Canadian Journal of Nursing Informatics

Nursing Students’ Informatics Competency in Action: Using QR Technology to Promote Health Education about Cannabis

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By Katelyn Kuchta, BSc
Mikaela Stiegelmar, BSc
Rachel Joffe, BSc
Manal Kleib, PhD, RN

Faculty of Nursing, University of Alberta

QR Technology

Abstract

Informatics is vital to advancing nursing practice and improving patient outcomes. With the recent cannabis legalization in Canada, we believe Canadians can benefit from easily accessible quality information about the health benefits and risks associated with cannabis use and regulations controlling its consumption. Under the mentorship of our nursing faculty, we employed design thinking to develop an innovation prototype using a QR code that linksto a web page providing evidence-informed resources andguidelines related to cannabis use.We are excited to be able to improve and further develop this prototype through the Student Innovation Centre at the University of Alberta. Our goal is to make this information available to our fellow students within our University community and expand its reach to the general public in the long term. This learning experience enabled the purposeful application of informatics knowledge and helped us begin acquiring required entry-to-practice nursing informatics competencies. Such learning opportunities are vital to our success as we join an increasingly digitally rich practice environment. Nurses are innovative by nature and can further advance their practice through informatics and design thinking. 

Keywordsnursing informatics competencydesign thinking, innovation, QR code prototype, cannabis health education

Background

Informatics is key for advancing nursing practice and improving patient outcomes (Canadian Nurses Association [CNA], 2001Canadian Nurses Association [CNA] and Canadian Nursing Informatics Association [CNIA], 2017;Canadian Association of Schools of Nursing [CASN], 2012). Upon entry-to-practice, Canadian registered nurses are expected to have acquired three core nursing informatics competencies: information and knowledge management, professional and regulatory accountability, and the ability to use information and communication technologies [ICTs] in the delivery of patient care (CASN, 2012). As nursing students who have grown up in the digital age, we recognize how important it is to advance our informatics knowledge to understand how technology plays into the context of patient care. Technology will continue to push boundaries and transform our lives. Subsequently, as nurses, we will need to adapt and develop new and innovative ways of thinking about health care to maximize our ability to influence patient outcomes (CNA, 2001). Creating learning opportunities to facilitate the development of these core informatics competencies during pre-licensure nursing education contributes to enhancing our success as we join an increasingly digitally rich practice environment (CNA, 2001CNA & CNIA, 2017). In this paper, we describe our learning experience in applying systems thinking in the development of an innovative prototype to increase public awareness about cannabis and discuss how this learning promoted the development of our informatics competencies (Figure 1). 

Description of the Learning Experience 

Innovative thinking is not necessarily about creating a brand-new product, but how existing products can be used in creative, useful, and novel ways. Indeed, adapting and improving existing technologies and ideas is a key part of innovation (Blakeney, Carleton, McCarthy, & Coakley, 2009). As part of our leadership course during our first year of the After-Degree Nursing Program at the University of Alberta, we were asked to employ design thinking processes to develop an innovative prototype to address a current health topic or issue. The design thinking process has been described in different ways in the literature (Altman, Huang, & Breland, 2018). For example, the Design Thinking for Educators Resource Toolkitdescribes the process as being comprised of five stages: (1) identifying areas of concern – discovery, (2) searching for meaning – interpretation, (3) generating possible solutions – ideation, (4) testing various prototypes – experimentation, and (5) evaluating effectiveness and planning ahead – evolution (Riverdale Country School & IDEO, 2012). In our project, we applied these steps as described below. 

Defining an Area of Concern

Increasingly, patients and their families are seeking health information online; however, discerning which information is credible can be challenging. Silver (2015) noted that patients have difficulty locating relevant health information when there are numerous sources on the Internet (Silver, 2015). Some of those resources can also be heavy with medical terminology and difficult to understand, creating anxiety for some patients (Silver, 2015). Another concern of using the Internet for health-related advice is how accurate the sources are and whether or not the recommended information is reliable (Silver, 2015).One of the informatics competencies of a nurse is to “assist patients and their families to access, review, and evaluate” online health information to make informed health care related decisions (CASN, 2012)

With the recent cannabis legalization in Canada, Canadians can benefit from easily accessible and quality online information about the health benefits and risks associated with cannabis use, as well as the regulations controlling its consumption (Government of Canada, 2018). This emerging health issue presented an area of concern for us given it is new legislation, requiring extensive efforts to increase public awareness. We believe nurses are in a unique position to support the public as they navigate cannabis health information online because of their extensive knowledge and expertise in health education and role expectations with regard to informatics competencies (Hannah & Kennedy, 2019). The next step in our design thinking process was to generate possible solutions and decide on an innovative prototype to support cannabis health education. As millennials, we were enthused to integrate technology into our project. 

Generating Possible Solutions, Testing Various Prototypes and Evaluating Effectiveness

Initially, we pondered the thought of developing a web page to provide cannabis-related health education. However, a major concern surfaced as to how we would come up with the content and ensure it is accurate and suitable for the public. In the process of researching different solutions and more information on the topic, we were able to identify a number of newly-developed cannabis educational resources available through the government, professional and regulatory associations, as well as health care organizations websites. While it was encouraging to see that extensive online resources have been developed to educate the public about cannabis, we wondered how accessible this information was to the average Canadian. In trying to decide on what solution we could use to help us enhance access to these information sources, we looked at the potential of apps, but finally decided to employ the QR code technology because of its potential to make better use of these well-developed educational resources at a very low cost without having to develop new content.

QR codes, short for “quick response codes”, are a cost-effective, easy to use technology that streamlines the process of accessing online information by linking users with the necessary information immediately after the QR code is scanned (Bassendowski, 2012Hayes, 2017Whaley, 2012). This way individuals are able to navigate a variety of credible web pages with information about cannabis use and regulations surrounding its consumption in a fast and efficient way. A QR code eliminates the need for remembering or memorizing a web page address every time the user needs to access the information, a quite appealing feature especially with the large number of web pages available on the Internet (Whaley, 2012). It also ensures the user is only directed to the most credible sources they can benefit from, as opposed to having to screen through a number of web pages to find the information they need. 

QR codes can be printed on posters and displayed over a given area (Hayes, 2017). They are also easily accessible with free apps available, such as SnapChat, which has QR code reading capabilities. An individual can easily take a picture of the QR code through the SnapChat app and click the link to open the website. These features were very appealing as we evaluated the functionality of the QR codes and their capabilities to support our project in comparison to other solutions. Because of their interactive nature, QR codes have been used in nursing education to promote experiential learning (Bassendowski, 2012), as well as to support patient education (Hayes, 2017). For example, a family medicine clinic displayed a variety of QR code posters in their waiting room, linking patients to information about health topics like influenza and medications (Hayes, 2017). These applications further supported our choice of the QR code as a suitable solution (Figure 2). 

Figure 2: A Screenshot of the QR Code for the Cannabis Project

In order to develop our innovation prototype, we used wix.com, a free website builder program, to create the cannabis education web page and provided some guiding information on how to navigate the page (Wix, Inc., 2019). Then, we created a QR code using a free QR code generator (Egoditor, Inc., 2019) to link to the web page, as shown in Figures 3 and 4 below. 

Figure 3: A Screenshot of the Homepage of the Cannabis Webpage  
Figure 4: A Screenshot of Resources Displayed on the Cannabis Web Page

We are excited to be able to use resources and support from the Student Innovation Centre at the University of Alberta to further enhance our prototype (University of Alberta, 2019). This centre fosters student-led projects through access to resources and guidance from experts to nurture and advance the innovative process. The Centre will provide us with the resources necessary for us to further enhance our prototype and web page design. Initially, we will make the QR code available to our fellow students within the University community and continue to improve on it so that we can expand its reach to the general public in the long term. Resources such as the Innovation Centre at the University of Alberta allow students to expand their creativity and innovative thinking and apply it in their area of study; therefore, schools of nursing can benefit from building strategic partnerships with these entities to further support and foster students’ creative thinking. 

Reflecting on the Learning Experience

This project was a great opportunity to foster our informatics competencies, innovative thinking and collaborative teamwork; critical requirements for nurses today. According to Blakeney et al. (2009), there are three components of the innovation process: creativity, the innovation, and an environment that is conducive to innovation (Blakeney et al., 2009). Our project and its process illustrated these three concepts. First, we worked as a team to identify creative ideas and applied our nursing informatics competency towards addressing a current health issue in Canada. Secondly, our cannabis QR code prototype allowed us to adapt existing technology to be used in a novel way to expand the public’s access to credible health information on an emerging health issue; thus, promoted innovative thinking (Figure 5)

Figure 5: Innovation Station Displaying Cannabis QR Code Prototype during the Innovation Design Fair at the University of Alberta

Thirdly, having the opportunity to display, develop and share our innovation with the public during a design fair reinforced the support and mentorship we received from our educators, and the staff at the Centre of Innovation to further expand our idea which all provided an environment conducive to fostering innovation and creativity. In conclusion, this learning experience expanded our innovative thinking and enabled the purposeful application of informatics knowledge, and it also helped us build on our technical skills. It enabled us to form meaningful connections between informatics concepts taught in theory courses and how they translate into clinical practice. As future nurses, we believe these learning experiences are vital to our success in today’s digitally rich health care environment.

References

Altman, M., Huang, T. T., & Breland, J. Y. (2018). Design thinking in health care. Preventing Chronic Disease, 15(E117), 1-13. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178900/

Bassendowski, S. (2012). Quick response (QR) codes. Canadian Journal of Nursing Informatics 7(1). Retrieved from http://cjni.net/journal/?p=1972

Blakeney, B.A., Carleton, P.F., McCarthy, C., & Coakley, E. (2009). Unlocking the power of innovation. The Online Journal of Issues in Nursing, 14(2), 1-11.

Canadian Association of Schools of Nursing (2012). Nursing informatics entry-to-practice competencies for registered nurses.[PDF]. Retrieved from https://www.casn.ca/wp-content/uploads/2014/12/Nursing-Informatics-Entry-to-Practice-Competencies-for-RNs_updated-June-4-2015.pdf

Canadian Nurses Association. (2001). What is nursing informatics and why is it so important? Nursing Now 11, 1-4. Retrieved from http://www.nursing-informatics.com/kwantlen/NursingInformaticsSept_2001_e.pdf

Canadian Nurses Association and Canadian Nursing Informatics Association (2017). Nursing informatics [Joint position statement].Ottawa, ON: Author. Retrieved from https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/nursing-informatics-joint-position-statement.pdf?la=en

Egoditor, Inc. (2019). QR code generator [Web page]. Retrieved from https://www.qr-code-generator.com/  

Government of Canada (2018). Cannabis in Canada [Web page]Retrieved fromhttps://www.canada.ca/en/services/health/campaigns/cannabis.html

Hannah, K. J. & Kennedy, M.A. (2019). Nursing informatics and Canadian nursing practice. In P.A. Potter, A.G. Perry, P.A. Stockert, & A.M. Hall (Eds). Canadian Fundamentals of Nursing, Sixth Edition (pp. 255-270). Milton, ON: Elsevier 

Hayes, W. C. (2017). Using QR codes to connect patients to health information. Annals of Family Medicine, 15(3):275. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422091/

Riverdale Country School & IDEO. (2012). Design thinking for educators toolkit (2nd ed.) [Web page]. Retrieved from https://designthinkingforeducators.com/about-toolkit/

Silver, M. (2015). Patient perspectives on online health information and communication with doctors: A qualitative study of patients 50 years old and over. Journal of Medical Internet Research, 17(1): e19, 1-15. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319073/

University of Alberta. (2019). Student Innovation Centre [Web page]. Retrieved from https://www.ualberta.ca/student-innovation-centre

Whaley, A. (2012). Why and how to use QR codes in health care [Web page]. Manage My Practice Blog. Retrieved from  https://managemypractice.com/why-and-how-to-use-qr-codes-in-health-care/

Wix, Inc (2019). Free Website Builder [Web page]. Retrieved from https://www.wix.com/

Authors’List and Bios

  • Katelyn Kuchta, BSc. Email: kkuchta@ualberta.ca. Bio: Katelyn completed her Bachelor of Science with a major in Psychology and a minor in Biology fromthe University of Albertain June2018. She is currently working towards a Bachelor degree in Nursing at the University of Alberta.
  • Mikaela Stiegelmar, BSc. Email: mstiegel@ualberta.ca. Bio: Mikaela completed her Bachelor of Science Degree with a major in Biology and a minor in PsychologyfromMacEwan UniversityinJune 2018. She is currently working towards a Bachelor degree in Nursing at the University of Alberta.
  • Rachel Joffe, BSc. Email: joffe@ualberta.ca. Bio: Rachel completed her Bachelor of Science Degree with a major in Biology and a minor in Sociology from the University of Alberta in June 2018. She is currently working towards a Bachelor degree in Nursing at the University of Alberta. 
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