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June 2008 Site of the Month

Evidence-Based Practice Tutorial for Nurses

Authors: Deborah Lovett, Nancy Henry & others
(See tutorial credits page:
Institution: Penn State, University Park

Interview with: Loanne Snavely, Head of Library Learning Services, with the tutorial authors

Interviewer: Robert Schroeder

Tutorial Description: A collaborative project between several partners including the Director of Nursing Research at Penn State Milton S. Hershey Medical Center and Penn State librarians, this tutorial was developed to assist nursing students and nurses in learning to implement evidence-based practice. Evidence-based practice (EBP) in nursing is using and carrying out nursing practices based on the best available knowledge. It integrates the nurse's clinical expertise with the best external research evidence and encourages nurses to examine nursing practices, analyze alternative and contradictory data, and make sound nursing care decisions supported by the best available research evidence.

Q: Evidence based practice for nursing is an extremely focused topic for a tutorial. What inspired you to create this tutorial?
A: At Penn State University Libraries we have been committed for over ten years to providing quality online learning materials that students can access anytime/anywhere and that can also be used by instructors in the classroom. During that time we have created ten tutorials. Each is a collaboration between the writer(s) of the content, an instructional designer, and a web developer. Our original tutorials were general ones on information literacy and the research process, such as Information Literacy & You, The Information Cycle and "What's a Journal?" Our next steps were to create more specialized tutorials to assist in particular areas of disciplinary research. We have created two for Business, one for Patents, one for Engineering, and one for Newspapers in addition to the one on evidence based practice for nursing. See this page for all of our tutorials:

So when we received an inquiry from our Health Sciences Librarian that she was working with others on a tutorial for nurses to meet some new requirements, we were very interested in being a partner and supporting the effort with design and web development. This was a collaborative effort between Victoria Schirm, Director of Nursing Research at the Penn State Milton S. Hershey Medical Center, Deb Lovett, who was a librarian there at the time (and later by her replacement, Valerie Gross), Nancy Henry, health sciences librarian at Penn State, University Park and our department, Library Learning Services. EBP is a new initiative in nursing to ensure that nurses use evidence to inform their nursing practices. New accreditation requirements were implemented on a short timeline, and the tutorial was one of the steps the Department of Nursing was taking to ensure their students understood how to search for proper evidence to inform their nursing practices. The tutorial and its use were critical to fulfilling the requirements for nursing accreditation.

We felt this was a very effective use of our time and effort, to create a tutorial with a real need through a partnership with a disciplinary unit. Extending information literacy and making learning resources available to all disciplines is a way to meet our information literacy goals.

Q: How long did it take for you to create your tutorial? We're there any stages in its development that went more smoothly than you imagined, and were there other things that took more time and energy from your development team?
A: The content development phase was quite long. Because a number of librarians, administrators and faculty were working together to get it right, we didn't actually begin designing the tutorial until long after our original projected date. Resources available within the academic medical center and college of medicine library were used, and included life sciences and medical librarians, nursing experts, and an instructional designer. This team worked collaboratively to promote appropriate project buy-in, overcome barriers to implementing Evidence-Based Nursing (EBN), determine feasibility for developing an online educational method, capitalize on available resources to create an online tutorial, and measure tutorial usage and educational impact. Continuous feedback throughout the project enabled ongoing refinements. Consequently, the team successfully confronted barriers to design and implemented an effective EBN program.

Once we had the content, it took several months to design the interface and shape it into the first version of the tutorial - the instructional design and web development aspects that our Library Learning Services unit provides. Originally the overall design and development was done by our web assistant, Jiyeon Ryu. We had several usability issues and design issues and after several months of use made some major changes to the look and feel and the way it worked. This updated version was created by Vicki Brightbill who came on board as our web designer. The content has remained consistent since then except for updates on changes in databases, etc. It was a major project and took about two years from initial inquiry to finalized, tested product.

Q: What kind of programming and software did you use in the creation of your tutorial?
A: This tutorial was created primarily with html in Dreamweaver, using Cascading Style Sheets for layout and font styles. Our earlier tutorials were created with Flash, but for this one we were looking for quick development time and easy update capabilities - as well as a simple, clean, easy-to-use interface and navigation. We created a menu system that is consistent throughout and modified the charts for consistency of fonts and colors.

Many of the charts and figures needed to be used with text, so we wanted to accommodate this use. However, in the first iteration, many windows had to be opened which were sometimes hidden if the previous window was not closed. So we worked through several phases to make it most useable and useful. The re-design also offers better accessibility (portions of the original were audio-only). The tutorial includes an introduction in both video and html format.

Q: How is the tutorial integrated into the nursing program? Do the nurses have to take it in conjunction with a certain class, or on their own?
A: There is a class devoted to Evidence-Based Nursing. During this class the tutorial is highlighted as a resource and used as a supplementary source of information. Participants are encouraged to use the tutorial to review evidence based concepts and resources. The tutorial is not demonstrated during class but is intended as an outside-of-class eLearning resource for nurses. The tutorial is available on the Internet via multiple access points 24/7.

Q: Have you gotten any feedback from the students or faculty on the tutorial? Have you performed any formal assessment?
A: Following a presentation at a national nursing conference this past year, there have been many requests from hospitals and academic institutions to either link to the tutorial or utilize parts of the tutorial in classes. Although no formal assessment has been completed, informal assessments from nurses, nursing faculty and administrators has been very positive, and it has been a very enthusiastically welcomed resource.

Q: Are there any other things you'd like our readers to know about the tutorial or your experience creating it?
A: The original expectation in pursuing a collaboration between the library and the nursing department was that the audience would be graduate nursing students, then undergraduates and finally clinical nursing staff in hospitals. Time-restraints and other considerations changed this so that the initial buy-in or incentive for collaboration on this project ended up being the clinical nursing staff first, because of the hospital participation in the ANA Magnet Recognition Program. Once the tutorial proved helpful in this process, the integration of the tutorial into the academic teaching environment was readily adopted by faculty.

Another lesson learned: eLearning projects take longer to complete than originally anticipated.

June 2008 PRIMO Site of the Month