The baccalaureate-prepared nurse must be able to identify a clinical question, appraise and integrate evidence into practice, and evaluate the outcomes of care (American Association of Colleges of Nursing, 2008). Although this direction is clear and unequivocal among nurse educators and leaders, it is less clear to undergraduate nursing students who have a different frame of reference for judging the essentials of nursing practice. Most students are highly motivated to learn what they need to pass their next exam or how to care for the patient during their next clinical rotation. Understanding research and evidence-based practice can take a back seat to these priorities.
The nurse educator assigned to teach research must accept this challenge with creativity and enthusiasm. This article highlights an innovative strategy that can be used to teach research and evidence-based practice to the current generation of nursing students.
BACKGROUND
Mansour and Porter (2008) used descriptive phenomenology to explore the experiences of faculty assigned to teach an undergraduate nursing research course. They identified four meaning units in their study: marketing the research content, introducing the research process, enhancing student abilities to learn about research, and enhancing the faculty member's ability to teach research. Of particular relevance are the themes related to marketing research (these would probably not be relevant for an undergraduate medical-surgical nursing course) and the themes related to enhancing the student and faculty member's ability to engage in the teaching-learning process.
Nurse educators who teach undergraduate research must be passionate about nursing research and resolved to not be discouraged by a few students who will inevitably ask, "Why do I have to take this class?" The millennial learner values experiential learning and active participation within groups (Billings & Halstead, 2016; Lowestein, 2017), a challenge in a didactic research course without a practice component. Although the faculty member teaching a research course may aspire to use active learning methods, a recent review of research related to active learning in nursing education concluded that there is insufficient evidence regarding its use and effectiveness in nursing and other health professions (Waltz, Jenkins, & Han, 2014).
EVIDENCE-BASED PRACTICE PROJECT
We have used a learning strategy that addresses the essentials of BSN education related to research and evidence-based practice in a large baccalaureate program (100 to 125 students/semester) in the first semester of the senior year. The strategy was designed based on the educational needs and priorities of students as well as the professional responsibility of faculty to provide a high quality course that meets essential content efficiently. The strategy is a two-part evidence-based practice project with a focus on collaboration and dissemination.
Meeker, Jones, and Flanagan (2008) suggest that, although evidence-based practice has been applied to clinical courses, the approach has been underutilized in research courses, even though such a course would enable students to be better at evaluating the care provided during their clinical rotations. O'Neal, McClellan, and Jarosinski (2016) describe a new model based on learning cooperatives that ties an evidence-based project to the clinical agency where the students practice. Our project uses a similar approach.
The project is divided into two parts. Students work in the same group that they are assigned for their clinical rotation. This has practical considerations in that students can meet before or after clinical to work on their projects beyond the assigned class period. Completion within their clinical groups also fosters collaboration with clinical instructors and staff as students discuss their project with these experts.
The first part of the project is a written assignment that consists of a review of the literature and the development of a PICOT (Population/Patient, Intervention, Comparison/Control, Outcome, Time) question, followed by a critique of an evidence-based clinical practice guideline using a rubric found in the textbook. The work is divided among members of the clinical group. When the project was first developed, student groups were able to choose their own clinical practice guideline, but this often led to frustration when students chose guidelines that were not relevant to nursing practice or were not reputable. Currently, students choose a clinical practice guideline from an extensive list provided by faculty, a list that allows for choice but also guidance. Faculty often recommend guidelines developed by nurses or nursing organizations, such as the Emergency Nurses Association or the American Association of Critical-Care Nurses, to emphasize the relevance of the project to the real world of nursing.
Once students have searched the literature to determine the scope and need for the clinical practice guideline, they develop a PICOT question related to the guideline. Most clinical practice guidelines are complex and include multiple interventions, but students are encouraged to develop a PICOT question that is more narrowly focused. For example, if they choose a guideline related to the prevention of ventilator-associated pneumonia, the guideline will include many interventions that are relevant to several disciplines. The students' task is to develop a question that has high relevance for nursing. In this situation, they might develop their PICOT question in the area of mouth care or positioning, two important interventions related to nursing. The PICOT questions for each group are presented during a class session; the group is given feedback, and they then complete and submit the first part of the project.
The second part of the project involves searching and grading the level of evidence for two additional research articles written since the clinical practice guideline was developed; identifying four to five clinical recommendations based on the guideline and research articles, including the level of evidence supporting the recommendations; a comparison of recommendations to the policies and procedures used on their clinical unit; and a discussion of policy implications such as reimbursement and patient outcomes. The group prepares this part of the project in a poster presentation format using a PowerPoint slide that can be projected to the class and to the judges.
The judges consist of faculty who are members of the college of nursing research committee, doctoral students, and clinical leaders from the medical center (e.g., the director of research or nurses working in quality improvement). These individuals provide exceptional feedback, helping students see the relevance of their work while also providing constructive feedback. The project is graded by course faculty; feedback and suggestions from the rubrics completed by the judges are provided in the graded student feedback.
The group that is judged to have completed the best project (often this is determined by a random drawing when there are ties) receives a prize, usually a $10 gift card to the bookstore. Funding for the prizes has been provided by the college of nursing office of research. Formative and summative evaluation from students has been overwhelmingly positive. Students have expressed interest in the projects' application to practice, with several students communicating with course faculty about the usefulness of their project in their first nursing position after graduation.
SUMMARY
Baccalaureate-prepared nurses are expected to enter the workforce with skills to identify clinical questions and integrate evidence into their practice. As such, nurse educators have the responsibility to provide nursing students with the opportunity to develop this skill set while in their respective programs of study. Developing and implementing teaching strategies to facilitate learning in a research class may present challenges.
In words attributed to Mark Twain and others, the "professor's lecture notes go straight to the students' lecture notes, without passing through the brains of either" (http://quoteinvestigator.com). The challenge is to use class time and assignments to help students understand content beyond their knowledge level. Suggestions for a learning strategy that has been implemented successfully in a large BSN program are presented in this article. Course work in an undergraduate research course should ideally promote excitement about the use of nursing research and include practical application of research into daily nursing practice.
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