This practicum report describes a six-month staff development program designed to train nurses at a nursing home care facility in the use of Computerized Provider Order Entry (CPOE) systems. Using Lewin's Model of Change as the theoretical framework, the program assessed baseline knowledge of health informatics, identified educational gaps, and delivered targeted training in both facility and community settings. Participants included Bachelor of Science in Nursing (BSN) graduates encountering CPOE technology for the first time. The program successfully advanced nurses' technical competency with the system, increased acceptance of automated healthcare technologies, and prepared both clinical staff and community members for effective implementation of modern health information systems.
This practicum focused on analyzing the current practices and educational needs of nurses in a nursing home care setting during the initial implementation of Computerized Provider Order Entry (CPOE) technology. The program involved developing, implementing, and evaluating evidence-based staff development practices for nurses with Bachelor of Science in Nursing (BSN) degrees who were using the technology for the first time. The six-month training program was grounded in Kurt Lewin's change theory, a foundational model for understanding organizational and individual transitions.
According to Lewin's Model of Change, the training program was structured in three phases. The unfreezing phase focused on enabling nurses to understand changes in the medical field with respect to health informatics, preparing them psychologically and organizationally for the transition ahead. This was followed by the transition phase, in which trainees were guided through the change process and developed competency with the new systems. Finally, the freezing phase stabilized their ability to use health informatics effectively in daily practice. The model emphasizes that acceptance of change must be built on preparation—familiarity with what is to occur enables individuals to understand why the transition is necessary. (Miner, 2005)
The training took place within a medical facility equipped with lecture rooms for formal instruction and in community settings including homes and community centers where practical training occurred. Over the six-month period, the facility's health informatics department pursued a mission to improve operational quality and enhance service provision to patients and stakeholders at both the healthcare facility and home care levels. The program recognized that training in both environments was essential to meet community needs for specialized in-home care while building public understanding of informatics capabilities.
The facility's broader goals included improving the quality of life for community members requiring specialized home care and sensitizing the public to the importance and effectiveness of health informatics. Churches and academic institutions served as primary locations for practical training, and community volunteers were engaged to support program outcomes.
The primary objective was to perform the role of nurse informatics staff development administrator by analyzing current practice and educational needs of nurses at initial CPOE use, then developing, implementing, and evaluating an evidence-based staff development program based on Lewin's change theory. The program pursued several complementary goals:
Initial assessment revealed that most nurses were familiar with basic computing tasks such as information retrieval but had minimal knowledge of retrieving and managing medical records through automated systems. Since all participants were using CPOE for the first time, foundational training was necessary. While most were experienced in facility-based patient care, few had provided home-based care, and even fewer had used health informatics capabilities in home environments. The widespread reliance on manual record systems—persisting due to fear of change and startup costs—created significant knowledge gaps that the program addressed systematically.
The training curriculum was designed to build competency in areas where nurses had minimal knowledge while reinforcing areas of partial familiarity. Activities included comprehensive instruction on CPOE system operation, with both theoretical and practical components delivered in medical facility settings. Nurses received training in entering records into the system, accessing and retrieving information, enhancing record security, deleting unwanted entries, creating backups, and troubleshooting system problems.
To promote acceptance of change, the program emphasized the practical benefits of CPOE technology. Nurses were educated on system advantages including enhanced document security, reduced physical space requirements, time savings in information retrieval, and decreased costs for information management. These benefits were also presented to community members to build public support for automated systems in nursing home and clinical settings. Graduate nurses gained hands-on experience using CPOE in actual nursing home-based care environments, creating a bridge between training and real-world application.
The integration of clinical decision-making support systems in the CPOE workflow was presented as a mechanism for improving care quality, drawing on systematic reviews demonstrating the critical features of successful health information technology implementation. (Kawamoto et al., 2005)
By the end of the six-month program, nurse participants achieved competency levels approaching those expected of a standard graduate nurse proficient in health informatics. They demonstrated proper use of the CPOE system and the ability to troubleshoot problems when they arose. Participants reported completely positive attitudes toward the system and indicated preference for automated systems over manual alternatives.
The primary challenge identified during the practicum was initial fear of adapting to new technological change—a resistance that the Lewin model framework successfully addressed through the staged approach. Community response was highly favorable, with members expressing satisfaction with the system's effectiveness and accepting it for use in nursing home and other medical facility settings. Community members also voiced preference for automated over manual systems and expressed openness to adopting other automated medical systems to enhance care performance.
The knowledge gaps regarding CPOE use among graduate nurses were effectively addressed through the program. This success has strong potential to improve healthcare provision not only at the implementing facility but across the region where nursing services are delivered, directly supporting the delivery of quality patient care and effective institutional transitions. The demonstration that health information technology can improve clinical outcomes and operational efficiency strengthened staff and community commitment to ongoing implementation.
The project, conducted across diverse environments, revealed that significant knowledge gains were achieved in the use of Computerized Provider Order Entry among the nurses. The well-presented information during the practicum and precision in execution were defining features of the program. Effective handling of all procedures and the substantial success achieved directly met the program's core objectives. The program successfully imparted required knowledge to trainees and achieved the majority of goals established at its inception, with outcomes demonstrating that theory-guided staff development is effective for promoting adoption of complex health information systems. The combined success of training nurses and engaging community members supports the sustainability of CPOE implementation and positions the facility and region for continued advancement in health informatics-enabled care delivery.
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