Learning evidence-based practice (EBP) and research is a core pillar of the American Association of Colleges of Nursing's (AACN's) Essentials: Core Competencies for Professional Nursing.1 Steps of EBP and competencies such as search for the best evidence, critically appraise the evidence, integrate the evidence with clinical expertise and patient preferences and values, evaluate the outcomes of the practice decisions or changes based on evidence, and disseminate EBP results2 are linked to learning outcomes in the Research and Evidence-Based Practice in Nursing course in which this teaching strategy was used. The aim was to help students bridge theory-to-practice gap and develop their presentation skills.
A systematic review on pedagogical strategies revealed that undergraduate nursing students experience difficulty visualizing how research findings contribute to nursing practice.3 Therefore, new pedagogical strategies are needed to help students scaffold previous coursework and experiences. Simple approaches help reinforce the "need to know" versus "nice to know" content in a course with new terminology, especially pertaining to research. In this teaching strategy, described in this article, faculty explored the use of a tool that had not yet been incorporated into the research and evidence-based nursing course.
Through the use of a customized Identification, Situation, Background, Assessment, and Recommendation (ISBAR) mnemonic tool,3 introduced in a discussion forum, faculty provided an opportunity for students to organize and practice professional presentation skills with their peers, with the goal of impacting perceptions of capability in professionally summarizing a completed literature review and meeting additional course outcomes. ISBAR is used regularly in clinical settings as a tool to reduce communication errors and increase patient safety.
As Situation, Background, Assessment, and Recommendation (SBAR) applies in health care, the situation is usually a brief description of the primary concern or scenario going on with a patient, whereas the background is any medical history or relevant information relating to the scenario. The assessment is the nurse or other health care provider's assessment of what is happening, and the recommendation is the recommended action, often with a specific request or need. Nursing students are typically introduced to the standard SBAR concept early in their curriculum while practicing communication techniques. Variations over time have also been known to add an "I" for identification of the nurse or provider.4 While ISBAR is not new, it provides a familiar template in which to become comfortable with practicing new skills for increased confidence. Students have foundational knowledge, which can be transferred to the application of this tool in a new context. In this teaching strategy, faculty explored whether the use of a customized ISBAR tool was perceived by students as a helpful resource in improving presentation skills.
Description of Strategy
This project was conducted in a hybrid format undergraduate nursing research and EBP course. Fifty-eight third-year nursing students were enrolled. Goals of the course are to integrate principles of scientific literacy, information management, and person-centered care to promote health and safety by application of research, EBP, and quality improvement concepts. For their final research appraisal poster project, students form working groups of 2 to 3 members each, tasked with performing a quantitative literature review with supporting components representing EBP. Faculty recognized a need for student organization, reflection on the comprehensive skills assessment, and dialogue prior to student poster presentations, based upon historical course data. The ISBAR tool was deployed in a discussion forum assignment.
The ISBAR tool used for students' professional presentations preparation includes the following:
Identification: Identify yourself as the presenter.
Situation: Summarize the topic and the clinical question surrounding the evidence source.
Background: Share the reason or clinical problem for which the research occurred. Refer to expert clinician interviews or discussions.
Assessment: Summarize the sources of literature. What levels of evidence include these sources? Does the evidence conclude that more research is needed? What do the results indicate? Is a change supported?
Recommendation: A recommendation of further research or support of a change.
Methods Used to Evaluate Outcomes
Faculty conducted a 5-point Likert-type anonymous and voluntary survey via the course learning management system to evaluate the students' perception of skills capabilities and progress toward course objectives. Following implementation of the ISBAR assignment, a posttest survey used the same items evaluating perception of skills/capabilities and, in addition, a 4-point Likert-type set of items on the level of agreement and use of the ISBAR tool. Institutional review board approval was obtained for this project.
Results
Of the 58 students enrolled in the course, 37 completed the pretest survey (64% response rate) and 12 completed the posttest survey (21% response rate). Preactivity, the majority of students ranked their perception of capability for performing actions/EBP skills as moderate capability for each item. Postactivity, the majority of responses were in the high capability ranking for each skill/outcome, demonstrating overall improvement in perception of skills.
When asked about the level of agreement with ease of use and confidence with the ISBAR tool (4 items), all respondents in the posttest survey indicated agreement (agree or strongly disagree) to the following items: (1) Framing the presentation info in an ISBAR format helped me relate the organization to a clinical conversation with other health care professionals; (2) I found the customized professional presentation ISBAR easy to use; and (3) I can utilize the ISBAR format in the future when preparing to discuss literature findings with colleagues.
Based on the success of this assignment and ease of use without adding much additional workload, this tool continues to be used to help students organize their professional presentations in subsequent semesters. The assignment was well received and adds an intentional step in group process to promote organization and dialogue.
Implications for Nursing Education
Use of the ISBAR tool in different nursing education experiences can help link theory to practice and promote enhanced communication. Formative assessments of knowledge and teaching/learning strategies provide the opportunity for faculty to maintain engagement and community with students.
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