Nursing Students’ Experiences of Registered Nurses’ of Ontario Best Practice Guidelines Implementation into Clinical Placements
Summary
My second Fellowship project was to build on my knowledge and skills in implementation science and program evaluation within the Ryerson University Daphne Cockwell School of Nursing (DCSN) academic setting. Guided by the RNAO Knowledge to Action Framework (2012), the project considered the identified enablers and challenges in implementation strategy development to sustain nursing knowledge and practice change. The Donabedian Quality of Care Model (1966) framed the structure, process, and outcome indicators to measure nursing student knowledge, skills and attitudes related to RNAO BPG implementation to enhance their academic experience. The project focused on Step 5 of the Knowledge to Action Framework: to monitor knowledge use and evaluate outcomes.
Learning from my first Fellowship in the practice setting, we adapted the evaluation methodology to the student context. We created an anonymous and confidential online student survey to obtain qualitative and quantitative data from the students. We obtained permission from the Ryerson University Research Board of Ethics to proceed with the survey as a method of program evaluation. The survey was available to the students for 3 weeks. We conducted a descriptive analysis of the quantitative and qualitative data. Recommendations and implications were generated based on survey findings.
In the organizational context, the findings from my first Fellowship informed the work of the DCSN BPSO Team and supported the evaluation plan of the BPG implementation strategies among nursing students. Our original plan was to survey all DCSN students and conduct focus groups based on the survey findings. However, due to the time constraints of the Fellowship and the goal to compare and contrast the findings to practicing nurses, we decided to modify the sample criteria and focus on a specific cohort of 175 post-diploma nursing students in their second clinical placements. Another modification to the survey was to include a validated instrument to measure student beliefs and implementation of evidence-based practice. We also created a specific recruitment strategy with the support from the clinical placement faculty advisors who posted my recruitment letter and the link to the survey on the student portal. The results are captured in the Outcomes section.
Outcomes
My overall learning goal for this academic Fellowship was to build upon the knowledge and skills I gained from my first Fellowship at York Region Public Health (September – December 2019) in implementation science and program evaluation. In addition to the self-guided studies and online course-work, I further enhanced my knowledge in BPG implementation and program evaluation by comparing and contrasting my learnings from a practice to an academic setting.
With this knowledge and the support from my mentorship team, I developed knowledge in evaluation methodology and narrative and statistical descriptive analysis. Using a theoretical lens, I have developed expertise in critically appraising and evaluating implementation strategies in both the practice setting with experienced nurses and in the academic setting with student nurses. To bridge the silos between academia and practice, we developed indicators for BPG implementation strategies in relation to student learning and to support them as they transition into practice. We were also able to measure student beliefs and implementation of evidence-based practice using a validated instrument that could be used with future student cohorts for comparative and evaluative purposes.
My abstract has been accepted at local, national, and international conferences with both practice and academic audiences. These opportunities will foster my growth in knowledge dissemination to the broader nursing community. It will further contribute to bridging the learning gap about the effectiveness of BPG implementation strategies at practice and academic levels.
Overall experience
As reflected in my first Fellowship, my learning experience has been continuously transformational as I strengthened the relationships with my mentorship team. It has truly been a privilege to have completed two Fellowships focused on bridging the gap between practice and academic settings in RNAO BPG implementation. It has been an honour to be mentored by a group of remarkable nursing scholars over the past 6 months. I am forever grateful to RNAO, York Region Public Health, and Ryerson University DCSN for this unique and outstanding experience.
My favourite moment was presenting at the RNAO ACPF Forum in March 2020 and learning about the outstanding work from the other RNAO Fellows. Having the opportunity to share my findings as oral and poster presentations facilitated further learning through meaningful interactions with colleagues and participants. It also helped me to identify future opportunities to enhance strategies and sustain BPG implementation among practicing and student nurses.
I look forward to the dissemination opportunities later this year. The recommendations and nursing implications are to develop a deeper understanding of the BPG implementation experiences of practicing and student nurses. Creating interviews or focus groups questions based on a theoretical lens such as Self-determination Theory or Behaviour Change Model may support the discovery the intrinsic factors that truly motivate and sustain BPG implementation. Future research to measure the impact of implementing a BPG on practice change and client outcomes is worth exploring.
