Purpose: The primary purpose of this research project was to measure the perceptions of undergraduate nursing students about EBP use, attitudes, knowledge, and skills in a nursing curriculum with threaded EBP experiential learning activities. Secondarily, the program level (semester and year) and the relationship of race/ethnicity on learning EBP was evaluated.
Design: Non experimental descriptive cross sectional study.
Methods: One hundred and fifteen undergraduate nursing students from a large university nursing program in Texas voluntarily participated in an online survey in 2016 (November 30 to December 21) to assess their perceptions related to level of practice, attitudes, skills, and ability to apply evidence in clinical practice. This sample included four cohorts: 1) Junior year, semester 1 (Jr1), 2) Junior year, semester 2 (Jr2), 3) Senior year, semester 1 (Sr1), and 4) Senior year, semester 2 (Sr2). The Student Evidence-based Practice Questionnaire (S-EBPQ), a psychometrically validated instrument used to measure the practice, attitude, knowledge, and skills specific to the EBP of nursing students, was used for this project. The instrument was adapted from the Evidence-based Practice Questionnaire (EBPQ), an earlier robust instrument to measure EBP in professional nurses and nurse educators. Students who agreed to participate anonymously access and complete a demographic questionnaire and the 21-item S-EBPQ by clicking on a PsychData link embedded in an email sent to students currently enrolled in the nursing program. The S-EBPQ questionnaire was subjected to an inter-item reliability analysis using Cronbach’s alpha to determine the reliability of the scale items. All four subscales (practice, attitude, retrieving and reviewing evidence, and sharing and applying EBP) demonstrated high inter-item reliabilities consistent with previous research. The study was approved by the university institutional review board.
Results: Several one-way ANOVA tests were used to compare practice, attitude, retrieving and reviewing evidence, and sharing and applying EBP among the Jr1, Jr2, Sr1 and Sr2 cohorts. Although Sr2 students were anticipated to have a higher self-perception of competencies and attitude as assessed by the four subscales than the other cohorts, no significant differences were found in any outcomes. Additional one-way ANOVA tests were conducted to determine if attitude, practice, retrieving and reviewing evidence, and sharing and applying EBP differed among self-identified race/ethnicity. Asian students reported a higher score (M = 5.22, SD = .97) in practice than Black students (M = 3.85, SD = 1.77), F (4, 110) = 4.45, p = .002. Hispanic students reported significantly higher score (M = 5.49, SD = .63) in sharing and applying EBP than Black students (M = 4.12, SD = 1.49), F (4, 110) = 3.88, p = .005. However, there were no significant differences on attitude, retrieving and reviewing evidence or application of EBP by self-identified race/ethnicity.
Conclusions: This is the first study reported in the literature to use the S-EBPQ to compare the EBP use, attitudes, knowledge, and skills in undergraduate nursing students by semester cohort and self-identified race/ethnicity. Undergraduate nursing student self-perceptions of practice, attitude, retrieving and reviewing evidence, and application of EBP may be indicative of a degree of evidence-based competency achievement; however, there also appears to be opportunity for improvement in all four subscales. There appears to be a difference in the confidence with EBP practice for Asian students scoring highest, and those of Black students scoring the lowest. When examining the subscale of sharing and applying EBP, Hispanic students scored significantly higher than Black students. There were less Blacks (13%) that participated in the study when compared to Caucasians, Asians, Hispanics, and other ethnicities (41%, 32%, 23%, 6% respectively) and this may have impacted findings related to race/ethnicity. Further research is necessary to explore the differences by race/ethnicity as well as to understand the similar confidence levels across the cohorts.
Clinical Relevance: Self-perception of practice, attitude, skill and application of evidence-based practice and competency may not be indicative of actual competency. The comparison of summative evaluations of EBP skills with self-perceptions of EBP value and competency throughout the nursing program could further define the importance of self-perceptions. There were differences in learning by race/ethnic in learning EBP throughout the cohorts. These differences need to be further explored to understand the etiology. Also, the active learning methodologies believe to be most effective in developing high levels of EBP competency could be explored during this process. EBP is currently threaded through the curriculum where this study was conducted, with a variety of active learning components incrementally added with the goal of increasing EBP competency as the student nears graduation. As there was not a significantly different assessment between the different cohorts, by semester and year, the learning activities need to be evaluated with a focus on revisions to scaffold the learning. The threading of the EBP skills should be re-evaluated to determine whether the leveling of learning and practice is truly incremental. A multi-country assessment and comparison of nursing student self-perception of attitudes and skills related to evidence-based practice along with corresponding cohort summative evaluations of EBP skills as students progress through the nursing program could be helpful in addressing EBP competency achievement on a global scale.