Health SA Gesondheid

ISSN: (Online) 2071-9736, (Print) 1025-9848

Page 1 of 9 Original Research

The experiences of nurse educators in implementing

evidence-based practice in teaching and learning

Authors: Background: Nurse educators have a vital role to mentor student nurses in relation to
Gloria N. Mthiyane
developing evidence-based practice (EBP) skills, accessing research products and
Debbie S. Habedi
participating in research projects. This requires more innovative teaching approaches that
Affiliation: promote active participation, creativity and critical thinking in students such as online
1
Department of Health teaching and learning, accessing electronic resources, video conferencing and research-
Studies, University of South
based teaching and learning.
Africa, South Africa
Aim: To determine the nurse educators’ experiences in implementing EBP in teaching and
Corresponding author:
Debbie Habedi learning, and to describe the importance and benefits of EBP teaching and learning to the
[email protected] nursing profession, especially for nurse educators and student nurses.

Dates: Setting: Two chosen campuses from Umgungundlovu Health District under the KwaZulu-
Received: 26 Apr. 2018 Natal College of Nursing (KZNCN) and offering a 4-year R425 training programme.
Accepted: 03 Sept. 2018
Published: 29 Nov. 2018 Methods: Qualitative research design and methods were followed in conducting the study. A
non-probability purposive sampling technique was used to access the sample of 12 nurse
How to cite this article: educators. Data were collected using semi-structured interviews, the interview guide, and the
Mthiyane, G.N. & Habedi,
D.S., 2018, ‘The experiences digital voice recorder.
of nurse educators in
Results: Data were analysed manually, following a content thematic approach and two themes
implementing evidence-
based practice in teaching emerged as challenges experienced by nurse educators with the implementation of EBP in
and learning’, Health SA teaching and learning and benefits and value of EBP in teaching and learning. Findings
Gesondheid 23(0), a1177. revealed that, although most of the nurse educators are supportive and displayed a positive
https://doi.org/10.4102/
attitude towards implementing EBP in teaching and learning, the level of knowledge and
hsag.v23i0.1177
skills was questionable. This was coupled with a lack of motivation and commitment towards
Copyright: research.
© 2018. The Authors.
Licensee: AOSIS. This work Conclusions: Evidence-based practice has an essential potential role to play through
is licensed under the incorporating more practice-based evidence of nurse educators in teaching and learning
Creative Commons implementation. The nurse educators should use EBP to ensure that student nurses receive
Attribution License.
high-quality nursing education.

Introduction
Evidenced-based practice (EBP) is described by Melnyk et al. (2012:410) as a problem-solving
approach to clinical decision-making in health care. Evidence-based practice integrates the best
evidence from well-designed studies with the clinicians’ expertise, including internal evidence
from patient assessments and practice data, and patients’ preferences and values. Melnyk et al.
(2012:410) further revealed that implementation of EBP leads to a higher quality of care, improved
patient outcomes, and decreased health care costs.

Evidence-based practice teaching and learning has become an important function for nursing
education. Research is used as an instrument in developing new teaching and learning strategies.
Nurse educators are guided by evidence-based practice in teaching and on research reports.
Evidence-based practice in learning is also based on research, meaning that students learn by
using research findings. Research-based teaching and learning encourages and stimulates critical
thinking for students (Felicilda-Reynaldo & Utley 2015:91).

Read online: Although EBP is known to improve health care quality, decreasing costs and empowering nurses,
Scan this QR the challenge is the way in which it ensures successful implementation by the nurses (Levin et al.
code with your
smart phone or 2011:21). The implementation of successful EBP education serves the function of developing
mobile device practitioners who value EBP and have the knowledge and skills to implement such practice
to read online.
(Lehane et al. 2017:8).

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 Page 2 of 9 Original Research

Background the importance and benefits of EBP in teaching and learning

in the nursing profession, especially for nurse educators and
Nurse educators play a key role in creation of opportunities for student nurses.
implementing EBP and in facilitating the implementation
process. The question now is how to foster implementation of
EBP. The most important factor that is likely to help nurses and
Questions
nurse educators to adopt EBP is the provision of adequate • What are the experiences of nurse educators regarding
training in EBP (Heikkila et al. 2017:3). The importance of implementation of EBP in teaching and learning?
embedding EBP in nurse education programmes cannot be • What recommendations may be made for nurse educators
underestimated if EBP and its positive patient outcomes are to to implement EBP in teaching and learning?
be realised in health care settings. According to Felicilda-
Reynaldo and Utley (2015:93), one nurse educator noted that
‘nurse graduates will be prepared to facilitate a transformation
Design and methods
of the health care system culture by implementing practice Design
review and revision consistent with evidence-based nursing A qualitative, explorative, descriptive research design, using
(EBN) research’. The above-mentioned statement highlights non-probability purposive sampling, focusing on
the importance of incorporating EBP throughout the understanding the social settings, facilitating the exploration
curriculum to prepare students for future success in using EBP of relationships and human experience within the research
in their professional nursing practice (Felicilda-Reynaldo & setting was followed. It also enabled face-to-face, personal
Utley 2015:93). Mackey and Bassendowski (2016:54) indicated contact in data collection (Moule & Goodman 2014:175).
that utilising nursing best practice guidelines, reviewing and Participants selected and interviewed were individuals who
implementing applicable research evidence, and taking were more knowledgeable about the phenomenon and
advantage of technological advances are ways in which qualified enough to answer the question at hand.
nursing can move forward as a well-informed discipline.

Malik, McKenna and Griffiths (2015a:158) in Australia Population

reported that integrating EBP into undergraduate nursing The total target population was 62 nurse educators in June
education and preparing future nurses to embrace EBP into 2017.The sample comprised 12 nurse educators in possession
clinical practice becomes crucial in today’s complex and of a nursing education qualification, registered by South
evolving health care environment. The study further implies African Nursing Council (SANC) as nurse educators and
that the role that EBP plays in the practical lives of student employed by the KwaZulu-Natal Department of Health. The
nurses will depend on the degree to which it is promoted by focus of the study was on nurse educators involved in
academics; the extent to which it is incorporated in course classroom teaching at the two chosen campuses from
objectives, content and assessments; and its application within Umgungundlovu Health District under the KwaZulu-Natal
the clinical setting (Malik et al. 2015a:158). In this way, nurses’ College of Nursing (KZNCN) and offering a 4-year R425
willingness to carry out research projects, as well as to utilise training programme.
the research findings effectively in practice is enhanced.
Sampling method
Traditional teaching methods and learning styles still
dominate in nursing education and these strategies do not The sampling process followed the non-probability method
encourage critical thinking among the nursing students; using a purposive sampling technique to select the
therefore, these methods will not prepare student nurses to participants. This type of sampling assisted the researcher
make sound clinical judgements in practice (Subhan 2014:35). to select those homogeneous participants who knew most
With the nursing profession experiencing many changes on about the phenomenon under study (Brink, Van der Walt &
contemporary issues, nursing students need to be prepared Van Rensburg 2012:139). All nurse educators who met the
for these challenges. Using EBP as one of the teaching and inclusion criteria were requested to volunteer for
learning strategies will qualify student nurses to become participation in the study. Clinical nurse educators were
excellent critical thinkers and solve problems in the clinical excluded from the study. The sample size was 12
area. However, EBP remains a relatively new concept to participants and was based on collecting detailed data to
nursing, and there is limited literature available addressing address the research questions, objectives, and the purpose
the incorporation of EBP into nursing curricula, especially at of the study.
the undergraduate level (Malik et al. 2015a:158). In South
Africa, there is a dearth of literature in the implementation of Data collection
EBP in nursing education.
Data were collected in June 2017 using semi-structured
interviews, interview guide and the digital voice recorder. To
Purpose ensure anonymity, code numbers were allocated to each
To determine the experiences of nurse educators in participant. The researcher kept all collected and private
implementing EBP in teaching and learning, and to describe information shared safely locked and/or encrypted in the

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 Page 3 of 9 Original Research

researchers’ computer for 5 years. Participants were informed Ethical considerations

of the presence of the research assistant during the interview
Ethics approval certificate (reference number HSHDC/​
process and all participants granted the researcher permission
537/2016) was obtained from the Research Ethics Committee
to record interviews.
of the Department of Health Studies, University of South
Africa (UNISA). Permission to conduct the study was granted
Semi-structured individual interviews were conducted using by the KwaZulu-Natal Department of Health, KwaZulu-
the self-developed interview guide and digital voice recorder Natal College of Nursing, and both principals of the colleges.
as data-collection instruments. The interview guide was Participants were informed about the study and that their
developed in English based on the research purpose, research participation was voluntary and they were advised of their
objectives, research questions and literature review. It rights to withdraw at any time. All participants signed
comprised predetermined open-ended questions to get in- informed consent forms, their responses were kept
depth information about participants’ experiences and was confidential and anonymous and their identities were not
pre-tested before conducting the main study to determine the divulged or disclosed during reporting of the findings.
feasibility of the instrument. All interviews were captured on
the digital voice recorder with the help of the research
assistant who had training in doing qualitative interviews
Biographical data of the participants
prior to data collection. Participants were from three race groups: African, Indian and
Coloured.1 They were all women. Their years of experience
ranged between 5 and 30 years, occupying the ranks of junior
Data analysis nurse educator, senior nurse educator and Head of
Data were analysed manually following a content thematic Department. The highest qualifications were a Bachelor’s,
analysis approach which involved a thorough review of all Honour’s or Master’s degree in Health and Nursing Science
recorded information that the researcher obtained during Studies as indicated in Table 1.
data collection (Brink et al. 2012:194). The researcher listened
to recorded interviews repeatedly. All recorded data were
transcribed into written format. Transcriptions were read
Themes, categories and findings
thoroughly and repeatedly; common themes and categories The following themes and categories emerged during data
of information were identified and grouped together. analysis and are summarised in Table 2.
Electronic files for each theme were created and labelled,
allowing for ease of access and management of data. Theme 1: Challenges with implementation of
Discussion and interpretation of the findings commenced evidence-based practice in teaching and learning
thereafter. The findings revealed that nurse educators are experiencing
certain challenges with the implementation of EBP in
Trustworthiness
TABLE 1: Demographic information of the sample.
Strategies employed to ensure the quality of data included Criterion Frequency Percentage
the following measures of trustworthiness as suggested by Position
 Junior 5 41.6
Lincoln and Guba’s framework (Polit & Beck 2017:560).  Senior 5 41.6
 Head of department 2 16.6
Work experience
Credibility: Data were collected through face-to-face  0–5 years 1 8.3
interviews, directly from the participants using a digital  5–10 years 4 33.3
 Above 10 years 7 58.3
voice recorder and they were given a chance to confirm data Highest qualification
before the final written report. Participants were provided  Bachelor’s degree 4 33.0
 Honour’s degree 2 1.0
with the opportunity to review the researchers’ interpretation  Master’s degree 6 50.0
 Doctoral degree 0 0.0
of data.  Professorship 0 0.0

Transferability: Sufficient description and interpretation of TABLE 2: Themes and categories.

data was supported by the relevant literature so that it can be Themes Categories
easily transferrable and applicable to other settings. Theme 1: Challenges with 1.1. Time constraints
implementation of EBP 1.2. Lack of and poor access to relevant resources
teaching and learning 1.3. Current teaching approaches
To ensure dependability, the researcher ensured that data 1.4. Lack of knowledge and skills by nurse educators
1.5. Student characteristics
collected remained stable over a period of time; meaning that
Theme 2: Benefits and/or 2.1 Keeping up to date with current information
information related to data collected would remain values of EBP in teaching and 2.2 Preparing student nurses to engage in EBP
learning 2.3 Improving quality care for patients
unchanged over time. Therefore, data were collected using 2.4 Reducing health care delivery costs
the digital voice recorder with a memory card and all other EBP, evidence-based practice.
information were properly stored and kept safely.
1.The author understands and acknowledges the sensitivity of the terms used and
The use of actual quotations from the participants in the prefers to use as classified according to the Republic of South Africa’s Government
Application Form for Employment in order to avoid misinterpretation of the study
discussion of the report supports the confirmability of data. results.

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 Page 4 of 9 Original Research

teaching and learning. They include time constraints, components and also allocate time for self-directed learning so
lack of and poor access to relevant resources, the use of that it comes in as part of the curriculum, like a prescribed kind
traditional teaching approaches which are still dominant, of thing, like for example saying that the students must have so
nurse educators’ lack of or poor knowledge and skills, and many assignments, must have so much library time.’ (Participant
3, Senior, 50 years old)
the quality of nursing students. Emmanuel et al. (2011:22) in
their study on developing EBP among student nurses in the
A study conducted by Malik et al. (2015b:50) on nurse
United Kingdom identified similar challenges that prevented
educators and clinical nurse coaches and specialists regarding
the nurses from successfully using EBP, which included poor
their perceived knowledge, skills, attitudes and contextual
access to facilities and information, lack of experience and
factors affecting EBP, revealed that insufficient time prevented
little confidence in using computers.
appraisal of literature on a regular basis and the searching of
research reports. There is no time to find and read research
Schoonees, Rohwer and Young (2017:11) reported that the
articles. Again, in circumstances where shortages of staff
challenges experienced by lecturers at a sub-Saharan African
exist, allowing staff adequate time to complete the requisite
academic institution were a lack of time by the programme to
reading to update their clinical or EBP knowledge or to
dedicate to evidence-based health care, lack of evidence
attend continuing nursing education is not always possible
related to a specific field, lack of student motivation and the
(Boswell & Cannon 2017:20).
students’ schooling background.

Category 1.1: Time constraints Category 1.2: Lack of and poor access to relevant resources
It is clear that for the nurse educators to implement EBP in
This study indicated that, for the nurse educators to
teaching and learning, special resources must be available
successfully implement EBP in teaching and learning, more
time is required in the library to search for information, for and accessible to both nurse educators and student nurses for
reading the literature, and for preparation and presentation successful implementation. Evidence is available in various
of the content. This applied to both the nurse educators and forms, such as books, videos, journals, and articles. Access to
student nurses. This statement is supported in the study evidence comes through the libraries, computer laboratories
conducted by Emmanuel et al. (2011:22), which indicated that with Internet access and mobile technology.
the use of EBP by the professionals requires accessing and
integrating a number of different resources which could be Participants responded this way when asked about their
time consuming. Lack of time was also mentioned as a major resources:
barrier when trying to access and review any of the evidence ‘For instance, if you look at the in-house, what you need to
(Emmanuel et al. 2011:22). make your teaching learning process smarter, is sometimes not
available.’ (Participant 11, Senior, 48 years old)
Nurse educators indicated that time is not allocated or ‘It could be available but you cannot access it easily.’
distributed fairly between library, theory and practice. The (Participant 8, Junior, 53 years old)
prescribed time in the curriculum does not provide sufficient ‘No not easily especially with the IT, we are limited for resources;
time for students to visit the library to search for information. I would have to go to the library to use it.’ (Participant 10, Senior,
The location of the library also contributed to time limits, 59 years old)
neither campus under study having a library on site. On ‘Eh I don’t think especially with our college, I do not think that
one campus, the library is 8 km away from the campus. At we do not, I mean we have enough resources, like for instance
the other campus, the library is within the hospital premises we need to have enough resources, the most recent textbooks
and not on the campus. These are both medical libraries, you know, even the library should make sure that it is well
which means that they are accessed by all hospital staff. The equipped with most recent textbooks, we have the computers
following statements were reported by the participants so that they have access to the internet which is the problem that
with regard to time allocation, prescribed time, and we are experiencing that we don’t have with our campus.’
preparation time: (Participant 4, HOD, 56 years old)

‘Yes, yes, the students have library, the problem that we

encounter when they are in block is that they do not have enough Hussein and Hussein (2014:870) agree with the statements
time to go to the library because the libraries are not situated in above in their study conducted in Egypt. Nursing education
the facilities, like colleges they must go out and find information must be committed to the principles of EBP and critical
that is our challenge for now.’ (Participant 1, Junior, 40 years old) thinking. Such education must provide resources and create a
‘So, you find that even the time that is allocated for library the supportive environment for the implementation of EBP in
moment they walk out to go to the library, you find that library teaching and learning. The fundamentals of teaching student
is in use full of doctors then that is a challenge and you find that nurses must be based on the best available evidence to recognise
now when they come back they are somehow late for classes so and deliver high-quality patient care (Emmanuel et al. 2011:21).
that is a challenge.’ (Participant 2, Junior, 42 years old)
‘Maybe we can move from what we have already, because you Insufficient financial resources as well as journals, reports
know generally there is allocated time for clinical exposure, and computers for making EBP a reality in theoretical and
allocated time for theory. Maybe we can look at both these clinical teaching could affect negatively the nurse educators’

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 Page 5 of 9 Original Research

ability to access evidence from various sources. It has been like more workshops on evidence-based and the importance of
discovered that when nurses are provided with the necessary using evidence-based, which is the challenge at the present
tools such as smart phones and computers inter alia, they are moment because it is not everybody that is well tuned with
much more likely to access relevant information and best evidence-based that is the challenge.’ (Participant 4, HOD,
56 years old)
practice guidelines (Mackey & Bassendowski 2016:53).
‘Research is very good, it is good and as much as this off the topic
you know we hate research, nurses hate research but I think they
Category 1.3: Current teaching approaches
should be encouraged so we have more EBP and you know
The study revealed that, currently, traditional teaching encourage the students.’ (Participant 6, Senior, 56 years old)
approaches are still dominant in nursing education. The
participants identified the following current teaching Although various studies indicate that nurse educators have
strategies used for teaching and learning: facilitation, group
a positive attitude towards EBP, it has been reported that a
discussion, simulation, assignments, role play, case study,
positive attitude is increased with advanced educational
clinical debates, lecture, self-activities, demonstrations, peer
level, higher academic ranking, years of experience, and a
group teaching, problem-solving, group presentations,
teaching and research role (Hussein & Hussein 2013:609).
games, case-based research, videos, reflective journals,
Therefore, findings suggest that continuing education for
portfolio of evidence, and learning package. Most of these
nurse educators on the EBP process is necessary to enhance
approaches lead to technical skills mastery but they do not
their knowledge and skills in acquiring appropriate research
stimulate the development of critical-thinking skills, as one
and analytic skills relevant to their teaching specialties
participant stated that:
(Hussein & Hussein 2013:617).
‘They promote psychomotor skills; the students get technical
skills to do the procedures and more.’ (Participant 9, HOD, 59
In an Australian study on integration of EBP into the
years old)
curriculum, Malik et al. (2015a:158) mention that there is lack
of clarity on EBP content and process. Clarity is frequently
Felicilda-Reynaldo and Utley (2015:94) recommended a
blurred with research processes and outcomes, which often
change in educational technology for nurse academics,
results in continuation of traditional nursing research courses
which include the teaching approaches that facilitate
in the hope of preparing EBP practitioners. Leufer and
critical thinking and provide opportunities for practising
Clearly-Holdforth (2015:11) state that if optimal patient
evidence-based patient care. The study by Leufer and
outcomes are to be maximised, practitioners’ skills and
Clearly-Holdforth (2015:6) mentions that the continuous
knowledge base must be fostered and enhanced through
assessment element of the module comprising an EBP
project and the lectures must provide ongoing support to ongoing education, training and support.
student nurses throughout the research module as they
develop their project. Tailored teaching and assessment Category 1.5: Student characteristics
methods must be implemented within the academy to Nurse educators had a challenge with students’ attitude and
foster a culture of EBP at undergraduate level and beyond perceptions towards EBP, and their lack of computer skills.
(Leufer & Clearly-Holdforth 2015:7). Teaching of student According to participants, students appear to have
nurses must be based on the best available evidence to preconceived ideas about research in general. These
recognise and deliver high-quality patient care (Emmanuel perceptions are negative and overwhelming for students.
et al. 2011:21). A negative attitude develops among the student
nurses, because students do not understand the
Category 1.4: Lack of knowledge and skills by nurse educators importance of EBP. Nurse educators felt that students’ lack
Other challenges experienced by nurse educators on EBP of confidence, motivation, and commitment to perform and
implementation in teaching and learning were expressed by use research contributed to misperception and their resultant
some of the participants as lack of confidence, lack of negative attitude. The nursing programme R425 is perceived
motivation, and lack of relevant knowledge and skills about as being full, overwhelming, with competing priorities of
EBP teaching. The following quotes were stated: research, clinical, and theoretical workloads.
‘I think educators need to know how to use EBP research, I ‘Students feel that it is an added responsibility.’ (Participant 7,
think that research for educators is something very important. Junior, 49 years old)
I am not really completely involved with research, I think they
‘Students that we are teaching, they look at this research as a
got to understand research, they got to practice research
monster.’ (Participant 12, Senior, 60 years old)
and then, we can bring it to the students.’ (Participant 8, Junior,
53 years old) ‘So, the experience that I am coming across when I teach is that
these students they do not like it.’ (Participant 12, Senior, 60
‘Maybe the in-service or the education of the staff themselves,
years old)
the information that they have regarding what problem-based
practice or research is all about. They need to be in serviced as ‘These students, they think that no eh eh we are overloading
well.’ (Participant 10, Senior, 59 years old) them.’ (Participant 5, Junior, 50 years old)
‘The first challenges will be the lack of motivation if they have ‘Yah there are challenges because at times the learners are lazy,
not been motivated that’s a challenge, because there need to be they do not want to do work.’ (Participant 11, Senior, 48 years old)

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Students’ attitudes and perceptions can influence EBP the right attitude for functioning as independent health care
learning either positively or negatively. Should students’ providers (Young et al. 2015:354). Nursing education
roles be clearly defined early during training, so that they institutions (NEIs) have a responsibility to provide support
understand the importance of EBP, a positive attitude to student nurses in the development of relevant IT skills.
develops within them. According to Malik et al. (2015a:158), This calls for services of the librarian to provide skills to
the role that is played by EBP in the practical lives of nursing student nurses in searching electronic databases for evidence.
students depends on the degree to which it is promoted by Clinical librarians in health services have to promote
academics, the extent to which it is incorporated into course information literacy in the workplace. Health-related degree
objectives, content and assessments; and its application to programmes need to adopt and incorporate EBP methods
clinical practice. into their curricula to prepare practitioners in training for
their future professional roles and responsibilities (Spring &
In a study by Hickman, Kelly and Phillips (2014:603) on McCuskey 2010:249).
exploring ways to optimise the uptake of EBP to
undergraduate nurses, findings indicated that students were The recommendations that were made by the participants
initially hesitant and reluctant towards the subject of research. concerning student nurses were about creating good
However, as they advanced with the subject their perceptions networking between the clinical practitioners and nurse
and beliefs changed to understanding the relevance of the educators to support the student nurses, providing students
research subject and its importance in improving patient with basic computer skills so that they can work
outcomes. independently, and introducing a reward system as
motivation for student nurses who are doing well.
Students’ lack of computer skills is another challenge that
nurse educators encountered. Students are fully dependent Theme 2: Benefits and value of evidence-based
on them for these skills and more time is needed to orientate practice in teaching and learning
students on how to use the computers. The use of EBP Although some studies indicated that the main barrier to EBP
requires searching of information from the Internet. To is lack of value for EBP (Melnyk et al. 2012:415), this study
accomplish this one must be able to use computers to search revealed that participants also believed that integration of
for information. These are the quotes from participants: EBP in teaching and learning as the best way to follow. It
‘When you ask students for instance, initially we had challenges showed ways in which EBP teaching and learning could
with them not knowing, because you find that at school they benefit the nurse educator, the nursing education discipline,
never did anything that has to do with computers, like any student nurses, patients, and the employer or institution.
classes and now when they come here they have to sit in front of Evidence-based practice is associated with critical-thinking
the computer, they do not even know what the mouse is, you skills which must be developed among the student nurses,
know.’ (Participant 3, Senior, 50 years old) and lifelong learning for nurses, to expand their knowledge
‘So, I would love to see in the initial stage of training, this newly and quality of care related to patient and health care facilities
employed student nurses to have a basic course in computer (Felicilda-Reynaldo & Utley 2015:91-92). The following
literacy so that when we send them to fish information or categories of information offer the benefits that come with
explore they have the skills on how to like do internet surfing, implementation of EBP in teaching and learning.
go through the specific web, SANC web and etc., so that we
are offload with them relying on us with computer skills.’
(Participant 9, HOD, 59 years old) Category 2.1: Keeping up to date with current information
Participants believed that EBP empowers and enriches the
Increasing competence in information literacy is the nurse educators and student nurses with up-to-date
foundation for EBP; this provides nurses with the skills to information, thus keeping their knowledge current. They
be literate consumers of information in an electronic also believe that EBP is based on researched international
environment (Emanuel et al. 2011:22). According to studies, and grounded on expert knowledge. These remarks
Emmanuel et al. (2011:23), advances in IT have had a radical were made by participants:
impact on health care delivery and nurse education. The use ‘I think it is the best way to do your teaching and learning
of sophisticated equipment and electronic assessment care because you have evidence to base your information on.’
packages requires nurses to be competent in IT skills. (Participant 1, Junior, 40 years old)
‘The other thing, you will find that you do not have to waste
For students to be ready for EBP learning, they need to have more time trying to give information to the students because
good basic computer skills and to develop the right attitude everything is there.’ (Participant 1, Junior, 40 years old)
towards learning using EBP. Their learning styles must ‘Again, that are not going to be having people that would be
support the inculcation of EBP. Fostering a culture of EBP in having something that is outdated, again when we actually
student nurses is essential to delivering effective health care engage in that we also update ourselves as lecturers.’ (Participant
(Leufer & Clearly-Holdforth 2007:4) and it is also important 12, Senior, 60 years old)
that student nurses be equipped with EBP knowledge and
skills to encourage evidence-informed decision-making after Nurse educators displayed a positive attitude and appeared
graduation (Schoonees et al. 2017:1). Students should have to be very supportive of EBP teaching and learning.

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Reinforcing this statement, Mehrdad et al. (2012:507) reported ‘Research helps in the improvement in the quality of care and in
that nurses’ knowledge and attitude towards EBP contribute how quick the patient recovers or how long he stays ill in the ward.’
to its implementation in health care. Therefore, nurse (Participant 3, Senior, 50 years old)
educators and nursing students need to keep up to date with ‘I think the benefits, the benefits are, because EBP is more patient
current evidence for use in practice. Current practices centered I think and therefore it is beneficial and also sometimes
relied on by senior nurses and nurse educators are frequently it becomes meaningful, you can even individualize the care to
based on personal experience, tradition, intuition, and the patient based on that EBP and the outcome of that so I think
organisational policies or protocols, rather than on evidence it is beneficial in that way but eh those are the benefits I think and
(Malik et al. 2015b:47). also improvement, improvement in patient care.’ (Participant 8,
Junior, 53 years old)

There is a belief that the use of up-to-date scientific findings

will improve the quality of care for patients and fill the gap When patient care is informed by sound evidence, it results
between research, theory, and practice (Mehrdad et al. in better and more affordable care towards people and the
2012:509). It is important that nurses use evidence to ensure community. Nursing evolved from a series of dictated tasks
their practice is up to date and based upon the best available to a holistic care approach which requires evidence that is
research (Hickman et al. 2014:604). Malik et al. (2015a:159) developed into guidelines. These guidelines support nurses
emphasise that the health professionals are required to be to promote individualised care (Emmanuel et al. 2011:22).
using up-to-date knowledge and evidence to guide their
decisions, hence improving patient care. In order for nursing Evidence-based practice is a patient-centred approach as it
education to keep up with the changes in nursing and health influences patient care and minimises the theory-practice
care, such professionals should be immersed in EBP gap with nursing (Mackey & Bassendowski 2016:53). The
(Felicilda-Reynaldo & Utley 2015:92). main aim of EBP is to optimise outcomes for patients and
clients by selecting interventions that have the greatest
Category 2.2: Preparing student nurses to engage in chance of success (Leufer & Clearly-Holdforth 2015:4).
evidence-based practice
According to the nurse educators, student nurses lack interest Category 2.4: Reducing health care delivery cost
in research. However, once they become involved with The use of EBP leads to improvement in the quality of care,
research activities, the tendency is for students gradually to thus reducing patient stay in hospital. Although quality is
develop more interest and a concomitantly positive attitude sometimes expensive, it comes with positive implications for
towards research. Equally, increased motivation and eagerness health care facilities, for example, when patients receive
to learn is noticed. The following statement was reported: quality care, their recovery is quicker and the numbers of
‘But when they come back from the library with those articles days spent in hospital are reduced, resulting in reduction of
you could see that they are now developing interest you know, patient-care costs. Therefore, the employer and institutions
they are developing interest, they seem to understand it is like
benefit positively from the use of EBP because of the end
now there is that curtain that has fallen away so they can see now
result, which is improvement in the patient outcomes. One
the light in this research.’ (Participant 6, Senior, 56 years old)
participant reported that:
Hickman et al. (2014:603) agree that developing the EBP ‘You know I feel like with EBP teaching and learning, it will be
capabilities of the emerging nursing workforce is essential in more important to use more in the clinical area.’ (Participant 10,
improving patient outcomes, promoting organisational Senior, 59 years old)
efficiencies and creating a satisfying work environment.
Engaging students in applying evidence into professional For the health institutions to provide effective services, their
practice is a critical role of nursing faculties. This results in functioning, planning, policies, and guidelines are informed
student nurses gaining confidence in the use of research and by researched evidence. The following statements were
EBP to inform decision-making. Hickman et al. (2014:603- reported:
604) further reveal that students demonstrated the ability to ‘I think EBP will be an excellent way to have proficient and
identify, criticise, and translate research to practice owing to efficient nurses in the ward.’ (Participant 5, Junior, 50 years old)
the increased understanding. Students also understood the
‘You get in improvement, quality improvement in nursing care
difference between research and EBP and how one informs and you find that with research, research helps in the
the other. Therefore, teaching concepts of EBP to student improvement in the quality of care and in how quick the patient
nurses to enable them to recognise and deliver high-quality recovers or how long he stays ill in the ward.’ (Participant 4,
care that is evidence-based is a key outcome of all nurse HOD, 56 years old)
education programmes (Leufer & Clearly-Holdforth 2015:4).
Reducing health care costs requires that nursing and health
Category 2.3: Improvement to quality care for patients care services be based on best current available evidence.
Evidence-based practice allows for individualised care, Improved cost-effectiveness of the health institutions allows
improvement in quality care leading to quick recovery of the administrators the ability to negotiate for better
patients and shortened period of hospitalisation which saves sponsorship and incentives from health care funders and
money for patients. Participants stated the following: insurers (Levin et al. 2011:22).

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 Page 8 of 9 Original Research

Discussion revealed that nurse educators had positive attitudes towards

EBP implementation. However, they demonstrated a lack
Evidence-based practice teaching and learning is not of knowledge and skills in appraising and incorporating
explicitly implemented. The current curriculum (R425) does evidence into practice. Nurse educators cannot be expected
not have any specific guidelines for EBP teaching and to teach what is not known to them, therefore; they must be
learning; it only requires that research processes and steps to equipped with knowledge and skills so that they can teach
conduct research projects be taught to student nurses. For EBP to produce professional nurses who are competent in
KZNCN, the research module is taught at third-year level, evidence-based care (Melnyk et al. 2012:416).
and it is covered under the Community Nursing Science
component. The learner study guide only requires the
nursing students to conduct and present a mini research Limitations
project. There is no mention of EBP skills or competencies It may not be possible to generalise the findings to all nurse
that must be acquired or achieved. educators because the study was limited to nurse educators
who work in the public institutions under Umgungundlovu
The researchers concluded that the information generated Health District, and who only provide R425 comprehensive
as experiences of nurse educators is not directly linked to 4-year programmes at two campuses. Therefore, findings
EBP in teaching and learning: it was more about teaching cannot be generalised to private institutions like universities,
and learning of research in general. Nevertheless, EBP other districts, provinces or even nationally and for other
depends for its success on researched information. Research nursing programmes.
is conducted to develop evidence that may be used for EBP.
The utilisation of researched evidence in practice is known
as EBP. It is never easy to separate research from EBP
Recommendations
because one complements the other. However, it remains the The current curriculum (R174) should be reviewed and
responsibility of the NEIs to encourage student nurses to restructured to allow for early introduction of EBP principles
promote and deliver EBP from the onset of training; therefore, at the onset of training. In addition, online and telematics
the principles of EBP should be introduced to students as studies together with the use of mobile technologies should
part of pre-registration education (Emmanuel et al. 2011:21). be included in the curriculum.

Lack of resources was one of the challenges mentioned by Relevant adequate resources should be made available and
most of the nurse educators, mainly the physical resources accessible to nurse educators and nursing students. Access
like lack of or poor access to computers and libraries. Non- to sufficient clinical facilities that are appropriate for the
availability of Internet access, current books, journals, and achievement of the outcomes of the programme should also
articles also contributed to poor access to relevant evidence be considered.
needed for successful implementation of EBP teaching and
learning.
Nurse educators should be supported through in-service
training, workshops and affiliation to journal clubs to improve
From the list of teaching strategies identified by nurse
their knowledge and skills regarding EBP competencies.
educators, it was clear that traditional teaching strategies are
still dominant in nursing education. Such strategies do not
promote or stimulate critical-thinking skills and EBP Conclusion
competencies to student nurses. A teaching method is The findings revealed both the challenges and benefits that
understood to be a particular technique a teacher uses to help come with the use of EBP in teaching and learning skills
learners gain the knowledge which they need and to achieve for the nursing education discipline, thus paving the way
a desired outcome. A desired outcome in this context is the for the implementation of the suggested recommendations.
development of critical thinking, problem-solving and good Evidence-based practice has an essential potential role to
decision-making skills for student nurses, which can be play through incorporating more practice-based evidence of
achieved by the use of EBP in teaching and learning as one of nurse educators in teaching and learning implementation.
the innovative teaching strategies.
Therefore, nurse educators should use EBP to ensure that
student nurses receive high-quality nursing education.
Though it transpired that most nurse educators were
supportive and had a positive attitude towards the
implementation of EBP in teaching and learning, their level Acknowledgements
of knowledge and skills was questionable; there was Thanks to Dr D.K.S. Habedi for her assistance and supervision
uncertainty in understanding the use of EBP in teaching and in writing this article. I am also thankful to the participants
learning; and a lack of motivation and commitment towards for their willingness to contribute in the study.
research was evident. Malik et al. (2015b:46), in a tertiary
health care facility in Victoria, Australia, investigated the
perceptions of nurse educators on factors promoting EBP and Competing interests
perceived barriers to facilitating EBP in a clinical setting The authors declare that there are no competing interests
before developing an educational programme. The findings with regard to the writing of this article.

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 Page 9 of 9 Original Research

Authors’ contributions Levin, R.F., Fineout-Overholt, E., Menlyk, B.M., Barnes, M. & Vetter, M.J., 2011,
‘Fostering evidence-based practice to improve nurse and cost outcomes in a
community health setting: A pilot test of the advancing research and clinical
G.N.M. is the author of the article and conducted the research. practice through close collaboration model’, Nursing Administration Quarterly
35(1), 21–33. https://doi.org/10.1097NAQ.0b13e31820320ff
D.S.K.H. provided guidance and assisted with the writing of
Mackey, A. & Bassendowski, S., 2016, ‘The history of evidence-based practice in
the manuscript. nursing education and practice’, Journal of Professional Nursing 33(1), 51–55.
https://doi.org/10.1016/j.profnurs.2016.05.009

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