Colleges Adust for the Constant Demand of Web Access

When it comes to increasing productivity and efficiency, enhancing patient safety and reducing the risk of medical errors, personal digital assistants are proving to be just what the doctor ordered – or in this case, the nurse.

Part of a growing trend in mobile computing among healthcare professionals, PDAs are serving as a highly effective go-to resource for students at Thomas Jefferson University's School of Nursing.

The Philadelphia university, which offers clinical experience in a wide variety of specialty areas, implemented a one-to-one PDA program in its nursing school, hoping to resolve a number of pain points that challenged its nursing students.

Enabling nursing candidates to keep abreast of the most up-to-date medical information, PDAs represent a convenient way to store and access healthcare data. Small enough to fit into a pocket, the tool is an inexpensive alternative to a desktop or notebook computer, and can be more frequently and easily updated than traditional reference books.

Easy Access

“We have found the PDAs to be extremely helpful because students have such easy access to information,” notes Karen Papastrat, assistant dean for pre-licensure bachelor of science in nursing (BSN) programs at the Jefferson School of Nursing.

“Other computer resources aren't always easy to use or aren't always accessible,” she acknowledges. “But this PDA is the student's own personal resource. They can answer a question at a patient's bedside. They don't have to leave the room to find the answers they need.”

In addition to providing quick access to data, PDAs offer nursing students a range of other advantages. For example, by accessing reference materials at the patient's bedside, they can plan care and promote decision-making using reliable evidence.

Furthermore, for licensed, registered nurses, the PDA is a handy tool for collecting patient and research data, as well as performing digital charting. When synchronized with a main computer, PDAs make it easy to upload patient charts and diagnostic study results. And because they are password protected, they comply with strict HIPAA regulations.

One to One

At Thomas Jefferson University, which this year enrolled 355 BSN and 220 associate of science in nursing (ASN) pre-licensure nursing students, PDA adoption was driven by a desire to increase the use of technology within the undergraduate nursing program, according to Papastrat.

“Graduates are expected to have basic technological competence, and the use of PDA technology supports this outcome,” she explains.

The nursing school first piloted its one-to-one initiative in 2005 among 20 nursing students with PDAs. Building on the success of the trial, the university expanded the program the following year, making PDAs optional for BSN students. Then, in 2007, the devices became a mandatory part of the BSN program, with the ASN program following suit in 2008.

The university gives students the freedom to purchase any brand or model of PDA, provided it is capable of running the Unbound Medicine Nursing Central software selections used in the nursing program. Unbound Medicine's products deliver the latest information about drugs, interactions, diseases, diagnostics, procedures and journal literature to handheld devices.

“Students can come in with any device, as long as it can run the Nursing Central software,” explains Papastrat.

Within its bookstore, the university offers the HP iPaq 110 Classic Handheld. The personal organizer lets users access the web even when Wi-Fi is not available. By connecting the PDA to a mobile phone with Bluetooth, students can browse the Internet through their cellular service.

Furthermore, as the first handheld organizer with the features of the Microsoft Windows Mobile 6 Classic operating system, the iPAQ 110 enhances productivity with mobile versions of familiar Office tools such as Word, Excel, PowerPoint and Outlook, and also provides the ability to view PDF documents. The model's bright 3.5-inch touchscreen display allows for easy viewing in any environment.

The cost of a basic PDA model (valued at around $288) as well as the Nursing Central software suite (valued at around $150) is calculated as part of students' overall book/equipment package, making them eligible for the additional amount in financial aid. The nursing school also supplies the iPAQ 110 device to all full-time BSN and ASN faculty, and extends a credit of 50 percent of the cost to part-time clinical instructors.

A Perfect Fit

Kathryn Shaffer, a faculty instructor for undergraduate BSN students, says professors greatly value the handheld devices.

“The PDA is downloaded with software that takes the place of heavy books they may use for reference,” she explains. “Students use the PDAs in the clinical setting for instant clinical information such as medications, diseases, processes and diagnostic testing.”

As a result, student nurses are better prepared on clinical aspects, using the resources more frequently throughout the day, with quicker access to the information. “I believe that the more frequently the students use the resources, the more likely they are to provide high-quality patient care,” says Papastrat. “They use them to look up drugs at least five or six times a day.”

Recent research supports these assessments. A survey completed by technology research firm Spyglass Consulting Group found that 87 percent of nurses interviewed owned and used a PDA. Conversely, 90 percent of respondents said they were reluctant to use a tablet PC for bedside nursing because of its inappropriate form factor.

Many cited tablets as being too fragile, too large and too heavy, coupled with inadequate battery life. The survey also found that nurses are reluctant to use computers on wheels because they are heavy and awkward to push, violate standards of The Joint Commission (formerly Joint Commission on Accreditation of Healthcare Organizations) and fire regulations, and are not well suited for older hospitals where hallways, doorways and rooms are often smaller.

The Numbers Add Up

This past spring, the Jefferson School of Nursing conducted its own survey on PDA use among its baccalaureate nursing students, finding that 73 percent of respondents use their PDAs up to 10 times a day. Nearly 77 percent revealed that during a typical clinical day they look up three to 10 drugs using the nursing reference software on their PDAs. Eighty-eight percent said they “agree” or “strongly agree” when asked if they are planning to use their PDAs as a practicing graduate nurse.

While 72 percent of Jefferson's nursing students credited the tool with making it easier to provide nursing care as well as help them retain reference knowledge, an overwhelming 92 percent agreed that PDAs are convenient and valuable in the clinical setting.

Planning a PDA Program

With so many benefits afforded by the PDA, the one-to-one initiative is thriving at the university. “There is increased faculty satisfaction with student performance in the clinical setting. Plus, there is a positive intent to continue to utilize the PDA format post-graduation,” says Papastrat.

For other universities considering a one-to-one PDA program, Papastrat emphasizes the need to cultivate early users – and a healthy dose of persistence.

As a starting point, Papastrat recommends conducting a trial with a small group of students. “I used student volunteers who already owned PDAs and provided them with free software and comparable textbooks,” she explains.

Simulations were then conducted in which students were divided into two groups, using either reference books or software, to manage a particular patient-care scenario. The results were later compared and revealed that students using PDAs were faster in retrieving the information necessary for patient care decisions.

Drumming up support among faculty members is also critical. “We started with the medical-surgical faculty, and they integrated the PDA into their classes and used it for case studies and in certain testing procedures,” says Papastrat.

The final step is to ensure students are properly trained to take full advantage of the new units. During the first few weeks of school, Unbound Medicine representatives conduct onsite student orientations, which are complemented by detailed case studies provided by the nursing school to help students navigate the handheld devices within clinical settings.

“I work with some of the library and clinical laboratory staff who can support the students if they have technical questions,” adds Papastrat. “Having a few key resources for students' questions or problems is very important. We also use an online discussion board for students to post their questions and solutions. Our students quickly become very savvy and after the first few weeks, need very little support.”