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Evidence-based practice behavior and implementations: a cross-sectional written report among undergraduate nursing students

• Salwa AbuAlrubⁱⁱ,
• Rana F. Obeidat³ &
• Kholoud Assmairan^four

BMC Nursing volume 20, Commodity number:xiii (2021) Cite this article

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Abstract

Background

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

Methods

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

Results

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

Conclusion

To advance nursing science, enhance practice for future nurses, and amend patient outcomes, information technology is disquisitional to teach nursing students not only the value of bear witness-based noesis, but as well how to access this knowledge, assess information technology, and apply information technology correctly every bit needed.

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Background

Evidence-based practice (EBP) integrates the clinical expertise, the latest and best bachelor research testify, every bit well as the patient's unique values and circumstances [one]. This class of practice is essential for nurses likewise equally the nursing profession every bit it offers a wide diversity of benefits: Information technology helps nurses to build their own trunk of knowledge, minimize the gap between nursing education, research, and practice, standardize nursing practices [ii], ameliorate clinical patient outcomes, improve the quality of healthcare, and decrease healthcare costs [3]. Thus, clinical conclusion-making by nurses should be based on the all-time and most up-to-date, available inquiry bear witness [iv].

Earlier studies of EBP implementation by nurses in their everyday clinical practice have shown that it is suboptimal [5,half dozen,7]. Implementation of EBP is defined every bit its awarding in clinical practice [8]. Findings from previous studies indicate that nurses' implementation of EBP can be promoted by improving their belief most EBP. Belief is the perception of the value and benefits of EBP and the perceived self-confidence in one'southward knowledge and skills of EBP [8]. Nurses with a stiff belief in EBP implement it more than than nurses with a weak belief in the aforementioned [seven, nine].

Preparing nurses for practice and ensuring that they have met a set of minimum cadre competencies at the point of graduation is accomplished through their undergraduate education [10]. Several formal entities such as the Plant of Medicine (IOM) [four] and the Accreditation Committee for Education in Nursing (ACEN) [xi] consider EBP as one of the core competencies that should be included in health care clinicians' education. However, this does not necessarily guarantee the bodily implementation of EBP in everyday clinical practice [12]. Information technology 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 raise their cocky-efficacy in implementing EBP. In society to event this change, it is crucial to amend the education process and to focus more on the knowledge and implementation of EBP.

In that location is consequent evidence showing that while undergraduate nursing students hold positive beliefs almost EBP and its value in patient care, they likewise report many challenges regarding its actual implementation in clinical do. For case, a mixed-methods written report indicated that 118 American undergraduate nursing students plant it difficult to distinguish between EBP and research. Students were able to search for bear witness, but were less able to integrate evidence to plan EBP changes or disseminate all-time practices [thirteen]. Additionally, a correlational written report was conducted in Jordan using a sample of 612 senior nursing students. The report 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. Nonetheless, they did non believe strongly in their ability to deport research [fourteen]. A cross-sectional report was conducted amid 188 Saudi undergraduate nursing students. Students reported positive beliefs about EBP; all the same, they reported a low mean score in EBP implementation (22.57 out of 72). Several significant factors accept been reported equally influencing EBP implementation, such as age, gender, sensation, and training on EBP [15]. A comparative survey comprised of 1383 nursing students from Bharat, Saudi Arabia, Nigeria, and Sultanate of oman. The written report reported that having no authority in irresolute patient care policies, the irksome publication of evidence, and the lack of fourth dimension in the clinical area to implement the evidence were major barriers in implementing EBP according to the participating students [16].

In Hashemite kingdom of jordan, testify-based knowledge with critical thinking is one of the seven standards for the professional practice of registered nurses that were released past the Jordan Nursing Council [17]. Despite the plethora of studies on undergraduate nursing students' behavior about EBP and its implementation in everyday clinical practise, 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 (one) explore nursing students' behavior 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.

Methods

Blueprint and setting

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

Population and sample

The target population of this report was the undergraduate nursing students in Jordan. The accessible population was undergraduate nursing students who are currently enrolled in the four-yr BSN programme in two governmental universities in the northern region of Hashemite kingdom of jordan. We calculated the sample size using the G*Power software (2014). Using a conventional power gauge of 0.8, with alpha gear up at 0.05, and medium effect size, information technology was estimated that for a Pearson Correlation exam, a total of 100 participants would need to exist recruited to examine the relationship between the beliefs and implementations of EBP. To annul anticipated not-response and to raise the power of the report, 300 students were approached. The inclusion criteria of the study participants were as follows: a) senior nursing students who are in the 3^rdor 4th-twelvemonth 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 equanimous of ii parts was used for information drove. The starting time part aimed to assemble the demographic information of the participants: gender, historic period, study twelvemonth level, academy, and whatever previous EBP grooming received in the nursing enquiry course. The second part independent the EBP Belief Scale and EBP Implementation scale adult by Melnyk et al. (2008) [18]. Both scales had previous satisfactory psychometric backdrop with a Cronbach'south blastoff of more 0.9 and good construct validity. The Testify-Based Practice Conventionalities Scale (EBPB) consists of 16 statements that describe the respondent's beliefs of EBP. Students were asked to report on a v-point Likert scale their agreement or disagreement with each of the xvi statements in the scale. Response options on this scale ranged from strongly disagree (ane bespeak) to strongly agree (5 points). All statements were positive except for two statements (statements xi and thirteen), which were reversed before computing the total and mean scores. Total scores on the EBPB ranged from 16 to eighty, with a college total score indicating a more positive belief toward EBP. In the current written report, the scale showed satisfactory internal consistency reliability with a Cronbach's Blastoff of .92 for the total calibration.

The Evidence-Based Practice Implementation Calibration (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 awarding 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–three times, 2 = four–5 times, iii = half dozen–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 language because English is the official linguistic communication of didactics and instruction in all schools of nursing in Jordan.

Ethical considerations

The Institutional Review Board (IRB) at the first author'south university granted ethical blessing for this study (Reference #xix/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 near the report purpose and procedures, and gave them 5 min to read the questionnaires and to decide whether to participate in the written report or non. Students who agreed to participate in the study were assured of voluntary participation and the right to withdraw from the study at any fourth dimension. Questionnaires were nerveless 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 written report. Permission to utilize the EBP belief scale and the EBP implementation scale for the purpose of this study was obtained from the authors of the instrument.

Information drove process

After upstanding blessing was granted to carry the study, data was collected during the second semester of the academic year 2018/2019 (i.east., January through June 2019). The questionnaires were distributed to the nursing students during the classroom lectures afterwards 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 written report parcel that included a cover letter and the study questionnaire. Students were given 20 min to complete the questionnaire and render it to the principal investigator who was available to answer students' questions during the information collection process.

Information assay

Descriptive statistics (e.g., means, standard deviations, frequencies, and percentages) were performed to describe the demographic characteristics of the participating students and the master written report variables. For the conventionalities scale, the two agreement categories (4 = agree, v = strongly agree) were collapsed to one category to indicate a positive conventionalities. For the implementation scale, the three categories (2 = 4–5 times, three = vi–8, and iv ≥ 8 times in the past 8 weeks) were collapsed to one category as (≥ 4 times) to indicate frequent implementation. Pearson'southward correlation examination was used to determine the relationship betwixt the full scores of the EBP belief and implementation scales. A chi-foursquare examination was used to examine the difference between trained and untrained students in terms of understanding 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-examination was used to examine the difference between trained and untrained students in terms of the total hateful scores of EBP beliefs. The Statistical Package for Social Sciences (SPSS) software (version 22) was used for information analysis.

Results

Among the 300 approached students, 35 students did non 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 historic period of the participants was 22.09 years (SD = i.55). The bulk of the participants were females (73.4%) and in the 4th twelvemonth of the undergraduate nursing programme (85.1%). Further, more than than one-half of the participants (67.6%) stated that they received EBP training earlier (Table 1).

Table 1 Distribution of the sample past demographic variables (due north = 241)

Full size tabular array

The total mean score of the EBP belief calibration was 54.32 out of 80 (SD = xiii.63). Overall, between 50.v and 73.4% of students agreed or strongly agreed on the 16 statements on the EBP conventionalities scale, which indicates positive beliefs. However, students held a more positive conventionalities regarding the importance and the usefulness of EBP in quality patient intendance than in their ability to implement EBP. For case, while the majority of students believed that "EBP results in the all-time clinical intendance for patients" and that "evidence-based guidelines tin can better clinical intendance" (73.iv and 72.2%, respectively), merely about 54% of them cited that they "knew how to implement EBP sufficiently plenty 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 than positive behavior) toward all items of EBP compared to those who did not receive preparation; still, the departure between the two groups was not ever meaning. For case, threescore.vii% of trained students believed that "they are sure that they tin can implement EBP" compared to 41% of untrained students χ^two (1, n = 241) = 8.26, p = .004. Furthermore, 58.three% of trained students were "clear about the steps of EBP" compared to 41% of untrained students χ^two (1, n = 241) = 6.thirty, p = .021 (Tabular array 2).

Table two Responses to bear witness-based practice belief calibration past trained and untrained students (n = 241)

Full size table

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 4 times or more than in the last 8 weeks. For instance, simply about one-tertiary 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 enquiry 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 merely EBP that was implemented by more than one-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 grooming on EBP reported more frequent implementations of all listed EBPs compared to those who did not receive training; however, the difference betwixt the two groups was non always significant. For case, l.nine% of trained students reported that they "shared an EBP guideline with a colleague" four times or more in the past viii weeks compared to xxx.8% of untrained students χ² (one, due north = 241) = 8.68, p = .003. Almost fifty % of the trained students "shared testify from a research study with a patient/family unit member" four times or more in the past 8 weeks, compared to 28.2% of the untrained students χ² (one, n = 241) = 9.95, p = .002 (Table iii).

Table 3 Responses to testify-based exercise implementation scale by trained and untrained students (north = 241)

Total size tabular array

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 grooming on EBP had a significantly higher hateful score on the EBP belief scale compared to students who did not receive previous training on EBP (t (239) = two.04, p = .042). In addition, at that place was a significant divergence in the total score of EBP implementation by previous preparation 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 grooming on EBP (t (239) = 3.08, p = .002) (Tabular array 4).

Table 4 Independent samples t-test between students who received EBP training and students who did not eeceive EBP preparation in terms of beliefs and implementations of EBP (n = 241)

Full size table

Finally, results of the Pearson correlation exam revealed that there was no significant association betwixt the full score of the EBP belief calibration and the full score of the EBP implementation calibration (r = 0.106, p = 0.101).

Discussion

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 all-time clinical care for patients and that evidence-based guidelines can improve clinical care. Nevertheless, a lower percent of students believed in their ability to implement EBP where they worked and an even lower pct of them actually implemented EBP frequently in their everyday clinical practice. For illustration, only i-third of the students accessed a database for EBP, have read and critically appraised a clinical enquiry study, or used evidence to change their clinical do iv times or more in the last viii weeks. Our results are consequent with previous studies amidst Jordanian nursing students which also showed students had positive attitudes towards research and its usefulness to providing quality patient care but had insufficient power to utilize research evidence in clinical practice [14]. Further, a recent report has shown that nursing students in Jordan had low knowledge about EBP regardless of their admitting university [xix]. These results indicate that there could be a gap in the education process of undergraduate nursing students in Jordan virtually EBP. Thus, schools of nursing in Jordan accept to critically review their current educational strategies on EBP and improve information technology to heighten students' knowledge of EBP likewise equally their abilities to implement prove in clinical practice.

The results of the electric current study revealed that despite the positive behavior of the nursing students, their implementation of EBP was very depression. There was no meaning relationship between the total score of EBP belief and the total score of EBP implementation. Our results are consequent with those reported amidst Saudi too as American nursing students who also had positive behavior about EBP simply implemented information technology 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 amend knowledge, self-efficacy in implementation, and by extension, implementation practices amidst nurses and nursing students [20,21,22]. On the other hand, in this report, we asked students whether they have received training on EBP during the nursing research course taught at their universities. More than one-tertiary of participating students in our study cited that they had non received previous training on EBP even though all of them accept successfully passed the nursing inquiry course offered at their universities. One possible explanation for this finding could exist that there is an inconsistency in the way the nursing research course is taught. It seems that EBP do is non always included in the content taught in this course. Thus, nursing schools in Jordan take to revise their curricula to ensure that EBP is included and is taught to all students before graduation.

The results of the electric current report accept several international implications that involve bookish didactics and nursing curricula. In that location is a pressing need to enhance the education procedure and to focus more on the knowledge and skills of EBP. Incorporating EBP into the nursing curricula, particularly the undergraduate program is disquisitional equally information technology is the first footstep to prepare the students for their professional roles as registered nurses. Sin and Bliquez (2017) stated that creative and enjoyable strategies are central in society to encourage students' commitment to and learning about EBP [23]. I of these constructive strategies is teaching the EBP procedure by request a clinical question, acquiring and searching for testify, appraising then applying this evidence, and finally evaluating the effectiveness of its application in clinical practice [viii]. A thematic review study demonstrated that various interactive educational activity strategies and clinically integrated education strategies have been emphasized to enhance EBP knowledge and skills [24].

Gaining cognition about undergraduate nursing students' beliefs and their power to implement EBP in a clinical setting is essential for nursing educators at the national and the international level. This knowledge might assistance 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 grade should focus more than on this topic and should include clinical scenarios that involve the awarding of EBP. In addition, clinical courses should include assignments for the purpose of integrating EBP within their clinical cases. The calibration used in this study could be implemented in clinical courses to evaluate students' applied skills concerning EBP. Finally, nursing instructors, leaders, and practitioners should always update their EBP cognition and skills through continuous education and workshops. Since they are the role models and instructors, they should be competent plenty to teach and evaluate their students. They should likewise cooperate to facilitate the implementation of EBP in clinical settings to overcome whatsoever barrier.

Written report limitations and recommendations

This report sheds light on the existing gap between the conventionalities in and the implementation of EBP amongst nursing students. Withal, convenience sampling, using ii universities simply, and self-study bias are all limitations of this study. In addition, the researchers did not investigate the blazon of EBP training that was received by the students in this report. More studies are needed in Hashemite kingdom of jordan and the Eye Eastern region about EBP using larger random samples in different settings. It is too recommended to investigate the barriers that prevent nursing students from implementing EBP other than not receiving preparation on information technology. Furthermore, conducting qualitative studies might assistance examine and sympathize students' perceptions every bit well as provide suggestions to bridge the gap between education and exercise. Finally, time to come experimental studies are needed to test the effect of sure interventions on enhancing the implementation of EBP among nursing students.

Conclusion

Testify-based practice is essential for nursing students worldwide. Nonetheless, having strong beliefs about EBP and its benefits does non necessarily mean that it is often implemented. On the other hand, providing training courses on EBP is an essential stride in the enhancement of EBP implementation. This means that in order to advance nursing science and heighten nursing care for future nurses, it is vital to comprise EBP within the nursing curricula. It is also critical to teach nursing students the value of evidence-based knowledge also as how to access this knowledge, appraise it, and utilise it correctly as needed. This tin 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 writer upon reasonable request and with permission of Jordan Academy of Science and Technology.

Abbreviations

EBP:

Evidence-Based Practice

IOM:

Found of Medicine

ACEN:

Accreditation Committee for Teaching in Nursing

EBPB:

Evidence-Based Practice Belief Scale

EBPI:

Testify-Based Practice Implementation Scale

SPSS:

The Statistical Package for Social Sciences

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Funding

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

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Affiliations

1. Faculty of Nursing, Customs and Mental Wellness Nursing Department, Hashemite kingdom of jordan University of Science & Engineering science, P.O Box 3030, Irbid, 22110, Jordan

   Nesrin N. Abu-Baker

2. Faculty of Irbid College, Department of Practical Sciences, Al-Balqa Applied Academy, P.O. Box 1293, Irbid, Jordan

   Salwa AbuAlrub

3. Faculty of Nursing, Zarqa University, 247D Khawarezmi Building, Zarqa, Jordan

   Rana F. Obeidat

4. Kinesthesia of Nursing, Al-Albayt Academy, P.O Box 130040, Mafraq, 25113, Jordan

   Kholoud Assmairan

Contributions

All authors; NA, SA, RO, and KA had active contributions to the conception and design and/or collecting and analysis of the data and/or the drafting of the paper. NA and RO as well fabricated critical revisions for of import content and finalized the terminal version of the manuscript. All authors canonical the final version of the manuscript.

Respective author

Correspondence to Nesrin Due north. Abu-Baker.

Ethics declarations

Ideals approval and consent to participate

Obtained from the Institutional Review Lath (IRB) at Jordan Academy of Science and Technology (Reference # 19/122/2019). All participants were asked to sign a consent form before data collection.

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Not applicable.

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The authors declare no competing or disharmonize of interests.

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

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• Received: 12 May 2020

• Accustomed: fifteen December 2020

• Published: 07 Jan 2021

• DOI : https://doi.org/10.1186/s12912-020-00522-10

Keywords

• Behavior
• Implementations
• Bear witness-based exercise
• Nursing students

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