Assignment: Effectiveness of EBP courses

ABSTRACT Background: Effective teaching is key in preparing students to become successful evidence- based healthcare professionals. The effectiveness of graduate evidence-based practice (EBP) pedagogy is not often a subject of research studies.

Purpose: The purpose of this study was to determine how faculty from the 50 top graduate nursing schools in the United States perceived the effectiveness of EBP courses for graduate nursing students.

Methods: A descriptive cross-sectional design was used to explore faculty perception of the effectiveness of EBP courses. A web-based survey was used for data collection. A total of 45 questionnaires were subjected to statistical analysis.

Results: The mean perception of the effectiveness of EBP courses for the whole sample, on a scale from 1 to 7, was 5.58 (min. 4.29; max. 6.73), a higher score signifying higher perceived effectiveness. The highest rated item concerned a school’s access to different databases. The strongest correlations were found between the total score and the scores for items describing students’ opportunities to strengthen and apply their EBP skills (rs = .66). The internal consistency of the Perception of Effectiveness of EBP Courses scale, based on standardized Cronbach’s alpha, was .84, which signifies strong internal consistency. Faculty perceived themselves as most competent at the following EBP skills: (a) “Asking questions regarding patients’ care” (6.56), (b) “Considering patient preferences when implementing EBP” (6.40), and (c) “Critically appraising the relevant body of evidence to address clinical questions” (6.40).

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Discussion: To strengthen the effectiveness of EBP courses, students should have more oppor- tunities to implement their EBP knowledge and skills after completing EBP courses.

Linking Evidence to Action: Evaluation of faculty perceptions of the effectiveness of EBP courses can help to guide the development of nursing school curricula that better integrate EBP. Further evaluation of the psychometric properties of the instrument used to measure perception of the effectiveness of EBP courses is required along with objective measures of faculty knowledge and skills in teaching EBP.

BACKGROUND AND SIGNIFICANCE Worldwide, evidence-based practice (EBP) has emerged as a major healthcare initiative (Thiel & Ghosh, 2008). One of the most consistent findings in health service research is the gap between best practice (as determined by scientific evidence) and actual clinical care (Flores-Mateo & Argimon, 2007). To accel- erate the translation of research findings into clinical practice, two major outcomes must be achieved: (a) Advanced practice and direct care nurses must acquire sufficient EBP knowledge and skills as well as strong beliefs about the value of EBP in clinical settings, and (b) educators must teach their students the EBP process to instill in them lifelong skills and the motivation to deliver the highest quality of care (Melnyk, Fineout-Overholt, Feinstein, Sadler, & Green-Hernandez, 2008).

Findings from a recent national survey by Melnyk, Fineout- Overholt, Gallagher-Ford, and Kaplan (2012) indicated that nurses surveyed across the country are ready for and do value EBP. The majority of participants who responded to the survey reported wanting to gain more knowledge and skills in order to deliver evidence-based care in their institutions. Nurses cited a top requirement for helping them implement EBP in daily practice as education. Assignment: Effectiveness of EBP courses

For students to become evidence-based healthcare profes- sionals, the teaching of EBP has to be effective (Spek, Wolf, Dijk, & Lucas, 2012). Little has been published about teach- ing EBP to nursing students (Stiffler & Cullen, 2010). Though there are systematic reviews and meta-analyses of teaching EBP in schools of medicine, there is a dearth of research in nursing,

Perception of Effectiveness of EBP Courses

especially in regard to graduate-level EBP pedagogy. According to Fineout-Overholt and Johnston (2005), further research is needed to assess effective teaching and evaluation strategies for EBP.

Teaching EBP to nursing students is usually based on the basic steps of EBP. Melnyk and Fineout-Overholt (2011) added two more steps to the five basic steps of EBP, which include: (a) cultivate a spirit of inquiry; (b) ask the burning clinical question in PICOT (P = patient population; I = intervention or area of interest; C = comparison intervention or group; O = outcomes; and T = time) format; (c) search for and collect the most relevant best evidence; (d) critically appraise the evidence; (e) integrate the best evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change; (f) evaluate outcomes of the practice decision or change based on evidence; and (g) disseminate the outcomes of the EBP decision or change. The seven steps of EBP can serve as a structure around which to build EBP curriculum for graduate nursing students.

The effectiveness of graduate EBP pedagogy is not often a subject of research studies. One of the problems is the com- plexity of the EBP process and the difficulty of assessing all aspects of its effectiveness. Shaneyefelt and colleagues (2006) performed a systematic review of EBP instruments. Their re- sults showed that the majority of instruments targeted stu- dents and postgraduate trainees, whereas nonphysicians were rarely evaluated. The available instruments most commonly evaluated EBP skills (predominantly focusing on the critical ap- praisal of evidence), knowledge, attitudes, and behaviors. Most instruments are designed for specific purposes, such as the evaluation of theoretical EBP courses (instruments to assess cognitive skills), or the evaluation of EBP in clinical practice (instruments to assess performance-based skills and applica- tion; Ilic, 2009).

The instrument used in this study for measuring the per- ception of the effectiveness of EBP courses was inspired by the ARCC-E (advancing research and clinical practice through close collaboration and education) conceptual model for teaching EBP (Melnyk & Fineout-Overholt, 2011). This model shows that organizational support, the identification of curricular strengths and barriers to teaching EBP and use of faculty EBP mentors play an important role in the effectiveness of EBP pedagogy. Based on this model, the parameters of effective EBP courses were set. The neces- sary conditions for successful EBP courses are: curricular strengths, organizational support, teachers’ mastery of EBP, and teachers’ involvement in EBP learning. In our instru- ment, we focused on the evaluation of the effectiveness of EBP courses from a faculty perspective. Therefore, items re- flected faculty perception of the integration of EBP in the curriculum, faculty involvement in learning and expectations they had of their students, mastery of subject matter, and or- ganizational support.

The instrument for measuring faculty perception of their own and students’ competence in EBP skills was designed to

address all seven steps of the EBP process based on a modified version of the list of EBP skills in Melnyk et al. (2008). EBP skills can be divided into three groups:

� Skills related to the implementation and dissemina- tion of EBP (e.g., applying synthesized evidence to initiate change, mentoring/teaching EBP to others).

� Skills in searching for and appraising evidence (e.g., searching efficiently for evidence, critically apprais- ing the relevant body of evidence to address clinical questions).

� Skills relating to cooperation with the clinical envi- ronment (e.g., assessing the clinical environment for readiness for EBP, asking questions regarding pa- tients’ care).

Teacher competency is one of the most important factors in the learning process. To be able to deliver EBP knowledge and skills properly, faculty have to be experts in these skills. However, there is a lack of studies focusing on the competence of teachers of EBP courses and on how they perceive their own EBP skills. It is not well known how competent graduate nursing faculty members are in EBP knowledge and skills. Assignment: Effectiveness of EBP courses

This study focuses particularly on faculty perception of the effectiveness of EBP courses and faculty perception of their own competence in EBP skills. Inclusion of a core EBP course in graduate nursing curricula is essential to establishing a foun- dation from which EBP knowledge and skills can be further de- veloped in the remainder of the students’ didactic and clinical coursework (Melnyk et al., 2008). Evaluation of the effective- ness of EBP courses can inform the improvement of future programs.

Three main research questions guided this study:

(1) What are faculty perceptions of the effectiveness of EBP courses for graduate nursing students?

(2) What are faculty perceptions of their own compe- tence in EBP skills?

(3) As judged by their teachers, how competent in EBP skills are students upon completion of EBP courses?

PURPOSE The purpose of this descriptive cross-sectional study was to de- termine how faculty from the 50 top graduate nursing schools in the United States perceived the effectiveness of EBP courses for graduate nursing students.

METHODS Study Design and Methods A descriptive cross-sectional design was used to explore per- ception of the effectiveness of EBP courses and perception of competence in EBP skills. A web-based survey was used

Original Article for data collection. Data collection was conducted by sending potential respondents an e-mail with a hyperlink to the web- based survey. Faculty members agreeable to participating were required to click on the link in the e-mail directing them to a study-specific, secured Survey Monkey website. The website consisted of a questionnaire that was developed by the investi- gators to assess perceptions of the effectiveness of EBP courses and perceptions of EBP skills. The questionnaire took approx- imately 5–10 minutes to complete.

Sample and Data Collection The sample population consisted of faculty from the top 50 graduate nursing schools across the United States according to the Top Universities in U.S. website (http://www.university-list.net/us/rank/univ-20131118.htm), who taught EBP courses for graduate nursing students.

Sixty-two nursing schools were contacted through their deans’ offices. E-mails were sent to the deans. Each e-mail con- tained a cover letter addressed to the dean and a cover letter for faculty members involved in teaching EBP courses. Deans who were agreeable to their faculty participating in the study were re- quested to forward an e-mail including the latter cover letter and a study-specific, secure, and de-identified link to the web-based survey to faculty members involved in teaching EBP courses. Deans of five nursing schools did not agree to their faculty par- ticipating in the study. E-mails were sent only once. Data were collected from the middle of January 2013 through the middle of March 2013. The study was conducted in three steps.

Step 1: Development of a questionnaire for evaluating the effectiveness of teaching EBP in nursing. The survey items were developed by the authors. Survey items were derived from the literature and from the authors’ teaching experiences. Items measuring perception of the effectiveness of EBP courses were devised in consultation with an expert from the Center for Instructional Development and Distance Education at the Uni- versity of Pittsburgh.

The survey was comprised of the following sets of ques- tions:

(1) Fifteen questions on the survey employed a scale of 1 (strongly disagree) to 7 (strongly agree) to assess per- ception of the effectiveness of EBP courses. These questions covered four areas: perception of the in- tegration of EBP in the curriculum, faculty involve- ment in EBP learning and the expectations they had of students, mastery of subject matter, and organiza- tional support.

(2) Fourteen questions included in the survey employed a scale of 1 (not at all competent) to 7 (extremely compe- tent) to assess faculty perceptions of their own com- petence in EBP skills. A list of EBP skills was adapted from Melnyk and colleagues (2008) with the consent of the first author. The list of skills did not include those with an immediate bearing on patient care.

These skills were added following an analysis of the definition of EBP by the researchers, and reflected a consensus reached among them. Besides this modi- fication, some items on the original list were omitted and others were paraphrased to make the question- naire more accessible to participants. Assignment: Effectiveness of EBP courses