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FACULTY KNOWLEDGE, ATTITUDES,AND PERCEIVED BARRIERS TO TEACHING

EVIDENCE-BASED NURSING

JAYNELLE F. STICHLER, DNSC, FACHE, FAAN,* WILLA FIELDS, DNSC, RN, FHIMSS,†SON CHAE KIM, PHD, RN,‡ AND CAROLINE E. BROWN, DED, CNS, WHNP§

ssor ans, San Dssor Sch

ssor, ScCA.nce Basego, CAress coCampar@aol.c223/10

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This study measured the knowledge, attitudes, and perceived barriers to teaching evidence-based practice (EBP) among nursing faculty at two schools of nursing with baccalaureate andmaster's level programs in southwestern United States. Survey instruments included ademographic survey, the Evidence-Based Practice Questionnaire, and the BARRIERS toResearch Utilization Scale. Descriptive statistics, Pearson's correlations, and hierarchicalmultiple regression procedures were employed to analyze the data. The results indicated thatmaster's prepared faculty had significantly higher mean scores in the practice of EBP ascompared with doctorally prepared faculty, and although faculty positively viewed EBP, theirattitude toward EBP was more positive than their knowledge/skills and practice of EBP. One ofthe major findings in the study was that traditional research knowledge and skills among facultydoes not necessarily translate to a supportive attitude or knowledge of the EBP process orskills in acquiring and appraising evidence. Understanding faculty's knowledge, attitudes, andpractice of teaching EBP is a critical step to successfully transforming the school's culture to anevidence-based framework for teaching nursing practice, integrating of EBP content intocurricula, and ensuring student mastery and appreciation of EBP. (Index words: Evidence-basedpractice; Faculty knowledge; Teaching strategies; Barriers to evidence-based practice) J ProfNurs 27:92–100, 2011. © 2011 Elsevier Inc. All rights reserved.

EDUCATING THE FUTURE nurse is a dauntingchallenge, especially providing graduates with skills

for lifelong learning. At best, nursing educators hope tograduate new nurses with beginning knowledge of thebiological and psychosocial sciences, nursing theory, andpatient care competencies; skills in critical thinking andprofessional judgment; and abilities to access clinicalinformation to support practice. Because of the prolifer-ation of clinical information in publications, Web sites,

d Concentration Chair for Nurse Leadership in Healthiego State University, San Diego, CA.ool of Nursing, San Diego State University, San Diego,

hool of Nursing, Point Loma Nazarene University, San

ed Practice and Research Liaison, UCSD Medical Center,.rrespondence to Dr. Stichler: San Diego State University,nile Drive, San Diego, CA 92182-4158. E-mail:om/$ - see front matter

Journarofnurs.2010.09.012

journal articles, and the internet, the education ofregistered nurses has included an introduction toresearch as a part of the baccalaureate curricula. Withthe publication of several sentinel books such as To Err isHuman (Kohn, Corrigan & Donaldson, 2000), Crossingthe Quality Chasm (IOM, 2001), and Keeping Patients SafePage, A. (Ed.) (2004), emphasis on the use of evidence toguide practice has become more commonplace. Respond-ing to the call to improve health-care quality, the (Greiner& Knebel, Eds., 2003) described five core competenciesfor all health-care disciplines including the use of anevidence-based approach to care, informatics, patient-centered care, quality improvement processes, andinterdisciplinary collaboration.

Evidence-based process (EBP) has been defined as adecision-making process for patient care that uses thebest evidence available combined with practice experi-ence and the patient's own values and preferences toguide patient care (Melnyk & Fineout-Overholt, 2005;Sackett, Straus, Richardson, Rosenbergy, & Haynes,2000). Evidence-based practice has been recognized bythe health-care community as well as by regulatory

l of Professional Nursing, Vol 27, No. 2 (March–April), 2011: pp 92–100© 2011 Elsevier Inc. All rights reserved.

93TEACHING EVIDENCE-BASED NURSING

agencies as being the gold standard for the provision ofsafe and compassionate health care to patients. Thecritical need for nurses to provide EBP has been cited bythe Agency for Healthcare Research and Quality (Hughes,2008) and the Joint Commission (2007) as a critical stepin improving health-care quality. Nursing educators canno longer focus entirely on clinical skills mastery andcontent knowledge, but they must also prepare nurses todevelop a spirit of inquiry and skills to search forevidence to support critical reasoning and thinking intheir practice. Because faculty shape the future practice ofnursing through education and role modeling, it isimportant that faculty include an evidence-based ap-proach to nursing practice in their work with students(Flesner, Miller, McDaniel, & Rantz, 2006).

The purpose of this study was to determine nursingfaculty knowledge, attitudes, and perceived barriers toteaching EBP. The study is significant to nursing becausethere are few studies that have described nursing faculty'sperceptions of EBP, and it is important to understandfaculty's knowledge, attitudes, practice, and perceivedbarriers to teaching EBP if we can expect that they willimpart an appreciation of EBP and the skills andcompetencies to engage in EBP by students. To besuccessful in moving evidence into nursing practice,teaching strategies must include an evidence-basedapproach across the curriculum in schools of nursingand tactics must address faculty and student perceivedbarriers and facilitators to the adoption of EBP(DeBourgh, 2001; Gosling, Westbrook & Spencer,2004; Killeen & Barnfather, 2005).

Research QuestionsThis study addresses the following research questions:

1. What is the faculty's level of knowledge,attitudes, and practice of teaching EBP?

2. What do faculty identify as barriers toteaching EBP?

3. What are the relationships among demographiccharacteristics, perceived barriers, and faculty'slevel of knowledge, attitudes, and practice ofteaching EBP?

Conceptual FrameworkTwo theoretical frameworks were used to guide thisstudy: (1) diffusion of innovation theory (Rogers, 2003)and (2) adult learning theory (Knowles, 1978). Thediffusion of innovation theory explains that the adoptionof new behaviors by recipients of the innovation isaffected by the complexity of the task to be learned.Evidence from the literature indicates that faculty andclinical nurses perceive the EBP process to be complex,likely reflecting their level of competence and confidencein acquiring evidence and appraising the findings. Barriersto EBP have included lack of knowledge about statisticalanalysis and immature skills in searching electronicdatabases for evidence. Rogers (2003) also postulatedthat the adoption of an innovation likely will be delayed

unless the participants see the relative advantage of thechange and its compatibility with existing values andcurrent personal needs, which can be influenced by howthe innovation is communicated to the participants. Withmore emphasis placed on EBP by service than inacademia, faculty may not recognize the value of teachingan EBP approach in patient care to students.

Knowles' (1978) adult learning theory was also usedto guide the study. Knowles' stated that adults learndifferently than children and that they are autonomous,self-directed learners who build new knowledge on aframework of life experiences and existing knowledge.Knowles indicated that adult learners must see therelevancy of the material to be learned, since they aregoal-oriented and practical in how they will put thematerial to use in their work. This theory is relevant forthis study because some faculty do not see a differencebetween research methods traditionally taught inschools as compared with teaching EBP and, therefore,do not see the relevance of including EBP content instudent learning experiences and assignments. Knowles'theory of adult learning and the Rogers' theory ofdiffusion of innovation explained the relationshipsamong the variables of interest in this study (Greenand Ellis, 1997). The review of the literature focusedon studies that demonstrated faculty knowledge,attitudes, practice, and perceived barriers to teachingevidence-based nursing practice and graduate nurses'acceptance and adoption of an EBP approach to theirown nursing practice.

Review of the LiteratureWhile most faculty members demonstrate knowledge andcompetencies in the traditional research process, manydo not have the knowledge, attitudes, or competencies inEBP to include the content in their coursework or studentassignments. Barriers and facilitators to the adoption ofteaching and practice of EBP in nursing have beenidentified by researchers (Burke et al., 2005; Ciliska,2005; DiCenso, Cullum, & Ciliska, 1998; DiCenso,Guyatt, Ciliska, 2005; Estabrooks, Floyd, Scott-Findlay,O'Leary, & Gushta, 2003; Fink, Thompson & Bonnes,2005; Funk, Champagne, Tornquist, & Wiese, 1991;Melnyk, Fineout-Overholt, Feinstein, Li, Small, Wilcox,& Kraus, 2004). Misconceptions about teaching EBP;lack of philosophical framework for the curriculum,administrative support, mentorship, time, informationliteracy skills, or resources (financial, limited access toelectronic data sources); poor understanding of statistics;and inconsistent basic knowledge and experience withresearch have been consistently reported as barriers.With a push from nursing service to meet regulatoryrequirements to constantly improve patient outcomesand Magnet's emphasis on professional nursing practice,faculty are challenged to use an evidence-based approachin their own educational practice and to teach students toappreciate and practice an evidence-based approach tonursing care.

94 STICHLER ET AL

Importance of Including EBP in Nursing CurriculumMelnyk et al. (2004) reported that the extent to whichclinical nurses (n = 160) implemented EBP was based ontheir knowledge of EBP (r = .42, P b .0001), involvementin EBP initiatives at work (r = .34, P b .001), andengagement with a mentor (r = .28, P b .003). This studyemphasizes the importance of faculty teaching EBP asfundamental knowledge and skills in students' educa-tional experiences. Similarly, an EBP curriculum based onadult learning theory has been correlated with improvedskills and behaviors in EBP in nursing students(Chaboyer, Willman, Johnson, & Stockhausen, 2004).To be successful in moving evidence into nursingpractice, teaching strategies must include an EBPapproach across the curriculum, and school of nursingtactics must address known barriers and facilitators to theadoption of EBP by faculty and student nurses: “Forlearners to grasp the need for integrating EBP principlesand to evaluate the transfer of information effectively, theculture must be imbued with EBP (Fineout-Overholt,2006, p. 145). Embedding EBP into the curriculumfacilitates graduate nurses' use of EBP in practice(Chaboyer et al., 2004).

Debate has focused on the appropriateness of teachingundergraduate students traditional research process ascontrasted to an evidence-based approach of researchanalysis and critical appraisal skills (Chaboyer et al.,2004). Most agree that instilling basic information-seeking behaviors in students, teaching searching skills,and promoting research utilization are basic competen-cies for baccalaureate students (Burke et al., 2005; Burns& Foley, 2005; Ciliska, 2005; Feldman, 1996; Killeen &Barnfather, 2005). Not only must students develop anappreciation for the need to search the literature forevidence and examples of best practices to guide clinicaldecision making, but they must also be taught criticalappraisal skills to analyze research methods and findingsand to determine the applicability of the evidence to theirown situation. Advancing students' knowledge andappreciation of EBP, ensuring competencies necessaryto find the evidence, and applying it to practice requireinnovative teaching strategies beyond the traditionallecture format. Clinical nurses' practice reflects theinfluence of their education and training, and theirappreciation for an evidence-based approach to patientcare is often shaped by their faculty's influence andemphasis placed on EBP in their educational experience(Ferguson & Day, 2004).

Faculty Attitudes about Teaching EBPTraditionally, faculty members have focused on teachingthe research process to both undergraduates and graduatestudents with some application of research utilization(Stetler, 2001). Most faculty are supportive of teachingEBP, but some may not fully comprehend the differencesbetween traditional research and an EBP approach.Traditional approaches to teaching research have oftenresulted in the students' lack of appreciation of the

research process and an inability to integrate researchinto their practice to answer pressing clinical questions.The change in focus from traditional research toevaluating evidence for use in nursing practice hascreated challenges to change traditional teaching meth-ods for clinical and leadership courses (Rosswurm andLarrabee, 1999). Faculty have been slow to adopt theparadigm shift to EBP and have related concerns aboutthe time it takes to integrate these knowledge and skills inan already full curriculum or they indicate their own lackof knowledge and skill in the critical appraisal andstatistical interpretation of data (Burke et al., 2005; Burns& Foley, 2005).

In a National League of Nursing (NLN, 2006) NursingAdvisory Council's survey, faculty were queried abouttheir perceptions that the NLN Hallmarks of Excellencein Nursing was reflected in their schools of nursing.Findings from the survey indicated that 88% of thefaculty believed that their curricula provided experiencesthat taught students about EBP and prepared them toprovide evidence-based nursing care. Seventy percent ofthe faculty reported implementing innovative strategiesto teach EBP to students, and 78% indicated that thosestrategies were based on evidence. Themes identified inthis study were consistent with earlier surveys indicatingthat technology has influenced the teaching/learningenvironment and that both students and faculty arecontinually learning new, innovative ways of implement-ing an evidence-based approach to patient care. The NLNand other professional organizations are advancingnumerous strategies to support the preparation ofstudents for EBP. The intent is to move the majority ofschools to using evidence as their pedagogical framework(Ironside & Speziale, 2006).

Strategies for Teaching EBPSeveral authors have outlined a number of strategies toteaching EBP including skills in asking focused clinicalquestions, searching electronic databases for evidence,critically analyzing the evidence, and determining ifthe published evidence fits with their clinical situa-tions and justifies making a change in practice (Burnes& Foley, 2005; Killeen & Barnfather, 2005; Levin &Feldman, 2006).

Schmidt and Brown (2007) described an innovation-decision process teaching strategy (I-DPTS) that wasbased on Roger's model of diffusion of innovation usedin this study as well. The I-DPTS was a collaborativeprocess between the school of nursing and communityhospitals. The four phases consisted of (1) gettingstarted (forming groups, collaborating with each otherand the librarian, and identifying clinical problems), (2)implementation (advanced literature search, researcharticle critique, and decisions about best practice), (3)dissemination (oral and poster presentation and prepa-ration of manuscripts), and (4) appraisal of studentassignments (peer evaluation of students' research grids,presentations, and an EBP nursing policy). In anevaluation of the I-DPTS, the faculty viewed the process

95TEACHING EVIDENCE-BASED NURSING

positively and reported that the process facilitateddevelopment of students' leadership skills, criticalthinking, communication (presentation, conflict resolu-tion, collaboration), and overall professionalism. Studentevaluation of the I-DPTS was not as positive as thefaculty perspective. Students valued the “real-life”experience and saw direct application to their practicebut struggled with managing group work when not allstudents' completed their assigned obligations. Althoughthis was frustrating to students, faculty identified thelearning opportunities in conflict resolution and prob-lem solving. Overall, the I-DPTS was a useful strategy inteaching baccalaureate students about EBP and providedan experiential method for students to develop compe-tencies to overcome perceived barriers to using researchto guide clinical practice.

Searching for evidence is a critical competency for EBPas is interpreting the key messages in the article andcritically analyzing the articles applicability to clinicalsituation or current problem (Courey, Benson-Soros,Deemer & Zeller, 2006; Ciliska, 2005; Shorten, Wallace& Crookes, 2001). It has been demonstrated thatintegrating information literacy and evidence searchassignments in the curriculum program enhancedstudents' competencies and confidence in searchingdatabases and in assessing the usefulness of specificstudies (Shorten et al., 2001). Expanding readingsbeyond the text and lecture materials and using anintegrated search approach in class assignments has beenviewed as a helpful strategy in advancing students'knowledge and skill in EBP (Burke et al., 2005). Havingthe students find articles pertinent to the clinical orseminar topic, critique the article, and determine itsusefulness in answering a clinical question has beenrecommended by many (Burke et al., 2005; Burns &Foley, 2005; Ciliska, 2005; Melnyk et al., 2004) as astrategy to enhance undergraduate student skills.

Most researchers and educators agree that undergrad-uate and master's level education should focus onresearch appraisal and research translation to practicewith the doctoral levels focusing on knowledge gener-ation. Building on this foundation, faculty teachinggraduate students may expand the assignments toinclude the requirement for the student to use theinformation to develop clinical protocols or for leader-ship students to create an innovation or managementchange project. Most authors agree that including EBP inthe curriculum at all levels of education for nurses is a“paradigm shift that is long overdue” (Burke et al., 2005,p. 359).

MethodologyThis cross-sectional exploratory study determined facul-ty knowledge, attitudes, and perceived barriers toteaching EBP. The study was conducted at two schoolsof nursing (one public and one private) with baccalau-reate and master's' level nursing education in thesouthwestern region of the United States. A conveniencesample was recruited from a combined pool of

approximately 125 faculty members. Eligible participantsincluded all tenure and tenure track faculty, lecturers,and adjunct clinical faculty. All adjunct nonclinicalfaculty were excluded, since they only had occasionalinteraction with clinical classes.

Study InstrumentsA 20-item demographic survey was designed to describethe sample and to control for possible extraneousvariables. Two other instruments, the Evidence-BasedPractice Questionnaire (EBPQ) and the BARRIERS toResearch Utilization Scale, were used to operationalizethe concepts of Knowledge, Attitudes, and Practice ofEBP and Barriers to Use of EBP.

The EBPQ is a 24- item self-report scale that isorganized into three subscales with reported internalreliability of Cronbach's alphas of .87 for the total scaleand .85 for the Practice of EBP subscale, .79 for theAttitudes subscale, and .91 for the Knowledge/Skillssubscale (Upton & Upton, 2006). Construct validity wasestablished by correlating the EBPQ scores using anindependent measure of subjects' awareness of EBP,which yielded a moderate and positive relationshipbetween scales (r = .30–.40). Discriminant validity wasdemonstrated with significant differences in the scoresbetween subjects who were involved in a local initiativeto advance knowledge of EBP with those who did notparticipate in the initiative.

The BARRIERS to Research Utilization Scale is a 29-item tool with four subscales: (1) Characteristics of theAdopter of Research, (2) Characteristics of the Organi-zation, (3) Characteristics of the Innovation (qualities ofthe research), and (4) Characteristics of the Communi-cation (presentation of the research). Internal reliabilitywas established with Cronbach's alpha of .80, .80, and.72, respectively, for the first three subscales, and .65 forthe last subscale (Funk et al., 1991). Fink, Thompson,and Bonnes (2005) described slightly higher Cronbachinternal reliability coefficients in their study, with alphasranging from .91 to .86.

Permissions to use and modify the wording in thedirections and items to make the questionnaires specificfor this study for the BARRIERS scale and the EBPQ wereobtained from both authors of the instruments prior tousing them for data collection. For the EBPQ, words inthe directions were changed from “among health-careprofessionals” to “among faculty” and from “yourpractice” to “your teaching practice.” For the BARRIERSscale, the words nurse, physician, and staff” were changeto faculty in each item where the words appeared.

Data Collection. After IRB approvals were obtainedfrom both universities, subjects were recruited bydescribing the study's purpose, design, and methods ofdata collection at the first faculty meetings of the fallsemester at each respective school. The faculty were toldthat their participation was voluntary and that comple-tion of the study instruments indicated their consent toparticipate in the study. The introductory/consent letter

Table 1. Sample Characteristics (N = 40)

Characteristic Value

UniversityPrivate 20 (50.0)Public 20 (50.0)

SexMale 1 (2.5)Female 39 (97.5)

Age (years), mean (range) 49 (28–68)EthnicityBlack 2 (5.0)White (non-Hispanic) 35 (87.5)Asian/Pacific Islander 2 (5.0)Other 1 (2.5)

Year of highest degree1970–1979 1 (2.5)1980–1989 5 (12.5)1990–1999 17 (42.5)2000–2009 17 (42.5)

Highest degree earnedBaccalaureate (nursing) 1 (2.5)Master's (nursing) 27 (67.5)Master's (other field) 2 (5.0)Doctoral (nursing) 10 (25.0)

RN experience (years), mean (range) 26 (5–47)Faculty teaching experience, mean (range), y 9.1 (0–34)Current faculty positionFull-time 23 (57.5)Part-time 17 (42.5)

No. of EBPNone 14 (35.0)1–4 19 (47.5)5–9 2 (5.0)N10 2 (5.0)

Note. Values are expressed as number (%), unless otherwise indicated.

Table 2. Mean Scores (SDs) and Cronbach's Alpha for EBPQ(N = 40)

Subscales Mean (SD)Cronbach's

alpha

Practice of EBP 4.86 (1.29) .90Attitude Toward EBP 5.64 (1.15) .74Knowledge/SkillsAssociated With EBP

4.93 (0.77) .92

Note. Possible range 1–7, with 7 as the optimal response.

96 STICHLER ET AL

and the study instruments were distributed to eachfaculty member at each school with a return envelopeattached with instructions to place the completed studyinstruments into the envelope and into the lockedcollection boxes located in each school's office.

Data AnalysisThe data were analyzed using SPSS software (version15.0, SPSS, Chicago, IL). Means, standard deviations,frequencies, and percentages were calculated for de-scriptive data analyses. To determine the relationshipbetween predictor variables of evidence-based knowl-edge, attitudes, and practice, post hoc bivariate Pearson'scorrelational analyses were first performed among thesedependent variables and the subjects' independentpredictor variables. The level of significance was set atP ≤ .05. Subject independent variables includeddemographic characteristics and four BARRIERS sub-scales, Characteristics of the Adopter, Characteristics ofthe Organization, Characteristics of the Innovation, andCharacteristics of the Communication. Dummy codeswere assigned for categorical variables, such as thehighest degree earned and current faculty position, asindependent variables. The significant demographiccharacteristic variables from the bivariate correlationalanalyses (P ≤ .05) were entered into the first step ofhierarchical multiple regression model. The four char-acteristics of BARRIERS subscales were entered into thesecond step of hierarchical multiple regression models.Hierarchical multiple regression model was employed toseparately assess the influence of BARRIERS subscalesand demographic variables. Hierarchical multiple regres-sion analyses were performed for each of the threedependent variables.

ResultsDemographic characteristics of the participants areshown in Table 1. A total of 40 faculty membersparticipated in this study; 20 from each institution, for a31% (40/125) response rate. The majority of the sample(97.5%) was female, between the ages of 28 and 68years, White (87.5%), and earned their highest degreebefore 2000 (57.5%). Most of the participants had amaster's degree (72.5%) as their highest educationaldegree and 25% had a doctoral degree. Years ofexperience as a registered nurse (RN) ranged from 5to 47 years and as a teacher ranged from 0 to 34 years.Just over half of the participants (57.5%) held a full-timefaculty position, and 35% reported that they had neverattended an EBP class.

Internal consistency reliability for the three EBPQsubscales and faculty mean scores for each subscale weresimilar to those reported by the original authors (Upton&Upton, 2006) and ranged from .74 to .92. Internalconsistency reliability for the four BARRIERS subscalesand faculty mean scores were similar to those reported bythe original authors (Funk et al., 1991), with a range from.60 to .87.

Research Questions ResultsWhat Is the Faculty's Level of Knowledge, Attitudes,

and Practice of Teaching EBP?Faculty mean scores ranged from 4.86 to 5.64 on a scaleof 1 to 7, with 7 being the optimal score (see Table 2).Although each of the subscales used a seven-pointresponse set from a low of 1 to a high of 7, each responseset was different. The Practice of EBP used a response setof never (1) to frequently (7), Attitude Toward EBP used aseven-point differential scale, and Knowledge/Skills ofEBP used a response set of poor (1) to best (7). TheAttitude Toward EBP subscale received the highest mean

Table 3. Mean Scores and Cronbach's Alpha for BARRIERS toResearch Utilization Scale (N = 40)

Subscales Mean (SD)Cronbach's

alpha

Characteristics of Adopter 1.91 (0.70) .87Characteristics of Organization 2.23 (0.65) .82Characteristics of Innovation 2.17 (0.47) .60Characteristicsof Communication

2.40 (0.68) .77

Note. Possible range 1–4, with 4 representing great extent.

97TEACHING EVIDENCE-BASED NURSING

score, followed by Knowledge/Skills Associated with EBP,and then Practice of EBP. These results indicated that thefaculty view EBP positively, although their AttitudeToward EBP tends to be more positive than theirKnowledge/Skills and Practice of EBP.

What Do Faculty Identify as Barriers toTeaching EBP?

Faculty mean scores ranged from 1.91 to 2.40 on ascale of 1 to 4, with 4 being the optimal score (seeTable 3). Among the four subscales, the Character-istics of Adopter had lowest mean barrier score (M =1.91), followed by Characteristics of Innovation (M =2.17), Characteristics of Organization (M = 2.23), and

Table 4. BARRIERS Scale Item Responses

Subscale It

Characteristics ofthe Adopter

Unaware of the research relevant toIsolated from knowledgeable colleaguDo not feel capable of evaluating theFeel that the benefits of changing theAre unwilling to change/try new ideaThere is no documented need to chDoes not see the value of research fSee little benefit for the student's lea

Characteristics ofthe Organization

Does not have time to read researchThere is insufficient time on the facuPhysicians will not cooperate with nuDo not feel she/he has enough authoclinical classes to EBPDo not feel that the results are notThe facilities are inadequate for teacOther faculty are not supportive ofUniversity administration will not allEBP content into curriculum

Characteristics ofthe Innovation

The research has not been replicatedThe literature supports conflicting reThe research has methodological inaResearch reports/articles are not puIs uncertain whether to believe the rThe conclusions drawn from the clin

Characteristics ofthe Communication

The relevant research is not compileStatistical analyses are not understanImplications for teaching that are noThe research is not supported clearlResearch reports/articles are not reaResearch is not relevant to a studen

then Characteristics of Communication (M = 2.40).These results indicated that faculty perceived personalcharacteristics (Characteristics of Adopter) as relativelylow barriers to practicing EBP, whereas the Character-istics of Innovation, Organization, and Communicationwere perceived as higher barriers to teaching EBP. Thecommunication barriers addressed characteristics relat-ed to finding relevant research, understanding statis-tics, understanding the relevance, and implications forteaching EBP.

The percentage of subjects' responses indicating towhat extent each of the BARRIERS scale items were eithera moderate or great barrier are shown in Table 4. Thehighest percentage of responses indicated that theCharacteristics of Communication subscale was per-ceived as having the greatest barriers to EBP, followed bythe subscales of Characteristics of the Organization andCharacteristics of the Innovation. The subscale with thelowest percentage of responses indicating the lowestbarrier to EBP was Characteristics of the Adopter. Theseresults suggested that faculty do not see their personalcharacteristics such as being aware of relevant research,willingness to try new ideas, and value of research forteaching clinical practice as barriers, since fewer than40% of the participants rated the items in this subscale asa moderate or great barrier.

em% Moderate orgreat barrier

clinical practice areas 39.4es with whom to discuss the research 38.4quality of the research 36.1ir classes to EBP model will be minimal 32.4s 29.7ange teaching practices 16.7or teaching clinical practice 12.9rning 7.9

51.2lty role to implement new ideas 47.4rses' implementation of EBP 46.9rity to change the focus of 45.7

generalizable to own setting 40.0hing EBP 27.0implementation 22.2ow implementation of 3.2

53.3sults 45.9dequacies 31.3blished fast enough 29.7esults of the research 18.2ical research are not justified 5.9d in one place 62.9dable 61.5t made clear 50.0y and readably 39.4dily available 36.8t's learning 18.4

Table 5. Bivariate Correlations Among Variables for EBP (N = 40)

Practiceof EBP

AttitudeTowardEBP

Knowledge/SkillsAssociatedWith EBP

Age .11 −.06 .24Years of RN .11 .01 .23Years of teaching .09 −.12 .10Master's degree −.14 .41 ⁎ −.21Doctoral degree .09 −.43 .22Part-time faculty .04 .05 .22Full-time faculty −.04 −.05 −.22No. of EBP classesattended

.22 .19 .21

BARRIER Adopter −.60 † −.10 −.46 ⁎BARRIEROrganization

−.40 .20 −.35

BARRIERInnovation

−.55 † −.18 −.58 †

BARRIERCommunication

−.50 † .19 −.46 †

⁎ P ≤ .05.† P ≤ .01

98 STICHLER ET AL

Fifty percent or more of the participants rated thefollowing items as moderate or great barriers to practicing/teaching EBP: (1) access to research in one place, (2)understanding of statistical analyses, (3) generalizableresults, (4) volume of available research, (5) lack ofreplication, (6) time to read research, and (7) lack of clearimplications for teaching as barriers. These findingssupport Knowles' theory that adult learners focus onlearning material that they believe to be of value to them,and since they do not see the research as generalizable orhave clear implications for practice, learning about andteaching EBP to students may not be a high priority forfaculty. The findings also support Rogers' theory, whichstates that the more complex the subject, the less likelythere will be early adopters of the innovation. This studysupports previous findings that faculty find searching forevidence and statistical interpretation complex, whichmayimpede their rapid adoption of teaching EBP to students.

Faculty indentified other barriers to teaching EBP as(1) insufficient time to read research, (2) lack of researchreplication to ensure the level of the evidence, (3)underdeveloped skills in finding evidence and interpret-ing statistics, and (4) lack of generalizability of researchfindings to their own specific clinical content as moderateto great barriers to EBP.

Study participants also rated “benefit to student'slearning,” “university administration support for EBP con-tent in the curriculum,” and “justifiable clinical researchconclusions” as low barriers to EBP, which supports thatfaculty have a positive attitude to EBP butmay not actuallyimplement teaching EBP to students.

What Are the Relationships Among DemographicCharacteristics, Perceived Barriers, and Faculty'sLevel of Knowledge, Attitudes, and Practice of

Teaching EBP?Correlations among the demographic variables, EBPQ,and BARRIERS subscales are shown in Table 5. The onlydemographic variable with a statistically significantcorrelation to Attitude Toward EBP was the facultymembers' highest degree with the master's degreepositively correlated (r = .41, P b .05) with AttitudeToward EBP. Surprisingly, the doctoral degree wasnegatively correlated (r = −.43, P b .01) with AttitudeToward EBP. It was assumed that doctorally preparedfaculty would have more positive attitudes to teachingEBP, but the findings for this sample did not support thatassumption. These findings likely occurred becausefaculty with master's degree typically work with studentsin the clinical service settings where EBP is emphasized.Doctoral faculty more often teach the theoretical aspectsof the curriculum in the classroom setting.

Other significant correlations included a positivecorrelation between EBP practice and Knowledge/Skillsassociated with EBP (r = .73, P b .01), suggesting that themore knowledge and skills faculty have about EBP, themore they practice EBP. Table 5 outlines the negativecorrelations between the BARRIERS subscales of Adopter,Innovation, and Communication and the EBPQ subscales

of Practice of EBP and Knowledge/Skills associated withEBP, suggesting that the lower the barriers for EBP, themore faculty practice and know about EBP.

Table 6 shows the hierarchical multiple regressionanalysis using the Practice of EBP as the first dependentvariable. The doctoral degree explained 0.6% of thevariance in Practice of EBP (R2 = .006). The entry of fourBARRIERS subscales in the second step changed the R2 by.425 (P = .001), resulting in the total R2 of .431. Thisindicates that the combination of all predictor variablesexplained a large fraction (43.1%) of the variance inPractice of EBP. Among the predictor variables, theBARRIER's Adopter subscale (beta = −.54, P = .05)reached statistical significance.

For the Attitude Toward EBP as the second dependentvariable, the doctoral degree explained 15.8% of thevariance in Attitude Toward EBP (R2 = .158). The entry offour BARRIERS subscales in the second step changed theR2 by .095 (P N .05), resulting in the total R2 of .253. Thisindicates that the combination of all predictor variablesexplained a large fraction (25.3%) of the variance inAttitude Toward EBP. None of the predictor variablesreached statistical significance (Table 6).

For the Knowledge/Skills associated with EBP as thethird dependent variable, the doctoral degree explained4.5% of the variance (R2 = .045). The entry of fourBARRIERS subscales changed the R2 by .283 (P ≤ .05),resulting in the total R2 of .328. This indicates that thecombination of all predictor variables explained a largefraction (32.8%) of the variance in Knowledge/Skillsassociated with EBP. None of the predictor variablesreached statistical significance (Table 6).

Therefore, the results from the hierarchical multipleregression analysis indicate that barriers to teaching EBPas measured by the BARRIERS scale effect the “practice”

Table 6. Hierarchical Multiple Regression Models Predicting Subscales of EBPQ (N = 40)

Predictors

Practice of EBP Attitude Toward EBPKnowledge/Skills

Associated With EBP

B SE(B) Beta B SE(B) Beta B SE(B) Beta

Step 1Constant 4.81 0.25 .08 5.89 0.20 −.40 ⁎ 4.84 0.14 .21Doctoral degree 0.22 0.48 −1.01 0.39 0.37 0.28

Step 2Constant 7.52 1.24 −.07 5.93 1.27 −.33 6.09 0.80 .16Doctoral degree −0.19 0.44 −.54 ⁎ −0.84 0.45 −.38 0.28 0.29 −.43BARRIER Adopter −1.11 0.45 .38 −0.70 0.46 .24 −0.54 0.29 .40BARRIER Organization 1.02 0.55 −.15 0.58 0.57 −.12 0.65 0.36 −.23BARRIER Innovation −0.51 0.61 −.34 −0.39 0.63 .19 −0.49 0.40 −.19BARRIER Communication −0.69 0.41 0.34 0.42 −0.24 0.27

R2 = .006 for step 1 R2 = .158 ⁎ for step 1 R2 = .045 for step 1ΔR2 = .425 for step 2 ΔR2 = .095 for step 2 ΔR2 = .283 for step 2ΔF(4, 31) = 5.778 † ΔF(4, 32) = 1.013 ΔF(4, 33) = 3.471 ⁎

⁎ P ≤ .05.† P ≤ .001.

99TEACHING EVIDENCE-BASED NURSING

of teaching EBP more than the “Knowledge and Skills”or “Attitudes” toward EBP. This is an important findingsince it is the practice of teaching EBP to students thatis most critical in their developing an appreciation forEBP and adopting an EBP approach to care in theirnursing practice.

Discussion and RecommendationsThe results of this study supported previous studiesdescribing perceived faculty barriers to teaching EBP(Burke et al., 2005; Burns & Foley, 2005; Ciliska, 2005;Chaboyer et al., 2004). Although the faculty in this studyhad a positive attitude about EBP, they did not rate theirknowledge and skills and practice of EBP as positively.Barriers cited by faculty to incorporating EBP in theirpractice included (1) characteristics of the organization(support, resources, and time), (2) the innovation itself(research methods, statistical analysis), and (3) commu-nication of research findings.

These findings suggest that continuing education forfaculty on the EBP process is necessary to enhance facultyknowledge and skills in acquiring appropriate researchrelevant to the subjects they are teaching and inunderstanding statistical analysis. Specific EBP contentshould include developing a clinical question, informa-tion literacy skills to gather evidence that answers thequestions, and statistical content such as odds ratios,relative risk, and number needed to treat. These EBPskills were not generally taught in academic programsprior to 2000, when most of the faculty received theirhighest academic degree. As faculty increase theirknowledge and skills with EBP, they likely will seemore opportunities to incorporate these practices inteaching their courses and student activities.

LimitationsOnly two schools of nursing in the same geographic areawere included in the study, and a convenience sampling

technique that resulted in a small sample size limited thegeneralizability of the study. Neither of the schools ofnursing have a doctoral program, although both schoolshave an undergraduate and master's degree programs,which may have also affected the findings. Feedback fromparticipants indicated that the BARRIERS scale wasdifficult to understand, which may have affected theirresponses and the findings of the study. It is uncertainhow other instruments measuring the same concepts inthe study would have affected the findings.

ConclusionsThis study adds new information about faculty knowl-edge, attitudes, and perceived barriers to teaching EBP tonursing students, and it cannot be assumed that facultywho know research will know how to teach EBP tostudents. Traditional research skills are not directlytransferable to knowledge or teaching of EBP. Sinceregulatory agencies and professional practice settingssupport EBP in practice, it is incumbent on nursingfaculty to attain these skills and integrate the conceptsinto clinical courses. Further research is needed to explorethe effectiveness of faculty education on the faculty'sintegration of the EBP process into course content,assignments, and students' clinical learning experiencesas well as into the faculty's professional practice.

AcknowledgmentsThis study was funded in part by Gamma Gamma

Chapter, Sigma Theta Tau International.

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