[Evidence-based practice in Bachelor of Nursing programmes in Austria, Germany, and Switzerland: A survey of general conditions, teaching content and methods]

BACKGROUND/AIM

Evidence-based practice (EBP) provides an important basis for improving both the quality of care and patient safety. Formulating a research question, searching the literature, and critical appraisal are crucial to developing evidence-based practice. The aim of this survey was to provide an overview of how these topics are integrated into bachelor's degree programs in nursing in Austria, Germany, and the German-speaking part of Switzerland. We also aimed to show how teachers implement these subjects and how they experience and assess the implementation.

METHOD

We conducted an exploratory cross-sectional study using an online survey sent out to program directors and teaching staff of all 58 bachelor's degree programs in nursing in Austria, Germany and the German-speaking part of Switzerland. For data collection, a questionnaire was developed containing items on general teaching conditions, contents, and methods of evidence-based nursing practice, as well as on the estimated thematic interest of students. The data were analysed descriptively.

RESULTS

The program directors returned 24 questionnaires (41%). Of 75 questionnaires forwarded to the faculty, 17 (23%) were received from nine programs. On average, 5.6 teaching units (SD 2.6) are used for formulating a research question, 10 teaching units (SD 4.1) for literature review, and 11.3 teaching units (SD 6.9) for critical appraisal. Half of the teaching staff indicated that linkages between education and nursing care practice have been established. The traditional teaching method of frontal teaching is used predominantly. Student interest in topics was rated as moderate by most teachers.

CONCLUSIONS

Topics on evidence-based practice are an integral part of bachelor's degree programs in nursing in German-speaking countries. An increase in teaching units, active learning methods and the growing interconnection between education and practice could improve the acquisition of competencies and attitudes of students regarding EBP and further advance its implementation in practice.

Evidence-informed practice versus evidence-based practice educational interventions for improving knowledge, attitudes, understanding, and behavior toward the application of evidence into practice: A comprehensive systematic review of UG student

Background

To produce graduates with strong knowledge and skills in the application of evidence into healthcare practice, it is imperative that all undergraduate health and social care students are taught, in an efficient manner, the processes involved in applying evidence into practice. The two main concepts that are linked to the application of evidence into practice are "evidence-based practice" and "evidence-informed practice." Globally, evidence-based practice is regarded as the gold standard for the provision of safe and effective healthcare. Despite the extensive awareness of evidence-based practice, healthcare practitioners continue to encounter difficulties in its implementation. This has generated an ongoing international debate as to whether evidence-based practice should be replaced with evidence-informed practice, and which of the two concepts better facilitate the effective and consistent application of evidence into healthcare practice.

Objectives

The primary objective of this systematic review was to evaluate and synthesize literature on the effectiveness of evidence-informed practice versus evidence-based practice educational interventions for improving knowledge, attitudes, understanding, and behavior of undergraduate health and social care students toward the application of evidence into practice. Specifically, we planned to answer the following research questions: (1) Is there a difference (i.e., difference in content, outcome) between evidence-informed practice and evidence-based practice educational interventions? (2) Does participating in evidence-informed practice educational interventions relative to evidence-based practice educational interventions facilitate the application of evidence into practice (as measured by, e.g., self-reports on effective application of evidence into practice)? (3) Do both evidence-informed practice and evidence-based practice educational interventions targeted at undergraduate health and social care students influence patient outcomes (as measured by, e.g., reduced morbidity and mortality, absence of nosocomial infections)? (4) What factors affect the impact of evidence-informed practice and evidence-based practice educational interventions (as measured by, e.g., course content, mode of delivery, multifaceted interventions, standalone intervention)?

Search Methods

We utilized a number of search strategies to identify published and unpublished studies: (1) Electronic databases: we searched Academic Search Complete, Academic search premier, AMED, Australian education index, British education index, Campbell systematic reviews, Canada bibliographic database (CBCA Education), CINAHL, Cochrane Library, Database of Abstracts of Reviews on Effectiveness, Dissertation Abstracts International, Education Abstracts, Education complete, Education full text: Wilson, ERIC, Evidence-based program database, JBI database of systematic reviews, Medline, PsycInfo, Pubmed, SciELO (Scientific Electronic Library Online), and Scopus; (2) A web search using search engines such as Google and Google scholar; (3) Grey literature search: we searched OpenGrey (System for Information on Grey Literature in Europe), System for information on Grey Literature, the Society for Research on Educational Effectiveness, and Virginia Henderson Global Nursing e-Repository; (4) Hand searching of journal articles; and (5) Tracking bibliographies of previously retrieved studies. The searches were conducted in June 2019.

Selection Criteria

We planned to include both quantitative (including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies) and qualitative primary studies (including, case series, individual case reports, and descriptive cross-sectional studies, focus groups, and interviews, ethnography, phenomenology, and grounded theory), that evaluate and compare the effectiveness of any formal evidence-informed practice educational intervention to evidence-based practice educational intervention. The primary outcomes were evidence-informed practice and evidence-based practice knowledge, attitudes, understanding, and behavior. We planned to include, as participants, undergraduate pre-registration health and social care students from any geographical area.

Data Collection and Analysis

Two authors independently screened the search results to assess articles for their eligibility for inclusion. The screening involved an initial screening of the title and abstracts, and subsequently, the full-text of selected articles. Discrepancies were resolved through discussion or consultation with a third author. We found no article eligible for inclusion in this review.

Main Results

No studies were found which were eligible for inclusion in this review. We evaluated and excluded 46 full-text articles. This is because none of the 46 studies had evaluated and compared the effectiveness of evidence-informed practice educational interventions with evidence-based practice educational interventions. Out of the 46 articles, 45 had evaluated solely, the effectiveness of evidence-based practice educational interventions and 1 article was on evidence-informed practice educational intervention. Hence, these articles were excluded as they did not meet the inclusion criteria.

Authors' Conclusions

There is an urgent need for primary studies evaluating the relative effectiveness of evidence-informed practice and evidence-based practice educational interventions targeted at improving undergraduate healthcare students' competencies regarding the application of evidence into practice. Such studies should be informed by current literature on the concepts (i.e., evidence-informed practice and evidence-based practice) to identify the differences, similarities, as well as appropriate content of the educational interventions. In this way, the actual effect of each of the concepts could be determined and their effectiveness compared.

Core Evidence-Based Practice Competencies and Learning Outcomes for European Nurses: Consensus Statements

Background

Consensus on evidence‐based practice (EBP) competencies and associated learning outcomes for registered nurses has not yet been achieved in the European context.

Aims

To establish a set of core EBP competencies for nurses and the most important EBP learning outcomes encompassing attitudes, knowledge, and skills dimensions for implementation into nursing education in European countries.

Methods

A multi‐phase modified Delphi survey was conducted: Phase 1, a literature review; Phase 2, a two‐round consensus of experts; and Phase 3, a Delphi survey. Experts from six European countries participated.

Results

In Phase 1, 88 records were selected and 835 statements extracted, which were grouped according to the seven steps of EBP. After removing 157 duplicates, the remaining competencies (n = 678) were evaluated in Phase 2. Then, a two‐round expert consensus was reached, with 24 competencies and 120 learning outcomes identified and divided into affective, cognitive, and skills domains. In Phase 3, based on a Delphi survey expert consensus, all evaluated statements were included in a final set of competencies and learning outcomes. Only two learning outcomes were recommended for allocation to a different domain, and four were reformulated as suggested, with no further changes to the others.

Linking Evidence to Action

The set of EBP competencies and learning outcomes can guide nurse educators, managers, and EBP stakeholders in the development of content that incorporates EBP knowledge, skills, and attitudes into educational programs. Prioritizing the EBP competencies and learning outcomes that are most necessary and adapting them to every context will provide healthcare organizations with guidelines for enhancing the continuing education of nurses. These results could facilitate the development of effective tools for assessing nursing students’ and nurses’ perception of competencies required for EBP processes.

Teaching evidence-based nursing practice: A systematic review and convergent qualitative synthesis

BACKGROUND

The benefits that ensue evidence-based nursing practice (EBNP) in health care settings have been globally communicated to the nurses. However, the current clinical activities surrounding EBNP demand the involvement of nursing schools to accelerate this practice.

OBJECTIVES

The purpose of this study was to synthesize, describe, and explore the evidence available to teach EBNP to undergraduate student nurses, so the students can continue to integrate EBNP in clinical settings upon becoming professional nurses.

DESIGN

Systematic review with convergent qualitative synthesis.

DATA SOURCES

Five electronic databases were searched; CINAHL, MEDLINE, EMBASE, ERIC, and Web of Science Core Collection.

REVIEW METHODS

This study followed the guidelines for writing systematic reviews by the Joanna Briggs Institute.

RESULTS

Two themes were generated; educational strategies, and EBNP knowledge and implementation. The latter theme had six sub-themes of timing, duration, content, delivery method, context, and prerequisites while the former theme had four sub-themes of knowledge acquisition, EBNP use and research utilization, collaborative teaching, and barriers and facilitators.

CONCLUSION

Well-designed educational strategies have a positive impact on students' EBNP knowledge and skills. These strategies are well suited for promoting EBNP implementation in clinical settings when students qualify as nurses.

Nursing student and faculty competency improvement through a nurse-bridging program in Cambodia

BACKGROUND

An adequate number of high-quality nurses are a key factor for superior patient outcomes. However, in 2015, Cambodia reported only 52 nurses with bachelor's degrees, three with master's degrees, and one with a doctorate. The fast track to getting a highly educated nursing workforce requires providing a bridging program for associate's degree nurses to achieve baccalaureate degrees.

OBJECTIVES

To assess improvement in the competency of nursing students and faculty members through a program that prepares associate's degree nurses to obtain bachelor's degrees in Cambodia.

DESIGN

Mixed methods.

SETTING

Educational institutes in Phnom Penh, Cambodia.

PARTICIPANTS

A total of 45 Cambodian nursing students participated in the Cambodian nurse-bridging program and 12 Cambodian faculty members served as co-teachers.

METHODS

We conducted three surveys to compare the competence of nursing students and faculty members before, during, and after the bridging program. We conducted focus-group interviews to support the qualitative results and explored changes in student and faculty competencies after the program.

RESULTS

Quantitative analysis revealed significant improvements in students' nursing competency (p < .001), critical thinking (p < .001), and research competency (p < .001) and faculty members' teaching competency (p < .001) and research competency (p < .001) after the program. Through qualitative analysis, students showed improvement in physical assessment, patient communication, critical thinking, evidence-based nursing, and research competency. Faculty members indicated they had experienced new teaching strategies and subjects, gained increased confidence in teaching, and even though research competency had been improved, more training was required.

CONCLUSIONS

This study provides evidence to support the effectiveness of higher nurse education in developing countries, and illustrates an opportunity to produce high-quality human resources in nursing.

Knowledge, skills and attitudes related to evidence-based practice among undergraduate nursing students: A survey at three universities in Colombia, Chile and Spain

Teaching nursing students about the model of evidence-based practice is a challenge for university faculty. The aim of this study was to measure knowledge, skills and attitudes related to evidence-based practice among undergraduate nursing students, as well as associated factors. The study involved a cross-sectional design using a survey of all students enrolled in a Bachelor of Nursing programme (1st to 4th year) in three nursing faculties of universities in Chile, Colombia and Spain. The Spanish version of the Evidence-Based Competence Questionnaire was used to measure knowledge, skills, attitudes and overall competency. In total, 875 students completed the questionnaire. The overall score of competency in evidence-based practice was similar in all three universities (range 1-5) (3.63 in Chile, 3.58 in Colombia and 3.68 in Spain). The score of self-rated attitudes was strongly correlated with the overall competency measured. More hours of training in research methods and reading nursing journals articles in the last month were the factors associated with higher scores in evidence-based practice competency. The undergraduate nursing students at the three universities surveyed obtained a high score in overall competency in evidence-based practice. No differences were found among them, despite the different approaches used in educational programmes.

Endeavoring to Contextualize Curricula Within an EBP Framework: A Grounded Theory Study

Adopting evidence-based practice (EBP) principles in undergraduate education can facilitate nursing students' appreciation of EBP. Using grounded theory method, this study aimed to explore processes used by nurse academics while integrating EBP concepts in undergraduate nursing curricula across Australian universities. Twenty-three nurse academics were interviewed and nine were observed during teaching of undergraduate students. In addition, 20 unit/subject guides were analyzed using grounded theory approach of data analysis. The theory " On a path to success: Endeavoring to contextualize curricula within an EBP framework" reflects academics' endeavors toward linking EBP concepts to practice, aiming to contextualize curricula in a manner that engages students within an EBP framework. However, academics' journeys were influenced by several contextual factors which require strategies to accomplish their endeavors. In conclusion, initiatives to minimize barriers, faculty development, and provision of resources across educational and clinical settings are fundamental to achieving undergraduate curricula underpinned by EBP concepts.

Effectiveness of an evidence-based practice (EBP) course on the EBP competence of undergraduate nursing students: A quasi-experimental study

BACKGROUND

International nursing institutions and experts recommend evidence-based practice (EBP) as a core component of the curriculum for nurses. However, the impact of EBP training on the competence of undergraduate nursing students remains unclear.

OBJECTIVES

To evaluate the effectiveness of an EBP course on the EBP competence undergraduate nursing students'.

DESIGN

Quasi-experimental study carried out in non-randomized intervention and control groups.

SETTINGS

The study was conducted in a Spanish public university in 2010.

PARTICIPANTS

Out of 420 second- and third-year nursing students, 75 were enrolled in the EBP course, forming the intervention group, and 73 were not enrolled in this course were recruited as controls.

PROCEDURE

The educational intervention was a 15-week course designed to teach EBP competence. The EBP Competence Questionnaire (EBP-COQ) was administered before and after the intervention. Repeated-measure ANOVA was used to compare intervention and control group scores before and at two months after the 15-week intervention period.

RESULTS

At 2months after the EBP course, mean EBP-COQ scores of the intervention group were significantly improved versus baseline in attitude (4.28 vs. 3.33), knowledge (3.92 vs. 2.82) and skills (4.01 vs. 2.75) dimensions, whereas little change was observed in control group scores over the same time period. Repeated-measures ANOVA revealed a significant effect of Time ×Group interaction on global competence and all three EBP-COQ dimensions.

DISCUSSIONS

Undergraduate nursing students experience positive changes in EBP competence, knowledge, skills, and attitude as the result of a 15-week educational intervention on EBP. This EBP course may provide nursing school educators and policymakers with a useful model for integrating EBP teaching within the nursing curriculum.

Educational strategies for teaching evidence-based practice to undergraduate health students: systematic review

PURPOSE

The aim of this systematic review was to find best teaching strategies for teaching evidence-based practice (EBP) to undergraduate health students that have been adopted over the last years in healthcare institutions worldwide.

METHODS

The authors carried out a systematic, comprehensive bibliographic search using Medline database for the years 2005 to March 2015 (updated in March 2016). Search terms used were chosen from the USNLM Institutes of Health list of MeSH (Medical Subject Headings) and free text key terms were used as well. Selected articles were measured based on the inclusion criteria of this study and initially compared in terms of titles or abstracts. Finally, articles relevant to the subject of this review were retrieved in full text. Critical appraisal was done to determine the effects of strategy of teaching evidence-based medicine (EBM).

RESULTS

Twenty articles were included in the review. The majority of the studies sampled medical students (n=13) and only few conducted among nursing (n=2), pharmacy (n=2), physiotherapy/therapy (n=1), dentistry (n=1), or mixed disciplines (n=1) students. Studies evaluated a variety of educational interventions of varying duration, frequency and format (lectures, tutorials, workshops, conferences, journal clubs, and online sessions), or combination of these to teach EBP. We categorized interventions into single interventions covering a workshop, conference, lecture, journal club, or e-learning and multifaceted interventions where a combination of strategies had been assessed. Seven studies reported an overall increase to all EBP domains indicating a higher EBP competence and two studies focused on the searching databases skill.

CONCLUSION

Followings were deduced from above analysis: multifaceted approach may be best suited when teaching EBM to health students; the use of technology to promote EBP through mobile devices, simulation, and the web is on the rise; and the duration of the interventions varying form some hours to even months was not related to the students' EBP competence.

Current state of evidence-based practice education for undergraduate nursing students in Taiwan: A questionnaire study

BACKGROUND

Evidence-based practice (EBP) has been emphasized as the core competency of undergraduate nursing students and must be cultivated before graduation. However, there is limited information of EBP education for undergraduate nursing students in Taiwan.

OBJECTIVES

The purpose of this study was to investigate the current state of EBP education for undergraduate nursing students in Taiwan.

DESIGN

A self-developed questionnaire, validated by experienced educators, was designed to explore curriculum design, teaching resources, qualification of teachers, and barriers regarding EBP education.

PARTICIPANTS

A total of 21 nursing schools and colleges participated. The chair of each recommended a faculty member involved in teaching EBP as the school's representative to fill out the questionnaire.

RESULTS

Among the 21 nursing schools and colleges, 18 (85.7%) had implemented EBP education in the curriculum. Among these schools, 22.2% conducted an independent EBP course, 50% incorporated EBP concepts into other courses, and the remainder offered both kinds of EBP courses. Multiple strategies were incorporated to teach the EBP. Less than 35% of the schools had designed or adopted standardized teaching materials and evaluated students' learning outcomes. Although 55.6% of the schools reimbursed faculty for participation in EBP training, 39% of their faculty members who taught EBP did not receive any EBP training. Shortage of qualified faculty and limited opportunity to involve students in evidence-based applications were reported as major obstacles to teaching EBP.

CONCLUSIONS

EBP education has already gained the attention of nursing schools in Taiwan. However, lack of comprehensive EBP training among teachers and the difficulty of teaching clinical application of EBP require special consideration. In order to promote EBP education in undergraduate nursing curriculums, we suggest that nursing schools reinforce and support faculty to participate in formal EBP training. Also needed is a systematic curriculum design with multiple teaching strategies and links with clinical practicum.

Nursing Students' Competencies in Evidence-Based Practice and Its Related Factors

Background:

Evidence-Based Practice (EBP) is one of the nursing professional roles that can lead them to provide the best and more effective care. However, no studies are available on nursing students’ competencies in EBP.

Objectives:

This study aimed to investigate the nursing students’ knowledge, attitude and intention to implement EBP and its related factors in two nursing and midwifery faculties in Tehran, Iran.

Materials and Methods:

In this cross-sectional study, 170 undergraduate nursing students were selected from two faculties of nursing and midwifery in Tehran, Iran. A census sampling method was applied and they were all before graduation in 2013. The Rubin and Parrish questionnaire was used to assess the students’ knowledge, attitude and intention to implement EBP as well as factors affecting the implementation of EBP. Students completed the instrument through self-report. Descriptive statistics, Independent sample t-test and Pearson correlation coefficient were used to analyze the data.

Results:

The students mean scores of knowledge, attitude and intention to implement EBP was 31.08 ± 5.77, 50.40 ± 9.58, 36.01 ± 4.64, respectively. The students’ age was inversely correlated with their scores of knowledge, attitude and intention to use EBP (P < 0.05). However, the students’ GPA was in direct association with their knowledge, attitude and intention to implement EBP (P < 0.05). No significant differences were observed between the males and females mean scores in the three subscales. However, significant differences were found between the students mean scores in the two subscales of knowledge and attitudes toward EBP in terms of familiarity with statistics and research methods (P < 0.05). Neither familiarity with research methods nor familiarity with EBP could significantly affect the students’ intention to implement EBP.

Conclusions:

The present study showed that nursing students have not a high mean score in the three subscales of knowledge, attitude and intention to implement EBP. It is essential for faculties and nurse managers not only to focus on education of EBP, but also to support nurses and nursing students to implement it in the process patient care.

The Call for 80% BSNs by 2020: Where Are We Now?

Many associate degree nurses are returning to school for a baccalaureate degree in nursing. This has resulted in changes in admission processes and delivery options in RN-to-BSN programs. As the number of completion programs increases, so do the ways in which nurse educators create positive learning environments for these students. Opportunities exist for faculty to encourage and promote the success of the RN-to-BSN student.

Improving the adoption of evidence-based practice through RN-to-BSN education

BACKGROUND

Although enrollment in RN-to-BSN degree completion programs has grown profoundly, a dearth of literature exists regarding the impact of RN-to-BSN education and the adoption of evidence-based practice (EBP). This study examined the elements of RN-to-BSN education that improve the awareness and adoption for EBP.

METHOD

A mixed methods meta-synthesis was conducted using qualitative, textual-narrative, and descriptive research studies. Data from six articles were analyzed, using standardized critical appraisal instruments.

RESULTS

Two findings were identified. First, EBP skills for RN-to-BSN students are influenced by exposure to educational partnerships, contextual teaching and learning, and practice experiences. Second, barriers to adoption exist for RN-to-BSN students, which limit advances in nursing practice.

CONCLUSION

A variety of contextual teaching and learning strategies can provide empowerment for RN-to-BSN students to adopt EBP in their practice. Forming partnerships in creating EBP experiences may set the stage for RN-to-BSN leadership opportunities in today's health care system.

Projeto Evidência: investigação e formação sobre acesso a bases de dados de informação científica nos Açores

O projeto Evidência visa estimular os enfermeiros na utilização das bases de dados de informação científica. Este estudo teve por objetivos desenhar uma intervenção formativa facilitadora do acesso a essas bases de dados por parte dos enfermeiros, efetuar avaliação de diagnóstico relativamente aos hábitos dos enfermeiros quanto a esse tipo de ferramenta e determinar o impacto de uma intervenção formativa sobre essas matérias entre os enfermeiros residentes nos Açores. Em termos metodológicos, foi desenhado um projeto de intervenção e realizado um estudo quantitativo, do tipo descritivo, para avaliar esse impacto aos dois e cinco mêses após a formação, em dimensões como o conhecimento, hábitos e objetivos de utilização. No projeto participaram 192 enfermeiros, e os resultados apontam para um impacto positivo dessa formação, não só no aumento da frequência de utilização das bases de dados de informação científica, como na autopercepção de competência na sua utilização e motivos invocados para explorar esse tipo de informação.

Using evidence-based practice in the school health room

School nurses should be engaging in evidence-based practice (EBP) in their health room settings as supported by the initiatives of the Institute of Medicine. EBP is a set of skills that health professionals can use in order to ensure high quality and current clinical care is provided. School nurses are faced with a diverse and complex population of children and often work in isolation from nursing peers, which can lead to limited professional peer discussions about recent changes or outdated clinical practices. EBP combines the use of evidence from the literature, expert guidelines, clinician expertise and client preferences in order to provide optimum care. This article leads the school nurse through the process and use of EBP in the school setting.

The cross-level impact of patient safety climate on nursing innovation: a cross-sectional questionnaire survey

AIMS AND OBJECTIVES

To explore the cross-level effects of the four dimensions of patient safety climate on nursing innovation.

BACKGROUND

Across the globe, nursing innovation is highly encouraged by nursing experts to improve nursing outcome. Nursing innovation, in turn, is affected by organisational climate, and a critical aspect of organisational climate is patient safety.

DESIGN

This is a cross-sectional study.

METHODS

We employed a questionnaire survey to collect data and selected nurses from Taiwan hospitals as samples. A total of 808 valid questionnaires in 172 teams of four hospitals were collected. Patient safety climate was aggregated by individual-level data; thus, we examined r(wg) , ICC 1 and ICC 2. Hierarchical linear modelling was used to analyse the data.

RESULTS

Of these three dimensions of nursing innovation, the level of knowledge creation was perceived by the nurses as the highest. In terms of patient safety climate, managerial practices regarding patient safety scored the highest, followed by patient safety procedures, patient safety information flow and patient safety priority. Only patient safety information flow yielded a significant positive influence on knowledge creation, innovation behaviour or innovation diffusion.

CONCLUSION

Hospital nurses do achieve better performance in knowledge creation. Patient safety information flow has positive and cross-level impact on nursing innovation; therefore, the method to increase safety information flow is the key focus of nursing innovation management.

RELEVANCE TO CLINICAL PRACTICE

Through the improvements made in patient safety climate, hospital managers could promote the development of nursing innovation. Patient safety information flow is positively associated with nursing innovation. Patient safety information could be integrated in nursing training in all levels. Rules and procedures regarding patient safety should be drafted in simple and clear terms. A procedure to review and revise the rules and procedures will also be helpful in improving patient safety information flow.