msera.orgmsera.org/2019/proceedings/1/146.docx · Web viewnursing educators’ perceptions of teaching information literacy to support. evidence-based practice: a mixed-methods

NURSING EDUCATORS’ PERCEPTIONS OF TEACHING INFORMATION LITERACY TO SUPPORT

EVIDENCE-BASED PRACTICE:A MIXED-METHODS STUDY

Ann Risher Deshotels

A dissertation submitted to the graduate faculty of the College of Education at the University of Louisiana at Monroe in partial fulfillment of the requirements

for the degree of Doctor of Education (Health Professions Education)

August, 2019

Approved by:

Ava Pugh, Ed.D. Major Professor

Paula Griswold, Ph.D. Committee Member

Myra Lovett, Ed.D. Committee Member

Lacy Hitt, Ph.D. Committee Member

2019Ann Risher Deshotels

ALL RIGHTS RESERVE

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ACKNOWLEDGMENTS

I want to acknowledge some exceptional people who supported me over the last

five years as I challenged myself to return to school in my late fifties. My loving parents

always encouraged me to advance my education, and my mother will get her wish to be

alive when I graduate, and dad will be with me in spirit. My children, Kimberly, Jamie,

Phil, Matthew, and Kirby, have been inspirational and patient with me through the

process, and my grandchildren, Emile, Aubrey Ann, and Jules will finally get their Annie

back to play with them. My significant other, Rob, was quite supportive and will get to

know me now that I am no longer in school!

I want to thank my dissertation committee, Dr. Pugh, Dr. Griswold, Dr. Lovett,

and Dr. Hitt and all of my ULM professors for their encouragement and support

throughout this scholarly process. I am grateful for my committee’s wise advice to

conduct a mixed-methods study and strengthen the results to provide the “so-what” for

the results of the study. I especially want to thank my NSU family and colleagues for

their encouragement and support through this challenging educational process. Dr.

Andary’s assistance for data analysis was immeasurable and based on evidence identified

in this study, I plan to become a champion for the initiative to integrate information

literacy competencies and support evidence-based practice in all nursing programs. I

want to thank Drs. Pierce, Tanner, and Pravikoff for their ground-breaking research on

information literacy and evidence-based practice in the nursing profession, and Drs.

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Fineout-Overholt and Melnyk for their dedicated scholarly promotion for evidence-based

practice in the nursing profession. Lastly, I want to thank all of the nursing educators who

participated in the study and supported my research.

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ABSTRACTAnn Risher Deshotels

Nursing Educators’ Perceptions of Teaching Information Literacy to Support Evidence-Based Practice:

A Mixed-Methods Study (Major Professor: Ava Pugh, Ed.D.)

Evidence-based practice (EBP) is the standard of care in healthcare, and educators

are obligated to prepare future nurses to utilize EBP supported by information literacy

competencies in the 21st century. The purpose of the mixed-methods study was to

examine educators’ perceptions and beliefs about teaching information literacy to support

EBP and determine cultural factors in academia that influenced the integration of EBP.

The Information Literacy for Evidence-Based Nursing Practice-Modified (ILNP-M),

Evidence-Based Practice Beliefs-Educator (EBPB-E), and Organizational Culture and

Readiness for School-Wide Integration of Evidence-Based Practice-Educator (OCRSIEP-

E) Scales were used to collect data in Phase I from 145 educators in a south-central state.

Phase II data were collected from 11 educators’ personal experiences teaching

information literacy and EBP with semi-structured, recorded interviews.

Most participants reported firm beliefs and confidence in teaching and utilizing

EBP and a positive movement toward sustainable cultures of college-wide integration of

EBP. Primary sources for information-seeking included professional journals, reference

textbooks, and healthcare databases, and rarely were librarians consulted. Availability of

databases and personal expectations for seeking new evidence were facilitators, and

barriers for searching for additional information included lack of time to search and

understand the organization of electronic databases. Most were aware of EBP but not

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information literacy competencies, and participants unanimously reported information

literacy was an EBP prerequisite and faculty were responsible for teaching both skills.

Though not statistically significant, educators younger than fifty years and teaching in

graduate and doctorate programs had higher mean scores on the EBPB-E Scale.

Statistical significance was found for movement toward a sustainable culture of EBP by

participants teaching in graduate and doctorate programs (p = 0.028) on the OCRSIEP-E

Scale.

Themes identified from interviews included the need to update and educate

nursing faculty about information literacy and EBP competencies, organizational

constraints for teaching competencies, and commitment for lifelong learning in the

nursing profession. Recommendations were for faculty development, orientation

programs, and consistent integration of competencies in all nursing programs. The

significance of the study validated the importance for nursing educators to be

knowledgeable and prepared to teach essential nursing competencies expected of nursing

graduates.

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TABLE OF CONTENTS

Page

LIST OF TABLES ..................................................................................................... xiv

LIST OF ABBREVIATIONS.................................................................................... xvi

1. INTRODUCTION ................................................................................................. 1

Statement of the Problem ................................................................................. 5

Purpose of Study .............................................................................................. 8

Theoretical Framework .................................................................................... 10

Research Questions ......................................................................................... 10

Definition of Terms .......................................................................................... 11

Limitations and Delimitations .......................................................................... 13

Assumptions ..................................................................................................... 15

Conclusion........................................................................................................ 15

2. REVIEW OF LITERATURE ................................................................................ 17

Introduction ...................................................................................................... 17

Rogers’ Diffusion of Innovation Theory.......................................................... 18

Evidence-Based Practice in Nursing ................................................................ 21

Information Literacy in Nursing ...................................................................... 28

Information Literacy Competency Standards andEvidence-Based Practice (EBP) in Nursing ........................................... 40

Nursing Faculty’s Role in Teaching InformationLiteracy for Evidence-Based Practice .................................................... 43

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Conclusion........................................................................................................ 48

3. METHODS AND PROCEDURES ....................................................................... 50

Introduction ...................................................................................................... 50

Research Design ............................................................................................... 52

Setting and Sample Selection for Phase I and Phase II .................................... 52

Study Instruments............................................................................................. 53

Phase I..................................................................................................... 53

Information Literacy for Evidence-BasedNursing Practice-Modified (ILNP-M)................................. 54

Evidence-Based Practice Beliefs-Educator(EBPB-E) Scale ................................................................... 56

Organizational Culture and Readiness for School- Wide Integration of Evidence-BasedPractice-Educator (OCRSIEP-E) Scale ............................... 57

Phase II Instrument ................................................................................. 58

Protection of Human Subjects .......................................................................... 59

Phase I..…............................................................................................... 59

Phase II ................................................................................................... 60

Data Collection................................................................................................. 61

Phase I..................................................................................................... 61

Phase II ................................................................................................... 62

Data Analysis ................................................................................................... 64

Phase I..................................................................................................... 64

Phase II ................................................................................................... 66

Trustworthiness ............................................................................. 68

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Conclusion……. ............................................................................................... 70

4. RESULTS .............................................................................................................. 71

Introduction ...................................................................................................... 71

Phase I Results ................................................................................................. 73

Information Literacy for Evidence-Based NursingPractice-Modified (ILNP-M) Questionnaire................................. 73

Demographic characteristics ......................................................... 74

First nursing degree....................................................................... 75

Highest nursing degree.................................................................. 76

Information seeking to support faculty role .................................. 77

Healthcare databases searched to support facultyrole ....................................................................................... 78

Facilitators for searching healthcare databases ............................. 79

Barriers for searching healthcare databases .................................. 80

Evidence-based practice competenciesand course in nursing program ............................................ 81

Information literacy competencies andinformatics course ............................................................... 82

Responsible for teaching information literacy skills..................... 83

Information literacy competencies educatorsprepared to teach ................................................................. 84

Results for Information Literacy for Evidence-Based Nursing Practice-Modified (ILNP-M) ...................... 85

Evidence-Based Practice Beliefs-Educator (EBPB-E) Scale ................. 87

Mean scores for Evidence-Based Practice Beliefs-Educator (EBPB-E) Scale.................................................... 88

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Evidence-Based Practice Beliefs-Educator (EBPB-E)Scale results for primary teaching program......................... 91

Evidence-Based Practice Beliefs-Educator (EBPB-E)Scale results for belief in evidence-basedpractice and primary teaching program ............................... 91

Evidence-Based Practice Beliefs-Educator (EBPB-E)Scale total scores for age range ........................................... 92

Evidence-Based Practice Beliefs-Educator (EBPB-E)Scale results for beliefs and age .......................................... 93

Results of the Evidence-Based Practice Beliefs-Educator (EBPB-E) Scale.................................................... 94

Organizational Culture and Readiness for School-Wide Integration of Evidence-Based Practice-Educator(OCRSIEP-E) Scale ...................................................................... 95

Mean scores on the Organizational Culture and Readiness for School-Wide Integration of Evidence-Based Practice-Educator(OCRSIEP-E) Scale............................................................. 96

Organizational movement toward a culture of evidence-based practice related toteaching program ................................................................. 99

Organizational Culture and Readiness for School- Wide Integration of Evidence-Based Practice-Educator (OCRSIEP-E) Scale total score relatedto educators’ age range..............................................................100

Organizational movement toward evidence-basedpractice for primary teaching program......................................101

Organizational movement toward culture ofevidence-based practice according to age.................................102

Results of the Organizational Culture and Readiness for School-Wide Integration of Evidence-Based Practice-Educator (OCRSIEP-E) Scale..........................103

Associations between EBPB-E and OCRSIEP-EScales........................................................................................105

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Comparisons for OCRSIEP-E and EBPB-E Scales............................105

Phase II Results......................................................................................................106

Themes and Categories.................................................................................106

Theme 1: Educating nursing educators and students..........................106

Category 1: Knowledge deficit related to link between information literacy andevidence-based practice competencies............................107

Category 2: Confusion about who, when, and how to teach information literacy andevidence-based practice competencies............................109

Theme 2: Organizational constraints for teaching information literacy and evidence-basedpractice......................................................................................112

Category 1: Educational constraints for teaching information literacy and evidence-basedpractice.............................................................................112

Category 2: Clinical constraints for teaching information literacy and evidence-basedpractice.............................................................................114

Theme 3: Educators’ commitment for teaching information literacy and evidence-basedpractice competencies................................................................116

Category 1: Personal and professional commitment for being an information literate educator to teach and promoteevidence-based practice...................................................116

Category 2: Educators’ commitment to promote evidence-based practice in clinicalsettings.............................................................................118

Conclusion.............................................................................................................121

5. DISCUSSION AND RECOMMENDATION............................................................122

Introduction............................................................................................................122

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Summary of the Study...........................................................................................124

Phase I Significant Findings...................................................................................125

Demographics...............................................................................................125

Educators’ knowledge of information literacy and evidence-based practice competencies and scholarly practice...........................126

Educators’ beliefs in evidence-based practice..............................................130

Cultural factors for implementation of evidence-basedpractice in education...........................................................................131

Phase II Significant Findings.................................................................................133

Triangulation of data.....................................................................................133

Theme 1: Educating nursing educators and students...................................135

Theme 2: Organizational constraints for teachinginformation literacy and evidence-based practice...............................140

Theme 3: Educators’ commitment for teaching informationliteracy and evidence-based practice competencies............................144

Additional Findings................................................................................................146

Implications for Nursing Education and Future Research.....................................147

Limitations.............................................................................................................151

Conclusion and Recommendations for Future Research.......................................152

Questions for future research...........................................................................155

APPENDICES

A: IRB Approval Letter from ULM.......................................................................157

B: Permission to Use and Modify Information Literacy forEvidence-Based Nursing Practice (ILNP) Tool...........................................158

C: Permission to Use Unmodified Organizational Culture and Readiness for School-Wide Integration of Evidence- Based Practice-Educator (OCRSIEP-E) and Evidence-

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Based Practice Beliefs-Educator (EBPB-E) Scales......................................159

D: Letter for Permission from Deans/Department Heads......................................160

E: Sample Agreement Letter from Colleges of NursingDeans/Directors............................................................................................161

F: Informed Consent for Phase I Data Collection..................................................162

F-1: Phase I Data Survey via SurveyMonkey.............................................163

G: Informed Consent for Phase II..........................................................................168

H: Phase II Interview Topics..................................................................................169

I: Phase II Qualitative Data Display Table............................................................170

REFERENCES................................................................................................................180

VITA................................................................................................................................198

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LIST OF TABLES

Table Page

1. Information Literacy (IL) Competencies Compared toEvidence-Based Practice (EBP) Process in Nursing .............................. 42

2. Demographic Characteristics ........................................................................... 75

3. First Nursing Degree........................................................................................ 76

4. Highest Nursing Degree................................................................................... 76

5. Information Seeking to Support Faculty Role ................................................. 78

6. Healthcare Databases Searched to Support Faculty Role ................................ 79

7. Facilitators for Searching Healthcare Databases ............................................. 80

8. Barriers for Searching Healthcare Databases .................................................. 81

9. Evidence-Based Practice Competencies and Coursein Nursing Program................................................................................. 82

10. Information Literacy Competencies and InformaticsCourse ..................................................................................................... 83

11. Responsible for Teaching Information Literacy Skills .................................... 84

12. Information Literacy Competencies Educators Preparedto Teach .................................................................................................. 85

13. Mean Scores for Evidence-Based Practice Beliefs-Educator (EBPB-E) Scale....................................................................... 90

14. Evidence-Based Practice Beliefs-Educator (EBPB-E)Scale Results for Primary Teaching Program......................................... 91

15. Evidence-Based Practice Beliefs-Educator (EBPB-E)Scale Results for Belief in Evidence-Based Practiceand Primary Teaching Program .............................................................. 92

16. Evidence-Based Practice Beliefs-Educator (EBPB-E)Scale Total Scores for Age Range .......................................................... 93

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17. Evidence-Based Practice Beliefs-Educator EBPB-E)Scale Results for Beliefs and Age .......................................................... 94

18. Mean Scores on the Organizational Culture and Readinessfor School-Wide Integration of Evidence-Based Practice-Educator (OCRSIEP-E) Scale ................................................................ 98

19. Organizational Culture and Readiness for School-Wide Integration of Evidence-Based Practice-Educator(OCRSIEP-E) Scale Related to Teaching Program......................................100

20. Organizational Culture and Readiness for School-Wide Integration of Evidence-Based Practice-Educator(OCRSIEP-E) Scale Total Score Compared for Age Range........................101

21. Organizational Movement Toward Evidence-Based Practicefor Primary Teaching Program.....................................................................102

22. Organizational Movement Toward a Culture of Evidence-Based Practice According to Age.................................................................103

23. Comparisons for EBPB-E and OCRSIEP-E Scales...............................................105

24. Themes and Categories from Phase II Interviews.................................................119

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LIST OF ABBREVIATIONS

AACN American Association of Colleges of Nursing

ACE Academic Center for Excellence

ACEN Accreditation Commission for Education in Nursing

ACRL Association of College and Research Libraries

ALA American Library Association

ANA American Nurses Association

ANE Academic Nurse Educators

APN Advance Practice Nurse

ASN Associate of Science in Nursing

BSN Bachelor of Science in Nursing

CCNE Commission on Collegiate Nursing Education

CINAHL Cumulative Index for Nursing and Allied Health Literature

DNP Doctor of Nursing Practice

DOI Diffusion of Innovation

EBIL Evidence-Based Information Literacy

EBM Evidence-Based Medicine

EBNP Evidence-Based Nursing Practice

EBP Evidence-Based Practice

IL Information Literacy

ILCSN Information Literacy Competency Standards for Nursing

IOM Institute of Medicine

IRB Institutional Review Board

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LSBN Louisiana State Board of Nursing

NLN National League of Nursing

NSU Northwestern State University

PICO Population Intervention Comparison Outcome

QSEN Quality and Safety Education for Nurses

RCT Randomized Control Trials

RN Registered Nurse

RN to BSN Registered Nurse to Bachelor of Science in Nursing

SCONUL Society of College National and University Libraries

TIGER Technology Informatics Guiding Education Reform

ULM University of Louisiana Monroe

URL Uniform Resource Locator

CHAPTER 1: INTRODUCTION

Evidence-based practice is the gold standard of care recognized by healthcare and

regulatory agencies in the United States (Brown, Wickline, Ecoff, & Glaser, 2009; Gupta,

Wander, & Gupta, 2016; Institute of Medicine, 2003; Stichler, Fields, Kim, & Brown,

2011; Trossman, 2010). Registered Nurses (RNs), the largest group of clinicians in the

healthcare workforce (U.S. Department of Labor Bureau of Labor Statistics, 2017), are

educated to enter nursing practice with core competencies to deliver patient care based on

current research evidence (American Nurses Association [ANA], 2010; Quality and

Safety Education for Nurses [QSEN], 2012). Some of the reported benefits of evidence-

based practice include improvements in healthcare quality, safety, lower costs, and less

variability of care, yet evidence-based practice is not consistently delivered to patients

(B. M. Melnyk & Fineout-Overholt, 2019; B. M. Melnyk et al., 2018). The use of

evidence for decision-making is not the norm in many healthcare systems due to a

generalized lack of competencies related to barriers in academia impacting how the

process is taught in academic and clinical settings (Horntvedt, Nordsteien, Fermann, &

Severinsson, 2018; B. M. Melnyk & Fineout-Overholt, 2019; B. M. Melnyk et al., 2018;

Milner, Bradley, & Lampley, 2018; Pravikoff, Tanner, & Pierce, 2005).

Evidence-based practice in healthcare is a decision-making approach for patient

care that integrates the best scientific evidence with the clinician’s expertise and the

patient’s preference for care (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014;

Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). The emphasis on evidence

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requires nurses to be information literate and know how to locate, access, and appraise

research studies that have relevance to clinical decision-making (Adams, 2014; Forster,

2012; Miller & Neyer, 2016). Information literacy skills are essential for healthcare

professionals to locate and use evidence for use in practice and are necessary in the

evidence-based practice process (Barnard, Nash, & O’Brien, 2005; Cheeseman, 2013;

Cobus-Kuo & Waller, 2016; Courey, Benson-Soros, Deemer, & Zeller, 2006; Franzen &

Bannon, 2016; Lalor, Clarke, & Sheaf, 2012; Majid, Chaudhry, & Xue, 2008; Pierce,

2005; Pravikoff et al., 2005; Ross, 2010; Schulte & Sherwill-Navarro, 2009; Sewell,

2019; Shorten, Wallace, & Crookes, 2001; Tanner, 2000; Tepe & Tepe, 2015). Forster

(2012) postulated that without knowing when and why information is needed, as well as

how to identify, locate, and evaluate the information, evidence-based practice would be

difficult to achieve. Nurses learn the competencies in nursing school and continue to

refine those skills throughout their nursing careers (Boruff & Thomas, 2011; Brettle &

Raynor, 2013; Carter-Templeton, Patterson, & Mackey, 2014; Franzen & Bannon, 2016;

Jacobs, Rosenfield, & Haber, 2003; Janke, Pesut, & Erbacker, 2012; Milner et al., 2018;

Morrison & Beedy, 2018; Weng, Chen, & Hsieh, 2016).

Nurses need to be competent and confident embracing evidence-based practice as

a standard of care, and faculty must seamlessly integrate sufficient skills to navigate

electronic databases, comprehend and analyze research, and make decisions based on

evidence throughout the various program curricula for nursing practice (Pierce, 2005;

Sewell, 2019). Cobus-Kuo and Waller (2016) concurred with Pierce and reported that the

evidence-based practice process requires information literacy skills, which are complex

research skills developed over time and with repetitive practice. Nurses need to be

3

knowledgeable and confident in making clinical decisions based on reliable and current

evidence, and both competencies should be integrated throughout nursing curricula for

students to value and appreciate the importance of evidence-based practice (Cobus-Kuo

& Waller, 2016; Pierce, 2005).

Students have an enormous amount of online resources available at their

fingertips and are adept at using electronic media, but locating resources for research

material was reported to often be a random search of the Internet (Gray & Montgomery,

2014; Pravikoff et al., 2005). Information literacy is more than Googling a search term

about a specific topic. Though students have more experience with technology today,

researchers report that students have trouble recognizing, accessing, analyzing, and

articulating their need for information (Sewell, 2019). Nursing students need a basic

understanding of the architecture of online databases for efficient and effective literature

reviews and access to multiple electronic databases (Jacobs et al., 2003; Shorten et al.,

2001).

Progress has been slow for including information literacy in nursing education

due to confusion about the concept of information literacy, as well as a misunderstanding

about who should teach the skills or what those skills include (McCulley & Jones, 2014).

According to Bonlokke, Kobow, and Kristensen (2012), information literacy is not easy

to teach or learn, and precise information about how information literacy should be

integrated into the curriculum has been lacking. Exposing students to literacy concepts

and the evidence-based practice process at the earliest stages of nursing education

promotes the development of baseline knowledge and skills that nursing students can

4

build upon during their education and future professional practice for lifelong learning

(Liou, Yu, Tsai, & Cheng, 2015).

Badke (2010) wrote that the concept of information literacy as a viable academic

subject remains misunderstood to many professors and educational administrators.

Information literacy is invisible to academia because it is misunderstood, academic administrators have not put it on their institutions’ agendas, the literature of information literacy is acquired only by experience, there is a false assumption that technological ability is the same as information literacy, faculty culture makes information literacy less significant than other educational pursuits, faculty have limited perception of the ability of librarians, and accrediting bodies have not yet advanced information literacy to a visible position in higher education. (Badke, 2010, p. 129)

Badke’s (2010) statement may explain the lack of value for information literacy, but what

about the evidence-based practice process that has been espoused to be the standard of

care and learning outcome in nursing education for more than twenty years? According to

the National League for Nursing (NLN, 2017), the average age of full-time nurse

educators is forty-six to sixty years. Many nursing educators did not have evidence-based

content in their primary nursing degree programs, because the competencies were not

introduced into nursing education until 2003 (Felicilda-Reynaldo & Utley, 2015; Stevens,

2013) and barriers such as lack of confidence in teaching the competencies and no

framework for curricula were reported by nursing educators (Stichler et al., 2011).

The Technology Informatics Guiding Education Reform (TIGER, 2009) Initiative

was designed to address informatics skills (computer, information technology, and

information literacy competencies) needed by all nurses practicing in the twenty-first

century (Hebda & Calderone, 2010). The TIGER Initiative led to an emphasis on

information management and informatics competencies and accelerated the need to

5

ensure that healthcare clinicians obtain competencies needed to work with electronic

health records and included computer skills, information literacy, and information

management (The TIGER Initiative, 2009). The American Association of Colleges of

Nursing’s (AACN, 2008) Essentials of Baccalaureate Education for Professional

Nursing Practice, known as The Essentials, are guidelines for educators to integrate

evidence-based practice and informatics into the curricula due to the many technological

changes in healthcare are. The National League for Nursing (NLN, 2008) recommended

that faculty participate in professional development programs to develop competencies in

informatics and every nursing school have informatics and evidence-based practice

champions. Informatics and evidence-based practice are expected outcome competencies

for nursing graduates, and nursing faculty are ethically obligated to be proficient in

teaching the skills to the students (Orta et al., 2016; Wang, Sun, Mulvehill, Gilson, &

Huang, 2016).

Statement of the Problem

The problem identified for the study was information literacy and evidence-based

practice competencies are not consistently prioritized and/or integrated in nursing

education, and graduates are not adequately prepared to use evidence-based information

in practice for clinical decision-making (Arguelles, 2012; Horntvedt et al., 2018; Melnyk

et al., 2018; Pierce, 2000; Pravikoff et al., 2005; Tanner, 2000). There is a lack of priority

and belief in the need for teaching the competencies due to barriers in nursing education

(Adams, 2014; Barnard et al., 2005; Diaz & Walsh, 2018; Forster, 2012; Phelps, Hyde, &

Wolf, 2015; Pierce, 2000; Pravikoff et al., 2005; Shorten et al., 2001; Wahoush &

Banfield, 2014; Wilson et al., 2015). The concept of evidence-based practice is

6

widespread and pervasive in nursing education, and educators anticipate that graduates

will enter practice with the ability to provide care based on the best available evidence

(Ferguson & Day, 2005), yet the literature does not support this premise (Melnyk et al.,

2018). Carter-Templeton et al. (2014) postulated that information literacy was often

taught inconsistently throughout many nursing programs and may be undervalued and

misinterpreted as an unimportant nursing skill.

Teaching strategies used in nursing education in the past are no longer adequate

due to technological changes, increased ease, and availability of online resources, and the

aging population that nursing educators and their students face in the twenty-first century

(Institute of Medicine [IOM], 2010). According to Finkelman and Kenner (2012), what

nursing educators teach is not always clear. Learners are influenced by nursing educators’

views about the content they teach, or not teach, and negative opinions or confusion

about information literacy and evidence-based practice may impede learners’ values for,

and readiness to apply evidence in practice (Fineout-Overholt & Johnston, 2006;

Pravikoff et al., 2005). Emerging evidence indicated nursing educators lack proficiency

to teach evidence-based practice (Milner et al., 2018), and there is a need for nursing

faculty to reflect on their knowledge and beliefs about information literacy and evidence-

based practice (Thompson & Burns, 2008).

For nursing graduates to be confident in their information-seeking skills to make

decisions for evidence-based practice in the clinical setting, nursing educators should be

role models and create an evidence-based practice culture in academia where the

adoption of evidence is valued in every level of nursing education (Diaz & Walsh, 2018).

Nursing faculty need to prioritize integrating information literacy and evidence-based

7

practice in all levels of nursing education to strengthen nursing graduates’ competence

and confidence in applying evidence when making decisions for patient care (Diaz &

Walsh).

Nursing educators are challenged to consistently focus on skill sets that prepare

students to use discipline-specific critical thinking skills for the application of research

evidence in their future nursing practice (Carter-Templeton et al., 2014). Another

challenge is to prepare future RNs with technology-focused information capabilities in an

increasingly data-rich health care environment (Flood, Gasiewicz, & Delpier, 2010).

Though time is consistently reported to be the primary cause for not utilizing evidence in

nursing practice, the underlying reason may be that nurses lack research and information-

seeking skills needed to access evidence-based information in an efficient and timely

manner (Barnard et al., 2005; Boruff & Thomas, 2011; Cobus-Kuo & Waller, 2016; Dee

& Stanley, 2005; Jacobs et al., 2003; Melnyk et al., 2018; Pierce, 2000, 2005; Pravikoff

et al., 2005; Ross, 2010; Tanner, 2000; Williamson, Fineout-Overholt, Kent, &

Hutchinson, 2011).

The meaning of evidence-based practice is not always clear (McFadden &

Thiemann, 2009), and the same is true about information literacy (Probert, 2009), yet

competent use of information literacy and evidence-based practice language are

expectations for RN students (Melnyk & Fineout-Overholt, 2019). Nurses need to master

skills for evidence-based practice in this rapidly changing technology environment where

literature is available in varying formats and differing resources (Barnard et al., 2005;

Cheeseman, 2013). Due to the increased demand for nursing graduates to take on a more

proactive and autonomous role in decision-making based on up-to-date scientific

8

literature, nursing students need to know how to efficiently and effectively locate and

translate research evidence into their nursing practice throughout their educational

experiences (Pierce, 2005). If nurses are to have the knowledge, positive attitudes, and

skills needed to value and utilize evidence in patient-care decisions, nursing educators

must integrate information literacy education into the curricula as a prerequisite for

effective evidence-based nursing practice and lifelong learning (Diaz & Walsh, 2018;

Majid et al., 2008; Verhey, 1999).

Purpose of Study

The purpose of this study was to examine nursing educators’ perceptions of and

beliefs about information literacy and evidence-based practice and examine the cultural

factors that influenced the readiness to integrate evidence-based practice within colleges

of nursing in a south-central state. A mixed-methods explanatory research design was

used to collect different, but complementary, data focused on the same concepts under

study to triangulate data sources and converge on the truth about these competencies

(Polit & Beck, 2018).

Evidence-based practice is imperative for ensuring patient safety and optimal

patient outcomes (Melnyk & Fineout-Overholt, 2019; Orta et al., 2016). Lower

morbidity, mortality, and medical errors along with optimal results are noted when nurses

utilize evidence-based practice for decision-making in healthcare (B. Melnyk & Fineout-

Overholt, 2019; B. Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012), yet

nurses may not be well prepared to apply evidence-based practice (Hornvedt et al., 2018).

Since nursing graduates are to have competencies in evidence-based practice and

9

informatics (AACN, 2008), the significance for identifying reasons why many nurses are

not prepared with necessary skills is essential (Thiel & Ko, 2017).

Important to note is that there are three educational choices with varying degree

requirements for registered nurse (RN) licensure recognized by most state boards of

nursing: Associate of Science in Nursing (ASN), Diploma in Nursing, and Bachelor of

Science in Nursing (BSN). Over half of the RNs practicing in the United States graduated

from either a Diploma or Associate of Science in Nursing degree program and did not

learn research skills in their primary nursing education, and differences in undergraduate

preparation may be one reason why nurses core competencies differ (Melnyk & Fineout-

Overholt, 2019). Regardless of the RN degree program, graduates are prepared to take the

same licensing exam to become an RN in the United States and need to be taught the

value of evidence-based practice related to quality and safe patient care (Moch, Quinn-

Lee, Gallegos, & Sorte, 2014; Pravikoff et al., 2005).

The Institute of Medicine (IOM) and the National Academy of Roundtable on

Evidence-Based Medicine set a goal that by the year 2020, 90% of all health care

decisions will be supported by up-to-date clinical evidence (IOM, 2011; National

Academy of Sciences, 2009). Information literacy and evidence-based practice

competencies were unanimously endorsed by nursing accrediting agencies to be

integrated into all levels of nursing education to develop skills for evidence-based

practice (AACN, 2008; ANA, 2015; NLN, 2008; QSEN, 2012).

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Theoretical Framework

Rogers’ diffusion of innovation theory (Rogers, 1995) was the theoretical

framework for this study. The stakeholders in the adoption of the innovation for this

study included nursing administration, nursing faculty, and nursing students in colleges

of nursing. Identifying factors that influence the adoption of information literacy skills

for the use of evidence in practice are essential to answer the research questions.

Evidence-based practice is a practice innovation, and information literacy is a technical

innovation (Pierce, 2000). When educational programs and healthcare agencies consider

adopting new innovations or reinvented innovations such as technology to assist

clinicians in the provision of care, there is not always one hundred percent agreement

(Geibert, 2006). Rogers informed potential adopters that all stakeholders may not readily

buy-in to the innovation even when a new or reinvented idea had apparent advantages,

and the diffusion process could take many years (Geibert, 2006). Diffusion is the process

in which an innovation is communicated over time among members of a social system

such as academia and the healthcare environment (Rogers, 1995). Rogers (2003)

developed a five-stage decision-making process that includes knowledge, persuasion,

decision, implementation, and confirmation. Each stage closely parallels the five steps in

the evidence-based practice process and information literacy process.

Research Questions

There is a need to examine nursing educators’ perceptions of and beliefs about

information literacy and evidence-based practice, and determine cultural factors that

influence the implementation of evidence-based practice in academia and perceived

11

readiness for school-wide implementation of evidence-based practice, the following

research questions were addressed in this study:

1. Are nursing educators knowledgeable about information literacy and evidence-based

practice competencies and prepared to teach information literacy to support evidence-

based practice in nursing education as measured by the Information Literacy for

Evidence-Based Nursing Practice-Modified (ILNP-M) questionnaire?

2. Do nursing educators have a firm belief and confidence in their ability to teach and

implement evidence-based practice as measured by the Evidence-Based Practice Beliefs-

Educator (EBPB-E) Scale?

3. What are the cultural factors that influence the implementation of evidence-based

practice within the educational environment and the perceived readiness for school-wide

integration of evidence-based practice as measured by the Organizational Culture and


E) Scale?

4. What are nursing educators’ experiences with and perceptions of teaching information

literacy and evidence-based practice?

Definition of Terms

The following terms and concepts are defined for clarity and understanding of the

variables that are relevant and meaningful to the study.

Competency is defined as the ability to demonstrate knowledge, attitudes, and

skills for a specific task that was measurable and evaluated against a set of expectations

(Chung & Staggers, 2014).

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Evidence-Based Practice (EBP) is defined as clinical decisions based on (a) the

best available up-to-date evidence, most often from disciplined, scientific research, (b)

clinician’s expertise and knowledge, and (c) patient’s values and preferences for care and

treatment (Melnyk & Fineout-Overholt, 2019; Sackett et al., 1996).

Evidence-Based Information Literacy (EBIL) is a systematic and reflective

approach for teaching information literacy to students in which information literacy is

regarded as the ability to find and use evidence for use in nursing practice (Andretta,

2011).

Informatics competencies range from basic computer skills to advanced-level

information technology and information literacy competencies and expertise (Hebda &

Calderone, 2010).

Information literacy is defined as the ability to recognize when information is

needed and have the ability to locate, evaluate, and use the needed information

effectively (Association of College and Research Libraries [ACRL], 2002).

An information literate nurse is able to determine that information is needed to

solve a healthcare problem, develop a specific PICO (population, intervention,

comparison, outcome) question, access, and critically evaluate the information, apply the

information for a specific purpose in a professional and ethical manner, and understand

the economic, legal, and social issues surrounding the information (ALA, 2000; Breivik,

2005).

Lifelong learning is an ongoing, voluntary, and self-motivated pursuit of

knowledge and information for personal and professional reasons (Definitions, n.d.).

13

Nursing educator/faculty is defined as an RN with a master’s degree or higher

degree teaching in an accredited Associate of Science in Nursing (ASN), Bachelor of

Science in Nursing (BSN), RN to BSN, graduate, and/or doctorate degree program.

Quality healthcare is the degree which health services for individuals and

populations increase the likelihood of desired health outcomes and are consistent with

current professional knowledge (Institute of Medicine [IOM], 2013).

Registered Nurse (RN) student is an RN student attending an accredited Associate

of Science in Nursing (ASN) or Bachelor of Science in Nursing (BSN) degree program in

preparation for licensure as an RN, or a licensed RN nursing student in an accredited RN

to BSN, Master of Science (MSN), and doctorate-degree program. In this study, the

word, nurse, was a licensed registered nurse.

Value for information literacy and evidence-based practice is defined as the

regard that information literacy and evidence-based practice competencies are essential

and useful for nursing graduates’ knowledge, confidence, and attitudes in taking steps

toward translating evidence into practice (Lovelace et al., 2017).

Limitations and Delimitations

Delimitations for this study included:

1. Due to the limited time to collect data, quantitative and qualitative data were only

collected from nursing faculty in schools of nursing in a south-central state whose deans

agreed to participate in the study. Sixteen of the 26 (62%) colleges of nursing in the same

state agreed to participate in the study. No response was received from the deans at seven

nursing programs, four deans were not able to give the researcher approval due to

institutional review board (IRB) time constraints, and one dean responded that the email

14

was found in the clutter box after Phase I data collection ended. The dean from one

nursing program reported finding the email to participate in the study in her spam

mailbox and the survey deadline had ended. That possibly could have been the case for

other colleges of nursing.

2. Unintended participants in Phase I were educators teaching in Licensed Practical

Nurses (LPN) programs due to both LPN and Associate of Science (ASN) programs were

offered in three of the participating colleges in the state.

3. Participants may have scored an item on the surveys higher or more positively due to

thinking that they should, instead of answering their accurate perception and belief of the

concepts reflecting response bias.

Limitations identified for this study included:

1. The study findings were limited to nursing faculty teaching in one south-central state

and may not be generalizable to other nursing faculty located in different regions of the

United States.

2. The study findings were limited to self-reported perceptions of nursing faculty in one

south-central state and may not accurately reflect their actual critical appraisal abilities

and behaviors (Diaz & Walsh, 2018).

3. Findings were limited by the fact that all nursing programs in the south-central state

did not agree to participate in the study and may not be generalized to other nursing

programs.

4. Purposeful convenience sampling method was used for both phases of the study

instead of a stronger method such as random sampling due to the ease, time, and

convenience of non-probability sampling.

15

5. The quantitative and qualitative responses were limited to nursing faculty from

participating schools of nursing and may reflect bias for those nursing programs.

6. Self-selected nursing educators were interviewed from eight of the sixteen

participating nursing programs and may have chosen to participate due to higher beliefs

about information literacy and evidence-based practice.

Assumptions

The participants answered the questions honestly and provided information based

on their perceptions of information literacy and evidence-based practice. Evidence-based

practice was accepted by nursing educators and health care professionals as the standard

of care for all RNs to deliver quality and safe patient care. Nursing faculty teach

evidence-based practice competencies as learning outcomes and consciously design

curricular strategies to enhance information literacy skills. The survey instruments were

valid and reliable to measure the concepts of interest as evidenced by their use with

similar groups. All participants had electronic access to their school of nursing’s online

library databases. Evidence-based practice is a prerequisite for information literacy.

Conclusion

Evidence-based healthcare requires that relevant technology and information

literacy skills be a part of nursing faculty and students’ academic experiences

(Williamson et al., 2011). Nurses learn how to efficiently and effectively search the

online literature to locate current and credible information for use in evidence-based

practice in nursing school. The purposes of the mixed methods explanatory research

study were to examine nursing educators’ perceptions of information literacy and

16

evidence-based practice in the nursing curriculum and school-wide readiness for

evidence-based practice in nursing education.

Nursing faculty’s primary goal is to prepare future nurses for clinical practice

with competencies to provide safe and quality patient-centered care. Healthcare requires

timely information for effective decision-making, and requires the integration of health

information-seeking skills throughout nursing education curricula to effectively promote

evidence-based practice (Hartt, 2008; Kinnunen, Rajalahti, Cummings, & Borycki, 2017;

Lilly, Fitzpatrick, & Madigan, 2015; McNeil et al., 2003; Ornes & Gassert, 2007). By

placing value on the importance of integrating information literacy for evidence-based

practice across the curriculum, students and educators will continually reexamine their

accountability to provide quality and safe care to their patients (Ross, Noone, Luce, &

Sideras, 2009).

An introduction to the problem, purpose, and significance for the study were

presented Chapter 1. The theoretical framework, research questions, definition of terms,

limitations, delimitations, and assumptions of the study were delineated in this chapter.

The research literature related to information literacy and evidence-based practice in

nursing education will be summarized in Chapter 2.

CHAPTER 2: REVIEW OF LITERATURE

Introduction

A nursing workforce prepared to make patient care decisions based on current

evidence for the delivery of safe, quality, and cost-effective care is the expectation in the

21st century (Fineout-Overholt, Melnyk, & Schultz, 2005; Williamson et al., 2011).

Nursing faculty are also charged with preparing nursing students at all levels of education

with information literacy skills for lifelong learning upon graduation (Beck, Blake-

Campbell, & McKay, 2012; Flood et al., 2010). The dangers of missing critical

information for evidence-based practice while working in a fast-paced clinical setting, as

well as drowning in data are real (Flood et al., 2010). Acquiring, organizing, evaluating,

and effectively using information are essential information literacy skills to support

evidence-based practice and deliver safe, high quality, and personalized care to patients

(Carter-Templeton et al., 2014; Stichler et al., 2011).


beliefs about information literacy and evidence-based practice and examine cultural


of nursing in a south-central state. The following questions were addressed in the study:



18










E) Scale?



Rogers’ Diffusion of Innovation Theory

Rogers’ (1995) diffusion of innovation (DOI) theory was selected to guide the

study. Rogers provided valuable insight into the reasons why some practices were

adopted and valued, while other methods were not. Despite the emergence, development,

and expectation for evidence-based practice over the last twenty-plus years in the nursing

profession, its adoption continues to be limited (Melnyk & Fineout-Overholt, 2019;

Mohammadi, Poursaberi, & Salahshoor, 2018). The twenty-year gap may be understood

when one realizes that published research findings and translation into clinical practice

often takes decades (Melnyk & Fineout-Overholt, 2019).

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Innovation is an idea, practice, or object that an individual perceives as new

(Pashaeypoor, Ashktorab, Rassouli, & Alavi-Majd, 2016). Though information literacy to

support evidence-based practice is not a new idea, these concepts are considered the

innovations to be adopted for the study. Rogers (1995) considered the attributes of

innovations to be factors for adoption using a five-step process.

• Knowledge occurs when decision-makers are exposed to the existence of an

innovation and gain understanding of the functionality of the innovation.

• Persuasion takes place when decision-makers form a favorable or unfavorable

attitude about the innovation.

• Decisions are made when individuals engage in activities that lead to the choice to

adopt or reject the innovation.

• Implementation occurs when decision-makers begin to use the innovation.

• Confirmation is accomplished when decision-makers and other individuals seek

reinforcement related to the decision (Rogers, 1995).

Rogers provided all of the steps to promote the adoption of evidence-based

practice in studies by Farokhzadian, Khajouei, and Ahmadian (2015), Mohammadi et al.

(2018), Pashaeypoor et al. (2016), and Yackel, Short, Lewis, Breckenridge-Sproat, and

Turner (2013). The adoption of new behaviors by recipients of the innovation can be

affected by the complexity of the task to be learned, and evidence from the literature

indicated that faculty and clinical nurses perceive the evidence-based process to be

complicated (Stichler et al., 2011). The perception of complexity reflects the level of

competence and confidence in skills needed to acquire and appraise research findings as

an information literate nurse.

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Rogers (1995) defined diffusion as “the process by which an innovation is

communicated through channels over time among the members of a social system” (p. 5),

and “communication as a process in which participants create and share information with

one another in order to reach a mutual understanding” (p. 6). Diffusion is a social process

or behavior among individuals and groups of adopters. For the study, the social system

included nursing educational programs and the innovation introduced was the awareness

about teaching information literacy skills for evidence-based practice in all nursing

courses and programs.

Communication is the process of sharing information that occurs between two

individuals or an organizational unit (Rogers, 1995). Communication includes increasing

awareness and knowledge about the need to adopt the innovation, and the diffusion

process became the information exchange between individuals or organizational units

(Pierce, 2000). In the study, the channels of communication were the interactions and

exchange of ideas that occurred between nursing administrators and nursing faculty in

colleges of nursing.

Information literacy that includes electronic access is a technical innovation used

to expedite access to information in the academic environment for evidence-based

practice (Pierce, 2000). Pierce (2000) believed that access to online resources facilitated

the retrieval and use of research literature to be used for clinical-decision making. If the

goal for nursing is evidence-based practice, then developing skills for information

literacy must reside in nursing education. Integrating information literacy to support

evidence-based practice was the innovation, and the social system was nursing education

for this study. Introducing information literacy and evidence-based practice competencies

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throughout the nursing curriculum will enhance students’ knowledge and confidence in

adopting evidence-based practice in the clinical setting.

Rogers (2003) postulated that the adoption of the innovation would be delayed

unless the participants saw the advantage of the change, along with its compatibility with

existing values and current personal needs. An individual’s personal needs are influenced

by how the innovation is communicated to the participants (Stichler et al., 2011). Nursing

administrators and champions of information literacy for evidence-based practice need to

be persuasive in their approach to communicate the importance of teaching the

competencies in all nursing courses (Geibert, 2006). Rogers’ theory was used by nursing

researchers as the theoretical framework to implement new practices in different clinical

and educational settings (Gale & Schaffer, 2009; Geibert, 2006; Mohammadi et al., 2018;

Pashaeypoor et al., 2016; Pierce, 2000; Stichler et al., 2011; Tanner, 2000; Yackel et al.,

2013), and was selected as the theoretical framework for this study.

Evidence-Based Practice in Nursing

The history of evidence-based practice in nursing evolved from Florence

Nightingale asking questions, collecting data, and making decisions based on evidence in

the 1800s, to nurses utilizing research based on one scientific study for patient care in the

1970s and 1980s, to today’s use of evidence-based practice that began in the late 1990s

(Mackey & Bassendowski, 2017). Lindeman (1975) conducted a nation-wide survey to

identify nursing strategies that had the greatest impact for improving nursing care, and

based on the findings, recommended to “determine means for greater utilization of

nursing research in practice” (p. 697). Lindeman’s recommendation is a similar

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recommendation for determining how to utilize evidence based on scientific evidence in

nursing practice.

Dr. Archie Cochrane was a pioneer of evidence-based medicine in the early 1970s

after publishing a book criticizing the medical profession for not reviewing research

evidence to make the best decisions about healthcare (Melnyk & Fineout-Overholt,

2019). Cochrane believed that limited resources would always be a concern in the

healthcare system, and clinicians needed to use only the procedures that had been

effectively supported by scientific research (Cochrane Collection, 2013). Randomized

control trials (RCT) and other bodies of research began to develop, and Cochrane

contended that RCTs provided the most reliable evidence. Dr. Cochrane’s promotion of

RCTs provided the foundation for healthcare decision-making that evolved into the

evidence-based medicine movement (Brower & Nemec, 2017). The term evidence-based

medicine (EBM) was not “coined” until 1992 (Mackey & Bassendowski, 2017). The

most widely used definition for evidence-based medicine cited throughout healthcare

literature today is: “The conscientious, explicit and judicious use of current best evidence

in making decisions about the care of individual patients” (Sackett et al., 1996, p. 71).

Sackett et al. (1996) placed a focus on patient-centered care by including the patient in

planning their care and utilized evidence-based medicine to its fullest. The definition of

evidence-based medicine was renamed to evidence-based practice when other healthcare

professionals adopted the method for their specialty, including the nursing profession

(Mackey & Bassendowski, 2017).

Stevens (2013) highlighted how the Crossing the Quality Chasm report (Institute

of Medicine [IOM, 2001] and the Health Professions Education report (IOM, 2003)

23

transformed healthcare professionals’ educational preparation. The writers of the latter

report declared that educational programs did not prepare nurses, physicians, and other

health professionals to provide high quality and safe care and education needed “a major

overhaul” to teach new skills in the academic and clinical settings focused on evidence-

based practice (Stevens, 2013). All members of the interdisciplinary healthcare team

should be educated to deliver patient-centered care based on evidence-based practice,

quality improvement, and informatics (IOM, 2003).

The nursing profession established a national consensus on evidence-based

competencies in 2004, and in 2009, the skills were extended (Stevens, 2009). Stevens

(2009) identified between 10 and 32 competencies to be integrated into four levels of

nursing education, and Melnyk et al. (2014) developed evidence-based practice

competencies for practicing nurses (13 competencies) and advance-practice nurses (11

competencies) in clinical settings. Findings from the national first study revealed the

nurses did not believe they were qualified in any of the 24 evidence-based practice

competencies (Melnyk et al., 2018).

Oversight and accreditation processes were put in place to encourage adoption of

the core competencies in nursing education (Stevens, 2013). The National League for

Nurses (NLN, 2008) developed competencies for nursing education, and new program

standards for undergraduate, graduate and doctorate levels of nursing education were

established by the American Association of Colleges of Nursing (AACN, 2015).

Curricular reform and faculty development initiatives are known as Quality and Safety

Education in Nursing Institute (QSEN, 2012) were developed. Education focusing on

evidence-based practice was launched with the publication, Teaching IOM (Finkelman &

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Kenner, 2006). Teaching IOM was updated in 2013 and identified teaching strategies and

learning resources for incorporating the Institute of Medicine (IOM) competencies in

nursing curricula in the United States (Stevens, 2013).

Evidence-based practice is seen as an ethical process in the health professions that

deals with a human’s health and welfare and the provision of patient care supported by

compelling research evidence (Forster, 2013). The definition of evidence-based practice

within the nursing profession evolved from a strictly clinical focus to a more holistic

approach that includes nursing research, nursing practice, nursing education, and theory

development (Stevens, 2013). Practitioners are encouraged to use empirical evidence to

make decisions rather than rely on tradition or opinion (Adams, 2014).

Despite the emergence and development of evidence-based practice initiatives in

the last twenty-plus years, RNs adopted the concept to a limited degree and failed to

provide evidence-based practice services to approximately 30% to 40% of patients in the

United States (Mohammadi et al., 2018). Melnyk et al. (2018) repeatedly reported that

evidence-based practice was not the standard of care in many healthcare systems across

the globe due to barriers such as inadequate knowledge and skills. Melnyk et al. (2018)

found barriers in academia impacted the way evidence-based practice was taught, and

cultures bound by traditions stifled educators to support the process. “Building student

and collegial beliefs” is imperative for educators to prioritize, teach, and integrate the

process throughout the curriculum in both classroom and clinical settings (Melnyk &

Fineout-Overholt, 2019). Melnyk and Fineout-Overholt (2019) believed that the

principles of evidence-based practice need to be foundational in every course in the

curriculum for students to realize the value of utilizing evidence in the clinical setting,

25

and not overtly experience a difference in expectations from faculty or believe that

research courses are “less than” clinical courses.

Beliefs in evidence-based practice are associated with a nurse’s use of evidence in

practice (Melnyk & Fineout-Overholt, 2019; Pravikoff et al., 2005). Hain and Haras

(2015) conducted a descriptive study during two nephrology preconference sessions. The

researchers asked how the evidence-based practice workshop affected their beliefs about

the value of evidence-based practice, and how attending a nursing organization’s

preconference workshop affected their views about the ability to implement the process.

Registered nurses’ and advance practice nurses’ (APN) beliefs about the value of

evidence-based practice were significantly higher after the workshop in each session and

in the combined sample than before the workshop (Hain & Haras, 2015). Changes in

beliefs were significant based on educational preparation; nurses with higher education

had higher beliefs about evidence-based practice. Hain and Haras postulated that nurse

leaders and educators played an essential role in facilitating learning opportunities and

provided supportive environments that reduced barriers to evidence-based practice.

Saunders and Vehvilainen-Julkunen (2016) conducted an integrative review to

identify factors related to nurse’s individual readiness for evidence-based practice and

determined the current state of the competencies. There were 37 primary research studies

published from 2004 through 2015. Although nurses were familiar with evidence-based

practice, had positive attitudes toward and believed in utilizing evidence for improving

care quality and patient outcomes, they perceived their knowledge and skills insufficient

for employing evidence into practice and did not routinely base their practice on current

evidence. The majority of the studies reviewed by Saunders and Vehvilainen-Julkunen

26

were cross-sectional surveys (81%) and used non-probability sampling methods (84%),

sample sizes were small, response rates were low, and most studies were of modest

quality. Saunders and Vehvilainen-Julkunen (2016) concluded that more robust,

theoretically-based, and psychometrically sound nursing research studies were needed.

Kin et al. (2013) explored nurses’ knowledge and attitudes towards evidence-

based practice and barriers and facilitators in the adoption of the process. The authors

found that time constraints and the lack of knowledge and skills were significant barriers

for RNs to adopt the practice. Registered nurses with higher designation as nurse

managers or who attended training courses were more likely to display positive attitudes

toward the process. Kin and colleagues recommended training and mentorship along with

creating awareness of the benefits to facilitate the use of evidence in practice and to gain

support from hospital administration.

Stokke, Olsen, Espehaug, and Nortvedt (2015) explored the positive feelings and

practices of evidence-based practice with nurses. The majority of nurses believed that

utilizing current evidence contributed to positive patient outcomes, but many nurses did

not consistently use evidence and were not confident about implementing evidence in

their daily practice. There was a positive correlation between beliefs and the

implementation of the process. Stokke et al. (2015) found the highest correlation was

related to the participants’ beliefs about their knowledge (p < .0001). Participants with

increased knowledge about evidence-based practice had significantly higher scores on the

EBP Belief Scale than participants unfamiliar with the process. Those involved in

evidence-based practice working groups reported significantly higher scores on the EBP

Belief Scale than those not involved in those groups.

27

Warren et al. (2016) evaluated the strength of and the opportunities for

implementing evidence-based practice across a multi-hospital healthcare system with a

cross-sectional survey of 6800 registered nurses. Nurses’ attitudes, beliefs, and

perceptions toward organizational readiness and implementation of evidence-based

practice were studied using the Evidence-Based Practice Beliefs (EBPB) Scale, the

Evidence-Based Practice Implementation (EBPI) Scale, and the Organizational Culture

and Readiness for System-Wide Integration of EBP (OCRSIEP) Scale. The nurses’

beliefs were positive, yet they reported their ability to implement the process as

extremely low. Registered nurses (RNs) with higher degrees, certifications, and in

leadership positions were favorable to use evidence in practice, as well as younger RNs

with fewer years in practice had positive beliefs and embedded evidence into the

organizational culture (Warren et al., 2016).

Milner et al. (2018) used a cross-sectional research design to describe health

profession faculty’s beliefs about and confidence to teach and implement evidence-based

practice (EBP) in education and organizational culture and readiness for EBP. The

educators reported positive beliefs about confidence in teaching and implementing EBP

and a sustainable culture of school-wide integration of EBP. The researchers concluded

that faculty adoption of EBP as a foundational pillar for teaching was essential. Milner et

al. (2018) recommended for organizations to set standards for faculty teaching in health

professions’ degree programs to be proficient in EBP, and programs preparing faculty to

teach in nursing must include educator competencies.

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Information Literacy in Nursing

Nurses are the largest group of health professionals and are not information

literate (Blythe & Royle, 1993). Publication of nursing research journals increased

significantly in the 1980s, and though nurses were becoming more educated, nursing

literature was underused (Blythe & Royle). Blythe and Royle identified reasons why

nurses neglected searching the research literature. Reasons included the overwhelming

volume of information, ignorance of searching techniques, and lack of time due to a work

environment where there was little opportunity or encouragement to use research material

(Blythe & Royle, 1993).

Wegener (2018) suggested that even though the concept of information literacy

had been around for more than forty years, “everyone” had their ideas on the definition of

the term. Information literacy was first introduced in the 1970s by Paul Zurkowski in

reaction to the emergence of the information age (Foo, Majid, & Chang, 2017).

Information literacy became a “buzz word” in 1983 when A Nation at Risk reported on

the state of educational policies and content by the U.S. Department of Education

(Mokhtar et al., 2012). Information literacy was used mostly in the library environment,

and various definitions and models have emerged (Wegener, 2018).

The American Library Association (ALA, 1989) first defined an information

literate individual as one who knew when information was needed and could effectively

find, access, and use the information. Ten years later, the Society of College, National

and University Libraries’ (SCONUL) definition of an information literate person was one

who had “an awareness of how to gather, use, manage, synthesize and create information

and data in an ethical manner and will have the information skills to do so effectively”

29

(Bent & Stubbings, 2011, p. 3). Though the ALA and SCONUL definitions were similar,

the original ALA definition did not specifically identify ethical use of information. The

ALA and ACRL approved the new standards for an information literate individual that

included “understanding the economic, legal, and social issues surrounding the use of

information, and access and use information ethically and legally (American Library

Association, 2000, para. 2). The Information Literacy Competency Standards for Higher

Education were endorsed by the American Association for Higher Education and the

Council of Independent Colleges (ALA, 2000).

The Association of College and Research Libraries (ACRL, 2014) developed a

discipline-specific tool for the promotion and integration of information literacy (IL) in

all nursing programs known as Information Literacy Competency Standards for

Nursing (ILCSN). “The standards directly address the information skills needed by

nursing students at the associate, baccalaureate, master’s and doctoral levels and are

written for nursing faculty and librarians who support nursing programs and nursing

students in academic settings” (ACRL, 2014, para. 2). Adopting the standards at the

earliest level possible in nursing education and by a variety of stakeholders were

effective strategies that could ensure nurses acquired the skills needed to utilize

evidence in professional practice (Phelps, Hyde, & Planchon Wolf, 2015).

As early as 1988, nursing faculty and librarians integrated information literacy

competencies into undergraduate nursing programs (Fox, Richter, & White, 1989). The

first standards for practice for nursing informatics were published in 1995 (ANA, 2015),

and Verhey (1999) focused on integrating information literacy in the nursing curriculum.

Arguelles (2012) noted that the definition of nursing informatics included information

30

technology and evidence-based practice, rather than associating information literacy and

information technology, and for many years, authors did not agree on nursing

competencies for informatics. The American Nurses Association (ANA, 2015) identified

computer literacy skills, information literacy skills, and information (knowledge)

management as the foundation for informatics competencies. These competencies are

needed in nursing practice and should be integrated into all levels of nursing curricula

(ANA, 2015). Important to note is that computer literacy was commonly misconceived as

information literacy (Schloman, 2001). Knowing the basics about computers to create

documents does not make an information literate person (Arguelles, 2012). Information

literacy includes aspects of both informatics and information technology (Miller &

Neyer, 2016).

Accrediting agencies, professional, and national nursing organizations all joined

the informatics movement and required undergraduate nursing education to include

essential informatics competencies. The National League for Nursing (NLN, 2008)

recommended that nursing faculty participate in educational programs to prepare them to

incorporate principles of informatics into each level of nursing education. The Essentials

of Baccalaureate Education for Professional Nursing Practice (AACN, 2008) included

nine essential outcomes for “all pre-licensure and RN completion programs” (p. 5). The

graduate nurse is prepared with a liberal education in the Essential I outcome that

includes the “use of skills of inquiry, analysis, and information literacy to address

practice issues” and “value the ideal of lifelong learning to support excellence in nursing

practice” (AACN, 2008, p. 12). For the Essential III outcome, the graduate is prepared

for evidence-based practice and have the ability to “evaluate the credibility of sources of

31

information, including but not limited to databases and Internet resources” and

“participate in the process of retrieval, appraisal, and synthesis of evidence” (AACN,

2008, p. 16). The graduate nurse is prepared for information management and application

of patient care technology in the Essential IV outcome because “computer and

information literacy are crucial to the future of nursing” (AACN, 2008, p. 17). The

graduate is prepared with professional values and professionalism for the Essential VIII

outcome that leads to “accountability for one’s self and nursing practice, including

continuous professional engagement and lifelong learning” (AACN, 2008, p. 26). The

nurse is prepared for generalist nursing practice with the Essential IX outcome to “deliver

compassionate, patient-centered, evidence-based care that respects patient and family

preferences” (AACN, 2008, p. 31). Important to note is that the Information Literacy

Competency Standards for Nursing (ILCSN) are called on in each of the Essentials’

documents and are a “germane resource” for nursing educators teaching information-

seeking skills (Phelps et al., 2015).

Webber and Johnston (2006) postulated that computer literacy was confused with

information literacy by administrators of higher education, and most participants in their

study could not define information literacy. Badke (2010) believed a crucial reason why

the term did not have an important place in academia was because information literacy

was an ambiguous concept, and often misunderstood and undervalued. Saunders (2011)

wrote, “Because of its emphasis on evaluation and use of information, information

literacy incorporates aspects of higher-order thinking abilities” (p. 54). Breivik’s (2005)

description of information literacy was a “kind of critical-thinking ability… a person who

32

is information literate specifically uses critical thinking to negotiate our information-

overloaded existence” (p. 23).

Members of some accreditation organizations underscore the importance of

information literacy as a learning outcome for college graduates and include such

outcomes in their standards (Saunders, 2011). Bradley (2013) noted that little was written

about inform information literacy in the context of educational accreditation standards

developed by three professions: nursing, social work, and engineering in four countries

including the United States. Bradley sought to define information literacy and note if the

term was used in accreditation criteria and determine what other terms were used in

accreditation criteria to describe associated skills and competencies. The norm was for

each profession to be accredited by a single body in a country, yet the United States had

two separate organizations that accredited nursing programs (NLN and CCNE). Bradley

chose the National League of Nursing (NLN) to identify information literacy terms and

concepts in their criteria for nursing accreditation. The NLN (2012) only mentioned

information literacy in the context of a competency required by program evaluators (p.

23) , and an attribute essential for graduate nursing students (p. 72), but the term was not

used in the context of undergraduate nursing requirements (Bradley, 2013, p. 49).

Important to note was that in the accreditation documents, the importance of recognizing

the need for information and pursuing lifelong learning and professional development

was unanimously, and repeatedly mentioned (Bradley, 2013, p. 50).

Agyei, Kofi, Fiankor, and Osman (2015) aimed to learn what nurses’ information

literacy competencies were for the evidence-based practice (EBP) process. Agyei et al.

(2015) discovered nurses perceived EBP competencies as “good,” yet had limitations

33

such as difficulty in judging the quality of a research study, inability to interpret the

results of studies, and were hindered in efficiently and effectively adopting EBP.

Relevant and current information is essential for EBP and knowing the sources of

information are crucial (Agyei et al., 2015). The researchers recommended introducing an

information literacy course in nursing education, establish resource libraries in health

facilities, workshops on competencies for all nurses, subscription of medical databases by

major health facilities, and encouraging nurses to develop a culture of reading (Agyei et

al.).

According to Mokhtar et al. (2012), planning and implementing active

information literacy education and evaluation should be significant aspects of emerging

research. Information literacy must be integrated into practice and used to support

knowledge management and goes beyond computer literacy or Internet skills. Mokhtar et

al. conducted a study to determine if nurses had the pre-requisite competencies to

effectively carry out evidence-based practice at the patient’s bedside. A self-reporting

questionnaire was used to gather data from 342 nurses in a government hospital in

Singapore to identify information needs and sources for information, searching

capability, and evaluation, synthesis, and application of information. The majority of the

nurses preferred traditional print and human information sources and were not able to

apply research findings in nursing practice. The nurses did not believe they had relevant

training in the process and were not confident in searching the literature via electronic

databases. The researchers discovered college-graduate nurses tended to have higher

information literacy knowledge compared to non-college graduate nurses (Mokhtar et al.,

2012).

34

Information literacy in higher education evolved over the past several decades

from a skill-based practice to a more integrative, transformative pedagogy that was

needed for students to be successful in the digital age (ACRL, 2015; NLN, 2018). Nurses

with information literacy skills and knowledge experienced enhanced professional

growth and development, enabled them to be literate of available print and electronic

formats of information, and kept them abreast of new health care innovations (Majid et

al., 2008). Majid et al. (2008) postulated that lack of skills resulted in information

overload, accessing irrelevant and inaccurate literature, missing critical information, and

wasting valuable time.

Partnerships commonly existed between librarians and faculty in health

professions programs where the librarian was responsible for teaching information

literacy skills to students (Jacobs et al., 2003; Shorten et al., 2001). Jacobs et al. (2003)

collaborated with librarians to identify ways to strengthen evidence-based practice

competencies in nursing students with skills to be information literate consumers in an

electronic environment. An evaluation plan was designed to assess the impact of an

initiative to determine the success of IL modules throughout the nursing curriculum. Test

scores continually improved with the completion of each module. The developers of this

project guided the future development and implementation of advanced information

literacy competencies that were embedded in specialty courses for evidence-based

practice.

Librarians were often expected to teach information-seeking skills in nursing

programs with “one-shot” information literacy sessions, but the retention of “one-shot”

information was not retained by the nursing students (Mery, Newby, & Peng, 2012). The

35

adage of use it or lose it applied to information literacy taught in “one-shot sessions,”

because information was not retained (Barnard et al., 2005; Farrell, Goosney, &

Hutchens, 2013). Carlock and Anderson (2007) found that students who received only

one session scored lower on their assessments over time than those who continued to

receive sessions through the course of the program. Professors found anecdotal

information after “one-shot” classes during the student’s first semester indicated that the

sessions were not adequate, and students were not finding sufficient material for research

papers.

The consensus between faculty and librarians was that students would benefit

from instruction sessions during the entire program, and each session should build on the

skills previously learned (Farrell et al., 2013). Farrell and colleagues taught an

information literacy program over three years and assessed the value for increased

exposure to training related to students’ levels of competence and confidence. The

researchers found improvements from the first to the fourth year, but not as improved as

the anecdotal information from faculty. Faculty reported that students no longer

complained that they could not find information on their topics and students’ papers

improved. Faculty devoted more time for information literacy sessions each semester,

which indicated recognition of the value of each session, and other faculty requested

supplements to the program with additional course-specific instruction (Farrell et al.,

2013).

Cobus-Kuo and Waller (2016) assessed teaching information literacy and

evidence-based practice skills using an active-learning library workshop in an

undergraduate capstone course taught by a health sciences librarian and a faculty

36

member. The students’ responses were measured with one-minute papers (OMPs). Fifty-

one OMPs were collected over two years. Students were asked two questions on the

OMP. “What information did you learn today that you think will be most useful to you in

your course work?” and “What question(s) do you still have?” Student reflections were

analyzed using qualitative methods. Researchers identified six themes that students found

helpful and the most common concept was search strategies. Student feedback on the

second question generated ten themes. Students asked about evidence appraisal and why

the material was not introduced earlier. In conclusion, the benefits of a librarian and

faculty member collaboratively teaching undergraduate students’ skills for finding

evidence-based literature were identified. Cobus-Kuo and Waller (2016) found that

students learned effective strategies for finding evidence-based information and

supported the integration of information literacy early and often in the curriculum.

Lalor, Clarke, and Sheaf (2012) focused on strengthening practitioners’ skills in

searching, information retrieval, appraisal, and utilization of research findings relevant to

practice. The researchers wanted to facilitate and improve the use of evidence-based

practice. In the United Kingdom, both the National Health Service (NHS) and the Royal

College of Nursing identified information literacy as a core competency for practitioners

and pre-registration students. Intending to drive forward the evidence-based practice

process, NHS healthcare staff were required to have information technology skills at

entry level to practice. One hundred eight students participated in a 16-hour library-based

instruction over three years of the program focused specifically on the information

literacy skills required to effectively utilize electronic resources to review the literature.

Students’ search history files were reviewed, and primary analyses were compared by

37

researchers related to each student’s pre- and post- instruction. Researchers found that

sessions during the first and second years resulted in improvements in searches with less

increase in the third year. Lalor et al. (2012) concluded that with complex interventions,

teasing out elements of the sessions were most beneficial and planned to identify ways

session skills could be strengthened.

Hobbs, Guo, Mickelson, and Wertz (2015) assessed student learning outcomes in

terms of demonstration of student information literacy skills and self-confidence in using

those skills. Students’ self-reflections on confidence and comfort in using library

resources were assessed with 120-minute hands-on library instruction and workshop

sessions. Students’ knowledge and skills in developing information search strategies,

locating journal articles, selecting, and searching databases were assessed. Though the

sample size was small, Hobbs and colleagues showed that providing library instruction to

students increased their skills and knowledge in information literacy, and a significant

increase in database selection skills and searching strategies were noted, with a moderate

increase in students’ abilities to access peer-reviewed journal articles and cite them

properly. Mulitple investigators noted overall improvements in knowledge, comfort, and

confidence levels after the educational sessions (Jacobs et al., 2003; Lalor et al., 2012;

Wallace, Shorten, & Crookes, 2000).

Without an understanding of nurses’ experiences with information literacy,

Forster (2015) hypothesized there was no convincing way to verify whether skills

developed in nursing education resulted in self-confidence, especially in the context of

evidence-based practice. Forster explored the dynamics surrounding information literacy

to understand the effect on evidence-based practice. Forster’s objectives for the

38

qualitative exploratory study were to investigate how nurses experienced information

literacy and use insights to describe parameters of information literacy in nursing,

including the role and value for evidence-based practice. Three nursing faculty with

many years of clinical and teaching experience were chosen for the pilot study.

Participants described their information-seeking activities when analyzing a clinical

problem for evidence-based practice. Forster identified provisional categories for how

information literacy (IL) supported evidence-based practice and included the following

themes/statements.

IL was experienced in the successful collection of sufficient and persuasive evidence to justify change in practice. IL was experienced in an ethical context, in the successful accumulation of evidence to establish what was the most ethically appropriate care? IL was experienced in the successful gathering of evidence to support the facilitation of culture change in the clinical environment. IL was experienced in obtaining information of clinical value that enabled nurses to contribute to a multidisciplinary team. IL enhanced professional competence through the location and application of key scientific or psycho-socio-cultural background knowledge. IL was experienced in the successful accumulation of sufficient and appropriate evidence to justify care strategies to reassure patients and families. IL was experienced in the successful establishment and support of an autonomous status for the nursing professional by providing evidence for independent and defendable clinical opinions. (Forster, 2015)

Forster (2015) postulated that an information literate nurse was confident, informed,

autonomous, and competent; therefore teaching information literacy education needed to

be visible and valued in nursing education.

Hines, Ramsbotham, and Coyer (2015) performed a systematic review to identify

the effectiveness of workplace, tertiary-level educational, or interventions designed to

improve or increase graduate nurses’ understanding of research literature and the ability

to critically interact with research literature and promote using research evidence in

39

practice compared to no intervention, other interventions, or usual practice. The

researchers identified more than four thousand potentially relevant quantitative studies of

nurses receiving educational interventions to increase or improve understanding of

research literature. Though a large body of research was examined, only a small number

of studies met inclusion criteria. Ten out of ninety-six studies were selected, and the

authors identified interactive interventions utilizing theory construction were beneficial to

increase students’ understanding of research and abilities to analyze research critically.

Hines and colleagues (2015) concluded that interactive interventions designed and

framed by an appropriate educational or behavior change theory were more likely to be

effective in improving nurses’ information literacy skills.

The Internet is a ubiquitous tool to find health information, and patients and

clinicians use online resources to learn about health-related topics (Wang, Sun,

Mulvehill, Gilson, & Huang, 2016). Clinicians provide healthcare education to their

patients and have the ethical duty to critique online resources for accurate patient-care

information. Wang et al. (2016) used a pre- and post-survey to question undergraduate

nursing students about the credibility and authority of healthcare websites. Wang and

colleagues supported the value of teaching nursing students how to critique online

healthcare resources correctly.

Sadoughi, Azadi, and Azadi (2017) identified barriers concerning the application

of electronic literature in nursing which included time constraints (81%) followed by lack

of knowledge of searching skills (66%) and access requirements (38%) of the reviewed

studies. The researchers concluded that education on using electronic evidence-based

literature was an essential requirement. Alving, Christensen, and Thrysoe (2018)

40

examined the literature and found similar barriers for not searching the literature: lack of

time, lack of information, lack of retrieval skills, and lack of training in database

searching. Melnyk et al. (2012) also noted barriers that included lack of support from

managers, leaders, and colleagues, education about evidence-based practice, access to

information, and health care organization culture.

Traditionally, educators focused on a series of skills with little focus on long-term

learning when teaching information literacy. Information literacy skills pervade

educational standards from elementary through higher education to empower students to

live and learn in a technology-based society (Post, 2010). Researchers reported the

importance of teaching the information literacy skills continuously in education with

reinforcement and repetition and embed professional development programs focused on

how information was conceptualized to be used in nursing practice (Arguelles, 2012).

Information Literacy Competency Standards and Evidence-Based Practice (EBP) in Nursing

The Information Literacy Competency Standards for Nursing and the steps in the

evidence-based practice process are similar, which strengthens the link between

information literacy and evidence-based practice (Adams, 2014). The Association of

Colleges and Research Libraries (ACRL) emphasized the importance of teaching

information literacy skills in higher education and recognized the value of curricular

integration of the skills on evidence-based learning for nursing students (Boruff &

Thomas, 2011).

As early as 1988, nursing faculty collaborated with librarians to teach information

literacy skills to students in undergraduate programs (Majid et al., 2008). Explicity

focused on this collaboration, the Association of College and Research Libraries

41

developed and published Information Literacy Competency Standards for Nursing in

2014 (Phelps et al., 2015). The purpose of the customized, discipline-specific standards

for the nursing profession was to accomplish the following:

• Provide a framework for faculty and students of nursing at the ASN, BSN, master’s, and doctoral levels in the development of information literacy skills for evidence-based practice.

• Encourage the use of a common language for nursing faculty and librarians to discuss student information seeking skills.

• Guide librarians and nursing faculty in creating learning activities that support the growth of information literacy skills over the course of a program of nursing education and for lifelong learning.

• Provide administration and curriculum committees a shared understanding of student competencies and need.

• Provide a framework for continuing education in the area of information literacy for the field of nursing practice and research. (ACRL, 2014)

The ACRL Standards for information literacy competencies for nurses are similar to

the five-step evidence-based practice process (Adams, 2014). Adams (2014) compared

each step of the evidence-based practice process to the ACRL Standards and noted the

similarities and differences between the two methods (Table 1). ACRL Standard 1 (Ask)

is an answerable question formulated by learners to define the need for information.

ACRL Standard 2 (Acquire) is effectively and efficiently acquiring the needed

information. ACRL Standard 3 (Appraise) is the critical evaluation of data from a variety

of sources related to reliability, validity, accuracy, authority, timeliness, and point of

view or bias is performed. ACRL Standard 4 (Apply) is when the clinician makes

decisions based on professional experiences, evidence, and patient values. Important to

note is that ACRL Standards are considered to be value-neutral, which is different in the

evidence-based practice process where the clinician’s professional experience and the

patient’s personal are included. ACRL Standard 5 (Assess) includes self-assessment that

42

can affect decision-making in the evidence-based practice (EBP) process. This EBP step

is different than Standard 5 where the information literate nurse understands the

economic, legal, and social issues surrounding the use of information and considers

information to be intellectual property. Copyright and plagiarism are also not directly

considered in the evidence-based practice process as in the ACRL Standards.

Table 1

Information Literacy (IL) Competencies Compared to Evidence-Based Practice (EBP) Process in Nursing

IL Competency Standards Steps of EBP Process

1. Define and articulate need for information. 1. Ask question using PICO method.

2. Access needed information effectively and efficiently.

3. Evaluate information. Modify initial query and/or seek additional sources or develop new search.

4. Use information effectively to accomplish a specific purpose individually, or as a member of a group.

5. Evaluate and understand ethical, legal, and social issues surrounding theuse of information technology.

2. Search and acquire the best evidence.

3. Appraise and select highest quality of evidence available.

4. Apply & use evidence with nurse’s expertise patient’s preferences to make the best decision.

5. Assess and evaluate the outcome of the EBP practice intervention.

(Adapted from Adams, 2014)

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Nursing Faculty’s Role in Teaching Information Literacy for Evidence-Based Practice

Searching for evidence is one of the evidence-based practice competencies

(Melnyk et al., 2014), and database searching-skills are essential to learning in nursing

education (Fineout-Overholt, Williamson, Kent, & Hutchinson, 2010; Jacobs et al., 2003;

McCulley & Jones, 2014). As early as 1999, Verhey identified the need to incorporate an

information literacy program throughout a nursing curriculum, rather than teaching the

skills in a brief orientation session or during one research course.

Morrison-Beedy (2018) wrote in a guest editorial in Worldviews on

Evidence- Based Practice Nursing wrote that nursing graduates got their knowledge,

skills, and abilities to implement evidence-based practice from the faculty who

educated them. Nursing faculty build the student’s understanding of the importance

of and build confidence in, their ability to implement evidence-based practice as

nurse graduates.

There are far too many faculty responsible for educating the next generation of nurses in EBP and its implementation within practice settings who do not have the background, nor a clear understanding of what EBP is, or why we need EBP, and how to educate students from an EBP lens. Far too often, faculty, who often have been educated when EBP was not front-and-center in curriculums by faculty who in their day had never even heard of EBP. (Morrison-Beedy, 2018, p. 245)

Nursing faculty are challenged with educating graduates to be safe, competent,

and knowledgeable nurses, yet knowledge and education about evidence-based practice

were consistently cited as reasons for not implementing the process in the clinical

environment (Melnyk et al., 2012). Nursing educators are required by national

accrediting agencies to provide education in specific competency areas to demonstrate

that new graduates are prepared to practice in the twenty-first century with a focus on

44

evidence-based practice. Improving the level of knowledge and investing funds for

continuing nursing education are right places to start promoting nurse champions as

mentors and prioritize consistent delivery of evidence-based care (Melnyk, 2016).

Laibhen-Parkes (2014) postulated that for nurses to achieve competencies,

nursing curricula need to be revised to prepare graduates for evidence-base practice in the

health care environment. Evidence of inconsistent integration of information literacy

throughout nursing curricula was found by multiple researchers noting that nursing

students, as well as practicing nurses, lacked skills necessary to locate and evaluate

scientific literature needed for clinical decision-making (Carter-Templeton et al., 2014;

Hunter, Dee, & Hebda, 2013; McNeil et al., 2003; Pravikoff et al., 2005; Probert, 2009;

Ross, 2010; Schutt & Hightower, 2009). McNeil et al. (2003) surveyed baccalaureate

nursing programs and found a lack of knowledge about information literacy and

computer literacy. Nurses must be skilled in information literacy to apply the evidence-

based practice process (Fox et al., 1989; Pravikoff et al., 2005). Pierce (2005) postulated

that educators must be responsive to market demands such as the impact of technology,

the knowledge explosion, and changing demographics of students and health care clients

to improve quality.

During their doctorate studies, Pierce (2000) collaborated with Tanner (2000) to

investigate information literacy and evidence-based practice among nursing faculty,

nursing students, and practicing RNs. Pierce and Tanner’s studies aimed to describe the

readiness of educators, students, and RNs, based on their information literacy skills and

readiness to implement evidence-based practice. Pierce (2000) and Tanner (2000)

identified needs related to information-seeking, information literacy skills, search

45

strategy effectiveness, mentoring, and research value. Pierce (2000) found that each of

these needs was effective strategies for implementing evidence-based practice, and all of

the needs represented deficits in the nursing education paradigm at that time. Pierce

(2000) concluded that nursing faculty need to prepare future nurses to be information

literate caregivers and to incorporate information literacy into all levels of nursing

curricula to prepare graduates for evidence-based practice. Pierce (2000) and Tanner

(2000) identified that overall, RNs were not familiar with evidence-based practice, and

gaps were noted in information literacy skills. Pierce and Tanner collaborated with

Pravikoff in 2005 to conduct a nationwide study to assess RNs’ readiness for evidence-

based practice. Pravikoff et al. (2005) examined RNs’ perceptions of tools to obtain

evidence as well as whether skills to do so. Three thousand RNs responded to the survey,

and respondents were more comfortable asking colleagues and peers along with

searching the World Wide Web (WWW) than using healthcare databases for scientific

and credible information. Registered nurses reported having little or no training in the

tools to help find evidence for patient-care decisions (Pravikoff et al., 2005).

Nelson and Staggers (2008) researched nursing faculty’s knowledge of

information literacy concepts and capabilities to adequately prepare future nurses to

practice in a computerized healthcare environment. Valuing information literacy and

infusing the skills into all levels of nursing curricula were priorities for nursing faculty.

Nurse educators skilled in searching databases and assessing evidence were better

positioned to teach those skills to students and provide guidance on the most accurate

online resources to guide clinical practice based on evidence (Wahoush, & Banfield,

2014).

46

Felicilda-Reynaldo and Utley (2015) used a mixed-methods design using an

online survey to analyze teaching philosophy statements from 375 academic nurse

educators (ANEs). The researchers explored how ANEs conceptualized evidence-based

practice within their teaching philosophy statements. The similarities and differences

based on years of teaching experience, educational preparation, type of nursing program,

and primary teaching modality were compared. Evidence-based practice and its

components were mentioned 2,745 times collectively. Forty-four academic nurse

educators (16%) specifically mentioned evidence-based practice in teaching philosophies.

Three themes were noted by the Felicilda-Reynaldo and Utley and included keeping up-

to-date, setting up student success with evidence-based practice, and evidence-based

practice as a teaching approach. The researchers concluded that to ensure nursing faculty

hold their students to high standards, integration of the components of critical thinking,

lifelong learning, and quality patient care were important to include in the program’s

philosophy. Felicilda-Reynaldo and Utley’s revealed that half of the faculty included

evidence-based practice in their teaching philosophies.

Carter-Templeton et al. (2014) conducted a descriptive study to determine nursing

faculty and students’ experiences with information literacy skills in the classroom and

clinical setting. Most of the participants in the study (98%) believed that information

literacy skills were valuable for patient care, yet less than half of the respondents said

they used up-to-date evidence for patient care, and less than half reported accessing

professional nursing websites. The majority of the participants (95%) reported being

computer literate to highly computer literate, and 89% rated themselves as proficient to

highly proficient related to information literacy skills. Carter-Templeton et al. found

47

similar barriers in other studies for accessing online information that included lack of

time, followed by no computer available to perform online searches, and inability to

access databases. All of the participants reported consulting a human resource at least

once a week. Carter-Templeton et al. (2014) added to the body of knowledge about

nursing faculty and students’ perceived competencies for using research evidence in

practice.

Lovelace et al. (2017) used a comparative design to learn whether evidence-based

practice self-study modules were associated with beliefs about the value, attitudes, and

implementation of evidence in practice. Lovelace and colleagues used four self-study

educational modules to teach students information literacy skills needed for evidence-

based practice. Scores for beliefs about the value and implementation of evidence-based

practice were similar to Melnyk et al.’s (2012) study reflecting a need to educate nurses

about evidence-based practice and apply evidence in practice (Lovelace et al., 2017).

Nurses were able to use self-study modules to gain knowledge at optimal times for

learning. Lovelace et al. recommended educators consider self-study continuing

education programs for nursing students refer to when needed.

In 2017, the National League of Nursing (NLN) partnered with Quality and

Safety Education for Nurses (QSEN) to survey integration of QSEN competencies in

prelicensure nursing programs (Altmiller & Armstrong, 2017). Two thousand thirty-

seven (2,037) nurse educators from all levels of nursing education completed a 19-

question survey assessing whether QSEN competencies (patient-centered care, evidence-

based practice, safety, teamwork and collaboration, quality improvement, and

informatics) were taught to nursing students, the extent of faculty development to

48

understand and use the competencies, and the degree of curriculum integration in nursing

programs (Altmiller & Armstrong, 2017). Wide disparities in faculty preparation to teach

competencies were noted. Competencies for patient-centered care, evidence-based

practice, safety, collaborative teamwork were represented positively in the curricula, and

competencies of quality improvement and informatics were less evident in the curricula

(Altmiller & Armstrong). Faculty training, education, development, and educational

materials to successfully integrate, implement, and evaluate the competencies in

education were not evident (Altmiller & Armstrong). Barriers included the need for

teaching strategies to incorporate the skills into the curriculum and time to learn about the

QSEN competencies (Altmiller & Armstrong). Altmiller and Armstrong (2017) called for

an increased national focus on the need to integrate all competencies into curricula and a

continuing need for more financial support for faculty development.

Conclusion

Evidence-based practice is an expected professional competency in nursing,

(Adams, 2014), yet nurses are not using the most up-to-date resources for evidence-based

practice due to lack of information literacy skills needed to search the literature (Carter-

Templeton et al., 2014; Pravikoff et al., 2005). Researchers identified evidence to support

the need for nursing students to learn information literacy skills at the preclinical level

and continue refining those skills throughout the educational process to effectively and

efficiently identify evidence for decision-making (Phelps et al., 2015). When nurses

valued and used evidence for decision-making, patients benefitted through improved

outcomes, lower costs, and higher satisfaction (Arguelles, 2012; Lovelace et al., 2017).

49

The importance of information literacy to support evidence-based practice in

health care was established in Chapter 2. Information literacy skills should be valued and

integrated throughout the undergraduate nursing curriculum to prepare nurses for today’s

challenging health care world, for utilizing evidence in practice, and for lifelong learning

(Hebda & Calderone, 2010; Kinnunen, Rajalahti, Cummings, & Borycki, 2017; Lilly et

al., 2015; Verhey, 1999). Nursing educators’ perceptions about information literacy and

evidence-based practice, specifically related to whether these concepts are valued and

consistently taught in undergraduate nursing programs need to be examined, as well as

colleges of nursing’s readiness for evidence-based practice.

The alignment of Rogers’ theory with the steps of information literacy and

evidence-based practice was presented along with conceptual and empirical evidence that

impacted the study. Research literature was presented related to evidence-based practice,

information literacy, information literacy and evidence-based practice, and nursing

faculty’s role in teaching information literacy for evidence-based practice. The research

methods used for sample selection, protection of human subjects, data collection, and

analysis of data are presented in Chapter 3.

CHAPTER 3: METHODS AND PROCEDURES

Introduction

The practice of evidence-based practice has been reported to lead to high-quality,

safe care, improved patient outcomes, reduced morbidity, mortality and costs, and

empowers and engages the healthcare team (Institute of Medicine 2001, 2009, 2010; B.

M. Melnyk et al., 2012; B. M. Melnyk et al., 2018). Adoption of evidence-based practice

by RNs continues to be a challenge and is not the standard of care for nurses practicing in

the twenty-first century (Melnyk et al., 2018; Warren, Montgomery, & Friedman, 2016).

Mthiyane and Habedi (2018) postulated that evidence-based teaching is an essential

function for nursing education, and educators play an important role in creating

opportunities in implementing and facilitating the process. Some of the barriers reported

in the literature for nurses not making patient-care decisions based on evidence were lack

of knowledge and value about evidence-based practice, lack of skills in locating and

analyzing evidence in the literature, and educational and cultural barriers that impact how

the competencies were taught in nursing programs (Finkelman & Kenner, 2012; B. M.

Melnyk et al., 2012; B. M. Melnyk et al., 2018; Moreton, 2013; Pravikoff et al., 2005).

Multiple researchers concluded that nursing graduates lack information literacy skills that

are needed to obtain up-to-date information for evidence-based practice (Aglen, 2016;

Andre, Aune, & Braend, 2016; Hain & Haras, 2015; Hines et al., 2015; Jameson &

Walsh, 2017; Pravikoff et al., 2005).

51




of nursing in a south-central state. To answer the research questions, data were collected

to examine nursing educators’ perceptions and beliefs about information literacy and

evidence-based practice and the cultural factors that influenced the implementation and

school-wide integration of evidence-based practice. The following questions were

addressed in the study:












E) Scale?



52

Research Design

A mixed-methods explanatory study was designed to collect quantitative and

qualitative data to answer the research questions. Quantitative data were collected in the

first phase of the study, followed by qualitative data collection in the second phase and

integrated within a single study (Polit & Beck, 2018). The two sources of data provided a

complementary and practical approach to learn more about the complexity of the

concepts of interest in the study and enhance the validity of the findings (Polit & Beck,

2018) by having the population most experienced in nursing education participate in the

study to answer the research questions. The approach was well suited for the study due to

reports that the concepts of interest were commonly misunderstood, and findings from

one method can be significantly enhanced with a second source of data to adequately

address the complexity of the research problem (Creswell & Plano Clark, 2011).

Setting and Sample Selection for Phase I and Phase II

Purposeful convenience sampling was used to identify nursing educators teaching

in Associate of Science in Nursing (ASN), Bachelor of Science in Nursing (BSN), RN to

BSN, graduate, and doctorate programs in a south-central state for both phases of data

collection. The list of RN nursing programs in the state was obtained from the State

Board of Nursing website (Louisiana State Board of Nursing [LSBN], 2019). The

deans/directors of 26 colleges of nursing in the state were initially contacted by email

with a request to allow their nursing faculty to participate in the study (Appendix D).

Permission was granted by sixteen deans/directors of the twenty-six (62%) colleges of

nursing (Appendix E) in the state. Though IRB approval was granted from the University

of Louisiana Monroe (ULM) for the study, five of the colleges participating in the study

53

required additional IRB approval from their university’s human subjects’ committee. The

IRB process was completed for each of the five colleges, and permission was granted to

collect data from nursing faculty teaching at each of the participating nursing programs.

The dean/director of each participating nursing program provided the total

number of educators who received the survey in Phase I and totaled four hundred two

(N = 402). Varying degrees offered in the participating nursing programs included:

licensed-practical nursing (LPN), LPN to Associate of Science (LPN to ASN), LPN to

Bachelor of Science in Nursing (LPN to BSN), ASN, BSN, RN to BSN, Master of

Science in Nursing (MSN) with various nursing concentrations such as education,

administration, and leadership, Nurse Practitioner (NP) with various concentrations such

as family, gerontology, women’s health, pediatrics, and cardiovascular, Doctor of

Philosophy (PhD), and Doctor of Nursing Practice (DNP).

Phase II included personal interviews with eleven nursing educators teaching at

eight of the participating colleges of nursing. Six of the participants taught in BSN

programs, three taught in ASN programs, and two taught in graduate programs. Five of

the educators had an MSN degree, and two of these educators were currently working on

a doctorate, and six educators had a doctorate.

Study Instruments

Phase I. Instruments used to collect quantitative data for Phase I of the study

included (a) a modified version of the Information Literacy for Nursing Practice

(ILNP-

M) questionnaire, (b) a non-modified version of the Evidence-based Practice Beliefs-

Educators (EBPB-E), and (c) a non-modified version of the Organizational Culture

and Readiness for System-Wide Integration of Evidence-Based Practice-E (OCRSIEP-

E).

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Permission was received from Drs. Pierce, Pravikoff, and Tanner to modify and use the

ILNP for the study (Appendix B), and Fineout-Overholt granted permission to use non-

modified versions of the EBPB-E and OCRSIEP-E Scales (Appendix C). The three

surveys were combined into one data collection tool with 60 items to add validation and

confidence in the findings (Appendix F-1). The survey was emailed to the nursing faculty

by the dean/director of each of the participating colleges of nursing. The email had an

embedded Uniform Resource Locator (URL) to the SurveyMonkey data collection tool.

SurveyMonkey is an online survey development cloud-based software company

(SurveyMonkey, 2018).

Information-Literacy for Evidence-Based Nursing

Practice-Modified (ILNP- M). The original Information Literacy for

Evidence-Based Nursing Practice (ILNP) survey was one of the earliest questionnaires

designed by Pierce (2000) and Tanner (2000) to assess readiness for evidence-based

practice from the perspective of information literacy (Leng, Lim, & Siew, 2016;

Pravikoff et al., 2005; Sleutel, Barbosa- Leiker, & Wilson, 2015; Thorsteinsson, 2012,

2013; Wilson et al., 2015). Researchers addressed information seeking needs and

availability of resources and how those resources were perceived to be used for

evidence-based practice with the ILNP questionnaire. The original ILNP included 93-

items to examine nurses’ perceptions of skill, ability, desire, and access to resources

(Pravikoff et al., 2005; Sleutel et al., 2015). The ILNP was designed first for separate

dissertation research studies by Pierce (2000) and Tanner (2000) to collect data from

nurses in one state, and later revised and piloted the tool for data collection from nurses

in two states, and then mailed to nurses in all 50 states to comprise a national sample

(Pravikoff et al., 2005). Content validity of the tool

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was established by nursing experts, librarians, and information science specialists

(Pravikoff et al., 2005). The ILNP was subsequently used by researchers in two separate

studies in 2008 and 2010 with findings similar to Pravikoff et al. (2005) and provided

further confidence in content validity. Questions were asked in varying formats such as

yes-no, or do not know, related to information literacy skills. Some questions required

ranking in a list such as barriers to using research evidence in practice and individual

barriers for using research in education. The ILNP tool was widely used yet construct

validity and reliability had not been reported until Sleutel et al. (2015) streamlined the

ILNP to eliminate unnecessary questions, clarify lengthy or unclear items, and ascertain

evidence of validity and reliability through psychometric analyses. Sleutel et al.’s revised

23-item tool was renamed Healthcare EBP Assessment Tool (HEAT) and demonstrated

adequate content validity with items being relevant and adequately covered the

constructs. Though exploratory factor analysis showed that one to five factor models did

not fit the data well, the pattern of factor loadings for the four-factor model showed a

strong pattern where items aligned onto frequency, ability, desire, and barrier factors

(Sleutel et al., 2015). The modified four-factor model demonstrated acceptable/mediocre

model fit except the confirmatory factor analysis, and the coefficient alpha for the HEAT

was reported as 0.87 (Sleutel et al.).

After receiving permission to use and modify the ILNP, sections of the original

93-item tool were omitted that were not related to faculty considerations. Similar to

Sleutel et al.’s (2015), Thorsteinsson’s (2013), and Wilson et al.’s (2015) studies, most of

the demographic items to reduce the potential for respondent identification were removed

and updated items were added to align with the current literature related to information

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literacy and evidence-based practice. Questions related to the location of access to

databases, printed indexes, journal clubs, and similar programs were removed. Most

nursing faculty had electronic access to the nursing programs’ online library databases.

Databases were included in the survey to note the faculty’s knowledge and use of

commonly used electronic databases to search for evidence-based literature. Content

validity of the survey modified for the study was supported by a nurse librarian

experienced in teaching information literacy and two nursing faculty experienced in

teaching informatics. The final questionnaire resulted in a 19-item survey known as the

ILNP-M designed to collect data from nursing educators.

Evidence-Based Practice Beliefs-Educator (EBPB-E) Scale.

The Evidence- Based Practice Beliefs-Educator (EBPB-E) Scale was designed to

measure educators’ beliefs about and confidence in their ability to teach and implement

evidence-based practice (Fineout-Overholt & Melnyk, 2010). Beliefs and confidence in

implementing evidence-based practice were measured with a 5-point Likert scale survey.

The EBPB-E Scale included 22 items with a 5-point Likert scale ranging from one point

to five points (1 =Strongly Disagree; 2 = Disagree; 3 = Neither Agree or Disagree; 4 =

Agree; 5 = Strongly Agree). Two reverse-scored items (I believe that EBP takes too

much time, and I believe EBP is difficult) were included in the survey. Mean scores

ranged from 22 to 110, and interpretation markers were 22, 44, 66, 88, and 110 (E.

Fineout-Overholt, personal communication March 15, 2018). Scores below 88 indicated

there were less than agreements with knowledge, confidence, and belief in abilities to

teach and implement evidence-based practice. Scores above 66 (neither agree nor

disagree), but less than 88, indicated that there was not a full commitment for evidence-

based practice. Scores less

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than 66 indicated that there was no commitment to teaching or implementing evidence-

based practice (E. Fineout-Overholt, personal communication March 15, 2018). The

closer the score to 88, but not exceeding, the more commitment/ belief in teaching and

implementing evidence-based practice. Mean scores greater than 88 indicated a firm

belief in and confidence about teaching the process. Any item with a 3.5 or below was an

area of opportunity to intervene (E. Fineout-Overholt, personal communication March

15, 2018). The validity of this scale was established and Cronbach alphas > 0.85 were

consistently reported across various samples (Melnyk & Fineout-Overholt, 2019; Milner

et al., 2018; Yackel et al., 2013).

Organizational Culture and Readiness for School-Wide

Integration of Evidence-Based Practice-Educator (OCRSIEP-E)

Scale. The Organizational Culture and Readiness for School-Wide Integration of

Evidence-Based Practice-Educator (OCRSIEP-E) Scale was developed by Fineout-

Overholt and Melnyk (2011) and designed to measure educators’ perceptions of cultural

factors that influenced implementation of evidence-based practice in the educational

environment and the perceived readiness of educators for school-wide integration of the

process. The OCRSIEP-E had 19 questions, and two of the questions (15 and 17) had

multiple responses resulting in a 25-item survey (Milner et al., 2018). Items in the

OCRSIEP-E solicited judgments regarding the extent that organizational structures or

resources were available, identified vital leadership roles in decision-making, and

participants were able to rate the organization’s readiness for evidence-based practice

(Warren et al., 2016).

The OCRSIEP-E was a 5-point frequency scale with a range from one to five

points (1 = None at All; 2 = A Little; 3 = Somewhat; 4 = Moderately; and 5 = Very

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Much). The range of scores was 25 to 125. Mean scores greater than 75 demonstrated

moderate movement toward a culture of evidence-based practice, but not yet sustainable.

Mean scores less than 75 indicated an opportunity for growth within the educational

setting to move toward a culture of evidence-based practice; scores greater than 100

indicated an essential movement toward a sustainable culture of school-wide evidence-

based practice (E. Fineout-Overholt, personal communication March 15, 2018). The scale

had established face and content validity and consistently performed reliability with

internal consistency ranging from 0.88 to 0.94 (Melnyk & Fineout-Overholt, 2019;

Milner et al., 2018).

Phase II Instrument

The study instrument for Phase II (Appendix H) was designed by the researcher

based on the independent variables, information literacy, and evidence-based practice

competencies, for the study. The original ten-question interview tool was reviewed by Dr.

Marc Forster (personal communication, January 16, 2019), a published author on the

concepts of interest, and resulted in a four-question interview tool designed for

interviewees to freely discuss teaching experiences related to information literacy and

evidence-based practice. The study instrument was emailed to the educators before the

scheduled interview for the participants to reflect on their perceptions and experiences

with the competencies in nursing education before the meeting. Participants were asked

to freely discuss their personal experiences and beliefs related to (a) nursing educators’

experiences with and perceptions of teaching information literacy to support evidence-

based practice, (b) evidence-based practice and information literacy competencies for

nursing graduates, (c) barriers that hindered nursing educators to teach information

59

literacy and evidence-based practice in the nursing curriculum, and (d) facilitators that

supported nursing educators to teach information literacy and evidence-based practice in

the nursing curriculum.

Protection of Human Subjects

Phase I. Once approval was received from the IRB, the data collection process

was conducted for the study (Appendix A). The survey designed in SurveyMonkey

included the informed consent for Phase I and also an explanation of the study’s purpose,

data collection process, confidentiality, risks, benefits of participation, and the survey

questions. Voluntary consent for participation was determined by the respondent’s

submission of the survey. The Anonymous Response Option available in SurveyMonkey

was used to protect the respondents’ identities, and responses could not be traced to any

participant’s Internet Protocol (IP) address or email address. To ensure confidentiality, no

personal information was collected, nor a specific nursing program in the ILNP-M

survey, and no personal information could be traced between individual responses or

schools of nursing.

The participants in Phase I were advised that the benefit of participating in the

study was knowing that they added to the current body of nursing educators’ knowledge

related to information literacy and evidence-based practice, and the evidence could be

used by colleges of nursing for curriculum review to ensure that nursing graduates were

prepared and confident to utilize the competencies in the clinical setting. The participants

were advised the risk of emotional stress due to the time commitment (approximately ten

minutes) and reflection related to their knowledge and beliefs of teaching information

literacy and evidence-based practice would be minimal. The participants were advised

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that results would be reported as aggregate data only, and no identifying information

could be traced to their personal identity or college of nursing. The participants were also

advised that the researcher had no financial or personal interest in any company or

instruments used in the study.

Phase II. A request for voluntary participation in Phase II of the study was

included in the Phase I survey. The last page of the survey included a Thank You note for

participating in the study and a request for volunteers to participate in Phase II data

collection. Educators interested in Phase II were asked to contact the researcher at the

email address located on the Thank You page of the Phase I survey. Participants were

assured that participation would be confidential and no personal information or the

college of nursing would be requested nor reported.

Twelve nursing educators participating in Phase I emailed the researcher and

expressed their interest in participating in Phase II of the study. The researcher emailed

the informed consent for Phase II (Appendix G) to each volunteer. The consent included

the privacy and security of the recordings, and data collected in Phase II would be

secured and locked in a safe area in the researcher’s home and destroyed five years after

the completion of the study. The consent included that the researcher had no financial or

personal interests in any company or instruments used in the study, and the results of the

study would be available and shared with those interested in the study and possibly

presented and published at a later date. Once the signed consent was emailed back to the

researcher, a meeting time was scheduled for the interviews. When each interview began,

the WebEx meeting was locked so that no one else could participate in the meeting, and

the participant was verbally asked for consent to audio-record the interview.

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Data Collection

Phase I. In the first phase, quantitative data were collected at one point in time

from each participant via an online survey. The survey for Phase I was emailed to the

dean/director of each college of nursing that voluntarily agreed to participate in the study.

The email included a brief explanation of the study and an embedded uniform resource

locator (URL) that linked to the 60-item survey in SurveyMonkey. In order to assure

confidentiality, the investigator requested that the linked survey be distributed via email

at the discretion of the head of the nursing program to the nursing faculty. The informed

consent for Phase I was located in the first section of the survey and implied consent was

determined with the submission of the online survey. Participants were asked to

voluntarily answer a 60-question survey to examine what their perceptions were about

information literacy and evidence-based practice in nursing education and cultural factors

that influenced implementation and perceived school-wide readiness for evidence-based

practice.

One week after data collection began, a follow-up email was sent to the

dean/director of each participating nursing program as a reminder to request faculty’s

participation, if they had not already done so. Time to complete the survey was

approximately ten minutes. Part 1 of the 60-question survey was the Information

Literacy for Evidence-Based Nursing Practice-Modified (ILNP-M) questionnaire and

included 19 items. The first six items pertained to participants’ age, gender, first nursing

degree, highest educational degree, current employment status, and program for primary

teaching responsibility. Thirteen questions related to participants’ perceptions,

knowledge, and beliefs about information literacy and evidence-based practice in nursing

education. Part

62

2 of the 60-question survey included 22 questions from the Evidence-Based Practice

Beliefs for Educators (EBPB-E) Scale. The Organizational Culture and Readiness for

School-Wide Integration of Evidence-Based Practice for Educators (OCRSIEP-E) Scale

was the third part of the data collection tool and included 19 questions for Phase I. One

hundred forty-five out of 402 (36%) nursing educators participated in Phase I data

collection of which 130 surveys were complete for a 32% completion rate on the ILNP-M

and OCRSIEP-E sections of the survey, and 137 surveys were complete on the EBPB-E

section for a 34% completion rate in Phase I. The survey was open for two weeks from

January 16 to 31, 2019.

Phase II. In the second phase of the study, a mutually agreed date and time was

scheduled with twelve consenting educators who had participated in Phase I data

collection. Eleven of the twelve interested educators participated in the audio-recorded

interviews. One educator did not accept the emailed invitation to participate in the

WebEx interview on the date and time previously scheduled and attempts to contact the

educator by email were not successful. Ten of the participants (67%) were female, and

one participant (33%) was a male.

Each participant chose his/her computer location for the one-to-one interview, and

the researcher conducted the interviews on the personal computer in her residence.

Before the conversation started, the participant was verbally asked again if they

voluntarily consented to being audio-recorded for the interview. The WebEx meeting was

locked, and the interview was private. Participants were advised that they could choose to

discuss all, some, or none of the interview topics, and participants were not coached,

coerced, or encouraged to share more than what they were comfortable to discuss. During

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each interview, a semi-structured protocol was used to freely discuss topics related to the

concepts of interest for the study. Each participant shared perceptions and experiences

related to information literacy and evidence-based practice as a nursing educator. No

personal information or the college of nursing where the participant was employed was

shared with anyone or reported in the findings of the study. The participants were ensured

that the entire interview would be kept confidential and that no one would be able to trace

their responses to any individual, and no sensitive or confidential information was

requested. Nine of the interviews went smoothly, but audio problems hindered two of the

meetings. The researcher was able to hear the interviewee over the computer, but the

interviewee was unable to listen to the researcher over the computer. Phone calls with

each interviewee took place to facilitate recording and successfully complete the

interviews.

Audio-recordings and verbatim transcriptions were conducted to ensure

credibility and authenticity (Polit & Beck, 2018) through audio-recorded interviews via

WebEx for the interviews. Nine of the meetings were face-to-face, and two of the

interviewees’ cameras were not turned on. To ensure dependability and reliability of data

over time and over conditions (Polit & Beck, 2018), the audio-recordings were collected

with the use of a reputable online meeting venue known as WebEx. The recordings were

saved in the researcher’s iCloud account and in a memory card that is properly stored and

secured in the researcher’s private residence (Davison, 1996, as cited in Creswell & Poth,

2018). The audio-recorded files will remain stable, secured, and unchanged for five years.

The time to complete each interview ranged between 12 to 51 minutes and averaged 25

minutes. Participants interviewed included nursing educators who were knowledgeable

64

about the phenomenon and qualified enough to discuss the interview topics. Data

collection for Phase II took place between January 21 and February 26, 2019.

Data Analysis

Phase I. Raw data collected in Phase 1 were automatically collated and

downloaded from SurveyMonkey and exported into an Excel file. Analysis of

quantitative data was done using IBM’s Statistical Analysis System (SAS) for Windows,

Version 9.4. Descriptive statistics were used to summarize the characteristics of the

sample, response frequencies, and distributions of survey answers. Means and standard

deviations were computed for continuous response variables for each data collection tool.

Correlational coefficients were calculated between groups of educators. The level of

significance was set for the study at P < 0.05. Descriptive statistics were used to describe

the sample and compare the ILNP-M, EBPB-E, and OCRSIEP-E Scales with frequencies,

percentages, means, and modes. Inferential statistics were used to analyze the ILNP-M,

EBPB-E, and OCRSIEP-E Scales with the use of analysis of covariance (ANOVA) to test

mean group differences between age groups and primary teaching programs for the

nursing educators (Polit & Beck, 2018). Chi-squared tests were used to the test

differences between age groups and primary teaching programs between the scales.

Pearson correlation coefficients were used to analyze the correlation between the

OCRSIEP-E and EBPB-E Scales. Scatter plots were used to correlate the EBPB-E and

OCRSIEP-E Scales, and Cronbach’s alpha tests were used to determine internal

consistency reliability for the EBPB-E and OCRSIEP-E Scales (Polit & Beck, 2018).

Research Question One: Are nursing educators knowledgeable about information

literacy and evidence-based practice competencies and prepared to teach information

65

literacy to support evidence-based practice in nursing education as measured by the

ILNP-M questionnaire? Items on the ILNP-M included six demographic questions and

thirteen information literacy and evidence-based practice questions. Specific questions

with multiple answer choices in the ILNP-M questionnaire relating to information

literacy included (a) how is information found to support the faculty role, (b) what

databases are commonly searched to find evidence to support teaching responsibilities,

(c) who is primarily responsible for teaching information literacy to nursing students, (d)

what Information Literacy Competency Standards for Nursing prepared to teach, and (e)

aware of the Information Literacy Competency Standards for Nursing (yes/no)? Specific

questions with a yes or no answer in the ILNP-M questionnaire relating to evidence-

based practice (EBP) included (a) being familiar with EBP competencies for RNs, (b) are

EBP competencies identified as learning outcomes in nursing courses, (c) what facilitates

and hinders locating and using current evidence to support faculty role, and (d) does the

nursing curriculum include a research/EBP course?

Research Question Two: Do nursing educators have a firm belief and confidence

in their ability to teach and implement evidence-based practice as measured by the

EBPB-E Scale? A sample of specific questions using a 5-point Likert scale ranging from

1 (strongly disagree) to 5 (strongly agree) in the EBPB-E Scale for evidence-based

practice (EBP) included (a) I am clear about the steps of EBP, (b) I am sure that I can

implement EBP, (c) I am sure that implementing EBP will improve the care that students

deliver to patients, and (d) I am sure that integrating EBP into the curriculum will

improve the care that students deliver to their patients.

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Research Question Three: What are the cultural factors that influence the

implementation of EBP within the educational environment and the perceived readiness

for school-wide integration of EBP as measured by the OCRSIEP-E Scale? Specific

questions using a 5-point Likert scale ranging from 1(Not at all) to 5 (Very much) in the

OCRSIEP-E Scale for evidence-based practice (EBP) included (a) what extent is

evidence-based education practiced in organization, (b) what extent is there a critical

mass of faculty who have strong EBP knowledge and skills, (c) what extent do faculty

model EBP in educational and clinical settings, and (d) rate institution’s readiness for

EBP. A sample of specific questions using a 5-point Likert scale ranging from 1(Not at

all) to 5 (Very much) in the OCRSIEP-E Scale related to information literacy were (a)

what extent do faculty members have access to quality computers and access to electronic

databases for searching for the best evidence, (b) what extent do faculty members have

proficient computer skills, and (c) what extent do librarians within organization have

evidence-based practice knowledge and skills?

Phase II. Eleven participants were asked to freely discuss their personal

experiences and beliefs related to (a) nursing educators’ experiences with and perceptions

of teaching information literacy to support evidence-based practice, (b) evidence-based

practice and information literacy competencies for nursing graduates, (c) barriers that

hindered nursing educators to teach information literacy and evidence-based practice in

the nursing curriculum, and (d) facilitators that supported nursing educators to teach

information literacy and evidence-based practice in the nursing curriculum.

Data were analyzed manually following a thematic approach that included a

thorough and repeated review of each recording (Creswell & Poth, 2018). After each

67

interview, the audio recordings were reviewed by the researcher and transcribed into

written format. A second review of the recordings was conducted by the researcher to

capture missing information from the first review and to gain an overall understanding

each interview. Several of the recordings required more than a second review to fully

transcribe the entire interviews and correct any errors in transcription. Common meanings

and shared experiences were identified by comparing and contrasting the recordings.

Content analysis was achieved by searching for broad themes that emerged from the

narrative data by breaking down data into small categories according to the content

represented (Polit & Beck, 2018).

Once all of the interviews were transcribed completely, the transcripts were coded

in quoted phrases on a data display table designed by the researcher and based on the

interview topics. Separate coding was used for age, gender, degree, teaching program,

years of nursing and years of teaching experience of each participant. For objective

external review, an outside reviewer was hired to listen to all of the recordings and enter

additional quoted phrases to the data display table. The outside reviewer did not have any

knowledge of the research study and was able to understand the language of the

interviewees as a graduate student in nursing. Intercoder agreement of the quoted phrases

was achieved between the researcher and the outside reviewer. The researcher emailed

the participants in Phase II to verify the quoted phrases for each interview and provide

feedback related to their true meaning about the interview topics. Each participant was

given a number to refer to on the data display table that pertained to their transcribed

quotes. All of the participants agreed with their individual transcript, and no new data

emerged.

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Colaizzi’s (1978) phenomenological approach was used to analyze the transcripts

in the data display table. With this method, all quoted transcripts in the data display table

were read several times to gather a feeling for the overall message. From each transcript,

significant phrases that pertained to the experiences of knowing about and teaching

information literacy to support evidence-based practice were identified (Creswell & Poth,

2018). Meanings were then formulated from the statements and phrases that were found

to be significant and repetitive. Relationships among categories emerged into themes.

The meanings were clustered into themes for commonality to emerge from all of the

transcripts. A draft of the themes and categories emerged along with illustrative quotes.

The results were then integrated into an in-depth description of the phenomenon

(Creswell & Poth, 2018).

Trustworthiness. Four criteria for the trustworthiness of qualitative research are

credibility, dependability, confirmability, and transferability, and these four criteria

parallel the requirements of internal validity, reliability, objectivity, and external validity

(Lincoln & Guba, 1985, as cited in Polit & Beck, 2018). Strategies to validate qualitative

research such as corroborating evidence through triangulation of multiple data sources,

clarifying researcher bias, member checking, and feedback, and enabling external audits

with knowledgeable peer reviewers for intercoder agreement (Creswell & Poth, 2018;

Polit & Beck, 2018; Tong, Sainsbury, & Craig, 2007). Transferability is analogous to

generalizability so that readers can evaluate the applicability of the findings to other

contexts (Polit & Beck, 2018). Descriptions and interpretations of data were supported by

multiple researchers’ evidence in relevant literature related to information literacy and

69

evidence-based practice to support transferability and will be applicable to other settings

(Melnyk & Fineout-Overholt, 2019; Mthiyane & Habedi, 2018; Pravikoff et al., 2005).

During data analysis, credibility and transferability were assured with the

saturation of data noted by redundancy in interviews numbers seven through eleven (Polit

& Beck, 2018; Tong et al., 2007). Member checking was used for the credibility and

dependability of the transcribed data (Polit & Beck, 2018; Tong et al., 2007). The

researcher emailed the completed data display table to each interviewee and requested

feedback to confirm that the interview data captured accurate wording in the transcription

of each interviewee and reflected the voice and interpretation of each interview

(Christenbery, 2017; Polit & Beck, 2018). All of the interviewees were emailed the data

display table with a number that coincided with their transcript. Ten of the interviewees

confirmed that the quoted transcriptions in the data display table were accurate and

offered no additional feedback. One interviewee replied in an email that a review of the

transcript would be completed, but never sent confirmation of the quotes and was

interpreted as approved by that individual.

Transcription rigor and data cleaning for credibility were accomplished with the

use of external audits that were performed by two peer reviewers (Polit & Beck, 2018).

For credibility and confirmability, an external peer reviewer (nursing graduate student not

familiar with the study) was hired to listen to the eleven audio-recordings, and manually

coded the findings into the qualitative display table. Categories for each theme were

matched, congruency was noted, and intercoder reliability and saturation were also noted

in the data display table (Polit & Beck, 2018). A second external reviewer, a doctorate

nursing colleague experienced in qualitative research, audited the data display table for

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both process and product intercoder reliability, credibility, and confirmability, and

offered constructive feedback related to the initial coding that was addressed adequately

in the current analysis for Phase II (Polit & Beck).

Conclusion

The mixed methods research design was described in detail in this chapter. The

ethical considerations for the study, setting, population and sample selection, data

collection tools and processes, and data analysis were presented in this chapter for both

Phase I and Phase II. Data collection tools for Phase I and Phase II were identified and

supported by earlier researchers and specifically focused on IL and EBP in nursing

education. The population included 402 nursing educators teaching in 16 nursing

programs in a south-central state. One hundred forty-five educators participated in Phase

I and eleven nursing educators participated in Phase II of the study. Descriptive and

inferential statistics were used to analyze the quantitative data collected in Phase 1 and

interpretive phenomenology was used to analyze the qualitative data in Phase II. The

results of the findings will be presented in Chapter 4.

CHAPTER 4: RESULTS

Introduction

Educators are ethically obligated to be aware of and knowledgeable about the

competencies that nursing graduates are expected to possess for clinical practice in the

twenty-first century (Kalb, O’Connor-Von, Brockway, Rierson, & Sendelbach, 2015).

There is an urgent need for nursing educators to promote and prioritize the use of

evidence-based practice in academia and prepare nursing graduates to learn how to use

evidence in most practice settings (Kalb et al., 2015). If clinical decision-making is to be

based on evidence, the faculty who teach future nurses need to be cognizant of the

competencies that are discipline-specific for nurses such as information literacy and

evidence-based practice competencies (Phelps et al., 2015; Pierce, 2006; Pravikoff, 2006;

Ross, 2010). Information literacy is necessary to support the successful implementation

of evidence-based practice in professional nursing education (Pierce, 2000). Educators

must reflect and examine personal knowledge about the competencies that students are

expected to learn in nursing school related to information literacy and evidence-based

practice.




of nursing in a south-central state. To answer the research questions posed for this study,

72

data were collected to examine nursing educators’ perceptions and beliefs about

information literacy and evidence-based practice and the cultural factors that influenced

the implementation and school-wide integration of evidence-based practice. The

following questions were addressed in the study:












E) Scale?



A mixed-methods explanatory research design was used to collect different, but

complementary data focused on the same concepts understudy and triangulated data

sources to converge on the truth about these competencies (Polit & Beck, 2018). Phase I

results and demographic profiles of the participants are presented in the chapter and

based on self-reported surveys from nursing educators. Phase II results are also presented

73

and based on transcribed semi-structured interviews conducted individually with nursing

educators. Data analysis for Phase I and Phase II are presented in this chapter related to

each research question with quantitative and qualitative results and findings.

Phase I Results

Three data collection tools were used to collect data and answer the research

questions in Phase I of the study. The three scales were combined into one 60-question

survey to measure nursing educators’ perceptions of and beliefs about information

literacy, evidence-based practice, and cultural factors that influenced the implementation

of evidence-based practice in colleges of nursing and perceived school-wide readiness for

integrating evidence-based practice. One hundred forty-five (145) educators from a

population of 402 teaching in sixteen nursing programs in the south-central state

participated in Phase I for a 36% response rate. The ILNP-M and OCRSIEP-E questions

had 15 incomplete answers leaving a sample of 130 surveys for a 32% completion rate.

The EBPB-E questions had eight incomplete responses leaving a sample or 137 surveys

for a 34% completion rate.

Information Literacy for Evidence-Based Nursing Practice-Modified (ILNP-

M) Questionnaire. The first section of the Phase I survey included nineteen questions

from the original Information Literacy for Evidence-Based Nursing Practice (ILNP)

questionnaire. Of the nineteen questions, there were six demographic and thirteen

information literacy and evidence-based practice questions from the original 93-item

ILNP. The modified tool was renamed as the ILNP-Modified (ILNP-M) questionnaire.

Data collected from the ILNP-M questionnaire are presented in narrative summaries and

tables to answer research question one: Are nursing educators knowledgeable about

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information literacy (IL) and evidence-based practice (EBP) competencies and prepared

to teach information literacy to support evidence-based practice in nursing education as

measured by the ILNP-M questionnaire?

Demographic characteristics. Demographic characteristics of

participants in Phase I of the study are displayed in Table 2. Though 130 participants

completed the ILNP-M, the researcher chose to demographically describe all participants

(145) for total disclosure of the sample. The majority (56%) of participants were between

forty to sixty years of age (4% less than thirty years, 13% aged thirty-one to thirty-nine

years, 28% aged forty to forty-nine years, 28% aged fifty to fifty-nine years, 26% aged

sixty to sixty- nine years, 1% greater than sixty-nine years). Participants were primarily

female (89%) and taught in baccalaureate programs (44%). Five percent taught in

Registered Nurse to Bachelor of Science in Nursing (RN to BSN) programs, and

participants teaching in associate-degree programs accounted for 29% of the sample.

Fifteen percent taught in Master of Science in Nursing and Nurse Practitioner (MSN/NP)

programs, 4% taught in Licensed Practical Nurse (LPN) programs, and 3% taught in

doctorate programs. The majority of the sample worked full-time (97%) and 3% were

classified as adjunct faculty.

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Table 2

Demographic Characteristics

Category Subcategory Frequency Percentage

Age < 30 5 430- 39 21 1540 - 49 40 2850 - 59 41 2860 – 69 37 26

>70 1 1

Gender Male 16 11Female 129 89

Primary LPN 6 4teaching ASN 41 28program BSN 64 44

RN - BSN 9 6MSN/FNP 21 15Doctorate 4 3

Work status Adjunct 5 3Full-time 140 97

(N = 145)

First nursing degree. The majority of participants’ first nursing degrees

included the Bachelor of Science in Nursing (BSN) degree (91, 70%), followed by the

Associate of Science in Nursing (ASN) degree (29, 22%), Diploma in Nursing degree (7,

5%), and the Master of Science in Nursing (MSN) degree (2, 1%). Data are reported in

Table 3.

One (1%) participant reported a Licensed Practical Nurse (LPN) degree as the first

nursing degree.

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Table 3

First Nursing Degree

Degree Frequency Percentage

Licensed Practice Nursing (LPN) 1 1%

Diploma in Nursing 7 5%

Associate of Science in Nursing (ASN) 29 22%

Bachelor of Science in Nursing (BSN) 91 70%

Master of Science in Nursing (MSN) 2 2%

(N = 130)

Highest nursing degree. Seventy-six (58%) participants reported the

Master of Science in Nursing (MSN) degree as the highest degree. Forty-nine (38%)

participants had doctorate degrees: Doctor of Nursing Practice (DNP) [30, 23%], Doctor

of Philosophy (PhD) [15, 12%], Doctor of Education (EdD) [4, 3%]. Five (3%)

participants reported the Bachelor of Science in Nursing (BSN) degree as the highest

degree. Two participants with BSN degrees were in school for the MSN degree, and five

participants with the MSN degrees were in school pursuing doctorate degrees. The

participants with a BSN degrees taught in Licensed Practical Nursing (LPN) programs.

Results for highest degree are noted in Table 4.

Table 4

Highest Nursing Degree

Degree Frequency PercentageBachelor of Science in Nursing (BSN) 5 4%Master of Science in Nursing (MSN) 76 58%Doctor of Nursing Practice (DNP) 30 23%Doctor of Philosophy (PhD) 15 12%Doctor of Education (EdD) 4 3%

(N = 130)

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Information seeking to support faculty role. The majority of

participants reported “always/frequently” finding information to support their faculty

roles in professional journals and reference textbooks (91%), in healthcare databases

(76%), from colleagues and peers (65%), Google and other non-healthcare databases

(48%), and other resources (39%) such as healthcare agencies’ policy and procedure

manuals, Up-to-Date, professional conferences, and assigned textbooks. Librarian’s

assistance (9%) was selected least of all. Information seeking selections are displayed in

Table 5 with eight missing responses. Chi-squared test was used to assess differences in

information-seeking sources. No statistically significant differences were noted in the

following categories for primary teaching program: Assistance from librarian (x2 = 7.53,

df = 8, p = 0.48); asking colleagues and peers (x2 = 11.73, df = 8, p = 0.16); searching

healthcare databases (x2 = 8,78, df = 8, p = 0.36); searching Google and other

nonhealthcare databases (x2 = 6.43, df

= 8, p = 0.60); reviewing professional journals (x2 = 8.26, df = 6, p = 0.22). A statistically

significant difference was noted in the Other selection (x2 = 15.80, df = 8, *p = 0.045).

The difference for the Other selection was noted in participants teaching in LPN, ASN,

and BSN programs. Participants teaching in MSN and doctorate levels of nursing did not

choose Other.

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Table 5

Information Seeking to Support the Faculty Role

databases

non-healthcare database

manuals, Up-to-Date,

the librarian(N = 130, *p < 0.045)

Healthcare databases searched to support faculty role.

Healthcare databases most commonly searched to find evidence to support teaching

responsibilities included: Cumulative Index for Nursing and Allied Health Literature

[CINAHL] (114, 88%), PubMed (80, 62%), MEDLINE (68, 53%), Cochrane Library

Nursing (54, 42%),

ProQuest (35, 27%), and Academic Search (34, 26%). The Joanna Briggs Institute (9,

7%) and Turning Research into Practice [TRIP] (6, 5%) databases were chosen least

(Table 6). Chi-squared statistics were used to assess differences in teaching programs. No

statistically significant differences were noted in the following databases: Academic

Search (x2 = 2.87, df = 2, p = 0.24); Cumulative Index for Nursing and Allied Health

Literature [CINAHL] (x2 = 3.46, df = 2, p = 0.18); Cochrane Library (x2 = 2.92, df = 2,

p = 0.23); MEDLINE (x2 = 1.52, df = 2, p = 0.47); PubMed (x2 = 0.42, df = 2, p = 0.81);

ProQuest (x2 = 0.43, df = 2, p = 0.81); Turning Research in Practice [TRIP] (x2 = 5.35,

Information Source Always/Frequently % Sometimes % Rarely/Never %

Professional journals 91% and reference textbooks

8% 1%

Search healthcare 76% 20% 4%

Colleagues and peers 65% 24% 11%

Search Google or other 48% 34% 18%

Other: Agency’s policy 39% 26% 35%

conferences

Seek assistance from 9% 36% 55%

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df = 2, p = 0.07); Google Scholar (x2 = 1.12, df = 2, p = 0.57); Other databases (x2 = 3.23,

df = 2, p = 0.20). A statistically significant difference was for found for participants

teaching in graduate and doctorate programs and using the Joanna Briggs Institute

database (x2 = 9.17, df = 2, p = 0.01). One missing response was noted for this question.

Table 6

Healthcare Databases Searched to Support Faculty Role

Online Healthcare Database Frequency Percentage

CINAHL 114 88

PubMed 80 62

MEDLINE 68 53

Cochrane Library for Nursing 54 42

Google Scholar 52 40

ProQuest 35 27

Academic Search 34 26

Other databases (Up-to-date, ScienceDirect, Medscape, NLN, AHRQ, Google, Scopus)

14 11

**Joanna Briggs Institute 9 7

TRIP Resources for EBP 6 4(N = 130, **p = 0.01)

Facilitators for searching healthcare databases. Facilitators

for locating and using current evidence to support participants’ faculty roles are

identified in Table 7. The most frequently selected facilitator was the availability of

healthcare databases for evidence-based practice (106, 82%). Personal expectations for

evidence-based practice as a nursing educator (93, 72%), faculty colleagues’

encouragement and support (73, 57%), availability of information technology (IT)

support (55, 43%), administrative encouragement and support (48, 37%), availability of

librarian to assist in searching the

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literature (32, 25%), and online tutorials (29, 23%) were also selected by participants.

There was one missing response for this question.

Table 7

Facilitators for Searching Healthcare Databases

Facilitators Frequency Percentage

Availability of healthcare databases for EBP 106 82

Personal expectation for EBP as a nursing educator 93 72

Faculty colleagues’ encouragement and support 73 57

Availability of information technology (IT) support 55 43

Administrative encouragement and support 48 37

Availability of librarians to assist in searching the literature 32 25

Availability of online tutorials to search databases 29 23

(N = 130)

Barriers for searching healthcare databases. Participants

teaching in all programs selected lack of time (80%) most frequently as a barrier that

hindered searching healthcare databases (Table 8). After time, lack of knowledge and

understanding the organization or structure of electronic databases (25%), other (15%),

lack of skills to analyze and apply research evidence (14%), lack of information literacy

(IL) skills (12%), lack of computer skills (12%), lack of librarian support (5%), and lack

of value for research evidence (4%) were additional barriers. Other option responses

included lack of administrative and faculty support/encouragement, lack of financial

resources, understanding the search terms, and searching was too overwhelming. There

were eight missing responses.

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Table 8

Barriers for Searching Healthcare Databases

Barriers Frequency Percentage

Lack of time 98 80

Lack of understanding organization of databases 25 21

Other: Too overwhelming, lack of administrative/faculty encouragement, lack of financial resources, understanding search terms

15 12

Lack of skills to analyze and apply research evidence 14 12

Lack of priority and value for EBP as compared to other teaching skills

13 11

Lack of information literacy skills 12 10

Lack of computer skills 12 10(N = 130)

Evidence-based practice competencies and course in nursing program.

Participants’ answers for evidence-based practice competencies and research course are

identified in Table 9. Participants teaching in all nursing programs were familiar with

evidence-based practice (EBP) competencies for RNs (119, 86%), and the majority

responded, Yes, that evidence-based practice competencies were identified as learning

outcomes in nursing courses (117, 85%). A research/evidence-based practice course was

included in most nursing programs (96, 70%). Thirty (30, 79%) participants teaching in

associate degree programs reported that a research/evidence-based practice course was

not in the curriculum, and five (5, 8%) of the Bachelor of Science in Nursing (BSN)

educators reported no research/evidence-based practice course in the curriculum.

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Table 9

Evidence-Based Practice Competencies and Course in Nursing Program

EBP Competencies Frequency Percentage

Familiar with EBP competencies 112 86

EBP identified as learning outcome in courses 110 85

Research/EBP course in the curriculum 92 71

(N = 130)

Information literacy competencies and informatics

course. Participants’ answers related to information literacy competencies for nurses

are displayed in Table 10. The majority of participants (123, 95%) reported that

information literacy was a pre-requisite for evidence-based practice. The majority (85,

65%) were not aware of the Information Literacy Competency Standards for Nursing,

and most participants (70, 54%) reported the nursing program did not include an

informatics course. Informatics courses were offered in 13% of Associate of Science in

Nursing (ASN) participants’ programs, 71% of Bachelor of Science in Nursing (BSN)

participants’ programs, 30% of Master of Science in Nursing (MSN) participants’

programs, and 75% of doctorate participants. There was no statistically significant

difference between participants’ age categories (< 50 years and

> 50 years) for awareness about information literacy competencies (x2 = 0.13, df = 1, p =

0.72), and no statistically significant differences related to primary teaching program (x2

= 2.51, df = 2, p = 0.28).

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Table 10

Information Literacy Competencies and Informatics CourseIL Competencies Yes % No %

Educators believe IL competencies are a prerequisite for EBP

123, 95% 7, 5%

Educators are aware of 45, 35% 85, 65%IL Competency Standards for Nursing (ACRL, 2014)

Informatics course offered in the nursing curriculum 60, 46% 70, 54%

(N = 130)

Responsible for teaching information literacy skills. The

results related to participants’ answers about who was primarily responsible for teaching

information literacy skills to nursing students are displayed in Table 11. The majority

(89, 69%) of the participants thought that nursing faculty were primarily responsible for

teaching information literacy skills in each nursing course. Participants believed nursing

faculty and librarians were responsible for teaching information literacy skills throughout

nursing education (58, 45%). Online tutorials through the library (41, 32%) and the

librarian in face-to-face sessions (39, 30%) were selected for students to learn

information literacy skills. Eleven percent selected students should be information literate

before they enter nursing school. The Other option (9, 7%) was selected and included

information technology (IT) department and teachers in the research course responsible

for teaching skills.

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Table 11

Responsible for Teaching Information Literacy Skills

Responsible for Teaching IL Skills Frequency Percentage

Nursing faculty in each nursing course 89 69

Nursing faculty and librarian teach 58 45throughout nursing education

Online tutorials through the library 41 32

Librarian in face-to-face sessions 39 30

Student should be information literate Before entering nursing school

14 11

Other: Information Technology (IT), research instructor

9 7

(N = 130)

Information literacy competencies educators prepared to

teach. Standard 2 was selected by the majority (97, 81%) of the participants

expressing that information literate educators were competent to assess needed

information effectively and efficiently.

Standard 1 was selected by 87 participants (73%) related to being able to define and

articulate the need for information. Standard 4 was selected by 81 (68%) educators

related to the ability to individually, or as a member of a group, use information

effectively to accomplish a specific purpose. Standard 3 was selected by 63 (53%)

educators believing they were able to critically evaluate information and its sources and

decide whether to modify the query and/or seek additional sources or develop a new

search process. Standard 5 was selected the least amount of times (52, 43%) and related

to educators’ beliefs that many of the economic, legal, and social issues surrounding the

use of information and access and use information ethically and legally were understood.

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The standards and results are reported in Table 12. Ten participants did not answer the

question.

Table 12

Information Literacy Competencies Educators Prepared to Teach

Information Literacy Competency Standards for Nurses Frequency Percentage

Standard 1: Define and articulate the need for information. 87 73

Standard 2: Assess needed information effectively and efficiently.

Standard 3: Critically evaluate the information and its sources and decide whether to modify the query and/or seek additional sources or develop a new search process.

Standard 4: Individually, or as a member of a group, use information effectively to accomplish a specific purpose.

Standard 5: Understand the economic, legal, and social issues surrounding the use of information and access and use information ethically and legally.

97 81

63 53

81 68

52 43

(N = 130)

Results for Information Literacy for Evidence-Based

Nursing Practice- Modified (ILNP-M). Research Question One: Are nursing

educators knowledgeable about information literacy and evidence-based practice

competencies and prepared to teach information literacy to support evidence-based

practice in nursing education as measured by the ILNP-M questionnaire? Demographic

information for the study included a sample of 145 nursing educators. The majority of the

sample were female (89%), employed full time (97%), taught in the baccalaureate level

of nursing education (49%), and had a graduate degree (59%) as the highest nursing

degree. Participants reported being under the age of 50 (45%) and over 50 (55%) years of

age. Sources used to find information for faculty needs primarily included professional

journals and reference

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textbooks (89%), healthcare databases (73%), and colleagues and peers (66%). The

librarian was used least of the time (9%). Though there was a statistically significant

difference noted for information sources used to find information on the Other response

(p = 0.045) and related to participants teaching in Licensed Practice Nursing (LPN),

Associate of Science in Nursing (ASN), and Bachelor of Science in Nursing (BSN)

programs, the researcher did not deem this finding to be significant related to making any

worthwhile conclusions and recommendations for the study.

Healthcare databases primarily searched were Cumulative Index for Nursing and

Allied Health Literature [CINAHL] (88%), PubMed (62%), and MEDLINE (53%) to

support participants’ teaching roles. Though there were no statistically significant

differences in most databases searched, a statistically significant difference was noted in

the Joanna Briggs Institute (p = 0.01) for nurses teaching in graduate and doctorate

nursing programs. This result was selected by nine participants teaching in graduate and

doctoral programs in the sample, and no recommendations will be made related to this

result. The availability of healthcare databases (82%) and personal expectations for

seeking evidence as a nursing educator (72%), and faculty colleagues’ encouragement

and support (57%) were the most selected facilitators for searching databases for

evidence-based practice. The most frequently selected barriers for searching databases for

evidence were lack of time (80%) and lack of understanding of the organization of

electronic databases (21%). The majority of educators were familiar with evidence-based

practice competencies (86%) and identified evidence-based practice as a learning

outcome in nursing courses (85%). Most nursing programs (71%) had a research or

evidence-based practice course in the curricula. The majority (80%) of participants

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teaching in Associate of Science in Nursing (ASN) programs reported no research or

evidence-based practice course and no informatics course (88%). This finding is not

unusual due to research was not traditionally included in associate degree nursing

education. Thirty percent of participants teaching in Bachelor of Science in Nursing

(BSN) programs reported no informatics course.

Contrary to beliefs about and awareness for evidence-based practice, the majority

of educators (65%) were not aware of information literacy competencies and reported no

informatics course in the curriculum (54%), yet 95% believed information literacy

competencies were prerequisites for evidence-based practice. The majority of participants

(69%) believed that nursing faculty were responsible for teaching information literacy

skills in each nursing course followed by nursing faculty and librarians collaborating and

teaching together throughout the nursing curriculum (45%). The majority of the

participants (81%) were prepared to teach students how to assess needed information

effectively and efficiently, define and articulate the need for information (73%), and

individually, or as a member of a group, use information effectively to accomplish a

specific purpose (68%). The unanimous belief that nursing educators were responsible for

teaching information literacy competencies will require faculty to learn how to critically

evaluate sources of information for use in practice and learn the economic, legal, and

social issues surrounding the use of information in nursing practice.

Evidence-Based Practice Beliefs-Educator (EBPB-E) Scale. The second part of

Phase I data collection survey included twenty-two questions. There were 137 completed

surveys for the Evidence Based Practice Beliefs-Educator (EBPB-E) Scale from 145 total

respondents for a 95% completion rate on the scale. Eight participants had partial data

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missing in this section of the survey. Scores ranged from 22 to 11, and interpretation

markers were on 22, 44, 66, 88, and 110. Bernadette Melnyk and Ellen Fineout-Overholt

designed the EBPB-E Scale to measure educators’ beliefs about evidence-based practice

(EBP). According to one of the authors of the EBPB-E Scale, scores less than 88

indicated less than agreement with the respondents’ knowledge of, confidence in, and

beliefs in their ability to teach and implement EBP, and scores greater than 66 (neither

agree nor disagree), but less than 88, indicated that there was not full commitment to

evidence-based practice (E. Fineout-Overholt, personal communication, March 15,

2019). Scores less than 66 indicated there was no commitment to teaching or

implementing evidence-based practice. Overall, the closer to 88, but not exceeding, the

more commitment/belief in teaching and implementing evidence-based practice, and

mean scores 88 indicated firm belief and confidence in teaching evidence-based practice

(E. Fineout-Overholt, personal communication, March 15, 2019). The overall EBPB-E

mean score was 91.57 (SD = 10.67) indicating that participants had firm beliefs and

confidence in their abilities to teach and implement evidence-based practice.

Mean scores for Evidence-Based Practice Beliefs-Educator (EBPB-E) Scale.

Mean scores for the Evidence-Based Practice Beliefs-Educator (EBPB-E Scale) are noted

in Table 13 in rank order. All mean scores for positive statements were > 3.5 indicating

strong beliefs in and confidence in teaching and implementing evidence-based practice

(EBP) competencies. Mean scores and standard deviations (M, SD) for the top five items

in ranked order were: I am sure that evidence-based guidelines can improve clinical care

(4.71, 0.49); I believe that evidence-based practice (EBP) results in the best clinical care

for my patients (4.65, 0.61); I believe that critically appraising evidence is an important

89

step in the EBP process (4.62, 0.52); I am sure that implementing EBP will improve the

care that my students deliver to patients (4.53, 0.56); and I am sure that integrating EBP

into the curriculum will improve the care that students deliver to their patients (4.49,

0.57). Means and standard deviations for the reverse scored items for participants

believed evidence-based practice was not difficult and evidence-based practice did not

take too much time (2.60, 0.92) and (2.34, 0.83).

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Table 13

Mean Scores for Evidence-Based Practice Beliefs-Educator (EBPB-E) Scale

Item Mean (SD) Strongly agree/ agree %

Neither agree nor disagree %

Evidence-based guidelines canimprove clinical care. 4.71 (0.49) 98.46 1.54

EBP results in the best clinicalcare for my patients. 4.65 (0.61) 96.92 2.31

Critically appraising evidence isImportant step in EBP process. 4.62 (0.52) 98.43 1.57

Implementing EBP improves thecare students deliver to patients. 4.53 (0.56) 96.92 3.08

Integrating EBP in curriculumwill improve the care students 4.49 (0.57) 95.39 3.85deliver to their patients.

I can implement EBP. 4.33 (0.74) 90.70 6.98I am clear about the steps of EBP. 4.32 (0.81) 88.46 7.69I deliver care based on evidence. 4.25 (0.60) 91.47 8.53I can teach how to search for

the best evidence. 4.25 (0.73) 77.52 17.83I know how to teach EBP enough to

Impact student’s practices. 4.21 (0.69) 84.61 13.08I can overcome barriers to

implement EBP. 4.21 (0.66) 81.39 14.73I can search for the best evidence to

answer clinical questions in a 4.19 (0.81) 82.94 13.18time efficient way.

I am sure I can teach EBP. 4.18 (0.78) 85.38 11.54I can teach how to develop a

PICOT question. 4.12 (0.85) 81.53 11.54I am sure about how to measure

the outcomes of clinical care. 4.07 (0.78) 80.62 15.50I can teach EBP in a time

efficient way. 4.00 (0.79) 75.38 21.54I can implement EBP in a

time efficient way. 4.00 (0.79) 77.70 17.69I can access the best resources

to integrate EBP in curriculum. 3.90 (0.76) 73.85 22.31I am confident about my ability to

implement EBP where I work. 3.88 (0.74) 70.77 24.62I know how to implement EBP

sufficiently curricular changes. 3.74 (0.82) 68.21 20.93

I believe EBP is difficult. 2.60 (0.92) 20.61 28.24I believe EBP takes too much time. 2.34 (0.83) 8.53 29.46

(N = 137)

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Evidence-Based Practice Beliefs-Educator (EBPB-E) Scale

results for primary teaching program. Nursing educators teaching in

Associate of Science in Nursing (ASN) programs had a mean score of 89.29 (SD =

10.42); educators teaching in Bachelor of Science (BSN) and RN to BSN programs had a

mean score of 92.56 (SD = 11.31). The highest mean score on the Evidence-Based

Practice Beliefs-Educator (EBPB-E) Scale was noted for participants teaching in Master

of Science in Nursing (MSN), Nurse Practitioner (NP) and Doctorate Nursing Programs

(DNP) with a mean score of 93.09 (SD = 9.46). No statistically significant differences

were noted using a one-way ANOVA (F = 1.37, df = 2, p = 0.26). Comparison statistics

for educators teaching in different educational programs are noted in Table 14.

Table 14

Evidence-Based Practice Beliefs-Educator (EBPB-E) Scale Results for Primary Teaching Program

Educational Program Frequency Mean (SD)

Associate of Science in Nursing (ASN) 38 89.29 (10.42)

Bachelor of Science in Nursing (BSN)/RN to BSN

64 92.56 (11.31)

Master of Science in Nursing (MSN)/ Nurse Practitioner (NP)/Doctorate

24 93.09 (9.46)

(N = 137, p = 0.26)


results for belief in evidence-based practice and primary

teaching program. Participants teaching in Associate of Science in Nursing

(ASN) programs (n = 38) were split in beliefs about evidence-based practice. Fifty-five

percent (55%) reported a strong belief in evidence- based practice (55%) and 45% of the

participants did not have a strong belief in

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evidence-based practice. Most participants teaching in Bachelor of Science in Nursing

(BSN) programs (n = 64), and Master of Science in Nursing (MSN), Nurse Practitioner

(NP) and Doctorate programs (n = 24) reported a strong belief in evidence-based

practice (BSN 65%, MSN/NP/Doctorate 67%) compared to not a strong belief in

evidence-based practice (BSN 35%, MSN/NP/Doctorate 33%). No statistically

significant differences were noted with the chi-squared test (x2 = 1.29, df = 2, p = 0.52).

There were 11 pieces of missing data related to this result and are reported in Table 15.

Table 15

Evidence Based Practice Beliefs-Educator (EBPB-E) Scale Results for Belief in Evidence Based Practice and Primary Teaching Program

Educational Program Frequency Strong Belief in Not Strong Belief inEBP % EBP %

Associate of Science in Nursing (ASN)

38 55% 45%

Bachelor of Science in 64 65% 35%Nursing (BSN)/

RN to BSN

Master of Science in 24 67% 33%Nursing (MSN)/Nurse

Practitioner (NP)/Doctorate

(N = 126, p = 0.52, missing data, n = 11)


total scores for age range. The mean scores for participants less than fifty

years was 93.32 (SD = 11.41), and the mean for those greater than fifty years was 90.01

(SD = 9.85). A one-way ANOVA comparing participants’ ages did not result in a

statistically significant difference (F = 3.13, df = 1, p = 0.08). Due to the score being

close to the level of significance (P < 0.05), age categories were compared individually to

note any statistically significant

93

differences. There were five participants under the age of thirty grouped with the less

than forty-year old participants (n = 22), and one participant was greater than seventy-

years old and grouped with the greater than sixty-year old participants (n = 35). Thirty-

six participants reported ages in the 40 to 49-year old range (n = 36), and thirty-seven

participants reported ages between 50 to 59-years (n = 37). Participants in the 40 to 49

age range had the highest score (M = 93.59, SD = 10.06) followed by participants in the

under 40-years group (M = 92.86, SD = 13.59). Participants 60-years or older (M = 91.61,

SD = 10.26) and educators between the ages of 50 to 59 had the lowest total score (M =

88.50, SD =9.34). No statistically significant differences for age ranges were noted with

the one-way ANOVA (F = 1.57, df = 3, p = 0.20). There were seven missing responses,

and frequencies, means, and standard deviations are reported in Table 16. The mean score

for participants under the age of fifty years was higher compared to those over fifty years.

Table 16

Evidence-Based Practice Beliefs-Educator (EBPB-E) Scale Total Scores for Age Range

Age Range Frequency Mean (SD)

Less than 40 year 22 92.86 (13.59)

40 – 49 years 36 93.59 (10.06)

50 – 59 years 37 88.50 ( 9.34)

Greater than 60 years 35 91.61 (10.26)

(N = 130, p = 0.20, missing data, n = 7)

Evidence-Based Practice Beliefs-Educators (EBPB-E)

Scale results for beliefs and age. The chi-squared test was used to assess

differences in age less than fifty compared to greater than fifty-years related to strong

belief in evidence-based practice

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(EBP), and not strong belief in EBP. Thirty-nine participants under the age of 50 reported

a strong commitment in EBP and 19 reported not a strong commitment to EBP. In the

greater than fifty-years group, 72 participants reported a strong commitment, and 31

reported not a strong commitment. The chi-squared test resulted in no statistically

significant differences between age groups (x2 = 1.44, df = 1, p = 0.23). Participants

under the age of fifty reported higher mean scores than those over the age of fifty-years.

There were seven missing responses and the results are reported in Table 17.

Table 17

Evidence-Based Practice Beliefs-Educator (EBPB-E) Scale Results for Beliefs and Age

Age Range Total Strong Belief in EBP Not Strong Belief in EBP

Less than 50 years 58 39 19

More than 50 years 72 41 31

(N = 130, p = 0.23, missing data, n = 7)

Results of the Evidence-Based Practice Beliefs-Educator

(EBPB-E) Scale. The research question to be answered with the Evidence-Based

Practice Beliefs-Educator (EBPB-E) Scale was: Do nursing educators have a firm belief

and confidence in their ability to teach and implement evidence-based practice as

measured by the EBPB-E Scale? The overall EBPB-E mean score of 91.57 (SD = 10.67)

indicating participants had a firm belief and confidence in their abilities to teach and

implement evidence-based practice. Participants’ responses on positive items for the

EBPB-E Scale were greater than 3.5. Areas of strength noted for individual means scores

on the EBPB-E Scale included (a) the educator was sure that evidence-based practice

(EBP) guidelines improved clinical care, (b) EBP resulted in the best clinical care for

patients, (c) critically

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appraising evidence was an important step in the EBP process, (d) implementing EBP

improves patient’s care, and (e) integrating EBP into the curriculum will improve the care

that students deliver to their patients. Participants did not believe that implementing

evidence-based practice was difficult nor the process took too much time. Participants

teaching in graduate and doctorate nursing programs had the highest mean score (93.10)

for the three categories of nursing programs on the EBPB-E Scale. Though there were no

statistically significant findings noted in the mean scores on the EBPB-E Scale related to

age of participants or primary teaching program, belief in evidence-based practice scores

were higher for participants in Bachelor of Science in Nursing (BSN), Master of Science

in Nursing (MSN), and Doctorate programs than noted in Associate of Science in

Nursing (ASN) programs. Age range for participants did not show any varying trends.

Organizational Culture and Readiness for School-Wide Integration of

Evidence Based Practice-Educator (OCRSIEP-E) Scale. The third part of Phase I data

collection included 19 questions with 25-items calculated due to multiple answers for two

of the questions. There were 130 completed surveys from the 145 total respondents for a

90% completion rate on the scale. The overall mean score for the Organizational Culture

and Readiness for School-Wide Integration of Evidence-Based Practice-Educator

(OCRSIEP-E) Scale was 95.13 (SD = 16.35) indicating essential movement toward a

sustainable culture of college-wide integration of evidence-based practice. Participants in

all levels of nursing education had a mean score greater than 75 reflecting

implementation of evidence-based practice within the educational environment and

perceived readiness for sustainable school-wide integration of evidence-based practice.

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Mean scores on the Organizational Culture and Readiness

for School-Wide Integration of Evidence-Based Practice-

Educator (OCRIEP-E) Scale. The ranked order of responses on the

Organizational Culture and Readiness for School-Wide Integration of Evidence-Based

Practice-Educator (OCRSIEP-E) Scale are displayed in Table 18. The

co-developer and owner of the OCRSIEP-E Scale, Ellen Fineout-Overholt, explained the

scoring method for the scale. Scores ranging from 75 - 100 demonstrated moderate

movement toward a culture of evidence-based practice, but not yet sustainable, and

scores less than 75 indicated opportunities for growth within the educational setting

toward a culture of evidence-based practice (E. Fineout-Overholt, personal

communication, March 15, 2019). Mean scores between four and five indicated

moderately to very much, and Mean scores less than four indicated somewhat to none at

all for school-wide readiness for evidence-based practice (E. Fineout-Overholt, personal

communication, March 15, 2019).

Participants believed their organizations were ready for evidence-based practice

with mean scores of 4.00 or higher. The top five mean scores indicated that (a) faculty

had access to computers and databases for searching for best evidence (4.51), (b) faculty

colleagues were committed to evidence-based practice (4.27), (c) evidence-based

education was practiced in participants’ organizations (4.26), (d) decisions were

generated from the administration (4.23), and (e) evidence-based practice was clearly

described as central to the mission and philosophy of the college of nursing (4.21). The

top five items with a mean score of 4.0 or lower on the OCRSIEP-E indicated areas for

improvement and included (a) faculty modeled evidence-based practice in academic and

clinical settings (3.93), (b) community partners were committed to evidence-based

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practice (3.92), (c) faculty measured and shared outcomes as part of culture where the

participant worked (3.88); (d) there was a critical mass of faculty with strong evidence-

based practice knowledge (3.85), and (e) institution’s overall readiness for evidence-

based practice (3.72). Six items had a mean score of 3.5 or lower indicating areas of

weakness and included (a) librarians were used to search for evidence (3.50), (b) there

were evidence-based practice champions among the junior faculty (3.41), (c) fiscal

resources were used to support evidence-based practice (3.32), (d) there were evidence-

based champions in the community (3.21), (e) there were doctorate faculty in the nursing

program to assist in generating new evidence when needed (3.09), and (f) there were

faculty who were evidence-based practice mentors (3.03).

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Table 18

Mean Scores on the Organizational Culture and Readiness for School-Wide Integration of Evidence-Based Practice-Educator (OCRSIEP-E) Scale

Ranked Order of Items Mean (SD) Moderately Very much %

Somewhat%

Faculty have access to computers & databases for searching for best evidence. 4.51 (0.79) 88 10

Faculty where you work are committed to EBP. 4.27 (0.82) 85 10Believe that evidence-based education is practiced

in your organization. 4.26 (0.84) 81 16

Decisions generated from college administration. 4.23 (0.78) 82 16

EBP clearly described as central to mission & philosophy of your institution.

4.21 (0.95) 77 17

Faculty members have proficient computer skills. 4.20 (0.76) 84 13

Librarians in college have EBP knowledge/skills. 4.16 (1.06) 78 13

Decisions generated by university administration. 4.09 (0.91) 75 20Administrators in organization committed to EBP

(resources/support) to initiate EBP. 4.08 (1.01) 75 16

Faculty model EBP in academic/clinical setting. 3.93 (0.88) 71 23

Community partners are committed EBP. 3.92 (0.86) 69 26

Measurement & sharing outcomes part of culture of organization where you work. 3.88 (1.01) 68 22

Critical mass of faculty with strong EBP knowledge. 3.85 (0.94) 68 22

Overall, rate your institution’s readiness for EBP. 3.72 (1.05) 65 21

There are EBP champions among senior faculty. 3.71 (1.10) 61 23

There are EBP champions among administrators. 3.67 (1.17) 59 25

There are EBP champions among clinical faculty. 3.65 (1.09) 56 30

Decisions are generated from faculty. 3.64 (1.07) 56 26Compared to 6 months ago, how much movement

toward an EBP culture in organization? 3.53 (1.11) 59 22

Librarians are used to search for evidence. 3.50 (1.16) 52 28

There are EBP champions among junior faculty 3.41 (1.20) 52 25

Fiscal resources are used to support EBP (conferences/computers/paid time). 3.32 (1.07) 44 34

EBP champions (willing to go extra mile to advance EBP) among community partners 3.21 (1.02) 39 38

There are doctorate nurses in college to assist in generating evidence when it does not exist. 3.09 (1.14) 36 32

There are faculty who are EBP mentors. (N = 126)

3.03 (1.12) 37 29

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Organizational movement toward a culture of evidence-

based practice related to teaching program. The Organizational

Culture and Readiness for School-Wide Integration of Evidence-Based Practice-Educator

(OCRSIEP-E) Scale was used to determine participants’ beliefs related to the nursing

program’s organizational movement toward a culture of evidence-based practice. One

hundred twenty-six (N = 126) participants completed this section of the survey with four

incomplete responses.

Descriptive statistics are reported in Table 19 for the OCRSIEP-E Scale by primary

teaching program resulted in Associate of Science in Nursing [ASN] (n = 38), Bachelor

of Science in Nursing [BSN] (n = 64), and Master of Science in Nursing [MSN] and

doctorate programs (n = 24). Participants teaching in ASN programs reported (a)

sustainable culture of evidence-based practice (42%), (b) movement toward a sustainable

culture (37%), and (c) an opportunity for movement toward a sustainable culture (21%).

Participants teaching in baccalaureate programs reported (a) sustainable culture of

evidence-based practice (53%), (b) movement toward a sustainable culture (41%), and (c)

an opportunity for movement toward a culture of evidence-based practice (6%).

Participants teaching in graduate and doctorate programs reported (a) sustainable culture

of evidence-based practice (42%), (b) movement toward a sustainable culture (58%). The

chi-squared test was used to determine differences between programs, and a statistically

significant difference was noted for respondents teaching in MSN and Doctorate

programs reporting a greater movement toward a sustainable culture of evidence-based

practice compared to the those teaching in undergraduate programs (x2 = 10.87, df = 4, p

= 0.028).

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Table 19

Organizational Culture and Readiness for School-Wide Integration of Evidence-Based Practice-Educator (OCRSIEP-E) Scale Total Related to Teaching Program

Primary Teaching Program Frequency Mean (SD)

Associate of Science in Nursing (ASN) 38 90.18 (18.95)

Bachelor of Science in Nursing (BSN) 64 97.01 (16.42)

*Master of Science in Nursing (MSN) Doctorate

24 98.94 ( 9.97)

(N = 126, *p = 0.028, missing data, n = 4)

Organizational Culture and Readiness for School-Wide

Integration of Evidence-Based Practice-Educator (OCRSIEP-E)

Scale total score related to educators’ age range. The influence of

age on cultural readiness for evidence-based practice on the Organizational Culture and

Readiness for School-Wide Integration of Evidence-Based Practice-Educator

(OCRSIEP-E) Scale was assessed to note significance between age groups. Participants’

ages were grouped as less than fifty-years (n = 58, M = 97.18, SD = 15.51) and greater

than fifty-years of age (n = 72, M = 93.43, SD = 16.94). A one-way ANOVA comparing

the OCRSIEP-E total scores among age groups resulted in no statistically significant

differences (F = 1.70, df = 1, p = 0.19). To analyze differences between individual age

ranges, participants were grouped as follows: Five participants

under the age of thirty were grouped together as less than forty-years old participants (n =

26); one participant was greater than seventy-years old and was grouped with the greater

than sixty years old participants (n = 38). Forty participants reported ages in the forty to

forty-nine years range, and forty-one participants reported in the fifty to fifty-nine years

range. A one-way ANOVA was used to compare mean group differences on age range

and indicated no statistically significant difference between age ranges for participants

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(F = 1.80, df = 3, p = 0.15). Frequencies, means, and standard deviations for each age

range are reported in Table 20.

Table 20

Organizational Culture and Readiness for School-Wide Integration of Evidence-Based Practice-Educator (OCRSIEP-E) Scale Total Score Compared for Age Range

Age Range Frequency Mean (SD)

< 40 years 22 95.85 (15.12)

40-49 years 36 98.03 (15.91)

50-59 years 37 89.93 (19.96)

> 60 years 35 97.03 (12.43)

(N = 130, p = 0.15)

Organizational movement toward evidence-based

practice for primary teaching program. Primary teaching programs were

analyzed for organizational movement toward a culture of evidence-based practice.

Participants teaching in Associate of Science in Nursing (ASN) programs reported (a)

sustainable culture of evidence-based practice (42%), (b) movement toward a sustainable

culture (37%), and (c) opportunity for movement (21%). Participants teaching in

baccalaureate programs reported (a) sustainable culture of evidence-based practice

(53%), (b) movement toward a sustainable culture (41%), and (c) opportunity for

movement (6%). Graduate and doctorate faculty reported (a) sustainable culture of

evidence-based practice (42%), and (b) movement toward a sustainable culture (58%).

Results are displayed in Table 21. The chi-squared test of independence was used to

compare the frequency of belief in evidence-based practice and organizational movement

toward evidence-based practice related to primary teaching programs. A statistically

significant difference was noted between teaching

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programs (x2 = 10.87, df = 4, p = 0.028) related to a sustainable culture of evidence-based

practice for participants teaching in graduate and doctorate programs compared to

respondents teaching in undergraduate programs. There were four incomplete responses

on this item.

Table 21

Organizational Movement Toward Evidence-Based Practice for Primary Teaching Program

Teaching Program n Sustainableculture %

Movement towardsustainable culture

Opportunity formovement %

Associate’s Degree 38 42 37 21

Bachelor’s Degree 64 53 41 6

*Graduate/Doctorate 24 42 58 0

(N = 126, *p = 0.028, missing data [n = 4])

Organizational movement toward a culture of evidence-

based practice according to age. Age groups were compared for

organizational movement toward a culture of EBP. Participants less than fifty-years (n =

59) reported the organization had a sustainable culture of evidence-based practice (29),

movement toward a sustainable culture (25), and opportunity for movement (5).

Participants greater than fifty-years of age (n = 71) reported a sustainable culture of

evidence-based practice (32), movement toward a sustainable culture (32), and

opportunity for movement (7). There were eight incomplete responses on the OCRSIEP-

E Scale and are reported in Table 22. No statistically significant differences were found

using the chi-squared test of independence (x2 = 0.23, df = 2, p = 0.89).

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Table 22

Organizational Movement Toward a Culture of Evidence-Based Practice According to Age

Age Frequency Sustainable Culture

Movement Culture

Opportunity for Movement

Less than 50 59 29 25 5

Greater than 50 71 32 32 7(N = 122, p = 0.89, missing data, n = 8)

Results of the Organizational Culture and Readiness for

School-Wide Integration of Evidence-Based Practice-Educator

(OCRSIEP-E) Scale. Research question two was the following: What are the

cultural factors that influence the implementation of evidence-based practice within the

educational environment and the perceived readiness for school-wide integration of

evidence-based practice as measured by the Organizational Culture and Readiness for

School-Wide Integration of Evidence- Based Practice-Educator (OCRSIEP-E) Scale?

Nursing educators scoring 75 or greater on the OCRSIEP-E Scale indicated an essential

movement toward a sustainable culture of school-wide evidence-based practice in

colleges of nursing. There were 130 completed surveys from the 145 total respondents.

Fifteen of the participants had data missing on this scale. The overall OCRSIEP-E mean

score was 95.13 (SD = 16.35) and indicated essential movement toward a sustainable

culture of school-wide integration of evidence- based practice. Participants teaching in all

levels of nursing education had a strong belief in evidence-based practice and a school-

wide readiness for evidence-based practice.

Areas of strength were noted in (a) access to computers and databases for searching for

best evidence, (b) faculty’s commitment for evidence-based practice, (c) faculty’s belief

that educators practiced the process in the college of nursing, (d) decisions generated

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primarily from the administration, and (e) evidence-based practice was clearly described

as central to the mission and philosophy of the college of nursing. Areas of weakness

included (a) lack of librarians used to search for evidence, (b) evidence-based practice

champions were not identified among the junior faculty, (c) fiscal resources were not

used to support evidence-based practice in the organization, (d) lack of evidence-based

practice champions in the community, (e) lack of doctorate faculty in the nursing

program to assist in generating new evidence when needed, and (f) lack of evidence-

based practice mentors in the college of nursing.

The chi-squared test was used to analyze responses related to teaching programs,

and a significant difference was noted between participants teaching in graduate and

doctorate nursing programs compared to educators in undergraduate programs (p =

0.028). No significant differences were noted in the OCRSIEP-E Scale and the age

ranges (p = 0.063). Areas for improvement included a need for (a) evidence-based

practice mentors in the organization, (b) more doctorate faculty in the organization to

assist in the generation of evidence when needed, (c) more community partners in the

healthcare environment to be evidence-based practice champions, (d) fiscal resources

used to support faculty attending conferences and paid time for scholarly activities

process, and (e) librarians to work with faculty to search for evidence. Areas of concern

were (a) more movement towards an evidence-based practice culture in the organization,

(b) evidence-based practice champions in nursing administration and in clinical faculty,

and (c) institution’s readiness for evidence-based practice.

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Associations Between EBPB-E and OCRSIEP-E Scales. The

one-way ANOVA and chi-squared tests were used to analyze differences between the

Evidence-Based Practice Beliefs-Educator (EBPB-E) and the Organizational Culture and


E) Scales. The total number of completed responses on the EBPB-E was 137 (missing

data, n = 8), and the total number of completed responses on the OCRSIEP-E was 130

(missing data, n = 15).

Comparisons for EBPB-E and OCRSIEP-E Scales. The total

mean score for the Evidence-Based Practice Beliefs-Educator (EBPB-E) was 91.49 (SD

= 10.67), and the total mean score for the Organizational Culture and Readiness for

School-Wide Integration of Evidence-Based Practice-Educator (OCRSIEP-E) was 95.13

(SD = 16.35). Cronbach’s alpha coefficient for the EBPB-E Scale was 0.93, and for the

OCRSIEP-E Scale, the Cronbach’s alpha was 0.94. There was a statistically significant

positive linear relationship between the EBPB-E and the OCRSIEP-E Scales (r = 0.554,

p < 0.0001) among nursing educators. Comparisons for the EBPB-E and the OCRSIEP-

E Scales are noted in Table 23 for the total means scores, standard deviations,

Cronbach’s alphas and Pearson’s correlation coefficients.

Table 23

Comparisons for EBPB-E and OCRSIEP-E Scales

Scale Mean Standard Deviation Cronbach’s alpha Pearson’s r **

EBPB-E 91.49 10.67 0.93 0.55

OCRSIEP-E 95.13 16.35 0.94 0.55(N = 130, **p < 0.0001)

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Phase II Results

Eleven nursing educators (one male and ten females) representing eight colleges

of nursing were interviewed in Phase II. Three of the participants taught in associate

programs, five in baccalaureate programs, and three in graduate and programs. Six of the

participants had a Master of Science in Nursing (MSN) degree and two of those

participants were currently in doctorate programs. Five of the participants had a doctorate

degree. The participants’ ages ranged from mid-thirties to mid-sixties. The professional

teaching experiences in nursing education ranged from three to more than forty-years.

Significant statements were extracted from each interview related to theme clusters

(Creswell & Poth, 2018) to answer research question four: What are nursing educators’

experiences with and perceptions of teaching information literacy and evidence-based

practice?

Themes and Categories. In qualitative research, themes and categories are broad

units of information and consist of codes aggregated to form a common idea (Creswell &

Poth, 2018). Three themes evolved from transcribed interviews with two interconnected

categories for each theme related to research question four and are identified in Table 24.

Theme 1: Educating nursing educators and students.

Educators need to be knowledgeable about all competencies expected of the graduate

nurse. The quintessential theme that emerged pertained to the need for nursing educators

to be knowledgeable about information literacy and evidence-based practice to

effectively teach students. All interviewees believed that evidence-based practice was

valued and prioritized to varying degrees in nursing education. Participants shared that

the term, evidence-based practice, was often paid lip-service due to not being valued as

should be, nor prioritized in

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academia and clinical settings. Participants shared that informatics, specifically

information literacy, was not understood, valued, nor taught to students due to varying

reasons identified in significant quoted statements.

Category 1: Knowledge deficit related to link between information literacy and

evidence-based practice competencies. Participants discussed the need for faculty to be

knowledgeable about competencies graduates needed for clinical practice. Discussions

often focused on who should teach competencies. A connection was noted from

transcribed interviews that possibly due to seasoned faculty not learning about

information literacy and evidence-based practice competencies in primary and/or

secondary nursing education, the competencies were overlooked or minimized.

Participants discussed how faculty were reluctant to change from traditional teaching

practices or learn new knowledge related to evidence-based practice. All participants

agreed that information literacy and evidence-based practice were not prioritized in

nursing programs, clinical settings, nor on the licensing exam for RNs possibly leading

educators to not prioritize or value the competencies. According to the participants,

evidence-based practice was not a topic commonly discussed in faculty and/or program

committee meetings, was not part of the orientation program for new faculty, and was not

an item for faculty evaluations, therefore, was not seen as necessary to learn or teach.

Participants unanimously agreed there was a disconnect between definitions of

information literacy and evidence-based practice, and the importance of teaching the

competencies in nursing courses was not discussed among faculty and program directors

compared to other competencies such as safety, patient-centered care, and quality

measures. Participants focused primarily on evidence-based practice and not on

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experiences with information literacy. Most participants were not aware of the

Technology Informatics Guiding Education Reform (TIGER) initiative related to

informatics and information literacy in nursing education. Following are significant

individual quotes clustered in Category 1 for knowledge deficit related to information

literacy (IL) and evidence-based practice (EBP) competencies.

EBP is valued, but due to aging faculty not wanting to change or learn something new, it is not prioritized. Aging faculty are stuck in traditional ways of teaching and don’t want to learn something new if not compensated. EBP was not taught to older faculty. Nursing informatics is new, not understood, and electronic charting was shoved down our throats due to CMS requirements.(# 1, MSN + degree, Age 50 +)

What is learned in conferences is not shared with faculty colleagues. There is a knowledge gap in faculty who do not attend conferences and in faculty who do not use databases for new information, and therefore, do not use evidence. EBP is not in annual performance review. (# 2, MSN + degree, Age 30 +)

I did not know about EBP and IL competencies until I took the survey for your study. The orientation process for new faculty is limited and expectancies related to EBP are not addressed. We don’t want others to know our weaknesses, so we do not admit what we don’t know to protect our ignorance. I first heard the EBP term approximately 20 years ago and was told that it was just a scholar’s word, not a practical nursing term for nurses working in hospitals and nursing homes. We might get more bang for our buck on Twitter or other social media talking about EBP.(# 3, DNP degree, Age 60 +)

Nursing educators need to know how to teach searching the literature to locate evidence and educate patients about health literacy. Information literacy is a new language. I did not know about competencies for EBP and IL until answering your survey. (# 4, DNP degree, Age 30 +)

Faculty lack knowledge on navigating databases. I think I know enough to teach IL but need to practice. If we do not feel confident, then how can we teach new skills? Faculty lack EBP and IL skills and there is a lack of priority to learn new skills. (# 5, MSN+ degree, Age 50 +)

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Faculty need to be better educated about IL because they lack knowledge on navigating databases and are not ready to teach students about searching databases. (# 6, MSN+ degree, Age 30 +)

The terms keep changing. EBP used to be research utilization.We need faculty development for EBP and IL because faculty arenot up to date on most of the competencies. There are differing levels of competencies. Informatics is new and was pushed on us and there’s no informatics or research course for ASN program. Nurses are legally responsible for the care they plan and deliver, and faculty do not always discuss this. (# 7, MSN degree, Age 60 +)

We need to educate the educator on moving forward based on current evidence and not on old practices. Our obligation is to teach students to protect the public, not just pass exams. New faculty needs to be oriented with expectations for them as EBP role models.(# 8, PhD degree, Age 40 +)

Older faculty lack research skills and do not want to talk about their lack of knowledge. If the teacher does not know how to read research, then how can they teach it? Unless faculty teach research, the average educator does not utilize evidence in practice. A positive person needs to teach research and be passionate about the subject, or the students do not get excited about the subject. Less than ten percent of classroom lessons include EBP or reflect research. Research is on the back burner in education. (# 9, MSN degree, Age 50 +)

Most nursing faculty are not comfortable with research and feel like EBP is a chore. Faculty need to learn the competencies so they can teach them. (# 10, DNP degree, Age 50 +)

A mentality of type the search word in Google, and the first thing that comes up is good enough and is what they use. Students think that if they can read and write, then they are literate. Undergraduate studentsdo not see value in IL and EBP skills and do not understand how to apply it in clinicals. I often track the history of their searches and find that they are not using databases that are available in our library. They use Google and Google Scholar. (# 11, DNP degree, Age 30 +)

Category 2: Confusion about who, when, and how to teach information literacy

and evidence-based practice competencies. All participants believed more emphasis

needs to be place on teaching evidence-based practice competencies in the classroom and

use of evidence in the clinical setting for students to see the link between evidence at the

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bedside for safe and quality patient-centered care. Participants reported teaching

information literacy skills to support evidence-based practice was not integrated in all

levels of nursing education and should be included in all courses and levels of nursing

education. In programs with a research/evidence-based practice course, participants

perceived that the course was not popular to teach and was considered less than important

compared to clinical courses by faculty and students. All participants believed

collaboration between nursing faculty and librarians were important. Following are

significant quotes related to Category 2: Confusion about who, when, and how to teach

information literacy (IL) and evidence-based practice (EBP) competencies.

The curriculum needs to be updated to meet competencies.Informatics is not in our curriculum. Librarian is the missing link for IL. (# 1, MSN + degree, Age 50 +)

There is a big disconnect between talking about EBP and actually, teaching it. There is no feedback to students to make connections to evidence in the literature and what students see in the clinical setting. Clinically-oriented faculty are not focused on EBP, and EBP is often only taught in one course and not threaded through curriculum. If what is taught in research and informatics are not carriedthrough in other courses, then loses its value and students do not realize the importance of the information. Students struggle searching if it is not introduced and taught early in the nursing program, especially before they are expected to search for scholarly literature. It is important to teach students about credible, authoritative, and current online resources and how to analyze a research study. There is not enough faculty to teach research or IL. There is no librarian involvement in undergraduate program, but there is in the graduate level. (# 2, MSN + degree, Age 30 +)

Quality and safety are prioritized more than EBP and IL. We need a proactive campaign for EBP and not a blame game. There is not enough time to learn and teach. (# 4, DNP, Age 30 +)

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If what is taught in one nursing course is not carried through in other courses, then it loses its importance. There is no time in clinicals to look up evidence, and faculty are too busy with heavy workloads. Faculty do not follow-up with articles in clinicals with students. Students see research as busy work and place no value on it or application to practice. Faculty need to introduce students to the librarian. (# 5, MSN + degree, Age 50 +)

Nursing faculty need to step up and advocate for EBP in the classroom and in clinicals. There is a lack of priority to teach IL and EBP. There are not enough EBP champions, and I do not know whether we follow up with faculty related to EBP. Students are not aware of the librarian, the databases, and the older, diverse student population are not well-versed in technology. Students do not know how to find information for EBP and exposure to IL is not threaded in curriculum. (# 6, MSN + degree, Age 30 +)

EBP should be words that students learn about in first nursing course, first day in clinical setting, and throughout the curriculum. Students need to learn that research/EBP are not just for the school setting, but for practice setting as a RN to improve patient care and outcomes. Students are more interested in grades rather than patient outcomes. There is not an informatics or research course in the ASN program. (# 7, MSN degree, Age 60 +)

Students need references for care plans, so knowing how tofind credible literature is a priority. Faculty need to encourage students to cite references outside of their textbooks to support EBP. Educators sometime lose the link to current bedside practices. EBP is not a specific course in our curriculum, but one of my colleagues has students make posters to display what they learn, and many of the posters are high quality and could be used at research conferences.This is not the norm in ASN programs, but we are preparing students to advance their education to the BSN and MSN. We fail our students if we do not teach them properly.(# 8, PhD degree, Age 40 +)

IL and EBP need more emphasis in the curriculum, and students need daily exposure to it. We need a positive role model teaching research and develop a culture to support and value EBPin the classroom and at the bedside. The librarian should be available at all levels. The students need to include evidence in most assignments and apply the evidence in the clinical setting.(# 9, MSN degree, Age 50 +)

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The term EBP is not used in the clinical setting. Evidence needs to be included in care plans. Textbooks are not interesting related to EBP and research, and nursing faculty are not comfortable teaching IL and EBP. Faculty do not do as good a job as we should teaching EBP. We do not discuss EBP in faculty meetings, and clinical nurses do not talk about EBP with the students. The librarian meets with the students at the beginning of the semester and is a huge resource for searching the literature.(# 10, DNP degree, Age 50 +)

The research course is designed to translate evidence into practice. My discussion forums are designed for the students to find evidence to support their answers. I try to drive students back to the evidence, but it is difficult. We do not teach enough IL in the undergraduate level; graduate students get more IL. The students want to learn from teachers and their classmates. We have to find EBP teaching strategies to enhance their learning.(# 11, DNP degree, Age 30 +)

Theme 2: Organizational constraints for teaching

information literacy and evidence-based practice. Participants

openly expressed concerns about organizational constraints that affected their ability to

focus on teaching information literacy and evidence-based practice in nursing courses as

well as in the clinical setting with nursing students. Participants shared perceptions that

nurses were not considered to be decision- makers or policy-makers in educational and

clinical settings. Participants believed there was not enough time to teach evidence-based

practice in the classroom or in the clinical setting, and administrators and directors did

not commonly discuss or prioritize evidence- based practice in nursing programs nor in

clinical environments.

Category 1: Educational constraints for teaching information literacy and

evidence-based practice. All participants believed that due to a lack of time, heavy

workloads, and lack of emphasis and value for evidence-based practice, nursing

educators were not designing teaching plans around evidence-based practice activities.

Integrating information literacy to support evidence-based practice was not prioritized in

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classroom settings, and most educators believed teaching evidence-based practice

was the research instructor’s responsibility. Most agreed that more resources were needed

to support faculty development, more collaboration was needed with librarians in the

classroom, and evidence-based practice mentors were needed in academia as well as

support and encouragement from colleagues and administration for evidence-based

practice. Most participants believed more doctorate educators were needed in all

levels of nursing education. Following are significant quotes related to participants’

perceptions of organizational constraints specific to academia for teaching information

literacy and evidence-based practice.

Faculty are too busy with heavy workloads and do not have time to learn new something. Buy-in from nursing leaders and administrators is essential. Hospitals want educators to prepare graduates for EBP, so curriculum needs to be updated. We need incentives for younger nurses to become nursing faculty. There are not enough doctorate nurses in education.(# 1, MSN + degree, Age 50 +)

Barriers for teaching IL and EBP include not enough faculty to teach research or know how to teach IL. There is not enough time to participate in scholarly activities. We need more support and encouragement from nursing administration related to EBP in the curriculum. EBP mentors and champions are needed in every level of our nursing program. We do not know what other teachers are including in their courses. We do not have enough faculty members who want to teach research. (# 2, MSN + degree, Age 30 +)

Moral distress is a problem related to students’ interests in EBP. Finding the evidence to support practice is critical and has to be more than telling students to get a scholarly article. We need to give students muscular questions which means they have to do their homework and have deeper learning. Students are more interested in reading social media instead of reading a journal. On average, a journal article is read by 17 people, but if you write what you learned about EBP in 240 characters or less on Twitter, you could have something go viral and read by thousands of people. (# 3, DNP degree, Age 60 +)

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Quality and safety are prioritized more than EBP and IL in course content and outcomes. There is not enough time to teach and look up stuff in the literature. We need more EBP role models.(# 4, DNP degree, Age 30 +)

Faculty lack experience in EBP and IL competencies. EBP is not an expectation for all faculty. We don’t know what faculty teach. The only reason why I get EBP is because I am back in school and EBP was one of our courses.(# 5, MSN + degree, Age 50 +)

Some faculty do not want to learn new things or attend any additional activities such as a skills fair. There are differing levels of competencies among faculty. We need faculty development to keep up with tech changes. (# 7, MSN degree, Age 60 +)

Educators are not studying students’ learning styles to understand how to present information in the most effective ways. Nursing programs need to develop policies and procedures for EBP in education and clinical settings. New faculty need to be oriented with expectations for them as EBP role models. (# 8, PhD degree, Age 40 +)

Students get excited about their grades, not the evidence.Students are in a survival mode most of the time, and their spirit of inquiry is limited. I guess we can say that about nursing faculty, too. There is a lack of administrative support, and we may let evidence go because of lack of interest by colleagues and directors. Faculty development is needed to increase awareness and knowledge. We have seen EBP result in positive changes such as CAUTI, DVT, decubitus care, and medication errors, but research to practice takes decades.(# 9, MSN, Age 50 +)

Faculty get time off to attend CE conferences, but extra time is not allotted or compensated for scholarly work that is expected of faculty. (# 11, DNP degree, Age 30 +)

Category 2: Clinical constraints for teaching information literacy and

evidence- based practice. Participants agreed time was the biggest constraint keeping

educators from looking up new evidence in a fast-paced clinical environment with the

students.

Participants teaching students in clinical settings agreed searching the literature with ten

students to one instructor was not an option. Participants believed there were not enough

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evidence-based practice champions and mentors in healthcare facilities where students

completed clinical requirements and reported clinical nurses did not talk about evidence-

based practice with students. Some participants believed healthcare administrators were

more concerned with the bottom line related to economics rather than on sending nurses

back to school or continuing education programs for evidence-based practice. Following

are significant quotes related to participants’ perceptions of clinical constraints for

teaching information literacy and evidence-based practice.

The Joint Commission and QSEN recommend the competencies for nursing graduates and practicing nurses, yet there is not enough administrative support to push for EBP. Informatics and electronic charting software are expensive for nursing programs to purchase, so faculty have to learn each system when they are in the clinical setting. (# 1, MSN + degree, Age 50 +)

EBP was introduced more than 20 years ago, and since research takes approximately 17 years to be adopted into practice, it is not surprising that we are still not witnessing EBP in clinical settings.Quarterly numbers are more important than values and principles related to quality care. Nurses are low on the totem pole for practice change unless they are experts and then others may listen. Nurses are not valued and not encouraged to make practice changes. No matter how proactive or courageous a nurse may be, they are treated like they are disrupting things instead of championing something to improve patient’s care. Students are not comfortable using or talking about evidence in practice in the clinical setting. (# 3, DNP degree, Age 60 +)

Nurses are legally responsible the care they plan and deliver. This is not always discussed. We have to find a way to confront errors in practice without blaming. (# 7, MSN degree, Age 60 +)

EBP projects in the clinical setting do not always end up in policy changes. There are EBP committees on shared governance in the Magnet hospitals, but you do not hear much about what they do.(# 10, DNP degree, Age 50 +)

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Theme 3: Educators’ commitment for teaching

information literacy and evidence-based practice

competencies. From interview transcriptions, there was a united voice to push for

prioritizing and promoting the integration of evidence-based practice in nursing

education. The majority of interviewees thanked the researcher for bringing awareness

about information literacy and evidence-based practice competencies nursing graduates

need to practice in the twenty-first century. Participants identified viable strategies to

encourage educators to teach information literacy and evidence-based practice in

educational and clinical settings. Participants agreed educators are obligated to personally

step up and be knowledgeable and accountable to teach all competencies needed by

nursing graduates. There was unanimous support for educators to collaborate with

librarians in colleges of nursing to teach and integrate information literacy throughout

each curriculum and support the evidence-based practice process.

Category 1: Personal and professional commitment for being an information

literate educator to teach and promote evidence-based practice. All participants believed

there was a strong need to prioritize and emphasize the need to integrate information

literacy and evidence-based practice throughout nursing curricula. There was agreement

that nursing educators needed to step up and learn information literacy and evidence-

based practice competencies and advocate for evidence-based practice in all nursing

programs. Participants unanimously agreed librarians need to be actively engaged and

visible in all nursing programs, both online and face-to-face. There was also agreement

faculty need to discuss ways to integrate information and evidence-based practice in the

nursing curriculum. Following are significant quotes related to participants’ perceptions

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of personal and professional commitment for becoming an information literate educator

to teach and promote evidence-based practice.

Regardless of an educator’s age, we need to get on board or retire. EBP needs to be the buzzword in all educational and healthcare settings. Nursing administrative “buy-in” is essential.(# 1, MSN + degree, Age 50 +)

There needs to be a push from the top for EBP in nursing education and practice. Simulation is a good example of EBP in the collegiate setting. We lead in simulation, but for everything else, there is a disconnect, and that needs to change.(# 2, MSN + degree, Age 30 +)

We need to highlight the strengths that others have. Trust is needed between colleagues. We need to discuss EBP in education and identify EBP champions in all nursing programs. We need to look for ways to drive EBP and remove or minimize the barriers. Educators need to learn how to confront others related to improper care and stop protecting our ignorance. We need to have the science back what we know to reduce discrepancies and suffering.(# 3, DNP degree, Age 60 +)

We need to identify EBP role models to work with faculty, students, and clinicians. (# 4, DNP degree, Age 30 +)

We do great things as faculty, but we don’t share it. We need to work more closely together and encourage one another.(# 5, MSN + degree, Age 50 +).

Focus faculty continuing education on EBP teaching methodologies and partner with the librarian in the classroom. (# 6, MSN + degree, Age 30 +)

We need to commit to talking about the competencies with one another, and what strategies others use that are effective. We need to look at patient outcomes based on high risk versus high volume. We need faculty development to keep up with technological changes. Faculty need to role model the use of EBP and prioritize it in the curriculum. All nursing faculty need to attend skills’ fairs at their local hospitals. (# 7, MSN degree, Age 60 +)

We need policies and procedures for EBP in education and clinical settings and make time for orientation to EBP in both academia and hospital. (# 8, PhD degree, Age 40 +)

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We need positive role models teaching research and bring EBP to the bedside. We need to develop a culture to support and value EBP. (# 9, MSN degree, Age 50 +)

I have a personal drive to do scholarly work because I know that it is a professional expectation and obligation.(#1 1, DNP degree, Age 30 +)

Category 2: Educators’ commitment to promote evidence-based practice in

clinical settings. There was agreement that educators need to proactively advocate for

evidence-based practice in clinical settings with students and clinicians in healthcare

agencies. Following are significant quotes related to promoting evidence-based practice

in clinical settings to support evidence-based practice for patient-care.

Accrediting agencies like the Joint Commission push EBP, and we need to know how to teach it and push it.(# 1, MSN + degree, Age 50 +)

Give students feedback about the research studies they select in the clinical setting to make the connection. Have students include evidence in the care plans and apply it in the clinical setting.(# 2, MSN + degree, Age 30 +)

Since we are moving from a volume-based to a value-based payment system, we are moving toward EBP. Penalizing hospitals for readmissions make EBP at a critical turning point at the bedside. (# 3, DNP degree, Age 60 +)

Students in our research course present their projects at research conferences and hospital research events that help them understand the connection between research and evidence in clinical practice. (# 10, DNP degree, Age 50 +)

We need to tie the evidence to patient-care scenarios before going into the hospital and again while in the hospital or during post-conference. (# 5, MSN + degree, Age 50 +)

Identify EBP informatics champions in the hospital to meet with students on clinical days. (# 6, MSN + degree, Age 30 +)

Look at EBP issues related to cultural and ethical concerns with students in the clinical setting. (# 7, MSN degree, Age 60 +)

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Look at policies and procedure and clinical practice guidelines in the clinical setting with the students. (# 8, PhD degree, Age 40 +)

Bring EBP to the bedside. Include healthcare agencies in culture development for EBP. (# 9, MSN degree, Age 50 +)

Table 24

Themes and Categories from Phase II Interviews

Themes Categories

Theme One

Educating Nursing Educator

s and Students

Category 1Knowledge deficit related to information literacy (IL)

and evidence-base practice (EBP) competencies

1. Lack of knowledge about competencies2. Confusion about definitions for IL and EBP3. Lack of knowledge about the link between IL and EBP4. Lack of skills to search online databases5. Generational concerns – educators older than 50 years

may not have learned IL and EBP in primary/secondaryeducation and may be inclined to stick to traditional teaching strategies

6. Lack of priority, value, and understanding of research7. Low to no expectations for learning or teaching

competencies8. New language and competencies related to IL and EBP

may be misunderstood and not addressed in faculty groups9. Not a priority for licensing exam for RN students

10. Research seen as burdensome and a chore instead of valued for improved patient outcomes

Category 2Confusion about who, when, and how to

teach IL and EBP competencies.

1. Lack of interdepartmental communication and orientation for IL and EBP competencies

2. Lack of integration of IL and EBP in every course and in Every nursing program

3. Believe research instructor is responsible for teaching EBP4. Vague understanding of IL and who should teach the skills

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5. Lack of value and priority for research and EBP in faculty evaluations

6. Database choice (Google vs. healthcare database)7. Research and EBP courses are not in all programs8. IL and EBP are not prioritized by faculty

Theme Two

Organizational Constraints for Teaching Information Literacy and

Evidence-Based Practice Competencies

Category 1Educational constraints for teaching IL and EBP

1. Many educators do not want to teach research and do not value the course or content

2. Research/EBP and informatics courses are not in all programs

3. IL and EBP are not prioritized by faculty4. Role models and EBP champions needed in faculty5. Learning styles for different generations of students6. Generalized lack of time by all nurses at all levels7. Lack of knowledge about IL and EBP competencies

among faculty8. Time constraints related to learning and teaching

something new due to heavy workloads9. Lack of administrative support/encouragement and resources

10. Lack of doctorate nursing faculty

Category 2Clinical constraints for teaching IL and EBP

1. Lack of EBP mentors and champions2. Lack of administrative support/encouragement and resources

for professional development3. Financial constraints for EBP in the clinical setting4. No performance evaluation criteria for EBP and scholarly

practice

Theme Three

Educators Commitment for Teaching Information Literacy and

Evidence-Based

Practice Competencies

Category1Personal and professional commitment for

being an information literate educatorto teach and promote EBP

1. Ethically responsible for preparing nurses to utilize evidence in nursing practice in the 21st century

2. Collaborate and partner with librarian in all programs3. Promote, applaud, and reward faculty participating in nursing

research and EBP projects

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4. Include EBP in performance evaluation criteria5. Become an advocate for EBP in nursing education and practice

Category 2Educators’ commitment to

promote EBP in the clinical setting

1. Ensure clinical practice guidelines and policies and procedures based on current evidence.

2. Encourage clinical partners to promote, applaud, and reward nurses participating in research and EBP projects

3. Include healthcare agencies in educational opportunities to utilize evidence in practice at patient’s bedside

4. Suggest that scholarly activities related to EBP be included in performance evaluation criteria for clinicians

5. Include informatics nurse and EBP champion in orientation at clinical agencies

6. Professionally/ethically utilize social media to promote EBP

Conclusion

The results of data analysis for Phase I and Phase II were presented in this

chapter, and all research questions were answered and discussed. One hundred forty-five

nursing educators in a south-central state participated in Phase I of the study, and results

from 130 completed surveys for the ILNP-M and OCRSIEP-E questions and 137

completed surveys for the EBPB-E questions in Phase I were presented. Eleven educators

from Phase I were interviewed in Phase II of the study and shared their perceptions and

experiences related to information literacy and evidence-based practice in nursing

education via audio-recorded WebEx interviews. Strategies to ensure trustworthiness for

data analysis and reporting for Phase II of the study were addressed in this chapter. Three

themes with related categories to each theme were revealed based on individual

transcriptions from each interview. The discussion and recommendations for the study

will be presented in Chapter 5.

CHAPTER 5: DISCUSSION AND RECOMMENDATIONS

Introduction

Teaching and integrating information literacy and evidence-based practice

competencies throughout nursing education to promote evidence-based practice in

healthcare settings need to be prioritized in nursing education; educators can no longer

minimize the importance of both competencies (Melnyk & Fineout-Overholt, 2019;

Pierce, 2000; Pravikoff et al., 2005; Reid, Briggs, Carlisle, Scott, & Lewis, 2017; Tanner,

2000). Accrediting bodies for nursing education, professional organizations, policy-

makers, and payers for healthcare services recommend teaching evidence-based practice

competencies for optimal patient outcomes (AACN, 2008, 2019; ANA, 2008, 2010,

2015, 2017; NLN, 2008, 2018; Centers for Medicare and Medicaid Services [CMS],

2014; Institute of Medicine [IOM] 2003, 2010, 2011, 2013; QSEN, 2015, 2017). The

integration of evidence-based practice into clinical nursing has been slow, inconsistent,

and continues to be a challenge for the profession in both academia and clinical practice

(Masters, 2018; Melnyk & Fineout-Overholt, 2019; Pierce, 2000, 2005; D. Pravikoff,

2006; D. Pravikoff et al., 2005; Tanner, 2000; Tuazon, 2017).

The need to establish nursing as a research-based profession was adopted in the

1970s and 1980s with the research utilization movement (Bostrom & Suter, 1993) and

evolved into the evidence-based practice movement in the late 1990s when evidence-

based decision-making to improve patient outcomes was recognized by the nursing

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profession (Cullum, DiCenso, & Ciliska, 1997; Dang & Dearholt, 2018; DiCenso &

Cullum, 1998; Kitson, 1997; Melnyk & Fineout-Overholt, 2019; Naish, 1997). The

concept of evidence-based practice is assumed to be widespread in nursing, and educators

anticipate all nursing graduates will enter practice with the ability to provide care based

on the best available evidence (Ferguson & Day, 2005), yet the literature does not support

this premise (Melnyk & Fineout-Overholt, 2019; Reid et al., 2017). Information literacy

is a prerequisite for evidence-based practice, and decades of research evidence repeatedly

revealed that nurses lacked skills needed for information literacy and evidence-based

practice due to barriers in academic and clinical environments (Brown et al., 2009;

Carter-Templeton et al., 2014; Masters, 2018; Melnyk & Fineout-Overholt, 2019; Pierce,

2000; Pravikoff et al., 2005; Reid et al., 2017; Tanner, 2000). Barriers for teaching and

learning competencies in nursing education are still pervasive in nursing education today

and warranted further examination in this study.




of nursing in a south-central state. To answer research questions posed for this study, data

were collected to examine nursing educators’ perceptions and beliefs about information

literacy and evidence-based practice and cultural factors that influenced the integration

and school-wide integration of evidence-based practice. The following questions were

addressed in the study:

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E) Scale?



Summary of the Study

The problem for the study was information literacy and evidence-based practice

competencies were not consistently prioritized and/or integrated in nursing education,

and graduates were not adequately prepared to use evidence-based information in

practice for clinical decision-making. The purpose for the study was to examine nursing

educators’ perceptions of and beliefs about information literacy and evidence-based

practice and examine cultural factors that influenced readiness to integrate evidence-

based practice within colleges of nursing in a south-central state. Rogers’ diffusion of

innovation theory provided the framework for the study to communicate the need to

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adopt and integrate integration literacy and evidence-based practice in nursing education.

The context and research related to the state of the competencies in nursing education

were presented in earlier chapters. The methodology and results of the study were in

Chapters 3 and 4, and observations, conclusions, and recommendations for future

research are identified in this chapter.

The mixed-methods approach was used to collect different, but complementary

data focused on information literacy and evidence-based practice to learn more about the

concepts in nursing education. Quantitative data collected in Phase I were further

explored in Phase II with the qualitative approach. Phase II data enhanced and enriched

the findings of the study and were used to triangulate the sources of data and converge on

a better understanding of teaching information literacy to support evidence-based practice

in nursing education. The researcher’s intent for the outcome of this study was to

encourage nursing educators to examine their perceptions of information literacy and

evidence-based practice on an individual and organizational level and consider adopting

and integrating the competencies throughout all nursing curricula. The following

discussion presents the evaluation and interpretation of each of the research questions.

Phase I Significant Findings

Demographics. One hundred forty-five educators from sixteen nursing programs

and teaching in either undergraduate, graduate, or doctorate programs participated in

Phase I of the study. The majority of the sample were female (89%), 50 years or older

(55%), employed full-time (97%), and had a master’s degree (59%). Demographics of

educators in this study were consistent with demographics in the state where the study

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was conducted: female (95%), 50 years or older (56%), employed full-time (86%), and

had a master’s degree (58%) [LSBN, 2018].

Similar to this study’s participants, nursing educators in Pierce’s (2000) study

noted an aging faculty and postulated that experience was an asset, but attitudes, training,

and abilities related to implementing technology for information seeking may be limited

due to lack of training. Experienced and wise educators are valued and appreciated, yet

the effects of an aging workforce may lead to pressures, tensions, and changes related to

critical roles as educators, researchers, administrators, and health care providers (Falk,

2014). Important to note is that there is not only a nation-wide shortage of nursing

faculty, there is also a shortage of nurses, and the same is true for the state where this

study was conducted (Bienemy, 2018). The baby-boomer generation of nursing faculty

are ready to retire in record numbers, and concerns related to faculty aging and the

nursing shortage will be addressed later in this chapter.

Educators’ knowledge of information literacy and evidence-based practice

competencies and scholarly practice. The first research question was: Are nursing

educators knowledgeable about information literacy and evidence-based practice

competencies and prepared to teach information literacy to support evidence-based

practice in nursing education as measured by the Information Literacy for Evidence-

Based Nursing Practice-Modified questionnaire? The first stage in Rogers’ diffusion of

innovation theory is knowledge acquisition when individuals are exposed to and gain an

understanding of an innovation and how the innovation functions (Rogers, 1995).

Information literacy and evidence-based practice are competencies that nursing

educators should possess to teach the competencies to students. The majority of

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participants reported being knowledgeable about and prepared to teach evidence-based

practice competencies more than information literacy competencies, even though most

believed that information literacy competencies were prerequisites for evidence-based

practice. This suggested a dichotomy of beliefs related to knowledge about information

literacy skills needed for the evidence-based practice process. There is a need to educate

and update educators about information literacy competencies that are needed for the

evidence-based practice process. The likelihood of diffusing knowledge about the

evidence-based practice process without adequate information literacy skills was in

question, especially when most participants believed that nursing educators were

responsible for teaching information literacy and evidence-based practice skills in each

nursing course. Most participants believed that critically appraising evidence was an

essential step in the evidence-based practice process, but almost half of the educators

reported not being able to evaluate new information critically, sources of information,

or decide whether to modify a search.

Participants teaching in baccalaureate and higher degree programs reported a

research/evidence-based practice course compared to the majority of participants

teaching in associate degree programs with no research/evidence-based practice course in

the curricula. Formal research courses are not usually included in diploma and associate

degree programs, and these findings are consistent with the literature. Unless evidence-

based practice concepts are taught in other nursing courses, graduates are not exposed to

the principles of evidence-based practice (Melnyk & Fineout-Overholt, 2019). One-third

of the RNs in the state where the study was conducted had an associate degree (LSBN,

2018) suggesting that these nurses did not receive formal education related to research

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and evidence-based practice processes and were members of the interdisciplinary care

team without core competencies expected for an RN (Lotz, 2010). Evidence-based

practice is an expectation for all health care practitioners, and associate degree and

diploma nurses are no exception (Lotz).

The majority (88%) of participants teaching in associate degree programs and

30% teaching in baccalaureate programs reported no informatics course in the curricula

even though accrediting agencies require undergraduate programs to include an

informatics course (AACN, 2008; NLN, 2008). This suggested graduates of those

programs enter practice without adequate searching skills needed for making decisions

based on evidence in the clinical setting. To implement evidence-based practice, nurses

need information literacy skills to search and retrieve relevant literature from massive

online resources regardless of the nursing degree (Polit & Beck, 2019). Nursing students

need to obtain skills in information literacy to understand information, ask

knowledgeable questions about nursing practice, and improve critical thinking skills for

lifelong learning and digital literacy (Badke, 2010; Bonlokke et al., 2012; Bradley, 2013;

Breivik, 2005).

Participants in the study reported sources of knowledge primarily used to locate

evidence-based practice information were professional journals and reference textbooks

(91%), followed by healthcare databases (76%), and colleagues and peers (65%). These

findings are scholarly improvements compared to Pierce’s (2000), Pravikoff et al.’s

(2005), Tanner’s (2000), and Thorsteinsson’s (2013) studies where nurses primarily

sought new information from colleagues rather than professional journals or textbooks.

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The nurses in Estabrooks’ (1998) study ranked literature, texts, and journals least of all

for sources of knowledge.

Approximately half of the participants reported rarely/never using the librarian’s

assistance (55%) to search for new literature and were confident searching Cumulative

Index for Nursing and Allied Health Literature [CINAHL] (88%), PubMed (62%), and

MEDLINE (53%) databases. These findings are also an improvement compared to

similar study’s conducted by Pierce (2000), Pravikoff et al. (2005), Tanner (2000), and

Yoder et al. (2014) where most respondents reported rarely/never using the librarian to

search for literature and were not confident searching CINAHL and MEDLINE

databases. Pierce (2000) expressed concern that there may be a false sense of productivity

based on one’s ability to access and move through the databases. Increased time and

effort searching for literature could lead to frustration, discouragement, and detract from

locating evidence for use in practice (Pierce, 2000).

The availability of healthcare databases and personal expectations for seeking

new evidence as a nursing educator were facilitators for evidence-based practice. A

statistically significant difference (p = 0.01) was found related to selecting the Joanna

Briggs Institute (JBI) database. Participants teaching in graduate and doctorate programs

chose the JBI database for evidence-based practice literature compared to participants

teaching in undergraduate programs. The JBI database is an online database providing the

best available evidence to inform nurses at the point of care with evidence-based practice

guidelines.

Interestingly, participants reported that implementing evidence-based practice was

not difficult nor did the process take too much time on the EBPB-E Scale. The primary

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barrier noted on the ILNP-M survey was lack of time followed by a lack of understanding

the organization of electronic databases for searches. Alving et al. (2018), Carter-

Templeton et al. (2014), Gale and Schaffer (2009), and Melnyk et al. (2004) also found

similar results related to insufficient time as the top barrier. Following time for evidence-

based practice, Pravikoff et al. (2005) found similar results related to lack of value for

research and lack of understanding the organization of databases as barriers. All of the

nursing students in Osman’s (2017) study agreed that e-databases were indispensable for

academic and professional practice, yet findings revealed the majority had low searching

skills and accounted for the sparse use of e-databases such as Cumulative Index for

Nursing and Allied Health Literature (CINAHL) and MEDLINE. Rogers (1995)

theorized that intervening variables might preclude the adoption of an innovation, which

could explain the influence of barriers that continually impede the implementation of the

evidence-based practice process in academia and clinical practice.

Educators’ beliefs in evidence-based practice. The second research question for

this study was: Do nursing educators have a firm trust and confidence in their ability to

teach and implement evidence-based practice as measured by the Evidence-Based

Practice Beliefs-Educator (EBPB-E) Scale? Persuasion is the second stage of Rogers’

diffusion of innovation theory, a decision is the third, and implementation is the fourth

stage (Rogers, 1995). Persuasion can foster positive attitudes toward the decision to

implement an innovation. Based on the findings from this study, persuasion, decision,

and implementation of integrating information literacy and evidence-based practice

competencies throughout nursing education should not be a concern since the majority of

participants reported a firm belief and confidence in evidence-based practice

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competencies, ability to teach the competencies, and firm beliefs that evidence-based

practice improved patient outcomes. Brown et al. (2009) reported that nurses’ attitudes

toward evidence-based practice were more favorable with associated knowledge and

abilities to apply evidence in nursing practice. Participants believed evidence-based

practice guidelines improved patient outcomes, resulted in the best patient care, and

integrating evidence-based practice in curricula improved care students delivered to

patients. Milner et al. (2018) recorded similar strong beliefs for evidence-based practice

by health educators and wrote that if nurses should make clinical decisions based on

evidence, faculty should have strong opinions and confidence in utilizing evidence-based

practice. Warren et al. (2016) studied clinical nurses’ beliefs about evidence-based

practice working in Magnet hospitals. Similar to this study, the overall nurses’ beliefs

were positive, yet only 44% believed they could implement evidence-based practice

compared to 77% of the participants in this study. Though not statistically significant,

participants in this study teaching in graduate and doctorate programs scored higher on

the beliefs scale compared to those teaching in undergraduate programs. Similar results

were noted for education and beliefs about evidence-based practice in Warren et al.’s

study where doctorate participants scored higher on the beliefs scale suggesting that

nurses with a master’s or higher degree had more favorable beliefs for evidence-based

practice.

Cultural factors for implementation of evidence-based practice in education.

The third research question was: What are the cultural factors that influence the

implementation of evidence-based practice within the educational environment and the

perceived readiness for school-wide integration of evidence-based practice as measured

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by the Organizational Culture and Readiness for School-Wide Integration of Evidence-

Based Practice-Educator (OCRSIEP-E) Scale? The majority of participants reported an

essential movement toward a sustainable culture of school-wide evidence-based practice,

yet areas for improvement included the need for (a) faculty to model and mentor

evidence-based practice in academic and clinical settings, (b) community partners and

healthcare agencies to commit to evidence-based practice, (c) measure and share

outcomes of evidence-based practice where participants worked in the colleges of

nursing, and (d) a critical mass of faculty to be knowledgeable about evidence-based

practice. Evidence-based practice champions and mentors were identified as areas of

weakness. Librarians used to search for evidence and dedicated fiscal resources to

support evidence-based practice were the greatest areas of need selected by the

participants. The majority of participants sought librarian’s assistance infrequently, and

similar findings of minimal use of this valuable resource were noted by Pierce (2000),

Pravikoff et al. (2005), and Tanner (2000).

A statistically significant difference was found in participants’ primary teaching

programs on the organizational movement scale. Participants teaching in graduate and

doctorate programs had a statistically significant difference in a positive movement

toward a sustainable culture for evidence-based practice (p = 0.028). Milner et al. (2018)

found similar results for perceptions about organizational culture and readiness for

evidence-based practice and similar areas of weaknesses related to using librarians to

search for evidence, more doctorate nurses needed, and fiscal resources needed for

evidence-based practice. Similar findings were noted in Milner et al. (2018) and this

study for overall readiness for evidence-based practice.

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Demographics related to educational degrees were similar in Felicilda-Reynaldo

and Utley’s (2015) study on educators’ teaching philosophy statements related to

evidence-based practice. Nursing educators with graduate and doctorate degrees scored

higher for identifying evidence-based practice in teaching philosophy statements. An area

noted for improvement in this study was the need for more doctorate nurses in academic

and clinical settings. The Institute of Medicine’s (IOM, 2010) recommendation to double

the number of registered nurses with doctorate degrees by 2020 in the U.S. was achieved.

There is more work to be done in the state where the study was conducted where only 1%

of the nurses had a doctorate (LSBN, 2019).

Strong positive scores were found on the EBPB-E and OCRSIEP-E Scales and

was confirmed by the statistically significant positive linear relationship noted between

the surveys (r = 0.55, p < 0.0001) for nurse educators. Milner et al. (2018) also realized a

statistically significant positive relationship between the same two scales for health

professions’ educators.

Phase II Significant Findings

Triangulation of Data. The fourth research question was: What are nursing

educators’ experiences with and perceptions of teaching information literacy and

evidence-based practice? Quantitative and qualitative data sources provided a mechanism

to make meaningful inferences by converging perspectives from multiple data sources

(Booker, 2017). Phase I results were triangulated with Phase II findings and the

professional literature. The semi-structured audio-recorded interviews limited the

subjectivity and bias of the researcher while triangulation and continuous comparison of

the data were used to ensure confidence in the results (Tuazon, 2017).

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Three themes emerged from the interview transcripts: Educating nursing

educators and students about information literacy and evidence-based practice

competencies, organizational constraints for teaching information literacy and

evidence- based practice, and educators’ personal and professional commitment for

teaching information literacy and evidence-based practice in education and practice

settings.

Phase II data highlighted the importance of being knowledgeable about the competencies,

teaching the competencies, who should teach the competencies, how and when to teach

the competencies, the need to address constraints in the classroom and the clinical

settings, and the personal and professional commitment to be information literate

educators to teach and promote evidence-based practice in academia and nursing practice.

Consistencies were identified between the findings in Phase I and Phase II,

specifically related to participants’ beliefs, knowledge of competencies, scholarly

activities as educators, and cultural factors that influenced school-wide integration of

evidence-based practice. Though Phase I results reported high level of beliefs in

evidence-based practice in nursing education and practice, there was an overt reality that

evidence-based practice was not understood or embraced as the process should be in

nursing education based on the interviews in Phase II. Results from participants in Phase

II indicated gaps in awareness of the competencies nursing educators and graduates

should possess. Inconsistencies were identified between Phase I and Phase II findings

related to the real-life experiences for knowledge and appreciation of the skills, teaching

the skills, and actual integration of the competencies in the academic and clinical

environments.

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Theme 1: Educating nursing educators and students. The first category in

Theme 1 was a knowledge deficit related to information literacy and evidence-based

practice competencies. Contrary to findings for a strong belief for evidence-based

practice and cultural readiness discovered in Phase I, participants reported inconsistencies

related to lack of knowledge and awareness about the competencies due to generational

traditions, no formal education for information literacy and evidence-based practice

competencies, and lack of collegial discussion and prioritization for evidence-based

practice. The goal of nursing education should be to teach core competencies expected

for graduates, and faculty must be knowledgeable and competent to teach competencies

(Orta et al., 2016). Similar to the findings in this study, the most recent national survey on

Quality and Safety Education for Nurses (QSEN) competencies found inconsistencies

among faculty formally trained in informatics and evidence-based practice competencies

(Altmiller & Armstrong, 2017). Though there is a strong need to prioritize and emphasize

the value of information literacy and evidence-based practice in nursing education,

faculty cannot teach content never learned and cannot mentor skills in which confidence

may be lacking (Melnyk & Fineout-Overholt, 2019). Nursing faculty must acquire an

acceptable level of knowledge and skills base along with a positive attitude towards

evidence-based practice (Melender, Mattila, & Haggman-Laitila, 2016). In this study,

educators shared a concern for faculty’s lack of knowledge and competencies to teach

evidence-based practice similar to Stichler et al. (2011) found deficits in nursing faculty’s

knowledge, attitudes, and evidence-based practice competencies.

I did not know about the information literacy and evidence- based practice competencies until I took the survey for this study. Informatics is a new language that was shoved down our throats.

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Older faculty lack research skills and do not want to talk about their lack of knowledge. If the teacher does not know how to read research, then how can they teach it?

First and foremost, educators need to be educated about the competencies and

learn effective strategies to teach and measure the competencies. Lack of awareness of

the competencies and value for teaching the competencies were reported to possibly

relate to the age of nursing faculty. Nursing faculty may not have learned information

literacy and evidence-based practice content in their education (Felicilda-Reynaldo &

Utley, 2015), yet nursing faculty, not just faculty teaching research and/or informatics,

must by fluent and knowledgeable about information literacy and evidence-based practice

language and competencies to adequately educate a nursing workforce prepared to meet

the needs of all patients (Morrison-Beedy, 2018). Pierce (2000) postulated nursing

faculty need information literacy skills to increase the success rate of information-seeking

and retrieval of information for evidence-based practice, and gaps in the educational

paradigm related to information literacy and evidence-based practice limit readiness to

integrate evidence-based practice.

The second category in Theme 1 was confusion about who, when, and how to

teach information literacy and evidence-based practice competencies. Participants

unanimously agreed evidence-based practice should be included in all nursing courses

and in all nursing programs, yet evidence identified from the interviews included a lack

of understanding about who teaches the competencies due to barriers in academia.

Cronenwett et al. (2007) and McNeil et al. (2003) found nursing faculty were uncertain

about what and how to teach nursing informatics.

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There is a big disconnect between talking about EBP and actually, teaching it. There is not enough faculty who want to teach research or information literacy. If what is taught in research and informatics are not carried through in other courses, then its value is lost, and students do not realize the importance of the information in patient care.

Without diffuse integration of the evidence-based practice paradigm, Melnyk and

Fineout-Overholt (2019) wrote there might be a disconnect by learners between the

paradigm and process. Students may view evidence-based practice as academic and not

related to clinical skills. Consistent with findings in this study, researchers learned that

the research course in nursing education was integrated at a low level compared to

fundamentals and medical-surgical courses (Altmiller & Armstrong, 2017). Altmiller and

Armstrong (2017) reported concern since research supports evidence-based practice and

serves as a bridge for the use of evidence in clinical practice. Informatics competencies

were least adopted in nursing curricula, and Altmiller and Armstrong recommended the

need to address why informatics was not prioritized in the nursing curriculum. Melnyk

and Fineout-Overholt (2019) stressed the importance of integrating the principles of

evidence-based practice in every course for students to realize the value of evidence-

based practice in clinical settings and not overtly experience a difference in expectations

from faculty or believe that the research course was less than clinical courses. In this

study, participants teaching research reported a lack of attention and importance for

research in comparison to clinical courses, possibly due to not seeing the connection of

the evidence to providing patient care. Interviewees reported some faculty saw research

as burdensome and a chore that negatively affected their perception of research and could

translate negative views to the students.

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Evidence-based practice should be the words studentslearn about in the first nursing class, on the first day in the clinical setting, and throughout the curriculum. Students need to learn that research and evidence-based practice are not just for the school setting, but for the practice setting as a RN to improve patient care and outcomes.

Lecturing students in a few class periods on the research process and expecting

them to use that new knowledge throughout their careers was insufficient for the

diffusion of information (DiCenso & Cullum, 1998). Educators in this study shared that

this method was utilized in their programs, and Melnyk and Fineout-Overholt (2019)

reported the same strategy in many contemporary nursing programs. Promotion for

teaching evidence-based practice in clinical practice was reported to be limited in nursing

education and was not prioritized in both educational and clinical settings, and Pierce

(2000) questioned the value of nursing research at the organizational level in both

academia and clinical practice.

Information literacy to support evidence-based practice are competencies nursing

graduates should possess, yet how nursing educators teach the competencies were not

clear. Some faculty may not be prepared to teach information literacy skills because they

often lack understanding in the area of informatics and information literacy (McNeil et

al., 2003). Teaching research and evidence-based practice should not be restricted to one

professor or even be a stand-alone course. Undergraduates overwhelmingly supported the

notion that evidence-based practice courses were less than other core courses in the

curriculum (Reid et al., 2017). The use of evidence found in research studies should be

woven into the fabric of academic programs so that evidence-based practice becomes part

of the culture (Melnyk & Fineout-Overholt, 2019). For nursing graduates to achieve all

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competency expectations needed in today’s healthcare environment, nursing curricula

need to be updated (Laibhen-Parkes, 2014).

The curriculum needs to be updated to meet competencies. Informatics is not in our curriculum. The librarian is the missing link for information literacy. We need to bring the librarian to the classroom.

Nursing programs of the participating schools of nursing had librarian support,

yet the librarians were not effectively and consistently utilized in all levels of nursing

education. Educators in this study believed that librarians were needed to assist nursing

faculty in teaching information literacy competencies. Melnyk and Fineout-Overholt

(2019) encouraged early involvement of the librarian in preparing for the integration of

evidence-based practice across the nursing curriculum because the librarian’s job is to be

proficient in knowing where and how to retrieve new information. Librarians collaborate

with health professions faculty to integrate information literacy and evidence-based

practice competencies into teaching plans and course content, as both are skills for

finding, evaluating, and using information in practice (Boruff & Thomas, 2011; Hobbs et

al., 2015; Jacobs et al., 2003; Lalor et al., 2012; Wallace et al., 2000). The vital

importance of the partnership between faculty and librarians was stressed in the literature

as well as the importance of the librarian taking on a teaching role inside and outside of

the library (Bonlokke et al., 2012; Diaz & Walsh, 2018; Franzen & Bannon, 2016; Gray

& Montgomery, 2014; Schulte & Sherwill-Navarro, 2009). Assistance from librarians to

support and develop faculty’s and students’ information literacy skills and embedding

strategies in all nursing courses to develop and refine information literacy skills were

recommendations repeated in the literature (Alving et al., 2018; Arguelles, 2012; Osman,

2017; Sadoughi et al., 2017) and by participants in this study.

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Theme 2: Organizational constraints for teaching information literacy and

evidence-based practice. Category 1 for Theme 2 focused on institutional constraints for

teaching information literacy and evidence-based practice. Nursing’s worth is often

measured in tasks performed by nurses rather than critical thinking done by nurses (Penz

& Bassendowski, 2006), and according to educators in this study, lack of value for

evidence-based practice in academia constrained the inclusion of evidence-based practice

content in academia. Concerning relationships between attitude and adoption of

evidence-based practice, Adams and Barron (2009) and Yoder et al. (2014) found nurses

generally had a positive attitude toward the process and believed the use of evidence was

necessary, yet the poor application of evidence-based practice remained in nursing

practice.

Similar to this study, time factors repeatedly were at the top of evidence-based

practice barriers in multiple research studies (Carter-Templeton et al., 2014; Hutchinson

& Johnston, 2004; Pierce, 2000; Pravikoff et al., 2005; Tanner, 2000). Challenges related

to lack of time to teach additional information in an already heavy workload and

organizational cultures that lacked leadership, lack of support and value for research, and

lack of knowledge and critical appraisal skills for evidence-based practice decreased the

use of evidence-based practice (Alving et al., 2018; Sadoughi et al., 2017), and these

barriers were also noted in this study. In the state where the study was conducted, thirty

percent of nursing faculty across all nursing programs reported dissatisfaction with

workload and support given by college/school for faculty research (Bienemy, 2018).

Barriers for teaching IL and EBP include not having enough faculty to teach research or know how to teach IL. There is not enough time to participate in scholarly activities. We need more support and encouragement from nursing administration related to EBP.

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Over the past twenty years, strategies were recommended and focused on

overcoming barriers such as time constraints, limited access to literature, lack of

instruction related to information seeking and critical appraisal skills, and a practice

environment that did not encourage information-seeking skills (Alving et al., 2018;

DiCenso & Cullum, 1998; Pierce, 2000, 2005; Pravikoff et al., 2005; Tanner, 2000).

Determining the nursing faculty’s necessary informatics competencies related to

information literacy and computer literacy are essential first steps in building the

foundation for teaching evidence-based practice (Melnyk & Fineout-Overholt, 2019).

Factors that negatively influenced information literacy skill development included:

inadequate computer literacy (Jacobs et al., 2003) and an inaccurate assumption that all

nursing faculty collaborate with librarians, nursing colleagues, and administrators

(Barnard et al., 2005).

The organization that skimps on educating nurses during the diffusion of

innovation will end up paying for the err in other ways (Geibert, 2006). Although

organizations spend millions of dollars on new technology, a key to the success or failure

relates to getting buy-in from educators and clinicians using the technology (Geibert).

We have to have buy-in for EBP from nursing leaders and administrators. We need administrative support and encouragement for EBP in academia and clinical practice.

Clinical constraints for teaching information literacy and evidence-based practice

were identified as Category 2 for Theme 2. Participants reported the importance of

connecting evidence to patient care with the students, yet in the fast-paced clinical

environment, there was not enough time for faculty to dedicate to searching the literature

when teaching ten students caring for a minimum of ten patients. Melnyk (2014)

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supported the belief that evidence-based practice flourished in organizations where there

was a spirit of inquiry and educators, students, and clinicians were always encouraged to

ask about their practices. Incorporating evidence-based practice into the clinical setting

requires developing a culture of inquisitiveness, openness, and emphasis on learning as a

professional obligation (Pravikoff, 2006).

The term EBP is not used in the clinical setting. Evidence needs to be included in care plans. Faculty do not do as good a job as we should teaching EBP. Clinical nurses do not talk about EBP with the students.

Students get excited about their grades, not the evidence. Students are in survival mode most of the time, and their spirit of inquiry is limited. I guess we can say that about nursing faculty, too. Administrative support is lacking for EBP, and we may let evidence go because of a lack of interest by clinicians, colleagues, and directors.

Cronje and Moch (2010) believed that immediate benefits of evidence-based

practice as an innovation were not immediately visible and may explain the survival

mode of students related to grades rather than finding evidence to support clinical

practice. A new generation (Generations Y and Z) of nursing students exists now.

Students today do not accept the status quo; We have always done it this way is no longer

acceptable (Dang & Dearholt, 2018). Efforts to introduce the experience and visibility of

evidence-based practice to students may enhance its adoption by students taught to

provide care based on evidence and not tradition (Pashaeypoor et al., 2016). Recognizing

nursing students in all undergraduate nursing programs need varying approaches to

teaching and learning evidence-based practice competencies, more guidance is needed on

how to incorporate the process into varying levels of nursing education (Melnyk &

Fineout-Overholt, 2019). Finding ways to use social media constructively may prove to

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be effective and efficient strategies that educators may need to utilize related to

disseminating evidence-based practice.

Students are more interested in reading social media instead of reading a journal. On average, a journal article is read by 17 people, but if you write what you learned about EBP in 240 characters or less on Twitter, you could have something go viral and read by thousands of people.

Traditional teaching strategies still dominate in nursing education and those

methods do not always encourage critical thinking among nursing students (Mthiyane &

Habedi, 2018). Traditional teaching is not necessarily a barrier when one considers that

the success rate on the national licensing exam for nursing graduates in the state where

the study was conducted is higher than the national pass rate. A standard measured in the

regulation of undergraduate nursing education programs leading to RN licensure is the

rate of first-time testers on the National Council of State Boards of Nursing (NCSBN)

NCLEX-RN since 1994 (Dufrene, 2017). In the state where the study was conducted,

first-time pass rates are consistently higher than the national pass rate. In 2016, national

pass rates were 84.56% and Louisiana’s pass rate was 89.16% (Dufrene, 2017). A review

of peer-reviewed manuscripts for the NCSBN indicated that 50% of new graduate nurses

were involved in errors of nursing, 65% of the errors were attributable to poor clinical

decision-making skills, and only 20% of employers were satisfied with clinical decision-

making skills of new nurses (Lyon, 2017). The knowledge of evidence-based practice

reflects the level of clinical judgment, and decision-making in clinical practice and

clinical decision-making is shaped by evidence (Tuazon, 2017).

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Theme 3: Educators’ commitment for teaching information literacy and

evidence-based practice competencies. The last theme from the interviews summed up

the educators’ desires to promote, prioritize, and professionally commit to learning and

teaching information literacy and evidence-based practice competencies and prepare

nursing graduates for practice in the twenty-first century. Evidence-based practice

mentors are needed to show enthusiasm and value for evidence-based decision-making

and encourage a spirit of inquiry in their organizational culture while supporting the

nursing faculty and students (Melnyk, 2014). Demonstrated commitment to strive for

excellence in education and practice among educators and administrators is imperative

for evidence-based practice to be integrated in all nursing programs (Melnyk & Fineout-

Overholt, 2019). Gale and Schaffer’s (2009) top reasons to adopt evidence-based practice

were personal interests in practice changes and value for using evidence-based decision-

making. Brown et al. (2009) reported that nurses with positive attitudes toward evidence-

based practice were associated with knowledge and abilities to apply evidence in nursing

practice.

We do not talk about EBP enough as faculty and do not do enough to advance and prioritize EBP. The only reason why I get EBP is because I am back in school in a doctorate program and EBP was one of the courses. We need to develop objectives aimed at research and EBP. We do not do enough to advance and prioritize EBP.

Personal and professional commitment to being an information literate educator to

teach and promote evidence-based practice evolved as a theme from the narrative

transcripts. Schulte and Sherwill-Navarro (2008) agreed that information literacy and

evidence-based practice require nursing educators to rethink their curricula and integrate

the competencies throughout all nursing programs. Educators’ awareness of the various

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forms of technologies to assist students in evidence-based decision-making, including

search-skills in online healthcare databases, will enhance teaching strategies and expand

faculty’s capacity to integrate information literacy and evidence-based practice in the

curriculum (Morrison-Beedy, 2018; Nelson & Staggers, 2008; Wahoush & Banfield,

2014; Williamson et al., 2011). To ensure nursing faculty hold their students to high

standards for success with evidence-based practice, the integration of the process and

related components of critical thinking, life-long learning, and quality patient care need to

be threaded in the nursing curriculum (Felicilda-Reynaldo & Utley, 2015). Faculty need

to model evidence-based practice in academic and clinical settings, community partners

need to commit to evidence-based practice, nurses need to measure and share outcomes

where participants work, and there needs to be a critical mass of knowledgeable faculty

about the process. In order to achieve information literacy and evidence-based practice

goals in academia, librarians need to increase efforts to educate nursing faculty such as

using the train-the-trainer strategy and initiate and implement creative and far-reaching

collaborations (Barnard et al., 2005; Bonlokke et al., 2012; Cobus-Kuo & Waller, 2016;

Schulte & Sherwill-Navarro, 2009).

Evidence-based practice existed for decades, yet the process was not routinely

used in many healthcare settings (Reid et al., 2017; Spruce, 2015). Students who do not

know how to question standard nursing practices or wonder why a nursing intervention is

selected for patient care may not develop the skills needed to continually enhance the

quality of nursing care (Penz & Bassendowski, 2006). Morrison-Beedy (2018) contended

that nurses who understand and implement evidence-based practice would proactively

address improved health outcomes. Consistent with the findings in this study,

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Pashaeypoor et al. (2016) postulated that attitude and positive beliefs about evidence in

practice could be facilitated through mentors and role models in educational and clinical

settings. In 1997, Naish cautioned that pushing evidence-based practice can make nurses

responsible for issues beyond their boundaries unless they work in an environment where

the culture adequately supports nurses to make decisions based on evidence.

Nurses are low on the totem pole for practice change unless they are experts and then others may listen. Nurses are not valued and not encouraged to make practice changes. No matter how proactive or courageous a nurse may be, they are treated like they are disrupting things instead of championing something to improve patient’s care.

In 2003, Young wrote that nurses embraced evidence-based practice ten years

earlier, and though the process was a worthy goal, evidence-based nursing practice was

far from being realized in many healthcare settings. A healthcare environment that

diminishes nurses’ authority, power, and independence over their practice will decrease

the integration of evidence-based practice (Gale & Schaffer, 2009). The culture in many

schools of nursing do not support educators to make changes and likewise, clinicians are

not encouraged to make changes in many organizations.

Additional Findings

Though results of Phase I indicated no statistically significant differences for age,

participants’ mean scores were higher for the group under the age of fifty years compared

to participants over the age of fifty years. Nursing education is faced with the challenge

of an aging workforce where more than half of the faculty are greater than fifty years old

(Bienemy, 2018). Aging educators may be perceived as resistant to change, lack

technology skills and knowledge for teaching competencies such as information literacy

and evidence-based practice, prefer traditional teaching strategies, and not interested in

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seeking higher degrees. Falk (2014) posited that failure to adapt to the perceptions

mentioned above was not only limited to senior nursing faculty. Nurses in Tuazon’s

(2017) study believed older or more senior nurses in the intensive care unit settings were

stuck in their ways, held more sacred cows in their practice, and tended to be more

resistant to change compared to new inexperienced nurses being more likely to apply

evidence-based practice because of being more open to new ideas. The idiom, “nurses eat

their young,” has been used for more than thirty years (Gillespie, Grubb, Brown, Boesch,

& Ulrich, 2017), and paradoxically, younger nursing faculty and clinicians may be

“eating their elders” in the age of high-tech and fast-paced technological healthcare

environment. Since schools of nursing across the country are experiencing a faculty

shortage (Bienemy, 2018), valuing the wisdom and knowledge that senior faculty bring to

nursing education is imperative for students and junior faculty (Falk, 2014). Falk (2014)

poignantly noted that administrators could lessen incongruence by readjusting the

pressures for ongoing change and seek new solutions to utilize what aging faculty bring

to nursing education based on current evidence.

Implications for Nursing Education and Future Research

Implications for the findings of this study are primarily for nursing educators,

however, educators are leaders in nursing practice, administration, and research. The

implications should be considered for the whole nursing profession. Educators are

champions, mentors, and role models for all nurses and are responsible and obligated to

prepare future nurses to work in interdisciplinary teams. According to a Gallup poll, for

the last seventeen years, registered nurses were considered to be the most trusted

profession in the U.S., and there was no differentiation between bedside nurses, nurse

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educators, and nurse managers, nor the degree of the registered nurse (Gaines, 2019).

Nurses are on the front lines providing care to millions of people every day and across

many healthcare settings. The nature of nursing practice requires the nurse to respond to

the individual needs of patients, families, and communities, and in doing so can prohibit

the nurse to make decisions based strictly on one type of evidence and important question

stemming from how evidence is defined to how nurses make decisions in the absence of

scientific evidence (Earle-Foley, 2011). Along with sources of knowledge such as

expertise, authority, tradition, intuition, and judgement, educators need to ensure that

future nurses are information literate and know how to ask a question when a problem

arises, how to locate, evaluate, and ethically and legally use current information based on

evidence for decision-making in patient care.

Twenty-one years ago, DiCenso and Cullum (1998) wrote the importance of

evidence-based practice was not new in nursing education. “Although we have advocated

for evidence-based practice for many years, we have struggled with how to make it

happen” (DiCenso & Cullum, 1998, p. 38). Tanner (2000), Pierce (2000), and Pravikoff

et al. (2005) laid the fundamental groundwork related to nurses’ information literacy

skills and readiness for evidence-based practice. Almost two decades later, progress has

been made related to nurses’ awareness about the importance of evidence-based practice

to improve patient outcomes, yet, nurses are still searching for strategies to overcome

similar barriers related to lack of time, lack of searching skills, lack of knowledge and

awareness about the competencies, lack of resources, lack of administrative support, and

a dire need for faculty development. Reportedly, research to practice takes seventeen

years (Clancy & Cronin, 2005), and today, the nursing profession must address and

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overcome each barrier in a strategic manner and put evidence-based practice on the

priority agenda.

Approximately half of the educators believed that faculty and librarians were

responsible for teaching information literacy skills throughout nursing curricula. Since

there are not enough librarians to champion the cause to promote information literacy,

faculty need to put the competency on the academic agenda and prepare the graduates to

be information literate and empower them for critical thinking, life-long learning, and

confident to competently search the multitude of online healthcare databases for evidence

to use in practice settings (Badke, 2017). Information literate individuals are reported to

be confident, informed, autonomous, and competent, therefore, information literacy needs

to be visible and valued in nursing education (Forster 2015). Nurses work in a

knowledge-driven environment where current information is required in order to plan and

deliver patient-centered care. Partnering with librarians already housed in colleges and

universities of most nursing programs seems to be a feasible and logical solution related

to integrating librarians’ expertise and knowledge in nursing education.

The Information Literacy Competency Standards for Nursing were designed to

provide a framework for faculty in all levels of nursing education to teach information

literacy skills for evidence-based practice (ACRL, 2014). Phelps et al. (2015) postulated

that adopting the standards at the earliest level in nursing education and by a variety of

stakeholders were effective strategies that could ensure nurses acquire skills needed to

utilize evidence in clinical practice.

Due to varying levels of nursing education for licensure as a registered nurse, all

nurses do not enter practice with the same competencies but are expected to deliver a

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minimum level of safe, quality care based on evidence, regardless of the educational

degree. Likewise, all registered nurses (RNs) do not enter practice with competencies due

to inconsistent integration of information literacy and evidence-based practice

competencies in all curricula. Regardless of the degree, graduates are expected to deliver

safe, quality care based on current evidence. The American Nurses Association (ANA)

revised Nursing: Scope and Standards for Practice in 2010 and made a substantive

change for the research standard by renaming research to “Evidence-Based Practice and

Research” (ANA, 2010). The competencies are specific and hold RNs accountable to (a)

utilize current evidence-based nursing knowledge, including research findings, to guide

practice, (b) incorporate evidence when initiating changes in nursing practice, (c)

participate, as appropriate to education level and position, in the formulation of evidence-

based practice through research, and (d) share personal and third-party research findings

with colleagues and peers (ANA, 2010). The ANA is the professional organization for all

RNs, not just nurses with a baccalaureate or higher degree.

Information literacy and evidence-based practice are more than just buzzwords in

nursing education and clinical practice (Badke, 2010; Masters, 2018). Though a clear

definition and understanding for information literacy were noted to be somewhat elusive

by nursing educators in this study, the language used to define the Information Literacy

Competency Standards for Nursing is very clear and can be readily understood by

educators and students in all nursing programs (ACRL, 2014; Phelps et al., 2015).

Reasonable evidence-based practice expectations and learning outcomes need to be

considered when planning learning activities and assignments for undergraduate and

graduate nursing students. Similar to The Information Literacy Competency

Standards

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for Nursing (ACRL, 2014), Melnyk and Fineout-Overholt (2019) developed

recommendations for evidence-based practice expectations and learning outcomes for

undergraduate nursing education. The expectations include competent use of EBP

language and using PICO to ask questions, novice systematic searching and critical

appraisal skills, novice skills in integrating evidence into practice, evaluating clinical

outcomes, and disseminating evidence-based practice project findings. The evidence-

based practice competencies can be used to guide nursing educators to prepare students

with the necessary knowledge and skills needed to leave nursing school and function

competently as practicing nurses in clinical settings (Melnyk, 2015).

Limitations

Purposeful, convenience sampling methods were used in both phases of data

collection, and data were collected from a limited number of nursing educators in one

state and limit the generalizability of the findings. All nursing programs in the south-

central state did not opt to participate in the research study and limited the

generalizability to other nursing programs in the state. The two-week time frame for

Phase I data collection prevented several of the nursing programs in the state to not

participate due to institutional review board (IRB) constraints. Another limitation of this

study was reliance on a small sample size for both phases of the study and completion

rate for Phase, and there may be some inaccuracies in reporting the variables. In addition,

allowing the participants to pause and later resume the survey might have increased the

number of completed answers. Self-reported data in Phase I may be interpreted as biased

by choosing to participate in online surveys, and self-selected participation in Phase II

may be considered as biased participation. Two of the participants in Phase II were

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colleagues of the researcher and could be perceived as sharing biased information. The

researcher was a nursing educator teaching at one of the participating nursing programs

in the study and recognized that potential bias could shape the interpretation and

approach to the study (Creswell & Poth, 2018).

Conclusion and Recommendations for Future Research

The evidence is irrefutable that nursing educators need to prepare graduates to be

competent and confident to utilize evidence-based practice in planning and delivering

care to patients, families, and communities (Melnyk & Fineout-Overholt, 2019; Thiel &

Ko, 2017). Students need high levels of information literacy skills in every phase of

education to function productively in the fast-changing information environment (Osman,

2017) and support evidence-based practice competencies in nursing education and

practice (Melnyk & Fineout-Overholt, 2019; Phelps et al., 2015; Sewell, 2019). In

academia, aligning competencies with program outcomes are well-known

recommendations and expectations (AACN, 2008, 2010; ANA, 2010; IOM, 2011;

Melnyk et al., 2014; QSEN, 2012). Quality and Safety Education for Nurses (QSEN) was

an initiative started in 2005 to support the adoption and integration of essential

competencies including evidence-based practice and informatics in nursing education

(Altmiller & Armstrong, 2017). The competencies are highly regarded in accredited

nursing education, yet researchers reported that progress varied in disseminating and

adopting all competencies among nursing programs and integration of evidence-based

practice and informatics were segmental and not integrated throughout nursing curricula

(Altmiller & Armstrong, 2017). Findings in this study for segmental and inconsistent

integration of competences were similar and not acceptable.

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Educators in all undergraduate and graduate nursing programs are ethically and

professionally obligated to be aware of, knowledgeable about, and prepared to teach all

competencies, not just a select few, that are required for nursing graduates in the twenty-

first century. Based on findings from this study, a commitment to teaching information

literacy to support evidence-based practice is essential by all educators in all nursing

programs. In the current healthcare environment where technology continually changes,

institutions of higher learning are attending to lifelong learning as a graduate outcome,

and teaching information literacy skills fall on the shoulders of discipline-specific faculty

such as the case for nursing educators. Educators are role-models for student nurses and

nursing leaders in the community and clinical environment, and if nursing educators have

a strong commitment and belief in evidence-based practice as noted in this study, then

nursing faculty should walk-the-walk (Melnyk & Fineout-Overholt, 2019). Individual and

collective voices pointed out in the survey and interview participants were clear. Nursing

educators in this study had a strong belief in teaching and implementing evidence-based

practice for improved patient outcomes in all nursing programs and settings. Linking

research to evidence for nursing practice began with Florence Nightingale, and

approximately, one hundred years passed until the nursing profession followed

Nightingale’s advice (ANA, 2010). Nursing research flourished as nurses received

advanced educational preparation after the 1950s, and nurse researchers significantly

contributed to the body of nursing knowledge after that. The time for adopting, valuing,

prioritizing, teaching, and learning information literacy and evidence-based practice in all

levels of nursing education have arrived.

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Today, nurses need to address barriers that preclude the use of evidence-based

practice as leaders in healthcare and advocate for nurses’ voices to be heard in all

educational and clinical settings with effective strategies based on current evidence. The

time is now to review the results of this and many other studies that support the need for

nursing educators to become aware of the need to educate the educator for information

literacy and evidence-based practice competencies. Nursing educators should proceed

with a level of confidence through Rogers’ (1995) stages of adoption for the

competencies in nursing curricula. Persuasion should be an easy stage with the wealth of

evidence to support evidence-based practice. Educators should make the decision to

adopt the competencies based on the overwhelming and compelling evidence and support

for evidence-based practice. Implementation will take place when administrators and

faculty work together to develop a plan of action to review the current curriculum and

identify areas of strength as well as areas of weakness. Information literacy and evidence-

based practice guidelines are available in specific and straighforward language for each

level of nursing education. The confirmation stage will occur through measurement

within individual nursing programs by using pre- and post-evaluations related to the

achievement of specific competency outcomes.

Based on this study, the following recommendations were made:

1. Nursing administrators need to address and provide faculty development and

continuing education related to all nursing competencies and in all nursing programs.

2. All nursing programs must examine curricula and identify learning outcomes and

evidence-based teaching strategies specific for information literacy and evidence-based

practice competencies.

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3. Systemic, collaborative partnerships between faculty and librarians are needed in all

nursing programs to integrate discipline-specific information literacy competencies early

in the curriculum and provide more opportunities for students to develop and practice

subject-specific research searching skills that are essential for implementation of

evidence-based practice.

4. The language and competencies for information literacy and evidence-based practice

need to be included in every nursing book, nursing course objective, outcome

competency, and in all nursing programs.

5. The name of nursing research courses needs to align with the recommendation by the

American Nurses Association (ANA, 2010): nursing research and evidence-based

practice.

Questions for future research. A young nursing professor asked a question that

resonates in the nursing profession today: “Do educational programs in nursing inculcate

intellectual skills and habits of mind so that a nurse practitioner can understand, interpret,

and evaluate a research report” (Ketefian, 1975, p. 92)? A supplement editor for Nursing

Times asked, “What exactly is evidence… How can it be found and evaluated” (Naish,

1997, p. 61)? These questions are still significant today as the observations and

recommendations based on the findings from the research study were reported.

Identified paradoxes noted in the study should be further explored by researchers

utilizing data collection tools that measure specific competencies for nursing educators

and students. Parametric sampling methods and rigorous research designs such as in pre-

and post- longitudinal studies should be selected to discover higher levels of evidence to

adopt curricula revisions. Questions for future research include (a) are nursing faculty

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formally educated on all expected competencies, (b) what measures are used to evaluate

each competency in educators and students, and (c) are information literacy and

evidence-based practice competencies integrated into all nursing curricula? Nursing

educators need to prepare graduates for lifelong learning with confidence and

competence to lead the interdisciplinary healthcare team in planning and providing

patient-centered care based on current research evidence, clinical expertise, and patients’

preferences for care.

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Appendix A

IRB Approval Letter from ULM

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Appendix B

Permission to Use and Modify Information Literacy for Evidence-Based Nursing Practice (ILNP) Tool

September 15, 2018

Dr. Susan PierceOf course, you may have my permission to use our tool and to modify it to better meet your needs. We ask that you provide us with the results of your work when done. Keep me posted on your progress. I am glad to help in any way.Susan Pierce, RN, EdD

September 15, 2018

Dr. Annelle TannerYES, indeed, you most certainly have our permission AND BLESSING to use and/or alter our tool. We would appreciate receiving results from your study when completed. It has been VERY interesting to see the MINIMAL change in nurse’s information seeking behavior/skills since our original study, initially in Louisiana (1998) and then nationally (2004). I am eager to see what you find. May you have times of joy and peace mixed in with the frustration and angst over the process!Annelle B. Tanner, RN, EdD

September 15, 2018

Dr. Diane PravikoffAnd I, of course, add my blessings to your work. Like, Annelle, I continue to be surprised by the consistency in results of nurses’ information literacy skills although I am seeing some improvement as the emphasis on BSNs continues. I have been “mentoring” several RN-BSN students over the last year – RNs who are doing their last quarter Capstone project – and they are doing well at not only gathering information for their need, but also writing about it. One step at a time.Diane S. Pravikoff, RN, PhD, FAAN

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Appendix C

Permission to Use Unmodified Organizational Culture and Readiness for School-Wide Integration of Evidence-Based Practice-Educator (OCRSIEP-E) and

Evidence-Based Practice Beliefs -Educator (EBPB-E) Scales

October 7, 2018

Hi Ann:I received your forms and check #443 – Thank you! Please send back your statement of agreement to the following terms:

ARCC LLC has agreed to provide permission for Ms. Ann Deshotels, EdD student, to use the OCRSIEP-E scale in her dissertation to assess information literacy for evidence- based practice in nursing education and the EBP Beliefs Scale for Educators (EBPB-E) to assess EBP beliefs of faculty in nursing programs in Louisiana. Ms. Deshotels and her team agree to make no changes to the scales, either any form. Ms. Deshotels agrees to deliver the scales via electronic data collection, with full title, copyright and instructions included (template to follow upon signing agreement). When published, either for academic or general readership [journals], the scales are not to be published in their entirety, i.e., as a scale. Random ordered or by result items (i.e., items should not be listed in the order of the scale) within tables with items means is acceptable. The template that will be provided for creating the online scales can be included in documents for IRB purposes. Ms. Deshotels and team also express a clear understanding and agreement that this permission is solely for this project, and at the end of data collection, the scale will be removed/deleted from any online format (electronic files) that has been created and electronic files and hard copies discarded. That is, Ms. Deshotels and her team agree that there will be no portion of the OCRSIEP-E or EBPB-E scales in electronic form after data collection is completed.

This signed affidavit is an acknowledgement all of these agreements between ARCC LLC and Ms. Deshotels and the team working with Ms. Deshotels.

Thanks so very much,Ellen Fineout-Overholt [email protected]

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Appendix D

Letter for Permission from Deans/Department Heads

January 1, 2019

Chair of Department of Nursing and Allied Health College of NursingAddress

Dear Dean:

My name is Ann Deshotels, and I am currently a doctoral student at the University of Louisiana Monroe (ULM) in the EdD program with a focus in Health Professions Education. My dissertation entitled, Nursing Educators' Perceptions of Teaching Information Literacy to Support Evidence-Based Practice: A Mixed Methods Study, aims to examine nursing educators' perceptions about the need to teach information literacy in each level of the nursing curriculum for evidence-based practice. I am requesting permission to ask nursing faculty at the University of XXXXXX to participate in the study. With your permission, I would like to email the nursing faculty and ask for their consent to participate in the study. Confidential data will be collected electronically via SurveyMonkey and distributed through each faculty member's school email address. I plan to collect data in January 2019. Completion of the survey will take approximately 20 minutes. At a later day, I will conduct a personal interview with a small number of volunteers from each of the participating nursing programs to collect qualitative data and explore the concepts in more detail.

By participating in the study, your faculty will have input and learn if information literacy is valued and integrated into all levels of nursing education to support evidence- based practice and strengthen graduates' confidence utilizing evidence in nursing practice. I believe the results of the study will be of interest to you and any respondents who request the information. The results will be reported as aggregate data, and no comments will identify any faculty or College of Nursing.

If you approve, I will need your consent to send to ULM's IRB committee. I will be happy to answer any questions that you may have or provide additional information related to the study. Thank you for your attention to this request.

Sincerely,

Ann R. Deshotels, MSN, RN, CNE Assistant Professor of

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Appendix E

Sample Agreement Letter from Colleges of Nursing Deans/Directors

162

Appendix F

Informed Consent for Phase I Data Collection

As a nursing educator currently teaching in a college of nursing in Louisiana, you are asked to

voluntarily participate in a research study entitled, Nursing Educators' Perceptions of Teaching

Information Literacy to Support Evidence-Based Practice: A Mixed Methods Study. Information

literacy and evidence-based practice (EBP) competencies are essential for RN students to acquire

during their education to ensure that nursing graduates are prepared to utilize current evidence in

the clinical setting. The purposes of the study are to examine nursing educators' perceptions and

beliefs about teaching student’s information literacy skills to support evidence-based practice and

educators' beliefs and readiness to teach evidence-based practice.

Approval to conduct the study was granted by the ULM Institutional Review Board (IRB) where

the researcher is a doctoral candidate and from the NSU IRB where the researcher is a member of

the nursing faculty. Data for Phase I of the study will be collected in the following survey based

on three separate data collection tools. You may choose to answer all, some, or none of the

questions included in this survey. Personal information about participants or the college of

nursing where participants teach will not be collected. No one will be able to track responses or

data back to participants' email or IP addresses due to the use of SurveyMonkey’s Anonymous

Response Option, which ensures the anonymity of participants' answers. To the best of my

knowledge, the risks of participating in Phase I are minimal due to the time commitment to

complete the survey (< 15 minutes) and are no greater than those encountered when completing

an online survey related to nursing education. Your voluntary consent to participate will be

determined by the completion and submission of this questionnaire.

Data collected from this survey will be kept confidential and privately secured in the researcher's

home. The researcher has no financial or personal interest in any company or instruments

approved for use in the study. Only aggregate data will be reported with those interested in the

study, and results and findings may be presented and published at a later date.

In Phase II, data will be collected from nursing educators who volunteer for an interview via an

audio-recorded WebEx meeting at a later date. A separate informed consent will be used for

Phase II of the study. Please feel free to contact the researcher with questions or feedback about

the study at the phone number or email address noted below. Thank you! Your participation

and interest in the study are sincerely appreciated.

Ann Deshotels, MSN, RN, CNE Assistant Professor of Nursing [email protected]

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Appendix F-1

Phase I Data Survey via SurveyMonkey

Survey 1The following questions are based on the Information Literacy for Evidence-Based Nursing Practice survey (Pierce, Pravikoff, & Tanner, 2003). The ILNP-M survey was modified with permission from the authors. Demographic data and questions related to information literacy and evidence-based practice are included in the following 19 questions. For the purposes of this study, Information literacy is defined as the ability to recognize when information is needed and have the ability to locate, evaluate, and use the needed information effectively (ACRL, 2002).Evidence-based practice is defined as clinical decisions based on the best available up-to-date evidence, clinician's expertise, and the patient's values and preferences for care (Melnyk & Fineout-Overholt, 2015).

1. Age: < 30 years; 31-39 years ;40-49 years; 50-59 years; 60-69 years; > 70 years

2. Gender: Female; Male

3. 1st nursing degree as a registered nurse: Diploma; ASN; BSN; Other; Name of other degree

4. Highest degree earned:MSN DNP DNS PhD EdD Other

5. Current employment status as a nursing educator:Part-time; Adjunct; Full-time; Other

6. Nursing program for your primary teaching and/or faculty responsibility: ASN BSN RN to BSN MSN/FNP DNP Other

7. When you need information to support your faculty role, how do you find the information? Select all that apply.Seek assistance from the librarian; Ask colleagues or peers; Search a healthcare database; Search Google or other non-healthcare database; Review professional journals and/or reference textbooks; Other

8. What databases do you commonly search to find evidence to support your teaching responsibilities? Select all that apply.Academic Search Complete; CINAHL Complete with Full Text; Cochrane Library Nursing; Joanna Briggs Institute; MEDLINE; PubMed; ProQuest; TRIP Resources for EBP; Google Scholar; Other database

9. What facilitates locating and using current evidence to support your faculty role? Select all that apply. Availability of:Librarian to assist in searching the literature; Healthcare databases for EBP; Information technology (IT) support; Online tutorials to search databases; Administrative encouragement and support; Faculty colleague’s encouragement/support; Personal expectation for EBP as a nursing educator; Other

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10. What hinders you from searching databases to locate evidence in the scientific literature to support your faculty role? Select all that apply.Lack of computer skills; lack of time; lack of value for research evidence; lack of information literacy skills; lack of skills to analyze and apply research evidence; lack of priority and value for EBP as compared to teaching other nursing skills; lack of understanding the organization or structure of electronic databases; lack of librarian support; Other

11. In the past year, how frequently did you participate in the following scholarly activities?> 3 times/year; 1-3 times/year; Not at all

Investigator/Co- investigator in nursing research; Evaluated research reports; Identified researchable healthcare problems; Used research findings in your faculty role; Mentored faculty/students for research; Published a scholarly article or research study; Presented at a nursing conference; Other scholarly activity

12. Are you familiar with the Evidence-Based Practice Competencies for Registered Nurses? Yes No

13. Are evidence-based practice competencies identified as learning outcomes in any of the nursing courses that you currently teach?Yes No

14. Does the nursing curriculum that you teach in include a research/evidence-based practice course?Yes No

15. Does the nursing curriculum that you teach in include an informatics course? Yes No

16. Who is primarily responsible for teaching information literacy skills (ability to recognize when information is needed and locate, evaluate, and use the information effectively) to nursing students at your school of nursing? Select all that apply.Librarian in face-to-face sessions; Online tutorials through the library; Nursing faculty in each course; Nursing faculty and librarian throughout the student's nursing education; Student should be information literate before they enter nursing school; Other

17. Are you aware of the Information Literacy Standards for Nursing Practice published specifically for the nursing discipline (ACRL, 2014)? Yes/No

18. What Information Literacy Competency Standards for Nursing are you prepared and skilled to teach as an information literate nursing educator? Select all that apply.Define and articulate the need for information; Assess needed information effectively and efficiently; Critically evaluate the procured information and its sources and decide whether or not to modify the query and/or seek additional sources and whether to develop a new research process; Individually, or as a member of a group, use information effectively to accomplish a specific purpose; Understand many of the economic, legal, and social issues surrounding the use of information and access and use information ethically and legally

19. Do you believe that information literacy is a prerequisite for evidence-based practice? Yes, No Other (please specify)

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Survey 2

Following are 19 items about evidence-based practice (EBP) in education based onthe Organizational Culture & Readiness for School-Wide Integration of EBP for Educators survey. Permission to use the OCRSIEP-E (2011) was granted by Fineout-Overholt and Melnyk. Please consider the state of your educational organization for the readiness of EBP and select the answer that best describes your response to each question. There are no right or wrong answers.

Answer choices: None at all A little Somewhat Moderately Very Much

20. To what extent is EBP clearly described as central to the mission and philosophy of your educational agency?

21. To what extent do you believe that evidence-based education is practiced in your organization?

22. To what extent is the faculty with whom you work committed to EBP?

23. To what extent are the community partners with whom you work committed to EBP?

24. To what extent are the administrators within your organization committed to EBP (i.e., have planned for resources and support [e.g. time] to initiate EBP)?

25. In your organization, to what extent is there a critical mass of faculty who have strong EBP knowledge and skills?

26. To what extent are there nurse scientists (doctorally-prepared researchers) in your organization to assist in the generation of evidence when it does not exist?

27. In your organization, to what extent are there faculty who are EBP mentors?

28. To what extent do faculty model EBP in their educational and clinical settings?

29. To what extent do faculty members have access to quality computers and access to electronic databases for searching for the best evidence?

30. To what extent do faculty members have proficient computer skills?

31. To what extent do librarians within your organization have EBP knowledge and skills?

32. To what extent are librarians used to search for evidence?

33. To what extent are the fiscal resources used to support EBP (e.g. education-attending EBP conferences/workshops, computers, paid time for the EBP process, mentors)?

34. Choose the best answer for each of the following groups: To what extent are there EBP champions (i.e., those who will go the extra mile to advance EBP) in the environment among: Administrators; Community Partners; Clinical Faculty; Junior Faculty; Senior Faculty

35. To what extent is the measurement and sharing of outcomes part of the culture of the organization in which you work?

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36. Choose the best answer for each of the following groups: To what extent are decisions generated from: Faculty; College Administration; University Administration

37. Overall, how would you rate your institution in readiness for EBP?Not ready; Getting ready; Been ready but not acting; Ready to go; Past ready & onto action

38. Compared to 6 months ago, how much movement in your organization has there been toward an EBP culture?

Survey 3

The last 22 statements are about evidence-based practice (EBP) in education based on questions from the EBP Beliefs Scale for Educators. Permission to use the EBPB-E scale was granted by Fineout-Overholt and Melnyk (2010). Please select the best answer that describes your agreement or disagreement with each statement. There are no right or wrong answers.

Answers choices: Neither agree nor disagree, Disagree, Strongly disagree, Agree, Strongly agree

39. I believe that EBP results in the best clinical care for patients.

40. I am clear about the steps of EBP.

41. I am sure that I can implement EBP.

42. I believe that critically appraising evidence is an important step in the EBP process.

43. I am sure that evidence-based guidelines can improve clinical care.

44. I believe that I can search for the best evidence to answer clinical questions in a time efficient way.

45. I am sure that I can teach how to search for the best evidence.

46. I believe that I can overcome barriers to implement EBP.

47. I am sure that I can implement EBP in a time efficient way.

48. I am sure that implementing EBP will improve the care that my students deliver to patients.

49. I am sure about how to measure the outcomes of clinical care.

50. I believe that EBP takes too much time.

51. I am sure that I can access the best resources in order to integrate EBP in the curriculum.

52. I believe EBP is difficult.

53. I know how to implement EBP sufficiently enough to make curricular changes.

54. I am confident about my ability to implement EBP where I work.

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55. I believe the care that I deliver is evidence-based.

56. I am sure that I can teach EBP in a time efficient way.

57. I am sure that integrating EBP into the curriculum will improve the care that students deliver to their patients.

58. I am sure I can teach EBP. Strongly Disagree

59. I am sure that I can teach how to develop a PICOT question.

60. I know how to teach EBP sufficiently enough to impact students' practices

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Appendix G

Informed Consent for Phase II

As a nursing educator currently teaching in a college of nursing in Louisiana, you are invited to participate in Phase II of a research study entitled, Nursing Educators' Perceptions of Teaching Information Literacy to Support Evidence-Based Practice: A Mixed Methods Study. The purposes of the study are to examine nursing educators’ perceptions and beliefs about teaching information literacy to support evidence-based practice (EBP) and examine nursing educators’ readiness for teaching EBP. You are asked to be personally interviewed via an audio-recorded WebEx meeting. The WebEx meeting will be locked, and the interview will be private. The semi-structure interview will be flexible to discuss the concepts of interest: information literacy and evidence- based practice. You may choose to answer all, some, or none of the questions, and you will not be coached, coerced, or encouraged to answer any of the questions. Your answers will not be manipulated or changed in any form or manner. Nopersonal information or the college of nursing where you teach will be shared with anyone else or reported in the findings of the study. The entire interview will be kept confidential. No one will be able to trace your responses to your identity, and no sensitive or confidential information will be requested.

By participating in the interview, you will benefit by knowing that you added to the current body of knowledge related to the link between information literacy and evidence- based practice. The evidence can be used by colleges of nursing for curriculum review and ensure that nursing graduates are prepared and confident to utilize EBP in the clinical setting. By participating in the interview, you may experience the risk of emotional stress due to the time commitment (approximately 15-30 minutes) and open-ended conversation about your knowledge and beliefs of teaching information literacy and evidence-based practice in nursing education.

All recordings and data collected will be secured and locked in a safe area in the researcher’s home and will be destroyed five years after the completion of the study. The researcher has no financial or personal interests in any company or instruments approved for use in the study. The results will be voluntarily shared with those interested in the study and may be presented and published at a later date. Your agreement and willingness to participate in Phase II of the study will be determined by signing this consent. You can choose to not participate at all, even after signing the consent. Thank you for voluntarily participating in Phase II of this study and agreeing to be personally interviewed and audio-recorded.I, , voluntarily agree to participate in an audio- recorded WebEx meeting with Ann Deshotels for a research study as an EdD candidate at ULM. I understand the risks and benefits of the study.

Ann Deshotels Name of Nursing Educator Date

169

Appendix H

Phase II Interview Topics

Nursing Educators’ Perceptions of Teaching Information Literacy to Support Evidence-Based Practice: A Mixed Methods Study

Please consider discussing your personal experiences related to the following topics.

1. Nursing educator’s experience with and perceptions of teaching

information literacy to support evidence-based practice.

2. EBP and informatics (specifically, information literacy) as competencies

for nursing graduates.

3. Barriers that hinder nursing educators to teach information literacy and

EBP in the nursing curriculum.

4. Facilitators that support nursing educators to teach information literacy

and EBP in the nursing curriculum.

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Appendix I

Phase II Qualitative Data Display Table

Interview Evidence- Based Practice

(EBP)

Information Literacy

(IL)

Barriers Facilitators Other

#11-21-19

*Valued, but due to aging faculty not wanting to change or learn something new, EBP is not prioritized by the older faculty.*EBP was not taught to older faculty.*Buzzword in magnet hospitals & accreditors like Joint Commission*Hospitals want educators to prepare graduates with EBPcompetencies.*Accredited nursing programs and QSEN address competencies for outcomes.*Curriculum updated several years ago; the new curriculum reflects EBP in course content.*Administrative support and push for EBP are essential.*TJC and QSEN push it

*Nursing informatics is new and is not understood*Informatics and electronic charting were shoved down our throats due to CMS requirements.*All faculty are not literate related to electronic charting.*Special software and training are expensive and not always affordable for nursing programs to purchase.*Informatics not in curriculum*Informatics shoved down our throats.*Librarian is missing link for IL

*Aging faculty stuck on traditional ways of teaching*Older nurses do not want to learn something new when not compensated to do so.*Paying for informatics software in schools of nursing is expensive*Not enough doctorate- prepared nursing faculty.*Faculty are too busy with heavy workloads.*Faculty do not want to learn something new.

*”Buy-in” with nursing leaders and administrators*Curriculum updated to meet competencies*Accrediting agencies’ recommendations*Incentives for younger nurses to become nursing faculty.

*Older nurses needto get on board or retire.*Thank you for focusing on this

*Does not knowabout TIGER Initiative

*Member Feedback was positive.

Fe 55 y/o

MSNworking on doctorate

Teaches in ASNprogram

26 years nursing

13 years teaching

#21-28-1920 minutes

37 y/o Fe

MSNworking

*Teaches EBP/ research course, but no one else wants to.*There is not a lot of interest in teaching research.

*Teaches an informatics course during same semester as research course.

*Knowledge gap in faculty who do not attend conferences.*Knowledge gap in facultywho do not use

*Librarian available in all levels.*Bring librarian to classroom.*Administrative support

*Thank you for focusing on this

*Yes, I am aware of

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on doctorate

Teaches in BSNprogram & teaches research in MSN program

15 years nursing

8 years teaching

*Simulation is a good example of EBP in the collegiate setting*Lead in simulation, but for everything else, we do not do a good job with EBP.*Big disconnect between talking about EBP and actually teaching it.*No feedback to students to make connections to evidence in literature and what students see in clinical setting.* Clinical- oriented faculty are not focused on EBP.*EBP is only taught in one course, not threaded through curriculum.

*Students are taught how to use databases*Responsible to prepare students for graduate school so should be prioritized.*Important to teach students about credible, authoritative, and current online resources and how to analyze a research study.*Students struggle searching if IL is not introduced & taught early in the nursing program, especially before they are expected to search for scholarly literature.*Need to teach how to develop a PICOTquestion.*If what is taught in research and informatics courses are not carried thru in other courses, then loses its value & students do not realize the importance of the information.

databases for new information, & therefore, do not use current evidence.*Lack of support and encouragement from administration* What is learned at conferences is not shared with faculty*EBP is not in annual performance review*Not enough faculty to teach research and/or information literacy*Not enough time and not enough teachers want to teach research/ EBP skills*No librarian involvement in undergraduate program, but librarian is available in graduate program.

*Include evidence in care plans and apply it in clinical setting.*EBP champions & mentors*Monetary support from professorships to attend conferences and share new information with faculty colleagues

TIGERInitiative

*Member feedback was positive.

172

#31-28-1951 minutes

M 60+

DNPteaching in RN to BSNand one graduate course

40 years nursing

3 years teaching

*Exposed to EBP for many years.*Did not know about competencies for EBP and IL until took the survey for this study.*First heard EBP term approx. 20 years ago and was told that it was just a scholar’s word - not a practical word.* People who hold purse strings in healthcare agencies think about EBP differently*Penalizing hospitals for readmission which makes EBP at a critical turning point at the bedside.*EBP is not a state board concern**Might get more bang for buck on Twitter or other social media talking about EBP.*Since we are moving from volume based to a value based, we are moving toward EBP.*Takes 17 years to translate evidence/ research into practice.*Give students an assignment that asks muscularquestions. Which

*Critical thinking needed for IL*Different definitions to IL*Information technology systems need to be utilized properly*Real-time data puts IL at the forefront of learning for critical thinking.*Finding the evidence is critical*First heard IL term in either my MSN or DNP program when I took an informatics course.*Has to be more than telling students to go get a scholarly article.*Any opinion in discussion board needs to be referenced.*Informatics is not an NCLEX concern.

*Students not comfortable using evidence in practice*Faculty do not want to call people out on what they do not know.*Outcome Competencies not discussed in new faculty orientation*Nurses are low on totem pole for practice change unless they are experts and then others listen.*Orientation process for new faculty is limited – EBP not included for new faculty.*Moral distress is a problem r/t students’ interest.*We don’t want others to know our areas of weaknesses– don’t want to admit and protect our ignorance!*On average, a journal article is ready by 17 people, but if you write what you learned about EBP in 240 words on Twitter, you can have something go viral and seen

*Ask muscle questions – do your homework.*Need more role models for EBP in all levels of nursing education* Highlight the strengths that others have.*Librarians are supportive*Knowledgeable colleagues*Faculty in graduate and doctoral programs discuss EBP.* Trust is needed*Leaders in nursing should be EBP champions, but there are few where I work.*Look for how to drive EBP and how to remove the barriers.*Find ways to expedite EBP process and trust ourselves – stop protecting our ignorance. We need to learn how to confront others related to improper care.*Have the science back what we know to reduce discrepancies and suffering

*Thank you for focusing on this work.*Day long workshops don’t get it.*Nurses are nottreated fairly. No matter how proactiveor courageous a nurse may be, they are treated like they are disrupting thingsinstead of championing something.*The only people lower than the nurses are thepatients. That is nurse’s fault.

*Does not know about TIGERInitiative

*Positive member feedback

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means they have by thousandsto do their of people.homework and *We don’t askhave deeper questions orlearning. challenge our

colleagues. Itis easier for usto go with theflow. It isbetter toexpressconcern.*Quarterlynumbers aremoreimportant thanvalues andprinciplesrelated toquality care*Nurses arenot valued andnotencouraged tomake practicechanges

#41-30-1916 minutes

*Took EBP course in doctorate program* Quality and safety are emphasized more than EBP*Need a positive campaign for EBP and not a blame game*Nursing administration brought in a NurseTim workshop for faculty related to EBP, and that was helpful.*We are moving in the right direction toward EBP, but there is room for improvement.

*Nurses need to know how to locate evidence and educate patients about health literacy.* New language*Nurses need to know how to educate patients for health literacy*Did not know about IL competencies until took the survey for this study.

*Lack of time is biggest barrier*Not enough time to learn and teach*No time to look up stuff in literature*Teaching more non- traditional students who are not prepared for technology challenges.

*Nurse Tim workshops for faculty development*Need EBP role models*IHI (Institute for Healthcare Improvement) presents quality and EBP projects in 8-week sessions.*Librarian- nursing faculty collaboration to teach in classroom and online.

*Thank you forfocusing on this.

Fe 30+

DNP*No for TIGERInitiative

Teaches in MSN/FNPprogram

*Positive member feedback.

13 years nursing

2 years teaching

#5 *We do not talk *I think I *No follow-up * Need to Need to take2-1-1928 minutes

about EBP know enough to teach but

with evidencearticles in

introduce steps to

174

Fe 50+

MSN and currently working on doctorate degree


enough as faculty.*It is not in our ASN curriculum*We need to help students see the link of evidence in clinicals*Do not do enough to advance and prioritize EBP.*Need EBP champions*Students are not encouraged enough to find evidence to support their care plans.* Need to take steps to develop objectives aimed at research and EBP.*The only reason why I get EBP is because I am back in school and EBP was one of the courses

need to practice.*If what is taught in my course is not carried thru in other courses, then it loses its value.*If we do not feel confident, then how can we teach*Can’t have EBP without IL.*Students are not encouraged enough to find evidence to support their care plans.*The only reason why I know about the databases is because currently in doctoral program.

clinical with students*No time in clinicals to look up evidence*Faculty are too busy with heavy workloads*Research is not graded hard.* We don’t know what other faculty teach.*Faculty lack experience*Students see research as busy work – no value and application to their practice.

students to librarian* We do great things, but we don’t share it.

develop objectives aimed at using research and EBP

*Heard of TIGERInitiative in doctoral program.

31 years nursing


23 years teaching

#62-1-19

Fe 30+

MSNworking on doctorate

*EBP is expected of students by some faculty, but not all.*Nursing faculty have to step up and advocate for EBP in classroom and clinicals.*Do not know whether we follow up with faculty related to EBP.

*Faculty need to be better educated about IL.* Students are not aware of what the databases are.*Students do not know how to find information for EBP.*Exposure to IL is not threaded through curriculum.*Faculty lack knowledge on navigatingdatabases.

*Need EBP champions*Lack of time* Lack of priority to teach IL* There are not enough doctorate- prepared faculty*Lack of time*Students are not aware of librarian as a resource or do not use if aware.*Diverse (older) student population are

*Focus faculty CEU’s on EBP teaching methodologies.*Partner with Librarian in the classroom*Need EBP champions

* Heard of TIGERInitiative


Teaches in BSNprogram

15 years nursing

5 years teaching

175

*IL steps are similar to EBP steps.*Students think that if you can read and write, then they are literate.

not all versed in technology.

#7 *Terms keep *New term *See librarian *Need to look at * Does not2-7-19 changing – used *Need faculty once and never patient outcomes know

to be research development again. based on high about TIGER12 minutes utilization – now for IL. *Costs related risk vs. high Initiative

EBP *Faculty are to using volumeFe 60+ *Process for not up to date evidence in * Faculty *Positive

EBP is needed, on most IL practice is a development to memberMSN but we have not competencies. barrier, yet keep up with feedbackteaches in found it yet. * Informatics EBP outcomes tech changesBSN *Have to find a new and reported to *Excellentprogram way to confront shoved down decrease costs, library resources

errors in practice our throats. hospital stays, and support with44 years without blaming. *No morbidity and databases andnursing * Faculty are not informatics in mortality. librarian

up to date on ASN *Differing collaboration35 most EBP curriculum. levels of *Faculty roleteaching competencies. competencies models needed in

*BSN includes among faculty. each level toassignments to *Hospitals teach value anduse evidence to focus on costs use of EBP.support care and *EBP skill fairsplans and clinical stakeholders that include EBPassignments. not interested competencies*EBP should be in spendingwords that more dollarsstudents learn on theirabout in first nurses.nursing course, *Studentsfirst day in moreclinical setting, interested inand throughout grades rathercurriculum. than patient* EBP leaders outcomes.need to step up *Some facultyand advocate for do not want toEBP for patient attend anysafety, and not additionalquarterly activities thanoutcomes. necessary such* Planning EBP as skill fairs.patient care *Nurses not upneeds to focus on to date onhigh risk vs. high most currentvolume. EBP standards.*Nurses arelegally

176

responsible for the care they plan and deliver– not always discussed*Students need to understand that research/EBP are not just for school setting, but for practice setting as a RN to improve patient care and outcomes.*EBP addressed in culture and ethics course.

#82-7-1932 minutes

*New faculty are oriented to know what is expected of them related to EBP at all levels.*One course in curriculum has students make posters to display what they learn, and many of the posters are high quality and could be used at research conferences – this is not the norm in ASN programs, but we are preparing our students to get there BSN and MSN.*Our obligation is to teach students to protect the public, not just pass exams.*We fail our students if we do not teach them properly.*Imperative to place emphasis

*Students need references for care plans, so knowing how to find credible literature is a priority.*No informatics course in curriculum.

*Orient new faculty about their responsibilities related to all competencies, not just technical competencies.*Educators are resistant to change often due to not enough time to learn new things.*EBP included in care plans and included in lectures*Have students present their work based on current evidence.*Educators are not analyzing students’ learning styles to better understand how to present information in most effective way.

*Encourage students to cite references outside of textbook to support EBP.*Educate the educator on moving forward based on current evidence and old practices.*Librarian collaboration.*Need policies and procedures for EBP in education and clinical*Make time for orientation to EBP in both academia and hospitals

* No for TIGERInitiative

Fe 40+



13 years nursing and 3 years teaching.

177

on importance of EBP.*Educators sometimes lose the link tocurrent bedside practices.

#92-14-1926 minutes

Fe 50+

*There is a need to improve evidence at the bedside.*Not introduced in ASN program*Less than 10% of classroom lessons include EBP or reflect research.*Unless faculty teach research, average educator does not utilize EBP in practice.*Need positive teacher to teach research.*EBP needs to be included in every course.*Research/EBP to bedside takes decades – i.e. Medication errors, CAUTI, DVT, Decubitus care*Research is on the back burner

*Kind of know what IL is, but overall IL is not understood*Faculty lack skills to teach to students.*Needs more emphasis in curriculum*Students need daily exposure to IL

*Lack of time and heavy workloads.*Lack of administrative support*We let evidence go because of lack of interest from colleagues*Lack of excitement by students who only get excited about grade, not the evidence.Students are in survival mode most of time, and spirit of inquiry is limited.*If teacher does not know how to read research, then how can they teach it.*Older faculty lack research skills and do not want to talk about their lack of knowledge.*Older nurses lack research skills

*Need evidence/ research in every class* Need EBP champions*Need positive role model teaching research* Bring EBP to bedside.*Develop a culture to support and value EBP*Include healthcare agencies in culture development for EBP*Faculty development to increase awareness and knowledge.

*Does not know about TIGERInitiative

MSN

Teaches in BSNprogram


40 years nursing

30 years teaching

#102-22-1927 minutes

50+ Fe

DNPteaching in

*Students in research course presents their projects at research conference andhospital research events.

*Not familiar with information literacy competency*informaticsnot in curriculum

*Nurses feel like EBP is a chore, do it to check the box off.*EBP projects do not always

*Require sources outside of the textbook*Include evidence in care plans*Librarian as a resource for

*Positive member check and

*No for TIGERInitiative.

178

BSNprogram.

26 years a nurse and 14teaching

*Term EBP not used in clinical setting by nurses*Faculty do not do as good a job as we should with teaching EBP*EBP committee in magnet hospitals, but you do not hear much about what they do.*Do not discuss EBP in faculty meetings*Clinical nurses do not use EBP in clinical setting with student nurses.*Textbooks are not interesting related to EBPand research

*Librarian meets with students at the beginning of the semester and is a huge resource for searching the lit.*Nursing faculty not comfortable with teaching.

result in a policy change*Lack of experience searching the literature affects time and efficiency in finding literature for EBP.

students and faculty*Faculty need to learn and talk about competencies

#112-26-1928 minutes

30+ Fe DNPteaches in BSNprogram and one course in education course in MSN

4 years teaching

*Not prioritized*Nurses need to learn how to find*Research course is translating evidence into practice.*Design discussion forums to find evidence to support their forum and also evidence to support their responses to their classmates.*I try to drive students back to the evidence, but it is difficult.*A mentality of type it in Google, and the first thing that comes up is what they will use.*I ask for students’

*No informatics course in the curriculum*Undergrad students do not see value in IL and do not understand how to apply it in clinical*Students not using correct databases for searches, instead using Google.*IL steps are similar to EBP steps.*Students think that if you can read and write, then they are literate.*Do not teach enough IL in both BSN and MSN levels.

*Not prioritized throughout the program*Lack of time*No informatics course in curriculum.*EBP is not front and center like it should be or could be. We are doing it, but the same across the curriculum.*Not addressed with new faculty.We talk about EBP in individual courses, but I do not know if it is followed up.*Extra time is not allotted for

*Require students to use IL and EBP by setting up assignments that need research/ literature to complete*Informatics in student learning outcomes*Professional development and increase faculty value of EBP.*Faculty attend CE conferences. Time is allowed for CE, but you still need to make the time because there is no time allotted for scholarly activities. It is expected, but not compensated or time aligned for additional

*Personal drive to do scholarly work because I know that it is aprofessional expectation and obligation.

*Yes heard of TIGERInitiative.

179

feedback so that *Graduate scholarly work outside work andI can see the way students get that is research.that I design my more IL. expected ofcourse is *IL affects faculty.effective and to how we teachmeet the our patients.students’ *Studentslearning needs. Google search*I actively work and use theto make my first thing thatclasses engaging. pops up.*They have to *Difficult tofind literature to get students tosupport their do searching.assignments, not *Nationaljust their Guidelinetextbooks. Clearinghouse*Students are isinterested in *librarianlearning from me liaison foras well as their each programclassmates puts on a classrelated to EBP. for the*Research students. Wecourse bring studentsdiscussion to library andincludes EBP in have librariantheir care maps come to theirto support the class.rationale for one *I still findof their that theirinterventions. articles do not*Don’t think that come from theIL is integrated libraryenough. First 3 databases,semesters, often Googlestudents have an or GoogleEBP journal. The Scholar. Theyfocus changes, look for theand toward the easy routeend of the instead ofprogram, EBP is through amore consistent. database.

180

REFERENCES

Adams, N. E. (2014). A comparison of evidence-based practice and the ACRL information literacy standards: Implications for information literacy practice. College and Research Libraries, 1-17.

Adams, S., & Barron, S. (2009). Use of evidence-based practice in school nursing: Prevalence, associated variables, and perceived needs. Worldviews on Evidence- Based Nursing, 6(1), 16-26. doi: 10.1111/j.1741-6787.2008.00141.x

Aglen, B. (2016). Pedagogical strategies to teach bachelor students evidence-based practice: A systematic review. Nurse Education Today, 36, 255-263. doi: 10.1016.j.nedt.2015.08.025

Agyei, D. D., Kofi, C. Y., Fiankor, D., & Osman, H. (2015). The experience of information literacy in evidence-based practice (EBP) among professional nurses in the Ho Municipality of Ghana. Library Philosophy and Practice (ejournal), 1236. http://digitalcommons.unl.edu/libphilprac/1236

Altmiller, G., & Armstrong, G. (2017). National QSEN faculty survey results. Nurse Educator QSEN Supplement, 42(5S), 53-57.

Alving, B. E., Christensen, J. B., & Thrysoe, L. (2018). Hospital nurses’ information retrieval behaviours in relation to evidence-based nursing: A literature review. Health Information Library Journal, 35(1), 3-23. doi: 10.1111/hir.12204

American Association of Colleges of Nursing (AACN). (2008). The essentials of baccalaureate education for professional nursing practice. Washington, DC: Author.

American Association of Colleges of Nursing (AACN). (2015). Maximizing nursing informatics competencies across the curricula. Retrieved from www.aacnnursing.org/cvweb/cgi- bin/eventsdll.dee/Eventinfo?sessionaltcd=WFR15_01_27&WRP=webinarinfohtm

American Association of Colleges of Nursing (AACN). (2019). U.S. nursing schools call for collaborative action to raise the education level of the nursing workforce.Retrieved from https://www.magnetmail.net/actions/email_web_version.cfm?ep=06- fZZcZL8zH3crC9nPmjhGOSQ7G56PG_mp1EF9d92Epf6VpSM9- d4LeLQvxraU15WSxyJVI0coSM36VhpvBZ2TzTrrkowKH0B4dPw1QNiYGPRt bR1I5U1TZskbQdUhY

American Library Association. (1989). Information literacy. Retrieved from http://www.ala.org/Template.cfm?Section=Home&template=%2FcontentManage ment%2FcontentDisplay.cfm&ContentID=33553

181

American Library Association. (2000). Information literacy competency standards for higher education. Retrieved from http://www.ala.org/Template.cfm?Section=Home&template=/ContentManageme nt/ContentDisplay.cfm&ContentID=33553

American Nurses Association (ANA). (2010). Scope and standards of nursing practice(2nd ed.). Silver Spring, MD: Author.

American Nurses Association (ANA). (2015). Scope and standards of practice: Nursing informatics (2nd ed.). Silver Spring, MD: Author.

Andre, B., Aune, A. G., & Braend, J. A. (2016). Embedding evidence-based practice among nursing graduates: Results from a pilot study. Nurse Education in Practice, 18, 30-35. http://dx.doi.org/10.1016/j.nepr.2016.03.004

Andretta, S. (2011). Evaluating information literacy educators’ practices before and after the course facilitating information literacy educaiton: From tutor to learner- centered. Health Information and Libraries Journal, 28, 171-178. doi: 10.1111/j.1471-1842.2011.00946.x

Arguelles, C. (2012). Program-integrated information literacy (PIIL) in a hospital’s nursing department: A practical model. Journal of Hospital Leadership, 12, 97- 111. doi: 10.1080/15323269.2012665717

Association of College and Research Libraries. (2002). Information literacy competency standards for higher education, information literacy defined. Retrieved from http://www.acrl.org/acrl/ilintro.html#ildef

Association of College and Research Libraries. (2014). Information literacy competency standards for nursing. Retrieved from http://www.ala.org/acrl/standards/nursing

Badke, W. (2010). Why information literacy is invisible. Communications in Information Literacy, 4(2), 129-139.

Badke, W. (2017). What I still don’t know about information literacy. Online Searcher,66-67.

Barnard, A., Nash, R., & O’Brien, M. (2005). Information literacy: Developing lifeling skills through nursing education. Journal of Nursing Education, 44(11), 505-510.

Bent, M, & Stubbings, R. (2011). The SCONUL seven pillars of information literacy: Core model for higher education. Retrieved from https://www.researchgate.net/publication/259341129_The_SCONUL_Seven_Pill ars_of_Information_Literacy_Research_Lens

182

Bienemy, C. (2018). Identifying factors contributing to the nurse faculty shortage in Louisiana: Findings from the Louisiana Center for Nursing 2018 nurse faculty survey. Retrieved from http://lcn.lsbn.state.la.us/Portals/0/Documents/NurseFacultySurvey.pdf

Blythe, J., & Royle, J. A. (1993). Assessing nurses’ infomration needs in the work envirnoment. Bulletin of the Medical Library Association, 81, 433-435.

Bonlokke, M., Kobow, E., & Kristensen, A. K. (2012). Curriculum integrated information literacy – a challenge. Nursing Science, 32(1), 53-55.

Booker, S. Q. (2017). Help for osteoarthritis pain in African American elders (HOPE): Patterns, predictors, and preferences of osteoarthritis and chronic joint pain in self-management (Doctoral dissertation). The University of Iowa.

Boruff, J. T., & Thomas, A. (2011). Integrating evidence-based practice and information literacy skills in teaching physical and occupational therapy students. Health Information Libraries Journal, 28, 264-272. doi: 10.1111/j.1471- 1842.2011.00953.x

Bostrom, J., & Suter, W. N. (1993). Research utilization: Making the link to practice.Journal of Nursing Staff Development, 9(1), 28-34.

Bradley, C. (2013). Information literacy in the programmatic university accreditation standards of select professions in Canada, the Unites States, the United Kingdom and Australia. Journal of Information Literacy, 7(1), 44-68. Retrieved from http://dx.doi.org/10.11645/7.1.1785

Breivik, P. S. (2005). 21st century learning and information literacy. Change, 37, 20-27.

Brettle, A., & Raynor, M. (2013). Developing information literacy skills in pre-registration nurses: An experimental study of teaching methods. Nurse Education Today, 33, 103-109. doi: 10.1016/j.nedt.2011.12.003

Brower, E. J., & Nemec, R. (2017). Origins of evidence-based practice and what it means for nurses. International Journal of Childbirth Education, 32(2), 14-18

Brown, C. E., Wickline, M. A., Ecoff, L., & Glaser, D. (2009). Nursing practice, knowledge, attitudes, and perceived barriers to evidence-based practice at an academic medical center. Journal of Advanced Nursing, 65(2), 371-381. doi: 10.1111/j.1365-2648.2008.04878.x

Carlock, D., & Anderson, J. (2007). Teaching and assessing the database searching skills of student nurses. Nursing Education, 32(6), 251-255. doi: 10.1097/01

183

Carter-Templeton, H. D., Patterson, R. B., & Mackey, S. N. (2014). Nursing faculty and student experiences with information literacy: A pilot study. Journal of Nursing Education and Practice, 4(1), 208-217. doi: 10.5430/jnep.v4n1p208

Cheeseman, S. E. (2013). Are you prepared for the digital era? Neonatal Network, 30,263-266. doi: 10.1891/07300832.30.4.263

Christenbery, T. (2017). Interviews and qualitative interviews. Nurse, Author & Editor, 27(4), 1-7.

Chung, S., & Staggers, N. (2014). Measuring nursing informatics competencies of practicing nurses in Korea. Computers, Informatics, Nursing, 32(12), 596-605.

Clancy, C. M., & Cronin, K. (2005). Evidence-based decision making: Global evidence, local decisions. Health Affairs, 24(1), 151-162.

Cobus-Kuo, L., & Waller, J. (2016). Teaching information literacy and evidence-based practice in an undergraduate speech-language pathology program: A student reflection. Contemporary Issues in Communication Science and Disorders, 43, 35-49. doi: 1092.5171/16/4301-0035

Cochrane Collection. (2013). Background of Cochrane. Retrieved from http://www.cochrane.org/about-us/history/archie-cochrane

Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. In R. Valle & M. King (Eds.). Existential phenomenological alternatives in psychology (pp. 48-71). New York: Oxford University Press.

Courey, T., Benson-Soros, J., Deemer, K., & Zeller, R. A. (2006). The missing link: Information literacy and evidence-based practice as a new challenge for nurse educators. Nursing Education Perspectives, 27(6), 320-323.

Creswell, J. W., & Plano Clark, V. L. (2011). Designing and conducting mixed-methods research (2nd ed.). Thousand Oaks, CA: Sage.

Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry & research design: Choosing among five approaches (4th ed.). Thousand Oaks, CA: Sage.

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D.T. & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131. doi:10.1016/j.outlook.2007.02.006

Cronje, R. J., & Moch, S. (2010). Part III. Reenvisioning undergraduate nursing students as opinion leaders to diffuse evidence-based practice in clinical settings. Journal of Professional Nursing, 26, 23-28. doi: 10.1016/j.profnurs.2009.03.002

184

Cullum, N., DiCenso, A., & Ciliska, D. (1997). Evidence-based nursing: An introduction.Nursing Standard, 11(28), 32-33.

Dang, D., & Dearholt, S. L. (2018). Johns Hopkins nursing evidence-based practice: Models and guidelines (3rd ed.). Indianapolis, IN: STTI Johns Hopkins Nursing.

Dee, C., & Stanley, E. (2005). Information-seeking behavior of nursing students and clinical nurses: Implications for health science librarians. Journal of Medical Library Association, 93, 213-222.

Definitions. (n.d.). Lifelong learning. Retreived from https://www.definitions.net/definition/lifelong-learning

Diaz, S., & Walsh, A. (2018). Promoting evidence-based practice and information literacy through an undergraduate nursing journal club. Pennsylvania Libraries: Research and Practice, 6(1), 23-38. doi: 10.5195/pairap.2018.171

DiCenso, A., & Cullum, N. (1998). Implementing evidence-based nursing: Some misconceptions. Evidence-Based Nursing, 1(2), 38-40.

Dufrene, P. (2017). NCLEX-RN: Implications of pass rates for Louisiana and the nursing education program. The Examiner, 26(2), 10-11.

Earle-Foley, V. (2011). Evidence-based practice: Issues, paradigms, and future pathways.Nursing Forum, 46(1), 38-44.

Estabrooks, C. A. (1998). Will evidence-based nursing practice make practice perfect?Canadian Journal of Nursing Research, 30(1), 15-36.

Falk, N. L. (2014). Retaining the wisdom: Academic nurse leaders’ reflections on extending the working life of aging nursing faculty. Journal of Professional Nursing, 30(1), 34-42. http://dx.doi.org/10.1016/j.profnurs.2013.06.013

Farokhzadian, J., Khajouei, R., & Ahmadian, L. (2015). Evaluating factorsassociated with implementing evidence-based practice in nursing. Journal of Evaluation in Clinical Practice, 21(6), 1107-1113. doi: 10.1111/jep.12480

Farrell, A., Goosney, J., & Hutchens, K. (2013). Evaluation of the effectiveness of course integrated library instruction in an undergraduate nursing program. Journal of the Canadian Health Libraries Association, 34, 164-175. doi: 10.5596/c13-061

Felicilda-Reynaldo, R. F., & Utley, R. (2015). Reflections of evidence-based practice in nurse educators’ teaching philosophy statements. Nursing Education Perspectives, 36(2), 89-95. doi: 10.5480/13-1176

185

Ferguson, L., & Day, R. A. (2005). Evidence-based nursing education: Myth or reality?Journal of Nursing Education, 44(3), 107-115.

Fineout-Overholt, E. & Johnston, L. (2006). Teaching EBP: Implementation of evidence: Moving from evidence to action. Worldviews on Evidence-Based Nursing, 4th

quarter, 194-200.

Fineout-Overholt, E., Melnyk, B. M., & Schultz, A. (2005). Transforming health care from the inside out: Advancing evidence-based practice in the 21st century.Journal of Professiona Nursing, 21(6), 335-344.

Fineout-Overholt, E., Williamson, K. M., Kent, B., & Hutchinson, A. M. (2010).Teaching EBP: Strategies for achieving sustainable organizational change toward evidence-based practice. Worldviews on Evidence-Based Nursing, 7(1), 51-53. https://doi.org/10.1111/j.1741-6787.2010.00185.x

Finkelman, A., & Kenner, C. A. (2006). Teaching IOM: Implications of the IOM reports for nursing education. Washington, DC: American Nurses Association.

Finkelman, A., & Kenner, C. A. (2012). Teaching IOM: Implications of the IOM reports for nursing education (3rd ed.). Washington, DC: American Nurses Association.

Flood, L. S., Gasiewicz, N., & Delpier, T. (2010). Integrating information literacy across a BSN curriculum. Journal of Nursing Education, 49(2), 101-104. doi: 10.3928/01484834-20091023-01

Foo, S., Majid, S., & Chang, Y. K. (2017). Assessing information literacy skills among young information age students in Singapore. Aslib Journal of Information Management, 69(3), 335-353. https://doi.org/10.1108/AJIM-08-2016-0138

Forster, M. (2012). The experience of information literacy in nursing practice. VISTAS: Education, Economy, Community, 2(1), 18-28.

Forster, M. (2013). A phenomonological investigation into information literacy in nursing practice – preliminary findings and methodological issues. Nurse Education Today, 33, 1237-1241. doi: 10.1016/j.nedt.2012.05.027

Forster, M. (2015). Six ways of experiencing information literacy in nursing: The findings of a phenomenographic study. Nurse Education Today, 35(1), 195-200. https://doi.org/10.1016/j.nedt.2014.06.005

Fox, L. M., Richter, J. M., & White, N. E. (1989). Pathways to information literacy.Journal of Nursing Education, 28, 422-425.

186

Franzen, S., & Bannon, C. M. (2016). Merging information literacy and evidence-based practice in an undergraduate health sciences curriculum map. Communications in Information Literacy, 10(2), 245-263.

Gaines, K. C. (2019). Nurses rank most honest profession 17 years in a row. Retrieved from https://nurse.org/articles/nursing-ranked-most-honest-profession

Gale, B. V., & Schaffer, M. A. (2009). Organizational readiness for evidence-based practice. The Journal of Nursing Administration, 39(2), 91-97.

Geibert, R. C. (2006). Using diffusion of innovation concepts to enhance implementation of an electronic health record to support evidence-based practice. Nursing Administration Quarterly, 30(3), 203-210.

Gillespie, G. L., Grubb, P. L., Brown, K., Boesch, M. C., & Ulrich, D. 92017). Nurses eat their young: A novel bullying educational program for student nurses. Journal of Nursing Education Practice, 7(7), 11-21. doi: 10.5430/jnep.v7n7P11

Gray, C. J., & Montgomery, M. (2014). Teaching an online information literacy course: Is it equivalent to face-to-face instruction? Journal of Library & Information Sciences in Distance Learning, 8, 301-309. doi:10.1080/1533290X.2014.945876

Gupta, V. K., Wander, P., & Gupta, M. (2016). Is evidence-based medicine a gold standard or can it be influenced? Indian Heart Journal, 68(5), 747-748.

Hain, D., & Haras, M. S. (2015). Changing nephrology nurses’ beliefs about the value of evidence-based practice and their ability to implement in clinical practice.Nephrology Nursing Journal , 42(6), 563-567.

Hartt, M. D. (2008). Informatics competency and development within the US nursing population workforce. A systematic literature review. Computers, Informatics, Nursing, 26, 320-329.

Hebda, T., & Calderone, T. L. (2010). What nurse educators need to know about the TIGER initiative. Nurse Educator, 35(2), 56-60.

Hines, S., Ramsbotham, J., & Coyer, F. (2015). The effectiveness of interventions for improving the research literacy of nurses: A systematic review. Worldviews on Evidence-Based Nursing, 12(5), 265-272.

Hobbs, D. I., Guo, R., Mickelson, W., & Wertz, C. I. (2015). Assessment of library instruction to develop student information literacy skills. Radiologic Technology, 86(3), 344-349.

187

Horntvedt, M. D., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for teaching evidence-based practice in nursing education: A thematic literature review. British Medical Education, 18,172. doi: 10.1186/s12909-018-1278-z

Hunter, K., Dee, M., & Hebda, T. (2013). The integration of informatics content in baccalaureate and graduate nursing education: A status report. Nursing Education, 38(3), 110-113. doi: 10.1097/NNE.0b013e31828dc292

Hutchinson, A. M., & Johnston, L. (2004). Bridging the divide: A survey of nurses’ opinions regarding barriers to, and facilitators of, research utilization in the practice setting. Journal of Clinical Nursing, 13(3), 304-315.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Cros sing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf

Institute of Medicine. (2003). Health professions education: A bridge to quality.Washington, DC: National Academies Press.

Institute of Medicine. (2010). The future of nursing: Focus on education. Washington, DC: National Academies Press.

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health.Washington, DC: National Academies Press. Retrieved from http://iom.nationalacademies.org/Reports/2010/The-Future-of-Nursing-Leading- Change-Advancing-Health.aspx

Institute of Medicine. (2013). Announcement. Crossing the quality chasm. The IOM health care quality initiative. Retrieved from www.iom.edu/Global/News%20Announcements/Crossing-the-Quality-Chasm- The-IOM-Health-Care-Quality-Initiative.aspx

Jacobs, S. K., Rosenfield, P., & Haber, J. (2003). Information literacy as the foundation for evidence-based practice in graduate nursing education: A curriculum- integrated approach. Journal of Professional Nursing, 19(5), 320-328. doi: 10.1016/S8755-7223(03)00097-8

Jameson, J., & Walsh, M. E. (2017). Tools for evidence-based vascular nursing practice: Achieving information literacy for lifelong learning. Journal of Vascular Nursing, 35(4), 201-210.

Janke, R., Pesut, B., & Erbacker, L. (2012). Promoting information literacy through collaborative service learning in an undergraduate research course. Nurse Education Today, 32, 920-923. doi: 10.1016/j.nedt.2011.09.016

188

Kalb, K. A., O’Connor-Von, S. K., Brockway, C., Rierson, C. J. & Sendelbach, S. (2015). Evidence-based teaching practice. Journal of Nurses Staff Development, 24(5), E8-E12. http://dx.doi.org/10.1097/01.NND0000320688.57308.19

Ketefian, S. (1975). Application of selected nursing research findings into nursing practice: A pilot study. Nursing Research, 24, 89-92.

Kin, Y. W., Mordiffi, S. Z., Liang, S., Ang, E. N., Xue, Z., & Majid, S. (2013). Nurses’ perception towards evidence-based practice: A descriptive study. Singapore Nursing Journal, 40(1), 34-41.

Kinnunen, U. M., Rajalahti, E., Cummings, E., & Borycki, E. M. (2017). Curricula challenges and informatics competencies for nurse educators. Forecasting Informatics Competencies for Nurses in the Future of Connected Health, 41, 41- 48. doi:10.3233/978-1-61499-738-2-41

Kitson, A. (1997). Using evidence to demonstrate the value of nursing. Nursing Standard, 11(28), 34-39.

Laibhen-Parkes, N. (2014). Evidence-based practice competence: A concept analysis.International Journal of Nursing Knowledge, 25(3), 173-181.

Lalor, J. G., Clarke, M, & Sheaf, G. (2012). An evaluation of the effectiveness of information literacy training for undergraduate midwives to improve their ability to access evidence for practice. Nurse Education in Practice, 12, 269-272. http://dx.doi.org/10.1016/j.nepr.2012.06.005

Leng, C. H., Lim, S. Y., & Stew, W. F. (2016). Are nurses ready for evidence-based practice? A descriptive study of information literacy competency among clinical practicing registered nurses in a private hospital in Malaysia. IeJSME, 10(1), 10- 16.

Lilly, K., Fitzpatrick, J., & Madigan, E. (2015). Barriers to integrating information technology content in Doctor of Nursing Practice curricula. Journal of Professional Nursing, 31(3), 187-199.

Lindeman, C. A. (1975). Priorities in clinical nursing research. Nursing Outlook, 23, 693- 698.

Liou, S. R., Yu, W. C., Tsai, H. M., & Cheng, C. Y. (2015). Teaching information literacy in nursing using blended learning pedagogy. Creative Education, 6, 1446- 1455. http://dx.doi.org/10.4236/ce.2015.613145

Lotz, K. S. (2010). The ABCs of evidence-based practice: Integrating evidence-based practice into associate degree nursing curriculum. Teaching and Learning in Nursing, 5, 95-97. doi: 10.1016/j.teln.2010.01.004

189

Louisiana State Board of Nursing (LSBN). (2019). LSBN approved nursing education programs. Retrieved on January 1, 2019 from http://www.lsbn.state.la.us/Portals/1/Documents/Forms/Schools.pdf

Lovelace, R., Noonen, M., Bena, J. F., Tang, A. S., Angle, M., Cwynar, R., . . .Albert, N.M. (2017). Value of, attitudes toward, and implementation of evidence-based practices based on use of self-study learning modules. The Journal of Continuing Education in Nursing, 48(5), 209-216. doi: 10.3928/00220124-20170418-0

Lyon, K. (2017). From the executive director. The Examiner, 26(2), 1-2.

Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice in nursing education and practice. Journa of Professional Nursing, 33(1), 51-55. http://dx.doi.org/10.1016/j.profnurs.201605.009

Majid, S., Chaudhry, A. S., & Xue, Z. (2008). Role of information literacy in effective evidence-based practice. ICOLIS 2008, 33-40.

Masters, K. (2018). Role development in professional nursing practice (5th ed.).Burlington, MA: Jones & Barlett Learning.

McCulley, C., & Jones, M. (2014. Fostering RN to BSN students’ confidence in searching online for scholarly information on evidene-based practice. The Journal of Continuing Education in Nursing, 45(1), 22-27. doi: 10.3928/00220124- 20131223-01

McFadden, J. J., & Thiemann, L. J. (2009). Evidence-based practice for lifelong learning.AANA Journal, 77(6), 423-426.

McNeil, B. J., Elfrink, V. L., Bickford, C. J., Pierce, S. T., Beyea, S. C., Averill, C., & Klappenbach, C. (2003). Nursing information technology knowledge, skills, and preparation of student nurses, nursing faculty, and clinicians: A U.S. survey.Journal of Nursing Education, 42(8), 341-349.

Melender, H. L., Mattila, L. R., & Haggman-Laitila, A. (2016). A systematic review on educational interventions for learning and implementing evidence-based practice in nursing education: The state of evidence. Nordic Journal of Nursing Research, 36(1), 3-12. doi: 10.1177/0107408315595162

Melnyk, B. M. (2014). Building cultures and environments that facilitate clinical behavior change to evidence-based practice. What Works? Worldviews on Evidence-Based Nursing, 11(2), 79-80.

190

Melnyk, B. M. (2015). Implementing the new essential evidence-based practice competencies in real-world clinical and academic settings: Moving from evidence to action in improving the healthcare quality and patient outcomes. Worldviews on Evidence-Based Nursing, 12(2), 67-69.

Melnyk, B. M. (2016). Widespread adoption of evidence-based practices is essential for a growing Medicare population. Evidence-Based Diabetes Management. Retrieved from https://www.ajmc.com/journals/evidence-based-diabetes- management/2016/may-2016/widespread-adoption-of-evidence-based-practices-is essential-for-a-growing-medicare-population

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare (4th ed.). Philadelphia, PA: Wolters Kluwer.

Melnyk, B. M., Fineout-Overholt, E., Feinstein, N. F., Li, H., Small, L, Wilcox, L., & Kraus, R. (2004). Nurses’ perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: Implications for accelerating the paradigm shift. Worldviews on Evidence-Based Nursing, 1, 185-193. doi: 10.1111/j.1524- 475X.2004.04024.x

Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educaotrs. Journal of Nursing Administration, 42, 410-417.

Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing, 11(1), 5-15.

Melnyk, B. M., Gallagher-Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A. (2018). The first U.S. study on nurses’ evidence-based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews on Evidence-Based Nursing, 15(1), 16-25.

Mery, Y., Newby, J., & Peng, K. (2012). Why one-shot information literacy sessions are not the future of instruction: A case for online credit courses. College & Research Libraries, 7, 366-377.

Miller, M., & Neyer, L. (2016). Mapping information literacy and written communication outcomes in an undergraduate nursing curriculum. Pennsylvania Libraries: Research and Practice, 4(1), 22-34. doi: 10.5195/palrap.2016.121

191

Milner, K. A., Bradley, H. B., & Lampley, T. (2018). Health professiona faculty beliefs, confidence, use, and perceptions of otganizational culture and reafiness for EBP: A cross-sectional survey. Nurse Education Today, 64, 5-10.doi: 10.1016/j.nedt.2018.02.003

Moch, S. D., Quinn-Lee, L., Gallegos, C., & Sorte, C. K. (2014). Navigating evidence- based projects: The faculty role. Nursing Education Perspectives, 36(2), 128-130. doi: 10.5480/12-1014.1

Mohammadi, M. M., Poursaberi, R., & Salahshoor, M. R, (2018). Evaluating the adoption of evidence-based practice using Roger’s diffusion of innovation theory: A model testing study. Health Promotions Perspectives, 8(1), 25-32. doi: 10.1517/hpp.2018.03

Mokhtar, I. A., Majid, S., Foo, S., Zhang, X., Theng, Y. L., Chang, Y. K., & Luyt, B. (2012). Evidence-based practice and related information literacy skills of nurses in Singapore: An exploratory case study. Health Informatics Journal, 18(1), 12- 25. doi: 10.1177/1460458211434753

Moreton, E. (2013). Embedding information literacy into evidence-based practice.NAHRS Newsletter, 33(2), 5-6.

Morrison-Beedy, D. (2018). How do you go from 1 to 135,000? Understanding the impact of nursing faculty on evidence-based practice. Worldviews of Evidence- Based Nursing, 15(4), 245-246. https://doi.org/10.1111/wvn.12302

Mthiyane, G. N., & Habedi, D. S. (2018). The experiences of nurse educators in implementing evidence-based practgice in teaching and learning. Health SAGesondheid, 23(0), a1177. https://doi.org/10.4102/hsag.v23i0.1177

Naish, J. (1997). So where’s the evidence? Nursing Times, 93(12), 61-63.

National Academy of Sciences. (2009). Leadership commitments to improve value in healthcare: Finding common ground: workshop summary. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK52847/

National League of Nursing. (2008). Position statement preparing the next generation of nurses practice in a technology-rich environment: An informatics agenda.Retrieved from http://nln.org/docs/default-source/professional-development- programs/preparing-the-next-generation-of-nurses.pdf?sfvrsn=

National League of Nursing. (2017). Faculty census survey 2017. Retreived from http://www.nln.org/docs/default-source/default-document-library/age-of-full- time-nurse-educators-by-rank-2017.pdf?sfvrsn=0

192

Nelson, R., & Staggers, N. (2008). Implications of the American Nurses Association scope and standards of practice for nursing informatics for nurse educators: A discussion. Nursing Outlook, 36(2), 93-94.

Ornes, L. L., & Gassert, C. (2007). Computer competencies in a BSN program. Journal of Nursing Education, 46(2), 75-78.

Orta, R., Messmer, P. R., Valdes, G. R., Turkel, M., Fields, S. D., & Wei, C. C. (2016).Knowledge and competency of nursing faculty regarding evidence-based practice. Journal of Continuing Education, 47(9), 409-419. http://dx.doi.org/10.3928/00220124-20160817-08

Osman, H. (2017). Nursing students’ experience with information literacy skill. Yangtze Medicine, 1, 157-168. doi:10.4236/ym.2017.13016

Pashaeypoor, S., Ashktorab, T., Rassouli, M., & Alavi-Majd, H. (2016). Predicting the adoption of evidence-based practice using Rogers diffusion of innovation model.Contemporary Nurse, 52(1), 85-94. Retrieved from http ://dx.doi.org/10.1080/10376178.2016.1188019

Penz, K. L., & Bassendowski, S. L. (2006). Evidence-based nursing in clinical practice: Implications for nurse educators. The Journal of Continuing Education in Nursing, 37(6), 250-254.

Phelps, S., Hyde, L., & Planchon Wolf, J. (2015). Introducing information literacy competency standards in nursing. Nurse Educator, 40(6), 278-280. doi: 10.1097/NNE.0000000000000170

Pierce, S. T. (2000). Readiness for evidence-based practice: Information literacy needs of nursing faculty and students in a southern U.S. state (Doctoral dissertation).Northwestern State University, Natchitoches, LA.

Pierce, S. T. (2005). Integrating evidence-based practice into nursing curricula. Annual Review of Nursing Education, 3, 233-248.

Polit, D. F., & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer Health.

Post, K. M. (2010). Technology, information literacy, and evidence-based practice.Technology: Special Interest Section Quarterly, 20(3), 1-2.

Pravikoff, D. S. (2006). Mission critical: A culture of evidence-based practice and information literacy. Nursing Outlook, 54(4), 254-255.

Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005). Readiness for U.S. nurses for evidence-based practice. American Journal of Nursing, 105(9), 40-51.

193

Probert, E. (2009). Information literacy skills: Teacher understandings and practice.Computers & Education, 53, 24-33. doi: 10.1016/j.compuedu.2008.12.018

Quality and Safety Education for Nurses (QSEN). (2012). QSEN competencies. Retrieved from www.qsen.org/competencies/pre-licensure-ksas

Reid, J., Briggs, J., Carlisle, S., Scott, D., & Lewis, C. (2017). Enhancing utility and understanding of evidence-based practice through undergraduate nurse education. BMC Nursing, 16, 58. doi: 10.1186/s12912-017-0251-1

Rogers, E. M. (1995). Diffusion of innovations (4th ed.). New York, NY: The Free Press.

Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: The Free Press.

Ross, A. M., Noone, J., Luce, L. L., & Sideras, S. A. (2009). Spiraling evidence-based practice and outcomes management concepts in an undergraduate curriculum: A systematic approach. Journal of Nursing Education, 48(6), 319-326. doi: 10.9999/0148434-20090515-04

Ross, J. (2010). Information literacy for evidence-based practice in perianesthesia nurses: Readiness for evidence-based practice. Journal of Perianesthesia Nursing, 25(2), 64-70. doi: 10.1016/j.jopan.2010.01.007

Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence-based medicine: What it is and what it isn’t. British Medical Journal, 312, 71-72.

Sadoughi, F., Azadi, T., & Azadi, T. (2017). Barriers to using electronic evidence based literature in nursing practice: A systematised review. Health Information and Libraries Journal, 34,187-199. doi: 10.1111/hir.12186

Saunders, H., & Vehvilainen-Julkunen, K. (2016). The state of readiness for evidence- based practice among nurses: An integrative review. International Journal of Nursing Studies, 56(2016), 128-140. http://dx.doi.org/10.1016/j.ijnurstu.2015.10.018

Saunders, L. (2011). Information literacy as a student learning outcome: The perspective of institutional accreditation. Santa Barbara, CA: Libraries Unlimited.

Schloman, B. F. (2001). Information literacy: The benefits of partnership. The Online Journal of Issues in Nursing, 6(2). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPerio dicals/OJIN/Columns/InformationResources/InformationLiteracy.html

194

Schulte, S. J., & Sherwill-Navarro, P. J. (2009). Nursing educators’ perceptions of collaboration with librarians. Journal of the Medical Library Association, 97(1), 56-59. doi: 10.3163/1536-5050.97.1.013

Schutt, M. A., & Hightower, B. (2009). Enhancing RN-to-BSN students’ information literacy skills through the use of instructional technology. Journal of Nursing Education, 48(2), 101-105.

Sewell, J. (2019). Informatics and nursing: Opportunities and challenges (6th ed.).Philadelphia, PA: Wolters Kluwer.

Shorten, A., Wallace, M. C., & Crookes, P. A. (2001). Developing information literacy: A key to evidence-based nursing. International Council of Nurses, 48, 86-92.

Sleutel, M. R., Barbosa-Leiker, C., & Wilson, M. (2015). Psychometric testing of the health care evidence-based practice assessment tool. Journal of Nursing Management, 23(3), 485-498. Retrieved from http://dx.doi.org/10.1891/1061-3749.23.3.485

Stevens, K. (2009). Essential evidence-based practice competencies in nursing (2nd ed.).San Antonio, TX: Academic Center for Evidence-Based Practice (ACE) of University of Texas Health Science Center in San Antonio.

Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing, 18. Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPerio dicals/OJIN/TableofContent/Vol-18-2013/No2-May-2013/Impact-of-Evidence- Based-Practice.html

Stichler, J. F., Fields, W., Kim, S. C., & Brown, C. E. (2011). Faculty knowledge, attitudes, and perceived barriers to teaching evidence-based nursing. Journal of Professional Nursing, 27(2), 92-100. doi: 10.1016/j.profnurs.2010.09.012

Stokke, K., Olsen, N., Espehaug, B., & Nortvedt, M. W. (2015). Evidence-based practice beliefs and implementation among nurses: A cross- sectional study. BMC Nursing, 13. Retrieved from http://www.biomedcentral.com/content/pdf/1472- 6955-13

SurveyMonkey. (2018). Retrieved from https://www.surveymonkey.com/dashboard

Tanner, A. B. (2000). Readiness for evidence-based practice: Information literacy

needsof nurses in a southern U.S. state (Doctoral dissertation). Northwestern State University, Natchitoches, LA.

195

Tepe, R., & Tepe, C. (2015). Development and psychometric evaluation of an information literacy self-efficacy survey and an information literacy knowledge test. Journal Chiropractic Education, 29(1), 11-15. doi: 10.7899/JCE-14-15

Thiel, L. M., & Ko, A. (2017). Baccalaureate nursing students’ attitudes toward evidence-based practice: A longitudinal study. Journal of Nursing Practice Applications & Reviews of Research, 7(2). https://doi.org/10.13178/jnparr.2017.0702.0706

Thompson, D. N., & Burns, H. K. (2008). Reflection: An essential element of evidence- based practice. Journal of Emergency Nursing, 34(3), 246-248. doi: 1- 1016/j.jen.2008.02.024

Thorsteinsson, H. S. (2012). Translation and validation of two evidence-based nursing practice instruments. International Nursing Review, 59, 259-265.

Thorsteinsson, H. S. (2013). Icelandic nurses’ beliefs, skills, and resources associated with evidence-based practice and related factors: A national survey. Worldviews on Evidence-Based Nursing, 10(2), 116-126.

The TIGER Initiative. (2009). Collaborating to integrate evidence and informatics into nursing practice and education: An executive summary. Retrieved from https://himss.org/collaborating-integrate-evidence-and-informatics-nursingpractice-education-executive-summary

Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups.International Journal for Quality in Health Care, 19(6), 349-357. doi: 10.1093/intqhc/mzm042

Trossman, S. (2010). Gold standards: ANA and nurse experts promote using national guidelines to inform, intervene with patients. American Nurse Today, 5(3).Retrieved from https://www.americannursetoday.com/gold-standards-ana-and- nurse-experts-promote-using-national-guidelines-to-inform-intervene-with- patients/

Tuazon, N. (2017). A case study on the meaning of evidence-based practice among ICU staff nurses. Journal of Nursing Practice Applications & Reviews of Research, 7(1), 4-13.

U. S. Department of Labor Bureau of Labor Statistics. (2017). Occupational employment and wages – May 2017. Retrieved from https://www.bls.gov/news_release/pdf/ocwage.pdf

196

Verhey, M. P. (1999). Information literacy in an undergraduate nursing curriculum: Development, implementation, and evaluation. Journal of Nursing Education, 38, 252-259.

Wahoush, O., & Banfield, L. (2014). Information literacy during entry to practice: Information-seeking behaviors in student nurses and recent nurse graduates. Nurse Education Today, 34, 208-213.

Wallace, M. C., Shorten, A., & Crookes, P. A. (2000). Teaching information literacy skills: An evaluation. Nurse Education Today, 20, 485-489.

Wang, W., Sun, R., Mulvehill, A. M., Gilson, C. G., & Huang, L. L. (2016). Handling Internet-based health information: Improving health information web site literacy among undergraduate nursing students. Journal of Nursing Education, 56(2), 110- 114. doi: 10.3928/01484834-20170123-08

Warren, J. I., Montgomery, K. L., & Friedmann, E. (2016). Three-year pre-post analysis of EBP integration in a magnet-designated community hospital. Worldviews on Evidence-Based Nursing, 13(1), 50-58.

Webber, S., & Johnston, B. (2006). Working towards the information literate university.In Walton, G. & Pope, A. (Eds). Information literacy: Recognizing the need. Staffordshire University, Stoke-on-Trent (pp. 46-58). Oxford, UK: Chandos. Retrieved from http://dis.shef.ac.ul/sheila/staffs-webber-johnston.pdf

Wegener, D. R. (2018). We may be teaching information literacy, but are the design first year students actually getting it? The Journal of Academic Librarianship, 44, 633- 641. https://doi.org/10.1016/j.acalib.2018.07.009

Weng, H. C., Chen, H. H., & Hsieh, P. N. (2016). A curriculum development and implementation of information literacy in nursing practice. Journal of Educational Media & Library Sciences, 53(2), 139-170.

Williamson, K. M., Fineout-Overholt, E., Kent, B., & Hutchinson, A. M. (2011). Teaching EBP: Integrating technology into academic curricula to facilitate evidence-based decision-making. Worldviews on Evidence-Based Nursing, 4th Quarter, 247-251.

Wilson, M., Ice, S., Nakashima, C. Y., Cox, L. A., Morse, E. C., Philip, G., & Vuong, E. (2015). Striving for evidence-based practice through a hybrid model journal club: A pilot study. Nurse Education Today, 35, 657-662. http://dx/doi.org/10.1016/j.nedt.2015.01.026

197

Yackel, E. E., Short, N. M., Lewis, P. C., Breckenridge-Sproate, S. T., & Turner, B. S. (2013). Improving the adoption of evidence-based practice among nurses in Army outpatient medical treatment facilities. Military Medicine, 178, 1002-1009. doi: 10.7205/MILMED-D-13-00191

Yoder, L. H., Kirkley, D. C., McFall, D., Kirksey, K. M., StalBaum, A. L., & Sellers, D. (2014). Staff nurses’ use of research to facilitate evidence-based practice.American Journal of Nursing, 114(9), 26-37. doi: 10.1097/01.NAJ.0000453753.00894.29

Young, K. M. (2003). Where’s the evidence? Evidence-based practice is not a reality for most nurses. American Journal of Nursing, 103(10), 11.

VITA

Ann Deshotels’ educational pursuits include the Doctor of Education degree

with a concentration in Health Professions Education completed in June 2019 at the

the University of LA at Monroe (ULM). The Master of Science in Nursing degree

with a clinical focus in adult health and a functional focus in education was completed in

December 1991 at Northwestern State University in Louisiana. The Bachelor of Science

in Nursing degree was completed at the University of Southwestern Louisiana in

Lafayette, LA in 1978.

Ms. Deshotels’ has been a Registered Nurse in LA since 1978 and is a Certified

Nurse Educator. She is an Assistant Professor of Nursing teaching in the RN to BSN

program at NSU for 27 years. Prior to NSU, clinical nursing experiences spanned 22

years beginning at Franklin Foundation Hospital in Franklin, LA in critical care and

evolved to cardiac and pulmonary rehabilitation at Our Lady of Lourdes and Hamilton

Medical Center hospitals in Lafayette, LA and at Rapides Regional Medical Center in

Alexandria, LA.

Prior research studies and scholarly works presented in various professional

nursing venues included Online Retention in RN to BSN Programs (2017),

Nursing Education and Practice: A Vision for the Future (2011), Adult Day Care

Program: Community Experience for Nursing Faculty and Students (2005), Nursing:

Issues Affecting an Aging Society (2005), Addressing the Primary Health Care Needs of

the Working Uninsured (2002), Outcomes Evaluation and Nursing Research (1996), ICU

Outcomes in an Elderly Population (1995), Nursing Research: Foundation for the

Future (1994), Effectiveness of Multidisciplinary Approach for Clients Disabled by

Chronic

Pain (1993), Key Aspects of Caring for the Acutely Ill: Technological Aspects, Patient

Education, and Quality of Life (1993), and Male and Female Perceptions of Quality of

Life in Cardiac Rehabilitation Programs (1991). Publications include a co-authored

chapter in Conversations in Nursing for Faculty (2008), co-authored Gender

Differences in Perceptions of Quality of Life in the Journal of Cardiopulmonary

Rehabilitation (1995), co-authored Quality of Life After Cardiac Surgery in AACN

Clinical Issues in Critical Care Nursing (1993).

Current professional memberships include Pi Kappa Phi, American Nursing

Informatics Association (AMIA), American Nurses Association (ANA), Louisiana State

Nurses Association (LSNA), Alexandria District Nurses' Association (ADNA), National

League for Nursing (NLN), and Sigma Theta Tau International (STTI) Beta Chi Chapter

and Nu Tau Chapters. Awards and honor include Louisiana’s Great 100 Nurses (2018),

Holder of Jewel Gandy Endowed Professorship (2016-2017), Holder of Rapides Medical

Center Endowed Professorship for Nursing (2010-2011), Holder of Robert Rife Saunders

Endowed Professorship for Nursing (2007-2008), Holder of Coughlin-Saunders Endowed

Professorship (2005), Nightingale Award: LSNA Officer of the Year (2005), ADNA

Educator of the Year (2003),Woman of the Year in Alexandria, LA (2003), Beta Chi

Travel and Research Award (1993), CURIA Research Grant (1993), and Beta Chi

Chapter (STTI) Outstanding NSU Graduate Student (1991).