Enhancing utility and understanding of evidence based practice through undergraduate nurse education

Evidence based practice is not a new concept in nursing; indeed the Briggs report [9] suggested that nursing should become a ‘research based’ profession. Despite this, recent research undertaken with over 1000 newly qualified nurses across Europe suggested they are uncertain about their intention to use research evidence [10] and international literature suggests that students can still struggle to understand the relevance of evidence based practice to nursing [11]. Nonetheless, present-day nursing demands that nurses provide care that is based on best available evidence, as opposed to care based solely on tradition or authority [12]. To do so, nursing education providers need to ensure they build capacity in undergraduate nursing students to equip them with the skills to understand the importance and application of EBP.

Current research demonstrates that student nurses generally acknowledge the role that EBP plays in clinical practice. Indeed a recent study of undergraduate student nurses noted that most participants reported a positive attitude towards EBP, with a majority indicating that it was important for practice and quality of patient car [13]. Additionally, empirical evidence has demonstrated that undergraduate student nurses overwhelmingly support the notion that EBP can improve clinical practice.[14]. Despite this, undergraduate student nurses still favour EBP courses less than other core modules in their curriculum [14]. Additionally, there is a necessity for meticulous planning of how EBP is delivered in undergraduate curriculum. Indeed a recent study indicated that prior to a ‘reshaping of the perception of EBP’ course the majority of undergraduate student nurses had indicated that they did not fully grasp how to link EBP to clinical practice and that their general attitude had been negative towards EBP [15]. Thus when developing EBP educational initiatives, careful consideration must be given not only to EBP skills such as critiquing but also to the relevance of EBP to nursing.

The evidence above was instrumental for module coordinators (JR and CL) when designing a new EBP module (Evidence Based Nursing 1, EBN1) for year 1 of a 3 year undergraduate nursing degree programme. This was a core module, accounting for 40 CATS of an undergraduate year 1 programme, made up of 24 h of tutorials and 48 h of lectures. The coordinators took steps to ensure the content was grounded in practice. These steps included discrete slides per lecture on applicability to practice; a theory to practice link on each page of a specially designed EBN 1 e-resource; and a video or audio clip from a current member of staff discussing how their own research directly informs practice. This innovative approach and focus on practice ensured the module co-ordinators were utilising different skills to help teach EBP [14]. Indeed, various approaches to teaching such as large lectures, small group tutorials, an eResource, and the use of student response systems (a small key pad held by each student where they can select an answer to questions posed by the lecturer, answers from the entire class are displayed in bar charts immediate after the student selects their response) were integrated into the delivery of this module to provide teaching methods reflective of the subject area. The use of differing teaching strategies in EBP aligns with previous research which highlighted the need for multilevel support when delivering an EBP teaching program [16]. There is no doubt that EBP is a challenging subject for all those involved and that it presents significant challenges to academic institutions if it is to be delivered well. Many resources need to be in place for there to be a positive uptake by students and the planning of the module and development of resources was extremely time consuming during the first year of the module development. Additionally, as highlighted within the literature [17] the module coordinators were cognisant of the skill base of those teaching EBP to students in order to determine an awareness of complementary skills that will generally aid in the positive delivery of EBP. Thus within the EBN1 module the module coordinators were supported by a teaching team with expertise in both research methods and nursing practice.

Evidence based practice is a seven step process [6]: (1) cultivate a spirit of inquiry; (2) formulate and answerable question; (3) Systematic search for research evidence; (4) appraisal of the validity, relevance, and applicability of the evidence; (5) integration of the research evidence with the clinical expertise of the practitioner and the wishes and desires of the patient / family; (6) Implementation of the evidence – based decision and evaluation of the outcomes; and (7) dissemination of the results. Numerous approaches have been proposed for the integration of EBP into undergraduate nurse education and the need for organisation support is also evidence [16]. Within this current study, the University sought to develop EBP modules across year 1, 2 and 3 of a 3 year degree in nursing program, this paper will evaluate year 1 which incorpatedEBN1.

This pilot pre-test post-test study used a prospective descriptive exploratory approach using non-probability convenience sampling of all undergraduate student nurses taking the compulsory “Evidence Based Nursing Modules 1” at a large teaching university within the United Kingdom was conducted from September 2014 to September 2015. This research involved students anonymously completing two validated scales (Evidence Based Practice Beliefs Scale© (EBPB) and Evidence Based Practice Implementation Scale© (EBPI)) [18] online via SurveyMonkey. The EBPB scale contains 16 items that are scored on a five point Likert scale, ranging from strongly disagree (1) to strongly agree (5). The EBPI scale contains 18 items, and are scored on a 5 point frequency scale reflecting the amount of times students implemented each of the 18 items inside the last 8 weeks (0 = 0 times and 4 = > 8).

Evidence Based Nursing 1 is core module (1/4 of the year 1 undergraduate course) in undergraduate nursing education within the recruiting university. The module runs across the entirety of year 1 undergraduate nurse education. The module utilises a blended learning approach using lectures, small group teaching and an online eResource (with formative and summative assessment built in).

Data collection was at two time points: Time 1 prior to undertaking the Evidence Based Nursing 1 (September 2014); and Time 2 on completion of year 1 (August 2015) and Evidence Based Nursing Module 1). Students were emailed an invitation letter from the principle investigator (JR) with a link to the data collection site. All data was collected anonymously online via SurveyMonkey.

Demographic data including specialism studied (adult nursing, mental health nursing, or learning disability nursing), gender and age was collected from all participants. Students were also asked to complete two scales: (Evidence Based Practice Beliefs Scale© and Evidence Based Practice Implementation Scale© [18]. The reliability and validity of the scales have been demonstrated with both cronbach alpha and Spearmans-Brown reliability coefficients >.85 for each scale [18].

School Research Ethics was granted in June 2014 to conduct this study. A clear description of the pilot pre-test post-test study was given both verbally and in writing to all potential participants. All potential participants were advised that: participation was voluntary; they had a right to withdraw from the project anytime; that their participation (or not) will not have an effect on their assessment or marks; only the investigator would have access to the raw data; that the results from this study would be published and presented at conferences; and that involvement would be anonymous. Potential participants were emailed a link to the SurveyMonkey site where all data was collected at Time 1 and 2. Submission of the completed questionnaire on Survey Monkey was taken as consent.

All data was collected and automatically collated online via SurveyMonkey. Quantitative descriptive and non-parametric statistics (Mann-Whitney U test) were used to summarise and interpret the findings of this study. All data was collected anonymously via survey monkey and then transferred into SPSS for data analysis. All anonymised data was analysed independent of the chief investigator (JR), by a third party outside the research team (DS).

As with any study there are limitations to this work. Firstly, this study did not include a control group and thus it is impossible to distinguish between the effect of providing the first year of a nursing degree programme without providing EBN1 and these results presented within this paper (first year of degree programme which incorporated EBN1). This data was anonymously submitted by students and therefore we can’t be sure that the people who provided data at follow-up actually gave baseline data; additionally responders may not be typical of the class as a whole. Additionally, the total numbers of undergraduate student nurses in this cohort was 311 and of this only 124 completed data collection at Time 1 and 56 at Time 2, thus data may not be comparable to all students. Finally, because we cannot look at individual pairs but have to look at pre and post groups the study may be under-powered, but we are constrained in this regard by the number of students per intake and the voluntary participation that is a requirement of this study. Nonetheless, these very positive set of findings, even given the limitations, illustrate that attending the EBN1 module has a major impact on EBP beliefs and implementation scores, which have direct applicability to the learning outcomes of the module.