A National Study Across Levels of Nursing Education: Can Nurses and Nursing Students Accurately Estimate Their Knowledge of Evidence-Based Practice?

AIM: This national study sought to: a) describe the evidence-based practice (EBP) knowledge levels of nursing students enrolled in baccalaureate through doctorate of nursing practice programs; b) examine relationships between objective and subjective EBP knowledge measures; c) describe correlations between educational and demographic factors and EBP knowledge; and d) further evaluate validity and reliability evidence for the Evidence-Based Practice Knowledge Assessment in Nursing. BACKGROUND: Rigorous evaluation of students' EBP knowledge across nursing program levels is vital to enhancing education and patient care. METHOD: A cross-sectional, correlational design using large-scale survey procedures was used in this study. RESULTS: Mean Evidence-Based Practice Knowledge Assessment in Nursing scores (N = 674 respondents from five universities in the United States) increased with greater levels of nursing education degree attainment. A weak, positive correlation was found between objective and subjective EBP knowledge measures (r = .13, p = .001). CONCLUSION: More research is needed to identify effective approaches to EBP education in nursing programs.

Gender Differences and Similarities in Accelerated Nursing Education Programs: Evidence of Success From the New Careers in Nursing Program.

AIM: The aim of the study was to examine the profile of male students in accelerated nursing education programs (ANEPs) focusing on key demographic, educational, and outcome variables and compare male and female students on these variables. BACKGROUND: Though ANEPs have proliferated over the last two decades, there has been little study of students enrolled in these programs and, consequently, the role ANEPs could play in enhancing nursing workforce diversity. METHOD: This study is a secondary analysis of data collected from 3,502 students who participated in the Robert Wood Johnson Foundation New Careers in Nursing Program from 2008 to 2016. RESULTS: ANEP completion and NCLEX-RN success rates were strong overall. Male and female ANEP students differed on several dimensions often associated with academic success, differences that have relevance for purposes of teaching, research, and program planning. CONCLUSION: ANEPs could be an effective mechanism for increasing the gender, racial, and ethnic diversity of the nursing workforce.

A Global Approach to Promoting Evidence-Based Practice Knowledge: Validating the Translated Version of the Evidence-Based Practice Knowledge Assessment in Nursing Into Spanish.

BACKGROUND: Government and professional organizations have issued a call for evidence-based practice (EBP), prompting the development of competencies and expectations for knowledge, skills, and attitudes. However, EBP is still inconsistently implemented. To advance the science of nursing globally, educators and leaders need to use consistent, rigorous evaluation methods to assess the EBP knowledge of students and clinicians. AIMS: This study sought to translate the Evidence-based Practice Knowledge Assessment in Nursing (EKAN) instrument into Spanish, evaluate the psychometric performance of the newly translated instrument, and establish a baseline measure of EBP knowledge of baccalaureate nursing (BSN) students for future program improvement. METHODS: This study utilized a cross-sectional, descriptive, correlational design. A total of 139 BSN students were recruited from a single study site in the Dominican Republic. Subjects completed the 20-item EKAN-Spanish, which was translated and back-translated to promote semantic accuracy. RESULTS AND FINDINGS: Infit and outfit statistics for the sample centered around 1.0 (weighted mean square = 0.978; unweighted mean square = 0.988), indicating strong evidence of validity. The individual items on the EKAN-Spanish showed item reliability of 0.94. The mean EBP knowledge score was 6.52 (SD = 2.03) with scores ranging from 2 to 12 points (20 points maximum). Differential item functioning (DIF) analysis supported translational accuracy. DISCUSSION: This study provides validation support for an objective assessment of EBP knowledge in the Spanish language and will be useful for future studies of EBP in over 21 Spanish-speaking countries. LINKING EVIDENCE TO ACTION: While EBP is a global nursing concept, there has been no instrument to objectively measure EBP knowledge across levels of education in academe and practice in Spanish-speaking countries until just recently. The availability of a validated instrument will promote global consistency in assessing EBP knowledge. Further, this will promote a collaborative approach in teaching EBP to nursing students and practicing nurses.

Capnography (ETCO2), respiratory depression, and nursing interventions in moderately sedated adults undergoing transesophageal echocardiography (TEE).

PURPOSE: Little attention has been paid to the safety of moderate sedation given to adult patients undergoing transesophageal echocardiography (TEE). Although capnography has been found to indicate respiratory depression earlier than pulse oximetry in other sedation scenarios, its usefulness during TEE has not been clearly documented. DESIGN: A prospective, single-group, observational design was used. METHODS: A total of 200 adult patients undergoing TEE with moderate sedation were studied. Patient demographic and procedural physiologic variables, types and doses of sedating medications administered, incidence of respiratory depression, and types and effectiveness of nursing interventions delivered when subjects experienced respiratory depression were examined. FINDING: Respiratory depression identified by capnography occurred in 45% of the subjects. Capnography provided earlier identification of respiratory depression than pulse oximetry. Hydromorphone was associated with respiratory depression more so than other agents; whereas nursing interventions were effective in preventing more serious cardiorespiratory compromise. CONCLUSIONS: Capnography, as a tool to provide early warning of respiratory depression or airway compromise, has the potential to further decrease the incidence of serious adverse events due to inadvertent oversedation.

A systematic review of the effectiveness of remediation interventions to improve NCLEX-RN pass rates.

First-time NCLEX-RN pass rates are important measures of educational quality in prelicensure nursing education programs. Licensure pass rate problems has been the subject of countless nursing education articles and studies over the past several decades. To improve NCLEX-RN pass rates, remediation is often prescribed for students who have academic performance deficits. This article presents a systematic review of studies on remediation interventions and their effects on NCLEX-RN pass rates. Most studies of remediation and its effects on licensure pass rates are descriptive program evaluation reports. The overall quality of studies included in this review is uneven but generally low. Nursing education researchers should focus on conducting higher quality intervention studies in which the fidelity of remediation interventions can be examined. Viewing licensure pass rates from a process improvement perspective and accounting for pass rate variations could also change the nature of scholarship on this topic.

Scholarship During a Pandemic: Secondary Data Analysis.

The COVID-19 pandemic has disrupted nearly every aspect of life in the United States and around the globe, including significant impacts to higher education, both in its teaching-learning and research missions. With the physical closure of so many college and university campuses, a looming challenge is how nurse researchers can continue to generate new knowledge during a temporary but extended period of social distancing where conducting research requiring physical interaction with participants is impossible. In this Methodology Corner installment, a brief overview of secondary data analysis is provided, and resources for locating potentially useful data are described. Although secondary data analysis will not replace the dominant approaches used in nursing education research, current circumstances require it to take a much more prominent place in the toolbox of nursing education researchers. [J Nurs Educ. 2020;59(5):245-247.].

Defining Practical Significance Is Hard, But We Should Do It Anyway.

Although it was decades in the making, the urgency to move beyond simplistic rules for interpreting p values is quickly increasing. While p values may never completely disappear from our quantitative analysis tool box, the need to actively consider the practical significance of our statistical findings increases each day. In this Methodology Corner article, the concept of practical significance is reviewed and compared to our evolving concept of statistical significance. Examples of how practical significance can be examined and communicated are provided to stimulate further thinking on this issue. [J Nurs Educ. 2019;58(11):623-626.].

Searching the Literature in Preparation for Research: Strategies That Matter.

Literature searches conducted in preparation for a study differ in both purpose and scope from the literature searches conducted to locate evidence relevant to specific, narrowly defined clinical or educational practice questions. In this Methodology Corner installment, several important considerations are reviewed, including the importance of understanding the scope and coverage of literature databases, the utility of database search fields and controlled vocabularies, search limiters and expanders, and the possible unintended consequences of limiting searches based on the availability of full-text resources. Examples are provided throughout to help nursing education researchers conduct more effective and efficient literature searches. [J Nurs Educ. 2019;58(8):441-443.].

A Guide to Guidelines for Nursing Education Researchers.

This installment of the Methodology Corner discusses the important role of research and quality improvement project reporting guidelines in the development of a field's evidence base. Several prominent guidelines, all with relevance to nursing education researchers, are described. Research and quality improvement reporting guidelines can be useful to researchers and quality improvement leaders long before the dissemination stage of a project and should be consulted from the earliest stages of a project. Consulting these guidelines earlier, rather than later, can increase the likelihood that studies and quality improvement reports will contribute meaningfully to the literature to which nurse educators look when making evidence-informed decisions. [J Nurs Educ. 2019;58(2):69-71.].

When "Little Is Known" Is Not Entirely True.

Research in nursing education often involves addressing problems and topics of interest to scholars from numerous fields outside of nursing-and to nurse educators from around the globe. Although it is sometimes true that little is known about a given topic of interest to nursing education researchers, often more is known about the topic if researchers consider evidence with extradisciplinary and international origins. In this Methodology Corner article, a framework for evaluating the applicability and transferability of study findings is presented alongside examples of how the framework can be operationalized to expand the evidence base from which nursing education researchers can draw when designing studies of their own. [J Nurs Educ. 2019;58(5):257-259.].

Accuracy and completeness are required: A response to Dreher et al (2019).

The authors of this response outline numerous factual errors and mischaracterizations about their prior work made by Dreher et al (2019). The authors reaffirm their original findings and conclusions and further argue that substantial empirical evidence not reviewed by Dreher et al (2019) support the conclusions reached by Spurlock and Hunt (2008) and Phelan (2012).

A study of the usefulness of the HESI Exit Exam in predicting NCLEX-RN failure.

Schools of nursing across the country are implementing progression policies that prohibit students from graduating or from taking the nursing licensure examination, sometimes based solely on a single predictive test score. In addition, little empirical evidence exists that supports progression policies as effective in increasing a school's NCLEX-RN pass rates. This article reports on a study conducted when one school did not achieve the results they expected after implementing a progression policy. With use of logistic regression, diagnostic indexes, and other methods, reasons for the disparity between expected and observed NCLEX-RN pass rates were examined. Results revealed that the Health Education Systems, Inc. (HESI) Exit Exam was not able to accurately predict NCLEX-RN outcomes for graduates and, further, that progression policies that allow retest after retest so as to achieve a minimum score on the HESI Exit Exam are not supported empirically. Conclusions and suggestions for schools using or considering progression policies are provided.

What's in a Name? Revisiting Pilot Studies in Nursing Education Research.

Pilot studies are a commonly described type of study in the nursing education literature. Although nursing education researchers continue to label small, single-site, hypothesis-driven studies as pilot studies, the consensus in other fields as to what constitutes a pilot study has changed over time to focus more narrowly on issues of feasibility and acceptability of study interventions and interactions. Nursing education researchers are encouraged to adopt more modern definitions of pilot studies that substantially reduce (or eliminate) the focus on inferential statistical testing while increasing the focus on practical and procedural aspects of study design and implementation. This article highlights the historical evolution of the term pilot study and provides researchers with suggestions about the purpose and focus of pilot studies that support development of the science of nursing education. [J Nurs Educ. 2018;57(8):457-459.].

The Single-Group, Pre- and Posttest Design in Nursing Education Research: It's Time to Move on.

Studying the effectiveness of educational interventions is centrally important to building the science of nursing education. Yet, the design most commonly used in the study of nursing education interventions-the single-group, preand posttest design-provides limited evidence to support claims of intervention effectiveness. In this Methodology Corner installment, the limitations of the single-group, preand posttest design are outlined and a review of the requirements for establishing stronger arguments for causality is presented. To overcome the limitations of single-group, preand posttest designs, nursing education researchers are encouraged to employ study designs and procedures that can significantly strengthen researchers' claims of intervention effectiveness. [J Nurs Educ. 2018;57(2):69-71.].

Statistical Power in Nursing Education Research.

Nursing researchers have been encouraged for decades to address the validity of their statistical conclusions in part by accumulating evidence from studies that are capable of correctly identifying relationships between variables when those relationships are truly present. However, it has been noted that only a fraction of nursing studies appear to have undertaken power analyses to help mitigate the risk of Type II statistical conclusion errors. This Methodology Corner article reviews some of the major aspects of power analysis procedures and reiterates recommendations that researchers who plan to use inferential statistical analyses also conduct a power analysis to guide decision making about target sample sizes to increase the validity of study findings. [J Nurs Educ. 2018;57(5):262-264.].

Beyond p < .05: Toward a Nightingalean Perspective on Statistical Significance for Nursing Education Researchers.

During the past decade, substantial concern has developed among scholars from a variety of disciplines about the common use and interpretation of p-values, used to indicate the statistical significance of inferential statistical analyses reported in quantitative studies. These debates have highlighted a widespread misunderstanding of p-values and the more limited role they should take in informing study conclusions and policy decisions. In this month's "Methodology Corner," I provide an overview of this debate, describe the limitations of statistical significance testing, and suggest that the nursing education research enterprise would benefit from following a more Nightingalean approach to statistical analysis, where the practical importance-the meaningfulness-of study findings is emphasized. [J Nurs Educ. 2017;56(8):453-455.].

The Purpose and Power of Reporting Effect Sizes in Nursing Education Research.

Like many other fields and subfields within the social sciences, education, and medicine, nursing education research has a long history of giving p-values associated with common statistical tests a position of primary importance in interpreting study findings. Global, transdisciplinary efforts are underway to diminish the role p-values play in making judgements about the significance of study findings by changing the threshold p-value used to pronounce statistical significance, through the use of Bayesian statistics, and through efforts to report effect sizes alongside p-values. In this month's Methodology Corner installment, the focus is on effect sizes and their role in enhancing the value and utility of nursing education research studies. [J Nurs Educ. 2017;56(11):645-647.].

Measurement Matters: Improving Measurement Practices in Nursing Education Research.

Measurement is a fundamental but often overlooked component of research design and scientific inquiry. In quantitative study designs, the data that are collected, the statistical analyses conducted, and the conclusions drawn from those analyses all hinge on the validity, reliability, and appropriateness of measurements taken during the investigation. Missteps in the measurement process can undermine the validity of a study's findings and in doing so, efforts to advance the science of nursing education will fall short. This month's Methodology Corner article highlights several important measurement-related considerations for nursing education researchers seeking to build the evidence base-the body of knowledge about nursing education-on which instructional, curricular, policy, and planning decisions are made. [J Nurs Educ. 2017;56(5):257-259.].

Accelerating Multisite Research in Nursing Education: Navigating Institutional Review Board Regulatory Issues.

Researchers investigating phenomena in nursing education are increasingly striving to conduct multisite studies. However, designing and managing multisite studies can be costly and time consuming. One complex and costly challenge of multisite studies can be anticipating and navigating the variations in the institutional review board requirements and expectations of different study sites. This article explores issues and regulations around protection of human subjects in multisite studies using the authors' experiences launching the 2016 National Nursing Education Research Network surveys as an exemplar. [J Nurs Educ. 2017;56(2):65-68.].