Preparing clinical preceptors to support nursing students in evidence-based practice

Between challenges and support: Preceptors run clinical nursing training amidst unprecedented crisis

Aim

This study aimed to address challenges facing nurse preceptors related to multifaceted educational roles, academic and institutional support during the COVID-19 pandemic in the Kingdom of Bahrain.

Background

Clinical nurse preceptors have faced great challenges since the influx of the COVID-19 pandemic. At this unprecedented time, they are overwhelmed with additional responsibilities to follow the COVID-19 precautionary measures alongside their usual educational role. So, they require careful preparation and massive institutional support.

Design

A descriptive study was conducted in different clinical settings in the Kingdom of Bahrain.

Methods

A sample of 125 clinical nurse preceptors who participated in the students' training for at least one full clinical rotation during the COVID-19 pandemic responded to two questionnaires regarding the clinical nurse preceptor role, preparedness, and institutional support provided to them during the COVID-19 crisis.

Result

It is revealed that 40.8%, 51.0%, and 53.0% of the preceptors faced major challenges regarding the teacher, facilitator, and feedback provider/evaluator roles during the COVID-19 pandemic. Moreover, 71.2% of the preceptors were incredibly overwhelmed with additional instructions related to COVID-19 precautions alongside covering course learning objectives for the students. However, most of them did not perceive challenges concerning both academic and institutional support.

Conclusion

The clinical nurse preceptors declared they received adequate pedogeological preparation, academic and institutional support throughout the COVID-19 pandemic. They also encountered moderate and minor challenges while mentoring nursing students during such a critical era.

Educational Interventions for Teaching Evidence-Based Practice to Undergraduate Nursing Students: A Scoping Review

Background: Evidence-based practice (EBP) is the appropriate approach to guide healthcare personnel in their clinical practice. Despite the importance of EBP, undergraduate nursing students are not very much engaged and have a lack of knowledge and skills. Aim: The aim of this study was to gather, assess and synthesize evidence on educational interventions promoting evidence-based practice competencies in traditional undergraduate nursing students. Methods: This is a scoping review on sixteen English and non-English databases. A data extraction form was established including authors, year of publication, country, types of participant, specific objectives, study design, educational intervention, comparison if existed, and outcomes of significance. Results: The search strategy retrieved 8901 records in total. After screening for duplicates and eligibility, 20 articles were included in the qualitative synthesis. Improvement in EBP domains such as knowledge, skills, attitudes/behaviours, EBP beliefs, use, practice, level of evidence, critical thinking and future use of EBP were mentioned and assessed in different studies. Conclusions: EBP training can improve nursing students' capacity in healthcare provision. Teaching EBP competencies along undergraduate nursing curricula should be a high priority at nursing programmes. The use of innovative approaches seems to be more effective than traditional ways. Education of EBP increases its future use and critical thinking and EBP programs improve self-efficacy and the level of evidence utilization.

Measures of evidence-informed decision-making competence attributes: a psychometric systematic review

Background

The current state of evidence regarding measures that assess evidence-informed decision-making (EIDM) competence attributes (i.e., knowledge, skills, attitudes/beliefs, behaviours) among nurses is unknown. This systematic review provides a narrative synthesis of the psychometric properties and general characteristics of EIDM competence attribute measures in nursing.

Methods

The search strategy included online databases, hand searches, grey literature, and content experts. To align with the Cochrane Handbook of Systematic Reviews, psychometric outcome data (i.e., acceptability, reliability, validity) were extracted in duplicate, while all remaining data (i.e., study and measure characteristics) were extracted by one team member and checked by a second member for accuracy. Acceptability data was defined as measure completion time and overall rate of missing data. The Standards for Educational and Psychological Testing was used as the guiding framework to define reliability, and validity evidence, identified as a unified concept comprised of four validity sources: content, response process, internal structure and relationships to other variables. A narrative synthesis of measure and study characteristics, and psychometric outcomes is presented across measures and settings.

Results

A total of 5883 citations were screened with 103 studies and 35 unique measures included in the review. Measures were used or tested in acute care (n = 31 measures), public health (n = 4 measures), home health (n = 4 measures), and long-term care (n = 1 measure). Half of the measures assessed a single competence attribute (n = 19; 54.3%). Three measures (9%) assessed four competence attributes of knowledge, skills, attitudes/beliefs and behaviours. Regarding acceptability, overall missing data ranged from 1.6–25.6% across 11 measures and completion times ranged from 5 to 25 min (n = 4 measures). Internal consistency reliability was commonly reported (21 measures), with Cronbach’s alphas ranging from 0.45–0.98. Two measures reported four sources of validity evidence, and over half (n = 19; 54%) reported one source of validity evidence.

Conclusions

This review highlights a gap in the testing and use of competence attribute measures related to evidence-informed decision making in community-based and long-term care settings. Further development of measures is needed conceptually and psychometrically, as most measures assess only a single competence attribute, and lack assessment and evidence of reliability and sources of established validity evidence.

Registration

PROSPERO #CRD42018088754.

Undergraduate nursing students' attitudes and use of research and evidence-based practice - an integrative literature review

AIMS AND OBJECTIVES

This integrative review of the literature addresses undergraduate nursing students' attitudes towards and use of research and evidence-based practice, and factors influencing this. Current use of research and evidence within practice, and the influences and perceptions of students in using these tools in the clinical setting are explored.

BACKGROUND

Evidence-based practice is an increasingly critical aspect of quality health care delivery, with nurses requiring skills in sourcing relevant information to guide the care they provide. Yet, barriers to engaging in evidence-based practice remain. To increase nurses' use of evidence-based practice within healthcare settings, the concepts and skills required must be introduced early in their career. To date, however, there is little evidence to show if and how this inclusion makes a difference.

DESIGN

Integrative literature review.

METHODS

ProQuest, Summon, Science Direct, Ovid, CIAP, Google scholar and SAGE databases were searched, and Snowball search strategies used. One hundred and eighty-one articles were reviewed. Articles were then discarded for irrelevance. Nine articles discussed student attitudes and utilisation of research and evidence-based practice.

RESULTS

Factors surrounding the attitudes and use of research and evidence-based practice were identified, and included the students' capability beliefs, the students' attitudes, and the attitudes and support capabilities of wards/preceptors.

CONCLUSIONS

Undergraduate nursing students are generally positive toward using research for evidence-based practice, but experience a lack of support and opportunity. These students face cultural and attitudinal disadvantage, and lack confidence to practice independently. Further research and collaboration between educational facilities and clinical settings may improve utilisation.

RELEVANCE TO CLINICAL PRACTICE

This paper adds further discussion to the topic from the perspective of and including influences surrounding undergraduate students and new graduate nurses.

Impact of a Multifaceted and Clinically Integrated Training Program in Evidence-Based Practice on Knowledge, Skills, Beliefs and Behaviour among Clinical Instructors in Physiotherapy: A Non-Randomized Controlled Study

Background and Purpose

Physiotherapists practicing at clinical placement sites assigned the role as clinical instructors (CIs), are responsible for supervising physiotherapy students. For CIs to role model evidence-based practice (EBP) they need EBP competence. The aim of this study was to assess the short and long term impact of a six-month multifaceted and clinically integrated training program in EBP on the knowledge, skills, beliefs and behaviour of CIs supervising physiotherapy students.

Methods

We invited 37 CIs to participate in this non-randomized controlled study. Three self-administered questionnaires were used pre- and post-intervention, and at six-month follow-up: 1) The Adapted Fresno test (AFT), 2) the EBP Belief Scale and 3) the EBP Implementation Scale. The analysis approach was linear regression modeling using Generalized Estimating Equations.

Results

In total, 29 CIs agreed to participate in the study: 14 were invited to participate in the intervention group and 15 were invited to participate in the control group. One in the intervention group and five in the control group were lost to follow-up. At follow-up, the group difference was statistically significant for the AFT (mean difference = 37, 95% CI (15.9 -58.1), p<0.001) and the EBP Beliefs scale (mean difference = 8.1, 95% CI (3.1 -13.2), p = 0.002), but not for the EBP Implementation scale (mean difference = 1.8. 95% CI (-4.5-8.1), p = 0.574). Comparing measurements over time, we found a statistically significant increase in mean scores related to all outcome measures for the intervention group only.

Conclusions

A multifaceted and clinically integrated training program in EBP was successful in improving EBP knowledge, skills and beliefs among CIs. Future studies need to ensure long-term EBP behaviour change, in addition to assessing CIs’ abilities to apply EBP knowledge and skills when supervising students.