Undergraduate Nursing Students' Beliefs and Readiness to Implement Evidence-Based Practice

Purpose:

Evidence based practice (EBP) is the use of the best evidence combined with clinical experience and patient preferences to provide quality nursing care (Melnyk & Finout-Overholt,2010). Despite the fact that utilizing EBP results in improved patient outcomes, it still takes years to implement new evidence into clinical practice.  This is due in part to the fact that students and clinical staff are taught research and EBP strategies in a classroom setting, which are often not translated into `real world' practice. Additionally, nurses report being overwhelmed with the amount of literature presented and the ability to critique it.  To move beyond the theoretical to concrete implementation, new educational tactics are needed. While there are multiple frameworks to implement EBP, there still remains a gap between evidence and practice (Melnyk, Finout-Overholt, Giggleman, & Cruz, 2010; Newhouse & White, 2011).

The purpose of this study was to explore nursing students' perceptions of EBP before and after implementation of innovative teaching methods in an undergraduate scholarly inquiry course. It was hypothesized that following the implementation of innovative teaching methods to teach evidence based practice and research; students would increase their belief and implementation of EBP and describe their experiences as more positive regarding the teaching methods.

Methods:

A convenience sample of 120 student nurses currently enrolled in a scholarly inquiry course, during two separate semesters, were approached to participate in this study. At the beginning and at the end of the course students were given the EBP Beliefs Scale, the EBP Implementation Scale and demographics. The EBP Beliefs Scale is a 16-item questionnaire measuring general beliefs about the usefulness of EBP rated on a 1-5 Likert scale (Strongly Disagree to Strongly Agree).  The EBP Implementation scale is an 18-item questionnaire that measures application of EBP activities in the 8-weeks prior.  The questions are rated on a 0-4 scale (0 = No Application and 4 = Applied this Principle 8 or More Times). Validity and reliability statistics are previously reported (Melnyk, Fineout-Overholt, & Mays, 2008). Data were entered into an Excel (Mocrosoft, 2007) spreadsheet. All analyses were performed using SPSS version 16 (SPSS Inc., 2007). All variables were reviewed for missing data and outliers using appropriate descriptive statistics and plots. Paired t-tests were used to assess pretest/posttest changes in EBP belief and implementation scores. Students received weekly instruction as part of the course. Innovative teaching methods included PowerPoint presentations, video clips, interactive games, hands-on activities and a scenario-based written paper about implementation of EBP. 

Results:

A total of 109 participants (Response rate 91%) completed questionnaires (106 at pretest, 101 at posttest), with a total of 98 completing questionnaires at both time points. Particpants were young and female (M= 20.7 years; 91% female). The average reported grade point average was 3.8 and 56% of the students reported working part–time in addition to attending school. EBP belief scores were negatively skewed and EBP implementation scores were positively skewed with univariate outliers noted in pretest scores for EBP Beliefs and EBP Implementation. Cronbach’s alpha for the EBP Beliefs scale was .85 at pretest and .82 at posttest. Cronbach’s alpha for the EBP Implementation scale was .87 at pretest and .85 at posttest. Paired t-tests were conducted to assess changes from pretest to posttest for both EBP belief scores and EBP implementation scores. The test for EBP belief was significant t (97) = -12.67, p < .001, d = 1.4. EBP belief scores increased from pretest (M = 53.7, SD = 6.9) to posttest (M = 62.7, SD = 5.6). The test for EBP implementation was significant t (97) = -14.59, p < .001, d = 1.6. EBP implementation scores increased from pretest (M = 8.2, SD = 6.2) to posttest (M = 19.6, SD = 8.0). As skewness and outliers were noted in pretest scores for both EBP belief and implementation scores, the analysis was repeated with the outliers deleted with similar results. Nonparametric comparisons also yielded significant results.

Conclusion:

Utilization of innovative teaching strategies were successful in improving the beliefs and implementation of EBP in undergraduate nursing students.  The hypothesis was supported.  These findings are corroborated by previous studies in the clinical setting that reported improved EBP beliefs and implementation following educational interventions (Wallen et al., 2010).  More research is needed in the effect of EBP education strategies in nursing students and the long term retention of EBP beliefs and implementation.

This study was conducting using a convenience sample of relatively young and primarily female student nurses from one university. Therefore, the results may not generalize well to male or older populations of student nurses.

The use of the latest evidence in nursing practice is essential for the provision of high quality care.  EBP beliefs are an important precursor to successful implementation.  These beliefs need to be fostered in the early stages of undergraduate nursing education.  In addition, in order to ‘hard wire’ EBP concepts into practice, students need opportunities to apply EBP principles in their practice.  It is therefore essential for faculty to collaborate with clinical sites and promote innovative teaching strategies to successfully engage the student in long-life learning of EBP principles.