Evidence-Based Practice in Nursing Education

By Susan Sportsman, PhD, RN, ANEF, FAAN

Last month, I was pleased to give a presentation at a faculty development workshop on Evidence-based Practice (EBP) in Nursing Education at the Jane and Robert Cizik School of Nursing at the University of Texas at Houston. The participants were very engaged in our discussion and provided me with food for thought for this blog. The question that kept bubbling up for me as I traveled home from Houston was, “What evidence do we actually use as we plan our curricula, our courses, and our teaching-learning strategies for class, lab/simulation, and clinical experience?”

As early as 2012, Patterson and Klein completed a national online survey of 295 nursing faculty from 86 programs to determine the source of the evidence faculty used to develop teaching-learning processes. Although quantitative or qualitative research findings and information shared at conferences were identified as resources, the respondents also indicated that they used written course evaluations as well as class feedback and student comments, typically not considered evidence.

Evidence-based practice in any arena is drawn from resources which represent a continuum, typically ranging from “best practices” to qualitative or quantitative research. Best practices are generally accepted, standardized techniques, methods or processes, often formulated by experts that have proven themselves over time. In contrast, research-based practice has been shown effective through rigorous scientific methodology, replication of findings with consistent results in more than one setting, and recognized in scientific journals by one or more published articles. Best practices, of course, have undergone a less complex evaluation process.

Since 2012 there has been an increased emphasis on developing and distributing best practices in nursing education. For example, the experts in nursing simulation associated with INACSL have developed standards covering all aspects of clinical simulation. These standards serve as important guidelines for all nursing faculty involved in simulation.

To continue the example of the EBP continuum using simulation, in 2014 the National Council of State Boards of Nursing (NCSBN) published a landmark, national, multi-site, longitudinal study of simulation use in pre-licensure nursing programs throughout the country. The purpose of this study was to implement a national survey of the use of simulation in pre-licensure nursing programs, followed by a randomized, controlled study examining the outcomes of various amounts of simulation to replace a portion of the hours spent in traditional clinical settings. This quantitative study provided substantial evidence that up to 50% simulation can be effectively substituted for traditional clinical experience in all pre-licensure core nursing courses under conditions comparable to those described in the study (Hayden, Smiley, et. al., 2014). These two examples highlight the relative strength of evidence generated from best practice criteria and research.

While the use of best practices in nursing education has grown in the last twenty years, evidence from rigorous quantitative and qualitative research in nursing education has lagged behind. What does this mean for those of us who are currently teaching? How can we be sure that we are structuring our classes, labs, and clinical experiences in a manner that gives students the best chance of learning and retaining necessary knowledge and judgment to provide safe care? Here are some suggestions for accomplishing this goal.
• Apply research from our colleagues in neurology and education to nursing education (For more information on this approach, see the blog post, Student Engagement and the Brain).
• Review our own thinking about the effectiveness of the teaching-learning strategies we typically use. There may be new evidence that supports the use of other methodologies.
• Develop expertise in evaluating evidence in order to model this behavior for students.
• Be open to new approaches. However, remember that individual reports of evaluation of specific teaching-learning strategies may be sufficiently interesting to try in our own teaching, but even if the results are positive, one positive (or negative) result alone does not represent a “best practice.”
• In order to escalate the availability of best practices and research-based teaching and learning, commit to evaluate as rigorously as possible our own work.
• Regularly review research literature related to nursing education. We should recognize that meta-analysis (for quantitative research) and meta-synthesis (for qualitative research) studies often provide us the most in-depth review of the literature regarding a particular area.

We all worry about our ability to stay current in our clinical area of expertise and in nursing education. Most of us feel as if we are “peddling as fast as we can” to keep up with new evidence—often with limited success. I would recommend that you regularly review organized repositories, such as the Virginia Henderson Repository or Joanna Briggs Institute, as well as best practices generated by various professional organizations and governmental agencies. In addition, we can collaborate with our own colleagues to collect and share literature highlighting best practices and research related to nursing education.

Nursing education has made progress in generating and implementing evidence as part of our teaching practice. However, there is much more work to be done. I challenge us all to keep building the evidence!

Patterson, B.J., Klein, J.M. (2012) Evidence for teaching: What are faculty using. Nursing Education Perspectives. 33(4) July-August, 240-245.

Hayden J. Smiley, R.A., Alexander, M., Kardong-Edgren, S., Jeffries, P. (2014) The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in pre-licensure nursing education. Journal of Nursing Regulation. 5(2) July Supplement. https://www.ncsbn.org/JNR_Simulation_Supplement.pdf Retrieved, May, 2019.

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