Knowledge Gaps in Practice-Based Problems and Research-Based Interventions among Online Graduate Nursing Students

Purpose:

This study sought to: (1) describe the salient clinical nursing problems identified by practicing MSN students (2) determine if areas of inquiry were congruent to the priority themes of the National Institute of Nursing Research; (3) determine if sufficient scientific literature existed to guide research-based interventions, and (4) identify gaps.

One of the many challenges with nursing education is to obtain a scientific measure of how nurses search for and implement scientific research and evidence into their professional nursing practice. The basis for this research evaluates student learning activities and assignment outcomes from two core courses in the online Master of Science in Nursing (MSN) Program at Drexel University- a Research Methods and Biostatistics course and an Advanced Ethical Decision Making in Health Carecourse. Graduate nursing students are licensed professional nurses who often work and study concurrently. In the aforementioned graduate courses, learning activities are designed to integrate their practice-based experiences with new critical thinking and research abilities and skills.

One key essential outcome for MSN core courses is that students learn to explore practice issues and questions that require concrete scientific evidence for application in the clinical practice setting (Botti & Reeve, 2003; Cader, Campbell & Watson, 2009; Rhodes, Schutt, Langham & Bilotta, 2012). MSN graduates must have essential knowledge, skills, and competency in knowing where to search for and implement scientific research and evidence into their professional nursing practice. Moreover, MSN graduates must be able to critically review scientific research and evidence to guide and clarify concepts and best practice translating that evidence into decision-making on a daily basis (Christensen, 2009; Flanagan, Baldwin & Ewert, 2000; Herbig, Bussing & Ewert, 2001; Louise & Smith, 2010; McCaughan, Thompson, Cullum, Sheldon & Thompson, 2002; Scott & McSherry, 2008; Standing, 2007; Williams, 2010).

While faculty design these courses to facilitate enhanced knowledge and skills to apply to nursing practice, faculty have tremendous opportunities to learn from students about current  knowledge gaps needed for  practice based on their identified research questions and issues identified through strategically designed assignments.  Opportunities exist to identify pertinent gaps in the scientific literature in Nursing need to address practice-based problems with research-based interventions. What is unknown is how the gaps identified by practicing nurses align with the National Institute of Nursing Research’s (NINR) strategic plan (2011). These NINR priority  areas help to guide scientific nursing inquiry. They include four themes with two additional cross-over themes: 1) Symptom science, 2) Wellness, 3) Self-management, 4) End of life and palliative care, 5) Technology and, 6) Research careers. 

Methods:

A secondary analysis of final course papers was conducted using primarily qualitative analyses. The sample for this study included 300 geographically diverse online students who completed two online graduate Nursing courses: (1) A Research Methods and Statistics course and, (2) an Ethics course during the 2013-2014 academic year.

To maintain confidentiality of all data from the faculty researchers, an honest broker was used to abstract all data (student papers) from the files stored in Blackboard learn. This included excluding all identifiers located in all of the data files (student papers).  Abstracted data were managed and organized by using Survey Monkey. Demographic data were entered directly into Survey Monkey using folders that contained de-identified papers. Data were sent to Survey Monkey which is a data collection repository so that typologies were developed for both the practice-based problems and research-based interventions.

The Krippendorf method (2005) of content analysis was used and then the key categories were further organized based on the National Institute of Nursing Research (NINR) themes. The practice-based problems and research-based interventions were identified under those themes with any gaps in the literature as cited by the MSN students. 

Results:

Using descriptive statistics, demographic data were analyzed using frequency and percentage distributions to describe the sample. Practice-based problems were compared to the NINR themes and placed in a typology. Research-based interventions were identified for each of those NINR themes and also placed in a typology. Gaps in evidence were identified for each of the NINR themes based on student reports of the available literature.

Preliminary results from the Research Methods course described the majority of practice-based problems as falling within the NINR theme of symptom science with gaps in the Nursing literature identified. One example of a specific practice-based problem selected under the symptom science theme included central line infections while the use of bathing protocols was identified as a common research-based intervention. Specific gaps in the literature included a lack of suggested educational interventions for nursing staff to use in order to implement existing protocols in the practice setting. Another example of a practice-based problem selected under the NINR symptom science theme included readmissions of Congestive Heart Patients to the acute care setting with the management of polypharmacy selected as an important research-based intervention to this problem. Gaps in the Nursing literature were identified. In particular, some of those gaps suggested by MSN students were the need for more helpful hints as educational aids for the practicing nurse to implement protocols found in the literature.

Preliminary results described the majority of practice-based problems in the graduate nursing Ethics course as falling within the NINR theme of end-of-life and palliative care with gaps in the Nursing literature for this theme. For example, specific gaps in the literature included a lack of suggested educational interventions for nursing staff to implement existing protocols in the practice setting. Examples of specific practice-based problems selected under the end-of-life and palliative care theme included consequences of the patient not having advanced directives in place when entering the healthcare system and being dependent on a surrogate to make the end-of-life care decisions when the patient was not able to do so for him/herself. Research-based interventions for these practice-based patient problems largely focused on application of ethical principles of patient autonomy and surrogacy and how nurses must rely on the science of managing symptoms of life limiting conditions and planning for end-of-life decisions prior to a critical state in which patients are no longer able to act autonomously on their own behalf. Gaps in the literature indicated nurses do not maximize their capacity as care givers for patients with end-of-life care and palliative care: the science of compassion to the full extent of their nursing education in the clinical practice setting.

Conclusion:

Further research needs to identify a better method other than student self-reports for capturing gaps in knowledge under practice based problems within the National Institute of Nursing Research priorities. A more objective means of identifying gaps in the literature need to be expanded in future work.