COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
1
Comparative Assessment of Informatics Competencies in Three Undergraduate Programs
By
Jeungok Choi, PhD, MPH, RN
Citation:
Choi, J. (June 2012). Comparative Assessment of Informatics Competencies in Three
Undergraduate Programs. Online Journal of Nursing Informatics (OJNI), vol. 16 (2), Available
at http://ojni.org/issues/?p=XXX
Abstract
This study was conducted to determine and compare the informatics competencies of students in
three undergraduate tracks: Traditional Pre-Licensure, Registered Nurse (RN) to Bachelor of
Science in Nursing (BSN), and Accelerated BSN. Data were collected from 131 students in fall
2011 using a 30-item Self-Assessment of Nursing Informatics Competencies Scale. Scale scores
indicated that RN to BSN (mean=3.21) and Accelerated BSN (mean=3.01) students were
competent in informatics, but not Traditional Pre-Licensure students (mean=2.82). Comparison
of competency scores by track reveal that RN to BSN and Traditional Pre-Licensure students
differed significantly in overall informatics competency (F(2, 92)=4.31, p=.02). This difference
may reflect students’ different levels of clinical nursing experience and the learning format of
each track. All students perceived they lacked competence in two subscale areas, “Applied
computer skills” and “Clinical informatics role.” These findings provide insight about the
strengths and weakness of the informatics competencies of nursing students and warrant
attention from nurse educators when designing nursing curricula.
Keywords: nursing informatics competencies, Self-Assessment of Nursing Informatics
Competencies Scale, SANICS, undergraduate nursing students, RN to BSN, Accelerated BSN,
Traditional Pre-Licensure
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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To ensure that nursing graduates are competent in the era of electronic healthcare
delivery, it is essential to integrate informatics into clinical nursing curricula. Before nurse
educators present informatics-related nursing content to the students, it is important to assess
nursing students’ current level of informatics competencies (Gassert, 2008; Hebda & Calderone,
2010). Incorporating this assessment to gauge informatics competency is essential for student
learning. The assessment provides feedback that can be used to adjust teaching methods or
content of the informatics curriculum to students’ various needs. Despite the importance of
assessing informatics competencies, few studies to date have reported informatics competencies
of nursing students in two specific types of undergraduate programs, the Registered Nurse (RN)
to Baccalaureate or Bachelor of Science in Nursing (BSN) and Accelerated BSN programs. The
RN to BSN program provides a baccalaureate nursing degree to licensed RNs with an associate
degree (American Association of Colleges of Nursing [AACN], 2011a), and the Accelerated
BSN program offers the BSN degree to students already holding a bachelor's degree in a
non-nursing discipline (AACN, 2011b).
To increase the proportion of baccalaureate-prepared nurses in the workforce to 80%
by 2020, as recommended by the Institute of Medicine (2011), many nursing schools have added
baccalaureate programs. Consequently, RN to BSN and Accelerated BSN programs are growing
fast, contributing a significant portion of nurses to the current nursing workforce. Despite the
growing number of students in these programs, however, only a few studies have reported their
informatics competencies (Desjardins, Cook, Jenkins, & Bakken, 2005; Elder & Koehn, 2009;
McDowell & Ma, 2007), and most studies combined students from these groups and reported the
findings in an aggregate form (Elder & Koehn, 2009; McDowell & Ma, 2007).
To date, no studies have compared informatics competencies of nursing students in the
three baccalaureate programs: Traditional Pre-Licensure, RN to BSN, and Accelerated BSN.
Students in these programs have different educational backgrounds and nursing practice
experience; thus, they might have different preparation levels in informatics. For example,
students in the Traditional Pre-Licensure program are generally younger than RNs who return to
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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nursing school to earn a BSN, and although they lack the nursing experience of RNs, they
typically are more proficient with computers and computer applications. Accelerated BSN
students have a baccalaureate or higher degree in another field and varied background
knowledge of computers and computer applications. These students are similar to Traditional
Pre-Licensure students in having little or no nursing experience, but many have been
exposed to computers from their previous degrees and job experiences. Because nursing
students across the undergraduate BSN options have such unique educational and nursing
practice backgrounds, their knowledge of and capabilities related to nursing informatics
competencies form a proverbial "mixed bag." Thus, the nursing curriculum needs to reflect
this variation while advancing the students toward proficiency in informatics competencies.
The purpose of this study was to determine and compare the informatics competencies of
students in three undergraduate tracks (Traditional Pre-Licensure, RN to BSN, and Accelerated
BSN).
Baccalaureate Nursing Students’ Informatics Competencies
According to Staggers and Gassert (2000), informatics competency is defined as the
integration of knowledge, skills, and attitudes in the performance of various nursing informatics
activities within prescribed four levels of nursing practice, beginning nurse, experienced nurse,
informatics nurse specialist, and informatics innovator. Informatics competencies and
recommended interventions to improve these competencies of baccalaureate nursing students
have been well studied.. Overall, baccalaureate nursing students are competent (Desjardins,
Cook, Jenkins, & Bakken, 2005) or have moderate informatics and technology knowledge,
attitudes, and skills (Fetter, 2009; McDowell & Ma, 2007). Looking back to the 1990s, a study to
assess computer literacy found baccalaureate nursing students’ had “some” experience in using
microcomputers, personal computers, and WordPerfect as well as some keyboard skills (Gassert
& McDowell, 1995). And in more recent studies, baccalaureate nursing students’ self-rated
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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competencies remained at a basic level, e.g., confidence in Internet searches, word processing,
using email, and systems operations (Desjardins et al., 2005; Fetter, 2009; McDowell & Ma,
2007). Students rated themselves lowest on care documentation and planning, valuing
informatics knowledge, skills development, and data entry competencies (Fetter, 2009). After
formal training and hardware provision was given, modest improvements were found in basic
computer knowledge and skills, but fewer gains in advanced skills and information literacy for
nursing students at the baccalaureate (McDowell & Ma, 2007) and post- baccalaureate (Cole &
Kelsey, 2004) levels. In two surveys of nurse executives and deans and directors of
undergraduate and graduate programs, the nursing executives reported that new graduate nurses
needed to be familiar with nursing-specific software such as computerized medicationadministration systems (McCannon & O'Neal, 2003) and recommended improving incorporation
of these skills into nursing curricula (McNeil et al., 2003).
Although nursing students nationwide reported positive attitudes toward technology, they
reported little formal education in using technology applications (Maag, 2006). Furthermore,
first-year baccalaureate nursing students rated themselves higher on their computer skills than
their actual performance of those skills, suggesting that actual competency levels are lower than
self-reported levels (Elder & Koehn, 2009). Most of these findings, however, were based on
mixed groups of baccalaureate students from Traditional Pre-Licensure, RN to BSN, and
Accelerated BSN programs (Elder & Koehn, 2009; McDowell & Ma, 2007), or only Accelerated
BSN students (Desjardins et al., 2005).
In summary, the review reveals that baccalaureate nursing students have competent
(Desjardins, Cook, Jenkins, & Bakken, 2005) or moderate informatics and technology
knowledge, attitudes, and skills (Cole & Kelsey, 2004; Fetter, 2009; McDowell & Ma, 2007).
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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These studies, however, included mixed groups of baccalaureate students from Traditional PreLicensure, RN to BSN, or Accelerated BSN students and reported the findings in an aggregate
form. To date, no studies have compared informatics competencies of nursing students in the
three baccalaureate programs. Thus, this study was undertaken to compare the informatics
competencies of students in three undergraduate tracks (Traditional Pre-Licensure, RN to BSN,
and Accelerated BSN).
Methods
Sample and Setting
A convenience sample of 131 students at a northeastern state university enrolled at the
school of nursing was used in the study. Students were aligned with one of three baccalaureate
tracks: 78 Traditional Pre-Licensure students, 32 RN to BSN students, and 21Accelerated BSN
students.
Data Collection
Data were collected on students’ informatics competencies by survey from September
2011 to January 2012. Competencies were assessed using the 30-item Self-Assessment of
Nursing Informatics Competencies Scale (SANICS; Yoon, Yen, & Bakken, 2009). The SANICS
was developed based on a set of informatics competency statements for beginning and
experienced nurses (Staggers, Gassert, & Curran, 2001; Staggers, Gassert, & Curran, 2002), with
additional items related to standardized terminologies, evidence-based practice, and wireless
communications (Yoon et al., 2009). Each item is self-rated on a 5-point Likert scale from 1 (not
competent) to 5 (expert). The SANICS has five subscales: “Clinical informatics role,” “Basic
computer knowledge and skills,” “Applied computer skills: clinical informatics,” “Nursing
informatics attitudes,” and “Wireless device skills.” The psychometric properties of the SANICS
have been well established, with high internal consistency reliabilities ranging from .89 (wireless
device skills) to .94 (basic computer knowledge and skills) (Yoon et al., 2009).
Procedure
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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After receiving approval for the study by the author’s university institutional review
board, a collection of student email addresses using LISTSERV was obtained from each track
director. This list didn’t include specific identifiers, e.g., student names or individual email
addresses. At the beginning of the semester, the students were introduced to the study and the
SANICS via email. This email contained an embedded link to the Internet survey package,
SurveyMonkey, which included the SANICS and demographic questions along with an online
consent form. Students indicated consent to participate by returning the instrument via Internet to
the SurveyMonkey secure site and checking off a box. Students were told the information was
being collected for course evaluation and improvement purposes, and responses to the survey
would have no effect on their current or future success in the course or program. In midNovember, students received a reminder email by LISTSERV to encourage study participation.
Data Analysis
Students’ informatics competencies and characteristics were summarized using
descriptive statistics (means and SDs). Differences in competencies by undergraduate track
(Traditional vs. RN to BSN vs. Accelerated BSN) were analyzed by ANOVA. The internal
consistency reliability of the SANICS was assessed using Cronbach’s alpha for the total scale
and its five subscales. SPSS, version 19.0 (Chicago, IL) was used for all analyses.
Results
Sample Characteristics
The sample comprised 131 nursing students enrolled in the fall semester 2011 at one state
university. The majority of students (59.5%) were in the Traditional Pre-Licensure track, 16.0%
were in the Accelerated BSN track, and 24.4% were in the RN to BSN track. Of 283 students
enrolled in the three tracks, 131 responded for a response rate of 46.3%.
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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The sample was predominantly female and from 20 to 30 years old (Table 1). Most
respondents used a computer several times a day and had used computers >2 years (Table 1).
The majority had worked in nursing <2 years (93.6% for Traditional Pre-Licensure, 76.2% for
Accelerated BSN), except 43.8% of RN to BSN had worked 5 to 10 years. For details, see Table
1.
Informatics Competencies
The SANICS had high internal consistency reliabilities; Cronbach’s alpha for the total
scale was .95, and subscale alphas ranged from .93 for “Basic computer knowledge and skills” to
.89 for “Clinical informatics role” and “Wireless device skills” (Table 2). With competence
indicated by a minimum SANICS score of 3 (Yoon et al., 2009), RN to BSN and Accelerated
BSN students were competent in informatics (mean=3.21, SD=.87 and mean 3.01, SD=.68,
respectively), but not Traditional Pre-Licensure students (mean=2.82, SD=.55) (Table 2).
Traditional Pre-Licensure students’ competency scores ranged from “Clinical informatics
role” (mean=1.80, SD=.61) to “Basic computer knowledge and skills” (mean=3.32, SD=.61).
Accelerated BSN and RN to BSN students reported their least competent area as “Applied
computer skills” (mean=1.93, SD=.81 and mean=2.58, SD=1.08, respectively) and their most
competent area as “Clinical informatics attitude” (mean=3.71, SD=.77 and mean=4.09, SD=.99,
respectively).
Comparison of Competency Scores by Undergraduate Track
RN to BSN students reported the highest mean informatics competency score
(mean=3.21, SD=.87), followed by Accelerated BSN (mean=3.01, SD=.68), and Traditional PreLicensure (mean=2.82, SD=.55) students. These scores differed significantly (ANOVA F(2,
92)=4.31, p=.02). Specifically, post hoc analysis indicates that RN to BSN students were
significantly more competent (mean=3.21) than Traditional Pre-Licensure students (mean=2.82)
(p=.02).
When each subscale was considered, significant differences were found for three
subscales, “Applied computer skills,” “Clinical informatics role,” and “Clinical informatics
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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attitude.” “Basic computer knowledge and skills” (p=.91) and “Wireless device skills” (p=.08)
were not significant. Post hoc analysis shows the difference in all three subscale analyses lies
between RN to BSN and Traditional Pre-Licensure students (all p<.001) (Table 2).
Discussion
Low Competence in Applied Computer Skills and Clinical Informatics Role
RN to BSN and Accelerated BSN students were generally competent in informatics, but
not Traditional Pre-Licensure students. Examination of participants’ SANICS subscale scores
shows that, regardless of undergraduate track, students perceived they were competent in two
areas, “Basic computer knowledge” and “Clinical informatics attitude.” The findings indicate
that participating baccalaureate students were most confident in basic computer skills such as
searching the Internet, word processing, systems-operations skills, as well as graphical and
multimedia presentation, similar to previous reports (Desjardins et al., 2005; Fetter, 2009;
Gassert & McDowell, 1995). Participants also fully recognized the value and positive impact of
informatics on nurses and nursing practice, consistent with a nationwide survey of undergraduate
and graduate nursing students (Maag, 2006).
Students in all three baccalaureate tracks perceived that they lacked competence in
“Applied computer skills” and “Clinical informatics role.” They were not confident in accessing
or extracting information from clinical data sets (e.g., minimum data set) or as a clinician
(nurse), participating in the selection process, designing, implementing, and evaluating systems,
or seeking available resources to help ethical decisions in computing. These findings are not
surprising considering the undergraduate students’ limited exposure to clinical nursing practice,
but our findings indicate that these areas warrant attention in the design of informatics course
curricula.
One interesting finding is that RN to BSN and Accelerated BSN students perceived that
they were competent in “Wireless device skills,” while the Traditional Pre-Licensure students
did not. The findings indicate that Traditional Pre-Licensure students perceived themselves as
not competent in locating and downloading resources and entering data using these wireless
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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devices. Interestingly, these students have been exposed to many technologies throughout
primary and secondary school and were anticipated to be more likely to rate themselves as
proficient in using wireless devices (personal digital assistants, smart phones).
Comparison of Competency Scores among Students in Three Baccalaureate Tracks
No significant differences were found in comparisons of either Traditional Pre-Licensure
and Accelerated BSN or RN to BSN and Accelerated BSN. However, students in the RN to BSN
track perceived themselves as more informatics competent than students in the Traditional PreLicensure track. These findings could not be compared to those in the literature because no
relevant studies were found. However, our findings may reflect the greater nursing practice
experience of RN to BSN students (62.6% had >5 years nursing experience), giving them greater
exposure to informatics systems than Traditional Pre-Licensure students, of whom 74.4% had no
nursing experience. These findings may also reflect the current online learning format of the RN
to BSN track at our university, whereas the Traditional Pre-Licensure and Accelerated BSN
tracks were taught in traditional classroom settings. The online learning format of the RN to BSN
track is similar to the nationwide trend; more than 63.2% of 633 RN to BSN programs are
offered at least partially online (AACN, 2011a). This learning format gives RN to BSN students
greater exposure to computer use and applications than students in traditional classroom settings.
When SANICS subscale scores were considered, RN to BSN and Traditional PreLicensure students differed significantly in three subscales: “Applied computer skills,” “Clinical
informatics role,” and “Clinical informatics attitude.” For all three subscales, RN to BSN
students perceived themselves more competent than the Traditional Pre-Licensure students. As
discussed above, these findings may reflect students’ previous clinical nursing experience and
the online learning format of their track. Further studies are needed to explore the differences in
competencies for students in these three tracks.
Future research is suggested to identify factors affecting competency (i.e., age, gender,
nursing work experience, basic computer skills, or formal informatics education. etc.) in students
in three undergraduate tracks. Identifying the predictors of informatics competency will help
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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develop appropriate strategies to prepare informatics competent graduates and further yield
valuable insight for informatics curriculum development (Hwang & Park, 2011).
Limitations
This study had several limitations. First, an inherent limitation of any study in which the
participants were volunteers and the response rate was low (46.3%), increasing the potential for
non-response bias. Combined with convenience sampling, there is a potential for selection bias,
which may threaten internal validity of the study. Second, the study generalizability was limited
because participants were recruited from one northeastern university. Third, informatics
competencies were measured by self-report, rather than actual informatics knowledge and skills.
Thus, students’ actual informatics competencies might be lower due to over-reporting, as
previously shown (Elder & Koehn, 2009). Further studies are suggested on informatics
knowledge and skills, with direct measures of informatics competencies. Lastly, the sample
distribution by programs is similar, but more Accelerated BSN students participated in this study
compared to the AACN Enrollment data (AACN, 2011c) (16.0% vs. 5.3%). This may limit
sample representativeness.
Conclusion
Establishing a baseline of informatics competencies in undergraduate nursing students is
vital to planning informatics curricula and adequately preparing students to promote safe,
evidence-based nursing care (Hebda & Calderone, 2010). The findings of this study indicate that
RN to BSN and Accelerated BSN students were competent in informatics, but not Traditional
Pre-Licensure students. Comparison of students in the three tracks reveal that RN to BSN and
Traditional Pre-Licensure students differed significantly in overall informatics competency,
which may reflect students’ experience in clinical nursing practice and the online learning format
of each track. Students in all three tracks perceived that they were competent in “Basic computer
knowledge” and “Clinical informatics attitude,” but not in “Applied computer skills” and
“Clinical informatics role.” These findings on specific areas of informatics competency indicate
topics for nurse educators to consider when designing an informatics curriculum.
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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References
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registered nurses: RN to master's degree and RN to baccalaureate programs. Retrieved
from http://www.aacn.nche.edu/media-relations/DegreeComp.pdf
American Association of Colleges of Nursing. (2011a). Accelerated baccalaureate and master’s
degrees in nursing. Retrieved from http://www.aacn.nche.edu/mediarelations/AccelProgsGlance.pdf
American Association of Colleges of Nursing. (2011c). The future of higher education in nursing
American Association of Colleges of Nursing 2010 Annual Report. Retrieved from
http://www.aacn.nche.edu/publications/annual-reports/AR2010.pdf
Cole, I., & Kelsey, A. (2004). Computer and information literacy in post-qualifying education.
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Gassert, C. A., & McDowell, D. (1995). Evaluating graduate and undergraduate nursing students'
computer skills to determine the need to continue teaching computer literacy.
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Gassert, C. A. (2008). Technology and informatics competencies. Nursing Clinics of North
America, 43(4), 507-521.
Hwang, J. I., & Park, H. A. (2011). Factors associated with nurses' informatics competency.
Computers, Informatics, Nursing, 29(4), 256-262.
Hebda, T., & Calderone, T. (2010). What nurse educators need to know about the TIGER
initiative. Nurse Educator, 35(2), 56-60.
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Maag, M. (2006). Nursing students' attitudes toward technology: A national study. Nurse
Educator, 31(3), 112-118.
McCannon, M., & O'Neal, P. (2003). Results of a national survey indicating information
technology skills needed by nurses at time of entry into the work force. Journal of
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McDowell, D., & Ma, X. (2007). Computer literacy in baccalaureate nursing students during the
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McNeil, B., Elfrink, V., Bickford, C., Pierce, S., Beyea, S., Averill, C., et al. (2003). Nursing
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Staggers, N., & Gassert, C. (2000). Competencies for nursing informatics. In B. Carty (Ed.),
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Staggers, N., Gassert, C. A., & Curran, C. (2001). Informatics competencies for nurses at four
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146, 546-550.
Table 1. Characteristics of Study Sample
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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Undergraduate Program
Variables
Gender
Traditional
RN-BSN
Second BSN
N
%
N
%
N
%
Female
74
96.1
30
93.8
21
100
Male
3
3.9
2
6.2
0
0
Race/Ethnicity
Asian/Pacific Islander
6
7.7
4
12.5
1
4.8
Black, not Hispanic
2
2.6
1
3.1
0
0
Hispanic/Latino
2
2.6
1
3.1
1
4.8
White, not Hispanic
65
83.3
23
71.9
18
85.6
Other
3
3.8
3
9.4
1
4.8
Age
20-29
78
100
16
50.0
13
61.9
30-39
0
0
3
9.4
4
19.0
40-49
0
0
11
34.4
4
19.0
50 or older
0
0
2
6.3
0
0
Years of working in nursing
Less than 2 years
73
93.6
4
12.4
16
76.2
2- 5 years
4
5.1
8
25.0
1
4.8
5-10 years
1
1.3
14
43.8
2
9.5
More than 10 years
0
0
6
18.8
2
9.5
Frequency of Computer Use
Several times/day
77
98.7
27
84.4
21
100
Once/day
1
1.3
1
3.1
0
0
Several time/week
0
0
3
9.4
0
0
Several times/month
0
0
1
3.1
0
0
Length of computer use
In the last six months
7
9.0
2
6.2
1
4.8
In the past two years
2
2.6
0
0
0
0
More than 2 years
69
88.5
30
93.8
20
95.2
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
16
Table 2. Summary of Competency Scores by Baccalaureate Track
SANICS subscale
Undergraduate Baccalaureate Track
Traditional
RN to BSN
Accelerated BSN
ANOVA*
mean
SD
mean
SD
mean
SD
F
p
Total Scale (30 items, α=.95)
2.82
.55
3.21
.87
3.01
.68
4.31
.02
Basic computer knowledge and skills
3.32
.61
3.39
.91
3.36
.79
.09
.91
1.68
.73
2.58
1.08
1.93
.81
10.04
<.001
1.80
.61
2.89
.95
2.22
.79
18.73
<.001
3.31
.79
4.09
.99
3.71
.77
7.02
<.001
2.69
1.21
3.38
1.41
3.09
1.39
2.60
.08
(15 items, α=.93)
Applied computer skills (4 items,
α=.90)
Clinical informatics role (5 items,
α=.91)
Clinical informatics attitude (4 items,
α=.89)
Wireless device skills (2 items, α=.89)
*Comparison of Traditional Pre-Licensure vs. RN to BSN vs. Accelerated BSN
α = Cronbach’s alpha
COMPARATIVE ASSESSMENT OF INFORMATICS COMPETENCIES
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Author Bio:
Jeungok Choi, PhD, MPH, RN is an Assistant Professor at the University of Massachusetts, Amherst, School of Nursing. She had
postdoctoral research training in Nursing and Biomedical Informatics at Columbia University School of Nursing sponsored by
Reducing Health Disparities through Informatics Research Training Program (NINR T32). Her research focuses on web-based,
pictograph-enhanced healthcare instructions for older adults with low literacy skills. She has completed several pilot studies for
immigrant women and older adults with hip replacement surgery funded by Susan G. Komen for the Cure Massachusetts and Healey
Endowment Grant University of Massachusetts, and is currently conducting two pilot projects which develop Web-based instructions
for low literate older adults funded by American Nurses Foundation Association of Rehabilitation Nurses, and Sigma Theta Tau
International, Inc. She currently teaches core DNP courses: Informatics for Nursing Practice, Intermediate Biostatistics, and Research
Methodology in Nursing.