One of the gaps in nursing education research is on implementing evidence-based educational approaches. Articles in Nurse Educator disseminate a wealth of innovative teaching strategies-some include research on their effectiveness, whereas others are ready to be studied to determine their impact on student learning. The effectiveness of any evidence-based approach, in health care or education, is contingent on its implementation.
We need studies to uncover processes nurse educators use to translate evidence-based teaching approaches into practice-into the real-world settings of the classroom, online courses, simulation, and clinical practice-and sustain those new practices. How do educators implement innovations and new educational approaches in their own programs and courses? If successful, what strategies do educators use to "bring along" faculty who may not want to change any of their current educational practices? What factors facilitate or are barriers to the adoption of an evidence-based educational practice? Do these new approaches result in better outcomes for students?1
Implementation science (IS) would guide this research. There is limited literature on using IS for adopting educational evidence and only a few articles in nursing education. If we learn about the implementation of evidence-based educational approaches in nursing education, we can better guide faculty in translating research evidence into practice and adopting new educational methods.1 Liaw and colleagues2 used IS for translating an evidence-based virtual reality simulation into undergraduate medical and nursing programs and studied the implementation outcomes. Many studies have been conducted on health care professions education, but there is limited research on the adoption of evidence generated from these studies. Thomas and Bussieres explored using concepts from knowledge translation and IS to advance evidence-informed health professions education, defined as "the process by which individuals involved in teaching, curriculum development, assessment, administration, and research, use research findings to inform their educational practices."3(p1158)
Oermann et al1 developed a framework for using IS to guide the adoption of educational evidence in nursing and study the processes and outcomes. This framework includes 3 phases-development, translation, and sustainment-based on an analysis of models and frameworks of IS by Huybrechts et al.4 The first phase is development: this involves activities that should be done by faculty before implementing educational evidence or a new approach. This includes identifying problems in the course or program indicating a need for a new approach such as decreases in NCLEX or certification pass rates, low course test scores, course evaluations, or feedback from faculty or students, among others.1 These are often triggers for change.
In the translation (second) phase, faculty implement the new evidence. To do this effectively, we need to know how best to prepare faculty and students, what resources are needed, how to engage administrators in the school if relevant to the change, factors that facilitate and impede using the evidence, and other factors unique to the setting and context that may influence implementation. Studies should identify strategies that are effective for implementing educational practices. In health care, some of these are audit and feedback, educational outreach, sharing evaluation results with colleagues, and reports, but evidence is not available as to strategies most effective in an educational setting with faculty (some of whom may not want to change approaches).
Critical to this process is to evaluate the new approach-does it improve students' learning or performance of competencies? Is the new approach worth the time and resources? In some schools, faculty are quick to engage in new technologies and strategies for teaching, but we need to measure if they are better (in terms of learning outcomes or competency attainment, faculty time and resources, impact on students) than the prior ones. The third phase, sustainment, is monitoring and measuring the use of the evidence-based approach over time-does it become a routine practice, or do faculty drift back to their prior teaching approaches, especially as faculty turn over?
I have written many times that nurse educators are the most innovative and creative educators in health care and likely other fields as well. As you implement new evidence-based educational approaches, at the same time, plan how you will evaluate outcomes, so you have data to measure their effectiveness and make decisions about whether to continue with that approach. Measuring outcomes will also aid in dissemination: for publication you need more than student and faculty perceptions of the new approach and their satisfaction with it. A few examples of outcome measures, depending on the evidence you are implementing, are students' grades on tests and quizzes, scores on standardized assessments, ratings on course evaluations, ratings on surveys used to gather feedback about a new approach, and observations and ratings of skills. For some teaching approaches, there may be validated tools you can use, for example, instruments for measuring outcomes of interprofessional collaboration. These tools add strength to any study of outcomes.
Also, set up some process measures so you can ensure the evidence is being implemented as intended. Examples of process measures are mid-semester course evaluations, feedback from students and colleagues, focus groups, and your observations of the implementation of the practice or approach. One last step is important: identify benchmarks or metrics to meet for evaluating the new approach such as students' test scores in a course improve by 5%, 90% of the students pass the skill assessments, or the mean score on your course evaluations is higher than the preceding 2 semesters. The Supplemental Digital Content Table (available at: http://links.lww.com/NE/B171) provides an example of using IS to map out the processes for adopting evidence in a nursing course or program and measuring outcomes.
We need research on translating evidence into educational practices so that we know strategies for doing this. Some research questions are listed in the Table. These are just a few questions to better understand how to move evidence into routine teaching practices in nursing and adopt new approaches. I know you will think of many more questions, but I hope these get you started.
References