Key EBP Nursing Topics: Enhancing Patient Results through Evidence-Based Practice

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Key EBP Nursing Topics Enhancing Patient Results through Evidence-Based Practice

Evidence-based practice (EBP) is the use of the best available evidence to inform clinical decision-making in nursing. EBP has become increasingly popular in nursing practice because it ensures that patient care is based on the most current and relevant research. In this article, we will discuss the latest evidence-based practice nursing research topics, how to choose them, and where to find EBP project ideas.

What is Evidence-Based Practice Nursing?

EBP nursing involves a cyclical process of asking clinical questions, seeking the best available evidence, critically evaluating that evidence, and then integrating it with the patient’s clinical experience and values to make informed decisions. By following this process, nurses can provide the best care for their patients and ensure that their practice is informed by the latest research.

One of the key components of EBP nursing is the critical appraisal of research evidence. Nurses must be able to evaluate the quality of studies, including study design, sample size, and statistical analysis. This requires an understanding of research methodology and the ability to apply critical thinking skills to evaluate research evidence.

EBP nursing also involves the use of clinical practice guidelines and protocols, which are evidence-based guidelines for clinical practice. These guidelines have been developed by expert groups and are based on the best available evidence. By following these guidelines, nurses can ensure that their practice is in line with the latest research and can provide the best possible care for their patients.

Finally, EBP nursing involves continuous professional development and a commitment to lifelong learning. Nurses must keep abreast of the latest research and clinical practice guidelines to ensure that their practice is informed by the latest research. This requires a commitment to ongoing learning and professional development, including attending conferences, reading scholarly articles, and participating in continuing education programs.

You can also learn more about evidence-based practice in nursing to gain a deeper understanding of the definition, stages, benefits, and challenges of implementing it.

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How to Choose Evidence-Based Practice Nursing Research Topics

Choosing a science-based topic for nursing practice can be a daunting task, especially if you are new to the field. Here are some tips to help you choose a relevant and interesting EBP topic:

  • Look for controversial or debated issues

Look for areas of nursing practice that are controversial or have conflicting evidence. These topics often have the potential to generate innovative and effective research.

  • Consider ethical issues

Consider topics related to ethical issues in nursing practice. For example, bereavement care, informed consent , and patient privacy are all ethical issues that can be explored in an EBP project.

  • Explore interdisciplinary topics

Nursing practice often involves collaboration with other health professionals such as physicians, social workers, and occupational therapists. Consider interdisciplinary topics that may be useful from a nursing perspective.

  • Consider local or regional issues

Consider topics that are relevant to your local or regional healthcare facility. These topics may be relevant to your practice and have a greater impact on patient outcomes in your community.

  • Check out the latest research

Review recent research in your area of interest to identify gaps in the literature or areas where further research is needed. This can help you develop a research question that is relevant and innovative.

With these tips in mind, you can expand your options for EBP nursing research topics and find a topic that fits your interests and goals. Remember that patient outcomes should be at the forefront of your research and choose a topic that has the potential to improve treatment and patient outcomes.

Where to Get EBP Project Ideas

There are several sources that nurses can use to get EBP project ideas. These sources are diverse and can provide valuable inspiration for research topics. By exploring these sources, nurses can find research questions that align with their interests and that address gaps in the literature. These include:

  • Clinical Practice Guidelines

Look for clinical practice guidelines developed by professional organizations or healthcare institutions. These guidelines provide evidence-based guidelines for clinical practice and can help identify areas where further research is needed.

  • Research databases

Explore research databases such as PubMed, CINAHL, and the Cochrane Library to find the latest studies and systematic reviews. These databases can help you identify gaps in the literature and areas where further research is needed.

  • Clinical Experts

Consult with clinical experts in your practice area. These experts may have insights into areas where further research is needed or may provide guidance on areas of practice that may benefit from an EBP project.

  • Quality Improvement Projects

Review quality improvement projects that have been implemented in your healthcare facility. These projects may identify areas where further research is needed or identify gaps in the literature that could be addressed in an EBP project.

  • Patient and family feedback

Consider patient and family feedback to identify areas where further research is needed. Patients and families can provide valuable information about areas of nursing practice that can be improved or that could benefit from further research.

Remember, when searching for ideas for EBP nursing research projects, it is important to consider the potential impact on patient care and outcomes. Select a topic that has the potential to improve patient outcomes and consider the feasibility of the project in terms of time, resources, and access to data. By choosing a topic that matches your interests and goals and is feasible at your institution, you can conduct a meaningful and productive EBP research project in nursing.

Nursing EBP Topics You Can Use in Your Essay

Here are some of the latest evidence-based practice nursing research topics that you can use in your essay or explore further in your own research:

  • The impact of telehealth on patient outcomes in primary care
  • The use of music therapy to manage pain in post-operative patients
  • The effectiveness of mindfulness-based stress reduction in reducing stress and anxiety in healthcare workers
  • Combating health care-associated infections: a community-based approach
  • The impact of nurse-led discharge education on readmission rates for heart failure patients
  • The use of simulation in nursing education to improve patient safety
  • The effectiveness of early mobilization in preventing post-operative complications
  • The use of aromatherapy to manage agitation in patients with dementia
  • The impact of nurse-patient communication on patient satisfaction and outcomes
  • The effectiveness of peer support in improving diabetes self-management
  • The impact of cultural competence training on patient outcomes in diverse healthcare settings
  • The use of animal-assisted therapy in managing anxiety and depression in patients with chronic illnesses
  • The effectiveness of nurse-led smoking cessation interventions in promoting smoking cessation among hospitalized patients
  • Importance of literature review in evidence-based research
  • The impact of nurse-led care transitions on hospital readmission rates for older adults
  • The effectiveness of nurse-led weight management interventions in reducing obesity rates among children and adolescents
  • The impact of medication reconciliation on medication errors and adverse drug events
  • The use of mindfulness-based interventions to manage chronic pain in older adults
  • The effectiveness of nurse-led interventions in reducing hospital-acquired infections
  • The impact of patient-centered care on patient satisfaction and outcomes
  • The use of art therapy to manage anxiety in pediatric patients undergoing medical procedures
  • Pediatric oncology: working towards better treatment through evidence-based research
  • The effectiveness of nurse-led interventions in improving medication adherence among patients with chronic illnesses
  • The impact of team-based care on patient outcomes in primary care settings
  • The use of music therapy to improve sleep quality in hospitalized patients
  • The effectiveness of nurse-led interventions in reducing falls in older adults
  • The impact of nurse-led care on maternal and infant outcomes in low-resource settings
  • The use of acupressure to manage chemotherapy-induced nausea and vomiting
  • The effectiveness of nurse-led interventions in promoting breastfeeding initiation and duration
  • The impact of nurse-led palliative care interventions on end-of-life care in hospice settings
  • The use of hypnotherapy to manage pain in labor and delivery
  • The effectiveness of nurse-led interventions in reducing hospital length of stay for surgical patients
  • The impact of nurse-led transitional care interventions on readmission rates for heart failure patients
  • The use of massage therapy to manage pain in hospitalized patients
  • The effectiveness of nurse-led interventions in promoting physical activity among adults with chronic illnesses
  • The impact of technology-based interventions on patient outcomes in mental health settings
  • The use of mind-body interventions to manage chronic pain in patients with fibromyalgia
  • Optimizing the clarifying diagnosis of stomach cancer
  • The effectiveness of nurse-led interventions in reducing medication errors in pediatric patients
  • The impact of nurse-led interventions on patient outcomes in long-term care settings
  • The use of aromatherapy to manage anxiety in patients undergoing cardiac catheterization
  • The effectiveness of nurse-led interventions in improving glycemic control in patients with diabetes
  • The impact of nurse-led interventions on patient outcomes in emergency department settings
  • The use of relaxation techniques to manage anxiety in patients with cancer
  • The effectiveness of nurse-led interventions in improving self-management skills among patients with heart failure
  • The impact of nurse-led interventions on patient outcomes in critical care settings
  • The use of yoga to manage symptoms in patients with multiple sclerosis
  • The effectiveness of nurse-led interventions in promoting medication safety in community settings
  • The impact of nurse-led interventions on patient outcomes in home healthcare settings
  • The role of family involvement in the rehabilitation of stroke patients
  • Assessing the effectiveness of virtual reality in pain management
  • The impact of pet therapy on mental well-being in elderly patients
  • Exploring the benefits of intermittent fasting on diabetic patients
  • The efficacy of acupuncture in managing chronic pain in cancer patients
  • Effect of laughter therapy on stress levels among healthcare professionals
  • The influence of a plant-based diet on cardiovascular health
  • Analyzing the outcomes of nurse-led cognitive behavioral therapy sessions for insomnia patients
  • The role of yoga and meditation in managing hypertension
  • Exploring the benefits of hydrotherapy in post-operative orthopedic patients
  • The impact of digital health applications on patient adherence to medications
  • Assessing the outcomes of art therapy in pediatric patients with chronic illnesses
  • The role of nutrition education in managing obesity in pediatric patients
  • Exploring the effects of nature walks on mental well-being in patients with depression
  • The impact of continuous glucose monitoring systems on glycemic control in diabetic patients

The Importance of Incorporating EBP in Nursing Education

Evidence-based practice is not just a tool for seasoned nurses; it’s a foundational skill that should be integrated early into nursing education. By doing so, students learn the mechanics of nursing and the rationale behind various interventions grounded in scientific research.

  • Bridging Theory and Practice:

Introducing EBP in the curriculum helps students bridge the gap between theoretical knowledge and clinical practice. They learn how to perform a task and why it’s done a particular way.

  • Critical Thinking:

EBP promotes critical thinking. By regularly reviewing and appraising research, students develop the ability to discern the quality and applicability of studies. This skill is invaluable in a rapidly evolving field like healthcare.

  • Lifelong Learning:

EBP instills a culture of continuous learning. It encourages nurses to regularly seek out the most recent research findings and adapt their practices accordingly.

  • Improved Patient Outcomes:

At the heart of EBP is the goal of enhanced patient care. We ensure patients receive the most effective, up-to-date care by teaching students to base their practices on evidence.

  • Professional Development:

Familiarity with EBP makes it easier for nurses to contribute to professional discussions, attend conferences, and conduct research. It elevates their professional stature and opens doors to new opportunities.

To truly prepare nursing students for the challenges of modern healthcare, it’s essential to make EBP a core part of their education.

In summary, evidence-based practice nursing is an essential component of providing quality patient care. As a nurse, it is important to stay up to date on the latest research in the field and incorporate evidence-based practices into your daily work. Choosing a research topic that aligns with your interests and addresses a gap in the literature can lead to valuable contributions to the field of nursing.

When it comes to finding EBP project ideas, there are many sources available, including professional organizations, academic journals, and healthcare conferences. By collaborating with colleagues and seeking feedback from mentors, you can refine your research question and design a study that is rigorous and relevant.

The nursing evidence-based practice topics listed above provide a starting point for further exploration and investigation. By studying the effectiveness of various nursing interventions and techniques, we can continue to improve patient outcomes and deliver better care. Ultimately, evidence-based practice nursing is about using the best available research to inform our decisions and provide the highest quality care possible to our patients.

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What is Evidence-Based Practice in Nursing? (With Examples, Benefits, & Challenges)

evidence based practice essay nursing

Are you a nurse looking for ways to increase patient satisfaction, improve patient outcomes, and impact the profession? Have you found yourself caught between traditional nursing approaches and new patient care practices? Although evidence-based practices have been used for years, this concept is the focus of patient care today more than ever. Perhaps you are wondering, “What is evidence-based practice in nursing?” In this article, I will share information to help you begin understanding evidence-based practice in nursing + 10 examples about how to implement EBP.

What Is Evidence-Based Practice In Nursing?

When was evidence-based practice first introduced in nursing, who introduced evidence-based practice in nursing, what is the difference between evidence-based practice in nursing and research in nursing, what are the benefits of evidence-based practice in nursing, top 5 benefits to the patient, top 5 benefits to the nurse, top 5 benefits to the healthcare organization, 10 strategies nursing schools employ to teach evidence-based practices, 1. assigning case studies:, 2. journal clubs:, 3. clinical presentations:, 4. quizzes:, 5. on-campus laboratory intensives:, 6. creating small work groups:, 7. interactive lectures:, 8. teaching research methods:, 9. requiring collaboration with a clinical preceptor:, 10. research papers:, what are the 5 main skills required for evidence-based practice in nursing, 1. critical thinking:, 2. scientific mindset:, 3. effective written and verbal communication:, 4. ability to identify knowledge gaps:, 5. ability to integrate findings into practice relevant to the patient’s problem:, what are 5 main components of evidence-based practice in nursing, 1. clinical expertise:, 2. management of patient values, circumstances, and wants when deciding to utilize evidence for patient care:, 3. practice management:, 4. decision-making:, 5. integration of best available evidence:, what are some examples of evidence-based practice in nursing, 1. elevating the head of a patient’s bed between 30 and 45 degrees, 2. implementing measures to reduce impaired skin integrity, 3. implementing techniques to improve infection control practices, 4. administering oxygen to a client with chronic obstructive pulmonary disease (copd), 5. avoiding frequently scheduled ventilator circuit changes, 6. updating methods for bathing inpatient bedbound clients, 7. performing appropriate patient assessments before and after administering medication, 8. restricting the use of urinary catheterizations, when possible, 9. encouraging well-balanced diets as soon as possible for children with gastrointestinal symptoms, 10. implementing and educating patients about safety measures at home and in healthcare facilities, how to use evidence-based knowledge in nursing practice, step #1: assessing the patient and developing clinical questions:, step #2: finding relevant evidence to answer the clinical question:, step #3: acquire evidence and validate its relevance to the patient’s specific situation:, step #4: appraise the quality of evidence and decide whether to apply the evidence:, step #5: apply the evidence to patient care:, step #6: evaluating effectiveness of the plan:, 10 major challenges nurses face in the implementation of evidence-based practice, 1. not understanding the importance of the impact of evidence-based practice in nursing:, 2. fear of not being accepted:, 3. negative attitudes about research and evidence-based practice in nursing and its impact on patient outcomes:, 4. lack of knowledge on how to carry out research:, 5. resource constraints within a healthcare organization:, 6. work overload:, 7. inaccurate or incomplete research findings:, 8. patient demands do not align with evidence-based practices in nursing:, 9. lack of internet access while in the clinical setting:, 10. some nursing supervisors/managers may not support the concept of evidence-based nursing practices:, 12 ways nurse leaders can promote evidence-based practice in nursing, 1. be open-minded when nurses on your teams make suggestions., 2. mentor other nurses., 3. support and promote opportunities for educational growth., 4. ask for increased resources., 5. be research-oriented., 6. think of ways to make your work environment research-friendly., 7. promote ebp competency by offering strategy sessions with staff., 8. stay up-to-date about healthcare issues and research., 9. actively use information to demonstrate ebp within your team., 10. create opportunities to reinforce skills., 11. develop templates or other written tools that support evidence-based decision-making., 12. review evidence for its relevance to your organization., bonus 8 top suggestions from a nurse to improve your evidence-based practices in nursing, 1. subscribe to nursing journals., 2. offer to be involved with research studies., 3. be intentional about learning., 4. find a mentor., 5. ask questions, 6. attend nursing workshops and conferences., 7. join professional nursing organizations., 8. be honest with yourself about your ability to independently implement evidence-based practice in nursing., useful resources to stay up to date with evidence-based practices in nursing, professional organizations & associations, blogs/websites, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. what did nurses do before evidence-based practice, 2. how did florence nightingale use evidence-based practice, 3. what is the main limitation of evidence-based practice in nursing, 4. what are the common misconceptions about evidence-based practice in nursing, 5. are all types of nurses required to use evidence-based knowledge in their nursing practice, 6. will lack of evidence-based knowledge impact my nursing career, 7. i do not have access to research databases, how do i improve my evidence-based practice in nursing, 7. are there different levels of evidence-based practices in nursing.

• Level One: Meta-analysis of random clinical trials and experimental studies • Level Two: Quasi-experimental studies- These are focused studies used to evaluate interventions. • Level Three: Non-experimental or qualitative studies. • Level Four: Opinions of nationally recognized experts based on research. • Level Five: Opinions of individual experts based on non-research evidence such as literature reviews, case studies, organizational experiences, and personal experiences.

8. How Can I Assess My Evidence-Based Knowledge In Nursing Practice?

evidence based practice essay nursing

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How to Write an EBP Nursing Research Paper – Helpful Guide for APA Nursing Research Papers [+ 6 Examples & Outline]

Rachel andel rn, bsn.

  • August 12, 2022
  • Nursing Writing Guides

Writing an evidence-based practice nursing research paper is a structured process that requires extensive research and the help of the right tools and guidance. An EBP nursing research paper has different components requiring systematic research, writing, and editing.

In this guide, we provide a structured approach on how to write an effective EBP Nursing Research Paper . 

How to Write an Evidence-Based Paper – Step By Step Guide for APA Nursing Research Papers

EBP Nursing Research Paper Writing

 EBP nursing research paper

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When writing an EBP nursing research paper, it is important to consider the components of an effective nursing research paper. Here are the different elements of an EBP paper and how to write each.

Introduction to the EBP Nursing Research Papers

In an introduction, you should briefly overview the topic you will discuss. This will help your instructor understand the main points of your paper.

How do you write an introduction for an EBP Nursing Research Paper?

The introduction should be brief but provide enough information to orient readers to the topic and guide them through the rest of the paper. It should also introduce key concepts and explain what will come.

When writing your introduction, make sure it;

  • Defines the problem; it answers the question
  • Patient/Problem: What problems does the patient group have? What needs to be solved?
  • Intervention: What intervention is being considered or evaluated? Cite appropriate literature.
  • Comparison: What other interventions are possible? Cite appropriate literature.
  • Outcome: What is the intended outcome of the research question?
  • Introduces the key concept, thus providing a transition to the next section, which reveals that the target population
  • Clearly states the purpose of the report
  • Identifies the target population.
  • Relates to the significance of the problem
  • also relates to the significance of the problem  

You should include a clear statement of the research problem at the beginning or end of the introduction. This research problem can also generate the research question used to conduct the research itself.

Here’s an EBP Nursing Research Paper example ;

(1) Root caries is a disease of humans, which manifests as lesions on the root surfaces of teeth producing loss of the natural tooth structure.  (2) The lesions progress to deeper and deeper levels of the root as well as spreading laterally to enwrap it.  (3) Ultimately a lesion can progress to involve the pulp, threatening the viability of the tooth resulting in pain and eventual tooth loss.  (4) When located between the teeth, the lesions are difficult to acess and therefore difficult to excise and restore.  (5) In otherwise healthy, North American populations, root caries lesions increase with age. (6) This report sets out to provide evidence-based guidelines on the prevention of root caries for Toronto Public Helath staff on the best available evidence. https://www.una.edu/writingcenter/docs/Writing-Resource

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EBP Nursing Literature Review

The literature review is one of the most important sections of an EBP paper. It should provide a detailed overview of the studies conducted on your topic. You should also include any relevant quotes from these studies.

When writing an effective EBP literature review, it is important to keep in mind the following tips:

  • Take the time to read all the articles you cite in your review. This will help you understand the literature better and contextualize it.
  • Be sure to cite your sources correctly. If you use a journal article, for example, include the author’s last name and publication year in your citations.
  • Be concise in your writing. A literature review should not exceed 10 pages in length. Try to focus on key points and highlight why they are important.
  • Use analytical techniques to help you evaluate the literature. For example, consider using qualitative or quantitative methods to analyze data.
  • Make sure that your writing is accessible to a broad audience. If your research is technical, explain clearly how it was conducted and what it suggests.

EBP Nursing Research Paper Methodology

The methods section should describe how you researched the topic you are writing about. You should include details about the study you chose to utilize and any statistical analysis you performed.

How to write a methodology in an EBP Nursing Research Paper

Instead of collecting data through surveys, interviews, or clinical records, as in a quantitative or qualitative study, the data you collect is the literature produced on your topic.

Remember, the research you obtain is evidence like quantitative or qualitative data. But what evidence do you select to analyze?

It can be difficult to select evidence. Don’t just go with sources that work well for you, as this will only discredit your ideas. Consider assessing the dependability of the source, ensuring you have different viewpoints when considering a change in practice.

  • What database did you search?
  • Which search terms did you use, and how many total articles came up with those searches?
  • If the search yielded few or fewer results, that may be because the search was too narrow.

The author considers many factors when evaluating sources. Here’s how to evaluate sources for your nursing research Papers

  • Assess how trustworthy the source is, how accurate it is, and whether the source has a bias.
  • The credibility of study material—is the study/journal credible and original? Research can be found in scholarly journals rather than general reading material.
  • Validity: Does the study measure what it says it measures? What demographic sample did the study use? A study may be invalid or inaccurate if it does not produce an accurate margin of error.
  • The same test needs to be done to get a true sense of reliability and yield the same results. The test needs to end when the results have been favorable. The results of the study are valid. The report suggests high levels of consistency and validity.

Here’s How to write a Critical Analysis in Nursing

Findings – How to present findings in the EBP Nursing Research Paper

The results and discussion section should provide a detailed analysis of your findings. Discuss the implications of findings and how policymakers can use them.

Your findings will be an analysis, possibly including a chart or table. You should present the studies you selected as the most appropriate sources for studying your problem and instituting your proposed change.

Be sure to compare the following aspects of each study:

  • Demographics, pools, and samples
  • Methods of discovery and analysis
  • Results and limitations

Remember that these studies are supposed to be the most reliable and valid ones for answering the problem you found or the practice you wish to change. Your findings should lay the groundwork for making this argument in your discussion section.

Discussion: Conclusion and Recommendations for the EBP Nursing Research Paper

The conclusion section should summarize everything that has been discussed in the paper. It should provide a summary of your findings, and make any recommendations that you have for policymakers. Be Sure to:

  • Argue that the findings lead to the specific change in practice you identified in your introduction.
  • Suggest a strategy for implementation. Will the change you recommend (which these studies probably also recommend) work in your situation? Why? What changes might be needed?

Here’s a video guide

Here are a few key points to remember when writing your conclusion for an EBP Research Paper. First, combine all the information and data you’ve gathered throughout your paper.

Second, summarize your study’s findings and what they mean for nursing practice. Finally, provide recommendations for future research in this area.

History of Evidence-based Practice

The history of evidence-based practice (EBP) can be traced back to the early 1990s, when the Institute of Medicine published “To Err Is Human: Building a Safer Health System” which called for more use of evidence in health care decision making.

In 1992, the National Academies Press published “Principles of Evidence-Based Practice” which was a synthesis of work from multiple organizations and aimed to provide guidance on how to use evidence to improve patient care.

Since then, EBP has evolved into an increasingly popular approach to nursing practice. Today, EBP is used by nurses at all levels of education and experience, and it is becoming more integral to the way nurses deliver care. There are many reasons why EBP has become such an important tool in nursing practice, and this article will discuss some of them.

First, EBP helps nurses make informed decisions about patient care. Nurses need reliable information to provide quality care for their patients, and EBP provides that information by providing systematic reviews of research studies. Systematic reviews are a type of scientific literature review that systematically assess the quality and applicability of research studies in order to provide recommendations for clinical practice.

Steps of the EBP process

There are six steps in the Evidence-based Practice process:

Evidence-based practice involves the following six steps:

  • Assess the need for change: Formulate the research question based on the inadequacies of current practice.-  Identification of a problem or issue. Nurses should identify problems they see in their clinical practice and believe could benefit from intervention. For example, nurses may want to investigate whether patients who experience poor patient-centred outcomes after surgery have different factors, such as pain medication use or depression, that need to be addressed.
  • Locate the best evidence: Obtain sources and assess their credibility and relevancy to the research question. Locate the best evidence & Synthesize evidence: Assessment of the current state of knowledge. To determine which interventions are likely to be effective, nurses should review the evidence on the effectiveness of interventions. This evidence can come from studies that have been conducted on interventions, from reviews of existing studies, or from clinical guidelines .
  • 1) the target population for the intervention,
  • 2) the severity of the problem or issue,
  • 3) the feasibility of implementing the intervention
  • 4) the cost of the intervention.
  • Design the change: Apply the synthesized evidence to create a change in practice that reflects the new understanding. Selection and implementation of interventions. Nurses should select interventions that are likely effective for their target population, based on the factors listed in Step 3. They should then implement the interventions in a feasible and affordable way.
  • Implement and evaluate: Apply the necessary changes and assess the changes to acquire new evidence. Evaluation of outcomes. After implementing interventions, nurses should evaluate their outcomes to determine their effectiveness. This evaluation can be done in several ways, such as through surveys or focus groups.
  • Integrate and maintain changes: Reassess based on new evidence to continue improvement.

Nurses can use these steps to guide their EBP research in a number of ways. For example, they may want to investigate which interventions are most likely to be effective for a particular target population or problem, or they may want to determine which interventions are the most feasible and affordable to implement.

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Evidence-based Practice Research Paper

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Evidence-Based Research Paper topics in Nursing

List of twenty EBP Nursing Research Paper ideas in nursing to write about

  • Effectiveness of interventions for preventing falls in the elderly
  • A pilot study of the efficacy of a home-based intervention to reduce falls in older adults
  • Evaluating the effectiveness of a community-wide fall prevention intervention for older adults
  • The impact of diabetes on balance and falls in older adults
  • The effect of social isolation on falls in older adults
  • The influence of ethnicity on falls in older adults
  • Assessment and management of postural instability in the elderly
  • Trends in hip fracture rates among older adults in the United States over time
  • Reducing the risk factors for institutionalization among elders with Alzheimer’s disease
  • Promoting healthy sleep habits among elders with dementia
  • Assessing and managing sleep disturbances in elders with dementia
  • Effects of exercise interventions on balance, mobility, and safety in seniors
  • Rehabilitation after stroke: Targeting fall prevention
  • The Effect of Nurse-Family Partnership on maternal and child health outcomes
  • The Relationship of Depression to Nursing Home Use and Mortality
  • Factors Influencing Patient Compliance with Diabetes Management Guidelines
  • Contributions of Breastfeeding to Infant and Young Child Nutrition
  • Role of the nurse in community-acquired pneumonia prevention
  • Effectiveness of home health aide services on elder quality of life
  • Impact of Acute Care Hospitals on the Nation’s Health

Plan of the EBP Nursing Research Paper

Writing an EBP Nursing research paper can be daunting, but it can be much easier with a plan. This guide will provide you with the essential steps you need to take to produce high-quality research papers. First, you will need to identify the problem you are researching. Next, identify the population most likely to experience the problem and/or share its consequences.

Finally, using evidence-based practices as your guide, develop a plan of action that will address the problem.

Read more on How to Format a CV for a Nursing Position Examples

Identify the Problem

The first step in writing an EBP nursing research paper is to identify the problem you are researching. This can be difficult, as the problem may be subtle or complex. However, you can use rigorous research methods to identify the problem and its consequences.

Once you have identified the problem, you must identify the population most likely to experience it and/or share its consequences. This can be a difficult task, as it may be difficult to differentiate between those affected by the problem and those not. However, by using reliable sources of information, you can develop a profile of the population that will help you identify which groups are most at risk.

Once you have identified the population most likely to experience the problem, you to develop a plan of action to address it. This action plan should be based on evidence-based practices, ensuring that your proposal is effective and efficient.

Find out more on Nursing Essay Thesis Statement [+How to & Examples]

Develop a Plan of Action

The next step in writing an EBP nursing research paper is to develop a plan of action. This action plan should be based on the evidence you have gathered and the population you have identified as most at risk.

Your action plan should include specific objectives, targets, timelines, and budgetary constraints. It should also include measures to resolve the problem, including benchmarks and measurements.

Finally, your action plan should be evaluated and revised based on stakeholder feedback. This feedback will help you ensure that your proposal is effective and efficient.

Writing an EBP nursing research paper can be daunting, but it can be much easier with a plan. This guide will provide you with the essential steps you need to take to produce high-quality research papers. First, you will need to identify the problem you are researching. Next, identify the population most likely to experience the problem and/or share its consequences. Finally, using evidence-based practices as your guide, develop a plan of action that will address the issue.

Steps of Writing an EBP Research Paper in Nursing

1. Determine the purpose of your EBP study. 2. Choose a relevant population or setting. 3. Identify the specific question you wish to answer. 4. Collect and analyze data. 5. Construct a hypothesis or theory based on your findings. 6. Write a conclusion that supports your thesis statement. 7. Offer suggestions for future research on evidence-based practice in nursing.

EBP Research Paper Literature Review Writing- Evidence-Based Practice (EBP)

Evidence-based practice (EBP) is an approach to nursing that focuses on using evidence to guide clinical decisions. EBP is effective in improving patient outcomes and reducing healthcare costs. To write an effective EBP literature review, it is important to understand the concepts of evidence and research.

The following section will provide a brief overview of the concept of evidence and its role in EBP. After this, the section will outline the different types of research used in EBP and discuss how to select appropriate research for your paper. Finally, the section will provide tips for writing an effective literature review.

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What is Evidence?

Evidence is information that supports a belief or theory. It can come from either personal experience or empirical research. Personal experience includes things like doctor’s orders or patient statements. Empirical research includes studies that use scientific methods to collect data about a particular topic.

Why Use Evidence in Nursing?

There are many reasons why using evidence in nursing is important. First, it can help improve patient outcomes. For example, using evidence-based practices when caring for patients with diabetes can help control their blood sugar levels and reduce the risk of complications.

Second, using evidence can reduce healthcare costs. For example, using evidence-based interventions when caring for patients with heart disease can help reduce the risk of death and hospitalization.

Finally, using evidence can help nurses make better decisions. For example, when caring for a patient with cancer, it is important to use evidence-based treatments that are effective in reducing the risk of cancer recurrence.

What Types of Research is Used in EBP?

There are many different types of research used in EBP. The following section will outline the different types of research and discuss how to select appropriate research for your paper.

  • Clinical trials: Clinical trials are experiments that are designed to test the effectiveness of a new treatment or intervention. Clinical trials can be conducted in hospitals or clinics.
  • Evaluation studies: Evaluation studies compare the outcomes of two or more treatments or interventions. Evaluation studies can be conducted in hospitals or clinics.
  • Observational studies: Observational studies collect data about how people behave without Intervention. Observational studies can be conducted at home, work, or anywhere people gather data.

How to Select Appropriate Research for Your Paper

When selecting research for your EBP nursing research paper, it is important to consider the topic you are writing about and the audience you are writing for. The following tips can help you select appropriate research for your paper.

  • First, consider the topic you are writing about. If you are writing about a new treatment or intervention, it is important to use clinical trials. Clinical trials are experiments that are designed to test the effectiveness of a new treatment or intervention.
  • If you are writing about an existing treatment or intervention, it is important to use observational studies. Observational studies are studies that collect data about how people behave without Intervention. These studies can be conducted at home, work, or anywhere else people gather data.
  • Second, consider the audience you are writing for. If you are writing for a healthcare provider, using evidence-based practices that effectively improve patient outcomes and reduce healthcare costs is essential. If you are writing for a patient or their family, using understandable and relatable information is essential.
  • Finally, always check the credibility of any sources used in your paper. Credible sources will typically have references that can be verified.

Using credible sources for Evidence-based practice paper

Evidence-based practice (EBP) is a nursing research methodology that draws on published, peer-reviewed scientific studies to develop rationales for and recommendations for patient care.

  • It is important to use credible sources to write an EBP paper that is both credible and useful. Credible sources have been examined by experts in the field and found to be reliable. To identify credible sources, it is helpful first to understand what constitutes evidence-based practice.
  • The five types of evidence considered most important in EBP are randomized clinical trials (RCTs), systematic reviews, meta-analyses, case reports, and expert opinion.
  • When using any of these types of evidence, it is important to ensure the study was conducted according to strict methodological standards.
  • For example, RCTs must be blinded (i.e., the participants and investigators should not know which group is receiving the treatment being studied). Furthermore, all data collected during an RCT must be reported accurately and completely.
  • Once you have identified a study as credible, the next step is to determine whether the study’s findings are relevant to your topic. It is important to note that not all studies that qualify as evidence-based practice apply to every topic.
  • For example, a study that explores the use of acupuncture as a treatment for chronic neck pain would not apply to writing an EBP paper on the use of epidural analgesia in childbirth.
  • Finally, it is important to consider the implications of the study’s findings when writing an EBP paper.
  • For example, if a study found that a particular treatment was ineffective, it is important to discuss why this might be the case and what can be done to address the issue.

What are the 5 A’s in evidence-based practice?

Evidence-based practice is a healthcare approach that is based on the use of evidence from research studies to make decisions about care. Here are the A’s in evidence-based practice:

  • Anchor: The anchor for your paper should be a specific and meaningful study that provides the basis for your argument.
  • Background: State the purpose of your paper, including why you are studying the issue.
  • Methods: Describe how you conducted your study and collected the data.
  • Results: Discuss the findings of your study in detail, including any relevant conclusions.
  • Discussion: Explain how this information can be used to improve patient care.

How do nurses write evidence based practice papers?

There are a few key steps that nurses should take when writing evidence based practice papers, including conducting research, analyzing data, and writing effective conclusions.

Here are more specific tips on how to go about each of these steps:

1. Conduct Research: The first step in writing an evidence-based practice paper is to conduct research. This means gathering information from reliable sources to support your arguments. You can find information on different types of research in the library, online databases, and journals. When selecting sources, be sure to select studies that are relevant to your topic and that you can trust.

2. Analyze Data: After you have gathered your data, it is important to analyze it carefully. This means looking at the data from different perspectives and using logic and reasoning to arrive at a conclusion. Be sure to state your findings clearly and concisely so that others can understand them.

3. Write Effective Conclusions: The final step in writing an evidence-based practice paper is to write effective conclusions. This section should summarize your findings and include any recommendations that you have for improving patient care. Remember to support your recommendations with credible evidence.

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  • Research article
  • Open access
  • Published: 07 January 2021

Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students

  • Nesrin N. Abu-Baker   ORCID: orcid.org/0000-0001-9971-1328 1 ,
  • Salwa AbuAlrub 2 ,
  • Rana F. Obeidat 3 &
  • Kholoud Assmairan 4  

BMC Nursing volume  20 , Article number:  13 ( 2021 ) Cite this article

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Integrating evidence-based practice (EBP) into the daily practice of healthcare professionals has the potential to improve the practice environment as well as patient outcomes. It is essential for nurses to build their body of knowledge, standardize practice, and improve patient outcomes. This study aims to explore nursing students’ beliefs and implementations of EBP, to examine the differences in students’ beliefs and implementations by prior training of EBP, and to examine the relationship between the same.

A cross-sectional survey design was used with a convenience sample of 241 nursing students from two public universities. Students were asked to answer the questions in the Evidence-Based Practice Belief and Implementation scales.

This study revealed that the students reported a mean total belief score of 54.32 out of 80 ( SD  = 13.63). However, they reported a much lower implementation score of 25.34 out of 72 ( SD  = 12.37). Students who received EBP training reported significantly higher total belief and implementation scores than those who did not. Finally, there was no significant relationship between belief and implementation scores ( p  > .05).

To advance nursing science, enhance practice for future nurses, and improve patient outcomes, it is critical to teach nursing students not only the value of evidence-based knowledge, but also how to access this knowledge, appraise it, and apply it correctly as needed.

Peer Review reports

Evidence-based practice (EBP) integrates the clinical expertise, the latest and best available research evidence, as well as the patient’s unique values and circumstances [ 1 ]. This form of practice is essential for nurses as well as the nursing profession as it offers a wide variety of benefits: It helps nurses to build their own body of knowledge, minimize the gap between nursing education, research, and practice, standardize nursing practices [ 2 ], improve clinical patient outcomes, improve the quality of healthcare, and decrease healthcare costs [ 3 ]. Thus, clinical decision-making by nurses should be based on the best and most up-to-date, available research evidence [ 4 ].

Earlier studies of EBP implementation by nurses in their everyday clinical practice have shown that it is suboptimal [ 5 , 6 , 7 ]. Implementation of EBP is defined as its application in clinical practice [ 8 ]. Findings from previous studies indicate that nurses’ implementation of EBP can be promoted by improving their belief about EBP. Belief is the perception of the value and benefits of EBP and the perceived self-confidence in one’s knowledge and skills of EBP [ 8 ]. Nurses with a strong belief in EBP implement it more than nurses with a weak belief in the same [ 7 , 9 ].

Preparing nurses for practice and ensuring that they have met a set of minimum core competencies at the point of graduation is achieved through their undergraduate education [ 10 ]. Several formal entities such as the Institute of Medicine (IOM) [ 4 ] and the Accreditation Commission for Education in Nursing (ACEN) [ 11 ] consider EBP as one of the core competencies that should be included in health care clinicians’ education. However, this does not necessarily guarantee the actual implementation of EBP in everyday clinical practice [ 12 ]. It is essential to educate undergraduate nursing students on EBP to improve their knowledge about it, to strengthen their belief regarding its benefits to patients and nurses, and to enhance their self-efficacy in implementing EBP. In order to effect this change, it is crucial to improve the education process and to focus more on the knowledge and implementation of EBP.

There is consistent evidence showing that while undergraduate nursing students hold positive beliefs about EBP and its value in patient care, they also report many challenges regarding its actual implementation in clinical practice. For instance, a mixed-methods study indicated that 118 American undergraduate nursing students found it difficult to distinguish between EBP and research. Students were able to search for evidence, but were less able to integrate evidence to plan EBP changes or disseminate best practices [ 13 ]. Additionally, a correlational study was conducted in Jordan using a sample of 612 senior nursing students. The study reported that students held positive attitudes towards research and 75% of them agreed on using nursing research in clinical practice. Students strongly believed in the usefulness of research. However, they did not believe strongly in their ability to conduct research [ 14 ]. A cross-sectional study was conducted among 188 Saudi undergraduate nursing students. Students reported positive beliefs about EBP; however, they reported a low mean score in EBP implementation (22.57 out of 72). Several significant factors have been reported as influencing EBP implementation, such as age, gender, awareness, and training on EBP [ 15 ]. A comparative survey comprised of 1383 nursing students from India, Saudi Arabia, Nigeria, and Oman. The study reported that having no authority in changing patient care policies, the slow publication of evidence, and the lack of time in the clinical area to implement the evidence were major barriers in implementing EBP according to the participating students [ 16 ].

In Jordan, evidence-based knowledge with critical thinking is one of the seven standards for the professional practice of registered nurses that were released by the Jordan Nursing Council [ 17 ]. Despite the plethora of studies on undergraduate nursing students’ beliefs about EBP and its implementation in everyday clinical practice, this topic has not been fully addressed among Jordanian undergraduate nursing students. Thus, the purpose of this study is to explore the self-reported beliefs and implementations of EBP among undergraduate nursing students in Jordan. The specific aims of this study were to (1) explore nursing students’ beliefs and implementations of EBP, (2) examine the differences in students’ beliefs and implementations by prior training of EBP, and (3) examine the relationship between nursing students’ beliefs and implementations of EBP.

Design and setting

A cross-sectional, correlational research survey design was used to meet the study aims. Recruitment of study participants was undertaken at two governmental universities in the northern part of Jordan. The two universities offer a four-year undergraduate nursing program aimed at graduating competent general nurses with baccalaureate degrees. The nursing research course is included as a compulsory course in the undergraduate nursing curricula in both universities.

Population and sample

The target population of this study was the undergraduate nursing students in Jordan. The accessible population was undergraduate nursing students who are currently enrolled in the four-year BSN program in two governmental universities in the northern region of Jordan. We calculated the sample size using the G*Power software (2014). Using a conventional power estimate of 0.8, with alpha set at 0.05, and medium effect size, it was estimated that for a Pearson Correlation test, a total of 100 participants would need to be recruited to examine the relationship between the beliefs and implementations of EBP. To counteract anticipated non-response and to enhance the power of the study, 300 students were approached. The inclusion criteria of the study participants were as follows: a) senior nursing students who are in the 3 rd or 4th-year level, b) students who are currently taking a clinical course with training in a clinical setting/hospital, c) and students who have successfully passed the nursing research course.

Measurement

A structured questionnaire composed of two parts was used for data collection. The first part aimed to gather the demographic data of the participants: gender, age, study year level, university, and any previous EBP training received in the nursing research course. The second part contained the EBP Belief Scale and EBP Implementation scale developed by Melnyk et al. (2008) [ 18 ]. Both scales had previous satisfactory psychometric properties with a Cronbach’s alpha of more than 0.9 and good construct validity. The Evidence-Based Practice Belief Scale (EBPB) consists of 16 statements that describe the respondent’s beliefs of EBP. Students were asked to report on a five-point Likert scale their agreement or disagreement with each of the 16 statements in the scale. Response options on this scale ranged from strongly disagree (1 point) to strongly agree (5 points). All statements were positive except for two statements (statements 11 and 13), which were reversed before calculating the total and mean scores. Total scores on the EBPB ranged from 16 to 80, with a higher total score indicating a more positive belief toward EBP. In the current study, the scale showed satisfactory internal consistency reliability with a Cronbach’s Alpha of .92 for the total scale.

The Evidence-Based Practice Implementation Scale (EBPI) consists of 18 statements related to the respondent’s actual implementation of EBP in the clinical setting. Students were asked to report the frequency of the application of these statements over the past 8 weeks. The answers were ranked on a Likert scale that ranged from 0 to 4 points (0 = 0 times, 1 = 1–3 times, 2 = 4–5 times, 3 = 6–8, and 4 ≥ 8 times). The total score ranged from 0 to 72, with the higher total score indicating a more frequent utilization of EBP.

Both scales were introduced to the participating students in their original language of English because English is the official language of teaching and instruction in all schools of nursing in Jordan.

Ethical considerations

The Institutional Review Board (IRB) at the first author’s university granted ethical approval for this study (Reference #19/122/2019). The code of ethics was addressed in the cover letter of the questionnaire. The principal investigator met the potential eligible students, provided them with an explanation about the study purpose and procedures, and gave them 5 min to read the questionnaires and to decide whether to participate in the study or not. Students who agreed to participate in the study were assured of voluntary participation and the right to withdraw from the study at any time. Questionnaires were collected anonymously without any identifying information from the participating students. The principal investigator explained to participating students that the return of completed questionnaires is an implicit consent to participate in the study. Permission to use the EBP belief scale and the EBP implementation scale for the purpose of this study was obtained from the authors of the instrument.

Data collection procedure

After ethical approval was granted to conduct the study, data was collected during the second semester of the academic year 2018/2019 (i.e., January through June 2019). The questionnaires were distributed to the nursing students during the classroom lectures after taking permission from the lecturer. The researchers explained the purpose, the significance of the study, the inclusion criteria, and the right of the students to refuse participation in the study. Students were screened for eligibility to participate. Students who met the eligibility criteria and agreed to participate were provided with the study package that included a cover letter and the study questionnaire. Students were given 20 min to complete the questionnaire and return it to the principal investigator who was available to answer students’ questions during the data collection process.

Data analysis

Descriptive statistics (e.g., means, standard deviations, frequencies, and percentages) were performed to describe the demographic characteristics of the participating students and the main study variables. For the belief scale, the two agreement categories (4 = agree, 5 = strongly agree) were collapsed to one category to indicate a positive belief. For the implementation scale, the three categories (2 = 4–5 times, 3 = 6–8, and 4 ≥ 8 times in the past 8 weeks) were collapsed to one category as (≥ 4 times) to indicate frequent implementation. Pearson’s correlation test was used to determine the relationship between the total scores of the EBP belief and implementation scales. A chi-square test was used to examine the difference between trained and untrained students in terms of agreement toward each EBP belief (disagreement vs. agreement) and in terms of frequency of each EBP implementation (less than 4 times vs. 4 times or more in the past 8 weeks). Finally, an independent samples t -test was used to examine the difference between trained and untrained students in terms of the total mean scores of EBP beliefs. The Statistical Package for Social Sciences (SPSS) software (version 22) was used for data analysis.

Among the 300 approached students, 35 students did not meet the inclusion criteria and 24 students refused to participate. Thus, a total of 241 undergraduate nursing students from both universities completed the study questionnaire for a response rate of 91%. The mean age of the participants was 22.09 years ( SD  = 1.55). The majority of the participants were females (73.4%) and in the fourth year of the undergraduate nursing program (85.1%). Further, more than half of the participants (67.6%) stated that they received EBP training before (Table  1 ).

The total mean score of the EBP belief scale was 54.32 out of 80 ( SD  = 13.63). Overall, between 50.5 and 73.4% of students agreed or strongly agreed on the 16 statements on the EBP belief scale, which indicates positive beliefs. However, students held a more positive belief regarding the importance and the usefulness of EBP in quality patient care than in their ability to implement EBP. For example, while the majority of students believed that “EBP results in the best clinical care for patients” and that “evidence-based guidelines can improve clinical care” (73.4 and 72.2%, respectively), only about 54% of them cited that they “knew how to implement EBP sufficiently enough to make practice changes” or were “confident about their ability to implement EBP where they worked”. Students who received previous training on EBP reported more agreements (i.e., more positive beliefs) toward all items of EBP compared to those who did not receive training; however, the difference between the two groups was not always significant. For example, 60.7% of trained students believed that “they are sure that they can implement EBP” compared to 41% of untrained students χ 2 (1, n  = 241) = 8.26, p  = .004. Furthermore, 58.3% of trained students were “clear about the steps of EBP” compared to 41% of untrained students χ 2 (1, n  = 241) = 6.30, p  = .021 (Table  2 ).

In contrast, students reported a much lower total score on the EBP implementation scale: 25.34 out of 72 ( SD  = 12.37). Less than half the students reported implementing all the listed EBPs four times or more in the last 8 weeks. For example, only about one-third of all students reported that they “used evidence to change their clinical practice”, “generated a PICO question about clinical practice”, “read and critically appraised a clinical research study”, and “accessed the database for EBP four times or more in the past eight weeks” (32.4, 33.6, 31.9, and 31.6%, respectively). The only EBP that was implemented by more than half of the students (54.8%) four times or more in the past 8 weeks was “collecting data on a patient problem”. Students who had previous training on EBP reported more frequent implementations of all listed EBPs compared to those who did not receive training; however, the difference between the two groups was not always significant. For example, 50.9% of trained students reported that they “shared an EBP guideline with a colleague” four times or more in the past 8 weeks compared to 30.8% of untrained students χ 2 (1, n  = 241) = 8.68, p  = .003. Almost 50 % of the trained students “shared evidence from a research study with a patient/family member” four times or more in the past 8 weeks, compared to 28.2% of the untrained students χ 2 (1, n  = 241) = 9.95, p  = .002 (Table  3 ).

There was a significant difference between students’ total scores on the EBP belief scale with respect to previous training on EBP. Students who received previous training on EBP had a significantly higher mean score on the EBP belief scale compared to students who did not receive previous training on EBP ( t (239) = 2.04, p  = .042). In addition, there was a significant difference in the total score of EBP implementation by previous training on EBP. Students who received previous training on EBP had a significantly higher mean score on the EBP implementation scale compared to students who did not receive previous training on EBP ( t (239) = 3.08, p  = .002) (Table  4 ).

Finally, results of the Pearson correlation test revealed that there was no significant association between the total score of the EBP belief scale and the total score of the EBP implementation scale ( r  = 0.106, p  = 0.101).

This study aimed to explore the self-reported beliefs regarding and implementation of EBP among undergraduate nursing students in Jordan. It is observed that Jordanian undergraduate nursing students valued EBP and its importance in delivering quality patient care as over 70% of them believed that EBP results in the best clinical care for patients and that evidence-based guidelines can improve clinical care. However, a lower percentage of students believed in their ability to implement EBP where they worked and an even lower percentage of them actually implemented EBP frequently in their everyday clinical practice. For illustration, only one-third of the students accessed a database for EBP, have read and critically appraised a clinical research study, or used evidence to change their clinical practice four times or more in the last 8 weeks. Our results are consistent with previous studies among Jordanian nursing students which also showed students had positive attitudes towards research and its usefulness to providing quality patient care but had insufficient ability to utilize research evidence in clinical practice [ 14 ]. Further, a recent study has shown that nursing students in Jordan had low knowledge about EBP regardless of their admitting university [ 19 ]. These results indicate that there could be a gap in the education process of undergraduate nursing students in Jordan about EBP. Thus, schools of nursing in Jordan have to critically review their current educational strategies on EBP and improve it to enhance students’ knowledge of EBP as well as their abilities to implement evidence in clinical practice.

The results of the current study revealed that despite the positive beliefs of the nursing students, their implementation of EBP was very low. There was no significant relationship between the total score of EBP belief and the total score of EBP implementation. Our results are consistent with those reported among Saudi as well as American nursing students who also had positive beliefs about EBP but implemented it less frequently in their everyday clinical practice [ 13 , 15 ]. Moreover, in line with previous studies which showed that training on EBP was one of the significant predictors of beliefs and implementation [ 15 ], students who previously received EBP training had significantly higher total belief and implementation scores than those who did not, in this study. This finding is expected as EBP training has been shown to improve knowledge, self-efficacy in implementation, and by extension, implementation practices among nurses and nursing students [ 20 , 21 , 22 ]. On the other hand, in this study, we asked students whether they have received training on EBP during the nursing research course taught at their universities. More than one-third of participating students in our study cited that they had not received previous training on EBP even though all of them have successfully passed the nursing research course offered at their universities. One possible explanation for this finding could be that there is an inconsistency in the way the nursing research course is taught. It seems that EBP practice is not always included in the content taught in this course. Thus, nursing schools in Jordan have to revise their curricula to ensure that EBP is included and is taught to all students before graduation.

The results of the current study have several international implications that involve academic education and nursing curricula. There is a pressing need to enhance the education process and to focus more on the knowledge and skills of EBP. Incorporating EBP into the nursing curricula, especially the undergraduate program is critical as it is the first step to prepare the students for their professional roles as registered nurses. Sin and Bliquez (2017) stated that creative and enjoyable strategies are fundamental in order to encourage students’ commitment to and learning about EBP [ 23 ]. One of these effective strategies is teaching the EBP process by asking a clinical question, acquiring and searching for evidence, appraising then applying this evidence, and finally evaluating the effectiveness of its application in clinical practice [ 8 ]. A thematic review study demonstrated that various interactive teaching strategies and clinically integrated teaching strategies have been emphasized to enhance EBP knowledge and skills [ 24 ].

Gaining knowledge about undergraduate nursing students’ beliefs and their ability to implement EBP in a clinical setting is essential for nursing educators at the national and the international level. This knowledge might help them to evaluate and improve the current strategies utilized to educate undergraduate students about EBP. Furthermore, academic administrators and teachers should design their courses to apply EBP concepts. They should promote EBP training courses, workshops, and seminars. For example, the research course should focus more on this topic and should include clinical scenarios that involve the application of EBP. In addition, clinical courses should include assignments for the purpose of integrating EBP within their clinical cases. The scale used in this study could be implemented in clinical courses to evaluate students’ practical skills concerning EBP. Finally, nursing instructors, leaders, and practitioners should always update their EBP knowledge and skills through continuous education and workshops. Since they are the role models and instructors, they should be competent enough to teach and evaluate their students. They should also cooperate to facilitate the implementation of EBP in clinical settings to overcome any barrier.

Study limitations and recommendations

This study sheds light on the existing gap between the belief in and the implementation of EBP among nursing students. However, convenience sampling, using two universities only, and self-report bias are all limitations of this study. In addition, the researchers did not investigate the type of EBP training that was received by the students in this study. More studies are needed in Jordan and the Middle Eastern region about EBP using larger random samples in different settings. It is also recommended to investigate the barriers that prevent nursing students from implementing EBP other than not receiving training on it. Furthermore, conducting qualitative studies might help examine and understand students’ perceptions as well as provide suggestions to bridge the gap between education and practice. Finally, future experimental studies are needed to test the effect of certain interventions on enhancing the implementation of EBP among nursing students.

Evidence-based practice is essential for nursing students worldwide. However, having strong beliefs about EBP and its benefits does not necessarily mean that it is frequently implemented. On the other hand, providing training courses on EBP is an essential step in the enhancement of EBP implementation. This means that in order to advance nursing science and enhance nursing care for future nurses, it is vital to incorporate EBP within the nursing curricula. It is also critical to teach nursing students the value of evidence-based knowledge as well as how to access this knowledge, appraise it, and apply it correctly as needed. This can be achieved through rigorous cooperation between nursing administrators, clinicians, teachers, and students to enhance the implementation process.

Availability of data and materials

Data are available from the corresponding author upon reasonable request and with permission of Jordan University of Science and Technology.

Abbreviations

Evidence-Based Practice

Institute of Medicine

Accreditation Commission for Education in Nursing

Evidence-Based Practice Belief Scale

Evidence-Based Practice Implementation Scale

The Statistical Package for Social Sciences

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This study was funded by Jordan University of Science and Technology Grant # (20190141). The funding source had no role in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript.

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Abu-Baker, N.N., AbuAlrub, S., Obeidat, R.F. et al. Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students. BMC Nurs 20 , 13 (2021). https://doi.org/10.1186/s12912-020-00522-x

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Addressing the current challenges of adopting evidence-based practice in nursing

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evidence based practice essay nursing

This aim of this article is to explore the current position of evidence-based practice (EBP) in nursing. The article provides an overview of the historical context and emergence of EBP with an outline of the EBP process. There is an exploration of the current challenges facing the nursing profession as it endeavours to adopt EBP into care delivery, along with actions to address these challenges. There will also be a discussion on how to integrate EBP into undergraduate nursing curricula as academic institutions implement the Future nurse standards of proficiency from the Nursing and Midwifery Council.

It has been suggested that the idea of delivering care based on evidence had its early foundations in the 1800s with Florence Nightingale, who aimed to provide better outcomes for patients who experienced unsanitary conditions ( Mackey and Bassendowski, 2017 ). However, it is generally agreed that Professor Archie Cochrane, whose work inspired the Cochrane Collaboration ( Smith and Rennie, 2014 ; Barker and Linsley, 2016 ), is credited for being at the forefront of the modern evidence-based practice (EBP) approach. The concept of evidence-based medicine (EBM) emerged from researchers at McMaster University, Canada, who redefined the practice of medicine to move from a culture based solely on clinical experience, to one which is more inclusive of medical evidence ( International Council of Nurses, 2012 ). Smith and Rennie (2014) noted that the phrase EBM was coined by Gordon Guyatt in 1991, so has had a relatively short life span. Although a number of individuals contributed to the development of EBM, David Sackett is regarded as the father of EBM as in 1996 he distinguished EBM as one that combines research evidence with clinical skills, and patient values and preferences ( Smith and Rennie, 2014 ).

From the emergence of EBM, the terminology EBP developed, which relates to all professional denominations, and then evidence-based nursing, as other professions adopted this approach ( Rees, 2010 ; Mackey and Bassendowski, 2017 ). EBP evolved into the nursing profession in the 1990s and in the context of the UK, is now endorsed by the Nursing and Midwifery Council (NMC) as the professional responsibility of registered nurses to adopt this approach ( NMC, 2018a ). From the introduction of EBP into the nursing profession, there is now a global consensus that healthcare providers integrate research evidence into their practice so new generations of health professionals have EBP embedded in programmes of study ( Al Khalaileh et al, 2016 ). There are multiple positive outcomes related to evidence-based care, such as improvements in healthcare quality, safety and a reduction in care costs ( Beyea and Slattery, 2013 ; Melnyk et al, 2018 ; Al Qadire, 2019 ). Despite the great strides undertaken in the previous three decades to integrate this concept into healthcare, there is evidence to suggest there are issues in understanding EBP and an inconsistent approach to implementing evidence-based care in practice ( Melnyk et al, 2010 ).

Exploration of definitions

Despite the range of terminologies used with regards to EBP, which includes discipline-specific evidence-based nursing and evidence-based medicine ( Barker and Linsley, 2016 ), the aim and key elements are essentially the same. Evidence-based medicine is the:

‘Conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.’

Sackett et al, 1996: 71

Although this definition recognises the need to integrate best current evidence with clinical expertise, a criticism is that it does not include the perspectives of service users ( Barker and Linsley, 2016 ) as previously outlined by Sackett and described by Smith and Rennie (2014) . The definition of EBP acknowledges a three-pronged approach, which includes best current evidence, clinical expertise, and the values and preferences of patients. The International Council of Nurses (ICN) states that:

‘Evidence-based practice is a problem-solving approach to clinical decision-making that incorporates a search for the best and latest evidence, clinical expertise and assessment, and patient preferences and values, within a context of caring.’

ICN, 2012: 6

A definition of evidence-based nursing is the:

‘Conscientious, explicit, and judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups of patients reflective of individual needs and preferences.’

Ingersoll, 2000: 152

EBP is embedded in the principle that patient care should be informed by rigorous evidence ( Mackey and Bassendowski, 2017 ); therefore, nurses need to learn how to gather evidence and how to put this knowledge into everyday practice. As not all evidence is robust or reliable, nurses must learn how to identify the best available evidence, taking into account the needs and preferences of health service users, while using their own expertise and clinical judgement to ascertain the feasibility of its use ( ICN, 2012 ).

Outcomes related to adopting an evidence-based practice approach

The main rationale for adopting an evidence-based approach in practice is to enhance the quality of care for patients and improve outcomes ( LoBiondo-Wood et al, 2019 ). Using an EBP approach also provides a framework that supports decision-making ( Mantzoukas, 2008 ; ICN, 2012 ; Beyea and Slattery, 2013 ), and helps health professionals make informed judgements ( Pooler, 2012 ). Using this approach helps nurses to be more prepared to ask relevant questions regarding changes to their practice and more equipped to evaluate their practice ( ICN, 2012 ). An evidence-based approach also contributes to a potential reduction in care costs ( Beyea and Slattery, 2013 ; Melnyk et al, 2018 ; Al Qadire, 2019 ).

Components of evidence-based practice

EBP is based on evidence that originates from three key components ( Rees, 2010 ):

  • Best available external evidence from published research

Clinical expertise

  • Patient values and preferences.

Each component is limited in its value until combined with the neighbouring components.

Best available external evidence

The first component of EBP is the sourcing, appraisal and implementation of best available external clinical evidence. Best evidence can originate from a range of sources such as randomised controlled trials, evidence from other scientific designations, which includes descriptive and qualitative research, and information from case reports ( LoBiondo-Wood et al, 2019 ).

The second component relates to clinical expertise, which is the proficiency and judgement that clinicians acquire through clinical experience ( Sackett et al, 1996 ) and has both knowledge and skill set components ( McCracken and Marsh, 2008 ). External evidence can inform, but not replace, individual clinical experience, as it is the expertise that decides whether the external evidence can be applied to the individual patient ( Sackett et al, 1996 ).

Patient values and preferences

The final component of EBP relates to patients' values and preferences, which are crucial in deciding on the appropriate management ( Haynes and Haines, 1998 ) because even excellent external evidence may be inapplicable to an individual patient ( Sackett et al, 1996 ). Incorporating patients' values and perspectives aligns to the person-centred approach to care, in which patients are active participants in their care ( Siminoff, 2013 ).

Steps in evidence-based practice

There are a range of models which outline the steps in the EBP process. One such model involves seven steps from step 0 to step 6 ( Melnyk et al, 2010 ):

  • Step 0 relates to cultivating a spirit of inquiry, which involves health professionals adopting an inquisitive approach to practice
  • Step 1 involves developing a focused question with one relevant framework available being PICO(T). This was introduced by Richardson et al (1995) and subsequently applied to other disciplines ( Schlosser et al, 2007 ). The acronym PICO(T) identifies the population (P), intervention (I), comparator (C), outcome(s) (O) and, if appropriate, the time (T) element in a focused question
  • Step 2 relates to searching for the best evidence using the key words and synonyms identified in the PICO(T) framework. Sources of evidence may include books, journals, government and policy documents, and grey literature, which is literature not formally published ( Barker and Ortega, 2016 )
  • Step 3 involves critically appraising the evidence sourced in Step 2. Registered nurses should have the ability to evaluate the strengths and weaknesses of research evidence, to determine the merit of research for use in practice ( LoBiondo-Wood et al, 2019 )
  • Step 4 relates to integrating the evidence sourced, along with clinical expertise and patient preferences in making the best clinical decisions
  • Step 5 involves evaluating the outcome(s) of the EBP approach, to determine the impact
  • Step 6 relates to disseminating the outcome(s) to enable others to learn and develop their practice ( Melnyk et al, 2014 ).

Hierarchy of evidence

When critically appraising the evidence as part of step 3 in the EBP process, an understanding of the hierarchy of evidence is important ( Table 1 ). This provides the rank order of sources of evidence, indicating which has the highest (level 5), and which has the lowest (level 1) with regards trust in their use for clinical decision making ( Rees, 2010 ). Although this is useful in determining the strongest evidence, it has been argued that this hierarchy is too linear and orderly and does not exist in the reality of clinical practice ( Mantzoukas, 2008 ). Therefore, it is crucial the reviewer continues to use their critical judgement skills to appraise the sources of evidence.

Current challenges to evidence-based practice

Although the national agenda for EBP is at the forefront of healthcare, there continues to be low implementation of EBP in healthcare settings ( Melnyk et al, 2018 ). It is argued that EBP is not the standard of care practised consistently across the globe despite the published benefits ( Melnyk et al, 2014 ). Organisational factors, including a lack of time to source, appraise, implement and evaluate evidence, are outlined by many authors as a key barrier to the EBP process ( Melnyk et al, 2005 ; Rees, 2010 ; Melnyk et al, 2014 ; Al Khalaileh et al, 2016 ; Kalavani et al, 2019 ). Nurses have also reported barriers to EBP connected to a lack of authority to change care procedures in practice ( Al Khalaileh et al, 2016 ) or a culture that adopts an attitude of ‘having always done it this way’ ( Melnyk et al, 2014 ). Consequently, nurses in the clinical environment often rely on policies and protocols for guidance on best practice.

Barriers associated with practitioners relates to not having the critiquing skills to assess the quality of the evidence ( Rees, 2010 ; Melnyk et al, 2014 ) or finding it challenging to interpret research findings due to the terminologies used and the statistical presentation of research results ( Rees, 2010 ; Barker and Linsley, 2016 ). Despite these challenges, the findings of an integrative review demonstrated that nurses had a positive attitude and belief in the value of EBP; however, they perceived their knowledge and skills related to EBP were insufficient for employing evidenced practice and, consequently, did not use this approach ( Saunders and Vehviläinen-Julkunen, 2016 ).

Barriers related to the evidence available includes the dearth of high-quality methodologically robust and clinically relevant research. When relevant evidence is available, research evidence is often translated into clinical practice at a slow pace ( Melnyk, 2017 ), with a lack of effective and efficient knowledge transfer activities. At times, there is conflicting evidence as a result of contextual variations in different settings; however, new research approaches are being introduced that seek to identify the impact of contextual variations on outcomes, such as realistic evaluation ( Pawson and Tilley, 1997 ).

A further challenge in the current context of the COVID-19 global pandemic relates to the surge of new evidence being presented and an associated urgency to collate, review, appraise and apply this information ( Carley et al, 2020 ). It remains crucial that evidence-based solutions continue to be embedded in responses to the challenges currently confronting the healthcare system ( Lake, 2020 ).

Recommendations to address current challenges for NMC registrants

Finding efficient and effective ways to promote the uptake of evidence-based interventions is a priority ( Haines et al, 2004 ). Although the health workforce has a positive view of the value of EBP ( LoBiondo-Wood et al, 2019 ), their knowledge and skills can be limited ( Kalavani et al, 2019 ). For many frontline nurses, there is no protected time available for providing a consistent approach to sourcing and implementing the current best available external evidence. Although it is important to follow best practice guidelines to enhance patient outcomes ( Mackey and Bassendowski, 2017 ), nurses should also engage individually in sourcing, appraising and implementing best evidence. To assist with this endeavour, research departments and practice development units within healthcare organisations are a resource to support nurses in sourcing and applying evidence in practice. There are also local clinically based initiatives to increase nurses' knowledge and capacity in evidence-based practice. One such example is the development of a hospital-based enhancement model to plan, develop and implement a research outreach, ward-based seminar programme focused on addressing common barriers to EBP and how to apply EBP in nursing ( Edward and Mills, 2013 ).

Protected time away from direct patient care should be available for nurses working in clinical practice for these activities. Although this may seem an unrealistic recommendation in already stretched healthcare systems, viable options may include support to complete modules of study and having access and time to search online databases ( Kalavani et al, 2019 ), or attend conferences in person or virtually. Some health and social care trusts and boards have appointed clinical educators with responsibilities that include encouraging frontline nurses to engage with clinically relevant research through initiatives such as journal clubs. However, time available away from clinical areas remains a challenge for frontline nurses.

Sourcing innovative methodologies to translate research findings into a language that is relatable to clinically based nurses is a priority, in addition to methods to effectively disseminate findings to expedite the process of implementing emerging evidence into practice. Knowledge translation refers to:

‘The process through which research knowledge is created, circulated and adopted into clinical practice.’

Curtis et al, 2017: 862

One knowledge transfer and exchange model is EMTReK (an Evidence-based Model for the Transfer and Exchange of Research Knowledge), which identifies six core components of knowledge transfer in the context of palliative care ( Payne et al, 2019 ). Highlights include ensuring the message outlines the impact on user need, the message being accessible, credible and actionable, having an ability to market the research findings through diverse activities, including social media, and considering the social, economic and cultural context to promote the possibility of a fertile ground for the implementation of research findings in practice.

Pre-registration nursing programmes

Within the NMC document Future nurse: Standards of proficiency for registered nurses ( NMC, 2018b ) there is continual reference to evidence-based nursing to ensure the registrant will have the underpinning knowledge to base their skills and nursing care on both theoretical and clinical components. These standards outline the importance of ‘being an accountable professional’, providing clear direction to academic institutions that nursing students must have a knowledge of the methods related to evidence-based practice. The standards state that, on entry to the NMC register, each nursing student should also be able to understand the processes of research methods ( NMC, 2018b ). It further identifies the need for the registrant to be able to critically analyse, safely use and apply the research findings to promote and inform the nurse's practice ( NMC, 2018b ), contributing to an evidence-based practice approach to care delivery. A knowledge and application of research methods is, therefore, important in pre-registration programmes of study.

The ability to scrutinise evidence and subsequently apply it in practice is emphasised in the theoretical components and procedural skills of the Future nurse standards ( NMC, 2018b ). The Future nurse proficiencies to be assessed in the clinical setting clearly state that each nursing student on registration to the NMC can safely demonstrate evidence-based practice related to the seven identified learning platforms in the specific communication and procedural skills and these form a component of the practice assessment documents ( NMC, 2018b ). Evidence-based nursing skills are also assessed in the university setting through simulated practice and in academic assessments that focus on the student demonstrating their ability to source, appraise and apply evidence. Each new NMC registrant should be able to provide the rationale for undertaking a skill in practice and use evidence-based research to support their actions. This should contribute to registered nurses demonstrating an approach which applies evidence-based knowledge and skills in every clinical situation and the continued development of autonomous practitioners.

However, despite EBP being embedded in pre-registration programmes of study ( Mackey and Bassendowski, 2017 ), with convincing evidence that an EBP approach contributes to the delivery of high quality patient care ( André et al, 2016 ), nursing students commonly struggle to recognise the relevance of EBP ( Disler et al, 2019 ). Recent literature has identified that nursing students have a low level of knowledge of EBP ( Al Qadire, 2019 ) and can experience challenges in linking the relevance of EBP from learning at the academic institution to their clinical practice, with many not recognising the relevance of the theory to practice ( Disler et al, 2019 ). These insights highlight the importance of academic institutions continuing to communicate the importance of EBP ( Melnyk et al, 2018 ) and adopt innovative learning methods with a focus on the application of theory to clinical practice ( Oh and Yang, 2019 ). This will enable students to increasingly recognise the relevance of an EBP approach in enhancing their practice ( Disler et al, 2019 ) and improving patient outcomes. Embedding reflection within clinical practice should also equip the student to incorporate EBP into their everyday nursing care ( Florin et al, 2012 ).

EBP is a global phenomenon that promotes best practice, clinical effectiveness and quality of care ( Barker and Linsley, 2016 ). It is a relatively new concept in healthcare, yet there has been a movement to recognise the value of using an EBP approach and embed this approach in practice. The national agenda for EBP is at the forefront of healthcare ( LoBiondo-Wood et al, 2019 ). However, there continues to be low implementation of EBP in some healthcare settings ( Melnyk et al, 2018 ). The challenge is to adopt innovative approaches to supporting nurses to implement EBP both in academic institutions and in practice settings. As nurses evolve to become more autonomous in decision-making and clinical judgement skills, the role must be developed so that nurses feel supported to search, appraise, implement and evaluate evidence, and integrate this with clinical expertise, while ensuring patients are increasingly empowered to be active participants in their care. The context of the COVID-19 global pandemic places a further emphasis on the need to ensure practice is evidence-based as emerging research requires an urgent and rigorous appraisal before the implementation of findings into practice. This will contribute to the development of a profession that is becoming increasingly autonomous in decision-making and in its significant contribution to maximising favourable patient outcomes.

  • Evidence-based practice (EBP) aims to promote best practice, clinical effectiveness and high-quality care
  • Although EBP is a relatively new concept in healthcare, there has been a global movement and recognition of the need to adopt this approach to care
  • Current challenges to the implementation of EBP in nursing include nurses having difficulty applying evidence to everyday practice and lack of time away from the clinical area to keep up to date with research
  • Recommendations to address the challenges related to the low implementation of EBP in nursing include an emphasis on EBP in nurse education, including academic assessments focusing on using evidence in everyday clinical situations

CPD reflective questions

  • What are the professional challenges in adopting an evidence-based practice (EBP) approach to care delivery?
  • What are the organisational barriers in embedding an EBP approach to care delivery?
  • Think about what two steps you could take to promote EBP in your care delivery

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Why has research-based practice become so important and why is everyone talking about evidence-based health care? But most importantly, how is nursing best placed to maximise the benefits which evidence-based care can bring?

Part of the difficulty is that although nurses perceive research positively, 2 they either cannot access the information, or cannot judge the value of the studies which they find. 3 This journal has evolved as a direct response to the dilemma of practitioners who want to use research, but are thwarted by overwhelming clinical demands, an ever burgeoning research literature, and for many, a lack of skills in critical appraisal. Evidence-Based Nursing should therefore be exceptionally useful, and its target audience of practitioners is a refreshing move in the right direction. The worlds of researchers and practitioners have been separated by seemingly impenetrable barriers for too long. 4

Tiptoeing in the wake of the movement for evidence-based medicine, however, we must ensure that evidence-based nursing attends to what is important for nursing. Part of the difficulty that practitioners face relates to the ambiguity which research, and particularly “scientific” research, has within nursing. Ambiguous, because we need to be clear as to what nursing is, and what nurses do before we can identify the types of evidence needed to improve the effectiveness of patient care. Then we can explore the type of questions which practitioners need answers to and what sort of research might best provide those answers.

What is nursing about?

Increasingly, medicine and nursing are beginning to overlap. There is much talk of interprofessional training and multidisciplinary working, and nurses have been encouraged to adopt as their own some tasks traditionally undertaken by doctors. However, in their operation, practice, and culture, nursing and medicine remain quite different. The oft quoted suggestion is that doctors “cure” or “treat” and that nurses “care”, but this is not upheld by research. In a study of professional boundaries, the management of complex wounds was perceived by nurses as firmly within their domain. 5 Nurses justified their claim to “control” wound treatment by reference to scientific knowledge and practical experience, just as medicine justifies its claim in other areas of treatment. One of the most obvious distinctions between the professions in this study was the contrast between the continual presence of the nurse as opposed to the periodic appearance of the doctor. Lawler raises the same point, and suggests that nurses and patients are “captives” together. 6 Questioning the relevance of scientific knowledge, she argues that nurses and patients are “focused on more immediate concerns and on ways in which experiences can be endured and transcended”. This highlights the particular contribution of nursing, for it is not merely concerned with the body, but is also in an “intimate” and ongoing relationship with the person within the body. Thus nursing becomes concerned with “untidy” things such as emotions and feelings, which traditional natural and social sciences have difficulty accommodating. “It is about the interface between the biological and the social, as people reconcile the lived body with the object body in the experience of illness.” 7

What sort of evidence does nursing need?

These arguments suggest that nursing, through its particular relationship with patients and their sick or well bodies, will rely on many different ways of knowing and many different kinds of knowledge. Lawler's work on how the body is managed by nurses illustrates this. 6 She explains how an understanding of the physiological body is essential, but that this must be complemented by evidence from the social sciences because “we also practice with living, breathing, speaking humans.” Moreover, this must be grounded in experiential knowledge gained from being a nurse, and doing nursing. Knowledge, or evidence, for practice thus comes to us from a variety of disciplines, from particular paradigms or ways of “looking at” the world, and from our own professional and non-professional life experiences.

Picking the research design to fit the question

Scientists believe that the social world, just like the physical world, is orderly and rational, and thus it is possible to determine universal laws which can predict outcome. They propose the idea of an objective reality independent of the researcher, which can be measured quantitatively, and they are concerned with minimising bias. The other major paradigm is interpretism/naturalism which takes another approach, suggesting that a measurable and objective reality separate from the researcher does not exist; the researcher cannot therefore be separated from the “researched”. Thus who we are, what we are, and where we are will affect the sorts of questions we pose, and the way we collect and interpret data. Furthermore, in this paradigm, social life is not thought to be orderly and rational, knowledge of the world is relative and will change with time and place. Interpretism/naturalism is concerned with understanding situations and with studying things as they are. Research approaches in this paradigm try to capture the whole picture, rather than a small part of it.

This way of approaching research is very useful, especially to a discipline concerned with trying to understand the predicaments of patients and their relatives, who find themselves ill, recovering, or facing a lifetime of chronic illness or death. Questions which arise in these areas are less concerned with causation, treatment effectiveness, and economics and more with the meaning which situations have—why has this happened to me? What is my life going to be like from now on? The focus of these questions is on the process, not the outcome. Data about such issues are best obtained by interviews or participant observation. These are aspects of nursing which are less easily measured and quantified. Moreover, some aspects of nursing cannot even be formalised within the written word because they are perceived, or experienced, in an embodied way. For example, how do you record aspects of care such as trust, empathy, or “being there”? Can such aspects be captured within the confines of research as we know it?

Questions of causation, prognosis, and effectiveness are best answered using scientific methods. For example, rates of infection and thrombophlebitis are issues which concern nurses looking after intravenous cannulas. Therefore, nurses might want access to a randomised controlled trial of various ways in which cannula sites are cleansed and dressed to determine if this affects infection rates. Similarly, some very clear economic and organisational questions might be posed by nurses working in day surgery units. Is day surgery cost effective? What are the rates of early readmission to hospital? Other questions could include: what was it like for patients who had day surgery? Did nurses find this was a satisfying way to work? These would be better answered using interpretist approaches which focus on the meaning that different situations have for people. Nurses working with patients with senile dementia might also use this approach for questions such as how to keep these patients safe and yet ensure their right to freedom, or what it is like to live with a relative with senile dementia. Thus different questions require different research designs. No single design has precedence over another, rather the design chosen must fit the particular research question.

Research designs useful to nursing

Nursing presents a vast range of questions which straddle both the major paradigms, and it has therefore embraced an eclectic range of research designs and begun to explore the value of critical approaches and feminist methods in its research. 8 The current nursing literature contains a wide spectrum of research designs exemplified in this issue, ranging from randomised controlled trials, 9 and cohort studies, 10 at the scientific end of the spectrum, through to grounded theory, 11 ethnography, 12 and phenomenology at the interpretist/naturalistic end. 13 Future issues of this journal will explore these designs in depth.

Maximising the potential of evidence-based nursing

Evidence-based care concerns the incorporation of evidence from research, clinical expertise, and patient preferences into decisions about the health care of individual patients. 14 Most professionals seek to ensure that their care is effective, compassionate, and meets the needs of their patients. Therefore sound research evidence which tells us what does and does not work, and with whom and where it works best, is good news. Maximum use must be made of scientific and economic evidence, and the products of initiatives such as the Cochrane Collaboration. However, nurses and consumers of health care clearly need other evidence, arising from questions which cannot be framed in scientific or economic terms. Nursing could spark some insightful debate concerning the nature and contribution of other types of knowledge, such as clinical intuition, which are so important to practitioners. 15

In summary, in embracing evidence-based nursing we must heed these considerations:

Nursing must discard its suspicion of scientific, quantitative evidence, gather the skills to critique it, and design imaginative trials which will assist in improving many aspects of nursing

We must promulgate naturalistic/interpretist studies by indicating their usefulness and confirming/explaining their rigour in investigating the social world of health care

More research is needed into the reality and consequences of adopting evidence-based practice. Can practitioners act on the evidence, or are they being made responsible for activities beyond their control?

It must be emphasised that those concerns which are easily measured or articulated are not the only ones of importance in health care. Space is needed to recognise and explore the knowledge which comes from doing nursing and reflecting on it, to find new channels for speaking of concepts which are not easily accommodated within the discourse of social or natural science—hope, despair, misery, love.

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The Importance of Evidence-Based Practice in Nursing Essay

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Empirically validated treatments are biomedical measures and/or medications that have favored biological treatment of a specific illness. This involves the precise handling of a medical case using treatments that have been discovered to work in the past. Such an approach does not necessarily mean that this specific treatment is the best solution for that particular medical illness. Several criteria have been identified to facilitate confirmation of an empirically validated treatment. One criterion describes that an empirically validated treatment has been proven by at least two superior experiments that show that the treatment is effective. A treatment is deemed to be effective when the results generated by the administration of such procedure are superior over the other treatment or the placebo control.

This may be determined through robust statistical analyses. This may be proven by employing a placebo in the experiment or by observing effective treatments in a conventional experiment consisting of amply sample sizes.

An empirically validated treatment may also be confirmed through the use of a vast amount of defined studies that show the efficiency of that particular treatment.

It is understood that these defined studies followed a competent experimental design and that the particular treatment being tested has been compared to another treatment, just like the placebo controls. Empirically validated treatments are also generally conducted based on a treatment manual.

This piece of documentation serves as the guideline for the investigator so that any modifications will be avoided, because any minor or major changes to a certain treatment may cause a different output or experimental result. In addition, this type of treatment provides precise descriptions of the samples that are included in the trial experiment. It is also important that empirically validated treatments are verified by at least two independent research groups that did not conspire to generate similar or exact observational results.

The healthcare profession involves the augmentation of a patient’s condition through therapeutic intervention. The shared moment between a healthcare worker and a patient who is unbearably suffering by himself provides guidance for the proper course of action, often resulting in greater patient satisfaction and healing potentialities (Gooden et al., 2001).

During this interaction, the healthcare professional establishes his presence by using a human care transaction mind-body-soul with another’s mind-body-soul in a lived moment.

Presence has been defined as a relational style within healthcare professional interactions that involves being with, as well as doing with. The core of this interaction is to learn and understand the circumstances of the situation and to direct the course of action to achieve the desired outcome of healing and recuperation on the part of the patient (Rachagan and Sharon, 2003; Hagihara A and Tarumi K, 2006). In addition, the focused shared moments with the patient and his family teach the healthcare professional to identify the key turning point necessary for the patient’s healing process (Gore and Ogden, 1998; Street et al., 2003). The professional learns the needs of his patient by being fully present and consciously relating to his whole being, enabling the professional to use aesthetic ways of discovering the obstructions in the hidden pathways preventing the healing process (Murphy DD and Lam CL, 2002). The healthcare professional plays a major role as a therapeutic agent by getting deeply involved with the situation using his inner energy of caring, being open and listening with solid awareness, and developing and sustaining a helping-trusting, authentic caring relationship (Ornstein, 1977; Heszen-Klemens and Lapinska E, 1984; Berry, 2007). Healthcare guidelines highlight that every healthcare professional is accountable for his decision and action and for maintaining competencies in every day of practice. This strong foundation requires that all nurses provide a therapeutic professional-patient relationship and provide care to patients under the scope of practice according to their needs, which will, in turn, lead to significant outcomes (Clark, 2002).

Healthcare workers use different types of presence in order to learn from their patients, in order a therapeutic relationship and mutual understanding under any circumstance.

The evidence-based practice focuses on observational studies to improve the methodological quality and effectiveness of the intervention. There is currently a vast amount of information regarding the incidence and prevalence of healthcare-related infections, as well as mortality data. Unfortunately, these significant figures are not efficiently disseminated and more importantly, not integrated into the general protocol of healthcare, because they have not been discovered by healthcare personnel for their own perusal and for integration into their routine services. Health care informatics is a recent area that involves the integration of health science, computer science, information science, and cognitive science to assist in the management of healthcare information (Saba and McCormick, 2001). By using the statistical information offered by these different fields of science, healthcare informatics may be divided into the areas of medical informatics, health informatics, dental informatics, and nursing informatics. The areas of medical, dental, and nursing informatics overlap in several areas such as information retrieval, clinical care, ethics, imaging, computer security, electronic medical records, and computer-assisted instruction.

The use of statistical information via informatics has been used in the field of medicine for more than two decades and has resulted in the establishment of the specialty field of medical informatics. Such area uses information technologies in relation to functions carried out when performing their duties (Hannah, 1985). It covers the entire range of information technology that is useful to nursing, especially for patient care, nursing practice, and healthcare management. It essentially helps in the processing of medical data, knowledge, and information to aid in medical practice and delivery of health care.

A parallel global scheme has existed for clinical trials, namely the Cochrane Collaboration, as well as the World Health Organization (WHO) Department of Reproductive Health and Research, aim to provide a comprehensive tabulation of available data on their specific fields of investigation. Such reviews also aim to calculate case-fatality rates and the proportion of preventable deaths by specific interventions. The development of search and retrieval strategies using statistical information should be sensitive and specific enough because there is so much information available in the databases and internet sources that it would seem very difficult for healthcare personnel to sieve through all the unnecessary and irrelevant entries. Databases are technically pools of information that may be useful should the right search results be presented to the investigator, or these may be useless if the investigator ends up with more confusion than when he just started using the database.

Statistical information that has been pooled into a central registry may serve as a convenient and systematic resource for the retrieval of medical information that is very useful for critical care management in the healthcare setting.

Two of the most recognized and employed databases in the medical field are MEDLINE and EMBASE. Both are universal bibliographical records of primary literature, with MEDLINE covering mostly North American publications, while EMBASE covers more European reports. Unfortunately, these two databases only have 30 to 50% overlap in their entries (Topfer, 1999). Unfortunately, databases employing evidence-based practice do not include unpublished reports, either because the investigators assumed that nobody else would be interested in looking at their data or because the investigators thought that a report that shows no significant differences is not worth publishing. In addition, non-English reports are not included in most of the databases due to language restrictions, yet these types of reports usually show statistically significant results as well as larger treatment effects. CINAHL is another database that healthcare practitioners, especially nurses, utilize for information on patient care and delivery.

It has been very useful in medical specialties including descriptive and explanatory information on nursing topics.

The employment of statistical information as applied to nursing care is highly interdisciplinary, with certain areas overlapping with computer science and education.

Nursing informatics provides a direct route to information connecting nursing informatics to research, especially evidence-based practice, and this provides a quicker mode for nursing to gather information on specific patient cases. In the earlier days, a healthcare practitioner needs to read a lot of research reports, journals, and books in order to be up-to-date with the latest trends in health care diagnosis, treatment, and delivery. The use of statistical knowledge and information as directly applied to evidence-based nursing provides a quicker way to access so much information that is available around the globe. It also saves time for the healthcare practitioner in researching for answers to their healthcare questions, leaving them more time to provide quality health care to their patients. In addition, the networking and establishment of databases serves as an essential tool to the construction of virtual global hospitals, wherein doors do not exist, but actually, bridges are erected.

  • Berry PA (2007): The absence of sadness: darker reflections on the doctor-patient relationship. J. Med. Ethics 33(5):266-8.
  • Clark PA (2002): Confidentiality and the physician-patient relationship – ethical reflections from a surgical waiting room. Med. Sci. Monit. 8(11):SR31-4.
  • Gooden BR, Smith MJ, Tattersall SJ and Stockler MR (2001): Hospitalised patients’ views on doctors and white coats. Med. J. Aust. 175(4):219-22.
  • Gore J and Ogden J (1998): Developing, validating and consolidating the doctor-patient relationship: the patients’ views of a dynamic process. Br. J. Gen. Pract. 48(432):1391-4.
  • Hagihara A and Tarumi K (2006): Doctor and patient perceptions of the level of doctor explanation and quality of patient-doctor communication. Scand. J. Caring Sci. 20(2):143-50.
  • Hannah KJ, Guillemin EJ and Conklin DN, eds. (1985): Nursing uses of computer and information science. Amsterdam, The Netherlands: Elsevier Science, 1985.
  • Heszen-Klemens I and Lapinska E (1984): Doctor-patient interaction, patients’ health behavior and effects of treatment. Soc. Sci. Med. 19(1):9-18.
  • Murphy DD and Lam CL (2002): Functional needs: agreement between perception of rural patients and health professionals in China. Occup. Ther. Int. 9(2):91-110.
  • Ornstein PH (1977): The family physician as a “therapeutic instrument”. J. Fam. Pract. 4(4):659-61.
  • Rachagan SS and Sharon K (2003): The patient’s view. Med J Malaysia. 58 Suppl A:86-101.
  • Saba VK and McCormick KA (2001): Essentials of computers for nursing: informatics for the new millennium. 3rd ed. New York, NY: McGraw-Hill.
  • Street RL Jr, Krupat E, Bell RA, Kravitz RL and Haidet P (2003): Beliefs about control in the physician-patient relationship: effect on communication in medical encounters. J. Gen. Intern. Med. 18(8):609-16.
  • Topfer LA, Parada A, Menon D, Noorani H, Perras C, Serra-Prat M (1999): Comparison of literature searches on quality and costs for health technology assessment using the MEDLINE and EMBASE databases. Int. J. Technol. Assess. Health Care 15:297-303.
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The Effectiveness of an Evidence-Based Practice (EBP) Educational Program on Undergraduate Nursing Students’ EBP Knowledge and Skills: A Cluster Randomized Control Trial

Daniela cardoso.

1 Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence-Based Practice: A Joanna Briggs Institute Centre of Excellence, 3004-011 Coimbra, Portugal; tp.cfnese@osodracf (A.F.C.); tp.cfnese@oiregor (R.R.); moc.liamg@7ramed (M.A.R.); tp.cfnese@olotsopa (J.A.)

2 FMUC—Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal

Filipa Couto

3 Alfena Hospital—Trofa Health Group, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3000-232 Coimbra, Portugal; moc.liamg@otuoccdapilif

Ana Filipa Cardoso

Elzbieta bobrowicz-campos.

4 Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3004-011 Coimbra, Portugal; [email protected] (E.B.-C.); tp.cfnese@stnasasiul (L.S.); tp.cfnese@ohnituocv (V.C.); tp.cfnese@otnipaleinad (D.P.)

Luísa Santos

Rogério rodrigues, verónica coutinho, daniela pinto, mary-anne ramis.

5 Mater Health, Evidence in Practice Unit & Queensland Centre for Evidence Based Nursing and Midwifery: A Joanna Briggs Institute Centre of Excellence, 4101 Brisbane, Australia; [email protected]

Manuel Alves Rodrigues

João apóstolo, associated data.

The data presented in this study are available on request from the corresponding author. The data are not publicly available because this issue was not considered within the informed consent signed by the participants of the study.

Evidence-based practice (EBP) prevents unsafe/inefficient practices and improves healthcare quality, but its implementation is challenging due to research and practice gaps. A focused educational program can assist future nurses to minimize these gaps. This study aims to assess the effectiveness of an EBP educational program on undergraduate nursing students’ EBP knowledge and skills. A cluster randomized controlled trial was undertaken. Six optional courses in the Bachelor of Nursing final year were randomly assigned to the experimental (EBP educational program) or control group. Nursing students’ EBP knowledge and skills were measured at baseline and post-intervention. A qualitative analysis of 18 students’ final written work was also performed. Results show a statistically significant interaction between the intervention and time on EBP knowledge and skills ( p = 0.002). From pre- to post-intervention, students’ knowledge and skills on EBP improved in both groups (intervention group: p < 0.001; control group: p < 0.001). At the post-intervention, there was a statistically significant difference in EBP knowledge and skills between intervention and control groups ( p = 0.011). Students in the intervention group presented monographs with clearer review questions, inclusion/exclusion criteria, and methodology compared to students in the control group. The EBP educational program showed a potential to promote the EBP knowledge and skills of future nurses.

1. Introduction

Evidence-based practice (EBP) is defined as “clinical decision-making that considers the best available evidence; the context in which the care is delivered; client preference; and the professional judgment of the health professional” [ 1 ] (p. 2). EBP implementation is recommended in clinical settings [ 2 , 3 , 4 , 5 ] as it has been attributed to promoting high-value health care, improving the patient experience and health outcomes, as well as reducing health care costs [ 6 ]. Nevertheless, EBP is not the standard of care globally [ 7 , 8 , 9 ], and some studies acknowledge education as an approach to promote EBP adoption, implementation, and sustainment [ 10 , 11 , 12 , 13 , 14 , 15 ].

It has been recommended that educational curricula for health students should be based on the five steps of EBP in order to support developing knowledge, skills, and positive attitudes toward EBP [ 16 ]. These steps are: translation of uncertainty into an answerable question; search for and retrieval of evidence; critical appraisal of evidence for validity and clinical importance; application of appraised evidence to practice; and evaluation of performance [ 16 ].

To respond to this recommendation, undergraduate nursing curricula should include courses, teaching strategies, and training that focus on the development of research and EBP skills for nurses to be able to incorporate valid and relevant research findings in practice. Nevertheless, teaching research and EBP to undergraduate nursing students is a challenging task. Some studies report that undergraduate students have negative attitudes/beliefs toward research and EBP, especially toward the statistical components of the research courses and the complex terminology used. Additionally, students may not understand the importance of the link between research and clinical practice [ 17 , 18 , 19 ]. In fact, a lack of EBP and research knowledge is commonly reported by nurses and nursing students as a barrier to EBP. It is imperative to provide the future nurses with research and EBP skills in order to overcome the barriers to EBP use in clinical settings.

At an international level, several studies have been performed with undergraduate nursing students to assess the effectiveness of EBP interventions on multiple outcomes, such as EBP knowledge and skills [ 20 , 21 , 22 , 23 ]. The Classification Rubric for EBP Assessment Tools in Education (CREATE) [ 24 ] suggests EBP knowledge should be assessed cognitively using paper and pencil tests, as EBP knowledge is defined as “learners’ retention of facts and concepts about EBP” [ 24 ] (p. 5). Additionally, the CREATE framework suggests EBP skills should be assessed using performance tests, as skills are defined as “the application of knowledge” [ 24 ] (p. 5). Despite these recommendations, few studies have assessed EBP knowledge and skills using both cognitive and performance instruments.

Therefore, this study aims to evaluate the effectiveness of an EBP educational program on undergraduate nursing students’ EBP knowledge and skills using a specific cognitive and performance instrument. The intervention used in this study was recently developed [ 25 ], and this is the first study designed to assess its effectiveness in undergraduate EBP.

2. Materials and Methods

2.1. design.

A cluster randomized controlled trial with two-armed parallel group design was undertaken (ClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT03411668","term_id":"NCT03411668"}} NCT03411668 ).

2.2. Sample Size Calculation

The sample size was calculated using the software G*Power 3.1.9.2. (Heinrich-Heine-Universität Dusseldorf, Düsseldorf, Germany) Recognizing that there were no studies performed a priori using a cognitive and performance instrument to assess the effectiveness of an EBP educational program on undergraduate nursing students’ EBP knowledge and skills, we used an effect size of 0.25, which is a small effect size as proposed by Cohen [ 26 ]. A power analysis based on a type I error of 0.05; power of 0.80; effect size f = 0.25; and ANOVA repeated measures between factors determined a sample size of 98 as total.

Taking into account that our study used clusters (optional courses) and that each one had an average of 25 students, we needed at least four clusters to cover the total sample size of 98. However, to cover potential losses to follow-up, we included a total of six optional courses.

2.3. Participants’ Recruitment and Randomization

We recruited participants from one Portuguese nursing school in 2018. From the 12 optional clinical nursing courses (such as Community Nursing Intervention in Vulnerable Groups; Ageing; Health and Citizenship; The Child with Special Needs: Diagnoses and Interventions in Pediatric Nursing; Liaison Psychiatry Nursing; Nursing in the Emergency Room; etc.) in the 8th semester of the nursing program (last year before graduation), students from three clinical nursing courses were randomly assigned to the experimental group (EBP educational program) and students from another three clinical nursing courses were randomly assigned to the control group (no intervention— education as usual ) before the baseline assessment. An independent researcher performed this assignment using a random number generator from the random.org website [ 27 ]. This assignment was performed based on a list of the 12 optional courses provided through the nursing school’s website.

2.4. Intervention Condition

The participants in the intervention group received education as usual plus the EBP educational program, which was developed by Cardoso, Rodrigues, and Apóstolo [ 25 ]. This intervention included EBP contents regarding models of thinking about EBP, systematic reviews types, review question development, searching for studies, study selection process, data extraction, and data synthesis.

This program was implemented in 6 sessions over 17 weeks:

  • Sessions 1–3—total of 12 h (4 h per session) during the first 7 weeks using expository methods with practice tasks to groups of 20–30 students.
  • Sessions 4–6—total of 6 h (2 h per session) during the last 10 weeks using active methods through mentoring to groups of 2–3 students.

Due to the nature of the intervention, it was not possible to blind participants regarding treatment assignment nor was it feasible to blind the individuals delivering treatment.

2.5. Control Condition

The participants in the control group received only education as usual; i.e., students allocated to this control condition received the standard educational contents (theoretical, theoretical–practical, practical) delivered by the nursing educators of the selected nursing school.

2.6. Assessment

All participants were assessed before (week 0) and after the intervention (week 18) using a self-report instrument. EBP knowledge and skills were assessed by the Adapted Fresno Test for undergraduate nursing students [ 28 ]. This instrument was adapted from the Fresno Test, which was originally developed in 2003 to measure knowledge and skills on EBP in family practice residents [ 29 ]. The Adapted Fresno Test for undergraduate nursing students has seven short answer questions and two fill-in-the-blank questions [ 28 ]. At the beginning of the instrument, two scenarios, which suggest clinical uncertainty, are presented. These two scenarios are used to guide the answers to questions 1 to 4: (1) write a clinical question; (2) identify and discuss the strengths and weaknesses of information sources as well as the advantages and disadvantages of information sources; (3) identify the type of study most suitable for answering the question of one of the clinical scenarios and justify the choice; and (4) describe a possible search strategy in Medline for one of the clinical scenarios, explaining the rationale. The next three short answer questions require that the students identify topics for determining the relevance and validity of a research study and address the magnitude and value of research findings. The last two questions are fill-in-the-blank questions. The answers are scored using a modified standardized grading system [ 28 ], which was adapted from the original [ 29 ]. The instrument has a total minimum score of 0 and a maximum score of 101. The inter-rater correlation for the total score of the Adapted Fresno Test was 0.826 [ 28 ]. The rater that graded the answers to the Adapted Fresno Test was blinded to treatment assignment.

Despite the fact that in the study proposal we did not consider any kind of qualitative analysis in order to assess EBP knowledge and skills in a more practical context, we decided during the development of the study to perform a qualitative analysis of monographs at the posttest. The monographs were developed by small groups of nursing students and were the final written work submitted by the students for their bachelor’s degree course. In this work, the students were asked to define a review question regarding the context of clinical practice where they were performing their clinical training. Students then proceeded to answer the review question through a systematic process of searching and selecting relevant studies and extracting and synthesizing the data. From the 58 submitted monographs (30 from the control group and 28 from the intervention group), 18 were randomized for evaluation (nine from the control group and nine from the intervention group) by an independent researcher using the random.org website [ 27 ] based on a list provided by the research team. Three independent experts (one psychologist with a doctoral qualification and two qualified nurses, one with a master’s degree) performed a qualitative analysis of the selected monographs. All experts had experience with the EBP approach and were blinded to treatment assignment. The experts independently used an evaluation form to guide the qualitative analysis of each monograph. This form presented 11 guiding criteria regarding review questions, inclusion/exclusion criteria, methodology (namely search strategy, study selection process, data extraction, and data synthesis), results presentation, and congruency between the review questions and the answers to them that were provided in the conclusion section. Thereafter, the experts met to discuss any discrepancies in their qualitative analysis until consensus was reached.

2.7. Statistical Analyses

The data were analyzed using Statistical Package for the Social Sciences (SPSS; version 24.0; SPSS Inc., Chicago, IL, USA). Differences in sociodemographic characteristics of study participants and outcome data at baseline were analyzed using Pearson’s chi-squared test for nominal data and independent the t -test for continuous data.

Taking into account the central limit theorem and that ANOVA tests are robust to violation of assumptions [ 30 ], we decided to perform two-way mixed ANOVA to compare the outcome between and within groups. The Wilcoxon signed-rank test was used to analyze how many participants had improved their EBP knowledge and skills item-by-item, how many remained the same, and how many had decreased performance within each group. Statistical significance was determined by p -values less than 0.05.

To minimize the noncompliance impact, an intention-to-treat (ITT) analysis was used to analyze participants in the groups that they were initially randomized to [ 31 ] by using the last observation carried forward imputation method.

2.8. Ethics

This study was approved by the Ethical Committee of the Faculty of Medicine of the University of Coimbra (Reference: CE-037/2017). The institution where the study was carried out provided written approval. All participants gave informed consent, and the data were managed in a confidential way.

Twelve potential clusters (optional courses in the 8th semester of the nursing program) were identified as eligible for this study. Of these, three were randomized for the intervention group and three for the control group. During the intervention, eight participants (two in the intervention group and six in the control group) were lost to follow-up because they did not fill-in the instrument in the post-intervention. Figure 1 shows the flow of participants through each stage of the trial.

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Consolidated Standards of Reporting Trials (CONSORT) diagram showing the flow of participants through each stage of the trial. ITT: intention-to-treat.

3.1. Demographic Characteristics

As Table 1 displays, 148 undergraduate nursing students with an average age of 21.95 years (SD = 2.25; range: 21–41) participated in the study. A large majority of the sample were female ( n = 118, 79.7%), had a 12th grade educational level ( n = 144, 97.3%), and had participated in some form of EBP training ( n = 121, 81.8%).

Socio-demographic characterization of the sample—ITT analysis.

* Defined as any kind and duration of evidence-based practice (EBP) training, such as EBP contents in a course, a workshop, a seminar.

At baseline, the experimental and control groups were comparable regarding sex, age, education, EBP training, and performance on the Adapted Fresno Test ( Table 1 and Table 3). The baseline data were similar with dropouts excluded; therefore, only ITT analysis results are presented.

3.2. EBP Knowledge and Skills

3.2.1. adapted fresno test.

The two-way mixed ANOVA showed a statistically significant interaction between the intervention and time on EBP knowledge and skills, F (1, 146) = 9.550, p = 0.002, partial η 2 = 0.061 ( Table 2 ). Excluding the dropouts, the two-way mixed ANOVA analysis was similar. Thus, only the ITT analysis results are presented.

Main effects of time and group and interaction effects on EBP knowledge and skills—ITT analysis.

To determine the difference between groups at baseline and post-intervention, two separate between-subjects ANOVAs (i.e., two separate one-way ANOVAs) were performed. At the pre-intervention, there was no statistically significant difference in EBP knowledge and skills between groups: F (1,146) = 0.221, p = 0.639, partial η 2 = 0.002. At the post-intervention, there was a statistically significant difference in EBP knowledge and skills between groups: F (1,146) = 6.720, p = 0.011, partial η 2 = 0.044 ( Table 3 ).

Repeated measures ANOVA and between-subjects ANOVA—ITT analysis.

To determine the differences within groups from the baseline to post-intervention, two separate within-subjects ANOVAs (repeated measures ANOVAs) were performed. There was a statistically significant effect of time on EBP knowledge and skills for the intervention group: F (1,73) = 53.028, p < 0.001, partial η 2 = 0.421 and for the control group: F (1,73) = 13.832, p < 0.001, partial η 2 = 0.159 ( Table 3 ).

The results of repeated measures ANOVA and between-subjects ANOVA analysis are similar if we exclude the dropouts; therefore, only ITT analysis results are presented.

The results of the Wilcoxon signed-rank test for each item of the Adapted Fresno Test are presented in Table 4 . The results of this analysis revealed that students in both the intervention and control groups significantly improved their knowledge and skills in writing a focused clinical question (Item 1) (intervention group: Z = −4.572, p < 0.000; control group: Z = −2.338, p = 0.019), in building a search strategy (item 3) (intervention group: Z = −4.740, p < 0.000; control group: Z = −4.757, p < 0.000), in identifying and justifying the study design most suitable for answering the question of one of the clinical scenarios (item 4) (intervention group: Z = −4.508, p < 0.000; control group: Z = −3.738, p < 0.000), and in describing the characteristics of a study to determine its relevance (item 5) (intervention group: Z = −2.699, p = 0.007; control group: Z = −1.980, p = 0.048).

Within groups comparison with Wilcoxon signed-rank test for each item of the Adapted Fresno Test—ITT analysis.

The students in the control group significantly improved their knowledge and skills in describing the characteristics of a study to determine its validity (item 6) ( Z = −2.714, p = 0.007). The students in the intervention group significantly improved their knowledge and skills in describing the characteristics of a study to determine its magnitude and significance (item 7) ( Z = −2.543, p = 0.011). No other significant differences were detected.

The results of the within groups comparison with the Wilcoxon signed-rank test are similar if we exclude the dropouts; therefore, only ITT analysis results are presented.

3.2.2. Qualitative Analysis of Monographs

Based on the experts’ consensus report of each monograph, the analysis of the intervention group monographs showed that the students’ groups clearly defined their review questions and inclusion/exclusion criteria. These groups of students effectively searched for studies using appropriate databases, keywords, Boolean operators, and truncation. Additionally, we found thorough descriptions from students concerning the selection process, data extraction, and data synthesis. However, only three students’ groups provided a good description of the review findings with an appropriate data synthesis as well as a clear answer to the review question in the conclusion section of their monographs. It is noted that the criteria for the results and conclusion sections were more difficult to successfully achieve, even in the intervention group.

The monographs of the control groups showed weaknesses throughout. From the nine monographs of the control group, only two presented the review question in a way that was clearly defined. In all of the monographs, the inclusion/exclusion criteria were either not very informative, unclear, or did not match with the defined review questions. Additionally, the search strategies were not clear and demonstrated limited understanding, such as lack of use of appropriate synonyms, absent truncations, and no definition of the search field for each word or expression to be searched. None of the monographs from the control group reported information about the methods used to study the selection process, to extract data, or to synthesize data. In the conclusion section, students from the control group also demonstrated difficulties in synthesizing the data and limitations by providing a clear answer to the review question.

4. Discussion

This study sought to evaluate the effectiveness of an EBP educational program on undergraduate nursing students’ EBP knowledge and skills. Even though both groups improved after the intervention in EBP knowledge and skills, the study results showed that the improvement was greater in the intervention group. This result was reinforced by the results of the qualitative analysis of monographs.

To the best of our knowledge, this is the first study to use a cognitive and performance assessment instrument (Adapted Fresno Test) with undergraduate nursing students, as suggested by CREATE [ 24 ]. Additionally, it is the first study conducted using the EBP education program [ 25 ]. Therefore, comparison of our findings with similar studies in terms of the type of assessment instrument and intervention is limited.

However, comparing our study with other previous research using other types of instruments and interventions demonstrates similar results [ 20 , 21 , 22 , 23 ]. In a quasi-experimental study [ 20 ], it was found that an EBP educational teaching strategy showed positive results in improving EBP knowledge in undergraduate nursing students. A study showed that undergraduate nursing students who received an EBP-focused interactive teaching intervention improved their EBP knowledge [ 21 ]. Another study indicated that a 15-week educational intervention in undergraduate nursing students (second- and third-year) significantly improved their EBP knowledge and skills [ 22 ]. In addition, a study by Zhang, Zeng, Chen, and Li revealed a significant improvement in undergraduate nursing students’ EBP knowledge after participating in a two-phase intervention: a self-directed learning process and a workshop for critical appraisal of literature [ 23 ].

Despite the effectiveness of the program in improving EBP knowledge and skills, the students included in the present study had low levels of EBP knowledge and skills as assessed by the Adapted Fresno Test at the pretest and posttest. These low levels of EBP knowledge and skills, especially at the pretest, might have influenced our study results. As a matter of fact, the Adapted Fresno Test is a demanding test since it requires that students retrieve and apply knowledge while doing a task associated with EBP based on scenarios involving clinical uncertainty. Consequently, this kind of test is very useful to truly assess EBP knowledge retention and abilities in clinical scenarios that do not allow guessing the answers. Notwithstanding, due to these characteristics, the Adapted Fresno Test may possibly be less sensitive when small changes occur or when students have low levels of EBP knowledge and skills. Nevertheless, even using instruments with Likert scales, other studies also showed that students have low levels of EBP knowledge and skills [ 21 , 22 , 23 ].

The low levels of EBP knowledge and skills of the undergraduate nursing students may be a reflection of a persistent, traditional education with regard to research. By this we mean that the focus of training remains on primary research—preparing students to be “research generators” instead of preparing them to be “evidence users” [ 32 ]. Furthermore, the designed and tested intervention used in this study was limited in time (only 17 weeks), was provided by only two instructors, and was delivered to fourth-year undergraduate nursing students, which are limitations for curriculum-wide integration of EBP.

Indeed, a curriculum that promotes EBP should facilitate students’ acquisition of EBP knowledge and skills over time and with levels of increasing complexity through their participation in EBP courses and during their clinical practice experiences [ 32 , 33 , 34 , 35 ]. As Moch, Cronje, and Branson suggest, “It is only in such practical settings that students can experience the challenges intrinsic to applying scientific evidence to the care of real patients. In these clinical settings, students can experience both the frustrations and the triumphs inevitable to integrating scientific knowledge into patient care.” [ 35 ] (p. 11). Therefore, in future studies, other broad approaches for curriculum-wide integration of EBP as well as its long-term effects should be evaluated.

Previously in the Discussion, we highlighted the limitations of the proposed intervention in terms of time constraints (only 17 weeks), instructors’ constraints (only two instructors provided the intervention), and participants’ constraints (fourth-year undergraduate nursing students). In addition, the study was also restricted to one Portuguese nursing school, which can limit the generalization of the results. However, our study tried to address some of the fragilities identified in other studies [ 20 , 21 , 22 , 23 ] on the effectiveness of EBP educational interventions by including a control group and by measuring EBP knowledge and skills with an objective measure and not a self-reported measure.

Bearing this in mind, future studies in multiple sites should assess the long-term effects of the EBP educational intervention and the impact on EBP knowledge and skills of potential variations in contents and teaching methods. In addition, studies using more broad interventions for curriculum-wide integration of EBP should also be performed.

5. Conclusions

Our findings show that the EBP educational program was effective in improving the EBP knowledge and skills of undergraduate nursing students. Therefore, the use of an EBP approach as a complement to the research education of undergraduate nursing students should be promoted by nursing schools and educators. This will help to prepare the future nurses with the EBP knowledge and skills that are essential to overcome the barriers to EBP use in clinical settings, and consequently, to contribute to better health outcomes.

Acknowledgments

This paper contributed toward the D.C. PhD in Health Sciences—Nursing. The authors gratefully acknowledge the support of the Health Sciences Research Unit: Nursing (UICISA: E), hosted by the Nursing School of Coimbra (ESEnfC) and funded by the Foundation for Science and Technology (FCT). Moreover, the authors gratefully thank Catarina Oliveira for all the support as a Ph.D. supervisor and Isabel Fernandes, Maria da Nazaré Cerejo, and Irma Brito for help and facilitation of data collection.

Author Contributions

Conceptualization, D.C., M.A.R., and J.A.; methodology, D.C., M.A.R., and J.A.; validation, D.C., M.A.R., and J.A.; formal analysis, D.C., F.C., and A.F.C.; investigation, D.C., F.C., A.F.C., E.B.-C., L.S., R.R., V.C., D.P., M.-A.R., M.A.R., and J.A.; resources, D.C., M.A.R., and J.A.; data curation, D.C., F.C., and A.F.C.; writing—original draft preparation, D.C.; writing—review and editing, F.C., A.F.C., E.B.-C., L.S., R.R., V.C., D.P., M.-A.R., M.A.R., and J.A.; supervision, M.A.R. and J.A.; project administration, D.C. All authors have read and agreed to the published version of the manuscript.

This work was funded by National Funds through the FCT—Foundation for Science and Technology, I.P., within the scope of the project Ref. UIDP/00742/2020.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by Ethical Committee of Faculty of Medicine of the University of Coimbra (protocol code: CE-037/2017 and date of approval: 22 May 2017).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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