Integration of Evidence-Based Practice in Undergraduate Nurse Education: A Grounded Theory Study

Considering the growing need to adopt an evidence-based practice (EBP) approach in response to increasing complexities in healthcare, nurses must be adequately prepared in their undergraduate degrees to implement EBP in clinical practice. However, there is a plethora of studies reporting that nurses’ educational preparation for embracing EBP is consistently inadequate. EBP adoption by graduating nurses depends on the degree to which it is prioritised by academics and the extent to which it is integrated into the curriculum. Despite the existence of many studies on EBP, its inclusion in nurse education is limited, and therefore requires investigation.
    The purpose of this study was to generate a substantive theory about the processes academics undertake when incorporating EBP in their teaching practices. In order to address the aims of the study, a constructivist grounded theory methodology informed by Charmaz was employed. In line with grounded theory approach, data collection and analysis were conducted simultaneously and continued until theoretical saturation was reached. Participant interviews, observations and document analysis were utilised to obtain data. In total, 23 academics across Australian universities participated in semi-structured interviews, and nine consented to be observed during their teaching with undergraduate students. Additionally, twenty unit guides shared by study participants were analysed to enrich data.
    In response to the central problem of how undergraduate education prepares nursing students to be evidence-based clinicians, a core process utilised by academics to tackle with this problem is conceptualised as “On a path to success: Endeavouring to contextualise curricula within an EBP framework”. This theoretical construct helps to explain academics’ actions and insights into teaching practices towards EBP integration in undergraduate education. A central aspect of this theory reflects meanings academics constructed around their endeavours towards achieving a fully integrated curricula that engages students with the EBP framework, linking EBP theory to practice. The core process is evident in three transitional stages of theory comprising: Embarking on a journey-Being prepared, Experiencing challenges, and Moving ahead-Linking EBP theory to practice. However, this process was mediated by contextual conditions of academic settings and individuals, curricula and practice settings.
    Four interrelated categories present the key activities academics were engaged with and are embedded in the core process. The first category, Valuing and Engaging with EBP, highlights academics’ preparation towards EBP teaching and its integration across courses. The second category, Enacting EBP Curriculum, reflects academics’ engagement with designing and enacting EBP and research units and working towards embedding EBP across units. The third category, Influencing EBP Integration, explores the teaching and learning strategies employed by academics to engage students with the EBP process, aiming to link evidence to practice in teaching units. The final category, Envisaging the Use of EBP, reveals how academics facilitated the use of EBP in theory and practice. Academics responses’ and the processes they used were influenced by three contextual factors consisting of academic settings and individuals, curricula design and implementation, and practice settings. These factors played an important role in academics’ endeavours to achieving a contextualised curricula, making EBP concepts relevant to practice.
    Therefore, the generated findings and theory offer valuable insights to nurse education within Australia that are also relevant for global nursing education. The substantive theory raises awareness of social processes and activities undertaken by academics and highlights obstacles, which require attention at school and practice setting levels to ensure academics are prepared, engaged and committed to incorporate EBP concepts in their teaching practices.