Acquisition of evidence-based practice (EBP) competence is vital to ensuring healthcare practitioners’ decisions are based on the best available evidence. Provision of safe, effective and high quality patient care requires nurses to be educated and supported to adopt EBP during their professional careers (DeBruyn, Ochoa-Marín, & Semenic, 2014). However, implementing evidence into practice has been recognised a complex process involving an array of individual, professional and organisational factors (Malik, McKenna & Plummer, 2016). It is commonly reported that nurses perceive EBP as a complicated task and voiced inadequate knowledge and skills to pursue into practice decisions. It is argued that EBP is more likely to be incorporated into nursing practice when nurses demonstrate positive attitudes and are adequately prepared to embrace it (Majid et al., 2011).
Academics teaching in undergraduate programs are challenged to overcome this by integrating the concepts and instilling the skills that prepare graduating nurses to be evidence-based practitioners. The combination of individual characteristics, nature of evidence, and organisational context to EBP have been reported in many studies examining enablers and inhibitors for EBP. To date, most studies exploring contextual factors have focused on practising clinicians (Rudman et al., 2012; Malik et al., 2016). Perspectives of nurse academics who engage in multiple roles of educating, facilitating the use of EBP and being involved in research offer understanding of issues they face. Existing literature is not exhaustive and requires comprehensive understanding of academics’ preparation and perceptions of contextual factors influencing EBP integration in undergraduate nursing programs. In this regard, Australian programs are no exception. Findings reported in this paper focus on factors contributing to individual characteristics, and organisational interplay.
Aim
The study aimed to explore the contextual factors that influenced the processes and activities of academics aiming to embed EBP concepts in undergraduate nurse education.
Methods
Design
Considering the study aim, a constructivist grounded theory methodology (GTM) was chosen to examine the factors influencing EBP integration in undergraduate education. GTM is underpinned by theoretical assumptions of symbolic interactionism, which places emphasis on processes and actions relating to particular situations, constructed between participants and researcher (Charmaz, 2006). Through interaction with participants in a sensitive and reflexive way, findings become a co-construction of participants’ experiences and the researcher’s interpretation of data (Charmaz, 2014).
Participants and Setting
Using purposive sampling, nurse academics across Australian educational institutions offering undergraduate nursing degrees, 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. In the beginning, the researcher used a short demographic survey and a guiding question to reveal participants’ understandings and experiences, for instance: What do you identify as facilitators and barriers to incorporating EBP into your teaching and learning practices? Nine participants consented to be observed during lectures, tutorials or laboratory teaching with undergraduate students. Field notes were written during and after the observations. Throughout the research process, participants were assigned pseudonyms by which their anonymity and confidentiality were protected.
Data Analysis
Data generated as a result of interviews and observations were analysed using coding methods, proposed by Charmaz (2006; 2014). NVivo 10 was used to organise and manage data. Simultaneous data collection and analysis assisted the researchers to engage with initial, focused and theoretical coding. As a result, preliminary subcategories and categories were constructed, which were constantly compared with codes, and emerging concepts to reveal actions, processes and events. By engaging with an iterative method of analysis, the advanced stage of coding resulted in three key categories addressing the enablers and inhibitors to EBP integration.
RESULTS
Despite widespread support to integrate EBP concepts, academics’ processes towards embedding EBP into curricula were mediated by contextual factors, which are categorised into: (i) Academic settings and individuals, (ii) Curricula design and delivery, and (iii) Practice settings.
(i) Academic Settings and individuals
Academics’ attitudes, and beliefs towards EBP played an important role in students’ adoption of EBP in practice context. Having positive attitudes and engagement with EBP, either at academic or practice level, influenced participants’ teaching practices and eventually inspired their students with EBP implementation in practice settings. Academic settings were perceived as facilitators when support was offered to individuals for continuing education and time was allocated to engage with research-related activities. Commitment within school and between colleagues, expectations within the school for research engagement and having a philosophy that supported EBP right across curricula were appreciated by study participants. Besides this, academics recommended workload management and inclusion of faculty clinical practice would likely to increase academics’ engagement with EBP. However, participants identified limited time to search for evidence, heavy workloads, and financial constraints within schools as obstacles to be evidence users.
(ii) Curricula design and delivery
Interviews and observations highlighted that alignment between theoretical and clinical subjects/units with underpinning EBP concepts was perceived as an enabler. Each subject outlining EBP concepts and preparing students within EBP framework was identified as an endeavour, academics wanted to work towards. However, a number of participants expressed concerns including: limited time for aligning and updating subjects/units, crowded curricula, heavy teaching and research workloads, insufficient EBP knowledge and skills, inexperienced academics in designing curriculum, and lack of consensus between academics, prevented EBP from being fully embedded across courses. Participants emphasised for being more vigilant in their approach of designing the content and implementing innovative methodologies for teaching EBP concepts. Despite being aware of the significance of effective and engaging teaching methods, academics struggled to implement proven teaching strategies due to insufficient resources within academic settings, poor time, heavy workloads, and continually increased number of students within programs were highlighted as impeding factors.
(iii) Practice Settings
Preparing students to embrace EBP during their clinical experiences was perceived as an effective method for linking EBP theory to practice. Participants included practice examples in their teachings, however when they designed assessments and projects that required involvement of clinical preceptors and clinical staff to work with students to achieve EBP implementation, they encountered hindrances. Workplace culture, lack of EBP competence among practice nurses, heavy patient loads, limited resources and insufficient time were considered as practice-related barriers that eventually affected students’ exposure to EBP during their clinical placements. Apart from practice barriers to EBP, academics also raised concerns around limited support and mentoring available for students to use evidence in practice. Another important issue relating to disconnect between theory and practice perceived by academics was having less credibility in practice settings. Most academics were not clinically active and even those who wanted to be involved in collaborative research projects were heavily loaded with teaching and administrative responsibilities.
Implications for Education, Practice and Research
Nurse academics are pivotal in preparing future generations of nurses as evidence-based practitioners. Overall, the interplay between academic settings, curricula and practice settings was evident in influencing academics’ teaching practices, and their endeavours in facilitating EBP integration across courses. Findings invite academic institutions and clinical settings to establish mechanisms by which curricula fully embedded with EBP concepts could be operationalised. Partnerships between academia and practice settings should be established and strengthened over time to ensure undergraduate students are provided with avenues to transfer classroom learning to practice. Academics should be encouraged to run collaborative research projects and undertake faculty practice which may enhance their practice credibility. EBP education will most likely to succeed with the improvement of contextual conditions. Future research could explore effectiveness of recommended strategies on mitigating cited barriers in embedding EBP within nursing curricula.
Conclusion
As nurses strive to provide the best healthcare outcomes for patients and families, well-educated and informed clinicians who are well-equipped with essentials tools of EBP can pursue this aspiration and enhance the effectiveness of the discipline through evidence-informed patient care.
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