Culture Crash regarding Nursing Students' Experience of Implementation of EBP in Clinical Practice

Abstract

IntroductionNursing students undergo clinical training in a rapidly changing health care system and many stress the need for evidence-based health interventions (1). However, educating students in evidence-based practice (EBP) is a challenge for both faculties and clinical practice, because EBP educational interventions may improve students' knowledge, but do not ensure its application in a clinical setting (2,3). Improving the transmission of EBP from the classroom to the clinical setting and to facilitate students' ability to integrate EBP naturally into their professional upskilling, requires an environment that challenges students in terms of evidence-based issues. It is only in such critical clinical settings that students can experience the challenge of applying evidence in their care of real patients (1,4). Nurses should challenge students to identify clinical problems and search for evidence-based solutions during their clinical training just as they challenge them about their clinical observations, interventions, procedures, etc. (5). For example faced with the assignment whether sterile intermitted catheterization is better to prevent urinary track infection compare to clean intermitted catheterization, nurses should challenge the students to conduct search in different databases, instead of given them the answer or asked the students to find answer in the textbook. However, according to Sackett et al. (6) this requires nurses with the competence to formulate answerable questions, search and critically appraise the evidence, apply the evidence and evaluate it. Research has shown that this competence is still lacking among nurses (7,8). A recent study in Norway concluded that nurses with skills in EBP could reduce the obstacles to the use of EBP and increase the use of science in practice (9), which is consistent with previous research (3,10).As has been stressed in previous research, problems are associated with the implementation of EBP when it is transferred from the faculty to clinical practice. Consequently, a collaboration between a faculty and a clinical practice was established to allow the implementation of EBP by students during their clinical training. The aim of this study was to examine the nursing students' experiences during the implementation of EBP in a practical setting. This article presents the main findings of this study. Literature reviewIn Norway, the focus on EBP in nursing education has increased since 2004, but no studies have examined Norwegian undergraduate nursing students' experiences of EBP or whether they support its use in clinical practice. Internationally, there is no research consensus about the role nursing students should play when EBP is integrated into clinical practice (11). A few studies have recommended a partnership between faculties and practices to facilitate EBP. Stone et al. (12) involved undergraduate students in finding the appropriate evidence for nurses in clinical practice, which led to changes in policy and nursing practice. They concluded that stud...

Student nurse perceptions on evidence-based practice and research: An exploratory research study involving students from the University of Greenwich, England and the Faculty of Health Care Jesenice, Slovenia

“…The difficulty of teaching nursing students EBP across educational settings and clinical placement is well recognised. Smith-Storm et al (2012) study of a small group of second year nursing students suggests these students were able to implement EBP according to the goals of their programme, but were not provided with the opportunity due to time constraints of clinical placements and a lack of sufficiently trained clinical nurse mentors. The results of these three studies demonstrate the need to support nursing students across both educational settings and clinical placements to increase knowledge, positive attitudes and successful implementation of EBP.…”

Studenterfaringer med veiledning og læring knyttet til deltagelse i et kvalitetsforbedringsprosjekt på sykehus med kunnskapsbasert praksis som arbeidsform, -en beskrivende og utforskende studie

“…Studier har vist at undervisning om kunnskapsbasert praksis på universitetet ikke er tilstrekkelig for at studenter skal utvikle en kunnskapsbasert holdning til fagutøvelse. De må erfare arbeidsformen i praksis noe som krever kompetanse hos veiledere og ansatte på praksisstedet (Dawes et al, 2005;Smith-Strøm, Oterhals, Rustad & Larsen, 2012;Olsen, Bradley, Lomborg & Nordtvedt, 2013;Olsen, 2015). I tillegg er det et mål at studenter skal kunne bidra i systematiske og kvalitetsforbedrende arbeidsprosesser, og det anbefales at studenter involveres i forsknings-, utviklings-og innovasjonsarbeid i løpet av praksisstudiene (UHR, 2016; Forskrift om felles rammeplan for helse-og sosialfagutdanninger, 2017, §2, punkt 11).…”

“…Undervisning på skolen om kunnskapsbasert praksis hadde studentene opplevd som teoretisk og mindre relevant. Ved å anvende metodikken i forbedringsarbeidet erfarte de en sammenheng mellom teori og praksis, og forstod hvordan de kunne benytte kunnskapsbasert praksis videre for å tilegne seg ny kunnskap og holde seg oppdaterte, i samsvar med funn fra andre studier (Smith-Strøm et al, 2012;Olsen et al, 2013;Olsen, 2015). I tillegg til gruppeveiledernes rolle som fasilitatorer i studentenes faglige utvikling, peker funn i denne studien på betydningen av at veilederne planlegger og organiserer prosjektene godt.…”

Kunnskapsbasert praksis i sykepleierutdanningen

“…Internasjonale studier viser at sykepleiere i praksisfeltet mangler grunnleggende kunnskaper i KBP (6,7) og at mange sykepleiere i praksis er negative til å anvende forskning (8,9). I en litteraturgjennomgang fra 2011 ble det påpekt at tiltak mot kartlagte barrierer, kompetanseoppbygging og fagutvikling har betydning for å fremme kunnskapsbasert praksis (10).…”

“…En norsk studie undersøkte sykepleiestudentenes erfaringer med implementering av KBP i praksisstudiene. Resultatet av den antyder at det kan foreligge kulturelle utfordringer mellom studentenes laeringsmål og anvendelse av KBP i praksis (9). En svensk studie (15) viste at det var store forskjeller i hvordan studentene fra forskjellige universiteter i Sverige opplevde at KBP var vektlagt i sykepleierutdanningene.…”