Integrating Evidence-Based Practice in a Lebanese Nursing Baccalaureate Program: Challenges and Successes

Background:Evidence-based practice (EBP) is defined as “the integration of best research evidence with clinical expertise and patient values” (Sackett, et. al., 2000).  According to the American Association of Colleges of Nursing (2014), registered nurses (RNs) with baccalaureate degrees are better prepared to optimize patient care, particularly by decreasing mortality rates in hospitals. Despite the inclusion of EBP as the appropriate preparation for giving bed side care, research skills remain suboptimal in enabling nurses to conduct and implement evidence-based practice (EBP). In the Middle East (ME) region, there is a pressing need to incorporate EBP into nursing curricula. Substantial attention needs to be given to increasing the appreciation for and use of evidence to guide nursing practice.

Purpose: This presentation describes how we have developed the evidence-based practice concept and integrated it into two courses at two different levels of the BSN curriculum. The process of threading the concept to meet the students’ learning needs and the learning assessment approaches are also described.

Methods: Aligned with American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education for Professional Nursing Practice (2008), teaching EBP is one of the educational objectives in our concept-based nursing curriculum. We integrate EBP in two courses at two levels by designing an EBP assignment at the two courses level.

Results: The first step of the EBP concept is incorporated into the research course offered to junior students and introduces fundamental research concepts and utilization. In the second step, senior students in the nursing synthesis course build on the fundamental concepts to design an evidence-based practice protocol for a selected health condition.  As well, students integrate evidence, clinical reasoning, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care. In both courses students review scholarly literature to apply and nurture beginning skills in evaluating research studies. In both courses, the most important learning assessment of the EBP concept is the EBP assignment whereby students apply EBP knowledge by completing a small scale project.  The EBP assignment introduced in the research course sets the groundwork for the advanced EBP assignment required in the nursing synthesis course. In both assignments, students have to answer a clinical question using the PICO template (Population, Intervention, Comparison and Outcome) by observing a selected clinical skill, then comparing what they observed to hospital protocol and against the latest evidence-based practice guidelines. In the second assignment, students pick a more complex clinical skill that is observed in critical care and psychiatric units. Additionally, students need to support their proposed changes in practice with scholarly literature. In terms of evaluation, in the first assignment students are evaluated on the integration and cohesiveness of ideas. In the second assignment, they are evaluated on critiquing the literature and using analytical writing.

Conclusion: The learning outcomes assigned for both courses are achieved. The overall experience of integrating EBP concepts and projects in the curriculum is fruitful for students, hospital administrators (for the projects are shared with them) and faculty. Having students identify clinical problems encountered in their professional practice gives meaning to their observations and highlights the value of their exposure for bed side care. They are able to reflect constructively and more importantly, address the problem scientifically and systematically. EBP broadens student’s ability to synthesize concepts learned earlier in the curriculum and helps prepare them to be lifelong learners.