and Medline, find

full-text articles, and employ RefWorks to store reference sources and produce bibliographies in

proper APA format. The site is not interactive, requires no assignments, and uses no instrument

to measure outcomes.

48
Pre-test for Attitudes Toward Computers in Healthcare (PATCH)

The Pre-test for Attitudes Toward Computers in Healthcare (PATCH) is an open source,

online tool for self-assessment of general nursing informatics competencies (Kaminski, 2011).

Modules on the site provide information, links, and self-assessment checklists for a variety of

computer based tasks. Attitudes regarding various computer skills are measured via an online

survey, covering the following competency items: Word processing, keyboarding, spreadsheets,

presentations, databases, desktop publishing, internet, e-mail, expert and decision support

systems, multimedia, web development, telecommunications, nursing information systems,

hospital information systems, peripherals, PDAs, nursing data and information, current computer

literacy, life-long learning, computer-human interface dynamics, networking, basic computer

configurations, protection for client data & information, and evidence based practice. A study of

Turkish nurses (n=200) was conducted to assess the validity and reliability of the PATCH Scale

(Kaya & Turkinaz, 2008). Test-retest reliability was 0.20-0.77 and 0.85 for the total scale. Item

total correlation was 0.06-0.68 and Cronbach's Alpha was 0.92 (2008).

49
Table 2

Non-Curricular Informatics Training Resources

Training Author(s) Delivery Population Description of Pre/Post Site

Site/ Method Training Tests
Resources
ECDL base
modules include
computer
essentials, online
essentials, word
processing and
Developed
spreadsheets.
the
European Council of General
certification http://www
Computer European population ECDL Standard Not
program as .ecdl.org/pr
Driver Prof. and skill add on options available
an online ogrammes/i
License Informatic standardizati include
way of to ndex.jsp?p
(ECDL) s Societies on within presentations,
promote =2931&n=
Certifica- (1997- the IT using databases,
information 2954
tion 2014) industry. web editing,
technology
image editing,
skills
project planning,
IT security, online
collaboration, 2D
CAD and Heath
Information
Storage.
On-line tutorials “No tools
with with
questionnaires and measured
demonstration reliability
assignments to and validity http://www
7 self-paced facilitate learning were .thejeo.com
Passport Edwards,
online Incoming needs of the available /Archives/
Project for J. &
learning nursing students. upon a Volume8N
Nursing O'Connor,
modules students 1: Basic review of umber2/Ed
Success P.
housed in n=90 Computing the wardsandO
(2011)
Blackboard 2: Nursing literature” ConnorPap
Program er.pdf
Handbook Five
3: College program
Orientation & evaluation
Resources questions

50
 4: Netiquette only.
5: Managing
Documents
6: Research &
APA
7: On-line Testing
Modules Include:
Word Processing,
Keyboarding,
Spreadsheets,
Presentations,
Databases,
An online
Desktop
tool for self-
Publishing, Test-retest
Pretest for assessment in
Internet, Email, reliability
Attitudes general
Decision Support was 0.20-
Toward nursing
Systems, 0.77, for the
Computers Informatics http://nursi
Registered Multimedia, Web total scale
in competencies ng-
Kaminski Nurses Development, was 0.85.
Healthcare . Various informatics
(2011) N=200 Telecommunicatio Item total
(PATCH) competency .com/niasse
Turkish ns, Nursing correlation
Self- taxonomies ss/plan.htm
nurses Information was 0.06-
Assessment have been l
Systems, Hospital 0.68 and
Tool reviewed and
Information Cronbach's
integrated in
Systems, Alpha was
the process.
Peripherals, 0.92.
PDAs, Data and
Information,
Computer
Literacy, Life
Long Learning,
Computer-Human
Interface and EBP
This tutorial
Nursing encompasses a
Kaplan Online
Resources: beginner's http://nyu.li
(2014). instructional Nursing
Self-Paced research guide, No bguides.co
New York tool Students
Tutorial web resources, instrument m/nursingt
University consisting of
and tools, and utorial
4 modules
Refresher evidence based
practice only.
Certiport Pearson One hour Incoming IC³ Fast Track can One-time
IC³ Vue online college be used to gauge fee based
Internet and Business competency students or digital literacy test

51
Computing (2000) test screening skills. https://ww
Certifica- tool for new No w.certiport.
tion job Certification published com/portal/
candidates. comprises data common/d
individual ocumentlib
175,000 examinations for No data on rary/IC3_G
exams computing psychometri S4_Progra
administere fundamentals, c properties m_Overvie
d monthly in key applications of w.pdf
148 (word processing, instrument
countries spreadsheet and
and 27 presentation
languages software), and
living online
(internet and
networking )
Tutorial:
Used to formulate
a research
question, navigate http://www
CINAHL and .libraries.ru
Rutgers Medline, find full- tgers.edu/r
Information No
University 3 online Nursing text articles, and ul/rr_gatew
Literacy instrument
Library sections Students employ RefWorks ay/research
Tutorial
(2008) to store reference _guides/nur
sources and sing/tutoria
produce l/
bibliographies in
proper APA
format

Five Modules:
http://acade
1.) Introduction to
mic.stedwa
Incoming Computers
St. Inactive rds.edu/co
freshmen 2.) World Wide
Computer Edward's 5 self-paced Test Link mpetency/
requirement Web
Competenc University online module2/L
until 2009. 3.) Introduction to
y Tutorial (1995- modules No esson1/ww
Currently Word Processing
2011) instrument wandintern
optional 4.) Introduction to
tgetconnect
Spreadsheets
ed.htm
5.) Multimedia

The TIGER
Online Self-
Assessment

52
The TIGER TIGER Nurses and Web based Tool- http://www
Virtual and Web based nursing informatics designed .thetigerinit
Demonstrat Hunter, conference students resources, and piloted; iative.org/v
ion Center McGonigl and including links to measures irtuallearni
e& simulation simulations, as self- ng.aspx
Hebda, center well as observable perceptions
(2013) and interactive of
demonstrations informatics
competency;
moderate
content
validity

Summary

For more than 30 years, authoritative nursing bodies have urged the nursing profession to

strategically address informatics competency for all nurses. Despite persistent recommendations

from the ANA, AACN, NLN, TIGER and IOM regarding the critical need for an informatics

competent nursing workforce, nurses still frequently lack essential informatics competencies,

including basic computer skills. Evidence based practice depends upon ability to use and apply

information technology skills, such as searching data bases and using nursing-specific software.

Studies of nurse executives and academicians describe a nursing profession which remains

insufficiently prepared with basic informatics skills upon entry to practice. Research supports

the effectiveness of courses which address the lack of informatics competencies of nursing

students, with recommendations that priority be given to groups possessing low computer

proficiency. Unfortunately, nursing programs have been slow to incorporate information literacy

skills into the curricula. Informatics training programs which could support nurses in practice

are sparse in the literature. Curriculum based instruction alone is no longer sufficient for nurses

attempting to keep pace in a fast paced technology-rich healthcare environment. Finally, this

review identified few or insufficiently validated instruments which could be used to measure

53
empirical outcomes resulting from delivery of nursing informatics training. The sparse number

of empirically supported informatics training resources and evaluative tools is inconsistent with

recommendations from official nursing and health organizations calling for a deliberate,

systematic approach to improve the basic computer skills and information literacy of the nursing

profession.

The SANICS has become a nationally recognized instrument with numerous empirical

studies attesting to its internal consistency reliability, responsiveness, and factorial validity

(Choi, 2012; Choi & Bakken, 2013; Choi & De Martinas, 2013). Studies of the SANICS to date

have focused on a variety of nursing student populations engaged in curriculum based

instruction. However, no studies to date have examined the effectiveness of the SANICS

instrument when used in a population of undergraduate nursing students before and after a self-

directed, web-based, informatics training program, such as SOLO-IT.

Curriculum-based instruction alone is no longer sufficient for nurses attempting to keep

pace in a fast paced technology-rich healthcare environment. Diffusion of informatics

competencies throughout the nursing workforce could depend upon the availability and usability

of on-demand training resources focused on the needs of the self-directed learner. Further

testing is necessary to examine the psychometric properties of the SANICS in a sample of BSN

entry-level nursing students. Principal component analysis will be used to examine the factor

structure of the SANICS. Internal consistency reliability will be used to determine if the

SANICS is responsive over time when used to measure informatics competencies.

54
 Chapter III

Research Methodology

Introduction

A comprehensive search of informatics training resources revealed a significant gap in

the literature regarding the availability of these resources, and a lack of valid, reliable tools to

measure informatics competencies. This study will use psychometric analyses as a means to

quantify the precision of the Self-Assessment of Nursing Informatics Competency Scale

(SANICS). The psychometric performance of the SANICS will be evaluated before and after

completion of Successful Online Learning and Orientation: Informatics Training (SOLO-IT) for

nursing students. Principal component analysis will be used to examine the factor structure of

the SANICS. Internal consistency reliability will be used to determine if the psychometric

properties of the SANICS remain consistent in a sample of BSN entry-level nursing students and

if the SANICS is responsive over time when used to measure informatics competencies. This

study will also evaluate the mean rating differences of the SANICS instrument before and after

completion of SOLO-IT. Construct validity of the SANICS will be assessed using a known

group approach to compare differences in means for each SANICS subscale (construct) before

and after completion of SOLO-IT modules.

Research Questions

1) What are the psychometric properties of the SANICS among a population of BSN

entry-level students?

2) Is the SANICS responsive over time when used to measure informatics competencies

following completion of Successful Online Learning and Orientation (SOLO)

Informatics Training (IT) modules?

55
  Hypothesis: There will be a significant difference in SANICS scores between

pre-SOLO and post-SOLO.

Research Design

Successful Online Learning and Orientation: Informatics Training (SOLO-IT) is a web

based remediation tool designed and created by the researcher to enhance the informatics

competencies (computer skills and information literacy) of nursing students (Godsey, 2011).

Online modules were designed to be self-guided and self-paced to allow nursing students to

learn, practice and demonstrate informatics competencies using common technological tools

embedded into the Blackbord ™ learning management system (Godsey, 2011). This study will

explore the psychometric performance of the SANICS instrument using archived survey data

collected before and after completion of SOLO-IT. A one-group pre/post-test design using the

30-item SANICS was utilized in a sample of undergraduate nursing students. The survey design

provides a “quantitative or numeric description of trends, attitudes, or opinions of a population

by studying a sample of that population” (Creswell, 2009, p. 145). Surveys comprised of

competency items contained within the SANICS instrument were administered via Survey

Monkey to student volunteers prior to and at the completion of SOLO-IT. Permission to use the

SANICS (2009; Appendix A) was requested and granted by Dr. Yoon and colleagues.

Conceptual Definitions

Informatics

The ANA defines nursing informatics as “a specialty that integrates nursing science,

computer science, and information science to manage and communicate data, information, and

56
knowledge in nursing practice” (2008, p. 177). The ANA’s (2001) position statement also

describes the relevance of informatics to nursing practice:

Nursing informatics facilitates the integration of data, information, and knowledge to

support patients, nurses and other providers in their decision-making in all roles and

settings. This support is accomplished through the use of information, information

processing, and information technology (p.17).

Informatics Competency

Staggers and colleagues made a significant contribution in the area of nursing informatics

when they defined the competencies, skills, knowledge, and abilities necessary for nurses based

on educational preparation and expertise: beginning nurse, experienced nurse, informatics nurse

specialist, and informatics innovator (Staggers, Gassert, & Curran, 2002). Since the present

study concerns measurement of nursing informatics competencies among undergraduate nursing

students, the following discussion of informatics competency (informatics knowledge and

computer skills) is limited to the beginning nurse only.

Informatics Knowledge. Informatics knowledge needed for nurses at the beginner level

has been categorized into data, impact, privacy/security, and systems information and is

described below (Staggers, Gassert, & Curran, 2002).

1. Data

• Recognizes the use and/or importance of nursing data for improving practice

2. Impact

• Recognizes that a computer program has limitations due to its design and capacity

of the computer

57
 • Recognizes that it takes time, persistent effort, and skill for computers to become

an effective tool

• Recognizes that health computing will become more common

• Recognizes that the computer is only a tool to provide better nursing care and that

there are human functions that cannot be performed by computer

• Recognizes that one does not have to be a computer programmer to make

effective use of the computer in nursing

3. Privacy/security

• Seeks available resources to help formulate ethical decisions in computing

• Describes patients' rights as they pertain to computerized information

management

4. Systems

• Recognizes the value of clinicians' involvement in the design, selection,

implementation, and evaluation of applications, systems in health care

• Describes the computerized or manual paper system that is present

• Explains the use of networks for electronic communication (e.g., Internet)

• Identifies the basic components of the current computer system (e.g., features of a

PC, workstation. (p.3)

Computer Skills. Staggers and colleagues outlined beginner level computer skills in the

competency categories of administration, communication, data access, documentation,

education, monitoring, basic desktop software and systems skills (2002). A beginner level

computer competent nurse possesses the following skills:

1. Administration

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 • Uses administrative applications for practice management (e.g., searches for

patient demographics, billing data)

• Uses applications for structured data entry (e.g., patient acuity or classification

applications)

• Communication (email, internet, telecommunications)

• Uses telecommunication devices (e.g., modems or other devices) to communicate

with other systems (e.g., access data, upload, download)

• Use e-mail (e.g., create, send, respond, use attachments)

• Uses the Internet to locate, download items of interest (e.g., patient, nursing

resources)

• Data access

• Uses sources of data that relate to practice and care

• Accesses, enters, and retrieves data used locally for patient care (e.g., uses HIS,

CIS for plans of care, assessments, interventions, notes, discharge planning)

• Uses database applications to enter and retrieve information

• Conducts on-line literature searches

• Documentation

• Uses an application to document patient care

• Uses an application to plan care for patients to include discharge planning

• Uses an application to enter patient data (e.g., vital signs

• Education

• Uses information management technologies for patient education (e.g., identifies

areas for instruction, conducts education, evaluates outcomes, resources)

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• Monitoring

• Uses computerized patient monitoring systems

• Basic Desktop Software

• Uses multimedia presentations

• Uses word processing

• Demonstrates keyboarding (typing) skills

• Systems

• Uses networks to navigate systems (e.g., file servers, www)

• Operates peripheral devices (e.g., bedside terminals, hand-helds)

• Uses operating systems (e.g., copy, delete, change directories)

• Uses existing external peripheral devices (e.g., CD-ROMs, zip drives)

• Uses computer technology safely

• Is able to navigate Windows (e.g., manipulate files using file manager, determine

active printer, access installed applications, create & delete directories)

• Identifies the appropriate technology to capture the required patient data (e.g.,

fetal monitoring device)

• Demonstrates basic technology skills (e.g., turn computer off & on, load paper,

change toner, remove paper jams, print documents)

(pp. 1-2).

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 Operational Definitions

Entry Level Nursing Student

For the purpose of this study, an entry level nursing student is defined as any student

enrolled in the first year (first or second semester) of a traditional Baccalaureate of Science in

Nursing (BSN) program. Students enrolled in the Registered Nurse to Masters of Science in

Nursing (RN to MSN) Program were excluded from data collection procedures.

Blackboard™. The Learning Management System (LMS) used to house SOLO-IT is

called Blackboard. A LMS uses web-based technologies to plan, organize and deliver on-

demand course content and also assess student performance and learner outcomes (Blackboard,

2004). Blackboard is one of the most popular LMSs nationally (Bradford, Porciello, Balkon, &

Backus, 2007; Ferrin, 2013), and was the system of choice for the mid-western university which

approved the conduct of this research and the completion of SOLO-IT by their BSN student

population.

Curricular Instruction. Informatics specific content provided as part of a nursing

school’s curriculum. This type of instruction typically occurs as part of a didactic course and

lasts for the duration of an academic semester or quarter. Curricular instruction may also refer to

informatics content delivered during the time of the student’s matriculation through the nursing

program, not limited to a single course.

Informatics Training. Informatics training refers to delivery of informatics content and

instruction as part of a brief, intensive, episodic program designed to increase the informatics

competencies of participants. Informatics training typically involves self-directed learning and

interactive teaching strategies which engage the learner to demonstrate competencies.

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 Competency on the SANICS. The SANICS instrument uses a Likert Scale ranging

from 1 (not competent) to 5 (expert). Self-perceived competence is indicated by a minimum

SANICS score of 3 (Yoon et al., 2009).

Instrumentation

The SANICS was developed by researchers out of Columbia University School of

Nursing (Yoon, et al, 2009; Appendix A). Development of this tool evolved primarily from a

Delphi Study conducted by Staggers and colleagues which incorporates competencies for the

beginner and experienced nurse (Staggers, Gassert & Curran, 2001). Additional items were

added to the SANICS by the researchers in areas relating to standardized nursing terminologies,

evidence based practice, and wireless communications (2009). The reliability and validity of the

SANICS has been established using a combined sample of 337 BSN/MSN students (Yoon, et.al,

2009). Cronbach’s α measurements confirmed the internal consistency of related items within

the scale. None of the inter-item correlations was less than α = .89. Reliability coefficients of .70

or higher are usually considered acceptable by most researchers (Bruin, 2006). Independent t-

tests confirmed the responsiveness of the SANICS over time and also measured the five

categorical factors of the scale: 1) Clinical Role, 2) Basic Computer Knowledge, 3) Applied

Computer Skills, 4) Clinical Informatics Attitudes, and 5) Wireless Device Skills. The sub-

scales and individual items contained within the SANICS instrument are described below:

1. Clinical informatics role

• As a clinician (nurse), participate in the selection process, design, implementation and

evaluation of systems

• Market self, system, or application to others

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 • Promote the integrity of and access to information to include but not limited to

confidentiality, legal, ethical, and security issues

• Seek resources to help formulate ethical decisions in computing

• Act as advocate of leaders for incorporating innovations and informatics concepts into

their area of specialty

2. Basic computer knowledge and skills

• Use telecommunication devices

• Use the Internet to locate, download items of interest

• Use database management program to develop a simple database

• Use database applications to enter and retrieve information

• Conduct on-line literature searches

• Use presentation graphics to create slides, displays

• Use multimedia presentations

• Use word processing

• Use networks to navigate systems

• Use operating systems

• Use existing external peripheral devices

• Use computer technology safely

• Navigate Windows

• Identify the basic components of the computer system

• Perform basic trouble-shooting in applications

3. Applied computer skills: Clinical informatics

• Use applications for diagnostic coding

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 • Use applications to develop testing materials

• Access shared data sets

• Extract data from clinical data sets

4. Clinical informatics attitudes

• Recognize that health computing will become more common

• Recognize human functions that cannot be performed by computer

• Recognize that one does not have to be a computer programmer to make effective use of

the computer in nursing

• Recognize the value of clinician involvement in the design, selection, implementation,

and evaluation of applications, systems in health care

5. Wireless device skills

• Use wireless devices to download safety and quality care resources

• Use wireless devices to enter date

Method to Test the SANICS Instrument

As described previously, the TIGER Collaborative has issued a call to action urging

improved informatics competencies, increased educational resources, and affordable programs

which foster information technology innovation and adoption by nurses (2008). In response to

this call, TIGER urges the development of competency based training strategies utilizing pre-

and post- test data as measure of effectiveness in meeting competencies (Ball, et al, 2008).

Successful Online Learning and Orientation: Informatics Training (SOLO-IT) is a web

based remediation tool designed and created by the researcher to enhance and measure the

informatics competencies (computer skills and information literacy) of nursing students (Godsey,

2011). Online modules were designed to be self-guided and self-paced to allow nursing students

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to learn, practice and demonstrate informatics competencies using common technological tools

embedded into the Blackboard ™ LMS (Godsey, 2011).

Sample. The sample for this study will be taken from archived data collected from a

population of 271 entry level nursing students during the Spring 2014 semester. All students

enrolled in the first year of the Baccalaureate of Science in Nursing (BSN) Program were

enrolled into SOLO-IT as a required assignment for most sections of an entry-level nursing

course. Students were instructed to complete SOLO-IT’s six modules during the first two weeks

of the semester in order to prepare for web enhanced instruction. The location for this study was

a medium sized, private university located in Cincinnati, Ohio with an enrollment of 6700

students, including 637 nursing students. Entry level nursing students were selected as the

population for this study since they may be at risk for lacking the informatics competencies

necessary to support and enhance their nursing education. Additionally, this population of

students will have had minimal exposure to nursing informatics or the Blackboard learning

management system (LMS) which houses course content and provides the educational

framework for program matriculation.

SANICS and SOLO-IT

Each competency measured by the five sub-scales of the SANICS has been incorporated

(either specifically or broadly) into the six educational modules of SOLO-IT. The SANICS was

administered as an analytical survey to measure self- perceptions of informatics competency

(Yoon, et al., 2009; Appendix A). Analytical surveys “go beyond simple description; their

intention is to illuminate a specific problem through focused data analysis, typically by looking

at the effect of one set of variables upon another set” (Kelley, et al, 2003). An advantage of

survey research is that it allows for the production of empirical data resulting from “real-world”

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situations (Kelley, et al., 2003, p. 261). Survey research can also produce a large amount of data

within a relatively short amount of time. Data resulting from representative samples can be

generalizable to other populations (2003). Certain disadvantages can also be present with survey

research. Response rates may be difficult to control, and data may lack detail or sufficient depth

(2003).

The SANICS survey was administered before and after completion of SOLO-IT. The

post survey also included Likert scale items, developed by the PI, measuring the experiences of

learners taking the course, and evaluations of overall course quality. Completion of SOLO-IT

also included successful submission of informatics assignments within the Blackboard ™ LMS.

Each module included quizzes and/or hands-on activities requiring actual demonstrations of

computer competency and information literacy skills. To demonstrate competency, students

were required to complete SOLO-IT with a minimum score of 92%, with no limit in the number

of times students could repeat modules, exercises or assignments.

Instructional Design of SOLO-IT

The structure of SOLO-IT provides an online framework where nursing students can

improve competence with commonly used technological tools (Godsey, 2011). Content was

designed to be consistent with the “beginner level” ICs identified by Staggers and colleagues

(2001).

Self-directed learning. The principles of self- directed learning (SDL) were the guiding

framework in the development of SOLO-IT. These principles emphasize the inherent

responsibility of the student to contribute to his or her own learning (Chang, 2006; Fisher et al.,

2001). Self-Directed Learning occurs “proactively, independently, and patiently” (Chang, 2006,

p. 269). Students engaged in SDL are charged with a responsibility to learn, schedule time for

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learning, and plan for integral learning as a means to meet an objective (Chang, 2006). The

concept of individuals who are capable of understanding their own learning needs, goals, and

requirements for learning has been widely studied since its introduction (Knowles, 1975). Self-

directed learning means “learning something proactively, independently, and patiently; being

responsible to learn; learning which is a challenge; a self- training ability and a high curiosity”

(Chang, 2006, p. 269 ). Self-directed learning involves a process by which “learners take

responsibility for planning, carrying out, and evaluating their own learning experiences”

(DeMaris, 2012, p. 42). Self -directed learning requires learners assume an active role as

investors in their own learning (Campbell, Campbell & Dickenson, 1996; Gureckis & Markant,

2012). Self- directed learning encourages students to assume some of the responsibility for their

own learning and views the instructor as facilitator (Hunt, Sproat, & Kitzmiller, 2004). The flow

of information intake is controlled by the learner in a manner that processes information into a

usable form which can be understood and retained (Mikulak, 2012).

Self-directed learners historically perform better in online learning environments (Chou,

2012). In the online environment, SDLs can progress through content at their own pace,

increasing the likelihood for retention of information which might otherwise be lost (Hunt,

Sproat, & Kitzmiller, 2004). Self-directed learning is the most recommended educational model

for competency skill development (Wang & Cranton, 2012).

SOLO’s Web-Based Modules

Each of SOLO-IT’s six modules are embedded within the Blackboard Learning

System™, the most popular distance learning platform used by institutions of higher learning

(Ferriman, 2013). One of the key features of SOLO Informatics Training is the availability of

supplemental tutorials which are easy to identify and select for the struggling new learner.

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Supplemental links lead students to additional demonstrations, screen shots, narrative

descriptions and competency based activities that reinforce content. Hands-on computer

activities occur liberally throughout the course and are structured so that competency

demonstrations are practiced repeatedly, in the absence of submission or time limits. A non-

punitive approach to evaluation is also a feature of SOLO-IT. All quizzes, demonstrations and

written assessments permit unlimited submissions and unlimited time for completion (see

Appendix B for SOLO-IT Course Overview and Grading Criteria; Godsey, 2011). This ‘safe

grading’ environment promotes repeated practice of computer and information literacy skills, in

the absence of time constraints. The foundational intent of SOLO-IT is to be a repository of

easily accessible, digitally based resources where professional students can learn and develop as

competent informatics users. Students remain enrolled in SOLO-IT during the duration of their

MSN Program progression, and may access or repeat training modules, as often as desired.

SOLO-IT consists of the following six modules:

• Module I: Introduction to SOLO-IT: Introduces nursing students to the features of SOLO-IT

and the Blackboard platform. The objectives for this module include:

1. Demonstrate the ability to navigate Blackboard

2. Describe the purpose of the Successful Online Learning Orientation (SOLO-IT) course

3. Perform a browser and software check to enable the necessary functions for successful

course completion

• Module II- Navigating the Computer and Web: Introduces nursing students to the parts and

functions of the computer and presents practice exercises for browsing the web. The

objectives for this module include:

1. Describe the parts and functions of a personal computer

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 2. Explore the use of the internet as a tool to inform nursing practice

3. Demonstrate the ability to use and manage an email account

4. Demonstrate understanding of the importance of anti-virus protection

5. Demonstrate the ability to back up computer files

• Module III- Computer Applications: Presents computer applications commonly used by

nurses, including spreadsheets, documents, and presentation software. The objectives for this

module include:

1. Apply the document construction principles of Microsoft Word, Excel, and Power Point

2. Demonstrate the ability to save and edit documents

3. Demonstrate the ability to create a folder for document organization

4. Demonstrate the ability to create and use Excel spreadsheets

5. Create a PowerPoint slide presentation

• Module IV- Information Literacy: Presents library and web based research tools that support

information literacy and Evidence Based Practice. The objectives for this module include:

1. Explain the nursing research process

2. Demonstrate effective use of search engines, such as Google Scholar

3. Locate scholarly articles and journals that support nursing research and Evidence Based

Practice

4. Demonstrate the process for locating and evaluating scholarly articles and websites

5. Discuss safeguards that should be applied when using social media

• Module V- Preparation for Research: Presents an overview of professional writing and

publication principles. The objectives for this module include:

1. Describe plagiarism avoidance and copyright issues

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 2. Demonstrate the principles of scholarly writing using American Psychological

Association (APA) format

• Module VI-Issues for the Professional e-Nurse: Introduces future e-nurses to professional

issues encountered in the clinical setting. The objectives for this module include:

1. Explore the role of nursing informatics in health care

2. Describe how Information Technology (IT) is transforming healthcare

3. Describe upcoming changes to healthcare due to the American Recovery and

Reinvestment Act (ARRA) and the Accountable Care Act (ACA)

4. Describe the roles and responsibilities of nursing in the area of health IT and Personal

Health Information (PHI).

5. Explain the difference between the electronic health record (EHR) and the electronic

medical record (EMR).

6. Outline opportunities for nursing in today’s technology rich healthcare environment

(Godsey, 2011)

Each SOLO-IT module requires various demonstrations of computer competency and

information literacy. The following list outlines the competencies which students must

demonstrate to successfully complete SOLO-IT:

• Understand the term hardware

• Understand the main components and functions of a personal computer

• Know the main parts of a computer

• Know the main types of storage media

• Identify the main input devices

• Know the main output devices

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• Understand the term software

• Understand the principles of an operating system

• Identify and know the uses of common software

• Understand what the internet is and know its main uses

• Understand the concepts of downloading and uploading

• Understand the term electronic mail

• Understand the importance of having backup copy of files

• Know ways to prevent data theft

• Understand the term computer virus

• Know how to protect against viruses

• Understand the term copyright

• Know how to store files

• Identify common file types: word processing, spreadsheet, database

• Name files/folders

• Copy files

• Open, close a word processing application

• Create a new document

• Save a document to a location on a drive

• Created a PowerPoint containing a background and at least one graphic (or whatever the

assignment was).

• Saved and attached documents

• Understand what the World Wide Web (www) is

• Explain the function of a web browser

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• Understand and use a search engine

• Know how to identify a secure web site

• Open, close a web browsing application

• Enter a URL in the address bar and go to the URL

• Navigate to the home page

• Select a specific search engine

• Copy, text, image URL from a web page to a document

• Preview a web page

• Understand the term email and know its main use

• Understand the make-up and structure of an email address

• Understand the importance of network etiquette

• Understand the difference between To, CC, BCC fields

• Open, close an email application

• Create a new email

• Enter an email address into the To, CC, BCC fields

• Enter a title in the subject field

• Send an email

• Use the reply, reply to all function

• Forward an email

• Delete an email

• Access needed information effectively and efficiently

• Use information effectively to accomplish a specific goal (Godsey, 2011).

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 Plan for Data Collection and Analyses

Process to Determine Study Feasibility

This study required access to a significant population of nursing students and use of the

university’s proprietary LMS, Blackboard. As such, a process was initiated during the 2012-13

academic school year to determine the feasibility of conducting dissertation research exploring

the role of SOLO-IT as an intervention to improve the informatics competencies of nursing

students. The process of determining feasibility is outlined below:

1. Permission was granted by the Director of the School of Nursing and the Nursing Faculty

Organization (NFO) to conduct future dissertation research using a population of entry level

undergraduate nursing students in the School of Nursing.

2. Permission was requested and obtained from the university’s Distance Learning Department

to use the Blackboard platform to house and deliver SOLO-IT modules.

3. Curricular policies were developed outlining the process for students to follow to

successfully complete SOLO-IT. This policy was collaboratively designed and

unanimously approved by the Nursing Faculty Organization. The policy included suggested

syllabus wording regarding the completion of SOLO-IT as a required assignment in certain

entry level courses.

4. Nursing faculty granted permission for the PI of this study to be enrolled (as a Teaching

Assistant) into the Blackboard sections of each designated course.

5. Completion of SOLO-IT will be required as a course assignment and will be worth 10% of

the course grade.

6. A Completion Certificate was awarded for all students who successfully completed SOLO-

IT with a grade of a 92% or higher. SOLO-IT has a maximum of 100 points possible and is

73
 worth 10% of the total course grade for select courses. The faculty determined that skills

obtained (or strengthened) through SOLO-IT are critically important and students would be

more likely to take the course seriously if assignment credit was associated with completion

of training.

Following more than one year of planning, it was concluded that dissertation research

involving a comprehensive educational intervention with a sample of approximately 270

nursing students and the use of proprietary LMS software was feasible at this university.

Unanimous approval by faculty of the School of Nursing, permission from the Director of the

School of Nursing and the Educational Technology Department, and the preliminary approval

of the sponsoring university’s IRB have been successfully obtained to conduct dissertation

research. Approval from the University of Hawaii’s IRB has been obtained to extract and

analyze archived survey data as a means of analyzing the psychometric properties and

performance of the SANICS instrument.

Data Analysis Plan

This research study will use principal factor analysis to examine the structure and internal

consistency reliability of the SANICS to examine the psychometric properties of the SANICS

among a sample of BSN entry-level nursing students, and to determine if the SANICS is

responsive over time when used to measure informatics competencies before and after

implementation of SOLO-IT modules. Construct validity of the SANICS will be assessed using

a known group approach to compare differences in means for each SANICS subscale (construct)

before and after completion of Successful Online Learning and Orientation Informatics Training

(SOLO-IT) modules. Means, standard deviations, and sample sizes will be computed for items

within each SANICS sub-scale category to test the hypothesis that differences in scores from

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pre- to post- survey (using archived data) will be significant following completion of SOLO-IT

training. Significant results, small p-values, and differences from pre-survey to post-survey in

amounts greater than zero may indicate that SOLO-IT training had a positive effect on students’

self-perceptions of IC. Significant results with a negative difference will indicate that an adverse

effect resulted from completion of SOLO-IT training.

Acquisition of informatics skills was the primary purpose of SOLO-IT. Repeated

attempts on assignments or demonstration exercises were encouraged and resulted in an

unusually high overall course average of 94%. Because all students were required to successful

complete SOLO-IT, the resulting final scores were high and did not provide the data spread

necessary to correlate demonstrated competency scores within SOLO-IT with self -reported

competencies on the SANICS. Plans are underway to re-design the assessment portion of the

course so that correlations between perceived versus demonstrated competencies can be made.

Statistical Power. This study will use a sample size of almost 500 nursing students (256

pre and 242 post SOLO-IT). Recommendations for sample size in factor analysis vary widely in

the literature. Traditional recommendations have included 10 respondents per item (Sapnas &

Zeller, 2002). However, “hypothetical and real research examples illustrate the usefulness of

sub-sample analysis in determining that a sample size of at least 50 and not more than 100

subjects is adequate to represent and evaluate the psychometric properties of measures of social

constructs” (Sapnas & Zeller, 2002, p. 135).

A power analysis using the G power program (Faul & Erdfelder, 2007) was performed to

determine the sample size required for a t-test comparison of means at alpha= 0.05. The result of

this analysis indicated a total sample size of 202 participants (101 for each group) would be

75
necessary to obtain a medium effect size (d=0.5) and 95% power (Faul & Erdfelder, 2007;

Appendix C).

Plan for Statistical Analysis. Survey Monkey™ was the software program used to

administer anonymous surveys using a 1-5 Likert Scale. Course evaluation procedures were also

conducted and included user satisfaction items ranked on a 1-5 Likert Scale, and open-ended

questions using text boxes to facilitate narrative comments.

A SPSS 21 Grad Pack will be used for all psychometric analyses. Principal component

analysis will be used to “extract the maximum variance from the data set, resulting in a few

orthogonal (uncorrelated) components” (2010, p. 234). A parallel analysis will be performed

using a simulator with the same number of variables and observations. Factor loadings and

promax rotation with Kaiser normalization will be used to examine and confirm correlations

among factors (Tabachnick & Fidell, 2007). The performance of the SANICS and the five

categorical factors of the scale will be assessed using Cronbach’s alpha (Tabachnick & Fidell,

2007). A standardized response mean will be used to evaluate the responsiveness of the

SANICS over time (Neale & Liebert, 1986). Differences between pre- and post- survey scores

will be analyzed using two sample t-tests at p = 0.05. The factor structure and internal

consistency reliability of the SANICS will be compared with the study conducted by the authors

of the SANICS instrument (Yoon, Yen & Bakken, 2009) to determine if the instrument’s

psychometric properties remained consistent when used in a sample of BSN entry level students

following informatics training.

Ethical Considerations

University of Hawaii Institutional Review Board (IRB). Approval has been granted

by the University of Hawaii’s IRB to conduct a psychometric analysis of archived SANICS data

76
(Appendix D). The request was made for exempt review since the study will involve no risk to

former study participants who completed SOLO-IT and participated in pre/post SANICS data

collection procedures. All data were collected in accordance with study procedures, as approved

by the sponsoring agency (Xavier University) at the time the SOLO-IT course was implemented.

All SANICS pre- and post-survey data were collected anonymously on an off-site third party

secure server. The software (Survey Monkey) has a decoding feature which provides the

following security functions: Firewall restricts access; intrusion detection systems and other

systems that detect and prevent interference or access from outside intruders; QualysGuard

network security audits performed weekly; McAfee SECURE scans performed daily; all data is

stored on servers located in the United States; backups occur hourly internally, and daily to a

centralized backup system for offsite storage; backups are encrypted (Survey Monkey, 2013).

Since the time of data collection, all study results have been stored securely within Survey

Monkey as anonymous, aggregate data.

Upon secure log on to SOLO-IT modules, students were routed to an announcements

page where they were introduced to the modules and provided a link to the pre-course survey.

Students were informed: 1) participation in the pre/post survey portion of the course was

completely voluntary, 2) identities would remain anonymous, 3) no effort would be made to

match survey responses with identifiers in Blackboard, and 4) survey data would be collected

and stored anonymously on Survey Monkey (secure, off-site, encrypted, survey software).

Students were also advised that any survey response (or lack of response) would have no impact

on assignment or course grade. Students were also informed that aggregate evaluative data

would facilitate course evaluation strategies and support quality improvement measures.

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 Xavier University IRB. To ensure compliance with university level policies and

procedures and to determine the level of cooperation by the university’s Institutional Review

Board (IRB), a SOLO-IT research proposal was submitted requesting advanced permission to

conduct future PhD student research using a population of nursing students attending the

sponsoring university. The preliminary request for IRB approval was made to determine the

feasibility of performing future research at the sponsoring institution in partial fulfillment of the

dissertation requirements leading to a PhD in Nursing from the University of Hawaii for the

study’s Principle Investigator (PI). Study approval was granted by the sponsoring university’s

IRB and included an open ended date for collection and analyses of study data (Appendix E).

Informed consent was obtained from each student participant. Students were advised of

study procedures and the voluntary nature of survey completion, as evidenced by: 1) the option

to click the link to gain voluntary access to the survey, 2) the option to voluntarily complete pre-

and post- surveys, and 3) the anonymous nature of the survey via an off-site secure server.

Nursing faculty of select entry level courses volunteered to include SOLO-IT completion

as one of the required assignments leading to partial fulfillment of one or more course objectives

(see Appendix C for Course Overview and Grading Criteria; Godsey, 2011). Completion of the

SOLO-IT modules was required for select entry level courses. However, completion of all

SOLO-IT related pre- and post- competency surveys was strictly voluntary.

During the first week of the semester, students enrolled into the SOLO-IT course

received an introductory e-mail message from the PI and SOLO-IT instructional designer

describing the training modules and outlining access to SOLO-IT training. To measure

perceptions of IC, students were asked to complete voluntary surveys prior to and immediately

following completion of SOLO-IT. Student volunteers were informed that data resulting from

78
completion of surveys would inform this research study and would support quality initiatives

within the nursing program. Instructions accompanying pre- and post-surveys restated and

emphasized the voluntary and anonymous nature of study participation. Students were also

advised that survey responses would be analyzed as aggregate data and no attempt would be

made to match enrollment data resulting from SOLO-IT training with anonymous survey data.

Additionally, students were informed that, while completion of SOLO-IT training is a course

requirement, lack of participation in voluntary survey procedures or quality of survey response

would have no impact on assignment or course grades. Finally, students were advised that

survey data would be collected via an off-site, secure server with encryption features. Refusal to

participate in the data collection procedures associated with SOLO-IT survey completion would

not be tracked in any way, further providing assurance that penalties could not be incurred for

lack of survey participation.

Limitations of the Design

A sample of undergraduate nursing students were pre-tested on the dependent variable

(informatics competencies) then post-tested following completion of SOLO-IT. This design is

considered superior to a post-test only design because it allows for the effect of the intervention

to be measured as the difference between pre-post scores. However, a one-group pre/post-test

design does not control for potentially confounding variables, such as history, maturation or

regression artifact (Johnson & Christensen, 2004). This study was taken from one sample of

undergraduate nursing students from a single private university in the mid-west, which could

limit generalizability of findings to other populations (eg. graduate students) or sites.

Additionally, measurements of computer competency were based on self-perceptions which may

not accurately represent ability to demonstrate competency. Finally, the possibility for a conflict

79
of interest exists given the intervention for this study (SOLO-IT) was also designed and

implemented by the researcher. Full disclosure of this association will be made in all forms of

reporting and in the dissemination of research findings.

Summary

The components of this study included a thorough literature review describing computer

competency, information literacy skills, and the current state of informatics competency among

the nursing profession. A comprehensive search of informatics training resources revealed a

significant gap in the literature regarding the availability of valid and reliable informatics

training resources and valid, reliable tools to measure informatics competencies. The SOLO-IT

program is an online educational intervention designed to improve the informatics competencies

of nursing students. A one-group pre/post-test design using the SANICS was utilized in a

sample of undergraduate nursing students. Surveys comprised of competency items were

administered via Survey Monkey to student volunteers prior to and at the completion of SOLO-

IT.

This study will explore the psychometric performance of the SANICS. Archived pre/post

SOLO-IT data will be used to assess the factor structure and internal consistency reliability of

the SANICS, and to examine the psychometric properties of the SANICS among a sample of

BSN entry-level nursing students, and to determine if the SANICS is responsive over time when

used to measure informatics competencies following completion of SOLO-IT. This study will

also evaluate the mean rating differences of SANICS scores before and after completion of

SOLO-IT. Construct validity of the SANICS will be assessed using a known group approach to

compare differences in means for each SANICS subscale (construct) before and after completion

of Successful Online Learning and Orientation Informatics Training (SOLO-IT) modules.

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 Chapter IV

Results

This chapter provides descriptions of the study sample and presents the factor structure,

internal consistency reliability and responsiveness of the SANICS instrument. Findings reported

in this chapter will serve to answer the following research questions:

 What are the psychometric properties of the SANICS among a population of BSN entry-level

students?

 Is the SANICS responsive over time when used to measure informatics competencies

following completion of SOLO-IT?

Research Design

This study explored the psychometric performance of the SANICS instrument using

archived survey data collected before and after completion of SOLO-IT. A pre/post-test design

using the 30-item SANICS was utilized in a sample of undergraduate nursing students. Surveys

comprised of competency items contained within the SANICS instrument were administered via

Survey Monkey to student volunteers prior to and at the completion of SOLO-IT.

Setting and Sample

During the period of January-March, 2014, two hundred seventy one (271) entry level

BSN students from a medium sized mid-western university were enrolled into SOLO-IT. A total

of 229 students (85%) successfully completed all SOLO-IT assignments, requiring an average of

two attempts per assignment in order to achieve the minimum passing score of 92% (overall

course average was 97%). Forty two students started, but did not complete all assignments in

SOLO-IT (although 13 of these students still chose to complete the post-training SANICS

survey). Most, but not all, course instructors required SOLO-IT completion. Courses which

81
lacked the formal requirement of SOLO-IT completion likely negatively influenced some of the

students’ decision not to complete the training.

Of the 271 students originally enrolled in SOLO-IT, 256 completed the pre-course

SANICS survey data (response rate of 94.4%) and 242 completed the post-training SANICS

survey (response rate of 89.2%), for a total sample size of 498 BSN students (see Figure 2).

Both the pre- and post- training surveys were administered using Survey Monkey software. All

data were entered and analyzed using Microsoft Excel and SPSS version 18.0 statistical

software.

Figure 2

SOLO-IT and SANICS: Participation and Return Rates

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Profile of Respondents

The sample for this study was 89.5% female and 10.5% male. Most of the student

volunteers were 20-29 (58.4%), followed by 30-39 (25.3%). Students in the combined 40-64 age

group made up 16.4% of the study population (12.1% in the 40-49 age group and 4.3% in the 50-

64 age group) (see Table 3).

Almost all of the BSN students in this study used computers for more than two years

(97.7%). Six students (2.3%) reported using computers for less than six months. The majority

of students reported using computers several times a day or daily (94.2%), followed by several

times a week (5.1%). Two students (0.8%) reported using computers only several times a

month, or never (see Table 3).

Table 3

BSN Demographics

Variable Count Percent

Gender
Female 230 89.5%
Male 27 10.5%
Total 257 100.0%
Age
20-29 150 58.4%
30-39 65 25.3%
40-49 31 12.1%
50-64 11 4.3%
Total 257 100.0%

Computer Experience
Just started using in the past 6 months 6 2.3%
In the past 2 years 0 0%
More than 2 years 251 97.7%
Total 257 100.0%

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 Frequency of Computer Use
Several times a day 195 76.2%
Once a day 46 18.0%
Several times a week 13 5.1%
Several times a month 1 0.4%
Never 1 0.4%
Total 256 100.0%

Presentation of Data for Research Question One

The first research question addressed by this study is “what are the psychometric

properties of the SANICS among a population of BSN entry-level students”? In response to this

question, the following discussion outlines the factor structure, internal consistency reliability,

and responsiveness of the SANICS instrument.

Principal Component Analysis

Principal component analysis was performed to determine the factor structure of the 30-

item SANICS (Table 4). Promax rotation with Kaiser Normalization was used to examine

correlations among five factors: Basic Computer Knowledge And Skills; Clinical Informatics

Role; Applied Computer Skills; Clinical Informatics Attitudes; And Wireless Device Skills.

Almost all (27 of 30) factor loadings increased over pre-SOLO-IT. Five factors accounted for

71.6% of the variance in the 30 item scale (pre-SOLO-IT) and the percentage of variation

increased to 77.3% post SOLO-IT.

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Table 4

Factor Structure Matrix Pre-and Post-SOLO-IT

Structure Matrix (Pre-SOLO-IT) Structure Matrix (Post-SOLO-IT)

Component Component
1 2 3 4 5 1 2 3 4 5
G1_Q1 .188 .824 .580 .403 .370 G1_Q1 .472 .908 .667 .386 .403
G1_Q2 .360 .869 .515 .375 .464 G1_Q2 .509 .920 .638 .497 .446
G1_Q3 .256 .867 .427 .431 .420 G1_Q3 .464 .915 .557 .489 .282
G1_Q4 .381 .847 .402 .334 .419 G1_Q4 .547 .909 .587 .533 .361
G1_Q5 .356 .888 .515 .335 .444 G1_Q5 .502 .941 .624 .485 .383
G2_Q1 .599 .373 .317 .229 .695 G2_Q1 .772 .502 .497 .429 .683
G2_Q2 .595 .383 .309 .483 .756 G2_Q2 .858 .448 .351 .572 .478
G2_Q3 .632 .607 .542 .111 .506 G2_Q3 .742 .548 .697 .437 .240
G2_Q4 .714 .565 .453 .218 .587 G2_Q4 .854 .476 .630 .470 .396
G2_Q5 .692 .449 .255 .443 .703 G2_Q5 .864 .488 .588 .578 .448
G2_Q6 .813 .186 .283 .174 .509 G2_Q6 .851 .401 .369 .521 .463
G2_Q7 .840 .195 .315 .176 .543 G2_Q7 .864 .418 .428 .573 .474
G2_Q8 .627 .233 .257 .376 .750 G2_Q8 .857 .359 .357 .557 .456
G2_Q9 .776 .465 .395 .301 .705 G2_Q9 .856 .475 .494 .500 .395
G2_Q10 .863 .376 .421 .259 .612 G2_Q10 .839 .521 .632 .571 .552
G2_Q11 .799 .423 .432 .281 .551 G2_Q11 .783 .511 .701 .473 .553
G2_Q12 .531 .309 .315 .369 .816 G2_Q12 .889 .493 .515 .619 .561
G2_Q13 .597 .437 .366 .443 .769 G2_Q13 .867 .429 .428 .594 .579
G2_Q14 .582 .430 .446 .425 .776 G2_Q14 .834 .406 .499 .531 .655
G2_Q15 .635 .495 .499 .407 .794 G2_Q15 .822 .463 .590 .436 .630
G3_Q1 .355 .517 .897 .252 .398 G3_Q1 .445 .634 .893 .402 .450
G3_Q2 .416 .543 .919 .268 .415 G3_Q2 .493 .677 .915 .455 .459
G3_Q3 .476 .481 .881 .308 .502 G3_Q3 .549 .592 .925 .507 .480
G3_Q4 .447 .547 .904 .341 .475 G3_Q4 .532 .579 .922 .515 .493
G4_Q1 .265 .405 .323 .920 .453 G4_Q1 .632 .506 .496 .932 .394
G4_Q2 .258 .431 .314 .922 .539 G4_Q2 .645 .515 .542 .944 .520
G4_Q3 .312 .411 .293 .924 .520 G4_Q3 .643 .508 .501 .955 .500
G4_Q4 .264 .427 .307 .926 .492 G4_Q4 .642 .589 .548 .940 .510
G5_Q1 .470 .505 .433 .455 .824 G5_Q1 .700 .486 .612 .554 .903
G5_Q2 .493 .477 .415 .430 .837 G5_Q2 .687 .483 .591 .559 .901

85
Parallel Analysis

Parallel analysis was conducted to determine which factors to retain. This simulation

method compared observed eigenvalues with eigenvalues from a random sample consisting of

the same number of variables and observations. All scores were over 0.50 on the primary

loading of items after rotation, which was the cut off for retention of items. Observed and

simulated eigenvalues intersected at the five factor level, further validating the five factors of the

SANICS (see Figure 3).

Figure 3

Parallel Analysis

14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
0 5 10 15 20 25 30

Simulated Eigenvalues OBS Eigenvalue

Psychometric Analysis: Comparisons with Original SANICS Study

Construct validity refers to an instrument’s ability to measure constructs adequately

(Shuttleworth, 2014). The presence of statistically significant differences between pre and post-

SOLO-IT suggest the construct validity of the SANICS is good. Effect size of the thirty items

showed a medium to large effect.

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 Internal consistency reliability was determined using Cronbach’s α for each of the five

sub-scales: Applied Computer Skills, Clinical Informatics Role, Wireless Device Skills, Basic

Computer Knowledge and Skills, and Clinical Informatics Attitudes.

Comparisons of factor loadings and Cronbach’s α were made between: 1) pre/post

SOLO-IT and 2) those reported by Yoon and colleagues (2009) (see Table 5). Cronbach’s α was

higher post-SOLO-IT (.95-.97) compared to pre-SOLO-IT (.92-.95), and compared to the

original SANICS study (.89-.94) for each of the five sub-scales of the instrument. These alphas

would be considered in the excellent range (Nunnally & Bernstein, 1994). Almost half (14 of

30) of the factor loadings were .90 or greater following SOLO-IT completion, compared to 23%

(7 of 30) pre-SOLO-IT.

Table 5

Factor Structure Compared to Original SANICS Study

Yoon Pre-SOLO-IT Post-SOLO-IT

SANICS SANICS SANICS
(BS/MS) (BSN) (BSN)
α = .91, α = .92, α = .96,
Clinical Informatics Role (5 items) n = 328, n = 251, n = 240,
M (SD) = M (SD) = M (SD) =
2.62 (.91) 2.65 (1.29) 3.52 (.96)
As a clinician (nurse), participate in the .83 .82 .91
selection process, design, implementation and
evaluation of systems.
Market self, system, or application to others .82 .87 .92
Promote the integrity of and access to .82 .87 .92
information to include but not limited to
confidentiality, legal, ethical, and security
issues
Seek resources to help formulate ethical .83 .85 .91
decisions in computing

Act as advocate of leaders for incorporating .83 .89 .94

innovations and informatics concepts into
their area of specialty

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 Basic Computer Knowledge and Skills α = .94, α = .94, α = .97,
(15 items) n = 321, n = 247, n = 238,
M (SD) = M (SD) = M (SD) =
3.86 (.71) 3.66 (1.15) 4.10 (.82)
Use telecommunication devices .73 .60 .77
Use the Internet to locate, download items of
interest .70 .60 .86
Use database management program to develop .68 .63 .74
a simple database
Use database applications to enter and retrieve .81 .71 .85
information
Conduct on-line literature searches .74 .69 .86
Use presentation graphics to create slides, .74 .81 .85
displays
Use multimedia presentations .74 .84 .86
Use word processing .72 .63 .86
Use networks to navigate systems .75 .78 .86
Use operating systems .74 .86 .84
Use existing external peripheral devices .79 .80 .78
Use computer technology safely .80 .53 .89
Navigate Windows .77 .60 .87
Identify the basic components of the computer .77 .58 .83
system
Perform basic trouble-shooting in applications .81 .64 .82
α = .89, α = .93, α = .95,
Applied Computer Skills: Clinical n = 330, n = 255, n = 240,
Informatics (4 items) M (SD) = M (SD) = M (SD) =
2.45 (1.03) 2.25 (1.36) 3.24 (1.07)
Use applications for diagnostic coding .71 .90 .89
Use applications to develop testing materials .69 .92 .92
Access shared data sets .75 .88 .93
Extract data from clinical data sets .77 .90 .92
α = .94, α = .95, α = .97,
Clinical Informatics Attitudes n = 332, n = 255, n = 242,
(4 items) M(SD) = M(SD) = M(SD) =
3.74 (.97) 3.82 (1.14) 4.15 (.85)
Recognize that health computing will become .82 .92 .93
more common
Recognize human functions that cannot be .83 .92 .94
performed by computer
Recognize that one does not have to be a .83 .92 .96
computer programmer to make effective use
of the computer in nursing
Recognize the value of clinician involvement .78 .93 .94
in the design, selection, implementation, and
evaluation of applications, systems in health
care
α = .90, α = .95, α = .96,
Wireless Device Skills (2 items) n = 328, n = 255, n = 242,
M(SD) = M(SD) = M(SD) =
2.75 (1.16) 3.44 (1.25) 4.07 (.84)
Use wireless device to download safety and .77 .82 .90
quality care resources
Use wireless device to enter data .76 .84 .90

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 Presentation of Data for Research Question Two

The following discussion answers the next question posed by this research: Is the

SANICS responsive over time when used to measure informatics competencies following

completion of SOLO-IT? Study participants were asked to rate perceived informatics

competencies for each of 30 SANICS items using a five-point Likert Scale, from one (strongly

disagree) to five (strongly agree). Two sample t-tests were used to determine means, standard

deviation, and sample sizes for each SANICS sub-scale category (Clinical Informatics Role,

Basic Computer Knowledge and Skills, Applied Composite Skills, Clinical Informatics

Attitudes, and Wireless Device Skills). It was not possible to pair sample data due to the

unplanned loss of an item on the post-survey (during a Blackboard upgrade) which requested the

respondent’s student identification number. Responsiveness of the SANICS was examined to

test the hypothesis that there would be a significant difference in SANICS scores between pre-

SOLO-IT and post-SOLO-IT.

All mean differences were significantly higher on each of the five SANICS sub-scale

categories following completion of SOLO-IT (p < 0.001). Differences from pre-score to post-

score are listed below from greatest to least amount of difference and are further delineated on

Table 6:

1. Applied Computer Skills (+2.02)

2. Clinical Informatics Role (+.87)

3. Wireless Device Skills (+.63)

4. Basic Computer Knowledge and Skills (+.44)

5. Clinical Informatics Attitudes, (+0.33).

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 Interestingly, differences in mean SANICS scores pre- to post-SOLO-IT were greatest in two

sub-scale categories not specifically covered by SOLO-IT’s introductory content (“Applied

Computer Skills” and “Clinical Informatics Role”). An explanation for this finding could relate

to the advanced wording of some of the competencies listed under this item, and will be further

discussed in the “Limitations” section of Chapter Five.

Table 6

Average Scores for Each SANICS Sub-Scale Pre/Post SOLO-IT

Pre-SOLO-IT Post-SOLO-IT Pre-SOLO-IT SANICS

SANICS SANICS -vs-
n= 256 n= 242 Post-SOLO-IT SANICS
Mean SD Mean SD P-value Conclusion
Basic Computer Post-SOLO-IT
Knowledge and Skills 3.66 1.07 4.10 0.81 P < .001 is higher

Post-SOLO-IT
Applied Computer Skills 1.87 1.10 3.89 0.87 P < .001 is higher

Post-SOLO-IT
Clinical Informatics Role 2.65 1.27 3.52 0.97 P < .001 is higher

Clinical Informatics Post-SOLO-IT

Attitude 3.82 1.14 4.15 0.85 P < .001 is higher

Post-SOLO-IT
Wireless Device Skills 3.44 1.25 4.07 0.84 P < .001 is higher

Mean SANICS scores following SOLO-IT completion were then compared with scores

from the original SANICS study conducted by Yoon, et al. (2009) in a population of BS/MS

students taking an informatics course. The population for this study consisted of all students

participating in a curriculum which emphasized informatics tools for patient safety, modeling,

and monitoring. The curriculum included didactic lectures on informatics for patient safety and

web-based reporting of hazards and near misses. Significantly higher mean SANICS scores

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were reported post-SOLO-IT on all five sub-scales compared to the mean SANICS scores

reported on the original SANICS study (p < 0.001) (see Table 7).

Table 7

SANICS Scores Post-SOLO-IT Compared to Original SANICS Study

Post-SOLO-IT Post-SOLO-IT SANICS

Yoon SANICS SANICS -vs-
n=332 (BS/MS)
N=242 (BSN) Yoon SANICS

Mean SD Mean SD P-value Conclusion

Basic Computer Post-SOLO-IT
Knowledge and Skills 3.86 0.71 4.10 0.81 p<.001 is higher

Applied Computer Post-SOLO-IT

Skills 2.45 1.03 3.89 0.87 p<.001 is higher

Clinical Informatics Post-SOLO-IT

Role 2.62 0.91 3.52 0.97 p<.001 is higher

Clinical Informatics Post-SOLO-IT

Attitude 3.74 0.97 4.15 0.85 p<.001 is higher

Post-SOLO-IT
Wireless Device Skills 2.75 1.16 4.07 0.84 p<.001 is higher

Value of SOLO-IT

Post-training SANICS surveys were identical to pre-training SANICS surveys, except for

the addition of 10 optional Likert scale items rating the overall effectiveness of SOLO-IT. At the

completion of the final assignment in SOLO-IT, students were asked to rate the value of the

training on a 1-5 Likert scale. Composite rating of all items was 4.0. Scores were highest on the

items “I found instructions in SOLO-IT clear and easy to understand” (4.1), “SOLO-IT provided

information in a manner that was easy to comprehend” (4.1), and “I feel confident I could now

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use Blackboard” (4.2). Scores were lowest on the items “using SOLO-IT was appropriate for my

learning as a nursing student” (3.8), and “I would recommend SOLO-IT to other students” (3.6)

(see Table 8).

Table 8

Value of SOLO-IT

Value of SOLO-IT N Mean SD

Using the SOLO-IT course was appropriate for my

learning as a nursing student. 241 3.8 0.88

I found the SOLO-IT site easy to use and follow. 241 4.0 0.82

I found instructions in SOLO-IT clear and easy to

understand. 240 4.1 0.78

The layout and design of SOLO-IT was user friendly. 241 4.0 0.79

SOLO-IT provided information I need. 239 4.0 0.80

I felt comfortable doing assignments in SOLO-IT 242 4.0 0.80

SOLO-IT provided information that will prepare me for

success as a student. 241 4.0 0.78

SOLO-IT provided information in a manner that was

easy to comprehend. 242 4.1 0.67

I feel confident that I could now use the online learning

course site, Blackboard 241 4.2 0.67

I would recommend SOLO-IT to other students 241 3.6 1.02

Composite 4.0

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 Summary

This chapter presented the factor structure, internal consistency reliability, and

responsiveness of the SANICS instrument before and after SOLO-IT training, and compared

those findings with the original SANICS research conducted by Yoon and colleagues (2009).

Evidence was presented which supports the reliability and validity of the SANICS as a tool to

measure perceptions of informatics competencies before and after a self-directed, online,

informatics training intervention. The next chapter will discuss implications of these findings for

the nursing profession.

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 Chapter V

Discussion

The previous chapter presented findings from this study. This chapter will include a

discussion of those findings, their implications for nursing practice, and recommendations for

future studies. Limitations of this study will also be described.

Sample Size and Return Rates

This study used a sample of 498 nursing students tested on the 30 item SANICS before

(n=256) and after (n=242) completion of SOLO-IT. The number of participants in this study

exceeded the minimum of 100 subjects recommended to evaluate psychometric properties of an

instrument (Sapnas & Zeller, 2002). Response rates for both pre- and post-SOLO-IT were high

at 94.4% and 89.2%, respectfully.

Study Participants

As is typical for an undergraduate nursing program, the majority of students were female

(89.5%) and between the ages of 20-39 (83.7%). Most students reported frequent use of

computers, with 94.2% reporting use several times a day for more than two years. The younger

age of participants and the frequency of computer usage suggest that most students were exposed

to computers during or prior to secondary school. However, despite the self-described

familiarity with computers, this younger group of nursing students still reported significant

increases in perceived competencies for each SANICS sub-scale following completion of SOLO-

IT. This finding is described in more detail in the discussion to follow.

Research Question #1

 What are the psychometric properties of the SANICS among a population of BSN entry-level

students?

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 The psychometric properties of the SANICS have been well described by Yoon and

colleagues (2009) with their combined sample of 337 BSN/MSN students. Reliability and

validity of the instrument was evident with their sample. Findings from this study also support

the SANICS as a psychometrically sound instrument when used before and after informatics

training in a population of undergraduate nursing students. Principle component analysis

supported the five factor structure of the SANICS, and was consistent with findings from the

original study. Reliability of the instrument was high and percent of variation for almost all

factors increased from pre- to post, as well as loadings within factors. Parallel analysis showed

all scores to be > .50 after rotation, and simulated eigenvalues validated the five factors of the

scale.

Cronbach’s α measurements confirmed the internal consistency of related items within

the 93 item scale. Cronbach’s α was in the excellent range (.95-.97) following SOLO-IT when

compared with pre-training and original SANICS scores. None of the inter-item correlations was

less than α = .89. Reliability coefficients of .70 or higher are usually considered acceptable by

most researchers (Bruin, 2006).

Research Question #2

 Is the SANICS responsive over time when used to measure informatics competencies

following completion of SOLO-IT?

The independent two sample t-test is “the most basic statistical test that measures group

differences…[and] analyzes significant differences between two group means” (Mertler &

Vannatta, 2010, p. 14). Independent t-tests confirmed the responsiveness of the SANICS over

time and also measured the five categorical factors of the scale: 1) Clinical Role, 2) Basic

Computer Knowledge, 3) Applied Computer Skills, 4) Clinical Informatics Attitudes, and 5)

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Wireless Device Skills. Significantly higher mean scores following SOLO-IT were reported on

each of the five SANICS’ five sub-scales, compared to pre-SOLO-IT (p < 0.001) and, when

compared to the original SANICS study (p < 0.001). This finding further supports the

responsiveness of the SANICS over time, when used to measure perceived informatics

competencies of nursing students. Each SANICS sub-scale score increased following SOLO-IT

(from a low of 1.87 pre-training to 3.89 post-training for the “Applied Computer Skills”

category, to the highest sub-scale scores for the “Basic Computer Knowledge and Skills”

category, which went from 3.66 pre-to 4.10 post-training). A competency score of 3.0 or greater

would be consistent with “perceived competence” (Yoon, et. al, 2009).

Differences from pre-score to post- score were greatest in the sub-scale categories

“Applied Computer Skills” (+2.02) and “Clinical Informatics Role” (+.87). These sub-scales

contained items, such as “use applications for diagnostic coding”, “extract data from clinical data

sets”, “act as advocate of leaders for incorporating innovations and informatics concepts into

their area of specialty”. Such a large increase from pre- to post-training suggests SOLO-IT may

have effectively introduced more advanced practice application concepts to entry level nursing

students who would not be expected to have experience or familiarity with these principles. The

areas with the least change from pre- to post- SOLO-IT were “ Basic Computer Knowledge and

Skills” and “Wireless Device Skills”, as might be expected in a younger population of nursing

students already accustomed to using computers and wireless devices.

Value of SOLO-IT

Post-training items to evaluate program effectiveness indicate that students valued the

online presentation and content offered by SOLO-IT. Composite score for all items was 4.0,

with the highest score reported for the item “I feel confident I could now use the online learning

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course site, Blackboard” (4.2). Program evaluation scores further support the potential value of

online informatics training as a tool to prepare and familiarize students with the educational

technologies used during nursing program matriculation.

Limitations

The sample population for this study was confined to one academic institution in the mid-

west which may limit generalizability to other settings. A one-group pre/post-test design does

not control for potentially confounding variables, such as history, maturation or regression

artifact (Johnson & Christensen, 2004).

Lack of randomization and the requirement (rather than the option) for entry level

students to complete SOLO-IT training could have also confounded study findings. Students

who felt they already possessed requisite computer and information literacy skills may have

reluctantly completed the training, and may have even resented the lack of an option to waive the

training requirement. Likewise, students who struggled with technology skills may have found

the online nature of the training insufficient for their learning needs, since it lacked immediate,

in-person feedback. Successfully completing SOLO-IT and receiving a completion certificate

may have given struggling students a sense of informatics competency, even when further

remediation may have been indicated.

Measurements of computer competency were based on self-perceptions which may not

accurately represent ability to demonstrate competency. Participants in this study may have

wanted to present themselves in a positive light, thus enhancing self-perceptions and biasing

study findings. Study subjects "have a tendency to want to present (themselves) in the best

light, and this may conflict with the truth” (Polit & Hungler, 1995, p. 312-13).

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 Completion of SOLO-IT provided many competency demonstration exercises and

knowledge acquisition assignments (quizzes). An average of two attempts per assignment was

necessary for most students to successfully pass each module and achieve the total minimum

completion score of 92%. Repeated attempts allowed students to review content and

practice/repeat demonstration exercises, but also resulted in high scores for every student

successfully completing the training (overall completion average was 97%). Such high

completion scores made the point spread within the data quite narrow and prevented an

opportunity to correlate students’ demonstrated abilities in SOLO-IT with their perceived

competencies, as rated on the SANICS.

The confounding variables of age and lack of nursing experience may have impacted

students’ understanding of some of the SANICS items. The majority of students (58.4%) fell

into the 20-29 year old age group. As first year students, it can be assumed these students had

little, if any, direct nursing experience. Competency on the SANICS assumed that students

possessed a certain degree of critical thinking skills. However, entry level nursing students may

not have understood some of the more complex items on the SANICS. For example, students

with no nursing experience may have lacked the background to fully comprehend and accurately

self-assess the competency item, “Recognize the value of clinician involvement in the design,

selection, implementation, and evaluation of applications/systems in health care”. Higher post-

scores could have simply reflected more familiarity with the item following informatics training,

rather than actual improved competency.

This study examined informatics competencies as reported by student perceptions via

pre/post surveys comprised of SANICS items. Actual demonstrations of informatics

competencies could provide comparative, objective data that would more accurately measure

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competency, and facilitate remediation strategies specific to the learning need. Sufficient

research exists delineating the lack of informatics competency among nurses and nursing

students. However, the lack of published studies examining the role of nursing informatics

competency training precluded comparisons or lessons gleaned from similar training

interventions.

Finally, the possibility for a conflict of interest exists given the intervention for this study

(SOLO-IT) was also designed and implemented by the researcher. Full disclosure of this

association will be made in all forms of reporting and in the dissemination of research findings.

Implications for Future Research

This study was limited to a single population of undergraduate nursing students. Future

studies should correlate demonstrated and perceived competencies, and should include the

validation of competency instruments which measure informatics training interventions among

diverse populations of undergraduate and graduate programs and with nurses in clinical practice.

During the course of the study, the version of Blackboard was updated by the university,

requiring the SOLO-IT course be imported into the new version. During this process, the item

on the post-survey which prompted students to enter their numerical identification number was

inadvertently omitted, making it impossible to pair post- with pre-training responses. Future

studies should include numerically paired codes which could allow for paired comparisons of

scores for each participant, as well as correlations of actual skill demonstrations with perceived

competency scores.

While nursing informatics competencies have been described for more than a decade, a

comprehensive review of the literature revealed a surprising lack of research studies describing

training interventions to address the problem of insufficient informatics competencies among

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nursing professionals. Published literature describing valid, reliable assessment tools to measure

the effect of informatics competency training among nurses or nursing students was also sparse.

Limitless opportunities exist for the creation, delivery, and evaluation of validated informatics

training products and instruments which can help ensure a highly qualified nursing profession,

capable of using and applying informatics in practice. Solution-driven research is recommended

to proactively address the need for a technologically competent nursing workforce.

Summary

This study explored the psychometric performance of the SANICS. Evidence was

presented which supports the SANICS as a psychometrically sound instrument when used in a

population of BSN entry-level nursing students. Archived pre/post SOLO-IT data were used to

confirm the factor structure and internal consistency reliability of the SANICS. This study

effectively demonstrated the responsiveness of the SANICS over time and supported its use as a

valid tool to measure pre- and post- informatics competencies associated with an online

informatics training intervention. Significant differences in each sub-scale mean score before

and after completion of SOLO-IT further supported the construct validity of the SANICS.

Results of this study suggest that SOLO-IT may be an effective tool for improving

perceptions of computer competencies among entry level BSN students. Future studies are

recommended which include paired samples of nurses and nursing students from various

populations which would allow for more extensive correlations. Finally, research is

recommended to correlate perceived informatics competencies with actual skill demonstrations.

Technology infused healthcare is rapidly evolving in an era of reform and expanding

regulatory demands. The concept of “competency” must be continually re-defined if metrics are

to remain current and reflective of a requisite informatics skillset for informed nursing practice.

100
As the nation’s largest consumers of health information technologies, it is no longer acceptable

for a coalition of 20 nursing informatics societies to endorse the European Computer Drivers’

License (ECDL) as the recommended solution for the lack of informatics competencies among

nurses. The ECDL was developed for use by a wide range of industries and does not address the

essential computer skills required in healthcare, or the unique challenges faced in the healthcare

setting (HIPAA, meaningful use, interoperability, etc.). Diffusion of informatics competency in

the face of ubiquitous change in healthcare will likely remain unrealized until the profession of

nursing responds with empirically grounded training innovations and validated instruments

which directly respond to the technological needs of today’s Registered Nurse.

101
 Appendix A: Self-Assessment Nursing Informatics Competency Scale

Permission to use the SANICS granted by the authors

For each statement, indicate your current level of competency on the scale of 1 to 5, where:
1 = Not competent, 2 = Somewhat competent, 3 = Competent, 4 = Proficient, and 5 = Expert.

Competent
competent

Somewhat
competent

Proficient

Expert
Not
1. As a clinician (nurse), participate in the selection process, design, 1 2 3 4 5
implementation and evaluation of systems

2. Market self, system, or application to others 1 2 3 4 5

3. Promote the integrity of and access to information to include but not 1 2 3 4 5

limited to confidentiality, legal, ethical, and security issues

4. Seek available resources to help formulate ethical decisions in computing 1 2 3 4 5

5. Act as advocate of leaders for incorporating innovations and informatics 1 2 3 4 5

concepts into their area of specialty

6. Use different options for connecting to the internet (phone line, mobile 1 2 3 4 5
phone, cable, wireless, satellite) to communicate with other systems (e.g.,
access data, upload, download)

7. Use the Internet to locate (e-learning, teleworking), download items of 1 2 3 4 5

interest

8. Use database management program to develop a simple database and/or 1 2 3 4 5

table

9. Use database applications to enter and retrieve information 1 2 3 4 5

10. Conduct on-line literature searches 1 2 3 4 5

11. Use presentation graphics (e.g., PowerPoint) to create slides, displays 1 2 3 4 5

12. Use multimedia presentations 1 2 3 4 5

13. Use word processing 1 2 3 4 5

14. Use networks to navigate systems (e.g., LAM, WLAN, WAN) 1 2 3 4 5

15. Use operating systems (e.g., copy, delete, change directories) 1 2 3 4 5

16. Use existing external storage devices (e.g., network drive, CD, DVD, 1 2 3 4 5
USB flash drive, memory card, online file storage)

17. Use computer technology safely 1 2 3 4 5

102
18. Navigate Windows (e.g., manipulate files using file manager, determine 1 2 3 4 5
active printer, access installed applications, create and delete directories)

19. Identify the basic components of the computer system (e.g., features of 1 2 3 4 5
a PC, workstation)

20. Perform basic trouble-shooting in applications 1 2 3 4 5

21. Use applications for diagnostic coding 1 2 3 4 5

22. Use applications to develop testing materials (e.g., e-learning) 1 2 3 4 5

23. Access shared data sets (e.g., Clinical Log Database, Minimum Data 1 2 3 4 5
Set)

24. Extract data from clinical data sets (e.g., Clinical Log Database, 1 2 3 4 5
Minimum Data Set)

25. Recognize that health computing will become more common 1 2 3 4 5

26. Recognize that the computer is only a tool to provide better nursing 1 2 3 4 5
care and that there are human functions that cannot be performed by
computer

27. Recognize that one does not have to be a computer programmer to 1 2 3 4 5

make effective use of the computer in nursing

28. Recognize the value of clinician involvement in the design, selection, 1 2 3 4 5

implementation, and evaluation of applications, systems in health care

29. Use wireless device (PDA or cellular telephone) to locate and download 1 2 3 4 5
resources for patient safety and quality care

30. Use wireless device (PDA or cellular telephone) to enter data 1 2 3 4 5

103
 Appendix B: Course Overview and Grading Criteria

SOLO for a DELTA©: An Online Informatics Training Course

Successful Online Learning and Orientation (SOLO)
for a DELTA (Digitally Enhanced Learning and Technological Arena)©

In order to prepare you for success in the nursing program, the nursing faculty at Xavier University
would like you to complete a nursing informatics training course called SOLO for a DELTA (SOLO). This
training course is embedded into an off-site distance learning platform called CourseSites© and is
operated by Blackboard©.

Why do I need SOLO for a DELTA?

SOLO (Successful Online Learning and Orientation) for a DELTA (Digitally Enhanced Learning and
Technological Arena) helps prepare nursing students for success by providing a self-guided, online
framework where new and experienced learners can work at their own pace to develop (or improve)
overall informatics competencies. One of SOLO’s key features is the ability for students to self-select
supplemental resources and tutorials to use as much or as often as needed. In SOLO, all students are
encouraged to repeat exercises, assignments, or quizzes with no limit on time or number of submissions.

Is SOLO for a DELTA required?

Yes. All new incoming graduate and undergraduate students will be required to complete SOLO for a
DELTA as a graded assignment in one of their courses: N 130 [BSN], N505 [MSN], N550 [MIDAS], N 496
[RN-MSN] and N556 [CNL]. SOLO for a DELTA is also a course pre-requisite for N 854: Advanced
Informatics [ALL MSN, including FNP].

SOLO is recommended early in the nursing program since the information contained in SOLO will help
prepare you with the foundational technological skills necessary for the nursing program and for nursing
practice.

Successful completion of SOLO is a pre/co-requisite for N 854 and is associated with assignment credit in
the courses listed above. Once you have completed SOLO, you will not have to repeat it during the
course where it is required (but you will still receive assignment credit/grade, if appropriate). Once SOLO
is completed, you will receive a Certificate of Completion with your final score. Be sure to keep this
certificate, and show it to your instructor as proof that you successfully completed the SOLO for a DELTA
Informatics Training Course.

How long will it take to complete SOLO?

The average time to complete SOLO is approximately 4 hours (with a range of 2-22 hours, depending
upon your experience and comfort level with computer applications).

104
Length of time varies widely, since students are encouraged to repeat exercises, assignments, and
quizzes as often as needed, in order to demonstrate competency. There is no limit in the amount of
time spent on a module, or the number of times an assignment or quiz can be re-submitted.

SOLO can also be accessed as often as needed in order to complete all six modules listed below. Since
each module builds upon information from previous modules, it is recommended the course be
completed within a one-two week period from the start date.

What informatics competencies are taught in SOLO for a DELTA?

SOLO consists of the following six modules:

 Module I- Introduction to SOLO: Introduces nursing students to the features of SOLO and
the Blackboard platform.
 Module II- Navigating the Computer and Web: Introduces nursing students to the parts and
functions of the computer and presents practice exercises for browsing the web.
 Module III- Computer Applications: Presents computer applications commonly used by
nurses, including spreadsheets, documents, and presentation software.
 Module IV- Information Literacy: Presents library and web based research tools that
support information literacy and Evidence Based Practice
 Module V- Preparation for Research: Presents an overview of professional writing and
publication principles.
 Module VI-Issues for the Professional e-Nurse: Introduces future e-nurses to professional
issues encountered in the clinical setting.

When do I start SOLO?

Once you have enrolled into the SOLO course, you will first be asked to participate in a survey as part of
a research study. Completion of surveys is strictly voluntary, but will greatly assist us in evaluating the
effectiveness of the SOLO course. As part of the study, you will do the following:

1) Prior to beginning SOLO, complete an anonymous 30 item survey. The survey will involve
ranking your present informatics skills and competencies on a scale from 1 to 5.
2) After completing SOLO, repeat the same anonymous survey (with some additional items
included for course evaluation purposes).

o Survey data are collected via a secure off-site server with SSL encryption.
o Refusal to participate in the data collection procedures associated with SOLO cannot be
tracked, and there are no penalties for lack of participation or type of response.
o Choosing to enter and complete the survey will indicate your permission to participate.

You will need to complete SOLO during the first two months of the semester as a required assignment in
one of the courses listed at the beginning of this document.

105
How do I enroll into the SOLO Course?

1) It’s easy! Check your Xavier email! We will e-mail your enrollment invitation. When you
receive it, click on the link provided in the e-mail to be taken to CourseSites where you will
register.
 Select a user name that does not include your actual name or other identifiers (eg.
Nurse1234), since pre and post course survey data will be paired anonymously by user
names. Pairing of anonymous data will allow us to determine how much (if any),
perceptions of informatics competency changed as a result of SOLO.
 Data will be reviewed and reported in aggregate form only and cannot be traced to
individual users.
2) Once you create your account, you will be automatically enrolled and can begin.
3) For your convenience, a SOLO Instructional Manual (Word document) is available at the
bottom of the first page of the SOLO course.
4) When you complete the course and all modules have been graded, a Completion Certificate
will be available in CourseSites. The certificate can be printed or saved. Your instructor may
require you to submit this certificate as proof you that you successfully completed the course.
5) It is recommended that you add completion of SOLO for a DELTA Informatics Training Course
to your resume!

An application requesting four continuing education (CE) units of credit has been submitted to the Ohio
Board of Nursing. If/when that application is approved, CE credit will be awarded and a certificate
provided to those who successful completed all six modules of SOLO for a DELTA.

What if I need help?

No problem! We are here to help! Simply contact the SOLO Help Desk at help@
. We will look into your issue and respond within 12 hours (excluding weekends and
holidays).

Wishing you every success on your SOLO journey and in your nursing education,

Judi A. Godsey, RN, MSN

SOLO Course Designer; Assistant Professor and Informatics Coordinator
Xavier University School of Nursing

106
 SOLO for a DELTA©: An Online Informatics Training Course
Successful Online Learning and Orientation (SOLO)
for a DELTA (Digitally Enhanced Learning and Technological Arena)©

Grading Criteria
Needs to Needs to Needs to Recomme Achieved POINTS
SOLO for a DELTA Repeat Repeat Review nd Maximum
Module Module and/or Review of Points
and and Repeat Module. Allowable
Objectives and Competency Assignme Assignme Module Repeat or -
Demonstrations/Activities nt nt and Correct No need
Repeat and to repeat
Assignme Re-submit Module
nt Assignme or
nt Assignme
nt
Module I Objectives:
Introduction to SOLO: Introduces nursing
students to the features of SOLO and the
Blackboard platform. Objectives for this
module include:

 Describe the purpose of the

Successful Online Learning
Orientation (SOLO) course
 Navigate the Blackboard platform
 Perform a browser and software
check in order to enable the necessary
functions for course completion

Module II Objectives
Navigating the Computer and Web:
Introduces nursing students to the parts
and functions of the computer and presents
practice exercises for browsing the
web. Objectives for this module include:
 Describe the parts and functions of a
personal computer
 Explore the use of the internet as a
tool to inform nursing practice
 Demonstrate the ability to use and
manage an email account
 Demonstrate understanding of the
importance of anti-virus protection
 Demonstrate the ability to back up
computer files
For Modules I and II, you will demonstrate
competencies by performing these
activities: 0-1 2 3 4 5
1. Show What You Know: Computers
Quiz 0-1 2 3 4 5
(5 points)
2. Show What You Know: Internet Quiz

107
 Needs to Needs to Needs to Recomme Achieved POINTS
SOLO for a DELTA Repeat Repeat Review nd Maximum
Module Module and/or Review of Points
and and Repeat Module. Allowable
Objectives and Competency Assignme Assignme Module Repeat or -
Demonstrations/Activities nt nt and Correct No need
Repeat and to repeat
Assignme Re-submit Module
nt Assignme or
nt Assignme
nt
(5 points)

Module III Objectives

Computer Applications: Presents computer
applications commonly used by nurses,
including spreadsheets, documents, and
presentation software. Objectives for this
module include:
 Apply the document construction
principles of Microsoft Word, Excel,
and Power Point
 Demonstrate the ability to save and
edit documents
 Demonstrate the ability to use and
edit Excel spreadsheets
 Create a PowerPoint slide
presentation
For Module III, you will demonstrate
competencies by performing these
activities:
1. Show What You Know: Microsoft 0-2 3-5 6-7 8-9 10
Word
(5 pts) 0-2 3-5 6-7 8-9 10
2. Show What You Know: Excel
(10 points) 0-2 3-5 6-7 8-9 10
3. Show What You Know: Power Point
(10 points)
Module IV Objectives
Information Literacy: Presents library and
web based research tools that support
information literacy and Evidence Based
Practice. Objectives for this module
include:
 Describe the basic principles of
nursing research
 Demonstrate effective use of
search engines
 Locate scholarly articles and
journals that support nursing
research and Evidence Based

108
 Needs to Needs to Needs to Recomme Achieved POINTS
SOLO for a DELTA Repeat Repeat Review nd Maximum
Module Module and/or Review of Points
and and Repeat Module. Allowable
Objectives and Competency Assignme Assignme Module Repeat or -
Demonstrations/Activities nt nt and Correct No need
Repeat and to repeat
Assignme Re-submit Module
nt Assignme or
nt Assignme
nt
Practice
 Demonstrate the process for
locating and evaluating scholarly
websites
 Discuss safeguards that should be
applied when using social media

Module V Objectives
Preparation for Research: Presents an
overview of professional writing and
publication principles. Objectives for this
module include:
 Describe how to avoid plagiarism
 Explain some of the common
issues associated with copyright
 Demonstrate the basic principles
of scholarly writing using American
Psychological Association (APA)
format
 Explore the role of Evidence Based
Practice (EBP) in nursing
 Describe the importance of
nursing research posters as a
means to disseminate research
findings
For Modules IV and V, you will
demonstrate competencies by performing
these activities:
0-9 10-19 20-25 26-29 30
1. Show What You Know: Locate a
Research Article; Complete an 0-2 3-5 6-7 8-9 10
Assignment (30 points)
2. Show What You Know: Plagiarism 0-2 3-5 6-7 8-9 10
Assignment (10 points)
3. Show What You Know: Research and
APA Quiz (10 points)
Module VI
Issues for the Professional e-
Nurse: Introduces future e-nurses to
professional issues encountered in the
clinical setting. Objectives for this module
include:
 Explore the role of informatics in

109
 Needs to Needs to Needs to Recomme Achieved POINTS
SOLO for a DELTA Repeat Repeat Review nd Maximum
Module Module and/or Review of Points
and and Repeat Module. Allowable
Objectives and Competency Assignme Assignme Module Repeat or -
Demonstrations/Activities nt nt and Correct No need
Repeat and to repeat
Assignme Re-submit Module
nt Assignme or
nt Assignme
nt
healthcare
 Describe how Information
Technology (IT) is transforming
health care
 Describe changes to healthcare
due to the ARRA and ACA
 Describe the roles and
responsibilities of nursing in the
area of health IT and PHI
 Explain the difference between
EHR and EMR
 Outline opportunities for nursing
in today’s technology rich
healthcare environment

For Module VI, you will demonstrate

competencies by performing these
activities:
0-1 2 3 4 5
1. Show What You Know: ACA, ARRA,
and ACO Quiz (5 points) 0-1 2 3 4 5
2. Show What You Know: EHR, EMR,
PHR Quiz(5 points)

TOTAL POINTS

110
Appendix C: Power Analysis

111
Appendix D: University of Hawaii IRB Approval

112
Appendix E: Xavier University IRB Approval

113
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