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Data Collection Methods and Needs Assessment
The purpose of the needs assessment is to identify the level of awareness of a particular issue or area of interest in a target audience. The data collected in the needs assessment process is used to justify the design of educational programs and to make them more efficient. To assess educational needs, one may use either quantitative or qualitative data collection instruments.
Qualitative methods (interview, field observation, focus group, etc.) may provide information on the relationship patterns between the studied variables, e.g., students attitudes and the actual state of knowledge, self-concepts, and barriers to knowledge (Keister & Grames, 2012). Qualitative data is interpretable and subjective, whereas, quantitative data is associated with a greater level of precision, accuracy, and objectivity.
Quantitative methods (survey, questionnaire, test, etc.) provide numerical and statistical information and are associated with a minimum risk of biasing. Both types of data collection techniques may be implemented in direct needs assessment which implies formal research aimed to gather primary data from the study sample. Such a form of assessment usually has a narrow focus and allows the evaluation of specific needs.
Conversely, an indirect needs assessment aims to examine secondary data. For this purpose, such data collection tools as a literature review may be used. By reviewing secondary findings provided in academic and professional sources, one may identify dominant trends in either the general population or a particular group. This assessment type does not require institutional approval and, therefore, it is considered more simple and less effort-consuming. Nevertheless, to receive credible results, all ethical and professional standards should be taken into account during the research.
Building the Culture of EBP: Administrative and Educational Perspective
The EBP process comprises five major steps: identifying practice needs and formulating a relevant question, searching for the best available evidence, critically evaluating the collected data, integrating the findings into ones knowledge and clinical environment, and evaluating the application outcomes. This model implies a comprehensive analysis of available evidence. However, many practitioners may not have sufficient time and skills to carry it out independently. For this reason, education and administration efforts aimed to build the culture of EBP should be interrelated.
First of all, practitioners should receive at least a basic familiarization regarding research methodology and practices. It may help them to evaluate evidence more efficiently and be more confident about this fundamental process of EBP. Inexperienced practitioners should always be provided with expert feedback (Taylor, 2016). Otherwise, it will be difficult for them to develop the necessary skills and obtain valid results. Ideally, not only should the practitioners be encouraged to engage in the research-informed practice, but also carry out the practice-informed research as it helps contribute to the improvement of the EBP process and fosters better outcomes.
It is almost impossible to bring EBP at an advanced level in a setting without substantial administrative support. Administrators should consolidate desirable behavior in healthcare providers by enforcing standards of practice, providing professional training, and raising awareness of the importance and value of EBP (Fearing, Barwick, & Kimber, 2014). At the same time, a favorable practice environment should be provided. Administrators thus should remove all organizational constraints (e.g., inadequate work scheduling, lack of resources, etc.) to ensure on-going learning and EBP improvement.
Quantitative Data: Reliability and Validity Measures
Validity and reliability define the rigor of quantitative studies. According to Heale and Twycross (2015), the term validity refers to the extent of accuracy in the measurement of the problem or a concept, and the term reliability refers to the accuracy of the implemented instruments. There are several types of validity: content, face, construct, and criterion validity. Content validity implies that selected methods meet research purposes and allow an adequate evaluation of variables.
The second type, face validity, implies the experts acknowledgment of the accuracy in the selection of the instrument and its ability to measure the intended concept. Construct validity refers to cause-and-effect relationships between the variables and the overall logic of those relations. According to this measure, valid research will always be homogeneous and valid evidence will support theoretical propositions made by an author. Lastly, criterion validity can be measured by using different instruments to analyze the same variable (Heale & Twycross, 2015).
Reliable research will show internal consistency, stability, and equivalence. The first attribute can be measured using item-to-total correlation or split-half reliability which implies that study results are divided into parts or halves, and correlations are then calculated. Strong correlations indicate the high reliability of the instrument, and weak correlations are associated with low reliability (Heale & Twycross, 2015). Stability can be measured using test-retest, i.e., assessment of the same sample several times. And equivalence is determined by analyzing the level of agreement in more than two researchers opinions on the inter-rater reliability of the instrument.
Qualitative Data: Trustworthiness
As stated by Noble and Smith (2015), qualitative methodology is often criticized for lack of scientific rigor, sufficient justification of the implemented tools, and transparency in analytical processes. There is a risk that findings in qualitative research may merely be a collection of individual opinions associated with various biases. In qualitative research, there is no statistical instrument to measure its validity like in the case of quantitative studies. However, researchers may use different strategies to ensure the accuracy and trustworthiness of findings.
First of all, the credibility of qualitative data largely depends on researchers ability to critically evaluate their positions and ideas and acknowledge potential biases in sampling, data collection, analysis, and interpretation (Noble & Smith, 2015).
A validation strategy can be the principle of intersubjective revision, i.e., the review of distinct interpretations of the concept provided by other professionals and scholars. It is considered that the trustworthiness of qualitative data can be determined by the extent to which other researchers accept the study findings, understand initial data provided in the paper, and comprehend suggestions and conclusions given by the author. Thus, to make the results of a qualitative study reliable, one should consider perspectives and instruments suggested by other researchers. The credibility of a qualitative paper depends on the extent to which it fits the discourse. Overall, qualitative research can be characterized by dependability on other works in the field of study.
Barriers to Perform
There are many barriers to the realization of high-quality care and EBP: cultural, economic, social, and so on. Among individual barriers, the cognitive-behavioral and the institutional ones are the most widespread (Altin, Passon, Kautz-Freimuth, Berger, & Stock, 2015). Cognitive barriers include a lack of knowledge, competence, and skills. The institutional barriers that impede individual performance are the lack of adequate infrastructure and training. The institutional barriers largely contribute to the individual ones by increasing practitioners exposure to stress and fostering nurses indifferent attitudes.
For instance, according to Mahmoudi, Mohmmadi, and Ebadi (2013), inadequate and nonprofessional managerial supervision results in increased practitioners cynicism, lack of motivation to comply with standards and regulations, and unwillingness to cooperate. Indifferent attitudes of health providers combined with the absence of appropriate leadership strategies lead to both non-adherence with the principles of EBP and neglect of patients. Altin et al. (2015) also state that individual attitudinal and rational-emotional barriers may largely interfere with EBP implementation.
One of the major concerns expressed by clinical practitioners interviewed by the researchers was that the application of EBP might overwhelm patients due to the encounter with a large volume of complicated information and excess demands (Altin et al., 2015). Moreover, some healthcare providers may consider that EBP is associated with a less individualized approach to patients. The excess criticism and mistrust of EBP contribute to a limited recognition of its values and interfere with its implementation at the hospital-wide level.
Bachelor Degree as an Entry Level into Nursing Practice
Nowadays, there is a large number of different educational programs for nurses in the United States: LPN Diploma Program, BSN, ADN Program, and some others. They largely vary by requirements for entry and completion. Moreover, many states regulate licensure differently. As a result, the issue of discrepancy in the level of competence and expertise of nursing practitioners arises.
It is possible to assume that the introduction of a uniform standard for entering into nursing practice may be of great benefit. For instance, it might facilitate policy-making, eliminate the risk of medical error due to the lack of skills in nurses, and contribute to the overall improvement of care. However, BSN should not necessarily be a criterion for entry into the profession, but the level of nurses preparedness and competence should. Although shorter education programs (e.g., ADN) may be administered at a lower academic level, they provide students with basic knowledge and allow developing all necessary skills and core competencies during the course.
BSN is associated with many professional advantages such as better self-esteem, confidence, etc. (Rogers, 2015), but since it is more time-consuming and requires greater financial investment, making it a criterion for entry can cause significant nurse shortages. It may be better to establish ADN as an entry-level but ensure that RNs experience would rise within the following years after they obtain licenses.
References
Altin, S., Passon, A., Kautz-Freimuth, S., Berger, B., & Stock, S. (2015). A qualitative study on barriers to evidence-based practice in patient counseling and advocacy in Germany. BMC Health Services Research, 15(1). Web.
Fearing, G., Barwick, M., & Kimber, M. (2014). Clinical transformation: Managers perspectives on implementation of evidence-based practice. Administration and Policy in Mental Health and Mental Health Services Research, 41(4), 455-68. Web.
Heale, R., & Twycross, A. (2015). Validity and reliability in quantitative studies. Evidence-Based Nursing, 18(3), 66-7. Web.
Keister, D., & Grames, H. (2012). Multi-method needs assessment optimises learning. Clinical Teacher, 9(5), 295-298. Web.
Mahmoudi, H., Mohmmadi, E., & Ebadi, A. (2013). Barriers to nursing care in emergency wards. Iranian Journal of Nursing and Midwifery Research, 18(2), 145151.
Noble, H., & Smith, J. (2015). Issues of validity and reliability in qualitative research. Evidence-Based Nursing, 18(2), 34. Web.
Rogers, C. (2015). New York state dental hygienists perceptions of a baccalaureate degree as the entry-level degree required for practice. Journal of Dental Hygiene, 89, 13-21.
Taylor, M. (2016). Evidence-based practice: Embracing integration. Nursing Outlook, 64(6), 575-582. Web.
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