- Email: [email protected]
Leveling Evidence-based Practice Across the Nursing Curriculum
BY FACULTY FOR FACULTY
Leveling Evidence-based Practice Across the Nursing Curriculum Karen Hande, DNP, ANP-BC, Christopher Ty Williams, DNP, ACNP-BC, FNP-BC, Heather M. Robbins, DNP, RN, Betsy B. Kennedy, PhD, RN, and Tom Christenbery, PhD, RN ABSTRACT
Evidence-based practice (EBP) competencies represent essential components of nursing education at all levels. The transition of EBP learning goals from the baccalaureate to the master of science in nursing and doctor of nursing practice levels provides a blueprint for the development and advancement of student knowledge, skills, and attitudes. The purpose of this article is to describe 3 nursing curricula related to EBP competencies at the baccalaureate, master’s, and doctor of nursing practice levels. Keywords: curricula, education, evidence-based practice, nursing Ó 2016 Elsevier Inc. All rights reserved.
T
he translation of knowledge into practice leads to improved patient outcomes. However, evidence-based practice (EBP) competencies vary among nurses.1 Developing EBP competencies according to the level of nursing education remains a challenge and warrants further exploration. Ensuring a seamless transition of EBP competencies across all levels of nursing curricula provides students the opportunity to develop their skills to critically evaluate, appraise, and apply nursing evidence as they advance their nursing education preparation. The purpose of this article is to describe strategies for student achievement of EBP competencies while progressing in baccalaureate, master’s, and doctor of nursing practice (DNP) levels of the nursing curriculum. BACKGROUND
The core knowledge and competencies for all levels of academic nursing degrees set the foundation for essential curricular elements and expected outcomes. The American Association of Colleges of Nursing defined specific EBP competencies in The Essentials of Baccalaureate Education for Professional Nursing Practice,2 The Essentials of Master’s Education in Nursing,3 and The Essentials of Doctoral Education for Advanced Nursing Practice.4 Across all 3 levels, www.npjournal.org
EBP competencies include clinical decision making, critical thinking, problem identification, and outcome measurement (Figure 1). The Essentials of Baccalaureate Education for Professional Nursing Practice2 Essential III outlined the competency of the baccalaureate, or baccalaureate equivalent, nursing student as the identification of pertinent practice issues, appraisal of the evidence surrounding practice issues, and evaluation of outcomes in essential. The Essentials of Master’s Education in Nursing3 expanded the EBP competencies of the baccalaureate level in Essential IV, translating and integrating scholarship into practice. Master’s-prepared nurses are expected to implement and evaluate change in the practice area. The Essentials of Doctoral Education for Advanced Nursing Practice4 identified Essentials I, Scientific Underpinnings for Practice; III, Clinical Scholarship and Analytical Methods for Evidence-Based Practice; and VIII, Advanced Nursing Practice as the competencies for the translation of science and knowledge into nursing practice. Achieving EBP competencies at each level of education enables nurses at all levels to participate in the provision of evidence-based health care that considers clinical expertise, patient values, and current research.5,6 The evolution of patient-centered The Journal for Nurse Practitioners - JNP
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Figure 1. Integration of EBP-related competencies into leveled nursing education.
care, continued emphasis on patient safety and outcomes, enhanced quality of life, and management of health care knowledge have precipitated the prominence of EBP in nursing education.4 The patient-centered care model stresses the role of the patient as a key decision maker and member of the health care team.7 Central to the nursing discipline, patient safety and outcomes are now receiving added attention through national initiatives.8 Finally, exponential growth in the body of knowledge in health care necessitated a systematic method of knowledge management for the delivery of targeted and optimal patient care.9 LEVELING THE EBP CURRICULUM MODEL
The concept of leveling in curriculum development describes moving learners from simple to complex knowledge in a specific area of study.10 Therefore, EBP competencies across nursing curricula help to ensure student engagement with EBP at the appropriate competency level. The transition of EBP learning goals from the baccalaureate to master of science in nursing (MSN) and DNP levels provides a blueprint for the development and advancement of student knowledge, skills, and attitudes. Emphasis on a cumulative trajectory represents the domains of psychomotor,11 affective,12 and cognitive stages at each program level.13 Students evolve through feelings and build knowledge and skills by transitioning through each domain essential for clinical decision making, critical thinking, problem identification, and outcomes measurement. e18
The Journal for Nurse Practitioners - JNP
At the baccalaureate level, students are introduced to EBP concepts to serve as the foundation for the EBP process. Students begin to identify the potential clinical questions as they become aware of current generalist nursing care problems. Using the EBP process to address practice issues, students are guided through the sequence of steps to review research and develop an EBP implementation plan. At the master’s level, students identify clinical inquiries using the Population/Patient Problem, Intervention, Comparison, Outcome, Time format. Students build confidence and develop proficiency assembling and applying best evidence to address advanced clinical practice problems. At the MSN level, application of the EBP process focuses on the value of change to the patient and the advanced practice registered nurse’s role in implementing practice change. The master’s level curriculum was designed to hone the skills of clinical decision making, critical thinking, problem identification, and measurement of outcomes to prepare students to transition to the DNP level. Students at the DNP level identify and solve clinically relevant practice and system problems through means of evaluation and synthesis of research, experience, and patient values. Identifying and solving complex clinical problems requires highly developed EBP competencies; at this level, competencies are extensively integrated into the curriculum and learning activities throughout the transition from the baccalaureate-prepared nurse to DNP nurse leader. PRACTICAL APPLICATION OF EBP EXPERIENCES ACROSS CURRICULAR LEVELS Baccalaureate Level
An introductory EBP course provides students a foundation for nursing research and the EBP process. Emphasis is placed on the integration of nursing science with clinical judgment and patient preferences for care. Students gain knowledge about the contributions of qualitative and quantitative research to clinical practice. Knowledge development and the interrelationship among theory, practice, and research are consistent themes discussed throughout lecture and class activities. Students identify clinical Volume 13, Issue 1, January 2017
Table 1. Baccalaureate Evidence-base Practice Learning Objectives, Learning Activities, and Evaluative Methods Learning Objectives Identify potential clinical questions from current nursing care. Recognize theoretical frameworks applied to nursing practice. Address research problems and quality improvement issues with the evidence based practice process. Review and define worth, merit, and application of published research. Describe influences on evidence-based practice implementation.
Learning Activities
Evaluative Methods
Team-based learning seminars Small group activities Identification of clinical problems Literature search Appraisal of the literature
Critical appraisal paper of research articles to evaluate worth, merit, and application Evidence-based practice implementation plan Group poster presentation: Population/Patient Problem, Intervention, Comparison, Outcome, Time question, recommendations for evidence-based practice change
problems, search scholarly literature for information related to those problems, and critically appraise the scholarly information for application to practice. The course culminates with the presentation of an evidence-based project addressing a selected clinical problem for the purposes of improving clinical outcomes. Table 1 provides sample learning objectives, activities, and evaluations to develop student competencies at the baccalaureate level. Master’s Level
Students enter the MSN curriculum prepared to evaluate the usefulness of nursing research and apply knowledge to professional nursing practice. Building on the foundations of baccalaureate nursing, the MSN curriculum provides advanced practice registered nurses with skills of critical thinking, creative reasoning, and critiquing science in relation to nursing practice.
Content and learning activities are designed to elevate student understanding of the relationships between theory, evidence, and practice. Students continue to explore the scientific and philosophical foundations of advanced nursing practice throughout the MSN curriculum. Evidence appraisal and knowledge translation skills are developed through critical thinking exercises, problem identification, and outcome measurement. Students examine the philosophy of nursing science and generation of ethical research. They develop a relevant clinical question in the Population/Patient Problem, Intervention, Comparison, Outcome, Time format and identify a primary concept of interest. Furthermore, they assemble primary research articles surrounding a phenomenon of interest, construct evidence tables, appraise the evidence, and write a synthesis of evidence paper. Students make recommendations for practice change
Table 2. Master’s-level Evidence-based Practice Learning Objectives, Learning Activities, and Evaluative Methods Learning Objectives Explain the relevance of meaningful clinical questions. Identify methods of knowledge development. Distinguish the levels in the hierarchy of evidence. Employ advanced search strategies and tools to obtain evidence. Evaluate the relationships between theory and practice. Describe the process of generating evidence.
www.npjournal.org
Learning Activities
Evaluative Methods
Readings Asynchronous lectures Small group seminars Discussion boards Literature search Evidence table construction Evidence appraisal
Paper: development of Population/Patient Problem, Intervention, Comparison, Outcome, Time question, recommendations for evidence-based practice change Discussion boards: philosophy of nursing science, data collection, and management Generating ethical research: role of the advanced practice registered nurse
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Table 3. Doctor of Nurse Practice (DNP)-Level Evidence-based Practice (EBP) Learning Objectives, Learning Activities, and Evaluative Method Learning Objectives
Learning Activities
Evaluative Methods
Readings, asynchronous lectures, faculty-facilitated seminars, peer learning and evaluation, discussion boards, and DNP practice hours facilitate the course specific activities
Construction of a concept map Paper: explain scholarly inquiry and analysis of the concept Discussion boards: knowledge translation, concept map evolution, theoretical and conceptual frameworks
CONSORT Checklist PRISMA Checklist AGREE tool CITI training modules
Independent paper and group memo of a(n) evaluation of a randomized controlled trial, meta-analysis critique, clinical practice guideline appraisal CITI training certification
Committee member choice Development of proposal introduction, problem statement, purpose, background, concepts, theoretical framework, or conceptual model
Project time line Proposal paper draft Demonstration of mastery DNP Essentials in a portfolio Project purpose and literature synthesis discussion board posts
Development of proposal methodology Proposal paper and presentation IRB application preparation
Project timeline Proposal paper Proposal slide presentation IRB application and submission
EBP I Explain how nursing philosophy generates fundamental questions. Identify sources of knowledge and levels of evidence. Describe methods of knowledge development. Explain gaps in the application of evidence to practice. Differentiate among deductive and inductive models of inquiry. Contrast the strengths and limitations of sources of knowledge. Examine the DNP role in the development and translation of clinical evidence. Analyze concepts related to a question relevant to practice. EBP II Review national databases to identify priority health issues. Examine evidence designed to improve clinical outcomes. Appraise qualitative and quantitative studies, systematic reviews, clinical practice guidelines related to topic of interest. Create strategies for dissemination of evidence-based practice into the health care environment. Explain integration of evidence-based individual decision making in the DNP role. EBP III Select project committee member(s). Select a practice problem. Collaborate with committee and course faculty to compose the project proposal. Critically evaluate and synthesize evidence. Explain concepts used in the project proposal. Apply a theory and/or conceptual framework to define the project variables. EBP IV Design a project methodology. Compose a written proposal. Defend the proposal. Create an application to the IRB.
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Volume 13, Issue 1, January 2017
Table 3. (continued ) Learning Objectives
Learning Activities
Evaluative Methods
Defend clinical scholarship and analytical methods for evidence-based practice.
Demonstration of mastery DNP Essentials in a portfolio Project methodology discussion board post
EBP V Implement the project. Evaluate and justify the project results. Disseminate the project in a written and oral presentation.
Project time line Project paper or journal article prepared for publication submission Project poster or slides presentation Demonstration of mastery DNP Essentials in a portfolio Project abstracts and visual presentation of results discussion board posts
Project implementation Outcomes measurement Data analysis Discussion synthesis Practice implications
AGREE ¼ appraisal of guidelines for research and evaluation; CITI ¼ collaborative institutional training initiative; CONSORT ¼ consolidated standards of reporting trials; IRB ¼ institutional review board; PRISMA ¼ preferred reporting items for systematic reviews and meta-analyses.
from appraisal of evidence demonstrating critical thinking skills, problem identification, and outcome measurement. After the completion of MSN coursework, graduates are equipped to appraise and translate evidence, leading to positive patient outcomes, and possess the foundation for a seamless transition to doctoral education. Table 2 identifies possible learning objectives, activities, and methods of evaluation to facilitate mastery of competencies related to the MSN Essentials. DNP Level
Students in a DNP program integrate scholarship and evidence into practice or system settings, measure outcomes, and disseminate scholarly products. Through literature reviews, evidence synthesis, exploration of the contextual influences of health care policy, finance, and ethics, students examine in-depth a phenomenon of interest. Through this process, students develop a DNP scholarly project, the hallmark of the practice doctorate. Sequential EBP courses in a DNP curriculum guide practice scholars to explore the generation of nursing knowledge with increasing attention to analytic methods and critical appraisal. The incremental sequence of courses provides students with mentored opportunities to apply clinical scholarship in the development of their DNP project proposal, www.npjournal.org
implementation, evaluation, and dissemination. Table 3 outlines a progressive sequence of learning objectives, activities, and evaluation methods to develop DNP students into practice scholars. OPPORTUNITIES AND CHALLENGES
The recommendation that the practice doctorate be the required graduate degree for advanced nursing practice is changing the landscape of nursing curricula.14 With the release of the white paper describing the importance of nursing schools offering a bachelors of science in nursing to DNP pathway,15 educators must examine curricula through the lens of seamless transition, with clear curricular distinctions to meet student needs and facilitate success. Evaluation of the effectiveness of students’ EBP competencies at each level of the nursing curriculum will ensure that nursing graduates are prepared to bridge the gap between evidence and clinical practice. CONCLUSION
Creating a seamless transition for the development of EBP competencies for nurses at each level of education requires thoughtful, strategically placed objectives and learning activities to be woven into the curriculum and courses. For this to occur, collaboration among faculty from each educational level, The Journal for Nurse Practitioners - JNP
e21
baccalaureate to DNP, must occur. Also, teachinglearning methods must be appropriate and engaging at each level. Finally, teaching-learning methods must challenge the student to apply and produce scholarly work for dissemination. References 1. Melnyk BM, Fineout-Overholt E. Nurses’ perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: Implications for accelerating the paradigm shift. Worldviews Evid Based Nurs. 2004;1(3):185-193. 2. The Essentials of Baccalaureate Education for Professional Nursing Practice. American Association of Colleges of Nursing. http://www.aacn.nche.edu/ education-resources/BaccEssentials08.pdf. Published October 20, 2008. Accessed May 17, 2016. 3. Essentials of Master’s Education in Nursing. American Association of Colleges of Nursing. http://www.aacn.nche.edu/education-resources/ MastersEssentials11.pdf. Published March 21, 2011. Accessed May 17, 2016. 4. The Essentials of Doctoral Education for Advanced Nursing Practice. American Association of Colleges of Nursing. http://www.aacn.nche.edu/ publications/position/DNP Essentials.pdf. Published October 2006. Accessed May 17, 2016. 5. DiCenso A, Guyatt G, Ciliska D. Evidence-based Nursing: A Guide to Clinical Practice. St Louis, MO: Mosby; 2005. 6. Porter-O’Grady T, Malloch K. Leadership in Nursing Practice. Burlington, MA: Jones & Bartlett; 2012. 7. Stewart M. Towards a global definition of patient centered care. BMJ. 2001;322(7284):444-445. http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC1119673/pdf/44 4.pdf. Accessed May 17, 2016. 8. Free from harm: accelerating patient safety improvement fifteen years after Err is to Human. National Patient Safety Foundation. http://www.aig.com/ content/dam/aig/ america-canada/us/documents/brochure/free-from-harm -final-report.pdf. Published 2015. Accessed May 17, 2016. 9. Kothari A, Hovanec N, Hastie R, Sibbald S. Lessons from the business sector for successful knowledge management in health care: a systematic review. BMC Health Serv Res. 2011;11:173. 10. Boland L. Developing curriculum: frameworks, outcomes, and competencies. In: Billings M, Halstead A, eds. Teaching in Nursing: A Guide for Faculty. 4th ed. St Louis, MO: Elsevier; 2012:138-159. 11. Simpson BJ. The classification of educational goals: psychomotor domain. Illinois J Home Econ. 1966;10(4):110-144.
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12. Krathwohl R, Bloom S, Masia B. Taxonomy of Educational Objectives, the Classification of Educational Goals. Handbook II: Affective Domain. New York, NY: David McKay Co, Inc; 1973. 13. Krathwohl DR. A revision of Bloom’s taxonomy: an overview. Theory Pract. 2002;41(4):221-218, http://www.unco.edu/cetl/sir/stating_outcome/ documents/ Krathwohl.pdf. Accessed May 17, 2016. 14. AACN position statement on the practice doctorate in nursing. American Association of Colleges of Nursing. http://www.aacn.nche.edu/publications/ position/DNP positionstatement.pdf. Published October 2004. Accessed May 17, 2016. 15. The doctor of nursing practice: current issues and clarifying recommendations report from the task force on the implementation of the DNP. American Association of Colleges of Nursing. http://www.aacn.nche .edu/aacn-publications/white-papers/DNP-Implementation-TF-Report-8-15 .pdf. Published August 2015. Accessed May 17, 2016.
All authors are affiliated with Vanderbilt University School of Nursing in Nashville, TN. Karen Hande, DNP, ANP-BC, is an assistant professor and DNP integrative application of evidence-based practice course series coordinator and can be reached at [email protected]. Christopher Ty Williams, DNP, ACNP-BC, FNP-BC, is an assistant professor and DNP faculty coordinator. Heather M. Robbins, DNP, RN, is an instructor. Betsy B. Kennedy, PhD, RN, is an associate professor and faculty development coordinator. Tom Christenbery, PhD, RN, is an associate professor and director of program evaluation. In compliance with national ethical guidelines, the author reports no relationships with business or industry that would pose a conflict of interest. 1555-4155/16/$ see front matter © 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2016.09.015
Volume 13, Issue 1, January 2017
Leveling Evidence-based Practice Across the Nursing Curriculum Karen Hande, DNP, ANP-BC, Christopher Ty Williams, DNP, ACNP-BC, FNP-BC, Heather M. Robbins, DNP, RN, Betsy B. Kennedy, PhD, RN, and Tom Christenbery, PhD, RN ABSTRACT
Evidence-based practice (EBP) competencies represent essential components of nursing education at all levels. The transition of EBP learning goals from the baccalaureate to the master of science in nursing and doctor of nursing practice levels provides a blueprint for the development and advancement of student knowledge, skills, and attitudes. The purpose of this article is to describe 3 nursing curricula related to EBP competencies at the baccalaureate, master’s, and doctor of nursing practice levels. Keywords: curricula, education, evidence-based practice, nursing Ó 2016 Elsevier Inc. All rights reserved.
T
he translation of knowledge into practice leads to improved patient outcomes. However, evidence-based practice (EBP) competencies vary among nurses.1 Developing EBP competencies according to the level of nursing education remains a challenge and warrants further exploration. Ensuring a seamless transition of EBP competencies across all levels of nursing curricula provides students the opportunity to develop their skills to critically evaluate, appraise, and apply nursing evidence as they advance their nursing education preparation. The purpose of this article is to describe strategies for student achievement of EBP competencies while progressing in baccalaureate, master’s, and doctor of nursing practice (DNP) levels of the nursing curriculum. BACKGROUND
The core knowledge and competencies for all levels of academic nursing degrees set the foundation for essential curricular elements and expected outcomes. The American Association of Colleges of Nursing defined specific EBP competencies in The Essentials of Baccalaureate Education for Professional Nursing Practice,2 The Essentials of Master’s Education in Nursing,3 and The Essentials of Doctoral Education for Advanced Nursing Practice.4 Across all 3 levels, www.npjournal.org
EBP competencies include clinical decision making, critical thinking, problem identification, and outcome measurement (Figure 1). The Essentials of Baccalaureate Education for Professional Nursing Practice2 Essential III outlined the competency of the baccalaureate, or baccalaureate equivalent, nursing student as the identification of pertinent practice issues, appraisal of the evidence surrounding practice issues, and evaluation of outcomes in essential. The Essentials of Master’s Education in Nursing3 expanded the EBP competencies of the baccalaureate level in Essential IV, translating and integrating scholarship into practice. Master’s-prepared nurses are expected to implement and evaluate change in the practice area. The Essentials of Doctoral Education for Advanced Nursing Practice4 identified Essentials I, Scientific Underpinnings for Practice; III, Clinical Scholarship and Analytical Methods for Evidence-Based Practice; and VIII, Advanced Nursing Practice as the competencies for the translation of science and knowledge into nursing practice. Achieving EBP competencies at each level of education enables nurses at all levels to participate in the provision of evidence-based health care that considers clinical expertise, patient values, and current research.5,6 The evolution of patient-centered The Journal for Nurse Practitioners - JNP
e17
Figure 1. Integration of EBP-related competencies into leveled nursing education.
care, continued emphasis on patient safety and outcomes, enhanced quality of life, and management of health care knowledge have precipitated the prominence of EBP in nursing education.4 The patient-centered care model stresses the role of the patient as a key decision maker and member of the health care team.7 Central to the nursing discipline, patient safety and outcomes are now receiving added attention through national initiatives.8 Finally, exponential growth in the body of knowledge in health care necessitated a systematic method of knowledge management for the delivery of targeted and optimal patient care.9 LEVELING THE EBP CURRICULUM MODEL
The concept of leveling in curriculum development describes moving learners from simple to complex knowledge in a specific area of study.10 Therefore, EBP competencies across nursing curricula help to ensure student engagement with EBP at the appropriate competency level. The transition of EBP learning goals from the baccalaureate to master of science in nursing (MSN) and DNP levels provides a blueprint for the development and advancement of student knowledge, skills, and attitudes. Emphasis on a cumulative trajectory represents the domains of psychomotor,11 affective,12 and cognitive stages at each program level.13 Students evolve through feelings and build knowledge and skills by transitioning through each domain essential for clinical decision making, critical thinking, problem identification, and outcomes measurement. e18
The Journal for Nurse Practitioners - JNP
At the baccalaureate level, students are introduced to EBP concepts to serve as the foundation for the EBP process. Students begin to identify the potential clinical questions as they become aware of current generalist nursing care problems. Using the EBP process to address practice issues, students are guided through the sequence of steps to review research and develop an EBP implementation plan. At the master’s level, students identify clinical inquiries using the Population/Patient Problem, Intervention, Comparison, Outcome, Time format. Students build confidence and develop proficiency assembling and applying best evidence to address advanced clinical practice problems. At the MSN level, application of the EBP process focuses on the value of change to the patient and the advanced practice registered nurse’s role in implementing practice change. The master’s level curriculum was designed to hone the skills of clinical decision making, critical thinking, problem identification, and measurement of outcomes to prepare students to transition to the DNP level. Students at the DNP level identify and solve clinically relevant practice and system problems through means of evaluation and synthesis of research, experience, and patient values. Identifying and solving complex clinical problems requires highly developed EBP competencies; at this level, competencies are extensively integrated into the curriculum and learning activities throughout the transition from the baccalaureate-prepared nurse to DNP nurse leader. PRACTICAL APPLICATION OF EBP EXPERIENCES ACROSS CURRICULAR LEVELS Baccalaureate Level
An introductory EBP course provides students a foundation for nursing research and the EBP process. Emphasis is placed on the integration of nursing science with clinical judgment and patient preferences for care. Students gain knowledge about the contributions of qualitative and quantitative research to clinical practice. Knowledge development and the interrelationship among theory, practice, and research are consistent themes discussed throughout lecture and class activities. Students identify clinical Volume 13, Issue 1, January 2017
Table 1. Baccalaureate Evidence-base Practice Learning Objectives, Learning Activities, and Evaluative Methods Learning Objectives Identify potential clinical questions from current nursing care. Recognize theoretical frameworks applied to nursing practice. Address research problems and quality improvement issues with the evidence based practice process. Review and define worth, merit, and application of published research. Describe influences on evidence-based practice implementation.
Learning Activities
Evaluative Methods
Team-based learning seminars Small group activities Identification of clinical problems Literature search Appraisal of the literature
Critical appraisal paper of research articles to evaluate worth, merit, and application Evidence-based practice implementation plan Group poster presentation: Population/Patient Problem, Intervention, Comparison, Outcome, Time question, recommendations for evidence-based practice change
problems, search scholarly literature for information related to those problems, and critically appraise the scholarly information for application to practice. The course culminates with the presentation of an evidence-based project addressing a selected clinical problem for the purposes of improving clinical outcomes. Table 1 provides sample learning objectives, activities, and evaluations to develop student competencies at the baccalaureate level. Master’s Level
Students enter the MSN curriculum prepared to evaluate the usefulness of nursing research and apply knowledge to professional nursing practice. Building on the foundations of baccalaureate nursing, the MSN curriculum provides advanced practice registered nurses with skills of critical thinking, creative reasoning, and critiquing science in relation to nursing practice.
Content and learning activities are designed to elevate student understanding of the relationships between theory, evidence, and practice. Students continue to explore the scientific and philosophical foundations of advanced nursing practice throughout the MSN curriculum. Evidence appraisal and knowledge translation skills are developed through critical thinking exercises, problem identification, and outcome measurement. Students examine the philosophy of nursing science and generation of ethical research. They develop a relevant clinical question in the Population/Patient Problem, Intervention, Comparison, Outcome, Time format and identify a primary concept of interest. Furthermore, they assemble primary research articles surrounding a phenomenon of interest, construct evidence tables, appraise the evidence, and write a synthesis of evidence paper. Students make recommendations for practice change
Table 2. Master’s-level Evidence-based Practice Learning Objectives, Learning Activities, and Evaluative Methods Learning Objectives Explain the relevance of meaningful clinical questions. Identify methods of knowledge development. Distinguish the levels in the hierarchy of evidence. Employ advanced search strategies and tools to obtain evidence. Evaluate the relationships between theory and practice. Describe the process of generating evidence.
www.npjournal.org
Learning Activities
Evaluative Methods
Readings Asynchronous lectures Small group seminars Discussion boards Literature search Evidence table construction Evidence appraisal
Paper: development of Population/Patient Problem, Intervention, Comparison, Outcome, Time question, recommendations for evidence-based practice change Discussion boards: philosophy of nursing science, data collection, and management Generating ethical research: role of the advanced practice registered nurse
The Journal for Nurse Practitioners - JNP
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Table 3. Doctor of Nurse Practice (DNP)-Level Evidence-based Practice (EBP) Learning Objectives, Learning Activities, and Evaluative Method Learning Objectives
Learning Activities
Evaluative Methods
Readings, asynchronous lectures, faculty-facilitated seminars, peer learning and evaluation, discussion boards, and DNP practice hours facilitate the course specific activities
Construction of a concept map Paper: explain scholarly inquiry and analysis of the concept Discussion boards: knowledge translation, concept map evolution, theoretical and conceptual frameworks
CONSORT Checklist PRISMA Checklist AGREE tool CITI training modules
Independent paper and group memo of a(n) evaluation of a randomized controlled trial, meta-analysis critique, clinical practice guideline appraisal CITI training certification
Committee member choice Development of proposal introduction, problem statement, purpose, background, concepts, theoretical framework, or conceptual model
Project time line Proposal paper draft Demonstration of mastery DNP Essentials in a portfolio Project purpose and literature synthesis discussion board posts
Development of proposal methodology Proposal paper and presentation IRB application preparation
Project timeline Proposal paper Proposal slide presentation IRB application and submission
EBP I Explain how nursing philosophy generates fundamental questions. Identify sources of knowledge and levels of evidence. Describe methods of knowledge development. Explain gaps in the application of evidence to practice. Differentiate among deductive and inductive models of inquiry. Contrast the strengths and limitations of sources of knowledge. Examine the DNP role in the development and translation of clinical evidence. Analyze concepts related to a question relevant to practice. EBP II Review national databases to identify priority health issues. Examine evidence designed to improve clinical outcomes. Appraise qualitative and quantitative studies, systematic reviews, clinical practice guidelines related to topic of interest. Create strategies for dissemination of evidence-based practice into the health care environment. Explain integration of evidence-based individual decision making in the DNP role. EBP III Select project committee member(s). Select a practice problem. Collaborate with committee and course faculty to compose the project proposal. Critically evaluate and synthesize evidence. Explain concepts used in the project proposal. Apply a theory and/or conceptual framework to define the project variables. EBP IV Design a project methodology. Compose a written proposal. Defend the proposal. Create an application to the IRB.
continued e20
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Volume 13, Issue 1, January 2017
Table 3. (continued ) Learning Objectives
Learning Activities
Evaluative Methods
Defend clinical scholarship and analytical methods for evidence-based practice.
Demonstration of mastery DNP Essentials in a portfolio Project methodology discussion board post
EBP V Implement the project. Evaluate and justify the project results. Disseminate the project in a written and oral presentation.
Project time line Project paper or journal article prepared for publication submission Project poster or slides presentation Demonstration of mastery DNP Essentials in a portfolio Project abstracts and visual presentation of results discussion board posts
Project implementation Outcomes measurement Data analysis Discussion synthesis Practice implications
AGREE ¼ appraisal of guidelines for research and evaluation; CITI ¼ collaborative institutional training initiative; CONSORT ¼ consolidated standards of reporting trials; IRB ¼ institutional review board; PRISMA ¼ preferred reporting items for systematic reviews and meta-analyses.
from appraisal of evidence demonstrating critical thinking skills, problem identification, and outcome measurement. After the completion of MSN coursework, graduates are equipped to appraise and translate evidence, leading to positive patient outcomes, and possess the foundation for a seamless transition to doctoral education. Table 2 identifies possible learning objectives, activities, and methods of evaluation to facilitate mastery of competencies related to the MSN Essentials. DNP Level
Students in a DNP program integrate scholarship and evidence into practice or system settings, measure outcomes, and disseminate scholarly products. Through literature reviews, evidence synthesis, exploration of the contextual influences of health care policy, finance, and ethics, students examine in-depth a phenomenon of interest. Through this process, students develop a DNP scholarly project, the hallmark of the practice doctorate. Sequential EBP courses in a DNP curriculum guide practice scholars to explore the generation of nursing knowledge with increasing attention to analytic methods and critical appraisal. The incremental sequence of courses provides students with mentored opportunities to apply clinical scholarship in the development of their DNP project proposal, www.npjournal.org
implementation, evaluation, and dissemination. Table 3 outlines a progressive sequence of learning objectives, activities, and evaluation methods to develop DNP students into practice scholars. OPPORTUNITIES AND CHALLENGES
The recommendation that the practice doctorate be the required graduate degree for advanced nursing practice is changing the landscape of nursing curricula.14 With the release of the white paper describing the importance of nursing schools offering a bachelors of science in nursing to DNP pathway,15 educators must examine curricula through the lens of seamless transition, with clear curricular distinctions to meet student needs and facilitate success. Evaluation of the effectiveness of students’ EBP competencies at each level of the nursing curriculum will ensure that nursing graduates are prepared to bridge the gap between evidence and clinical practice. CONCLUSION
Creating a seamless transition for the development of EBP competencies for nurses at each level of education requires thoughtful, strategically placed objectives and learning activities to be woven into the curriculum and courses. For this to occur, collaboration among faculty from each educational level, The Journal for Nurse Practitioners - JNP
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baccalaureate to DNP, must occur. Also, teachinglearning methods must be appropriate and engaging at each level. Finally, teaching-learning methods must challenge the student to apply and produce scholarly work for dissemination. References 1. Melnyk BM, Fineout-Overholt E. Nurses’ perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: Implications for accelerating the paradigm shift. Worldviews Evid Based Nurs. 2004;1(3):185-193. 2. The Essentials of Baccalaureate Education for Professional Nursing Practice. American Association of Colleges of Nursing. http://www.aacn.nche.edu/ education-resources/BaccEssentials08.pdf. Published October 20, 2008. Accessed May 17, 2016. 3. Essentials of Master’s Education in Nursing. American Association of Colleges of Nursing. http://www.aacn.nche.edu/education-resources/ MastersEssentials11.pdf. Published March 21, 2011. Accessed May 17, 2016. 4. The Essentials of Doctoral Education for Advanced Nursing Practice. American Association of Colleges of Nursing. http://www.aacn.nche.edu/ publications/position/DNP Essentials.pdf. Published October 2006. Accessed May 17, 2016. 5. DiCenso A, Guyatt G, Ciliska D. Evidence-based Nursing: A Guide to Clinical Practice. St Louis, MO: Mosby; 2005. 6. Porter-O’Grady T, Malloch K. Leadership in Nursing Practice. Burlington, MA: Jones & Bartlett; 2012. 7. Stewart M. Towards a global definition of patient centered care. BMJ. 2001;322(7284):444-445. http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC1119673/pdf/44 4.pdf. Accessed May 17, 2016. 8. Free from harm: accelerating patient safety improvement fifteen years after Err is to Human. National Patient Safety Foundation. http://www.aig.com/ content/dam/aig/ america-canada/us/documents/brochure/free-from-harm -final-report.pdf. Published 2015. Accessed May 17, 2016. 9. Kothari A, Hovanec N, Hastie R, Sibbald S. Lessons from the business sector for successful knowledge management in health care: a systematic review. BMC Health Serv Res. 2011;11:173. 10. Boland L. Developing curriculum: frameworks, outcomes, and competencies. In: Billings M, Halstead A, eds. Teaching in Nursing: A Guide for Faculty. 4th ed. St Louis, MO: Elsevier; 2012:138-159. 11. Simpson BJ. The classification of educational goals: psychomotor domain. Illinois J Home Econ. 1966;10(4):110-144.
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12. Krathwohl R, Bloom S, Masia B. Taxonomy of Educational Objectives, the Classification of Educational Goals. Handbook II: Affective Domain. New York, NY: David McKay Co, Inc; 1973. 13. Krathwohl DR. A revision of Bloom’s taxonomy: an overview. Theory Pract. 2002;41(4):221-218, http://www.unco.edu/cetl/sir/stating_outcome/ documents/ Krathwohl.pdf. Accessed May 17, 2016. 14. AACN position statement on the practice doctorate in nursing. American Association of Colleges of Nursing. http://www.aacn.nche.edu/publications/ position/DNP positionstatement.pdf. Published October 2004. Accessed May 17, 2016. 15. The doctor of nursing practice: current issues and clarifying recommendations report from the task force on the implementation of the DNP. American Association of Colleges of Nursing. http://www.aacn.nche .edu/aacn-publications/white-papers/DNP-Implementation-TF-Report-8-15 .pdf. Published August 2015. Accessed May 17, 2016.
All authors are affiliated with Vanderbilt University School of Nursing in Nashville, TN. Karen Hande, DNP, ANP-BC, is an assistant professor and DNP integrative application of evidence-based practice course series coordinator and can be reached at [email protected]. Christopher Ty Williams, DNP, ACNP-BC, FNP-BC, is an assistant professor and DNP faculty coordinator. Heather M. Robbins, DNP, RN, is an instructor. Betsy B. Kennedy, PhD, RN, is an associate professor and faculty development coordinator. Tom Christenbery, PhD, RN, is an associate professor and director of program evaluation. In compliance with national ethical guidelines, the author reports no relationships with business or industry that would pose a conflict of interest. 1555-4155/16/$ see front matter © 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2016.09.015
Volume 13, Issue 1, January 2017