A measurement properties systematic review of instruments for assessing undergraduate nursing students’ evidence-based practice knowledge, attitudes, and skills

Article type
Cardoso D1, Riitano D2, Stephenson M2, Santos E1, Cardoso ML3, Rodrigues M1, Apóstolo J1
1Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra
2Joanna Briggs Institute, School of Translational Health Science, University of Adelaide
3Health Sciences Research Unit: Nursing, Nursing School of Coimbra
Background: Using evidence-based practice (EBP) in clinical practice have multiple benefits, such as improvement of patient outcomes, decrease health care costs, and increase quality of care. As education is a strategy to promote the EBP use in clinical practice, undergraduate nursing curricula should be based on EBP principles to train future nurses on EBP use. Therefore, good quality instruments are needed to measure undergraduate nursing students’ EBP attitudes, knowledge, and skills and, consequently, the impact of the EBP educational programs in those outcomes.

Objectives: To assess the measurement properties of the available instruments for measuring undergraduate nursing students’ EBP knowledge, attitudes, and skills.

Methods: This systematic review was conducted in accordance with a priori published protocol and was registered in PROSPERO (CRD42017074920).
A search strategy in 3 steps from 1996 until July 2018 was performed to find studies in Portuguese, English and Spanish. Two independent reviewers analyzed the title/abstract and the full-text against the inclusion criteria. Using the COSMIN Checklist, two independent reviewers performed the critical appraisal and a third reviewer analyzed the disagreements. Details of general characteristics of the instruments; characteristics of the study populations in which the measurement properties were validated; and the results of the measurement properties were extracted from each included paper. Overview tables were created to synthesize the data.

Results: We found 1942 records. From these, 11 papers were included reporting data on the following five instruments: Evidence Based Practice Questionnaire; Student Evidence-based Practice Questionnaire; Evidence-based Practice Knowledge Assessment in Nursing; Evidence Based Practice Evaluation Competence Questionnaire; and Evidence-based practice profile questionnaire.
No study assessed measurement error and criterion validity. Only the internal consistency was assessed by all studies with very good methodological quality. Responsiveness was assessed only by one study but with inadequate methodological quality. The methodological quality of the structural validity varied across the eight studies from inadequate to very good. The methodological quality of the remaining measurement properties assessed in the included studies varied from inadequate to adequate.

Conclusions: We found five instruments to measure undergraduate nursing students’ EBP knowledge, attitudes, and skills. However, only two measured the three constructs of interest.
Due to the low number of studies per instrument version (e.g., language and context), it was not possible to perform a best-evidence synthesis.

Patient or healthcare consumer involvement: The input of nurses and nursing educators was sought to guide the design of the systematic review.