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In today’s societal and healthcare climate, evidence-based practice is fundamental. Much ‘lip service’ is paid to evidence-based practice, and many argue it is already a reality (McKenna, Ashton, and Keeney, 2004). However, when examined in the philosophical and contextual context of evidence-based practice, this claim needs to be scrutinized. Such an anomaly has implications for nurse education, particularly the presentation and delivery of research to students. With this in mind, two undergraduate nursing research modules were modified to embed an evidence-based practice culture through module content teaching and delivery. Teaching and assessment were designed to help students understand the principles and process of evidence-based practice. This initiative’s impact was formally assessed using a quantitative post-test-only design. This initiative aimed to foster an evidence-based practice culture at the undergraduate level and beyond by implementing specifically tailored teaching and assessment methods within the academy. It also aimed to elicit the attitudes and beliefs, knowledge level, and utilization of evidence-based practice of undergraduate student nurses after they completed an evidence-based practice research module. The Evidence-Based Practice Beliefs Scale and the Evidence-Based Practice Implementation Scale were used to collect data. A sample of 217 undergraduate nursing students yielded a 66% response rate. The data were analyzed using descriptive and inferential statistics. Key findings show that students have a favorable attitude toward evidence-based practice. However, the implementation of evidence-based practice scored lower, and possible explanations will be provided. If evidence-based practice and its positive patient outcomes are to be realized in healthcare settings, embedding it in nurse education programs cannot be overstated.
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Advancement of Evidence-Based Practice through Nurse Education Leufer, T., Cleary-Holdforth, J. (Dublin City University) Abstract In today’s societal and healthcare climate, evidence-based practice is significant. Much ‘lip service’ is paid to evidence-based practice, and many argue it is already a reality (McKenna, Ashton, and Keeney, 2004). However, when examined in the philosophical and contextual context of evidence-based practice, this claim needs to be scrutinized. Such an anomaly has implications for nurse education, particularly the presentation and delivery of research to students. With this in mind, two undergraduate nursing research modules were modified to embed an evidence-based practice culture through module content teaching and delivery. Teaching and assessment were designed to help students understand the principles and process of evidence-based practice. This initiative’s impact was formally assessed using a quantitative post-test-only design. This initiative aimed to foster an evidence-based practice culture at the undergraduate level and beyond by implementing specifically tailored teaching and assessment methods within the academy. It also aimed to elicit the attitudes and beliefs, knowledge level, and utilization of evidence-based practice of undergraduate student nurses after they completed an evidence-based practice research module. The Evidence-Based Practice Beliefs Scale and the Evidence-Based Practice Implementation Scale were used to collect data. A sample of 217 undergraduate nursing students yielded a 66% response rate.
The data were analyzed using descriptive and inferential statistics. Key findings show that students have a favorable attitude toward evidence-based practice. However, the implementation of evidence-based practice scored lower, and possible explanations will be provided. If evidence-based practice and its positive patient outcomes are to be realized in healthcare settings, embedding it in nurse education programs cannot be overstated. Evidence-Based Practice, Nurse Education, Teaching and Learning, Patient Outcomes, and Research are some of the keywords used in this article. Background To provide clinically effective health care, healthcare practitioners must adopt an evidence-based practice culture (Fineout-Overholt, Melnyk, and Schultz, 2005; McInnes et al., 2001). As a result, the potential to provide better CARE, 1(1) CARE, Glasgow Caledonian University & HealthQWest, ISSN: 1755-1412 3
Patient outcomes are possible (Craig & Smyth, 2007). Many healthcare practitioners believe that their practice is evidence-based, but this often refers to the healthcare policies they follow supported by research findings. According to Gournay (2001), Pearson (2003), and McKenna et al. (2004), there is little evidence of evidence-based practices among nurses. In their study, Pravikoff, Pierce, and Tanner (2005) demonstrated that nurses only sometimes have the necessary knowledge and skills to find evidence to base their practice. Implementing policies based solely on research findings does not guarantee that the care provided is evidence-based. Such beliefs can arise from a lack of understanding of what evidence-based practice is and the fact that it is frequently associated with research utilization (McKenna, Cutcliffe, and McKenna, 1999; Goode, 2003; Foster, 2004). This is a misunderstanding that must be corrected. Evidence-based practice is defined by Melnyk and Fineout-Overholt (2005, p.6) as a “problem-solving approach to clinical practice that integrates: • a systematic search for and critical appraisal of the most relevant evidence to answer a burning clinical question, • one’s own clinical expertise, • patient preferences, and values.” While using research findings is essential in evidence-based practice, evidence-based practice is far more comprehensive and patient-centered than research use alone. The above definition implies that the process highly values the practitioner’s experience and expertise and the patient’s preferences. The primary goal of evidence-based practice is to improve outcomes for patients and clients by selecting interventions with the highest likelihood of success (Melnyk & Fineout-Overholt, 2005). CARE, Glasgow Caledonian University and HealthQWest, ISSN: 1755-1412 4
The Role of Education in EBP Fostering an evidence-based practice culture in nurses will allow them to influence policy and potentially transform healthcare for future generations (Killeen & Barnfather, 2005). For such a culture to flourish, appropriate training must begin as early as possible in the nurse’s career, ideally at the pre-registration level of nurse education. Teaching concepts of evidence-based practice to student nurses so they can recognize and deliver evidence-based care is a crucial outcome of all nurse education programs (Nursing and Midwifery Council, 2004; An Bord Altranais, 2005). To ensure safe nursing practice, the Nursing and Midwifery Council of the United Kingdom (2004, p.5) requires nurses to engage in a practice that is “based on the best available evidence” upon qualification. Similarly, the Irish Nursing Board (An Bord Altranais) expects students to “develop domains of competence and become safe, caring, competent decision-makers willing to accept personal and professional accountability for evidence-based nursing care” (An Bord Altranais, 2005, p.43). It could be argued that incorporating evidence-based practice principles, processes, and skills into nursing curricula can improve research dissemination and utilization, promote evidence-based nursing care, contribute to ongoing professional development, and foster a culture of life-long learning. Educational Preparation All undergraduate and postgraduate nurse education programs include research modules designed to help nurses develop the skills to read, critique, understand, and conduct research. Despite this, nurses struggle to translate theory learned in academic research modules into bedside practice (Thompson, 2006; Tarrier, Haddock, and Barrowclough, 1999; Grant & Mills, 2000; Milne, Westerman, and Hanner, 2002). Instilling and fostering research appreciation among nurses appears to be a lofty goal, as many nurses do not appear comfortable or competent in carrying out fundamental research principles, as McKenna, Ashton, and Keeney demonstrated (2004). However, if this ideal is not realized, it will continue to serve as a deterrent to conducting research or, worse, its practical application (Ferguson & Day, 2005). CARE, Glasgow Caledonian University and HealthQWest, ISSN: 1755-1412 5
Creating clinical practice guidelines based on research is also necessary for advancing evidence-based nursing (Fineout-Overholt et al., 2005; Killeen & Barnfather, 2005). Any program that promotes evidence-based practice should strive to provide students with the knowledge and skills they need to progress as active discerning consumers of research and practitioners of evidence-based practice (Thompson, 2006; Burns & Foley, 2005; Ciliska, 2005; Fineout-Overholt et al., 2005; Coomarasamy & Khan, 2004). The reviewed studies advocate for incorporating evidence-based practice into the curriculum (Thompson, 2006; Bradley et al., 2005; Burke et al., 2005; Burns & Foley, 2005; Ciliska, 2005; Coomarasamy & Khan, 2004). However, the findings could be clearer regarding integrating evidence-based practice into the curriculum and what teaching strategies will best achieve this integration (Bradley et al., 2005; Coomarasamy & Khan, 2004). Evidence-based practice has implications for nurse education, particularly the presentation and delivery of research to students. The importance of incorporating evidence-based practice into the curriculum has emerged as an immediate priority for nurse educators. To that end, it was decided that two undergraduate research modules coordinated and delivered by the researchers would be modified to embed an evidence-based practice culture through module content teaching and delivery. In an attempt to make the principles and process of evidence-based practice meaningful for students, teaching and assessment strategies were introduced around the process of evidence-based practice. Structured tutorials and a virtual learning environment to facilitate online discussions between lecturers and students were effective teaching and learning strategies. Collaboration with the subject librarian improved students’ ability to access and search databases and other literature sources strategically. The module’s continuous assessment component included an evidence-based practice project. This project was designed following the process of evidence-based practice, and lecturers provided ongoing support to students throughout the module as they developed their projects. The initiatives above were then formally evaluated as a research project using the Evidence-Based Practice Beliefs Scale (EBPB) and Evidence-Based Practice Implementation Scale (EBPI) (EBPI). CARE, Glasgow Caledonian University and HealthQWest, ISSN: 1755-1412 6
The project’s overall goal was to foster a culture of evidence-based practice at the undergraduate level and beyond by implementing tailored teaching and assessment methods within the academy. The study also sought to ascertain undergraduate student nurses’ attitudes and beliefs, knowledge level, and utilization of evidence-based practice after completing an evidence-based practice research module. The research design used was a descriptive exploratory approach with non-probability convenience sampling. It entailed the distribution of two different questionnaires (the Evidence-Based Practice Beliefs Scale (EBPB) and the Evidence-Based Practice Implementation Scale (EBPI)). Melnyk and Fineout-Overholt created these questionnaires (of the Centre for the Advancement of Evidence-Based Practice at Arizona State University). The developers graciously granted permission to use the questionnaires. The non-probability convenience sampling method was used for this study’s sampling. Subjects are chosen in a non-random manner using this method, with those most accessible and available on the day of data collection eligible to participate. However, the risk of bias increases, and in some cases, the generalizability of the research findings is limited (LoBiondo-Wood & Haber, 2006) because the sample may only partially represent the target population. The sample frame included 217 undergraduate nursing students currently pursuing degree-level studies. The sample consisted of students who were present in college on the day the data were collected. Data Collection After completing the modified module, two separate questionnaires (Evidence-Based Practice Beliefs Scale and Evidence-Based Practice Implementation Scale) were distributed. The questionnaires were created by CARE, Glasgow Caledonian University, and HealthQWest, ISSN: 1755-1412 7
Melnyk and Fineout-Overholt (of Arizona State University’s Center for the Advancement of Evidence-Based Practice) and their reliability and validity have been demonstrated, with Cronbach alpha coefficients ranging from 0.9 to 0.96 and factor analysis coefficients ranging from 0.6 to 0.8, respectively (Melnyk and Fineout-Overholt, personal communication, 12th April 2007). Two 5-point Likert-type questionnaires were used in the study to collect primary data on the attitudes and beliefs, knowledge level, and use of the evidence-based practice of undergraduate students who had completed a research module that had been modified to include the principles and process of evidence-based practice. On the EBP Beliefs Scale©, participants were asked to respond to each of the sixteen items, for example, ‘I believe that EBP results in the best clinical care for patients, ‘I believe that the care I deliver is evidence-based. On the EBP Implementation Scale, participants were asked to respond to each of the eighteen items on a 5-point Likert-type scale regarding the extent to which they implemented evidence-based practice in the previous eight weeks, such as ‘I used evidence to change my clinical practice’ or ‘I critically appraised evidence from a research study.’ Participants were required to circle their preferred statement options on both scales. The questionnaires were piloted before general distribution to identify any potential ambiguities, language difficulties, or other issues that needed to be addressed before the main study. Data Analysis The software package SPSS for Windows was used to summarize and interpret the study’s findings using descriptive and inferential statistics (Version 12.). Descriptive statistics described the sample’s characteristics. Correlations between individual items on each scale and correlations between the two scales were also investigated. The significance level was set at 0.05 (p = 0.05), with a 5% chance that the observed relationships occurred by chance. Ethical Considerations The School of Nursing Research and Teaching Ethics Committee and the University Ethics Committee both granted permission to conduct the study. The study included students who were dependent on the CARE, 1(1) CARE, Glasgow Caledonian University, and HealthQWest, ISSN: 1755-1412 8
The investigators played a role in the module evaluation because they were the coordinators for the two modules with eligible participants. A clear explanation of the proposed study was provided both verbally and in writing. Before submitting a completed questionnaire, participants were informed of their right to withdraw from the project at any time. The completion of a questionnaire was interpreted as informed consent. Participants were explicitly informed that their participation would have no negative impact on their assessment or exam grades. Participants were also informed that only the investigators would have access to the data, that their participation would be anonymous, and that any data submitted would be kept strictly confidential. Findings: 145 people participated in the total sampling frame of 217 people, representing a 66% response rate. Quantitative data from the questionnaires (Evidence-Based Practice Beliefs Scale (EBPB) and Evidence-Based Practice Implementation Scale (EBPI)) produced fascinating statistics on evidence-based practice beliefs, attitudes, and values, as well as, to a lesser extent, evidence-based practice implementation. On the EBP Beliefs Scale, potential summative scores ranged from 5 to 80.
The study sample’s mean summative score on this scale was 56.47. (SD 7.71). On the EBP Implementation Scale, potential summative scores ranged from 0 to 72. The study sample’s mean summative score on this scale was 18.21. (SD 9.32). Notably, a positive correlation (Pearson’s r) between the two scales (r =.347) indicated that the greater the belief in evidence-based practice, the greater the likelihood of evidence-based practice implementation. Participants strongly agreed that evidence-based practice results in the best clinical care for patients regarding direct patient care (M 4.54 SD 0.624). When participants were asked if they thought their care was evidence-based, their answers tended to cluster around the neutral value on the scale. These findings are reflected in the EBP Implementation Scale, indicating that evidence-based practice implementation requires significant attention. CARE, Glasgow Caledonian University and HealthQWest, ISSN: 1755-1412 9
Discussion of Findings Although the response rate could have been higher, at 66% of the sampling frame, it was still possible to draw meaningful conclusions from the data in terms of evidence-based practice beliefs and evidence-based practice implementation. The mean summative score of 56.47 (SD 7.71) on the EBP Beliefs Scale indicates that participants strongly prefer evidence-based practice. This bodes well for future patient care, assuming this tendency is translated into actual practice. It is critical to ensure that students, who will be future practitioners, use an evidence-based practice approach to underpin care. ‘Therein lies the rub,’ however. Given the results of the EBP Implementation Scale (M 18.21 SD 9.32), which showed that participants’ implementation of evidence-based practice could have been better, this remains a challenge. This low score could be explained by several factors.
First and foremost, students who took part in the study had spent the previous five weeks in college (at the beginning of the academic year) receiving theoretical instruction as part of their nursing program. As a result, their most recent clinical exposure could have been up to six months before they participated in the study.
Furthermore, this practice placement took place before any formal instruction on the principles and process of evidence-based practice.
Furthermore, given their level of experience and confidence, students may not feel sufficiently empowered to influence or drive change in practice. The factors mentioned earlier must be considered when planning similar studies in the future. When both scales were examined more closely, a positive correlation (Pearson’s r) was discovered (r =.347). This clearly shows that the stronger one’s beliefs about evidence-based practice, the more likely one is to implement evidence-based practice. Positive beliefs should be translated into best practices through education, thus improving patient outcomes. The results of the EBP Beliefs Scale show that this positive attitude was achieved in this sample of students. Subsequent research on this specific sample could show whether this positive attitude has translated into actual evidence-based practice implementation in patient care settings. Participants strongly agreed that evidence-based practice results in the best clinical care for patients regarding direct patient care. This is consistent with CARE, 1(1) CARE, Glasgow Caledonian University, and HealthQWest, ISSN: 1755-1412 10
The mean summative score on the EBP Beliefs Scale reaffirmed the positive attitude toward evidence-based practice. When asked if they thought their care was evidence-based, their responses tended to cluster around the neutral value on the scale, indicating a reluctance to either strongly agree’ or’strongly disagree’ on this item. While the response to this single item does not provide a conclusive answer, combined with the summative score for the EBP Implementation Scale, it may imply that practice in this sample is not evidence-based. While a single-site study has obvious limitations in terms of generalizability, the study did produce some enjoyable and reassuring data on students’ willingness and desire to engage in evidence-based practice. The original research design for this study was a pre-test / post-test quasi-experimental approach. This would have been more reliable than the non-experimental post-test design used. However, time constraints related to ethics approval resulted in an overall delay in the study’s start, by which time module instruction had already begun. As a result, it was decided that a post-test-only design would be more appropriate in this case. Conclusion Overall, the findings support current evidence that supports the incorporation of evidence-based practice into nursing curricula. We have a genuine opportunity to influence practice on a larger scale if we change the beliefs and attitudes of nursing students through our curriculum. According to Short, Kitchener, and Curran (2004) and Pearson, Field, and Jordan (2007), nursing teams that take a proactive role in the development and promotion of evidence-based practices will be the catalyst for optimal patient care. Educational and healthcare organizations must foster philosophies open to inquiry, change, and development. If optimum patient outcomes are to be achieved, practitioners’ skills and knowledge base must be fostered and enhanced through ongoing education, training, and support. Such strategies will result in a safer, more empowering organization for patients and employees, one that values patient-centered, cost-effective care.
QUESTION
400 words, minimum 2 references less than 5 years,APA 7 format, (SEE UPLOAD FILE FOR DETAILS, course description, learning outcomes, etc).