Evidence-Informed Education and Practice in Collaborative Learning Units: A Mixed-Methods Study

Abstract

Purpose: The primary purpose of this study was to evaluate evidence-informed practice knowledge, capacity, and skills of senior baccalaureate nursing students, nurses, and nursing faculty involved with the dedicated education unit/collaborative learning unit (DEU/CLU) practice education model. Secondary objectives were to 1) explore student, nurse, and faculty DEU/CLU practice education experience, and 2) obtain nurses views of the DEU/CLU practice education model and suggestions for improvement.

Method: We used a convergent parallel mixed-methods design with a nested case study. Data were collected across 23 DEU/CLUs within three acute care facilities and one university with students (n = 18), nurses (n = 97), and academic faculty (n = 7) for 122 participants. Survey questions used 5-point Likert scales and were analyzed using proportion of positive responses, stratified by group. Differences between groups were assessed using confidence intervals. Four focus groups for nurses (n = 10) were conducted across six clinical units in two facilities to enhance richness of nurses’ views of the DEU/CLU practice education model. NVivo software was used to support inductive thematic analysis of qualitative data.

Results: Students, nurses, and academic faculty had similar patterns of evidence-informed practice knowledge, capacity, and skills, except for integration of research findings into quality improvement initiatives, where faculty and nurses reported significantly more knowledge than students. Nurses and academic faculty expressed concerns regarding limited opportunities for collaboration between practice and education, challenges with communication around student progress, and insufficient resources to support the DEU/CLU learning model. Nurses reported benefits of DEU/CLUs including collaborative team learning for students and opportunity for independence, while challenges included students with greater learning needs “falling through the cracks” in the absence of a consistent nurse overseeing their learning progress. Nurses suggested a DEU/CLU and preceptor hybrid approach, titrated for transitioning between the two based on the individual students’ capacity, confidence, and comfort levels. Nurses expressed that the DEU/CLU model enables evidence-informed nursing practice through practice–academic collaboration provided that experienced nurses are available, and unit census and nurse–patient ratios are appropriate.

Conclusion: Critical resources for student clinical education and evidence-informed clinical learning environments include strong inter-institutional collaborative partnerships, nurse and academic faculty mentoring and orientation, and formalized communication channels. Adequately supported DEU/CLUs with available experienced nurses and appropriate nurse–patient ratios, in collaboration with strong practice–academic partnerships enable development of evidence-informed nursing skills and practice.