Evidence-based practice (EBP) is an expectation among health professionals due to its incontrovertible positive impact on patient safety and care quality (Melnyk, Gallagher-Ford, Long, & Overholt, 2014), yet nurses’ use of EBP remains inconsistent and inadequate (Saunders & Vehvilainen-Julkunen, 2016). A commonly reported barrier to EBP is lack of EBP knowledge (Blackman & Giles, 2017; Crabtree, Brennan, Davis, & Coyle, 2016; Melnyk et al., 2014; Wonder et al., 2017). Unfortunately, few studies specify what knowledge nurses lack that prevents them from effectively using EBP. A clear conceptualization of EBP knowledge in new nurses is needed in order to address learning needs and improve EBP implementation in practice.
Background
Accrediting bodies for nursing education programs include EBP competencies among their expected outcomes, but explicate neither the knowledge nor the types of experiences that are required to achieve EBP outcomes (Accreditation Commission for Education in Nursing, 2017; Commission on Collegiate Nursing Education, 2013). And despite an abundance of literature examining teaching practices that may impart EBP knowledge (Fiset, Graham, & Davies, 2017; Patelarou et al., 2017; Ramis, Chang, & Nissen, 2015), there are few measures to determine whether student nurses actually meet EBP knowledge competencies (Spurlock & Wonder, 2015). Hence, even when EBP objectives are included in undergraduate nursing curricula, new nurses enter practice with varying degrees of exposure to EBP (Wonder, A., Spurlock, D., & Ironside, 2016) and a perceived lack of EBP knowledge (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012).
Method
A concept analysis was undertaken to expand the current understanding of EBP knowledge and to form a refined definition of EBP knowledge in new nurses. The concept analysis was performed using a hybrid method, which merges theoretical analysis with empirical observation (Schwartz-Barcott & Kim, 2000). This method was chosen for its inclusion of new nurses’ perspectives on the concept of EBP knowledge, which is currently lacking in the literature. Existing descriptions and measures of EBP knowledge were examined in the literature, followed by semi-structured interviews with new nurses. Data were then analyzed for similarities and differences.
Findings
This hybrid concept analysis revealed crucial insights about the nature of EBP knowledge and resulted in a new definition of the concept of EBP knowledge in new nurses. Findings indicate that new nurses arrive at their professional roles with an understanding of EBP principles and sufficient knowledge to ask clinical questions, yet may not possess the expected propositional and procedural knowledge required to carry out the full EBP process.
Conclusion
Inconsistent conceptual definitions of EBP knowledge, particularly for new nurses, may interfere with the development of effective EBP interventions. The findings from this concept analysis illuminate opportunities to enhance EBP competence in both academic and practice settings. Nurse educators can help address EBP knowledge gaps by establishing curricula that build nursing students’ practical EBP knowledge. Nurse employers, supervisors, and preceptors can capitalize on new nurses’ existing EBP strengths and build their capacity for EBP implementation through targeted interventions.
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