Chief Nursing & Midwifery Information Officer, Northern Sydney Local Health District
Before digital health, things were much simpler for both the student nurse, and midwife, in relation to learning how to document assessments, medications, observations, and care. Back in the early eighties, when I trained in both areas, we had a very hands-on integrated approach to learning how to document, compared to today’s world, with basic observational charts, fluid balance charts, medication charts and what was known as a ‘Nursing/Midwifery Kardex’ to document care and plans. What we learnt around nursing and midwifery documentation in the classroom, was then emulated on our placements under the supervision of the registered nurses/midwives and tutors. At the end of each placement, we mastered the art of caring for and documenting our patient’s/woman’s/baby care assessments, goals, treatments and interventions, for that specialty/area.
Today, it has become much more complex. There is not only paper documentation but more often than not there is a digital health record and other digital health technologies to learn. Do the current nursing and midwifery undergraduate students have the same experience in preparing them for their placements? With the fairly rapid rise in digital health, it seems university education around preparing students for digital health systems has lagged. In 2013, Baillie et al.  conducted a survey that investigated student nurse and midwife experiences of using the electronic medical record (EMR) in practice. The results indicated that there needed to be more opportunities to enable students to be more competent in using EMRs prior to placement, with a request for more hands-on practice in a simulated environment. Following the published paper, a collaboration between the university and its affiliated health organisations established governance around onboarding and guidelines around usage, and also provided formalised EMR training for their students.
A recent qualitative study by Peacock, Slade & Wilson  around nursing and midwifery students’ perspectives on the use of digital systems during placements revealed that moving between paper and digital records was quite taxing. Whilst they recognised the benefits of documenting digitally, the participants considered paper much easier to use and documenting digitally at the bedside proved onerous for many. Again, for many, a lack of preparation and access granted to them to use the system was often challenging and frustrating. The study summarised that the students felt that being able to practice in a simulation centre with the ability to have interactive modules prior to placement would make them more confident in using the systems to review and document patient care.
In addition to learning how to document in an EMR, a student also has to work with other digital technologies, such as smart intravenous pumps, wearables, virtual care, and cybersecurity, to name a few. They are also required to understand nursing and midwifery data terminology, and the use of clinical technologies is only looking to expand in the future [3-4]. Within Australia we have had an explosion of digital health maturity – Queensland Health has adopted a single digital record strategy , NSW is in the process of finding a vendor to consolidate the domains of its digital records and pathology into one single digital health platform , and both Western Australia and Tasmania have announced budget and planning for a single digital health platform [7-8].
Where does this leave our student nurses and midwives today? Some great work has already been achieved to assist not only students but the general nursing and midwifery workforce, with the development and publication of a National Nursing and Midwifery Digital Health Capability Framework , and free competency-based learning modules hosted by the Australian College of Nurses . According to the Australian College of Nursing, “interactive online resource has been developed specifically for Australian nurses, midwives and nursing and midwifery students to support the development of their knowledge and skills in relation to digital health technologies. The content of the resource has been informed by the National Digital Health Strategy, the development of which was led by the Australian Digital Health Agency (ADHA) in collaboration with key stakeholder groups including, amongst others, the Australian College of Nursing” .
Most students are frequent internet and social media users . But for them to gain confidence in using digital health systems, there is a need for more digital health training [10-13], particularly around learning the concepts of digitally documenting, and a standardised approach, given there appears to be so much variability currently across university curricula. Foundational nursing and midwifery studies need to provide more digital health literacy interventions .
To assess the level of competency for students, should the National Nursing and Midwifery Digital Health Capability Framework  be the recommended framework to be used across all undergraduate nursing and midwifery programs? The recent response to an independent review on nursing education  recommends that the framework could address some of the issues raised. If adopted widely, it could assist student nurses and midwives in assessing their digital competencies prior to and after their placements, perhaps even on a yearly basis . With the Australian federal government supporting the National Nursing and Midwifery Education Advisory Network , there is scope to identify if further work is required and an anticipation that further review will take place.
The status quo, with limited access to simulated EMRs, different onboarding processes and procedures, and limited expertise to support digital health for not only student nurses and midwives but also the nursing and midwifery workforce, is a major issue that needs to be considered by all organisations that offer nursing and midwifery courses. The difficulty in funding, maintaining, and building an EMR for our undergraduate students within university simulation centres remains a challenge. However, our undergraduate students are the future, and in this ever-increasing digital health world, it is essential that they have gained basic competencies around using digital health technology, and understand the full benefits for their patient’s care, in using a digital health record, across the patient journey.
- Baillie L., Chadwick S., Mann R., & Brooke‐Read M. (2013). A survey of student nurses’ and midwives’ experiences of learning to use electronic health record systems in practice. Nurse Education in Practice, 13, 437–441 [VIEW ONLINE]
- Peacock, A. , Slade, C. & Brown Wilson, C. (2022). >Nursing and midwifery students’ perspectives of using digital systems on placement. Journal of Advanced Nursing, 78 (4), 1128-1139. doi: 10.1111/jan.15091. [VIEW ONLINE]
- Australian Digital Health Agency (ADHA). National Nursing and Midwifery Digital Health Capability Framework. Sydney, Australia: NSW Australian Government; 2020. [VIEW ONLINE]
- Rowland D. What Is Digital Health? Why Does It Matter? White Paper. Australia: Digital Health Workforce Australasia; 2019 [VIEW ONLINE]
- Queensland Health. Integrated electronic medical record (ieMR) Retrieved 26/6/22: [VIEW ONLINE]
- eHealth NSW. Single digital patient record set to deliver vastly improved patient experience; 2020. Retrieved 26/6/22: [VIEW ONLINE]
- WA Health Digital Strategy 2020 – 2030. Retrieved 26/6/22: [VIEW ONLINE]
- McDonald K; Tasmania sets out bold strategy for statewide digital health transformation. Pulse IT published 26 May 2022. Retrieved 26/6/22: [VIEW ONLINE]
- ACN; Digital Health Online Educational Resource. Retrieved 26/6/22: [VIEW ONLINE]
- Lokmic-Tomkins, Z., Choo, D., Foley, P., Dix, S., Wong, P. & Brand, G. (2022). Pre-registration nursing students’ perceptions of their baseline digital literacy and what it means for education: A prospective cohort survey study. Nurse Education Today, 111: N.PAG-N.PAG. [VIEW ONLINE]
- Sinha, Rajesh Kumar and Joy, Jinu. (2022). Nurses’ knowledge of and attitude to nursing information systems. British journal of nursing (Mark Allen Publishing), volume 31, issue 12, pages 648-654. [VIEW ONLINE]
- Brown Wilson C., Slade C., Wong W. Y. A., & Peacock A. (2020). Health care students experience of using digital technology in patient care: A scoping review of the literature. Nurse Education Today, 95, 104580. [VIEW ONLINE]
- Meum, T. T., Koch, T. B., Briseid, H. S., Vabo, G. L. & Rabben, J. (2021). Perceptions of digital technology in nursing education: A qualitative study. Nurse Education in Practice, 54: N.PAG-N.PAG. [VIEW ONLINE]
- Commonwealth of Australia (2021). Australian Government response to the independent review of nursing education. Educating the Nurse of the Future. Publications number: DT000981. Recommendation 20; P20. [VIEW ONLINE]