Refinement of a Nursing Concern into an Evidence-based Practice Proposal Using the Research Process

Week 2: Refinement of a Nursing Concern into an

Evidence-Based Practice Proposal Assignment

Chamberlain College of Nursing

NR-505: Advanced Research Methods: Evidence-Based Practice

Refinement of a Nursing Concern into an Evidence-based Practice Proposal

Overview of Selected Evidence-based Practice Project

Where research investigates and develops new knowledge and theories, evidence-based practice translates that knowledge or those theories into practice. According to Connor (2014), “the purpose of conducting research is to generate new knowledge or to validate existing knowledge based on a theory. Research studies involve systematic, scientific inquiry to answer specific research questions or test hypotheses using disciplined, rigorous methods.” (Connor, 2014, para. 4). Connor further stresses that in order to be reliable, researchers must utilize the scientific method to conduct their investigations and studies (Connor, 2014). Evidence-based practice differs from research in that it draws from the results of available research and applies that knowledge to clinical practice. Connor (2014) noted that “unlike research, EBP isn’t about developing new knowledge or validating existing knowledge. It’s about translating the evidence and applying it to clinical decision-making. The purpose of EBP is to use the best evidence available to make patient-care decisions” (Connor, 2014, para. 11).

According to Stevens (2013), the transition to and acceptance of evidence-based practice has been driven by the need for accountability in the area of patient safety and a demand for quality improvement in the health care industry. “Leaders in the field have defined EBP as ‘Integration of best research evidence with clinical expertise and patient values’ (Sackett et al, 2000, p. ii). Therefore, EBP unifies research evidence with clinical expertise and encourages individualization of care through inclusion of patient preferences.” (Stevens, 2013, para. 8).

Identification of the Nursing Concern to be Improved

My MSN Program Specialty Track is nursing education in an undergraduate setting. Based upon the increasing emphasis on evidence-based practice, the proper education of future nurses must include training in the fundamentals of evidence-based practice. Theofanidis (2015) believes that teaching the fundamentals of evidence-based practice to undergraduate nursing students “is the basic ‘educational springboard’ for future staff nurses to be able to initiate improvements and change of practice” (Theofanidis, 2015, para. 3). According to Stevens (2013), after evidence-based practice began to become widely accepted as the desired framework of the future, numerous models began to be developed that were intended to “guide the design and implementation of approaches intended to strengthen evidence-based decision making” (Stevens, 2013, para. 14). Stevens (2013) noted that over forty-seven different models for evidence-based practice can be found in a review of pertinent literature.

The specialty track of education is critical to the training and development of future generations of nursing professionals. By learning how to implement evidence-based practice, identify problems and seek change, the nursing profession will be equipped to evolve and implement changes to improve patient care and outcomes. Nurse educators have the opportunity to inspire students to achieve greatness, to appreciate the value of lifelong learning to the nursing profession and cast a wider net of care because of the legacy that they can help to create by teaching the future generation of nurses. Nurse educators also function as leaders in the profession, inspiring increased quality of care and facilitating positive change through the use and interpretation of evidence-based practice projects. (Mattison, 2016).

The selected nursing concern that I have chosen is the education of millennial learners in undergraduate nursing to best develop their critical thinking skills. This nursing concern occurs with all nursing students between the ages of 22 and 37 who enter an undergraduate nursing program. The students of today are vastly different from the students of the past, having grown up in the age of the Internet, learning to use Google searches instead of the antiquated Dewey Decimal and card catalog systems to find answers to their questions (Tai, 2014). Known as “millennial learners,” these students are far more comfortable with the use of technology than their predecessors, and, according to Revell and McCurry (2010), “prefer interactive classrooms with individual feedback and peer collaboration.” (Revell & McCurry, 2010, para 1). Battersby (2017) noted that Generation Y students learn differently than students in the past, and educators must learn to develop educational strategies to best teach these students. (Battersby, 2017). A key characteristic of millennial learners is their comfort with the use of technology in every facet of their lives. Because of the way in which these millennial learners process information, Battersby noted, “millennials prefer a variety of active learning methods incorporated into the curriculum to help them learn. Educators need to be constantly changing their methods, for example, from lecture to discussion, to watching a video, to group work, in order to hold the attention of Millennials” (Battersby, 2017, p. 122).

It would seem that educating nursing students in evidence-based practice projects dovetails nicely with the varied learning styles of the millennial learner and their need for active, hands-on training in group or team settings. According to Gaberson and Oermann (2010), “Today’s millennial generation of nursing students requires a teaching pedagogy that is based on collaboration, increased participation, and a realistic immersion, recognizing their familiarity with the process of learning”. (Gaberson, K. & Oermann, M., 2010, p. 158). Just as modern educators must use creative teaching tools to convey ideas and knowledge to their students, they must also craft “creative and enjoyable teaching strategies are instrumental in order to promote students’ learning about EBP” (Sin & Bliquez, 2017, para. 2). Sin and Bliquez (2017) encourage employing group collaboration on projects as the students work through an EBP project, a method that should be embraced by millennial learners. They suggest that the group work together to formulate their problem statement that will be the subject of the project. The millennial learners’ familiarity with technology to acquire evidence and work with librarians to learn new search techniques, as well as to appraise and apply the evidence collected to the project selected. (Sin & Bliquez, 2017).

Effective instruction of future nurses may prove to be a challenging task, particularly for educators who may not be as technologically savvy as the students in their classrooms. Bonaduce and Quigly (2011) query, “How does a nursing instructor in the classroom communicate to millennial students in a caring way, in the presence of overwhelming technology, which the instructor may not fully understand, so that students, may in turn, initiate caring for their clients?” (Bonaduce & Quigly, 2011, p. 158). If an instructor can successfully bridge the gap between old school nursing instruction and new school nursing students, that instructor will be able to profoundly affect future generations of nurses. While methodology and technology will always be in a state of flux, as new innovations and theories replace older ones, the core concept of caring that is consistent across the profession will not change. Bonaduce and Quigly (2011) opine that “Nursing needs to re-discover itself in a highly technological classroom, re-ground itself in a caring paradigm within that classroom, and transmit this knowledge of caring to Millennial students for use in their profession.” (Bonaduce & Quigly, 2011, p. 158). The effective educator must recognize and embrace the differences between generations, yet reinforce the common core values that bind all generations into one caring profession.

Doey and Kincaid (2012) agree that socially astute millennial students are better suited for collaborative learning environments; therefore, “Instructors must also offer collaborative, interactive learning, opportunities for social learning activities, a variety of technology in instruction and assignments, and simulated case work” in their courses. (Doey & Kincaid, 2012, p. 14). Promoting a team concept in nursing education, and in particular to the teaching of evidence-based practice, will appeal to the millennial learners who are particularly receptive to this approach. One such method of instruction is known as “flipping the classroom,” where new information and knowledge is obtained independently out of class, while classroom time is used for discussion, debate, simulations and practical application of the new knowledge. (Betihavas, Bridgman, Kornhaber & Cross, 2016). Betihavas, Bridgman, Kornhaber & Cross (2016) noted there has been a movement toward transformation, “wherein students engage as active learners, content is taught in-context, and educators facilitate clinical reasoning and critical thinking rather than imparting factual information” (Betihavas, Bridgman, Kornhaber & Cross, 2016, p. 15). Development of course-appropriate activities geared toward the millennial learner, including collaboration, team activities and use of technology will facilitate positive change. As Battersby (2017) noted, “educators need to be constantly changing their methods, for example, from lecture to discussion, to watching a video, to group work, in order to hold the attention of Millennials” (Battersby, 2017, p. 122).

Because nursing education and the development of critical thinking skills are essential to positive patient outcomes and patient safety, the stakeholders who are impacted by the education of millennial nursing students are the students themselves, the teaching faculty, and the educational institutions. Perhaps the most important stakeholders are the patients and the healthcare institutions for whom the nurses will ultimately work. The consequences of the ineffective education of millennial nursing students are significant. A shortage of quality nurses will directly affect patient care, resulting in more negative patient outcomes, more repeat admissions, more cost to healthcare systems, including increased liability for errors caused by nurses lacking in proper education and training. One solution to this nursing concern is adapting nursing education programs to address the particular strengths of millennial learners, introducing the concept of “flipped classrooms,” and implementing the use of technology and simulators to better train millennial nursing students in critical thinking skills. The purpose statement for this evidence-based practice proposal is to evaluate the effectiveness of using a “flipped classroom” system and utilizing technology and simulators in teaching millennial undergraduate nursing students on their development of critical thinking skills.

PICOT Question and the Literature Review Process

The PICOT question formulated for this EBP proposal is as follows: In millennial nursing students (P), how does traditional learning (I) compared to flipping the classroom (C) affect critical thinking skills (O) within nursing school (T)? The expected outcome is that a flipping the classroom scenario will result in increased critical thinking skills in millennial undergraduate nursing students. This will be useful in my future practice setting as a nurse educator, because it will enable me to more effectively teach millennial nursing students in the undergraduate setting through the use of appropriate and targeted technology.

The purpose of a literature review is to examine the existing research and sources that are pertinent to an area of interest or theory that will be the focus of a research proposal. According to Larabee (n.d.) writing in the Research Guide for Communication Studies (2018),

A literature review surveys scholarly articles, books and other sources relevant to a particular issue, area of research, or theory, and by so doing, providing a description, summary, and critical evaluation of these works. Literature reviews are designed to provide an overview of sources you have explored while researching a particular topic and to demonstrate to your readers how your research fits into the larger field of study” (Larabee, n.d., para. 1).

Conducting a literature review will accomplish two purposes for my EBP proposal. First, the process of conducting the review will make me familiar with the existing research that has been done regarding the education of millennial students in the undergraduate nursing programs. Second, it will help me refine my research question by identifying issues that require additional research.

For my literature review, I utilized the Chamberlain College of Nursing Library and the keywords “millennial learners,” “flipping the classroom” and “simulation.” I also utilized additional search terms such as “nurse educators” and “critical thinking skills.” I performed additional Google searches as I could, targeting scholarly articles for the identified search keywords. Some specialty organizations relevant to the EBP proposal would be the American Association of Colleges of Nursing Staff (AACN), the American Nurses Association (ANA), and the National League for Nursing (NLN).

Theoretical Framework

The theoretical framework applicable to my EBP proposal would be based upon Orem’s (2001) self-care deficit theory. The self-care deficit nursing theory is a grand nursing theory developed between 1959 and 2001 by Dorothea Orem. Self-care nursing deficit theory suggests that all individuals have the natural ability to provide their own care to some degree; however, they need to be educated and guided by nursing to develop the skills necessary to do so (Simmons, 2009). According to a study conducted by Uzuncakmak and Beser (2017), self-care education directly relates to empowering the patient to perform self-care activities (Uzuncakmak & Beser, 2017). Just as nurses teach their patients principles of self-care to best manage their medical conditions, so too do nurse educators teach their students the skills and information that they will need to function independently in their careers.

By engaging in methods of teaching that will best reach the millennial learner, such as “flipping the classroom,” the nurse educator can better equip the millennial learner with the knowledge and skills that they need to engage in critical thinking independent of their instructors and mentors. As Roehl, Reddy & Shannon (2013) noted, “through active learning and technology-enabled flipped classroom strategies, students may develop higher order thinking skills and creativity” (Roehl, Reddy & Shannon, 2013, p. 48). As nurse educators shift from a traditional teaching-centered curriculum to a “flipping the classroom” curriculum with collaborative hand-on classroom learning, the focus should be less on rote memorization of information and more on developing critical thinking skills to apply in real-life simulations.

This approach is directly in line with Orem’s (2001) self-care deficit theory, in that the nursing students are learning and mastering the skills necessary to function independently in a healthcare environment. Measuring critical thinking skills would be accomplished with a series of simulations related to acute patient symptoms and would be assessed based on repeated performances on simulations over time, both independently and collaboratively. Doey and Kincaid (2012) agree that socially astute millennial students are better suited for collaborative learning environments; therefore, “Instructors must also offer collaborative, interactive learning, opportunities for social learning activities, a variety of technology in instruction and assignments, and simulated case work” in their courses. (Doey & Kincaid, 2012, p. 14). Promoting a team concept in nursing education via interactive classroom simulations will appeal to the millennial learners who are particularly receptive to this approach. By teaching today’s undergraduate nursing students, most of whom are now considered “millennials,” via methods that they understand and to which they are accustomed, we will train qualified, quality nurses who can function outside the classroom setting, think critically, and ultimately, provide better patient care resulting in better patient outcomes.

References

American Association of Colleges of Nursing Staff (AACN). (2011). The essentials of master’s education in nursing. American Association of Colleges of Nursing. Retrieved from: http://www.aacnnursing.org/Portals/42/Publications/MastersEssentials11.pdf

Battersby, L. (2017). Education strategies that best engage Generation Y students. Canadian Journal of Dental Hygiene, 51(3), 118-125. Retrieved from: http://eds.b.ebscohost.com.chamberlainuniversity.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=2&sid=7b87e5f4-fcfa-42bd-9c1c-964354c7a418%40sessionmgr101

Betihavas, V., Bridgman, H., Kornhaber, R., & Cross, M. (2016). Review: The evidence for “flipping out”: A systemic review of the flipped classroom in nursing education. Nurse Education Today, 38 15-21. doi: 10.1016/j.nedt.2015.12.010

Bonaduce, J., and Quigly, B. (2011). Florence’s candle: Educating the millennial nursing student. Nursing Forum, 46(3), 157-159. doi:10.1111/j.1744-6198.2010.00186.x. Retrieved from: http://onlinelibrary.wiley.com.chamberlainuniversity.idm.oclc.org/doi/10.1111/j.1744-6198.2010.00186.x/epdf

Connor, B. (2014). Differentiating research, evidence-based practice, and quality improvement. American Nurse Today. 9(6). Retrieved from: https://www.americannursetoday.com/differentiating-research-evidence-based-practice-and-quality-improvement/

Doey, K. and Kincaid, J. (2012). Educating the professional millennial student. Distance Learning, 9(2), 11-17.

Gaberson, K. and Oermann, M. (2010). Clinical Teaching Strategies in Nursing, Third Edition. New York: Springer Publishing Company. Retrieved from: http://eds.b.ebscohost.com.chamberlainuniversity.idm.oclc.org/eds/ebookviewer/ebook/bmxlYmtfXzMxNTc2NV9fQU41?sid=2afac603-1a83-401a-a6d6-b4444e23d54e@sessionmgr102&vid=3&format=EB&ppid=pp_158

Revell, S. & McCurry, M. (2010). Engaging millennial learners: Effectiveness of personal response system technology with nursing students in small and large classrooms. J Nurs Educ. 49(5) 272-275. doi: 10.3928/01484834-20091217-07  Retrieved from: https://www.healio.com/nursing/journals/jne/2010-5-49-5/%7b101ee637-b76a-4797-9f3c-f41eacf62a8c%7d/engaging-millennial-learners-effectiveness-of-personal-response-system-technology-with-nursing-students-in-small-and-large-classrooms#divReadThis

Larabee, R. (n.d.). Communication studies: The literature review. University of Southern California, Research Guide for Communication Studies. Retrieved from: https://libguides.usc.edu/c.php?g=234974&p=1559473

Mattison, M. (2016). Top 5 reasons to become a nurse educator. The Chamberlain Blog. Chamberlain University. Retrieved from: http://www.chamberlain.edu/blog/top-5-reasons-to-become-a-nurse-educator

Moore, J., Everly, M., Bauer, R., (May 31, 2016) Multigenerational challenges: Team-building for positive clinical workforce outcomes” OJIN: The Online Journal of Issues in Nursing 21(2) Manuscript 3. DOI: 10.3912/OJIN.Vol21No02Man03

Orem, D. E. (2001). Nursing: Concepts of practice (6th ed.). St Louis, MO: Mosby.

Roehl, A., Reddy, S. & Shannon, G. (2013). The flipped classroom: An opportunity to engage millennial students through active learning strategies. JFCS. 105(2). 44-49.

Simmons, Laurie. (2009). Dorthea Orem’s self care theory as related to nursing practice in hemodialysis. Nephrology Nursing Journal; Pitman 36(4) (Jul/Aug 2009): 419-21. Retrieved from: https://search.proquest.com/openview/0db353c1859cef5ea6831d7bfd5be870/1?pq-origsite=gscholar&cbl=45638

Sin, M. and Bliquez, R. (2017). Original article: Teaching evidence based practice to undergraduate nursing students. Journal of Professional Nursing, 33. 447-451. doi:10.1016/j.profnurs.2017.06.003. Retrieved from: https://www-sciencedirect-com.chamberlainuniversity.idm.oclc.org/science/article/pii/S8755722316301077?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb

Stevens, K., (May 31, 2013) The impact of evidence-based practice in nursing and the next big ideas. OJIN: The Online Journal of Issues in Nursing 18(2) Manuscript 4. doi:10.3912/OJIN.Vol18No02Man04. Retrieved from: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html

Tai, W.A. (2014). Millennial learners. Stanford University Teaching Commons. Retrieved from: https://teachingcommons.stanford.edu/teaching-talk/millennial-learners

Theofanidis, D. (2015). Evidence based practice and evidence based nursing education. Journal of Nursing and Care, Retrieved from: https://www.omicsonline.org/open-access/evidence-based-practice-and-evidence-based-nursing-education-2167-1168-1000279.php?aid=63108

Uzuncakmak, T. and Beser, N. (2017). The effects of self-care education of adolescents on the power of self-care. International Journal of Caring Sciences, 10(3), 1368-1373.