Innovative Evidence-Based Practice Education: Battling Dr. Google and Nurse Jackie

In Canada, Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) are required to engage in evidence-based practice (EBP) as an entry to practice competency (CCNRN, 2012, CCPNR 2013). However, despite this expectation, and research findings that nurses generally have a positive attitude toward evidence-based practice (Yoder, Kirkley, McFall, Kirkey, StalBaum, & Sellers, 2014) globally there is poor uptake in the application of this process.  Thiel and Ghosh (2008) conducted a cross-sectional survey of 121 practicing nurses in the Midwestern United States to determine how they accessed information and their readiness to engage in evidence-based practice.  Results of this survey concluded that while 75% of nurses indicated they were familiar with evidence-based practice processes, only 24% stated they used a health database like CINAHL when they needed information.  The majority of respondents (72.5%) reported using their nursing colleagues and peers as the primary source of practice information. A similar study conducted in Ireland by O’leary and Mhaolrunaigh (2011) examined the information seeking behaviours of practicing nurses, again results showed that most nurses accessed other people, especially their colleagues when seeking information and making decisions on care.

In 2014 Yoder et al. conducted a survey of 1,112 practicing nurses in the United States to determine what types of knowledge RNs working in the hospital system use in their practice and to what extent they utilize research findings.  Their results showed little difference from previous studies.  Only 11% of respondents stated that they did not know very much about EBP.  However, when asked about how they access information in practice 75% of nurses surveyed stated they relied on personal experience as their primary source of knowledge and only 23% noted using nursing research journals. When asked about how they accessed nursing information on-line, 71% stated they used Google while less than half (45%) reported using databases like CINAHL or MEDLINE. This evidence clearly outlines a ‘gap’ between the expectation of EBP and the actual implementation of EBP.

With the identification of this gap, many researchers have examined the barriers that prevent nurses from engaging in EBP. The most common barriers identified by nurses include a lack of time and a lack of skill (Chang & Crowe, 2011; Hewitt-Taylor, Heaslip, & Rowe, 2012; Majid, et al., 2011; Wallin, Bostrom, & Gustavsson, 2012).  In their study of 1,486 practicing nurses in Singapore, Madji et al (2011) found that nurses had limited skills in searching the literature and understanding the evidence.  The majority of nurses were unable to adequately perform search strategies for given nursing topics and less than 25% were familiar with Boolean operators. In addition to the lack of literature searching skills, the nurses in this study indicated that inadequate understanding of statistical terms and research jargon limited their ability to engage in EBP. These nurses indicated that additional training in EBP skills would help them to implement EBP. Hewitt-Taylor et al. (2012) in their study of Finnish nurses noted that nurses lacked confidence in their ability to use research in practice. They suggested that interventions to support EBP implementation should focus on helping practicing nurses develop the skills required to understand what makes research usable by focusing on the process of deciding what information is needed, searching for this information, and then evaluating the utility of that information. Chang and Crow (2011) noted that nurses had limited confidence in their ability to find, appraise, and then implement evidence into their clinical practice, but that exposure to education on EBP enhanced nurses’ self-efficacy in engaging with EBP.  This finding is supported by a study of 1,256 Swedish nurses that noted that the nurses with the highest levels of EBP capability beliefs used research findings in practice more than twice as often and engaged in the implementation of evidence seven times as often as those with lower capability beliefs (Wallin et al., 2012).

In order to bridge the EBP expectation/implementation gap, we collaborated to develop an accessible education program for nursing professionals that targets essential EBP skills. This program emphasizes the development of practitioner self-efficacy, critical thinking, and the utility of research in everyday practice. Aimed at nursing students (both RN and LPN) and working nurses (LPN and RN continuing education), the program consists of a series of six interactive webinars designed to increase nurses’ skills in EBP and their self-efficacy for carrying out those skills in practice through a strong clinical focus using an inquiry based, guided discovery approach.  This focus on clinical versus academic application of EBP skills helps demonstrate the relevance and utility of research for practice and enhances the real-world application of EBP for practicing nurses (Christie, Hamill, & Power, 2012).  Topics covering information literacy and the steps of EBP, including an overview of knowledge translation strategies and implementation science are included to better equip nurses to effectively apply evidence in their daily nursing practice.