This post is written by Reena Antony Samy who is a Practice Development Nurse and nurse educator who recently completed the module EDM122. Her essay is licensed under CC-BY NC SA and she writes about digital literacy in critical care:
The use of Digital Health Technologies in the healthcare sector is rapidly increasing, and the expectation is to keep up the pace, adapt and maintain a high level of Digital Literacy. Technology was thought to be more confined to technically proficient people in the past. However, now everyone must have sufficient digital literacy to perform their jobs. Moreover, since the Covid 19 pandemic, technology-enhanced learning has become integral to teaching and learning.
I work as a Practice Development Nurse (PDN) / Nurse Educator at Adult Critical Care Unit, teaching the novice staff appointed to the critical care unit. Working in the Critical Care Unit for more than 15 years, I have come across many changes both in nursing education and the clinical care aspect, the most important one being Digitalisation. Replacing paper-based documentation with the Electronic Health Record Service (EHRS) is a significant transformation to the healthcare system. As a result, nurses are expected to be digitally proficient in using Information Systems and Digital Technology. Part of my job is to ensure the Electronic Health Record Service is safely implemented in the unit by ensuring that the nurses are confident and competent in using the new system. Health Education England (HEE, 2018) emphasises that every healthcare professional should have sound digital capabilities grounded in knowledge, skills, attitudes, and behaviours that will enable them to provide the utmost effective and high standard of compassionate care.
Digital Capabilities and Digital Literacies.
HEE (2018) proposed a Digital capability framework. However, there needed to be more clarity between Digital Capabilities and Digital Literacy. Secker J (2017) says that Digital Literacy is sometimes called Digital Capabilities. The author further argues that the term capabilities may result partly in acknowledging the problem related to digital literacy. HEE (2018) defines Digital Literacies are capabilities that fit someone for living, learning, working, participating, and thriving in a digital society. As technology evolves, the health and social care workforce should aim to be fully competent, confident, and capable of using the technology so that technology related incidents can be prevented.
Implementation of the EHRS faced many challenges in the unit. The main barrier whilst implementing the EHRS was the human factor. Staff’s behaviours and attitudes around digital literacy posed a significant challenge in implementing this project. Lack of confidence, the fear of using the technology and unwillingness to learn can prevent or slow the technology’s pace. The staff’s current digital literacy level impacted the staff engagement in adapting to the new system. The confident and proficient staff in social and digital media embraced this change much more quicker and easier. HEE (2018) states that staff with better digital literacy tend to have more positive attitudes and behaviours in adopting new technology. Moreover, the attitude of the staff towards changes also has an impact on the staff engagement levels, which in turn can affect the safety and quality of patient care (Kuek and Hakkennes, 2020). HEE (2018) declares that organisational policy can sometimes create barriers. Like the employer’s unwillingness to use personal phones and learning devices in the workplace. Sometimes Wi-Fi and appropriate internet speed within the organisation may hinder access to digital facilities. For example, though the unit agreed for staff to use their devices, the speed of the internet posed a significant challenge, which affected the staff’s learning experience in adopting the new system.
Healthcare is said to be traditionally slow in adopting new digital tools and technologies, with some staff feeling nervous and sceptical about the digital revolution (Pearce, 2017) and sometimes due to technical factors in the organisation. It is essential to develop and improve the digital literacies of an individual and the organisation to transform how healthcare professional’s practise.
Role of the nurse educator in digital literacy
The nurses must use technology effectively in the clinical setting to provide a high standard of patient care and decrease clinical errors. With the growing need for nurses to develop these digital skills, it is imperative to embed digital literacy in the nursing curriculum. One of the four aspects of developing digital literacies in practice (JISC, 2014) is ‘Curriculum Change’. The development of digital literacy must start with the pre-registration students. The nursing and Midwifery Council (NMC) have included digital literacy in the 2018 Standards for Pre-Registration Nursing programmes and standards of Proficiency for Registered Nurses. Even though the main challenge is to overcome the financial implications (Peltonen et al ., 2019), Lokmic- Tomkins et al. (2022) emphasise targeted digital literacy education to improve nursing students’ baseline digital literacy before clinical placements. This must be scaffolded across the program to ensure a smooth transition to nursing practice. Even though most nursing curricula worldwide have endeavoured to incorporate the subject, adopting recommended curriculum change has needed to be faster (Cummings et al., 2016).
Further, Kennedy and Yaldren (2017) argue that curriculum modifications do not necessarily reflect the needs of workplace digital literacy. Therefore, in addition to the pre-registration education, continuing professional development and on-site training are needed to build the knowledge further. Brown et al. (2020) state that digitally literate nurses can better embrace and use new technology in various ways in clinical settings. The Adult Critical Care Unit’s staff ranged from brand-new graduates to well-experienced nurses. Though the newly qualified nurses with some digital literacy adopted the changes readily, others have trouble grasping the EHRS technological changes.
-Supporting the staff.
User engagement and training are vital in successfully implementing electronic health record services. It was evident that complex digital skills were necessary for this digitally-driven work environment. It was necessary to know the staff’s digital literacy level and attitude towards new technology to tailor training to the need (Jobst et al., 2020). Paul Gilster (1997), in the use of the term digital literacy, said it is about ‘mastering ideas – not keystrokes’. Being digitally literate is an ongoing process, and becoming more confident and proficient over time. The learning literacies and development framework (JISC, 2014) adapted from Sharpe and Beetham (2010) emphasise the development of digital literacies from access and functional skills to higher-level capabilities and identity.
Though the readiness assessment was carried out to identify the barriers and facilitate the successful adoption of EHRS, an individual’s self-assessment to assess the level of digital literacy should have been performed. Therefore, identifying the staff’s digital literacy level and customising the training according to the need was challenging. However, generalised training was provided for all the staff prior to the introduction of EHRS. As a result, some staff could accept it effortlessly while others had difficulty adapting to the new system.
It is not about introducing a new change to the system; as a nurse educator, my role was to incorporate and facilitate the changes in the best possible way and develop the staff to be more proficient. Familiarisation with the new system beforehand was initialised, which acted as an icebreaker. This enhanced the individual’s willingness, self-efficacy, and positive attitude towards the changes. Those already exposed to technology will be more confident using it than those new to digital technologies (Jobst et al., 2022). Moreover, raising awareness and engaging stakeholders in discussion is essential to develop shared understanding and goals. JISC (2013) gives a key message, ‘Involve Students’, as this will help focus on developing the technology, making the system more usable, and meeting the end user needs.
The most significant factor in achieving digital literacy and effectively implementing the EHRS is to identify digital champions who will support and develop the digital skills of the front-line staff. Digital champions were mainly enthusiastic volunteers willing to take up this role. Pearce, L. (2017) says that healthcare needs staff who are enthusiastic about technology and willing to embrace the changes. Digital champions acted as a bridge, provided feedback information, and enabled two-way conversation.
This project enhanced the digital literacy skills of the nurses. Digital literacy is a multi-layered, dynamic set of knowledge, skills and attitudes which shifts according to individual goals (HEE, 2018) that will enable them to improve the quality of care. Health Education England (2018) categorised digital literacy under the following domains.
- Communication, collaboration and participation.
- Teaching, learning and self-development
- Information data and media literacies.
- Creation, innovation and scholarship
- Technical Proficiency
- Digital identity and well being
Nurses are vital in introducing and implementing technology in clinical practices, such as using patient-related sensors and monitoring equipment. Though these are widely used in the critical care unit, using technology to input patient data is new. The expectation of the staff to use the technology effectively to ensure quality, safety and efficiency in health care services (Gonen et al., 2016). Therefore, technological literacy is crucial in the nursing world. The staff were exposed to a wide range of technologies like wristband scanners and were trained to use and troubleshoot when needed. Nes et al., 2021, emphasise that nurses should learn to use the technology and actively participate in developing it.
Another significant learning curve for the nurses in implementing the EHRS is information and data literacy. The nurses are to input the patient’s data, collate, and analyse the information and formulate a nursing care plan for the patient. Bergren and Maughan (2020) argue that nurses should be able to use computers and information systems and apply data and evidence to inform practice. Though the staff are so used to the paper system, this project paved the way to acquire the knowledge to collect and analyse the data digitally. Furthermore, Li et al. (2022) state that Information literacy is an essential foundation for evidence-based nursing, which is imperative in health and social care to provide the best possible patient outcome.
In addition, implementing the EHRS enabled the nurses to communicate and collaborate with many people using the digital platform. Therefore nurses should also be able to recognise and act on situations that might compromise personal, professional and organisational security. HEE (2018) states that nurses must develop the ability to develop, promote and safeguard appropriate digital identities to support both personal and organisational reputations. Digital identity is one of the aspects nurses should take on as they enter into this digital age.
Moreover, nurse educators must be digitally competent and confident to impart knowledge to learners. The competencies nurse educators must impart to their students are highly significant, and the nurse educator should remain abreast of this new technology. Developing the clinical educator’s digital literacy is equally important so that they can support students more effectively. In implementing this project, the nurse educators were given the ‘Train the Trainer’ (TTT) sessions, so that nurse educators would act as a champion in promoting the new technology. HEE (2018) recommends that digital champions must be able to teach confidently and proficiently, coach, mentor, and train using different technologies.
Commencing on this Digital Literacy and Open Practice module revealed the importance of being digitally literate. It empowered me to implement EHRS in our critical care unit, which enhanced my digital literacy skills. I learnt to use different types of technologies to train the staff. We were constantly participating in online meetings and discussion forums, sharing files, and sometimes working online with others. Though the TTT was thoughtfully arranged, some nurse educators needed more help acquiring the knowledge and skills. Jobst et al. (2022) state that nurse educators must be digitally competent to promote learning among nurses. This project served as a base to scaffold digital literacy not only for the nurses but also for the nurse educators at different levels of digital literacy.
Implementing Electronic Health Record service is a significant aspect of the digital health and social care transformation. The necessity for current and future nurses to be digitally literate is eminent. This essay explored the importance of nurses’ digital literacy in safely caring for patients using different technologies. It also identifies that equally; nurse educators must be competent to embed the knowledge among the nurses. Assessing the digital literacy knowledge among the staff before the training is crucial so the training can be customised to the need. Therefore, a self-assessment tool and a comprehensive digital Literacy training programme for the nurses are highly recommended as the way forward for the safer implementation of EHRS.
Bergren, M.D. and Maughan, E.D. (2020) ‘Data and Information Literacy- A fundamental Nursing Competency’, NASN School Nurse, 35(3), pp: 140.
Brown, J., Pope, N., Bosc,A.M., Mason,J. and Morgan, A. (2020) ‘Issues affecting nurses’ capability to use digital technology at work : An integrative review’, Journal of Clinical Nursing, 29, pp: 2801- 2819.
Cummings, E., Shin, E., Mather, C., and Hovenga, E. (2016) ‘Embedding nursing informatics education into an Australian undergraduate nursing degree’, Studies in Health Technology and Informatics, 225, pp: 329–333.
Developing Digital Literacies (2014) https://www.jisc.ac.uk/guides/developing-digital-literacies
accessed on 07/01/2023
Gilster, P. (1997) Digital Literacy. New York,NY: John Wiley & Sons, Inc.
Gonen,A., Sharon,D., Offir,A. and Lev-Ari, L. (2014) ‘How to enhance nursing students’ intention to use information technology: The first step before integrating it in nursing curriculum’, Computers, Informatics, Nursing, 32 (6), pp. 286-293.
Health Education England (2018) ‘Digital literacy Capability Framework’, https://www.hee.nhs.uk/sites/default/files/documents/Digital%20Literacy%20Capability%20Framework%202018.pdf Accessed on 8/1/2023
Jobst,S., Lindwedel,U., Marx, H., Pazouki, R, Ziegler, S., Konig,P., Kugler, C and Feuchtinger, J. (2022) ‘Competencies and needs of nurse educators and clinical mentors for teaching in the digital age – a multi-institutional, cross-sectional study’ BMC Nursing, 21(1) https://doi.org/10.1186/s12912-22-01018-6 Accessed on 10/01/2023
Kennedy, S., and Yaldren, J. (2017) ‘A look at digital literacy in health and social care’, British Journal of Cardiac Nursing, 12(9), pp. 428–432.
Kuek,A . and Hakkennes, S. (2020), ‘Healthcare staff digital literacy levels and their attitudes towards information systems’ Health Informatics Journal, 26(1), pp: 592-612.
Li,X., Zhang,J., Zheng,Y., Wang,Y and Hao,W. (2022) ‘Factors associated with information literacy of nursing undergraduates in China’, BMC Nursing, 21:81. https://doi.org/10.1186/s12912-022-00855-9 Accessed on 15/01/2023
Nes, A.A.G., Steindal, S.A., Larsen, M.H., Heer, H.C.,Laerum-Onsager, E. and Gjevjon,E.R. (2021) ‘ Technology Literacy in Nursing education’, Journal of professional Nursing, 37(2), pp: 320 -334 https://doi.org/10.1016/j.profnurs.2021.01.008 Accessed on 15/01/2023
NMC (2018) ‘Standards framework for nursing and midwifery education’ https://www.nmc.org.uk/globalassets/sitedocuments/standards-of-proficiency/standards-framework-for-nursing-and-midwifery-education/education-framework.pdf
Accessed on 10/01/2023
Pearce L. (2017), ‘Digital Literacy’, Nursing Standard, 31(48), pp: 18-20.
Peltonen,L.M., Nibber,R., Lewis,A., Block,L., Pruinelli,L., Topaz,M., Perezmitre,E.L. and Ronquillo, C. (2019) ‘Emerging professionals’ observations of opportunities and challenges in nursing informatics’ Nurse Leadership , 32, pp. 8-18.
Secker, J. (2017) ‘The trouble with terminology: Rehabilitating and Rethinking Digital Literacy’. In Reedy, K. & Parker, J. (eds.) Digital Literacy Unpacked. London: Facet Publishing, pp. 3-16.
Sharpe, R. & Beetham, H. (2010) ‘ Understanding students’ uses of technology for learning: Towards creative appropriation’. In Sharpe,R., Beetham,H. and de Freitas,S. (eds.), Rethinking learning for a digital age: how learners shape their experiences. Routledge Falmer, London and New York, pp. 85-99.
This essay is published under common creative licence ‘Attribution- NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0).