Nurse Education Today 35 (2015) e6–e11

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Nurse Education Today

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Review

Student nurse perceptions on evidence-based practice and research: An

exploratory research study involving students from the University of
Greenwich, England and the Faculty of Health Care Jesenice, Slovenia
Joanne Brooke a,⁎, Simona Hvalič-Touzery b,1, Brigita Skela-Savič b,1
a
Faculty of Education and Health, University of Greenwich, Avery Hill Road, Eltham, London SE9 2UG United Kingdom
b
Faculty of Health Care Jesenice, Spodnji Plavž 3, 4270 Jesenice, Slovenia

a r t i c l e i n f o s u m m a r y

Article history: Background: The importance of evidence-based practice (EBP) and research within nursing has been acknowl-
Accepted 26 February 2015 edged since the 1970s. Research proficiencies for nurses include the abilities to search for and evaluate
evidence, disseminate findings and apply findings to practice within the context of caring. However, there is a
Keywords: lack of information on how new undergraduate nursing curriculums have impacted on student nurses' percep-
Nursing students tions on and importance of EBP and research.
Evidence-based practice
Objectives: The study aimed to explore student nurses' perceptions on and importance of EBP and research.
Research
Focus groups
Methods: Data were collected via focus groups in 2013 with undergraduate student nurses from the University of
Interpretative phenomenological analysis Greenwich, England (n = 7) and the Faculty of Health Care Jesenice, Slovenia (n = 3). Cross-sectional sampling
included focus groups with 1st year nursing students (4, n = 22), 2nd year (4, n = 38) and 3rd year (2, n = 10).
Data were analysed using Interpretative Phenomenological Analysis (IPA).
Results: Four emergent themes regarding students' perceptions of EBP and research were ‘provided confidence,
knowledge and empowerment in clinical practice’, ‘vital for improvements in patient care and safety’, students'
‘responsibility to develop nursing as a profession’ and ‘realities of research in clinical practice’.
Discussion: Student nurses found EBP and research daunting and difficult to understand, although perceived EBP
and research as necessary for their current and future practice. However, student nurses highlighted the lack of
clinical nurses' involvement in research and therefore struggled to conceptualise how they could maintain their
EBP and research skills on leaving the academic setting.
Conclusion: The importance of EBP and research was realised by student nurses across the two institutions.
However, further development and involvement of clinical nurses with EBP and research is required to enable
students to develop a clear understanding of how to take these skills forward in their future careers.
© 2015 Elsevier Ltd. All rights reserved.

Introduction Secruity, 1972) recommended nursing should become a ‘research-

Evidence based practice (EBP) has been defined as the ‘integration of
the best research evidence with clinical expertise and the patient's
unique values and circumstances’ (Sackett et al., 2011). The International
Council of Nurses (ICN) describe EBP as a problem solving approach for
decisions made in clinical practice, which involves contemporary robust
evidence, clinical expertise, holistic assessment and a consideration of
the patients views and preferences within a caring approach (ICN, 2012).
The importance of EBP and research has been identified in nursing as
far back as 1972. The Briggs Report (Department of Health and Social
⁎ Corresponding author at: The Oast, Unit D, Hermitage Court, Maidstone, Kent, UK
ME16 9NT. Tel.: +44 20 8331 8737; fax: +44 20 8331 8060.
E-mail addresses: joanne2651brooke@gmail.com (J. Brooke), shvalictouzery@fzj.si
(S. Hvalič-Touzery), bskelasavic@fzj.si (B. Skela-Savič).
1
Tel.: +386 4 5869 360; fax: +386 4 5869 363.
based’ profession. EBP and research has been fully integrated in pre-
registration nursing curricula since 1980 in the UK (UKCC, 1986) and
1990 in Slovenia (Tierney, 1998). In the UK the Nursing and Midwifery
Council Standards for pre-registration nursing education (NMC, 2010)
include the ability of students to be able to use ‘up-to-date knowledge
and evidence to assess, plan, deliver and evaluate care’.
In the UK the nursing profession has developed into a degree entry
level qualification and the delivery of programmes in higher education
institutions (HEIs). In Slovenia the nursing profession is at the 1st Bolo-
gna cycle professional diploma degree level and is also delivered in HEIs.
Identifying elements of EBP and research within a pre-registration
programme can be problematic as both concepts draw on a range of
skills across a range of disciplines (Peckover and Winterburn, 2003). A
review of pre-registration courses in the North of England found that
in the first year EBP and research were taught simultaneously (Badger
et al., 2012). The current curriculum for undergraduate nursing at the

http://dx.doi.org/10.1016/j.nedt.2015.02.026
0260-6917/© 2015 Elsevier Ltd. All rights reserved.
 J. Brooke et al. / Nurse Education Today 35 (2015) e6–e11 e7

University of Greenwich involves the delivery of taught modules rele- Participants

vant to EBP and research across the three years of the programme. In
the first year students are taught academic skills, such as the ability to
access and utilise appropriate academic resources as well as applying
these skills to academic pursuit and professional practice. In the second
year students are taught the concepts of the nature of knowledge and
the principles underpinning EBP as well as research methodology in
healthcare, and how to critique this research methodology. In the
third year students are taught critical enquiry in order to promote EBP
care within clinical practice, encompassing ethical professional and
anti-discriminatory issues. The students are required to critically review
the literature in a defined aspect of professional practice and appraise
the relevance of the conclusion to current clinical practice.
The current curriculum for undergraduate nursing at the Faculty of
Health Care Jesenice involves the delivery of taught modules relevant
to research in first year and third year of the programme. In the first
year students complete a comprehensive module on research para-
digms including approaches of quantitative and qualitative research,
data collection, analyses and interpretation of population, sample, fre-
quencies, mean and standard deviation. The module also encompassed
the importance of research for nursing care, ethics and the ability to
assess and critically analyse research on a selected subject matter. In
the third year students nurses have the option of selecting a module
on EBP, however all students participate in Diploma seminars. The
seminars prepare the student nurse to apply research methodology to
their final research project. Once the student nurses have completed
their thesis they are required to defend their diploma work which has
10 ECTS.
Both undergraduate nursing programmes encourage and support
students to publish their third year thesis, for student nurses studying
at the Faculty of Health Care Jesenice this is in the Slovenian Nursing
Review, which is peer reviewed journal. For student nurses studying
at the University of Greenwich this may be in the Nursing Standard or
another appropriate peer reviewed journal. Student nurses studying at
the Faculty of Health Care Jesenice are also encouraged to present
their work at professional conferences in Slovenia.
However, it has been acknowledged few nurses will undertake
research during their clinical careers (Gerrish and Lacey, 2006). More
recently, Forsman et al. (2012) found only a modest level of intention
to use research evidence in a sample of 1319 newly graduated nurses.
Further information is required to understand student nurses perspec-
tives of EBP and research and how these are influenced throughout
their 3 year programme. Undergraduate nursing programmes develop
and change to meet the continuingly developing world of medicine
and health, how these changes have impacted on student nurses
perspectives of EBP and research is important to understand to ensure
good practices are recognised, developed and incorporated into all
undergraduate programmes.
Participants were undergraduate student nurses recruited from the
University of Greenwich and the Faculty of Health Care Jesenice. Re-
cruitment occurred across each of the three years of the programme.
All students were completing full time studies. A total of 70 student
nurses participated in 10 focus groups; refer to Table 1 for the structure
of each focus group.
Data Collection
All focus groups were facilitated by the first author, although simul-
taneously translated for students from the Faculty of Health Care
Jesenice, by the second author. A question route was applied with
open questions such as; ‘What is research?’ ‘What has research to do
with nursing?’ Focus groups, were small enough for everyone to have
an opportunity to share insights and yet large enough to provide diver-
sity of perceptions. Each focus group was composed of participants who
were similar to each other (current year of studies and HEI). Focus
groups provided a more natural environment because participants
were influencing and being influenced by others (Webb and Kevern,
2001). The process for integrating focus group data into an IPA study
has been developed and is well documented (Palmer et al., 2010).
Ethics
Ethical approval was obtained as per protocol from both the Univer-
sity of Greenwich and Faculty of Health Care Jesenice prior to recruit-
ment of participants. Ethical approval was essential as nurse educators
were involved in the recruitment of current student nurses. The authors
took on a dual responsibility to these students, the concept of a dual role
(Loftin et al., 2011) has been acknowledged in educational research. A
participant information sheet and consent form were provided and
explained to each student nurse prior to recruitment.
Data Analysis
Focus groups were audio recorded and transcribed verbatim. Data
from the Faculty of Health Care Jesenice focus groups were transcribed
in Slovenian and English. All data were collected prior to the com-
mencement of analysis. The data was analysed applying the six stages
of IPA (Smith et al., 2009). Analysis commenced by the first author read-
ing and re-reading the transcript from the first focus group to become
familiar with the data. The next stage involved initial noting of points
relevant to the research aim. Themes were constructed from the initial
notes with constant referral back to original text. On completion of the
development of themes, connections across themes were searched for.

Aim
Table 1
Structure of each focus group.
The aim of the study was to explore student nurses' perceptions on
and importance of evidence-based practice and research in relation to Focus Higher education Current year of Number of participants
group institute programme
their current and future practice.
1 U of G 3rd 4
Methods 2 U of G 3rd Removed as only one student
volunteered
3 U of G 1st 7
Design 4 U of G 1st 6
5 U of G 2nd 5
The design of the study was informed by Interpretative Phenomeno- 6 U of G 2nd 15
7 U of G 2nd 10
logical Analysis (IPA) including the three concepts of; phenomenology
8 U of G 1st 4
(the study of experience), hermeneutics (the theory of interpretation) 9 FHCJ 1st 5
and idiographic (a particular person making sense of their experience 10 FHCJ 2nd 8
(Smith et al., 2009)). The study was phenomenological to allow an ex- 11 FHCJ 3rd 6
ploration of how nursing students made sense of the EBP and research U of G — University of Greenwich.
to their ‘being’ a student nurse and future healthcare professional. FHCJ — Faculty of Health Care Jesenice.
e8 J. Brooke et al. / Nurse Education Today 35 (2015) e6–e11
This process was completed for each focus group prior to the search for
patterns across focus groups.
Findings
Student nurses from both institutions demonstrated an understand-
ing of EBP and research. Frist year student nurses discussed EBP with
reference to nursing guidelines and protocols that were based on cur-
rent evidence. Research was described using broad generic terms such
as a ‘quest for knowledge’ and ‘scientific evidence’. However, second
and third year student nurses from both institutions demonstrated a
more in depth understanding, including discussions on qualitative and
quantitative research methods including sampling techniques. Third
year student nurses at the Faculty of Health Care Jesenice also discussed
the use of SPSS, ranking, coding, T-Tests and Chi-Square tests.
Four emergent themes regarding student nurses' perceptions of EBP
and research included; (1) provided confidence, knowledge and em-
powerment in clinical practice, (2) vital for improvements in patient
care and safety, (3) students' responsibility to develop nursing as a
profession, and (4) realities of research in clinical practice. Refer to
Diagram 1 for the development of emergent super-ordinate themes
from sub-themes and Table 2 for extracts from transcripts.
Theme: Provided Confidence, Knowledge and Empowerment in Clinical
Practice
The superordinate theme ‘provided confidence, knowledge and
empowerment in clinical practice’ emerged from the three subthemes:
lack of awareness of EBP and research, knowledge was empowering in
practice, and knowledge provided confidence in practice. Student
nurses from both institutions reported commencing their programme
with little or no understanding of EBP or research and were unaware
of the importance of these concepts within nursing. First year student
nurses from the Faculty of Health Care Jesenice described learning
about EBP and research as entering a completely new world and sug-
gested the inclusion of research during secondary level education.
First year students from the University of Greenwich who had studied
psychology described understanding some aspects of research, but
had not related this information to nursing. However, following courses
and progression through the programme second and third year student
nurses from both institutions expressed insight and knowledge into EBP
Diagram 1. Emergent subthemes and superordinate themes.
and research. Student nurses related these concepts to their clinical ex-
perience and expressed the importance of delivering evidence based
care.
Student nurses from both institutions acknowledged EBP and re-
search provided them with confidence when in clinical practice and
empowered them when caring for patients. Second year student nurses
from the University of Greenwich discussed the importance of being
able to evaluate research and understand the evidence supporting prac-
tice, thus enabling them to provide evidence-based care. Student nurses
for the Faculty of Health Care Jesenice discussed the lack of current
nursing research in Slovenia and the need to explore international
research to enable them to provide evidence-based care.
Theme: Vital for Improvements in Patient Care and Safety
The superordinate theme ‘vital for improvements in patient care and
safety’ emerged from the two subthemes: informs best practice and
exploration of poor healthcare. Student nurses from both institutions
explored the importance of EBP and research in understanding best
practice. Student nurses from the University of Greenwich found EBP
and research provided information on successful and unsuccessful
care/treatments. Whereas, the student nurses from the Faculty of
Jesenice discussed the importance of incorporating new evidence into
practice with reference to both nursing and medical interventions/
treatments.
EBP and research were also identified by nursing students at the
University of Greenwich as tools to explore and understand poor
healthcare. Nursing students discussed the need to understand poor
healthcare so the same mistakes are not repeated, but also to under-
stand the process that enabled poor healthcare provision. Whereas,
student nurses from the Faculty of Health Care Jesenice discussed the
importance of people in their care and the acceptance of the need for
research to provide care and therefore research is part of being a nurse.
Theme: Responsibility to Develop Nursing as a Profession
The superordinate theme ‘responsibility to develop nursing as a
profession’ emerged from three subthemes: research as essential to de-
velop nurses recognition, provide updates in nursing care and provide
nursing care based on evidence. Student nurses form both institutions
recognised the importance of EBP and research in developing nurses
recognition and thereby developing nursing as a profession. However,

Table 2
Super-ordinate themes with transcription extracts of student nurses' perceptions of EBP and research.
Super-ordinate themes
Provide confidence, knowledge and
empowerment in clinical practice
Vital for improvements in patient
care and safety
Responsibility to develop nursing as
a profession
Realities of research in practice
J. Brooke et al. / Nurse Education Today 35 (2015) e6–e11 e9
Transcripts highlighting the essence of each theme
Subtheme: lack of awareness of EBP and research
Focus group 9 (Faculty of Health Care Jesenice):
Participant 2: “The language of research is too difficult, specific terminology is difficult to understand …”
Participant 3: “I think if we had started to learn about research in primary school and then in high school at secondary level it would be
easier for us, but now it is like entering a completely new world, which I agree is difficult.”
Focus group 4 (University of Greenwich):
Participant 3: “I always thought research was very clinically based and clinicians are trying to see what works and what doesn't. I have
always thought it [research] to be more pharmaceutically based before I started my nurse training, I didn't realise how evidence-based
the practical elements of nursing were.”
Subtheme: knowledge provided confidence in practice
Focus group 5 (University of Greenwich):
Participant 16: “I think research for me has really improved my confidence and I think I love what I have seen of research because it underpins
everything that I am hoping to do in my practice. I mean the research is my knowledge so I think it is vital, it underpins everything.”
Participant 17: “I think similarly although research has the potential to be biased, but I think that is why it is important to have the ability to
appraise individual research to make up your own mind whether there is any bias in that research, so you understand the evidence behind
your practice.”
Subtheme: knowledge was empowering in practice
Focus group 11 (Faculty of Health Care Jesenice):
Participant 14: “I had not realised the importance of research, but research informs and governs my practice, research empowers me to make
clinical decisions on scientific information.”
Focus group 3 (University of Greenwich):
Participant 7: “It doesn't matter how much research we do it will always comes down to what the patient wants and what is best for them …”
Participant 8: “I agree but research underpins the information we give to patients so they can have an informed decision …”
Participant 9: “Research is the source of all of that information we provide to patients …”
Participant 8: “I think I like research so much because it [research] is giving me so much knowledge, it is empowering me. I feel as I couldn't
give any type of argument if I didn't have the evidence behind me, so it is really empowering, to have research.”
Subtheme: informs best current practice
Focus group 3 (University of Greenwich):
Participant 5: “It [EBP and research] allows us to understand best practices, it allows us to develop better ways of caring for people,
better medicine, looking into what works and what doesn't, it gives you guidance to what is actually true… we are not just going out and
doing this kind of care for this person because that is what we have read in some book it is actually backed up by concrete evidence …”
Participant 7: “For me if you do research it will give you information about the recent updates in nursing care and with the updates we
can apply that within the care that we give so we can be in the present situation.”
Focus group 10 (Faculty of Health Care Jesenice):
Participant 6: “We are here for the people and we want to work with the people and we are aware that research is important, so we take
it as part of our job.”
Participant 10: “Research is for the good of the patients, so that is very important.”
Subtheme: exploration of poor healthcare
Focus group 8 (University of Greenwich):
Participant 41: “I think research gives us an idea of when things were done wrong and what has been done to correct it and it helps you
as an individual, as a nurse or even a student to go on the right path.”
Participant 42: “I agree, so you don't make the same mistake. I think research is studying something that has happened or something
that someone has done and see what they have done wrong and how that happened and why you shouldn't do that.”
Subtheme: provides updates in nursing care
Focus group 1 (University of Greenwich):
Participant 2: “Nursing is all about our own resources and capabilities we have a responsibility to research… out own personal
responsibility, you have got to keep reflecting what you are doing and there has to be research going on to move forward.”
Focus group 10 (Faculty of Health Care Jesenice):
Participant 5: “research is the gaining of new knowledge and we all need to research to get developed and to get new ideas into practice,
so it is something that is necessary.”
Participant 6: “Research is a part of every job …”
Participant 7: “We all have to research.”
Subtheme: research essential to develop nurses recognition
Focus group 6 (University of Greenwich):
Participant 27:“I think in the past doctors were more educated and they were the ones that completed research so there wasn't a lot
done by nurses, although I think it is coming as nurses now have degrees, masters and PhDs, so I think it is actually kind of a
development where nurses are starting to do research specifically in the nursing field because in nursing we use a log of research done
by doctors… not really by nurses, so I think this is a change that is occurring.”
Focus group 10 (Faculty of Health Care Jesenice):
Participant 7: “Perhaps research can eliminate the belief that nurses are the ones who only work and follow orders. The purpose of
research is to develop our profession, to continue learning at different levels.”
Participant 8: “Yes the purpose of research within nursing is to develop the profession, it is also to overcome the point of the view that nurses
are only as the right hand of doctors that they cannot do things, that they cannot develop things on their own as in the doctors profession.”
Participant 7: “Research helps get rid of this general belief.”
Participant 9: “Research is the way to break the taboo and the general opinion about the nursing profession.”
Subtheme: nurses involvement in research
Focus group 7 (University of Greenwich):
Participant 33: “Senior nurses, specialist nurses are involved in research, so I've seen tissue viability research, diabetes research, but it
tends to be by more senior nurses.”
Participant 31: “I have only seen doctors gathering evidence when I have been in practice.”
Participant 34: “I agree with [participant 33] it is more specialist nurses that do research, where as a band 5 [newly qualified] or a ward
nurse they don't have time to do research, they are just busy with the patients and looking after them. I wonder how long they
[ward nurses] retain the ability to do research and think like that.”
Participant 37: “I was quite shocked at the lack of ward nurses doing research in practice, my mum is a nurse and was forever doing
(continued on next page)
e10 J. Brooke et al. / Nurse Education Today 35 (2015) e6–e11

Table 2 (continued)

Super-ordinate themes Transcripts highlighting the essence of each theme

research, I don't know I expected nurses to do research, but I was kind of shocked that nobody does.”
Subtheme: nurses lack of involvement in research
Focus group 6 (University of Greenwich):
Participant 23: “I have seen nurses supporting research, which was actually more done by the doctors. The doctors gave forms to the
nurses to ask the patients to fill in, so it wasn't actually done by nurses themselves.”
Participant 24: “I think nurses are more likely to follow what happens after research than do it themselves, maybe I haven't seen a lot
just yet but from placements I have been on I haven't seen nurses carrying out research it is more research has been done and this was
the outcome and therefore you need to do things this way.”
Subtheme: how to maintain research skills when qualified
Focus group 9 (Faculty of Health Care Jesenice)
Participant 6: “I think I will need to proceed and study a Master's programme to understand research and be able to research as a
qualified nurse …”
Participant 6: “We do learn about research but more the basics of research, I don't think we could complete scientific research, not yet …”
Focus group 1 (University of Greenwich)
Participant 3: “I know how to access research journals here at the university, but I have no idea where or how I can do this when I finish this
programme.”
Participant 4: “I have asked mentors when I have been in practice and they [mentors] send me to the library, but I don't have access … so
this worries me …”

student nurses from the University of Greenwich discussed the comple-
tion of research as part of professional development within the academ-
ic setting, whereas students from the Faculty of Health Care Jesenice
discussed the importance of completing research to challenge the tradi-
tional image of nurses as the ‘right-hand’ of doctors.
Student nurses from both institutions discussed the importance of
not following routines or traditions and their personal responsibility
to become involved in research as qualified nurses to develop new
ideas and to provide contemporary nursing resources to be implement-
ed in practice.
Theme: Realities of Research in Clinical Practice
The superordinate theme of ‘realities of research in clinical practice’
emerged from three subthemes: nurses lack of involvement in research,
nurses need to become involved in research and how to maintain re-
search skills when qualified. Student nurses from both institutions
discussed the importance and relevance of EBP and research in develop-
ing nursing as a profession. However, all students agreed that this was
not necessarily the reality in clinical placements. Student nurses from
the University of Greenwich found a lack of junior nurses being involved
in research, with only specialist nurses with advanced knowledge
completing research. This was reflected in student nurses discussions
from both institutions as they expected to be involved in research in
the future, but first needed to become experienced qualified nurses.
Student nurses from both institutions discussed the importance
of nurses leading on nursing research and not just implementing
evidence-based practice. Although student nurses also discussed rea-
sons why nurses may not be actively involved in research, such as
time limitations and responsibility to care for patients. Lastly, student
nurses from both institutions questioned the ability of qualified nurses
to retain research skills, as once qualified the need to become an expe-
rience nurse would take precedence over research. Third year student
nurses from the University of Greenwich discussed their concerns on
how to access information, such as electronic journals on leaving the ac-
ademic setting. Third year student nurses from the Faculty of Health
Care Jesenice discussed the importance of completing a MSc in Health
to understand research in more depth. The combination of these
reasons led to the acceptance of a lack of research being completed in
clinical practice which was led by nurses.
Discussion
Current student nurses studying at the University of Greenwich,
England and the Faculty of Health Care Jesenice, Slovenia discussed
the importance of EBP and research with reference to their current
and future clinical practice. Student nurses from both HEIs agreed
EBP and research provided them with confidence, knowledge and
empowerment in clinical practice. Student nurses also discussed re-
alities of research in clinical practice with common issues across
both countries. This issue has been acknowledged previously with
a detrimental impact on student nurses becoming under committed
to research due to minimal exposure to research in clinical practice
(Mattila and Eriksson, 2007).
One difference between the two institutions was the emphasis stu-
dent nurses placed on patient care and safety; student nurses from the
University of Greenwich discussed the importance of EBP and research
in exploring and understanding poor healthcare to improve patient
care and safety. However, student nurses from the Faculty of Health
Care Jesenice discussed the importance of the people in their care and
the necessity of providing safe and evidence based care. Lastly, student
nurses from the University of Greenwich discussed the importance of
developing their profession through academic qualifications and
progression. However, student nurses from the Faculty of Health Care
Jesenice discussed the importance of developing nursing as a profession,
one that is separate and independent from other health professionals.
The differences in student nurses emphasis on two of the themes
may be due to the relatively new emphasis on EBP and research on un-
dergraduate nursing programmes within Slovenia. In contrast in the UK,
EBP and research has have been introduced into undergraduate nursing
programmes over the past 3 three decades. The integration of nursing
research in undergraduate nursing programmes in Slovenia has only oc-
curred in the past 10 years, and is not predominantly taught by nurses.
The Faculty of Health Care Jesenice is usual in their strong emphasis on
nursing research with modules for both student nurses and clinical
mentors. The joint focus of research across academic and clinical
settings may have reinforced the student nurses understanding of
research and the importance of research in developing nursing as a
profession in Slovenia. Over the past 10 years the modules on nursing
research have highlighted some of the obstacles to research in clinical
practice (Skela-Savič, 2009), but have also had a positive impact on
nurses attitudes, research activities and their commitment to research
in general (Strojan et al., 2012).
On qualifying, student nurses from the Faculty of Health Care
Jesenice will have acquired a good general knowledge of research and
the ability to be involved in research in clinical settings. However, this
is not uniformed practice in faculties across Slovenia; therefore caution
regarding generalising these results is required. Student nurses qualify-
ing from the University of Greenwich will have acquired the ability to
complete a literature review, rather than being involved in clinical
research. The process of a literature review involves academic skills,
which may have impacted on the views of these student nurses that
research is part of academic progression rather than clinical work.
The emergent themes of EBP and research as providing information,
confidence and empowerment in clinical practice and the responsibility
 J. Brooke et al. / Nurse Education Today 35 (2015) e6–e11
of the students is consistent with a study completed in the USA. Brown
et al. (2010) explored knowledge and attitudes of EBP of nursing
students at two universities and found both knowledge and attitudes
increased with academic levels. Increased knowledge and positive atti-
tudes were predictors for EBP use and future use of EBP (Brown et al.,
2010). However, a national study in Sweden exploring nursing students'
perceptions of being supported to develop their EBP and research skills
reported greater support through nurse educators than clinical mentors
(Florin et al., 2012). The difficulty of teaching nursing students EBP
across educational settings and clinical placement is well recognised.
Smith-Storm et al. (2012) study of a small group of second year nursing
students suggests these students were able to implement EBP according
to the goals of their programme, but were not provided with the oppor-
tunity due to time constraints of clinical placements and a lack of
sufficiently trained clinical nurse mentors. The results of these three
studies demonstrate the need to support nursing students across both
educational settings and clinical placements to increase knowledge,
positive attitudes and successful implementation of EBP.
The emergent theme of EBP and research as vital for improvements
in patient care and safety is widely recognised in literature. Melynk et al.
(2014) acknowledge EBP improves healthcare quality and patients
outcomes but is not standard practice across the globe. Recent develop-
ment of 13 competencies for registered nurses and 11 additional com-
petencies for advanced practice nurses to provide EBP aims to address
this issue (Melynk et al., 2014). How the competencies will impact on
nursing care and patient outcomes, and how the competencies will be
adopted by the ICN/NMC remains unclear. However, Jeff et al. (2013)
developed a measurement framework to assess the impact of such
competencies, and in particular clinical and professional guidelines,
especially focusing on patient outcomes. The framework is a multiface-
ted approach that has potential to be applied to other organisations
providing healthcare, which will begin to provide outcomes of the
implementation of EBP.
The emergent theme of EBP and research as essential in the develop-
ment to the nursing profession is consistent with an attribute of a pro-
fession which is a knowledge base grounded in research (Johnson
et al., 2010). Estes et al. (2009) acknowledge qualified nurses need to
balance research with their primary responsibility for patient care and
many nurses to do not feel they have the education and skills to conduct
research in clinical practice. Newly qualified nurses through the devel-
opment of new curriculum may have enhanced skills to conduct
research, but these skills as identified by the participants of this study
may be forgotten or lost prior to being put to practice as the need to
develop clinically as a qualified nurse is the first priority.
Conclusion
Nursing students from the University of Greenwich and the Fac-
ulty of Health Care Jesenice who participated in this study under-
stood the importance of EBP and research, the benefits for their
patients, the need to implement EBP and become actively involved
in research. For the vision of these nursing students to be fulfilled
further support across clinical placement and the development of
clinical mentors to engage students in EBP and research is required.
Nursing students need to be engaged in EBP and research through-
out their programme to demonstrate how these can be achieved
and maintained as they become qualified nurses. Further research
is required to explore how this can be achieved at a practical level.
e11
Acknowledgements
Thank you to the student nurses who took time to become involved
in the focus groups. No funding was obtained externally for the comple-
tion of this study.
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