Evidence-Based Practice Knowledge and Beliefs Among Associate Degree Nursing Students: A National, Multisite Study

The importance of evidence-based practice (EBP) to reduce undesirable variability in healthcare and afford optimal outcomes for patients and organizations has long been acknowledged (Institute of Medicine, 2001); yet, full implementation at the point of care is still lacking (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014). While a strong emphasis is placed on preparing baccalaureate nursing (BSN) students for EBP, associate degree (ADN) nurses often work in similar, generalist roles – and little is known about the extent to which they are prepared to deliver evidence-based care. A further complication is the routine reliance by educators and researchers on self-reports of knowledge or competence which have been found to correlate poorly with more objective measures of the construct of interest (e.g., knowledge), both within and outside nursing (Wonder et al., 2017; Zell & Krizan, 2014). To prepare pre-licensure students to implement EBP at the point of care it is essential to: a) accurately evaluate students’ EBP knowledge with measures with solid validity and reliability evidence; b) develop and test educational strategies to facilitate development of EBP knowledge across levels of education; c) identify what supports are needed as graduates transition into practice; and d) study the durability of EBP knowledge to determine what supports are needed over the course of nurses’ careers.

Here we report results from a descriptive, correlational study of 149 ADN students from 5 programs located in the Midwest and Northeast United States conducted in 2016-2017. The purpose of the study was to describe the levels of EBP knowledge among the sample of ADN students, describe relationships between demographic factors and EBP knowledge, describe the relationships between objective and subjective measures of EBP knowledge, and lastly, to gather validity and reliability evidence for the EKAN in a sample of ADN students from programs in the United States.

In proctored computerized data collection sessions, study subjects from all study sites first completed a demographic and personal characteristics questionnaire. Next, subjects completed the Evidence-Based Practice Questionnaire (EBPQ), a self-report questionnaire by Upton and Upton (2006) that contains three subscales focusing on EBP practice/use, attitude, and knowledge/skills. Subjects then completed the Evidence-based Practice Knowledge Assessment in Nursing (EKAN; Spurlock & Wonder, 2015), a 20-item multiple-choice exam with items addressing EBP-related domains described by the American Association of Colleges of Nursing (AACN, 2008) Essentials of Baccalaureate Education for Professional Nursing Practice (Essentials) and the Quality and Safety Education for Nurses (QSEN; Cronenwett et al., 2007) prelicensure competencies.

Subjects were predominantly female (81.9%, n=122), White/Caucasian (83.2%, n=124) and reported English as their primary language (95.3%, n=142). A mean age of 30.3 years (range=19-58 years) was noted for the sample.

Results showed the mean EKAN sum score was 8.77 (SD=2.09) out of a possible 20 (range=3-13). In a prior study by Spurlock and Wonder (2015), BSN students showed a mean EKAN sum score of 10.4 (range 5-16), a mean difference of about 1.6 points and a lower range of scores. The current study showed no significant relationships between EKAN sum scores and any demographic variable.

In the current study, the EKAN demonstrated a strong item reliability (0.96) under the single parameter Rasch model (1-PL), but low person reliability (0.16), indicating extreme trait restriction (homogeneity in scores/ability). All EKAN infit and outfit parameters were between 0.8 and 1.2, indicating strong item-model fit. The EBPQ demonstrated a Cronbach’s alpha internal consistency reliability of 0.95 for the total scale, with the following subscale results: 0.92 for practice/use subscale, 0.75 for the attitude subscale, and 0.95 for the knowledge/skills subscale. Strong, statistically significant correlations were noted among each of the EBPQ subscales. However, there were no statistically significant correlations between any of the subjective (EBPQ subscales) and objective (EKAN) measures. The correlation between the EKAN and the EBPQ subscale for knowledge was -0.20, indicating that subjects with higher self-rated knowledge levels had fewer correct answers on the EKAN. Subjects were asked to rate their agreement with the statement, “I am sure I can deliver evidence-based care” on a 5-point Likert type scale where 1=Strongly Disagree and 5=Strongly Agree. A total of 126 subjects (84.6%) responded as either Agree or Strongly Agree (M = 4.05). Subjects’ responses to this statement correlated strongly with the EBPQ subscales for practice (r = 0.347) and knowledge (r = 0.359), showing positive relationships that were significant at the < 0.01 level. There was no significant correlation between subjects’ responses to this statement and the EKAN (r = .037, p = .650), providing additional evidence on the lack of correlation between subjective and objective measures of knowledge.

This presentation will provide insight into what areas of EBP knowledge were more familiar to ADN students and how to use rigorous evaluation to develop and test educational strategies across levels of education. Through the use of consistent evaluation, faculty can work collaboratively to prepare all prelicensure students to be providers of evidence-based care.