Considering the growing need to adopt an evidence-based practice (EBP) approach in response to increasing complexities in healthcare, nurses must be adequately prepared in their undergraduate degrees to implement EBP in clinical practice. However, there is a plethora of studies reporting that nurses’ educational preparation for embracing EBP is consistently inadequate (Malik, McKenna & Plummer, 2015). EBP adoption by graduating nurses depends on the degree to which it is emphasised by academics and the extent to which it is integrated into course content and outcomes (Melnyk & Fineout- Overholt, 2015). Although the significance of applying evidence to practice is unquestionable, many Australian and international undergraduate programs continue to emphasise research process and underpinning methodology, rather than teaching research from evidence-based perspectives (Malik, McKenna & Griffiths, 2015; Brooke, Hvalič-Touzery & Skela-Savič, 2015). Despite the existence of many studies on EBP, its inclusion in nursing education is limited and represents an area of crucial investigation.
Aim
This abstract reports the resulting substantive theory, conceptualised as: “On a path to success: Endeavouring to contextualise curricula within an EBP framework”, that offers an abstract understanding of the processes and activities academics were engaged with when considering to integrate EBP in undergraduate education.
Methods
Design
Considering the aim of the study, a constructivist grounded theory informed by Kathy Charmaz was employed. Having its roots embedded in symbolic interactionism, this methodology was suitable for the current study as the purpose was to explore processes in the specific context. Informed by Charmaz, (2006), the constructivist theorist views data as constructed between participants and researcher rather than discovered; and analysis as interpretive rather than predictive. The resultant theory offers the greatest range of interpretation and understanding of concepts, grounded in data.
Data Collection
Ethical approval was granted from the relevant university. Using purposive sampling, nurse academics across Australian educational institutions offering undergraduate nursing programs were invited to participate. Twenty three nursing academics were interviewed until emerging categories were saturated. Participants were interviewed one-on- one at their work premises, or a mutually agreed location for approximately one hour, using a semi-structured format. With participants’ permission, interviews were audio recorded and subsequently transcribed.
Nine participants consented to be observed during lectures, tutorials or laboratory teaching with undergraduate students. Field notes were written during and after observations. Additionally, twenty unit/ subject guides were analysed to add richness to data that were shared by some participants. Throughout the research process, participants were assigned pseudonyms by which their anonymity and confidentiality were protected.
Data Analysis
In keeping with the tenets of grounded theory, data collection and analysis were simultaneously performed and continued until theoretical saturation was reached. Data were analysed using open, focused and theoretical coding, proposed by Charmaz (2014). NVivo 10 was used to organise data. Interview transcripts and field notes were read multiple times to generate open and focused codes. Codes were raised to sub-categories which were compared with data to seek relevance and fit. By using the constant comparative method, sub-categories were further developed to a level where emerging categories could be examined and compared with codes and emerging concepts. As a result of this iterative and interactive process, four categories emerged. Using theoretical coding, the emerged categories were further raised to an abstract level where they were theorised in a form of a core category.
Results- The Theory
In line with constructivist GTM, the theoretical construct, “On a path to success: Endeavouring to contextualise curricula within an EBP framework”, explicates a core process utilised by most participants and offers understanding of participants’ actions and processes when striving to embed EBP concepts into their teaching practices. The theoretical construct overarches the existing processes identified in three transitional stages: Embarking on a journey-Being prepared, Encountering challenges and Moving ahead-Linking EBP theory to practice. Four interrelated categories present the activities academics undertook during the core process comprising Valuing and Engaging with EBP, Enacting EBP curriculum, Influencing EBP integration and Envisaging EBP use. A core process reflects academics’ endeavours towards linking EBP concepts to practice, aiming to contextualise curricula in a manner that engages students within an EBP framework. However, these processes are moderated by a number of contextual determinants found to be influential that requires strategies to accomplish their endeavours. The theoretical model, provides a visual representation of the relationship between them, which will be illustrated in the oral presentation. The presented theory is grounded in data as the core process meets the criteria proposed by Charmaz (2014) that integrates relationships between the stages and categories. It is a process, which is comprehensive, occurs over time, and helps to understand variation in the data.
Implications and Recommendations
Current study findings create a call for educational institutions and practice settings to employ strategies such as including EBP as an integral part of a school’s philosophy, infusing EBP principles and concepts into academics’ ongoing developmental opportunities, mentoring in designing and implementing an EBP embedded curricula, creating academia-practice partnerships, and provision of sufficient resources within school and clinical settings serve as effective means for successful EBP integration. These implications support participants’ recommendations for a paradigm shift from isolated research courses to curricula fully encompassing EBP pedagogies. Largely, very limited examples of how EBP has been threaded through the curriculum are cited in the global literature. This study has adopted a unique approach in presenting a core process, explaining academics’ journeys that may be used to explain similar phenomenon. Our theory raises awareness of activities undertaken by academics and related challenges faced by them when considering to include EBP into undergraduate education. Future research could examine effectiveness of implemented strategies on academics’ engagement with EBP and its inclusion into their teaching practices.