Differences in information acquisition from electronic medical records between nursing students and nurses: An eye-tracking study.

BACKGROUND

Understanding how nursing students and nurses acquire information from electronic medical records (EMRs) is essential for clinical reasoning development in nursing education. However, most studies on information acquisition in nursing have focused on physiological indicators in crisis situations. Moreover, reliance on self-report approaches limits the capture of reasoning that is difficult to verbalise and information attended to in information-rich clinical environments.

AIM: To identify differences in information acquisition from the EMR between nursing students and nurses, using eye-tracking and high-dimensional data analysis.

METHODS

In this exploratory cross-sectional study, 20 students and 20 nurses were recruited from one hospital and two nursing universities in Japan. Eye-tracking data were collected while reviewing the EMR of a patient with heart failure. Viewer numbers and viewing time across 15 EMR sections were compared between groups. Fixation durations of 4118 areas of interest (AOIs) were analysed using a kick-one-out-based variable selection method to identify differences in records consulted and information attended to.

RESULTS

Data from 18 students and 20 nurses were analysed. Fewer students than nurses viewed treatment-related EMR sections, and students spent less time on them. A total of 111 AOIs were identified. AOIs characterising students were primarily derived from nurse-documented assessments, care plans and screening scores, reflecting daily-life and psychosocial information. In contrast, AOIs characterising nurses were mainly derived from physician documentation and orders, reflecting information related to disease severity and treatment management.

CONCLUSION

Nursing students and nurses differ in information acquired from the EMR. Educational interventions should support students in integrating perspectives on disease severity, treatment response and patients' daily lives. These findings also suggest that students' reliance on others' judgements and explicit criteria may reflect an imitative stage in the development of clinical reasoning, supporting education tailored to students' readiness.