Abstract
Awareness of faculty members with regards to evidence-based practice (EBP) in the teaching of baccalaureate nursing is yet to be conclusively determined. It is a fact that EBP is not a new concept in teaching and practice in the nursing field. However, its implementation is characterized by a number of challenges. Various studies have been carried out in relation to the issue of how nursing faculties are coping with this model. The following study adopts this line of thinking and explores the concept of EBP and its relevance to the nursing profession. To this end, a number of articles and other material on EBP teaching, strategies, and obstacles related to implementation are reviewed in this study. The report concludes that nursing faculties are aware of EBP and its significance to the nursing practice. The awareness is apparent in both graduate and undergraduate studies. Future studies need to focus on the development of strategies and frameworks to facilitate teaching of EBP approaches in nursing.
General Definition of Statement
The implementation of evidence-based practice (EBP) is a core objective in the healthcare profession. The concept is used in various settings and disciplines in nursing. According to Eizernberg (2010), the Healthcare Profession Education Manual advances five core competencies for clinicians. The five include employment of evidence-based practice and working with interdisciplinary teams. Others are the provision of patient centered care and utilization of informatics (Eizernberg, 2010). The last competence involves the application of quality improvement measures.
Today, EBP is regarded as a major requirement for practitioners in the healthcare sector. However, the level of awareness among faculties teaching BSN students in relation to these elements is not very clear. Different scholars define EBP variously depending on their personal and professional inclinations. Generally, the concept is regarded as the conscientious usage of the best evidence found in literature to guide healthcare decisions. Martin (2007) defines EBP as the critical evaluation and incorporation of ‘best’, relevant, and patient centered clinical expertise in decision-making.
EBP entails systematic approach to problems faced by healthcare providers, including nurses. The best evidence available for decision-making at a particular time is utilized. Consequently, nurses who are competent in EBP are expected to provide consistent and high quality care to patients. The growing popularity of this concept in nursing practice is attributed to the numerous benefits associated with it. The benefits accrue to the nurses, patients, and other stakeholders. Traditionally, nurses carry out their duties by strictly adhering to the models taught in graduate nursing schools. Consequently, most of these students have been doing only what is expected of them in accordance to their workplace. The adoption of EBP changes all this. It enhances quality service delivery to patients and minimizes wastage of finite resources used in ineffective interventions.
Commitment to EBP allows healthcare organizations to position themselves as quality institutions in the market. Including this model in the BSN curricula facilitates the development of confident nursing professionals. In addition, the students are assured of the ability to deliver quality services to their charges. As such, they are confident enough to the extent of being comfortable to be held legally accountable.
Introduction
Idealistic students are likely to become disillusioned in case their expectations are not met. They may be discouraged if they are expected to be competent in EBP without prior adequate training. As such, faculties have to address this problem, especially among Bachelor of Science in Nursing (BSN) students. It is not clear whether or not the content of the curricula used in these institutions creates a link between classroom teaching and application of knowledge in real life situations.
The demand for patient safety and quality healthcare is on the rise. To meet this demand, best possible evidence should be translated into practice. Nursing education provides the society with competent nurses. The practitioners should be knowledgeable and ready to implement EBP in their service delivery.
The emphasis on EBP in the healthcare sector has increased. As such, many people expect nurses to utilize research findings in making informed clinical decisions (Doumit, Gattellari, Grimshaw & O’Brien, 2010). The situation is made worse by the increasingly changing and complex healthcare environment. According to Llaus (2011), nursing educators are expected to foster critical appraisal skills among their students. In their efforts to meet the present demands, nursing students should be able to turn research findings into practice. The need for this ability notwithstanding, the level of awareness of EBP teaching among BSN students’ faculties remains unascertained.
Various organizations are currently pushing these issues into the frontline. Such bodies acknowledge that nurses and other professionals are important in the provision of quality healthcare services. As a result, the practitioners should be very thorough in carrying out their duties. The elements of Baccalaureate Education for the Professional Nursing Practice play a role in shaping the character of practitioners. Educators impact on the entire nursing field, including on the welfare of the patients. They are tasked with the responsibility of equipping BSN students with the skills needed to enhance the quality of services.
According to Burns and Foley (2005), teaching EBP in BSN classes is beneficial to both the nurses and the healthcare systems. Apart from enhancing the achievement of cost effectiveness, the concept facilitates consistent decision-making in the sector. On their part, nurses are made aware of emerging technologies, improving their performance in the process.
Teaching EBP boosts the status of these professionals when interacting with other multi-professional teams. According to Killeen and Barnfather (2005), nurses who are well grounded in EBP have been shown to express a sense of growth and professionalism. The competency helps in the development of their professional identity.
The relevance of EBP to the contemporary nursing practice is indisputable. The model is an inevitable requirement for practicing nurses, explaining the increasing need for its incorporation in BSN curricula. Failure to adopt this aspect of present day nursing exposes the students, the present generation of nurses, to numerous shortcomings. According to Bostwick (2013), there are three significant aspects of EBP that students need to be aware of. One of them is the application of research based evidence in decision making. The concept extends to finding, systemically appraising, and condensing evidence to assist in clinical operations.
The duty of BSN teachers goes beyond the development of experts. The gap between theory and practice among the students remains largely unexplored. The gap should be addressed to improve the skills of these future practitioners. Jones (2010) postulates that the need for safety and quality in the provision of care makes it apparent that nursing can no longer rely on traditions.
Review of Related Literature
The Role of EBP in the Nursing Profession
The recognition and appreciation of the role played by EBP in the healthcare sector is growing by the day. Consequently, a number of professional bodies, including the nursing teaching fraternity, are tasked with the responsibility of identifying the various roles of this model in the field. As mentioned earlier in this paper, there are five areas in which nurses are required to be competent in. The Institute of Medicine (IOM) included an additional element into these competencies. The organization introduced the concept of familiarization with EBP (Institute of Medicine [IOM], 2010). The institution called for the inclusion of the practice in the mainstream nursing profession. It emphasized on the need for this skill among students undergoing training in nursing.
The American Association of Colleges of Nursing [AACN] (2008) and the National League of Nursing [NLN] (2007) have supported the call by IOM. The two organizations are in agreement that proficiency in EBP improves the outcome in the nursing practice. The three bodies have taken it upon themselves to advocate for the advancement of EBP in teaching of nursing students. The organizations have advanced a raft of reforms in nursing education. In addition, they have highlighted the need for the development of curricula programs aimed at enhancing the acquisition of specific EBP competencies among nursing graduates.
The definition of the mandates of the healthcare institutions mentioned above is driven by a wide range of concerns related to the nursing practice. For instance, a 2001 report by IOM indicated that between 30 and 40 percent of healthcare clients in the United States of America receive treatment that is not in accordance with research evidence (IOM, 2010). Similar figures are reported by Doumit et al. (2010). According to Doumit et al. (2010), 20% of healthcare consumers in the U.S. receive unnecessary or potentially harmful care. The 2001 IOM report further revealed that medical errors committed in hospitals alone account for between 44000 and 98000 fatalities every year (Sammer, Lykens, Singh, Mains & Lacken, 2010). However, most fatalities in the country are related to deaths resulting from highway accidents, Acquired Immune Deficiency Syndrome (AIDS), and breast cancer.
The existence of the healthcare bodies tasked with the responsibility of adopting and promoting EBP highlight the significance of this model in the healthcare system. The central role occupied by EBP in the health industry highlight the importance of teaching these competencies in nursing classrooms. For instance, the AACN reports that BSN programs play a significant role in the performance of practicing nurses (AACN, 2008). In addition, the autonomy of entry-level nurses is rising, a development that calls for the adoption of this model.
The education system plays a critical role in the development of nurses and preparing them for the ever increasing demands associated with their profession. The National League for Nursing Accrediting Commission [NLNAC] (2002) and AACN determine the importance of EBP curricula in training nurses. The institutions have found that program curricula are needed to adequately prepare the graduate nurse for their life outside the classroom. The programs equip the students with the knowledge and competencies needed to improve the outcome of nursing interventions.
In light of the issues discussed above, BSN education programs are expected to develop graduates that are capable and willing to identify issues that call for the application of research evidence. When such students enter the nursing profession, they are likely to improve the quality of care provided to patients. IOM (2010) concurs with this observation. For instance, the organization came up with an initiative calling for the need to assess and transform the nursing profession. As a result, IOM (2010) believes that higher education in nursing should be evaluated to enhance the proficiency of BSN students.
Faculty Attitudes towards Teaching EBP in Nursing
The attitudes of nursing faculties towards EBP in the US vary significantly. According to Stichler, Faan, Fields, Kim and Brown (2011), traditionally, faculty members have focused on research in the process of teaching graduate and undergraduate nurses. Utilization of research findings has received little or no attention from these educationists.
Most faculties support the inclusion of EBP in the teaching programs (Stichler et al., 2011). However, some do not fully comprehend the differences between EBP approach and conventional research. Achterberg, Schoonhoven and Grol (2008) further note that traditional approaches to teaching of research have made students fail to acknowledge the importance of the process. In addition, most of these students lack the ability to turn research into practice when addressing compelling clinical questions.
The shift in focus from traditional research to evaluation of evidence in the nursing practice has led to various challenges with regards to the teaching methods used in nursing (Mantzoukas, 2006). It is noted that the paradigm shift from traditional processes to EBP has been slow. Some of the challenges include concerns over the duration needed to integrate these skills and sets of knowledge into the otherwise already full curricula. The slow rate of adoption also indicates lack of knowledge and related skills in relation to the appraisal and interpretation of data by some nursing faculties.
According to Stichler et al. (2011), the National League of Nursing conducted a Nursing Advisory Council’s survey in 2006. The survey sought to determine the perceptions of faculties in relation to NLN Nursing Hallmarks of Excellence. The study also determined to establish how these elements of excellence are reflected in nursing schools. The study shed light on faculty’s awareness of teaching EBP in nursing.
According to the survey, 88% of faculties believe that their curricula include experiences that address the issue of EBP in teaching nursing students (Stichler et al., 2011). In addition, the faculties prepared students to provide care based on this model. According to Stichler et al. (2011), 70% of those sampled reported that they have implemented innovative strategies in teaching EBP. In addition, 78% of the participants indicated that their strategies were evidence based (Stichler et al., 2011).
The themes highlighted in the survey cited above correlate with those in other studies conducted in the field. For instance, according to Bostwick (2013), new technologies influence the teaching and learning environments. Consequently, nursing students and their faculties are continually learning new and innovative ways of implementing EBP strategies.
Conclusion of the Literature Review
Numerous healthcare institutions advance various strategies to further EBP teaching and implementation in nursing faculties. The institutions seem intent on moving the majority of nursing schools towards the utilization of evidence in their pedagogical frameworks. The studies in this field show that the awareness of nursing faculties with regards to EBP teaching is growing among healthcare institutions in the US. However, a lot remains to be done to realize the optimum potential of this model in nursing. The reason is that in spite of this high level of awareness, the adoption and implementation of EBP in nursing teaching continues to be affected by various obstacles.
The shortcomings associated with the implementation of EBP in nursing training have been attributed to various developments. According to Burns and Foley (2005), one of the barriers is insufficient time. Most of the nurses prefer consulting their peers or using online databases to access research findings. They shun peer reviewed reports due to time constraints.
Other indentified barriers include inadequate resource and difficulties associated with the ability to understand and judge the quality of research materials (Stichler et al., 2011). Jones (2010) determined that many nurses have problems comprehending the strength of evidence provided in research articles. Bostwick (2013) postulates that basic and advanced curricula have failed to promote the adoption of EBP and research in nursing education. In addition, a number of clinical faculties are hesitant to incorporate EBP and research fundamentals into their teaching (Doumit et al., 2010). Furthermore, some of the faculties lack the time to embrace the new model. They are also uncomfortable with the introduction of EBP to their practice. The shortcomings have denied the students the chance to benefit from the strategy.
The lack of a culture supporting EBP in the various faculties of nursing has also been shown to be an obstacle (Doumit et al., 2010). The cultural obstacle is made worse by the heavy workload of nursing teaching staff. Bostwick (2013) adds that barriers arise due to lack of enough role models well versed in EBP in the nursing academic setting.
Conclusion
Considering the current status of EBP teaching and implementation in nursing faculties, one can conclude that the concept has been fairly embraced in this field. Evidence reveals that faculties and other stakeholders in nursing training realize the importance of this concept. In light of this, the adoption of this model among nursing faculties in the US can be regarded as fair. However, school administrators and other parties involved in training nurses need to do more to improve the adoption of this concept. Such institutions as NLN, AACN, and IOM have played a significant role in driving nursing practice towards evidence-based practice.
To realize the benefits of EBP in nursing faculties, the management should come up with strategies to enhance teaching and successful application of this model. Future studies on EBP need to focus on the development of a guiding framework. To this end, nursing faculties should develop a framework to promote EBP in the teaching of BSN students. Measures should be put in place to identify the strategies that promote the adoption of this approach in nursing. Pilot intervention studies should be conducted in the future to lay the ground for the implementation of the model. In addition, studies should be conducted to determine valid and reliable instruments to measure EBP capabilities among nurses.
Teaching EBP in nursing baccalaureate programs will promote the realization of not only this IOM core competency, but also the other four capabilities. The evidence supporting the benefits of this model reveals that a major obstacle faced in the implementation of this strategy is lack of skills and knowledge. The challenge can be overcome realistically by teaching EBP in nursing faculties under well defined curricula programs.
References
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