Nurse educators and faculty in both academic and healthcare settings consistently work to promote evidence-based practice (EBP) by teaching process and strategies for incorporation of clinical inquiry and use of EBP and quality improvement (QI) approaches in clinical practice. Nurses and students often view EBP and QI as "extra work" instead of seeking to facilitate the strategies as a foundation for practice.
Healthcare organizations' nursing populations include experienced nurses who graduated prior to 2003, when EBP was not consistently included in nursing program curricula, and new nurse graduates entering practice with basic EBP knowledge that may or may not have included hands-on experience. Current literature describes EBP internship programs offered to nurse employees with practice experience,1 but little information was found about inclusion of EBP projects as a component of programs designed to facilitate the transition from nursing student to practicing nurse clinician. To promote a culture of clinical inquiry, a large healthcare organization set goals to educate existing nursing staff and support nurse graduates transitioning into practice with hands-on experience for conducting EBP projects.
Ferguson and Day1 identified that new nurses initially focus on workplace tasks and demands and become more capable of EBP after approximately 6 months of practice. However, the authors advocated creating and advocating a climate of EBP and providing mentorship for development of EBP competencies from beginning practice. Early experience with incorporating appropriate, credible evidence and client preferences into care decision making can assist with development of critical thinking skills and sound clinical judgment.2
Challenges to EBP in Practice Settings
Healthcare organizations have been challenged to foster environments conducive to providing care based on evidence and best practice recommendations.3 The Institute of Medicine4 identified that EBP is not implemented fully in most practice settings. Other authors have identified that EBP is often viewed as an individual's professional responsibility that is not necessarily supported by their practice setting.5 Studies have demonstrated that education, availability of relevant research, time, positive attitudes, and mentorship have a positive correlation to nurses' intentions to use evidence in practice.6 EBP challenges include time constraints, lack of appraisal skills, and/or lack of access to resources with current evidence.6 Experienced nurses are expected to precept new nurses and role model EBP; however, often they are struggling to implement the EBP process in their own practices.
Intervention
Gawlinski7 identified distinguishing factors of effective hospital nursing research and EBP programs as providing structures to unleash the creativity of staff and securing involvement in EBP early in nurses' practices by educating and involving nurses in EBP projects. At this site, participation in an EBP project was added as a requirement of the Nurse Internship Program (NIP) to provide experience with the development of PICO (patient problem, intervention, comparison, and outcome[s])8 questions, conducting literature searches, appraising evidence, creating evidence summary tables, and making practice recommendations. The EBP program includes didactic education and facilitates teams of nurses to work on group projects. At the end of phase I of the internship, nurses prepare posters and PowerPoint slides and give group presentations to describe how they used steps of the EBP process. Interns are encouraged to share information at staff meetings and in their community of practice and to consider implementing recommendations and disseminating project results within the organization, as well as externally via local and national presentations and/or publication. Nurse intern EBP project posters are displayed for all nurses to view during Nurses' Week.
Study Aim
The purpose of this study was to evaluate the experiences of participation in an EBP project by nurse interns during the transition period from student nurse to practicing nurse.
Study Design and Sample
A purposive sample of RN interns received an introduction letter, a survey form, and an addressed return envelope providing opportunity to participate in the study within 6 weeks after graduation from the NIP.
Instrument
Permission was received from the authors of an instrument developed to evaluate the staff EBP NIP at the Center for Nursing Quality, Professional Development, Research and Informatics, Department of Nursing and Patient Care Services, University of Iowa Hospitals and Clinics. The instrument uses a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = uncertain, 4 = agree, 5 = strongly agree) for nursing feedback about the usefulness of the course and materials, understanding and application of the EBP process, personal growth and development, adequacy of support to overcome barriers, and the value of EBP. Cronbach's [alpha] for the instrument for this study application was .963.
Results
Twenty of the 46 graduates from a program responded to the study invitation (43% response rate). Results are presented in Table, Supplemental Digital Content 1, which shows study results, http://links.lww.com/NE/A122. Nurse interns agreed (55%) or strongly agreed (45%) that the program made it possible for them to complete an EBP project (mean, 4.55 [SD, 0.510]). Forty-five percent agreed and 55% strongly agreed that program content facilitated their learning about EBP (mean, 4.55 [SD, 0.510]). Fifty percent agreed and 50% strongly agreed that the program provided knowledge to use EBP to answer a clinical question (mean, 4.5 [SD, 0.513]).
Thirty percent of nurse interns agreed and 45% strongly agreed that they planned to use EBP in the future as a result of the hands-on experience, whereas 25% indicated they were uncertain (mean, 4.2 [SD, 0.834]). Fifty percent agreed and 40% strongly agreed with the statement that including an EBP project in the NIP helped with professional growth, and 10% were uncertain (mean, 4.3 [SD, 0.657]).
In the category "Valuing EBP," 85% nurse interns strongly agreed and 10% agreed that evidence-based nursing practice is important (mean, 4.89 [SD, 0.315]); 75% strongly agreed and 20% agreed they would recommend use of EBP process to solve clinical issues (mean, 4.79 [SD, 0.419]), and 65% strongly agreed and 30% agreed they would recommend the EBP component of the NIP to others (mean, 4.68 [SD, 0.478]). Study results identified barriers with support provided to nurse interns by their preceptors (mean, 3.32 [SD, 1.29]) and units (mean, 3.2; SD, 1.28]).
Discussion
Study results supported that inclusion of EBP classes and project work in the NIP helped facilitate EBP as an expected component of nursing practice. Results also helped justify offering additional educational programs to address EBP knowledge deficits of current staff so they can be better prepared to provide support to the new graduate nurses joining their team.
Implications for Nurse Educators and Faculty
Nursing faculty may use the study information to strengthen participation of students in learning the EBP process. Healthcare organizations expect that graduate nurses have basic preparation to conduct EBP projects as they transition into practice. Evidence is provided to support nurse educators to teach EBP to tenured nurses who lacked EBP course work in their nursing programs so that all nurses are prepared to use clinical inquiry for improving nursing practice and patient outcomes.
References