Post a critique of the research study in which you: Evaluate the research questions and hypotheses. The Research Questions and Hypotheses Checklist serves as a guide for your evaluati

Original Article

Faculty Perception of the Effectiveness of EBP Courses for Graduate Nursing Students Renáta Zelenı́ková, RN, PhD • Michael Beach, DNP, ACNP-BC, PNP • Dianxu Ren, MD, PhD • Emily Wolff • Paula Sherwood, RN, PhD, CNRN, FAAN

Keywords

evidence-based practice,

faculty, teaching, curricula

ABSTRACT Background: Effective teaching is key in preparing students to become successful evidence- based healthcare professionals. The effectiveness of graduate evidence-based practice (EBP) pedagogy is not often a subject of research studies.

Purpose: The purpose of this study was to determine how faculty from the 50 top graduate nursing schools in the United States perceived the effectiveness of EBP courses for graduate nursing students.

Methods: A descriptive cross-sectional design was used to explore faculty perception of the effectiveness of EBP courses. A web-based survey was used for data collection. A total of 45 questionnaires were subjected to statistical analysis.

Results: The mean perception of the effectiveness of EBP courses for the whole sample, on a scale from 1 to 7, was 5.58 (min. 4.29; max. 6.73), a higher score signifying higher perceived effectiveness. The highest rated item concerned a school’s access to different databases. The strongest correlations were found between the total score and the scores for items describing students’ opportunities to strengthen and apply their EBP skills (rs = .66). The internal consistency of the Perception of Effectiveness of EBP Courses scale, based on standardized Cronbach’s alpha, was .84, which signifies strong internal consistency. Faculty perceived themselves as most competent at the following EBP skills: (a) “Asking questions regarding patients’ care” (6.56), (b) “Considering patient preferences when implementing EBP” (6.40), and (c) “Critically appraising the relevant body of evidence to address clinical questions” (6.40).

Discussion: To strengthen the effectiveness of EBP courses, students should have more oppor- tunities to implement their EBP knowledge and skills after completing EBP courses.

Linking Evidence to Action: Evaluation of faculty perceptions of the effectiveness of EBP courses can help to guide the development of nursing school curricula that better integrate EBP. Further evaluation of the psychometric properties of the instrument used to measure perception of the effectiveness of EBP courses is required along with objective measures of faculty knowledge and skills in teaching EBP.

BACKGROUND AND SIGNIFICANCE Worldwide, evidence-based practice (EBP) has emerged as a major healthcare initiative (Thiel & Ghosh, 2008). One of the most consistent findings in health service research is the gap between best practice (as determined by scientific evidence) and actual clinical care (Flores-Mateo & Argimon, 2007). To accel- erate the translation of research findings into clinical practice, two major outcomes must be achieved: (a) Advanced practice and direct care nurses must acquire sufficient EBP knowledge and skills as well as strong beliefs about the value of EBP in clinical settings, and (b) educators must teach their students the EBP process to instill in them lifelong skills and the motivation to deliver the highest quality of care (Melnyk, Fineout-Overholt, Feinstein, Sadler, & Green-Hernandez, 2008).

Findings from a recent national survey by Melnyk, Fineout- Overholt, Gallagher-Ford, and Kaplan (2012) indicated that nurses surveyed across the country are ready for and do value EBP. The majority of participants who responded to the survey reported wanting to gain more knowledge and skills in order to deliver evidence-based care in their institutions. Nurses cited a top requirement for helping them implement EBP in daily practice as education.

For students to become evidence-based healthcare profes- sionals, the teaching of EBP has to be effective (Spek, Wolf, Dijk, & Lucas, 2012). Little has been published about teach- ing EBP to nursing students (Stiffler & Cullen, 2010). Though there are systematic reviews and meta-analyses of teaching EBP in schools of medicine, there is a dearth of research in nursing,

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Perception of Effectiveness of EBP Courses

especially in regard to graduate-level EBP pedagogy. According to Fineout-Overholt and Johnston (2005), further research is needed to assess effective teaching and evaluation strategies for EBP.

Teaching EBP to nursing students is usually based on the basic steps of EBP. Melnyk and Fineout-Overholt (2011) added two more steps to the five basic steps of EBP, which include: (a) cultivate a spirit of inquiry; (b) ask the burning clinical question in PICOT (P = patient population; I = intervention or area of interest; C = comparison intervention or group; O = outcomes; and T = time) format; (c) search for and collect the most relevant best evidence; (d) critically appraise the evidence; (e) integrate the best evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change; (f) evaluate outcomes of the practice decision or change based on evidence; and (g) disseminate the outcomes of the EBP decision or change. The seven steps of EBP can serve as a structure around which to build EBP curriculum for graduate nursing students.

The effectiveness of graduate EBP pedagogy is not often a subject of research studies. One of the problems is the com- plexity of the EBP process and the difficulty of assessing all aspects of its effectiveness. Shaneyefelt and colleagues (2006) performed a systematic review of EBP instruments. Their re- sults showed that the majority of instruments targeted stu- dents and postgraduate trainees, whereas nonphysicians were rarely evaluated. The available instruments most commonly evaluated EBP skills (predominantly focusing on the critical ap- praisal of evidence), knowledge, attitudes, and behaviors. Most instruments are designed for specific purposes, such as the evaluation of theoretical EBP courses (instruments to assess cognitive skills), or the evaluation of EBP in clinical practice (instruments to assess performance-based skills and applica- tion; Ilic, 2009).

The instrument used in this study for measuring the per- ception of the effectiveness of EBP courses was inspired by the ARCC-E (advancing research and clinical practice through close collaboration and education) conceptual model for teaching EBP (Melnyk & Fineout-Overholt, 2011). This model shows that organizational support, the identification of curricular strengths and barriers to teaching EBP and use of faculty EBP mentors play an important role in the effectiveness of EBP pedagogy. Based on this model, the parameters of effective EBP courses were set. The neces- sary conditions for successful EBP courses are: curricular strengths, organizational support, teachers’ mastery of EBP, and teachers’ involvement in EBP learning. In our instru- ment, we focused on the evaluation of the effectiveness of EBP courses from a faculty perspective. Therefore, items re- flected faculty perception of the integration of EBP in the curriculum, faculty involvement in learning and expectations they had of their students, mastery of subject matter, and or- ganizational support.

The instrument for measuring faculty perception of their own and students’ competence in EBP skills was designed to

address all seven steps of the EBP process based on a modified version of the list of EBP skills in Melnyk et al. (2008). EBP skills can be divided into three groups:

� Skills related to the implementation and dissemina- tion of EBP (e.g., applying synthesized evidence to initiate change, mentoring/teaching EBP to others).

� Skills in searching for and appraising evidence (e.g., searching efficiently for evidence, critically apprais- ing the relevant body of evidence to address clinical questions).

� Skills relating to cooperation with the clinical envi- ronment (e.g., assessing the clinical environment for readiness for EBP, asking questions regarding pa- tients’ care).

Teacher competency is one of the most important factors in the learning process. To be able to deliver EBP knowledge and skills properly, faculty have to be experts in these skills. However, there is a lack of studies focusing on the competence of teachers of EBP courses and on how they perceive their own EBP skills. It is not well known how competent graduate nursing faculty members are in EBP knowledge and skills.

This study focuses particularly on faculty perception of the effectiveness of EBP courses and faculty perception of their own competence in EBP skills. Inclusion of a core EBP course in graduate nursing curricula is essential to establishing a foun- dation from which EBP knowledge and skills can be further de- veloped in the remainder of the students’ didactic and clinical coursework (Melnyk et al., 2008). Evaluation of the effective- ness of EBP courses can inform the improvement of future programs.

Three main research questions guided this study:

(1) What are faculty perceptions of the effectiveness of EBP courses for graduate nursing students?

(2) What are faculty perceptions of their own compe- tence in EBP skills?

(3) As judged by their teachers, how competent in EBP skills are students upon completion of EBP courses?

PURPOSE The purpose of this descriptive cross-sectional study was to de- termine how faculty from the 50 top graduate nursing schools in the United States perceived the effectiveness of EBP courses for graduate nursing students.

METHODS Study Design and Methods A descriptive cross-sectional design was used to explore per- ception of the effectiveness of EBP courses and perception of competence in EBP skills. A web-based survey was used

402 Worldviews on Evidence-Based Nursing, 2014; 11:6, 401–413. C© 2014 Sigma Theta Tau International

Original Article for data collection. Data collection was conducted by sending potential respondents an e-mail with a hyperlink to the web- based survey. Faculty members agreeable to participating were required to click on the link in the e-mail directing them to a study-specific, secured Survey Monkey website. The website consisted of a questionnaire that was developed by the investi- gators to assess perceptions of the effectiveness of EBP courses and perceptions of EBP skills. The questionnaire took approx- imately 5–10 minutes to complete.

Sample and Data Collection The sample population consisted of faculty from the top 50 graduate nursing schools across the United States according to the Top Universities in U.S. website (http://www.university-list.net/us/rank/univ-20131118.htm), who taught EBP courses for graduate nursing students.

Sixty-two nursing schools were contacted through their deans’ offices. E-mails were sent to the deans. Each e-mail con- tained a cover letter addressed to the dean and a cover letter for faculty members involved in teaching EBP courses. Deans who were agreeable to their faculty participating in the study were re- quested to forward an e-mail including the latter cover letter and a study-specific, secure, and de-identified link to the web-based survey to faculty members involved in teaching EBP courses. Deans of five nursing schools did not agree to their faculty par- ticipating in the study. E-mails were sent only once. Data were collected from the middle of January 2013 through the middle of March 2013. The study was conducted in three steps.

Step 1: Development of a questionnaire for evaluating the effectiveness of teaching EBP in nursing. The survey items were developed by the authors. Survey items were derived from the literature and from the authors’ teaching experiences. Items measuring perception of the effectiveness of EBP courses were devised in consultation with an expert from the Center for Instructional Development and Distance Education at the Uni- versity of Pittsburgh.

The survey was comprised of the following sets of ques- tions:

(1) Fifteen questions on the survey employed a scale of 1 (strongly disagree) to 7 (strongly agree) to assess per- ception of the effectiveness of EBP courses. These questions covered four areas: perception of the in- tegration of EBP in the curriculum, faculty involve- ment in EBP learning and the expectations they had of students, mastery of subject matter, and organiza- tional support.

(2) Fourteen questions included in the survey employed a scale of 1 (not at all competent) to 7 (extremely compe- tent) to assess faculty perceptions of their own com- petence in EBP skills. A list of EBP skills was adapted from Melnyk and colleagues (2008) with the consent of the first author. The list of skills did not include those with an immediate bearing on patient care.

These skills were added following an analysis of the definition of EBP by the researchers, and reflected a consensus reached among them. Besides this modi- fication, some items on the original list were omitted and others were paraphrased to make the question- naire more accessible to participants.

(3) Fourteen questions employed a scale of 0 (not well at all) to 7 (extremely well) to measure faculty per- ceptions of students’ competence in EBP skills af- ter completing EBP courses. Faculty members were asked how well students who had completed EBP courses had mastered a specific set of EBP skills. The list of EBP skills was the same as the list of EBP skills for faculty.

(4) Sample characteristics (e.g., gender, age, years of ex- perience teaching EPB courses, number of years as a faculty member, and training in teaching EBP).

(5) Questions regarding teaching strategies (e.g., barri- ers to teaching EBP, the most important EBP skills to focus on).

Once the survey items were developed, they were reviewed for content validity and clarity by an interdisciplinary group of EBP experts.

Step 2: Conversion of paper survey to web-based survey and pilot testing. The paper survey was converted to a web version and piloted by the authors and several colleagues. Issues and limitations with the design of the web-based survey were dis- cussed within the research team and modifications were made to increase ease of use.

Step 3: Web-based survey. Questionnaires were completed online via SurveyMonkey, which keeps data private, safe, and secure.

ETHICAL CONSIDERATIONS Approval was obtained from the Institutional Review Board of the University of Pittsburgh prior to participant recruitment. A cover letter explaining the aim of the study was attached to all surveys. The cover letter also addressed the voluntary nature of the survey and guaranteed confidentiality to the fullest possible extent. Completing the questionnaire served as a participant’s consent to take part in the research study. The total duration of subject participation was the time taken to complete a one-time questionnaire.

STATISTICAL ANALYSIS Descriptive statistics were used to describe the sample char- acteristics and perceptions of effectiveness of EBP courses as well as perceptions of competence in EBP skills. The Spear- man Correlation coefficient was used to examine the correla- tion between the total score for the instrument and the score for each item. Reliability of the scale was measured by Cronbach’s

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Perception of Effectiveness of EBP Courses

Alpha. Interitem correlations were calculated and an item- total analysis was performed. The Kaiser-Meyer-Olkin Measure of Sampling Adequacy and Bartlett’s Test of Sphericity were conducted before factor analysis. Factor analysis (extraction method: principal component analysis) with Varimax rotation was performed. Statistical analyses were conducted using the Statistical Package for the Social Sciences 16.0 for Windows (SPSS, Chicago, IL, USA).

RESULTS Fifty-seven nursing schools deemed likely to agree to partici- pate were contacted. In response, 74 questionnaires from fac- ulty were received, though not all of them were complete. A total of 45 completed questionnaires (60%) had less than 5% of the data missing and were used in the statistical analysis. The majority of participants were involved in teaching EBP courses. Approximately two-thirds of the participants were teaching EBP courses for graduate students (62.3%), others were teaching EBP courses for both graduate and undergraduate students (15.5%), or were teaching EBP courses for undergraduate stu- dents (13.3%), or else included EBP content in other courses (8.9%). Of the entire sample, 42 (93.3%) participants were fe- male and 3 were male (6.7%). The largest segment of the sam- ple, 24 (53.4%), were 56 years old or older, whereas 15 (33.3%) were 46–55 years old. More than 80% of those surveyed had been faculty members for more than 6 years. Approximately two-thirds of participants had been teaching EBP courses for 4 or more years. Of all the participants, 30 (66.7%) cited self- study as their primary training in the teaching of EBP, whereas 12 (26.7%) received several days of training, and 3 (6.6%) of the participants used online training (see Table 1).

Teaching Strategies Faculty from the top 50 graduate nursing schools across the United States cited lectures (n = 32; 71.1%), projects (n = 32; 71.1%), group work (n = 31; 68.9%), computer-based teach- ing strategies (n = 26; 57.8%), training students to critically appraise a published article (n = 26; 57.8%), and training stu- dents to develop clinical protocols (n = 8; 17.8%) as the most frequently used teaching strategies in EBP courses. The num- ber of students enrolled in EBP courses was 5–20 (n = 21; 46.6%), 21–40 students (n = 12; 26.7%), and 41 or more (n = 12; 26.7%).

Barriers to the Teaching of EBP The main barriers to the teaching of EBP identified by faculty were (a) time (n = 8) “limited class time and competition for that time with so many other skills and theory,” (b) insufficient statistical and research background of students (n = 5), (c) lack of faculty experts in the area of EBP (n = 4), and (d) large class size (n = 3).

The Most Important EBP Skills to Teach According to our sample, the most important EBP skills to focus on when teaching EBP courses are:

� Critically appraising the relevant body of evidence to address clinical questions (n = 37; 82.2%);

� Searching efficiently for evidence that answers the clinical questions (n = 29; 64.4%);

� Synthesizing evidence to make decisions about pa- tient care (n = 27; 60%);

� Formulating searchable, answerable clinical ques- tions in PICOT format (n = 24; 53.3%);

� Selecting the best evidence from what is found in the search (n = 21; 46.7%);

� Analyzing outcomes of evidence-based interventions, practice changes, and clinical guidelines (n = 20; 44.4%).

Perception of the Effectiveness of EBP Courses The mean perception of the effectiveness of EBP courses mea- sured on a scale from 1 to 7 was 5.58 (s2 0.45; min. 4.29; max. 6.73) for the whole sample, and the mean perception of faculty competence in EBP skills was 6.16 (s2 0.06; min. 5.73; max. 6.56). In both cases, a higher score signifies higher perceived effectiveness or competency (see Table 1).

Reliability. The interitem correlations of the 15 items ranged from −.16 to .98, with the majority being around .40. The inter- nal consistency of the scale, based on standardized Cronbach’s alpha, was .84, which signifies strong internal consistency. The item-total analysis showed a range for Cronbach’s alpha if item deleted from .81 to .85, showing that every item contributes to the overall reliability.

Factor analysis of perception of the effectiveness of EBP courses. A factor analysis (extraction method: principal com- ponent analysis) with Varimax rotation in SPSS was performed on the 15 items of the Perception of the Effectiveness of EBP Courses scale. A ratio of 3:1 (subject-to-variables) was used in the sample. The minimum sample size according to Mund- from, Shaw, and Ke (2005), with good level for variables-to- factors ratio set at seven and the number of factors set at three, is 40–65. The Kaiser-Meyer-Olkin Measure of Sam- pling Adequacy was .647, above the .6 suggested minimum. Bartlett’s Test of Sphericity was significant (<.001). Four fac- tors emerged with eigenvalues over 1.0 (5.47; 2.44; 1.34; 1.2). The results for the four factors can be found in Table 2. The first factor explains 36.3% of the variance; the second fac- tor explains 16.3% of the variance; the third factor explains 8.9% of the variance, and the fourth factor explains 8% of the variance. The first factor, labeled “Integration EBP in cur- riculum,” contains five items and assesses a school’s commit- ment to teaching EBP, the integration of EBP concepts in the

404 Worldviews on Evidence-Based Nursing, 2014; 11:6, 401–413. C© 2014 Sigma Theta Tau International

Original Article Table 1. Sample Characteristics (n = 45)

Characteristics n %

Gender Female 42 93.3

Male 3 6.7

Age 36–45 years 6 13.3

46–55 years 15 33.3

56 or over 24 53.4

Years as a faculty member 1–5 years 8 17.8

6–10 years 12 26.7

11–20 years 9 20

21–30 years 9 20

31 or more years 7 15.5

EBP courses taught For graduate students 28 62.3

For undergraduate students 6 13.3

For graduate and undergraduate students 7 15.5

As a part of other courses 4 8.9

Years of teaching EBP courses 1–3 years 15 33.3

4–6 years 13 28.9

7–10 years 8 17.8

11 or more years 5 11.1

Not applicable 4 8.9

Training in teaching EBP Self-study 30 66.7

Several days of training 12 26.7

Online training 3 6.6

Sources used for primary training in EBP Reading journals 34 75.6

Reading textbooks 31 68.9

Conferences 22 48.9

Conversations with other instructors 18 40

Workshops 13 28.9

Webinars 11 24.4

Online tutorials 11 24.4

Mean (s2) Min; Max (range)

Perception of effectiveness of EBP courses (number of items: 15) 5.58 (.45) 4.29; 6.73 (2.44)

Perception of faculty competence in EBP skills (number of items: 14) 6.16 (.06) 5.73; 6.56 (.82)

Note. s2: sample variance.

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Perception of Effectiveness of EBP Courses

Table 2. The 15 Items of “Perception of the Effectiveness of EBP Courses Scale” Arranged According to Four Factor Model (n = 45)

Statement Standardized factor loadings

Factor 1—Integration EBP in curriculum (five items)

It is part of the philosophy or mission of my school to teach EBP 0.678

EBP concepts are integrated in the curriculum of my school 0.799

My school supports teaching EBP in separate EBP courses 0.767

My school supports teaching EBP in other courses (i.e., clinical courses) 0.794

Students completing EBP courses typically have opportunities elsewhere in the curriculum to strengthen and apply their EBP skills

0.522

Factor 2—Teacher’s involvement in EBP learning and expectations (five items)

I serve as an EBP mentor to other healthcare professionals 0.662

I would like to serve as an EBP mentor to other healthcare professionals 0.803

I have high expectations of what graduate nursing students can achieve in EBP courses 0.671

EBP courses are very useful for graduate nursing students 0.638

Graduate nursing students view EBP courses favorably in comparison to other courses 0.716

Factor 3—Teachers’ mastery (three items)

There are librarians who have EBP knowledge involved in teaching EBP courses 0.430

I have sufficient knowledge of EBP 0.895

I have adequate EBP skills 0.916

Factor 4—Organizational support (two items)

My school has access to different search databases (i.e., PubMed, CINAHL) 0.882

Educators from my school cooperate with healthcare institutions to incorporate EBP in clinical practice 0.474

curriculum, support for teaching EBP in separate EBP courses and as part of other courses, and students’ opportunities for strengthening and applying EBP skills in the curriculum. The second factor, labeled “Teacher’s involvement in EBP learning and expectations,” contains five items and assesses EBP men- torship and willingness to serve as an EBP mentor to other healthcare professionals, perception of the popularity and use- fulness of EBP courses for graduate nursing students, and faculty expectations concerning student achievement in EBP courses. The third factor, labeled “Teacher’s mastery,” contains three items and assesses perception of knowledge and skills, as well as librarians’ involvement in teaching EBP courses. The fourth factor, labeled “Organizational support,” contains two items and assesses a school’s access to different databases and the cooperation of its personnel with healthcare institutions.

Perception of the effectiveness of EBP courses was mea- sured using a 15-item instrument (Perception of the Effective- ness of EBP Courses scale). Respondents were asked to rate on a scale of 1 (strongly disagree) to 7 (strongly agree) how they

perceived the effectiveness of EBP courses for graduate nursing students. The average total score for perception of the effective- ness of EBP courses for all items was 84.76 (SD 12.14; min. 46; max. 105), with 105 a maximum possible score (the potential range was 15 to 105).

The highest rated item was, “My school has access to differ- ent search databases” (6.73). Other highly rated items were the following: “EBP courses are very useful for graduate nursing students” (6.51), and “I have high expectations of what gradu- ate nursing students can achieve in EBP courses” (6.16). The item “I serve as an EBP mentor to other healthcare profession- als” was ranked the lowest (4.29), with the item “I would like to serve as an EBP mentor to other healthcare professionals” ranked just above it (4.36; see Table 3).

All correlations between the score for each item and the total score for perception of the effectiveness of EBP courses were positive. The weakest correlation (.28) was found between the score for the item “My school has access to different search databases” and the total score. This was the only nonsignificant

406 Worldviews on Evidence-Based Nursing, 2014; 11:6, 401–413. C© 2014 Sigma Theta Tau International

Original Article Table 3. Perception of Effectiveness of EBP Courses for Graduate Nursing Students (n = 45)

Statement Mean* Range SD

My school has access to different search databases (i.e., PubMed, CINAHL) 6.73 4—7 .75

EBP courses are very useful for graduate nursing students 6.51 4—7 .82

I have high expectations of what graduate nursing students can achieve in EBP courses 6.16 3—7 1.07

It is part of the philosophy or mission of my school to teach EBP 6.02 2—7 1.36

Students completing EBP courses typically have opportunities elsewhere in the curriculum to strengthen and apply their EBP skills

5.80 3—7 1.25

My school supports teaching EBP in other courses (i.e., clinical courses) 5.69 1—7 1.49

EBP concepts are integrated in the curriculum of my school 5.69 1—7 1.52

I have adequate EBP skills 5.60 1—7 1.34

There are librarians who have EBP knowledge involved in teaching EBP courses 5.58 1—7 1.90

I have sufficient knowledge of EBP 5.49 1–7 1.44

Educators from my school cooperate with healthcare institutions to incorporate EBP in clinical practice 5.29 1—7 1.63

My school supports teaching EBP in separate EBP courses 5.27 1—7 1.80

Graduate nursing students view EBP courses favorably in comparison to other courses 5.24 2—7 1.40

I would like to serve as an EBP mentor to other healthcare professionals 4.36 1—7 2.12

I serve as an EBP mentor to other healthcare professionals 4.29 1—7 2.16

Note. *1 (strongly disagree) to 7 (strongly agree).

correlation. The strongest correlations were found between the total score and the scores for items describing (a) students’ opportunities to strengthen and apply their EBP skills (.66), (b) the incorporation of EBP education as part of the mission of the school (.66), (c) students’ attitude to EBP courses (.64), (d) teachers’ high expectations of what students can achieve in EBP courses (.64), (e) adequacy of teachers’ knowledge (.61) of EBP and adequacy of their EBP skills (.59), and (f) whether librarians were involved in teaching EBP courses (.55).

Perception of Faculty Competence in EBP Skills Perception of faculty competence in EBP skills was measured using a 14-item instrument. A scale of 1 (not at all competent) to 7 (extremely competent) was employed. The average total score for perception of the effectiveness of EBP courses was 83.71 (SD 12.6; min. 52; max. 98), with 98 the maximum score (the potential range was 14–98).

Reliability. The initial testing of the 14 items comprising the Perception of Competence in EBP Skills scale was conducted with a group of 45 faculty from the 50 top nursing graduate schools across the United States. The interitem correlations of the 15 items ranged from .08 to .95, with the majority being around .50. The reliability analysis yielded a Cronbach’s alpha coefficient of .93. The item-total analysis showed a range for

Cronbach’s alpha if item deleted from .92 to .94, showing that every item contributes to the overall reliability.

Factor analysis of the perception of competence in EBP skills scale. A factor analysis (extraction method: principal component analysis) with Varimax rotation in SPSS was per- formed on the 14 items of the Perception of Faculty Compe- tence in EBP Skills scale. The Kaiser-Meyer-Olkin Measure of Sampling Adequacy was .818. Bartlett’s Test of Sphericity was significant (<.001). Three factors (see Table 4) emerged with eigenvalues over 1.0 (7.76; 1.84; 1.23). The first factor explained 55.5% of the variance; the second factor explained 13.2% of the variance; the third factor explained 8.8% of the variance. The first factor, labeled “Skills for Implementation and Dissemination,” contained six items and assessed the abil- ity to challenge current institutional or unit-based practices, to apply synthesized evidence to initiate change, to analyze the outcomes of evidence-based interventions, to mentor others in EBP, to communicate best evidence to the patient, and to consider patient preferences when implementing EBP. The second factor, labeled “Skills for Searching and Appraising Evidence,” contained four items and assessed the ability to ef- ficiently search for evidence that answers clinical questions, to select the best evidence, critically appraise the evidence and synthesize

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