Locating and Critically Analyzing Primary Research Articles

Locating and Critically Analyzing Primary Research Articles
JONAVolume 47, Number 4, pp 212-218Copyright B2017 Wolters Kluwer Health, Inc. All rights reserved. THE JOURNAL OF NURSING ADMINISTRATION Nursing Informatics Competency Assessment for the Nurse Leader The Delphi Study Sarah Collins, PhD, RN Po-Yin Yen, PhD, RN Andrew Phillips, PhD, RN Mary K. Kennedy, MS, RN-BC OBJECTIVE: The aim of this study was to identify nursing informatics compete ncies perceived as relevant and required by nurse leaders. BACKGROUND: To participate as a full partner in healthcare leadership among rapidly advancing health information technologies (HITs), nurse leaders must attain knowledge of informatics competencies re- lated to their clinical leadership roles and respon- sibilities. Despite this increased need to engage in HIT-related decision making, a gap remains in vali- dated informatics competencies specific to the needs of nurse leaders. METHODS: An environmental scan and 3-round sur- vey using Delphi methods used with nurse leaders for competency identification were used. RESULTS: Between 26 and 41 participants responded to each Delphi round. Most nurse leaders acquired HIT knowledge through on-the-job training. We identified 74 competencies from an initial list of 108 competencies. CONCLUSION: This work can advance nursing prac- tice to move beyond Bon-the-job informatics training [ to a more competency-based model of nursing infor- matics education and practice. In today _s high-technology environment, leaders in the healthcare field encounter decisions related to health information technology (HIT). The roadmap and recommendations identified by the AMIA Elec- tronic Health Record 2020 Task Force include simpli- fying and speeding up documentation, improving data exchange and interoperability, reducing data entry, focusing on patient outcomes, improving usability and safety, fostering innovation through the use of application programming interfaces and data stan- dards, and promoting integration of electronic health records (EHRs) to include all areas of care. 1The achieve- ment of these recommendations to resolve complex EHR issues that bridge the cli nical, policy, and technical domains will require effective collaboration between vendors, informaticians, and clinical leaders at health- care organizations. To parti cipate as a full partner in these collaborations, clinical leaders must attain knowl- edge of informatics compete ncies related to their clin- ical leadership roles and res ponsibilities. Nurse leaders serve as the voice for more than 3 million nurses, the largest segment of the US healthcare workforce, across hospital, ambulatory, community, home, and long-term-care settings. 2According to the American Organization of Nurse Executives, the roles that rep- resent most nurse leaders are directors (32%), man- agers (26%), and chief nursi ng officers (CNO)/chief nursing executives (CNEs) (17%). 3We believe that similar to the diffusion of evidence-based nursing practice nurse leaders _ability to make informed strategic and operational decisions related to HIT adoption, implementation, and innovation is critical, necessitating the attainment of informatics competencies relevant to their work. 4,5 Despite this increased need to engage in HIT-related decision making, a gap remains in 212 JONA Vol. 47, No. 4 April 2017 Author Affiliations: Senior Clinical and Nurse Informaticist and Instructor in Medicine (Dr Collins) , Partners Healthcare Systems, Brigham and Women _s Hospital, Harvard Medical School, Boston, Massachusetts; Clinical Assistant Professor (Dr Yen), Department ofBiomedical Informatics, The Ohio State University, Columbus;Assistant Professor (Dr Phillips), MGH Institut e of Health Professions, School of Nursing, Massachusetts General Hospital, Partners HealthSystem, Boston; and Informati cs Specialist and Consultant (Ms Kennedy), AEGIS Informatics LLC, Barrington, Rhode Island. The authors declare no conflicts of interest.Correspondence: Dr Collins, Partners Healthcare System, 93 Worcester St, Floor 2, Wellesley, MA 02481 ( [email protected] ). DOI: 10.1097/NNA.0000000000000467 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. validated informatics competencies specific to the needs of nurse leaders and reflective of the rapidly changing information technology (IT) environment. 6,7 Background Clancy 8reported on 28 nursing schools identifying significant nursing informatics deficits in faculty com- petencies and curriculum. These deficits may inhibit nursing_s advancements toward future Real-Time Healthcare System (RTHS) defined as providing 4 rights:Bthe right information, at the right time, in the right formatIto the right audience.[ 9Information life-cycle management is a key technology instrumen- tal to the success of the RTHS and is a fundamental component of nursing informatics. 10 Specifically, the RTHS is a next-generation,transformative model for healthcare operations, management, and information technology in whichBchief information officers (CIOs) should activate an engagement plan with the CNO including these steps: Educate the CNO about the major technology breakthroughs that build the RTHS manage- ment paradigm. Review the evolving land- scape of applications, real-time analytics, and infrastructure. Together, build specificvalue cases that clarify RTHS benefitsVstarting with mature wins, like finding smart pumps, but moving ahead to nurse and patient experience and patient throughput. Emphasize those cases with a positive impact on nurses”daily work lives, patient satisfaction, and quality of care. Seek out innovative nurse managers and key influencers of staff attitude to improve cultural readiness. As part of this readiness, create or re- invent the role of chief nursing informatics officer, whose focus goes well beyond support of the EHR.[ 11(p1) These recommendations, aligned with our team_s recent work on nursing informatics governance struc- tures, are especially noteworthy for nursing practice in that they forecast future competencies for many nurse leader roles and will move well beyond the use of EHRs and management of EHR implementation projects, toward a continued focus on improving the patient experience, as well as the nursing care environment through innovative and applied technologies. 12 In fact, Hessels et al 13 reported evidence linking lower 7-day readmissions and shorter length of stay to advanced EHR adoption, while noting that a supportive nursing environment is independentlyand positively linked to better delivery of nursing care and patient satisfaction, inferring a significant role for informatics competen- cies to appropriately integrate technology into nursing practice. Too often IT decisions are left to others as nursing leaders lack the competencies necessary to actively participate in theIT decision-making process. 6 As technologies rapidly expand and new models of healthcare delivery emerge, a new set of competencies are required by today_s nursing professional and are critical for nursing practice leaders to continue to ad- vance and innovate. To address the gap of a lack of nursing infor- matics competencies for nurse leaders, we conducted a 2-year, multimethod study to define, develop, and validate a nursing informatics competencies self- assessment instrument specific to the needs of nurse leaders to evaluate their levels of nursing informatics competencies and target learning and professional development opportunities. We followed the 8-step scale development process by DeVellis. 14 These steps are summarized in Table 1. For each step, we identi- fied the process step and method(s) utilized: (1) clarify the intended concepts to measure, (2) generate an item pool, (3) determine the format for measurement, and (4) have the initial item pool reviewed by experts, (5) consider inclusion of validated items, (6) administer items to a development sample, (7) evaluate the items Table 1.Eight-Step Scale Development Process and the Corresponding Methodologies Used in Developing the Nursing Informatics Competency AssessmentVNurse Leader Survey Instrument Development Phase Instrument Development Process Steps Method(s) Utilized Competency identification 1. Clarify the intended concepts to measureEnvironmental scan of indexed research databases using key terms to identify initial list of competencies for evaluation 2. Generate an item pool 3. Determine the format for measurement 4. Have the initial item pool reviewed by expertsDelphi study in 3 rounds for content and face validity using a survey instrument and CVI Factor analysis 5. Consider inclusion of validated items Multivoting and survey instrument 6. Administer items to a development sample 7. Evaluate the itemsExploratory factor analysis for scale optimization and factor identification 8. Optimize scale length JONA Vol. 47, No. 4 April 2017213 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. (item performance, factor analysis,!), and (8) opti- mize scale length. We further separated the 8 steps into 2 phases: competency identification (steps 1-4) and factor anal- ysis (steps 5-8). In order to provide details of the process, we published the study into 2 articles. In this article, we summarize the 1st phase of the scale development process: competency identification. Con- currently, we published the 2nd phase of the pro- cess, factor analysis, into a 2nd publication, entitled BNursing Informatics Competency Assessment for the Nurse Leader: Instrument Refinement, Valida- tion, and Psychometric Analysis,[ 15 which details our development of a final validated instrument to mea- sure informatics competencies specific to the Nurse Leader: Nursing Informatics Competency Assessment for the Nurse Leader. The aim of this article is to identify the nursing informatics competencies perceived as relevant and required by today_s nurse leader and/or manager. Methods We conducted an environmental scan to identify existing work related to nurse leaders_informatics competencies to inform development of our survey deployed using the Delphi method for nurse leader competency identification. Environmental Scan We performed an environmental scan during fall 2012, to identify existing work related to nurse leaders_infor- matics competencies (steps 1-3). We searched PubMed and CINAHL for literature with validated competency statements and self-assessment scales and used Google and Google Scholar search engines to find related edu- cational resources and reports. The following search terms were used:Binformatics[and/orBcompetency[ and/orBhealth information technology[and/orBHIT[ and/orBnursing[and/orBself-assessment scale.[ Delphi Survey Method to Establish Content/Face Va l i d i t y In step 4, we aimed to understand the nursing infor- matics competencies perceived as relevant and required by today_s nurse leader and/or manager. We conducted a Delphi survey to seek opinions of nursing leadership about HIT competencies critical for the nurse leader and at the same time establish the content/face validity of the survey instrument. We selected sets of compe- tencies based on results of our environmental scan and closely replicated the methods used by Westra and Delaney. 16 The Delphi survey was developed using REDCap software and included 3 rounds. The survey was distributed using snowball sampling to nurseleaders and managers in the Organization of Nurse Leaders (ONL) (Massachusetts and Rhode Island) via e-mail, leveraging the ONL governance structure (ie, board and committee members) as targeted partic- ipants were also asked to forward the survey within their network of nurse leaders and managers. All study procedures were approved by Partners Healthcare System_s institutional review board. In rounds 1 and 2, we asked participants to vote on each competency as relevant or not relevant, using a binary response, yes or no. The respondents were also able to include comments as free text, such as suggested changes to the phrasing of the competency in an effort to provide unbiased feedback. This also provided a source of qualitative data for further evaluation of results and clarification of included competencies. For the final survey round, a 4-point Likert scale (1 = not relevant, 2 = somewhat relevant, 3 = quite relevant, 4 = very relevant) was used so that a more sophisticated analysis and reduction ofthe competencies could be performed. During rounds 2 and 3, the results from the previous round, including all free-text comments, were anonymized and provided to the participants. A content validity index (CVI) score was calcu- lated to evaluate the ranked relevance of the compe- tencies by participants. 17 The threshold to retain a competency was a CVI greater than 0.80, derived from the Likert scale votes ofBquite important[orBvery important,[and was consistent with the work of Westra and Delaney. 16 We used Kruskal-Wallis anal- ysis of variance to identify differences among groups (ie, different types of organizations and roles). We also evaluated criteria with a borderline CVI threshold of less than 0.80 using qualitative data but did not exclude any items with a CVI of greater than 0.80. Results Environmental Scan In 2002, Staggers et al 18 used the Delphi method to establish the 1st reliable and valid informatics compe- tencies for nurses at 4 levelsof practice (entry level to advanced informatics specialists). Since that research, knowledge related to nursing informatics competen- cies has grown as technology has moved closer to the bedside, and chair side, of clinical practice. We s t r a a n d D e l a n e y 16 defined competencies for nurse and health leaders in 2008 with a focus on infor- matics knowledge and skills. Gassert 19 recognized the potential of clinical informatics to transform clinical practice with the right tools and skills. Also in 2008, Hart 20 performed a review of the literature in an effort to define those competencies that would advance evidence-based practice and the use of HIT. That research revealed a history of research that focused 214JONA Vol. 47, No. 4 April 2017 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. on attitudes and use of e-resources but not necessarily the competencies and skills needed by nurses to work in a technology-rich work environment. Hart 21 later went on to focus on job-specific nurs- ing informatics competencies for nurse managers, noting that this focus was too narrow because infor- matics competencies were not incorporated into spe- cific jobs for nurses. In 2013, Simpson 7emphasized the importance of job-specific nursing informatics competencies required by the CNE and how the lack of key competencies was a barrier to full engagement in HIT decision making. Some of his key findings went on to reveal that their role is often tactical (ie, func- tional) and that the CNE is often in aBrecommender[ role. The study also revealed an informatics compe- tency deficit related to societal and technical trends as they relate to nursing. 7The need for job-specific com- petencies continues to be recognized as a need for the future of nursing. 2Based on these findings, we selected Westra and Delaney_s 16 competencies with those more recently identified by Simpson 7as the initial set of 108 competencies in the item pool for the Delphi survey. Delphi Study to Establish Content/Face Validity The Delphi study was performed to establish content/ face validity of items that would later be used in the development of a validatedself-assessment instru- ment. Three rounds of surveys were conducted: (1) June to July 2013, (2) September to October 2013, and (3) December 2013 to January 2014 (Figure 1). A high-level summary of the sample population and initial findings are available online (http://www.himss.org/ ni-impact-survey; HIMSS 2015 Nursing Informatics Symposium). 22 There were 34 participants in round 1, 26 participants in round 2, and 41 participants in round 3 (Table 2). Most participants were execu- tives, followed by directors and then managers and then those who were holding master_sordoctoral degrees. The largest number of respondents came from community hospitals and then from academic medical centers. When asked about their HIT training, mostrespondents replied that their knowledge came from Bon-the-job[training or self-learning. The Delphi survey began with 108 competency items. The list was reduced to 98 items when 10 items were excluded after round 1 and further reduced to 92 items when 6 additional items were excluded after round 2. During rounds 1 and 2, we rephrased 29 competencies based on feedback from the respon- dents. After the last round, a total of 74 competencies were retained when 18 items were excluded because of having a CVI of less than 0.80 (Figure 1). The 74 retained competencies mapped into 15 broad informatics categories, based on modified Westra and Delaney_s 16 competency categories (Table 3). The top 15 competencies, in detail, were ranked by priority (Table 4). The 1st 2 items received 100% of the votes asBquite[orBvery relevant[: (1) the ability to ensure that nursing values/requirements are represented in HIT selection and evaluation and (2) inclusion of nursing information within HIT systems. The subsequent items focused on collabo- ration, communication, and advocacy. Discussion This initial study identified 74 competencies with a CVI of greater than 0.80 specific to nurse leaders and nurse managers from an initial list of 108 competen- cies. The large number of competencies identified as Bimportant[speaks to the urgent need for informat- ics education and the increasing complexity of the nursing leadership role. We observed a changing emphasis on competencies focused on outcomes, quality, and cost compared with studies conducted in past years 16; these new areas of focus could be attributed to an ever increasing volume of patient data that require new tools for nurse managers to use to effectively evaluate care. Skills in managing large outcomes, quality, and cost data sets are needed to ensure nursing isBat the table[and is able to advocate for nursing-specific needs. The current on-the-job nature of informatics education identified in the survey responses is inadequate to meet this need. Too often, HIT leadership and strategic decisions are based within IT versus at the provider leadership level, although this trend may be changing. 12 Nursing must be in a position to lead and participate in HIT selection, development, and optimization. Our data showed that this need is not limited to large health systems but is consistent across all organization types and nursing leadership roles. There is a clear educational gap around nursing informatics exemplified by the large number of com- petencies identified in ourdata and the majority of on- the-job training noted. A validated self-assessment tool, the next step in our research, will provide nursing with Figure 1. Delphi study: results after each round. JONA Vol. 47, No. 4 April 2017215 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. a means to identify need and then develop appropriate and responsive informatics education. Practice Implications for the Nurse Executive It is clear that nursing informatics and HIT knowl- edge should no longer be delegated to a specialist, but should be an expected core competency of profes- sional practice. This research engaged expert nurse leaders to identify areas of nursing informatics that are important in their practice as leaders. Identifica- tion of these areas can bring greater specificity, in discussion with the information technology commu- nity, about domains that are ripe for development. This work can also provide a foundation for engage- ment plans that are developed and revised to support the healthcare deliverysystemoftomorrow. The competencies identified here have application for the design of residency programs, continuing edu- cation programs, and curriculum development for nurse executives, leaders, and nurse managers. The level of Table 2.Delphi Round Sample Sizes and Demographics Delphi Round SamplesRound 1 Round 2 Round 3 Total n = 34 Total n = 26 Total n = 41 Participant characteristics Highest education level Doctoral 7 (20.6%) 4 (16%) 11 (26.8%) Master 24 (70.6%) 21 (84%) 23 (56.1%) Bachelor 2 (5.9%) 0 (0%) 5 (12.2%) Associate 1 (2.9%) 0 (0%) 2 (4.9%) Years of experience 925 14 (41.2%) 15 (60%) 19 (46.3%) 16-25 11 (32.4%) 4 (16%) 8 (19.5%) 11-15 3 (8.8%) 2 (8%) 8 (19.5%) 6-10 5 (14.7%) 3 (12%) 6 (14.6%) 3-5 1 (2.9%) 1 (4%) 0 (0%) 1-2 0 (0%) 0 (0%) 0 (0%) G1 0 (0%) 0 (0%) 0 (0%) Role Executive 18 (52.9%) 10 (40%) 13 (31.7%) Director 8 (23.5%) 7 (28%) 13 (31.7%) Manager 6 (17.6%) 6 (24%) 11 (26.8%) Staff nurse 0 (0%) 1 (4%) 0 (0%) Researcher 0 (0%) 0 (0%) 1 (2.4%) Other 2 (5.9%) 1 (4%) 4 (9.8%) Self-rated HIT knowledge Above average 13 (39.4%) 11 (44%) 23 (59%) Average 16 (48.5%) 14 (56%) 15 (41%) Below average 4 (12.1%) 0 (0%) 0 (0%) HIT education received Formal education 5 (14.7%) 7 (28%) 12 (29.3%) On-the-job training 33 (97.1%) 22 (88%) 40 (97.6%) Self-learner 16 (47.1%) 11 (44%) 22 (53.7%) Other 0 (0%) 0 (0%) 2 (4.9%) Participants_organization characteristics Type of organizationCommunity Hospital 17 (50%) 10 (40%) 16 (39%) Critical-access hospital 2 (5.9%) 0 (0%) 2 (4.9%) Academic medical center 10 (29.4%) 9 (36%) 11 (26.8%) Integrated delivery network 2 (5.9%) 4 (16%) 4 (9.8%) Academic/university 0 (0%) 1 (4%) 4 (9.8%) Other 3 (8.8%) 2 (8%) 6 (14.6%) MagnetistatusYes 6 (17.6%) 6 (24%) 6 (14.6%) No 28 (82.4%) 19 (76%) 35 (85.4%) Percent for each item may not sum to 100% because of multiselect answer choice options. Total counts for each item may not sum to total sample because of missing responses. Ta b l e 3 .Categories of Competencies Retained in Round 3 Results (CVI90.80) CategoryNo. of Competencies Retained Management concepts 9 Requirements and system selection 9 Ethical/legal concepts 8 Information systems concepts 7 Advanced software applications 6 Executive leadership 5 Financial 5 Implementation/management 5 Patient-related applications 5 Data issues 4 Technical knowledge 4 Collaboration 2 Electronic communications 2 HIT selection 2 Standardization 1 Total 74 216JONA Vol. 47, No. 4 April 2017 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. detail within the description of each competency pro- vides additional opportunities to close education and skill gaps as we look to support ongoing professional education, optimize HIT to improve patient care out- comes, enhance the patient experience, and optimize nursing workflow. In addition to psychometric valida- tion of these competencies, future work should explore opportunities to develop interprofessional programs and partnerships with organizational CIOs to identify and specify nursing requirements for tomorrow_sreal- time healthcare system (ie,value cases) and evaluation of EHR impact on outcomes and patient satisfaction. Limitations Our findings are limited to the experiences of the survey responders who may have a specific interest in infor- matics or an already identified need. To limit bias, we used a comprehensive compilation of existing com- petencies identified from our environmental scan. In addition, no new competencies were identified by res- pondents during the Delphi process. We are unable toreport a response rate because of our snowball sam- pling methodology. Conclusions This research begins to identify the competencies nurse leaders have identified as relevant to their practice in today_s rapidly evolving, technology-rich healthcare delivery system. The nursing profession is quickly moving beyond EHR implementation work as a major focus toward the optimal use of EHR tools and data. We e xpe ct that as information technology continues to mature nursing practice will move beyondBon-the-job infor- matics training[to a more competency-based model of nursing informatics education and practice. This com- petency identification research can serve as a pragmatic foundation to advance nursing informatics practice. Acknowledgments The research team thanks the executive leadership, com- mittees, and membership of ONL (Massachusetts, Rhode Island, New Hampshire, Connecticut) for their support. References 1. Payne TH, Corley S, Cullen TA, et al. Report of the AMIA EHR- 2020 Task Force on the status and future direction of EHRs. J Am Med Inform Assoc. 2015;22(5):1102-1110. 2 . Institute of Medicine.The Future of Nursing: Leading Change, Ad- vancing Health. Washington, DC: The National Academies Press; 2011.3. American Organization of Nurse Executives. AONE Salary and Compensation Study for Nurse Leaders, Executive Summary [Internet]. 2013 [cited December 29, 2015]. p10. http:// wwwaoneorg/resources/nurse-leaders-compensation-summarypdf. Accessed January 20, 2017. Table 4.Top 15 Competency Priority Ranking Final Competencies to Be Retained by PriorityNot Relevant, %Somewhat Relevant, %Quite Relevant, %Ve r y Relevant, % CVI 1. Ability to ensure that nursing values/requirements are represented in HIT selection and evaluation0 0 35 65 1 2. Inclusion of nursing information within HIT system 0 0 22 78 1 3. Budgeting using technology 0 2 39 59 0.98 4. Data-based planning and decision making through the utilization and synthesis of HIT system data0 3 54 44 0.98 5. Ability to collaborate with other departments regarding project management and resource allocation for HIT system implementation0 3 47 50 0.97 6. Ability to collaborate with chief medical officer peers related to HIT and needs of nurses and physicians0 3 37 61 0.98 7. Ability to collaborate with interprofessional team in HIT selection process0 3 38 59 0.97 8. Ability to advocate for the development (or purchase) and use of integrated, cost-effective HIT systems within the organization0 3 35 62 0.97 9. Communicating a system and nursing vision about the benefits of HIT0 3 30 68 0.98 10. Ability to involve frontline staff in the evaluation of HIT systems related to their practice0 3 32 65 0.97 11. Ability to involve frontline staff in the development of HIT system requirements0 3 24 73 0.97 12. Ability to involve frontline staff in appropriate aspects of HIT design, implementation, and testing related to their practice0 3 24 73 0.97 13. Ability to see HIT as a top priority and strategic decision 0 3 31 67 0.98 14. Recognition of value of clinicians_involvement in all appropriate phases of HIT0 5 36 61 0.97 15. Quality assurance using technologyV5 38 58 0.96 JONA Vol. 47, No. 4 April 2017217 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. 4. Crow G. Diffusion of innovation: the leaders_role in creating the organizational context for evidence-based practice.Nurs Adm Q. 2006;30(3):236-242. 5. Shirey MR. Evidence-based practice: how nurse leaders can facilitate innovation.Nurs Adm Q. 2006;30(3):252-265. 6. Remus S. Advancing the digital health discourse for nurse leaders.Stud Health Technol Inform. 2016;225:412-416. 7. Simpson RL. Chief nurse executives need contemporary informatics competencies.Nurs Econ. 2013;31(6):277-287; quiz 288. 8. Clancy T.Integrating AACN Essentials, QSEN KSAs, and TIGER Competencies for Nursing Informatics.Orlando,FL: National Nursing Informatics Deep Dive Program; 2015. 9. KHare S. Gartner Symposium/ITxpo 2014: Key Tenets of a Real- Time Healthcare System (RTHS) [Internet]. MicroPact.com. 2014 [cited June 18, 2016]. http://www.micropact.com/blog/ detail/key-tenets-of-a-real-time-healthcare-system-rths/. Accessed January 20, 2017. 10. American Nurses Association.Nursing Informatics: Scope and Standards of Practice. 2nd ed. Silver Spring, MD: nursesbooks. org; 2015. 11. Shaffer V, Runyon B. Healthcare Provider CIOs Must Boost CNO Collaboration to Materialize the Real-Time Health System [Internet].Gartner, Inc. 2016. https://www.gartner.com/ doc/3241419/healthcare-provider-cios-boost-cno. Accessed January 20, 2017. 12. Collins SA, Alexander D, Moss J. Nursing domain of CI governance: recommendations for health IT adoption and optimization.JAmMedInformAssoc. 2015;22(3):697-706. 13. Hessels A, Flynn L, Cimiotti J, Bakken S, Gershon R. Im- pact of Heath Information Technology on the Quality of Patient Care [Internet].Online Journal Nursing Informatics. 2015;19 [cited May 5, 2016]. http://www.himss.org/impact-heath-information-technology-quality-patient-care. Accessed January 20, 2017. 14. DeVellis RF.Scale Development: Theory and Applications. Thousand Oaks, CA: Sage Publications; 2011. 15. Yen P, Phillips A, Kennedy M, Collins S. Nursing Informatics Competency Assessment for the Nurse Leader: Instrument Refinement, Validation, and Psychometric Analysis.J Nurs Adm. 2017, in press. 16. Westra BL, Delaney CW. Informatics competencies for nurs- ing and healthcare leaders. In:AMIA Annual Symposium Pro- ceedings of the American Medical Informatics Association Annual Fall Symposium, 8Y12 November 2008. Washington DC; 2008: 804-808. 17. Polit DF, Beck CT. The content validity index: are you sure you know what_s being reported? Critique and recommendations. ResNursHealth. 2006;29(5):489-497. 18. Staggers N, Gassert CA, Curran C. A Delphi study to deter- mine informatics competencies for nurses at four levels of practice.Nurs Res. 2002;51(6):383-390. 19. Gassert CA. Technology and informatics competencies.Nurs Clin North Am. 2008;43(4):507-521. 20. Hart MD. Informatics competency and development within the US nursing population workforce: a systematic literature review.Comput Inform Nurs. 2008;26(6):320-329. 21. Hart MD. A Delphi study to determine baseline informatics competencies for nurse managers.Comput Inform Nurs. 2010; 28(6):364-370. 22. Collins S, Kennedy M, Phillips A, Yen P. Nursing informat- ics competencies for nurse leaders/managers: a Delphi study. HIMSS 2015 Nursing Informatics Symposium. Chicago, IL: Healthcare Information and Management Systems Society (HIMSS); 2015:1. http://s3.amazonaws.com/rdcms-himss/files/ production/public/2015Conference/handouts/PSNI13.pdf. Accessed March 4, 2017. 218JONA Vol. 47, No. 4 April 2017 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Locating and Critically Analyzing Primary Research Articles
Nursing Informatics fudy Murphy The Nursing Informatics Workforce: Who Are They and What Do They Do? EXECUTIVE SUMMARY Nursing informatics has evolved into an integral part of health care delivery and a differentiating factor in the selection, implementation, and evaluation of health IT that supports safe, high-quality, patient-centric care. New nursing informatics workforce data reveal changing dynamics in clinical experience, job responsibilities, applications, barriers to success, information, and com- pensation and benefits. In addition to the more traditional informatics nurse role, a new position has begun to emerge in the health care C-suite with the introduction of the chief nursing infor- matics officer (CNIO). The CNIO is the senior informatics nurse guiding the implementation and optimization of HIT systems for an organization. With their fused clinical and informatics background, informatics nurses and CNIOs are uniquely positioned to help with “meaningful use” initiatives which are so impor- tant to changing the face of health care in the United States. T Judy Murphy I o MARK MY FIRST anniversary las a Nursing Economics columnist, I would like to revisit the nursing infor- matics (NI) workforce, since so much has happened in the last year related to health information technology and the implementa- tion of elecfronic health records. In my inaugural column, I de- scribed NI as a well-established specialty within nursing, provid- ed background on the birth and evolution of NI, and explored the NI scope of practice and certification (Murphy, 2010). But I did not elaborate on the unpar- alleled potential of NI and the NI workforce as we move into the era of practice transformation enabled by health information technology (HIT). There is no question nursing informatics has evolved into an inte- gral part of health care delivery and a differentiating fUDY MURPHY RN, EACMI, FHIMSS. is Vice President- Information Services, Aurora Health Care, Milwaukee, WI; a HIMSS Board Member; Co-Chair of the Alliance for Nursing informatics; a member of the federal HIT Standards Committee; and is a Nursing Economics Editorial Board Member. Comments and suggestions can be sent to [email protected] factor in the selection, implementation, and evalua- tion of health IT that supports safe, high-quality, patient-centric care. So, let’s explore the why’s and how’s of that statement, and take a closer look at the NI profession’s reality and potential in this age of meaningful use. First, we will look at the NI workforce as a whole by examining select results from the Healthcare Information and Management Systems Society 2011 Nursing Informatics Workforce Survey (HIMSS, 2011). In this survey, data were collected to gain a bet- ter understanding of the background of informatics nurses, the issues they address daily, and the tools they use in their jobs. Data from the 2011 survey were also compared to similar surveys done previously (HIMSS, 2004; HIMSS, 2007), in order to gain insights into how the NI profession and roles have changed over the years. Next we will examine the up-and-coming role of the chief nursing informatics officer (CNIQ) and look at how this function augments the informatics nurse and the chief nursing officer (CNÜ)/chief nursing executive (CNE) position, and adds benefit to the organization. Finally, we will discuss how the nurs- ing informatics workforce is uniquely positioned to help with the federal incentives for clinician adoption of electronic health records spelled out in the American Recovery and Reinvestment Act and its Health Information Technology Act component. HIMSS 2011 Nursing Informatics Workforce Survey Participation in the survey was solicited using NI organizations’ email distribution lists, with a total of 660 usable responses obtained. Data collection was completed in December 2010 and January 2011 using a web-based survey. The results showed the following primary workplaces: about half at hospitals, 20% at health care systems’ corporate offices, 9% in academ- ic settings, 5% in consulting firms or vendors, and the remaining working at a variety of organizations, including ambulatory facilities, home health agen- cies, managed care/insurance companies, or govern- ment/military facilities. Survey results regarding edu- cation background of informatics nurses indicated 56% held post-graduate degrees (35% with a master’s degree in nursing, 1% with a PhD in nursing, 24% with a master’s degree in a field other than nursing, and 3% with a PhD in a field other than nursing). Nineteen percent of the respondents held nursing informatics certification from the American Nurses Credentialing Center. NURSING ECONOMIC$/May-June 2011A/ol. 29/No. 3 Glinical experience. As for clinical experience, 46% spent at least 16 years at the bedside prior to becoming an informatics nurse, 20% had 11-15 years of clinical experience, and the remaining 34% had 10 years of experience or less. In terms of tenure in the NI role, 26% had been in the role more than 5 years, 30% for 3-5 years, and 44% for 2 years or less. These survey demographics are actually quite interesting, as they parallel the overall demographics of the profes- sion fairly well, and provide an insight into this nurs- ing specialty. Reporting structure. The reporting structure for informatics nurses includes: 42% report within the information technology department, 32% report to nursing, 22% report to administration, and the remaining 4% report to varying small departments. Sixty-one percent of the respondents reported no direct reports, 9% mentioned one to two individuals reported to them, 16% indicated three to five individ- uals reported to them, and the remaining 14% men- tioned 11 or more people reported to them, fob responsibilities. As in 2004 and 2007, the 2011 respondents identified systems implementation (57%) and systems development (53%) activities as their top two job responsibilities. Implementation includes activities such as preparing users, training, and providing support. System development includes customizing and/or updating a vendor system or developing and/or updating an in-house system. Quality initiatives, which include system evalua- tions/problem solving and quality improvement/ patient safety, were the third most mentioned job responsibilities (31%). Quality initiatives are men- tioned in the top three for the first time since the tri- ennial survey was initiated in 2004. Applications. Respondents identified the types of systems for which they were presently participating in the development or implementation process. Nursing/clinical documentation was selected by 77% of respondents in 2011 (unchanged from 2007). The next highest applications selected were electronic health records (62%), computerized practitioner order entry (60%), and clinical information systems (58%). This illustrates a shift in the focus of informat- ics nurses, as electronic health records were not in the top four systems in either of the previous surveys. Clinical information systems slipped to the fourth spot, which represents a departure from previous sur- veys where clinical information systems was the highest mentioned application. Barriers to success. The past 3 years have result- ed in a change in the largest barrier to the success of informatics nurses. Financial resources are no longer the most identified barrier to success as mentioned in the 2004 and 2007 surveys. This year lack of integra- tion/interoperability was mentioned most frequently as the top or secondary barrier, and financial resources dropped to the second highest barrier. Respondents were least likely to identify HIPAA reg- ulations as a barrier. Information. Over the course of all three surveys, websites and the Internet were the resources most valu- able for carrying out day-to-day job activities. While list servs were among the next highest mentions in 2004 and 2007, in 2011, networking became the second highest mentioned source for day-to-day job activities. As for continuing education credit sources, distance learning (e.g., audio conferences or webinars) was rated the highest, while national conferences were consid- ered the top selection for continuing education. Gompensation and benefits. The average salary of 2011 respondents is $98,702, compared to $83,675 in 2007 and $69,500 in the 2004 surveys, demonstrating the increasing maturity and value of the specialty. The average salaries reported in 2011 are almost 16% higher than in 2007 and 42% higher than in 2004, Gonclusion. The health care industry is increas- ingly recognizing the value of nursing informatics. One metric in particular speaks to the importance of informatics nurses in the health care industry — base salary. The level of base compensation this year is sig- nificantly more than in the past two surveys, with an average salary of nearly $100,000 (and even higher in consulting and in vendor settings). This is impressive considering the current economic landscape. Future surveys will determine whether the base compensa- tion ceiling has been reached. Another important finding is the statistically significant increase of post graduates (those with master’s degrees and/or PhDs) in the specialty in 2011, marking a positive trend that the NI profession continues to attract from a highly qualified and formally educated demographic. Finally, it’s worth noting the 2011 respondents tend- ed to have less clinical experience than their 2007 and 2004 counterparts, but they have more experi- ence as nurse informaticists. About two in five nurse informaticists in the 2011 survey have been in this position for 10 years or more, compared to only one- third in 2007 and one-quarter in 2004. The Evolving Role of the CNIO In addition to the more traditional informatics nurse role, a new position has begun to emerge in the health care C-suite with the introduction of the chief nursing informatics officer. The CNIO is the senior informatics nurse guiding the implementation and optimization of HIT systems for an organization. The word “nurse” in the acronym does not necessarily mean nursing is the only discipline for which they are responsible; but rather the position is typically filled by a nurse who has experience and education in informatics. Organizations have just begun to use this title over the last few years, so other titles are also still used to describe the most senior nursing position in HIT, such as vice president of nursing informatics and vice president of clinical integration. NURSING ECONOMIC$/May-June 2011/Vol. 29/No. 3 The key job responsibilities for this senior-level position capitalize on their nursing informatics knowledge and skills to be both a strategic and a tac- tical/operational leader. Examples of the GNIO strate- gic role include activities such as guiding an electron- ic health record (EHR) system selection process, defining an HIT governance process, engaging senior executives in the culture and practice changes required when an EHR is being implemented, advis- ing on the sequencing for EHR module implementa- tions, consulting on the methodology for implementa- tion (big bang vs. incrementally phased), and assisting in identifying appropriate value proposition and key performance indicators for an HIT implementation. GNIO tactical/operational leadership examples include providing oversight of system design and implementation, creating implementation and key performance indicator score cards, determining an enhancement request system and the corresponding prioritization process, and staffing ongoing process improvement initiatives. Inherent in both the strate- gic and tactical/operational components is the GNIO role as educator — the ability to explain what is pos- sible with deployment of health technology, and how the interplay with people and process changes must be considered to realize the full benefits of implemen- tation. Gritical to the success of the GNIO is the relation- ship with three key stakeholders in the organization: the GNO or GNE, the GIO, and the chief medical infor- matics officer (GMIO). The GNIO usually reports either to the GNO/GNE or the GIO with a dotted line to the other. Either structure appears to be effective. Another important linkage is the matrix relationship to the GMIO. Being a member of both the IT and nurs- ing leadership teams invariably leads to some period- ic challenges, but maintaining relationships among these key leaders is essential. The GNIO provides a number of benefits to an organization. At a strategic level and permeating throughout the organization, she/he serves as a strong advocate for the adoption of HIT. The GNIO under- stands the importance of heavy clinical involvement in all aspects of HIT implementation and subsequent workflow optimization and clinical transformation. She/he can champion the redesign of clinical work- flow and processes essential for the adoption of new technology. She/he knows the link between technolo- gy and outcomes, and can ensure performance meas- urement of both clinical and financial outcomes. Finally, from an operational standpoint, the GNIO can help “rally the troops” for clinical involvement in all aspects of the HIT system lifecycle. The Age of Meaningful Use It is hard to pick up a health care magazine or attend a health care conference today without hearing about “meaningful use” and the federal incentives for clinician adoption of electronic health records with the passage of the American Recovery and Reinvestment Act and its key Health Information Technology Act in early 2009. Many health care organizations are scrambling to select, implement, enhance, or measure the care impact of EHRs to achieve the “meaningful use” criteria and qualify for Genters for Medicare & Medicaid Services incentive payments. Having a qualified workforce to facilitate these tasks will be essential to accomplishing them. This is where our nursing informatics workforce has an impact. With their fused clinical and informatics background, informatics nurses and GNIOs are uniquely positioned to help with these initiatives which are so important to changing the face of health care in the United States. At the core of the new reform initiatives, the incentivized adoption of EHRs will improve care quality and better manage care costs, meeting clinical and business needs by capturing, storing, and dis- playing clinical information when and where it is needed to improve individual patient care and to pro- vide aggregated, cross-patient data analysis. EHRs will manage health care data and information in ways that are patient centered and information rich. Improved information access and availability will increasingly enable both the provider and the patient to better manage each patient’s health by using capa- bilities provided by enhanced clinical decision sup- port and customized education materials. Dr. David Blumenthal, former national coordina- tor for health information technology, summed it up when he said, “I believe that when we look back on the road we traveled, the year 2011 will stand out not merely as one more milestone, but as the time when medical care entered a new era — the age of meaning- ful use of health information…We have indeed entered the age of meaningful use — a time of action and transition, a time of opportunity and challenge, and hopefully a time for keeping our eye on the ball. Success is not guaranteed. Hard and focused work has brought us this far, and more of the same lies ahead” (Blumenthal, 2011). More than a decade ago, the Institute of Medicine’s (2001) landmark report stated: “Between the health care we have and the care we could have lies not just a gap, but a chasm.” HIT has long been seen as a fundamental enabler for closing that chasm and delivering the care we should have. This is our time to use our nursing expertise and our nursing informatics knowledge to ensure that statement becomes a reality. $ references continued on page 153 NURSING ECONOMIC$/May-June 2011A/ol. 29/No. 3 Letter to the Editor Thriving on Innovative Technology To the Editor: We are nursing students at Curry College in Milton, MA. We applaud Judy Murphy’s wonderful article, “Nursing and Technology: A Love/Hate Relationship,” published in the November/December (2010) issue of Nursing Economics. It is worth men- tioning Ms, Murphy’s belief that nurses should lead the charge in using technology when it comes to implementing information technology in clinical practice. Thus, turning nursing and technology from a “love/hate relationship” into a “true marriage” is important in nursing practice. As nursing students, we have worked in a variety of health care settings with the majority using health information technology (HIT) such as electronic med- ication administration records and quality improve- ment methods such as Transforming Care at the Bedside (TCAB). Although TCAB is a quality improvement initiative, having HIT systems in place contributed to achieving improved, safe, reliable, and quality care of patients. We will be completing our clinical rotation on a medical-surgical unit that has implemented the TCAB initiative. Using HIT systems and a quality improvement initiative in our clinical experience has not hindered our workflow process, time management, and quality of patient care; rather it streamlines the nursing care process. For example, scanning a patient’s identification band along with each individual medication at the bedside may be time consuming, especially when a patient takes more than a dozen medications at once. However, we see it as simply allowing us to spend more time with our patients. While Ms. Murphy emphasizes the importance of nursing and technology being in harmony, we would also like to emphasize that the Institute of Medicine’s report “The Future of Nursing: Leading Change, Advancing Health” without any doubt expects HIT to lead the change and advance our health care prac- tices. According to Skiba (2010), nurses are “expected to use a variety of technological tools and complex information management systems that require skills in analysis and synthesis to improve the quality and effectiveness of care.” Skiba (2010) further states “if we are truly at the crossroads of transforming health care, nurses must have the knowledge and skills to use disruptive innovations to facilitate and encourage new methods to deliver health care.” Introduction of any new innovation to practice can be cumbersome to the flow of health care. Since nurses are at the front- line of patient care, we have the ability to lead this charge in using information technology to facilitate improving health care delivery. Our generation of undergraduate nursing stu- dents currently thrives on innovative technology, such as use of laptops, iPads, and smartphones. New nursing graduates must embrace this synergy – nurs- ing and information technology. Charlene Fay Lozel S. Greenwood Dedham, MA REFERENCES Murphy, J. (2010). Nursing and technology: A love/hate relation- ship. Nursing Economics, 28{6], 405-408, Skiba, D.J. (2010). Emerging technology: The future of nursing and the informatics agenda. Nursing Education Perspectives, ,33(6), 390-391. Enhancing Nursing as a Career continued from page 144 Roe, A. (1956). The psychology of occupations. New York: Wiley. Sharf, R.S. (2006). Applying career development theory to counseling (4th ed.). Canada: Thomson Corporation. Staiger, D,O., Auerbach, D,I., & Buerhaus, P,I. (2000), Expanding career opportunities for women and the declining interest in nursing as a career. Nursing Economics, 30(5), 230-236, Super, D.E., Crites, J.O., Hummel, R.C., Moser, H,P,, Overstreet, P,L,, & Wamath, C.F. (1957). Vocational development: A framework for research. New York: Teachers College, Columbia University, TYacey, T.J. (2002). Development of interests and competency beliefs: A 1-year longitudinal study of fifth-to eighth-grade students using the ICA-R and structural equation model. Journal of Counseling Psychology, 49(2], 148-163. Tïacey, T.J., & Ward, C.C. (1998). The structure of children’s interests and competence perceptions. Journal of Counseling Psychology, 45(3), 290-303, Watson, J. (1985). Nursing: The philosophy and science of caring, Niwot, CO: University Press of Colorado. Wilson, C,S., & Mitchell, B,S, (1999). Nursing 2000: Collaboration to promote careers in registered nursing. Nursing Outlook, 47[2], 56-61. Nursing Informatics continued from page 152 Blumenthal, D. (2011). The age of meaningful use. Retrieved from http://healthit.hhs.gov/portal/server.pt?open=512&mode=2 &objID=3541 HIMSS Nursing Informatics Workforce Survey. (2011). Healthcare Information and Management Systems Society. Retrieved from http://www.himss.org/content/files/201 lHIMSSNurs ingnformaticsWorkforceSurvey.pdf HIMSS Nursing Informatics Survey. (2007). Healthcare Information and Management Systems Society. Retrieved from http://www.himss.org/content/files/surveyresults/ 2007NursingInformatics.pdf HIMSS Nursing Informatics Survey. (2004). Healthcare Information and Management Systems Society. Retrieved from http://www.himss.org/content/files/nursing_info_sur- vey2004.pdf Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: Author, Murphy, ). (2010). Nursing informatics: The intersection of nursing, computer, and information sciences. Nursing Economics, 28[3], 204-207. NURSING ECONOMIC$/May-June 2011A/ol. 29/No. 3 Copyright of Nursing Economic$ is the property of Jannetti Publications, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use.
Locating and Critically Analyzing Primary Research Articles
© 2014 Laureate Education, Inc. Page 1 of 7 Common APA Style and Formatting Challenges The following guidelines are followed by most faculty members on most Walden coursework, theses, and dissertations. Occasionally, Walden faculty will ask for slight variations on these rules. 1. Font : Use a 12 -poin t serif font, such as Garamond, Times Roman, Palatino, or Century Schoolbook . Tit les, headings, and table titles and copy should also appear in the same 12 -point type. 2. Spacing : Double -space all of your work , per guidelines in the 6 th edition of the APA s tyle manual . Per APA, you should insert two space s after a sentence ending period, although many Walden members allow a single space after a period. 3. Margins and page numbers: All margins should be 1 ” from the edge of the paper. Page numbers go in the uppe r right corner, 1 ” down and 1 ” in from the edge of the paper. The first line of text should start 1.5 ” down. ( Note: MS Word defaults the first line of text at 1 ”.) 4. Italics : Use italic s, not underlines. The APA manual offers guidance on the use of italics in Chapter 4. 5. Punctuation: The APA nuance most commonly missed by students follows: In a series of three or more nouns or noun phrases, you must insert a comma before the word and or or , as in the following examples: bacon, lettuce, and tomato; Tom, Dic k, or Harry; eating lunch, going to the gym, and heading home. Use a semicolon to combine two independent clauses or to separate elements of a list that contains a comma, as in the past example. Add an apostrophe + s for possessives of names: Smith ’s; Jo nes ’s. 6. Capitalization and spelling: Job titles are not capitalized unless immediately preceding a person ’s name: the superintendent, but Superintendent Williams; the president of the school board; Vice President Agnew. Use a lowercase letter after a colo n unless you ’re introducing a complete sentence. In general, words with prefixes are not hyphenated: pretest, posttest, antidiscrimination, bilingual, codependent, multinational, underserved, overextended , semistructured, nondenominational, multimedia, ant isocial. © 2014 Laureate Education, Inc. Page 2 of 7 7. Lists (Seriation) and Bullets . Within a paragraph, list items using (a), (b), (c), and so on. The teachers identified three challenges: (a) teaching hungry children, (b) making do with outdated books, and (c) organizational bureaucracy. In a v ertical list, the items would be listed like this: 1. Teaching hungry children . 2. Making do with outdated books. 3. Organizational bureaucracy. The 6 th edition of the APA manual allo ws for the use of bullets. See C hapter 3 for guidance. 8. Numbers and percentages . The rules for numbers are tricky and should be studied. In general, numbers 10 and higher appear as numerals; nine and lower are written out. There are exceptions: elements of time, distance, ratios, and percentages always appear as numerals, unless at the start of a sentence. Use a percentage sign with numer als unless at the start of a sentence: There was a 4% increase in the price of lettuce. Seventy percent of the children were malnourishe d. 9. Use respectful language. Chapter 3 in the APA ma nual presents important information on language use with respect to gender, race, disabilities, and so forth. Avoid the generic pronouns he and she , or he/she , when possible, by using they: Wrong: When a teacher has a bad day, she feels like screaming. Better: When teachers have a bad day, they feel like screaming. 10. Tables and figures. Sections on tables and figures in C hapter 4 are critical to your accurate and persuasive portrayal of data. Read through these sections when developing tables and figures i n your papers and reports. Quick Guide to Citing Sources in APA Style While the publication m anual may look overwhelming to you when you first start using it, remember that nearly everything you need to know can be found in three sections of the manual. Formatting in -text citations can be found in C hapter 6. © 2014 Laureate Education, Inc. Page 3 of 7 The gist of what you need to know for references lists can be found in the examples in Chapter 7. Formatting In -text Citations These basic rules relate to in -text citations . 1. Use the a uthor/date system. Be careful with your punctuation. Gould ’s (1999) analysis was later challenged by others (Duncan, 2003; Evans & Barker, 2004). Notice that the two pairs of studies are separated with a semicolon and that you use an ampersand (&) as a sub stitute for the word and when showing the names of authors inside parentheses. 2. Do not plagiarize. Just changing a couple of words or rearranging a sentence isn ’t paraphrasing. For direct quotes, you must identify the page number or paragraph number of the original source. For paraphrases, you are strongly encouraged to do so. Original of Latham ( 200 8): Luxury boxes and other amenities aimed at affluent fans are one way to attract new revenue to a stadium, but the public dollars that fund them benefit o nly the privileged classes, not the common good. Plagiarism: Luxury boxes and other amenities aimed at rich fans are a way to get new revenue at a stadium. However, the public monies that fund them benefit only the wealthy — and not the common good (Latham, 200 8). Paraphrased: Latham (200 8) argued that spending public dollars on comforts enjoyed solely by wealthy fans is not in the overall public interest (p. 432). 3. Normally, the final punctuation after a direct quote comes after the page identifier whil e the final/closing quotation mark comes right before page identifier, as in this example : Jorgenson (2005) indicated that the price of coffee rose “dramatically ” during the previous decade because of “consumers ’ lust for an overpriced buzz ” (p. 513) . © 2014 Laureate Education, Inc. Page 4 of 7 4. When directly quoting a source of 40 or more consecutive words , format the quote in block form . The final punctuation comes before the parenthetical element. If this were a direct quote, indent about five spaces on the left. It is 43 words, which is wh y it is formatted in block form. The final period is placed before the parenthetical element, not after it as in the Latham examples. (Rachmaninoff, 1936, p. 3) 5. List authors in groups of different sources in alphabetical order by first listed author ’s surname. Separate groups with semicolons. (e.g., Hart, 1998; Iksic & Holmes, 1995; Melnick, Ek, & Fazio, 2004) . 6. “Et al. ” should not be used the first time a work is cited unless that work has six or more authors. For works with fewer than six authors , list all authors in the first citation, then use the surname of the first author and “et al. ” and the year in subsequent references. Be careful with the punctuation. Usually there ’s no comma between the author and et al. As noted earlier, Melnick et al. (2004) suggested that. . . . 7. With two or more authors in a parenthetical citation, use “&” rather than “and ” before the last author. Stein and Hernandez (1995) , but other authors (Gomez & O’Hara, 1995). . . . Formatting the Reference List Several s oftware companies have created programs to format your reference list automatically per APA (including APA itself). Students have spoken highly of Perrla.com and, for use with Firefox, free software available from www.zotero.org . Check the Walden Writing C enter for information. The following examples are formatted with hanging indents. Commas separate all authors and use an ampersand ( &), not the word and . Only surnames appear in full; otherwise, use initials. Use italics or underlines — but choose one and b e consistent. Book titles appear in sentence case — not title case. 1. An entire book. Melnick, A., Ek, S. A., & Fazio, M. J. (2004). Finishing high school without trying . Erie, PA: Peach St reet Press. © 2014 Laureate Education, Inc. Page 5 of 7 2. A chapter in an edited book. Pogoff, S. ( 200 8). Hair and nails to match. In L. Rubenstein & A. Cukier (Eds.), Preteen survival guide (pp. 48 –56). New York , NY : Longman . Note that in the above example, Pogoff, the chapter author, gets the in -text citation — not the book editors. 3a. A journal article wi th a DOI number printed . The DOI number identifies the source of an article. Not all journal articles show one, but if it ’s there, it ’s usually on the first page of the article. You might find the DOI number listed in your database search. Latham, M. ( 20 08). The future of stadiums is not the past. Sports Economics, 17 , 431 –468. doi:10 -9876.5432.098 Note that the title of the article is written in sentence case, an d no quotation marks are used, nor does pp. appear before the page numbers. No punctuation follows the DOI number. 3b. A journal article with no available DOI number. The sixth edition of the APA manual requires you to find the URL homepage of the journal you are citing if no DOI number is available. Clemente , R. ( 2009 ). Incidence of asthma in rural Puerto Rico . Journal of Latino Health , 23 , 32 –39 . Retrieved from www.jlh.com/index.pr.html 4. A magazine article, no author. Enough scandals for one day. ( 2009 , May 19). Newsweek , 46 . When the author is not provided, indicate the title of the au thor in the first spot. In the in -text citation, the article title is shortened, in quotation marks, to lead the reader to the right spot in the references. ( “Enough Scandals, ” 1998). © 2014 Laureate Education, Inc. Page 6 of 7 5. Article from ERIC found online. Thomas, M., & Donahue, P. (1995). Reexamining the effects of TV on the elderly . Minneapolis , MN: Center for the Study of the Visual Media. (ERIC Document Reproduction Service No. ED 543 980). Retrieved from ERIC database. 6. The DSM -IV . American Psychiatric Association. (2000 -TR). Diagnos tic and statistical manual of mental disorders (rev. 4 th ed.). Washington, DC: Author . In text : (DSM -IV -TR, 2000 ) 7. One author, two publications in the same year. Whittemore, A. (2001a). Finding a path toward recovery. Journal of Zen Studies, 15, 314 –345. Whittemore, A. (2001b). Loss of hair and the effect on the aging male. Coping Today, 13 , 25 –29 . In text, note the first publication by citing it as (Whittemore, 2001a), the second as (Whittemore, 2001b). 8. A reprinted version of an earlier text, in an edited volume. Watson, M. (2004). Balancing family and work. In H. Simon & F. Parker (Eds.) , Psychological despondence (pp. 135 -150). (Original work published 1915) © 2014 Laureate Education, Inc. Page 7 of 7 If you read something that was originally published in a different book or journa l, cite both dates in text, separated with a slash: (Watson, 1915/2004) 9. A secondary source — meaning, you didn ’t read something that the author you read has referred to. Suppose you read the following on page 203 in a book by Hassan (2006), and you want to refer to the work by Reynolds that you did not read firsthand: Economic and political conditions in sub -Saharan Africa in the 1990s led to a large increase in the number of African immigrants to the Upper Midwest (Reynolds, 2003). In your paper, you will write : Reynolds (as cited in Hassan, 2006) stated that struggles in sub -Saharan Africa near the end of the 20 th century resulted in an increase in the native African population into the American Upper Midwest (p. 203). Only works you read firsthan d appear in the reference list. Note that many Walden faculty approve of secondary sources only if you are unable to locate and read the original source, 10. Personal communication. Per APA, references to personal communication, such as letters, memos, e -mail messages, or phone interviews show up only in -text and not in the reference list. The drop in crime among youth may actually increase the need for mental health services in Aitkin County (M. Lemieux, personal communication, February 1, 2005). Refer to http://www.apastyle.org/ for examples of other online references.
Locating and Critically Analyzing Primary Research Articles
Introduction to Scholarly Writing: Plagiarism and Academic Integrity Is plagiarism a concern at Walden? Yes —just as it is a concern in institutions throughout the world. However, in a largely online environment , where the written word is the only evidence of a student’s knowledge of a topic, it is more than a little tempting for students to “borrow” the words and ideas of others, especially when it’s late at night and the hardworking student has finally put the kids to bed (especially when someone else has written such brilliant words so beautifully) . But in starkest terms: Plagiarism is not tolerated at Walden University. What Do We Mean by Plagiarism? The Walden Student Catalog (20 10-201 1) defines plagiarism as the use of intellectual material produced by another person without acknowledging its source. For example, plagiarism includes: o Wholesale copying of passages from works of others into an assignment, paper, discussion board posting, thesis , or dissertation without acknowledgment. o Using the views, opinions, or insights of another without acknowledgment. o Paraphrasing another person’s characteristic or original phraseology, metaphor, or other literary device without acknowledgment. What does that all mean to you? Compare the following two paragraphs on the next page. (The paragraph on the left appeared in a journal. A student wrote the paragraph on the right.) © 2014 Laureate Education, Inc. Page 1 of 4 Journal Article In recent decades, men have been bombarded with images in society that depict the “ideal” male: strong, muscular, lean, w ith perfect features. What many adolescents do not realize is that most of the male bodies that they idealize can be acquired only with the use of anabolic steroids. Thus, many adolescent boys find themselves pursuing a body type that is impossible to obta in. By the time these boys reach adulthood, many have developed an eating disorder, such as bulimia, or an image disorder, such as muscle dysmorphia. In this article, the authors describe body image disorders in adolescent males and offer intervention stra tegies for school counselors. Stout, E. J., & Frame, M. W. (2004). Body image disorder in adolescent males: Strategies for school counselors. Professional School Counseling, 8, 176 –181. Student Writing Over the past 30 years, men have seen many images that show the “ideal” male: strong, muscular, lean, with perfect features. Many adolescents do not realize that most of the male bodies that they idealize can be acquired only with the use of steroids. Thus, many teenaged boys find themselves pursuing a body type that is impossible to obtain. When these boys reach adulthood, many have developed an eating disorder, such as bulimia or anorexia, or an image disorder, such as muscle dysmorphia. In their article, Stout and Frame (2004) described body image disorders in adolescent males and offered intervention strategies for high school and junior high school counselors. Is the paragraph on the right an example of plagiarism? Put it this way: These paragraphs might not be identical twins, but they are certainly fraternal twins. In the student version, a few words were changed here and there, but the ideas, the order in which they were presented, and nearly all of the words were written as if they were the student’s own rather than those of Stout and Frame , who actually wrote them . So yes, the paragraph on the right is plagiarism. You cannot take someone else’s words and ideas and recast them as your own, as if the original work were not at your elbow. Does that mean that you can never refer to someone else’s writ ing? Use a few of someone else’s words? Quote © 2014 Laureate Education, Inc. Page 2 of 4 another author? Only if you document your sources carefully so your reader knows who wrote what. Remember, scholarly writers read and think critically, so there is no reason to copy material word for word. And, scholarly writers synthesize what they have read to show, in their own words, that what they are writing is factual. Using Direct Quotes Direct quotes can enhance your writing; however , there are important considerations to keep in mind. Consider using direct quotes when o the writer has expressed something in a way you consider to be “just right” ; o the writer has revealed something about him or herself by the words he or she has chosen ; or o the original words are critical to a specific definition or point that you are trying to make . There are a considerable number of rules when it comes to using direct quotes. Here is just a sampling (based on APA style). o Direct quotes require quotation marks and, in parentheses, a page or paragraph identifier. o Gener ally, the close -quote mark comes before the parenthetical citation and is followed by a period. Example: In an earlier study, Davis (1978) reported, “Children need to exercise every day for at least 45 minutes” (p. 36). o Block quotes are required when dir ect quotes are 40 words or longer. o The final punctuation comes before the parenthetical citation at the end of a block quote. o Most Walden instructors prefer single- spaced block quotes. o Block quotes require no opening or closing quotation marks or elli pses. © 2014 Laureate Education, Inc. Page 3 of 4 o Block quotes are best avoided or used minimally. Example: Capuzzi and Gross (2005) assert ed: The testing process, when focusing upon characteristic behaviors, also facilitates counselees’ self -understanding. Many tests incorporate logical, semant ic, and relatively “transparent” approaches to analysis of human behavior. Thus, actually engaging in the testing process may enable counselees to learn new ways of evaluating themselves. (p. 289) Journal Article In recent decades, men have been bombard ed with images in society that depict the “ideal” male: strong, muscular, lean, with perfect features. What many adolescents do not realize is that most of the male bodies that they idealize can be acquired only with the use of anabolic steroids. Thus, many adolescent boys find themselves pursuing a body type that is impossible to obtain. By the time these boys reach adulthood, many have developed an eating disorder, such as bulimia, or an image disorder, such as muscle dysmorphia. In this article, the auth ors describe body image disorders in adolescent males and offer intervention strategies for school counselors. Stout, E. J., & Frame, M. W. (2004). Body image disorder in adolescent males: Strategies for school counselors. Professional School Counseling, 8, 176 –181. Student Writing Over the past 30 years, men have seen many images that show the “ideal” male: strong, muscular, lean, with perfect features. Many adolescents do not realize that most of the male bodies that they idealize can be acquired only with the use of steroids. Thus, many teenaged boys find themselves pursuing a body type that is impossible to obtain. When these boys reach adulthood, many have developed an eating disorder, such as bulimia or anorexia, or an image disorder, such as muscle dysmorphia. In their article, Stout and Frame (2004) described body image disorders in adolescent males and offered intervention strategies for high school and junior high school counselors. © 2014 Laureate Education, Inc. Page 4 of 4
Locating and Critically Analyzing Primary Research Articles
Introduction to Scholarly Writing: Tips for Success General Resources for Writers To learn more about reading and writing critically, check the wealth of information offered at the Critical Th inking Consortium, particularly the link, ” The Role of Questions in Thinking, Teaching, & Learning .” (Teachers might be particularly impressed with this site’s l esson plans and instructional design materials.) And for excellent instructional material on essay writing and learning how to go beyond parroting someone else’s pabulum and turning it into your own golden prose, explore Empire State College’s essay writing section . There are many quality books on scholarly writing. Visit a large bookstore and leaf through the section on academic writ ing. Graduate students might want to start with a good college writing text such as ones by Diana Hacker or Toby Fulwiler. An inexpensive classic is Strunk and White’s Elements of Style (any edition will do). Also, take a look at • Becker, H. (1986). Writing for Social Scientists: How to Start and Finish Your Thesis, Book, or Article (Chicago Guides to Writing, Editing, and Publishing) . Chicago, IL: University of Chicago Press. • Hoover, K. R. , & Donovan, T. (2003). The Elements of S ocial Scientific T hinking (8th ed.). New York , NY: Wadsworth Publishing . Walden Resources for Writers The Walden Writing Center http://writingcenter.waldenu.edu/ The Walden Writing Center offers resources to help you with everything from starting to think about writing a course paper all the way through to finishing and publishing a dissertation. Writing Tutors If you need help with your writing , send an e-mail message to the Walden writing specialists at [email protected] . Writing Course s If you are a graduate student and having difficulties with writing, consider taking SBSF 6000: Graduate Writing or other student success courses described in the Walden catalog . Learn more about this course and related resources at http://inside.waldenu.edu/c/Student_Faculty/StudentFaculty_1459.htm . © 2014 Laureate Education, Inc. Page 1 of 1
Locating and Critically Analyzing Primary Research Articles
Stages in Critical Reading of Research Articles Stage Purpose Activities or Critical Questions Previewing and determining legitimacy Judging if the study or article is high quality and legitimate • Check the authorship credibility. • Is the work peer review ed? • Is there a bibliography or reference list? • Is the research timely or current? Preliminary understanding Skimming or quickly reading to gain familiarity with the content and layout of the article • Is the research question significant to your study? • Highlight or underline main steps in the research process. • Make notes (comments, key variables, and questions). • Decide if the research will be of benefit to your study. Annotating Noting the information needed for future use • Create an APA reference citati on. • Write a brief summary or keywords identifying the source. Comprehensive understanding Increasing understanding of concepts and research terms • Clarify all unfamiliar terms before a second reading. • Identify how the main concepts relate to each other and the context of the study. • Write a brief summary of the main idea or themes of the article in your own words. • Identify any questions or areas that need further clarification. Analysis understanding Breaking the study into parts; understanding each aspec t of the study; • What is the purpose of this article? • Am I clear about the specific design used so I can apply appropriate critiquing criteria? © 20 14 Laureate Education, Inc. Page 1 of 2 Stage Purpose Activities or Critical Questions relating to steps in the research process • How was the study carried out? • What are the researchers’ main conclusi ons? • Can I say that I understand the parts of the article and summarize them in my own words? Synthesis understanding Pulling together the above steps to make a (new) whole; making sense of it; explaining relationships • Briefly summarize the study in your own words; identify gaps, weaknesses, and ideas for new theories or projects. • Write a critical commentary on the study. Adapted from “Critical Reading Strategies: Overview of the Research Process .” (2002) I n G. LoBiondo- Wood, J. Haber, & B. Krainovich -Miller (Eds.), Nursing Research: Methods, Critical Appraisal, and Utilization (5th ed., chapter 2) . St. Louis, MO: Mosby; Publication Manual of the American Psychological Association. Washington, DC: American Psychological Association. © 20 14 Laureate Education, Inc. Page 2 of 2