lable at ScienceDirect

Nurse Education in Practice xxx (2013) 1e7

Contents lists avai

Nurse Education in Practice

journal homepage: www.elsevier .com/nepr

A model (CMBP) for collaboration between university college andnursing practice to promote research utilization in students’ clinicalplacements: A pilot study

Jette Elsborg Foss a,*, Kari Kvigne b,1, Bodil Wilde Larsson b,2, Elsy Athlin b,3

aDepartment of Nursing and Mental Health, Faculty of Public Health, Hedmark University College, N-2418 Elverum, NorwaybDepartment of Health Sciences, Faculty of Health, Science and Faculty of Health Science and Technology, Karlstad University, S-651 88 Karlstad, Sweden

a r t i c l e i n f o

Article history:Accepted 13 November 2013

Keywords:Evidence-based practiceResearch utilizationNursing educationCollaboration

* Corresponding author. Tel.: þ47 624 30 787, þ47E-mail addresses: jette.foss@hihm.no, jette.foss@g

1 Tel.: þ47 624 30 231, þ47 928 67 181 (mobile).2 Tel.: þ46 (0) 54 700 24 86, þ46 (0) 70 522 13 533 Tel.: þ46 (0) 54 700 24 86, þ46 (0) 76 809 28 67

1471-5953/$ e see front matter � 2013 Elsevier Ltd.http://dx.doi.org/10.1016/j.nepr.2013.11.008

Please cite this article in press as: Foss, J.E., eresearch utilization in students’ clinicalj.nepr.2013.11.008

a b s t r a c t

Background: A collaborative project was initiated in Norway between a university college and a hospitalin order to improve RNs’ and nursing students’ research utilization in clinical placements. This paperdescribes the model (CMBP) that was developed, its first application, and evaluation.Aim: The evaluation aimed at describing nurses’ and students’ experiences of the CMBP related tocollaboration, facilitation, learning, and impact on nursing care.Methods: Thirty-eight students from the second and third year of nursing education, and four nursesanswered questionnaires with closed and open ended questions. In addition two of the nurses wrotediaries. Data were subjected to qualitative and quantitative analysis.Findings: Almost all participants reported that collaboration between nursing college and nursingpractice had been beneficial. Most students and all nurses reported about valuable learning, increasedunderstanding of research utilization, and improved quality of nursing care. Both students and RNsrecommended the CMBP to be used in all clinical placements to support academic learning and increaseresearch utilization in clinical practice.Conclusion: Despite study limitations the findings indicate that the CMBP has a potential to be a usefulmodel for teaching RNs’ and students EBP. However, further refinement of the model is needed, followedby a more comprehensive implementation and evaluation.

� 2013 Elsevier Ltd. All rights reserved.

Background

In nursing today registered nurses (RNs) are expected to applyresearch findings in their daily work in order to give patients thebest possible nursing care. Moreover, the importance of an aca-demic learning environment for nursing students in their clinicalplacements has been stressed for many years (Flesner et al., 2006).As a result of this, models for facilitating research utilization innursing practice have been developed in the last decade. These aredescribed and to some extent also evaluated in the large amount ofliterature on the subject (Rosswurm and Larrabee, 1999; Rycroft-Malone, 2004; Gerrish et al., 2006; Kitson et al., 2008). Commonto many of these models is the emphasis on the importance oforganizational support, involvement of nurse leaders and

414 27 542 (mobile).mail.com (J.E. Foss).

(mobile).(mobile).

All rights reserved.

t al., A model (CMBP) for collaplacements: A pilot study

knowledgeable and interested clinical nurses with regard to theutilization of research findings (Kajermo, 2004; Kitson et al., 2008).Rycroft-Malone (2004) has presented a framework, called “Pro-moting Action on Research Implementation in Health Services”(PARIHS). In this framework, three core elements are highlighted:the level of evidence, the context inwhich the change is expected totake place, and the facilitator’s role in the implementation process.The framework highlights the fact that it is not only the individualnurse who is responsible for making use of research in practice, butalso the whole organisation, with the emphasis on the leaders ashaving a key role (Rycroft-Malone et al., 2009).

In Norway, as in many other countries, the law relating to healthpersonnel puts a demand on clinical nurses to base their work onthe best available research findings, their experiences, and thepatient’s values and preferences (Helse- og omsorgsdepartementet,2001; Robertson and Jochelson, 2006; Kitson, 2004). In line withthis, the Norwegian nursing education has been transferred to anacademic level since the 1990s with 3 years of training for abachelor degree. Nursing students today learn about EvidenceBased Practice (EBP) including such things as searching for and

boration between university college and nursing practice to promote, Nurse Education in Practice (2013), http://dx.doi.org/10.1016/

Fig. 1. The collaboration model of best practice.

J.E. Foss et al. / Nurse Education in Practice xxx (2013) 1e72

critical appraisal of research literature and research utilization intheir theoretical courses. This learning is expected to continue intheir clinical placements in hospitals and community care withexperienced clinical nurses as preceptors and role models. Inaddition, clinical lecturers are serving as academic supervisors forcombining theoretical knowledge and practice experiences (Hovet al., 2005; Barrett, 2006; McSharry et al., 2010).

Despite the many efforts that have beenmade since the 1980s toimplement scientific knowledge in clinical nursing practice, manybarriers still remain. The literature about these barriers is extensive,and according to Estabrooks et al. (2003), individual factors such asnurses’ attitudes to scientific knowledge, their involvement inresearch activities, and knowledge about evaluating scientificliterature are important to research utilization. Björkström and co-workers found that many nurses (Björkström and Hamrin, 2001)and nursing students (Björkström et al., 2003) were unaware oftheir responsibility to use research findings in their clinical work.Previous studies have also reported that nurses, despite a positiveattitude to researchutilization, seldomuse researchfindings in theirdaily work (Boström et al., 2009; Wangensteen et al., 2010). Thisindicates that students seldommeet nurses whowould be valuablerole models in this respect. As role models are an important part ofstudents’ learning (Danielsson et al., 2009; Perry, 2009) this lack ofutilization of research findings in the clinical placements is a greatproblem, as it may impact on the students’ opportunities to becomeconvinced users of research findings in their future work as nurses.

Many researchers have highlighted that nurse lecturers wouldbe valuable as facilitators for the improvement of research utiliza-tion in the clinical realm, since they possess a high level ofknowledge both in teaching and in research (Milner et al., 2005;Winch et al., 2005). If nursing students had more opportunities topractise the use of research findings together with clinical nursesalready in their clinical placements supervised by a clinical lecturer,this would probably increase their understanding of the value ofresearch utilization. However, research about such collaborationbetween the university nursing college and clinical placements isstill scarce.

With this as the background, a collaborative project was initi-ated in Norway between a university college and the hospital thatprovided placements to nursing students during the clinical part oftheir education. The overall purpose of the project was to improveRNs’ and nursing students’ research utilization in the clinicalplacements. A steering group for the project was established,consisting of the nurse director at the hospital, a professor innursing (EA) from the Nursing College, and a clinical nurse lecturer(JF). This paper describes the collaborative model that was devel-oped in the project, and a pilot study of its first application andevaluation.

The collaborative model and its application

The model and its content

A model called “The Collaboration Model of Best Practice”(CMBP) (Fig. 1) was developed and used in the project. The foun-dation of the model was a close cooperation between facultymembers, nursing students, nurse leaders and clinical nurses inorder to reach ‘best practice’, which in the literature means thatguidelines and procedures in practical nursing are anchored in sci-entific knowledge in order to ensure quality in nursing care. Thedevelopmental process was based on the literature about previousmodels of research utilization in nursing practice (Kitson et al., 1998;Rosswurm and Larrabee, 1999; Rycroft-Malone et al., 2004). Keyelements in the model included critical reflection, evidence-basedpractice, learning environment and facilitation. Embedded in the

Please cite this article in press as: Foss, J.E., et al., A model (CMBP) for collaresearch utilization in students’ clinical placements: A pilot studyj.nepr.2013.11.008

model was the EBP process (Leach, 2006), consisting of five steps. 1:identification of improvement area; 2: search for research literature;3: critical appraisal of the evidence; 4: application of evidence intopractice; and 5: evaluation of effectiveness of evidence (Fig. 2).

The context

The head nurses of one surgical and one medical wardannounced their interest in participating in the project. Thesewards usually collaborated with the faculty about the students’clinical education in the second and third year of their education. Inthe project a nurse with at least two years of clinical experience,academic courses, and special interest in supervision and teachingwas selected from thewards as a main preceptor for the students ineach ward. Eight to nine students at a time in the second and thethird year respectively spent their eight weeks of clinical studies inthe two wards during some part of the project period (in total 68students). These students, together with two RNs from each ward,were invited to play a central role in the first application of themodel, and they were called ‘key persons’. This meant that four tofive students collaborated closely during the project with one RN.

A facilitator group was established to facilitate the students andthe four nurses in their learning. The facilitator group consisted ofone clinical nurse lecturer (JF) and one main preceptor from eachward, with the clinical nurse lecturer as the group leader. Third-year students took part in steps two to four and second-year stu-dents in step five of the EBP process. The four nurses took part in allfive steps. The other nurses in the wards were continuouslyinformed about the project and its progress, and were particularlyinvolved in step one and step four.

Identification of the improvement area (step one)

After a critical review of current practice, the head nursetogether with the facilitator group, the RNs and all nurses on thewards decided areas for improvement and patient groups to focusupon. In the surgery ward, nauseawas selected as the improvementarea with the focus on patients with gynecological cancer and

boration between university college and nursing practice to promote, Nurse Education in Practice (2013), http://dx.doi.org/10.1016/

Fig. 2. The evidence-based practice process.

J.E. Foss et al. / Nurse Education in Practice xxx (2013) 1e7 3

patients suffering from post-operative nausea. In the medical ward,oral hygiene was chosen with the focus on patients in the terminalphase of life and patients being treated with antibiotics.

Search for research literature (step two)

Before starting the search for research literature, a librariantrained the key persons (students and RNs) and main preceptors incomputer-based literature search. Research literature relevant tothe chosen improvement areas and identified patient was used inthe training.

Critical appraisal of evidence (step three)

In order to critically appraise the literature, the key persons metat the university college for four days together with the facilitatorgroup. They read, appraised, and discussed the articles that werechosen as being relevant. The appraisal concerned the scientificrigour of the articles and recommendations of best practice. Finally,the students documented an overview of the findings with regardto best practice, and together with the four RNs they summarizedthe recommendations for changes of routines in nursing practice.

Application of evidence (step four)

The students presented the findings from the literature searchabout ‘best practice’ and the recommendations for changes in anopen meeting with support from the RNs and the facilitator group.Both nursing personnel on the project wards and other employeesin the hospital were invited to participate in this session in order tospread the acquired knowledge maximally. Thereafter, the nursedirector, the head nurses from both wards, the RNs and the facili-tator group discussed and decided which of the findings and

Please cite this article in press as: Foss, J.E., et al., A model (CMBP) for collaresearch utilization in students’ clinical placements: A pilot studyj.nepr.2013.11.008

recommendations could be transferred into practice. Preparationsfor changing the current practice were then initiated, through arevision of existing guidelines, procedures and nursing care plansor by the creation of new care plans. During this step all the nurseson the wards were invited to participate. Finally, information aboutthe coming changes (new guidelines, routines and procedures) wasconveyed during regular ward meetings.

On the surgical ward, the following changes were implemented

� Revised nursing guidelines to all patients with nausea.� Use of the ‘Postoperative Nausea and Vomiting (PONV) IntensityScale’.

� Stimulation of acupressure point (P6) as a treatment for nausea.

On the medical ward, the following changes were implemented

� A care plan for all patients with special needs for oral hygiene.� Two brochures for patient information focussing on preventionand treatment of fungal infection related to treatment withantibiotics.

� Use of soft toothbrushes for the patients.

Evaluation of effectiveness of evidence (step five)

No systematic evaluation was carried out regarding the effect ofthe changes implemented. However, the second-year students,who arrived in the wards during step four of the EBP process whennew routines and procedures had been in use for five weeks, weretaught about the CMBP, the improvement area which had beendecided after a critical review of current practice on the wards, andthe changes of routines which had taken place during the projectperiod. Together with the four nurses they read, appraised anddiscussed the articles, which had been used as the evidence for thechanges. In this learning they were supervised by the facilitator

boration between university college and nursing practice to promote, Nurse Education in Practice (2013), http://dx.doi.org/10.1016/

Table 1Response frequencies on the questionnaire.

Areas and questions Very high/quite high degree Very little/not at all

Students secondyear n (%)

Students thirdyear n (%)

Students secondyear n (%)

Students thirdyear n (%)

To what degree.Collaboration and facilitationDid the collaboration betweenRNs and students work?

19 (100) 18 (95) e 1 (5)

Was the CMBP anchored in the ward? 11 (58) 19 (100) 8 (42) e

Did you get the facilitation you needed? 12 (71) 16 (89) 5 (29) 2 (11)LearningDid the CMBP contribute to valuable learning? 13 (69) 18 (95) 6 (31) 1 (5)Did the collaboration project improve the learning environment in the ward? 3 (16) 14 (74) 16 (84) 5 (26)Did you experience that the CMBP has increased your understandingof the need for research utilization in nursing?

14 (74) 18 (95) 5 (26) 1 (5)

Impact on nursing careDid the CMBP contribute to change in clinical nursing practice in the ward? 2 (25) 11 (65) 6 (75) 6 (35)Did the CMBP contribute to increased quality in patient care? 7 (41) 16 (84) 10 (59) 3 (16)

J.E. Foss et al. / Nurse Education in Practice xxx (2013) 1e74

group. Thereafter the students’ observed to what extent the de-cisions about changes were followed. This evaluationwas, however,not systematically recorded.

Evaluation of the CMBP

At the end of the project a follow-up study was carried outaimed at describing the key persons’ (students and RNs) experi-ences of the CMBP related to collaboration and facilitation, learningand impact on nursing care.

Methods

Data collection

All the students (n ¼ 68: 34 in their second year and 34 in theirthird year) and the four RNs were asked to respond to a ques-tionnaire. No reminder was made. Thirty-eight students e 19 fromeach year (55% response rate) e and all the RNs answered thequestionnaire.

The questionnaire was developed by three of the authors (JF, EA,KK) and was designed to measure the following four areas:collaboration (two questions), learning (three questions), facilita-tion (one question), and impact on nursing care (two questions). Afour-point response scale ranging from one (not at all) to four (to avery high degree) was used in all the questions. The participantswere also asked to respond to three open-ended questions con-cerning: (1) what participation in the project had meant to thempersonally; (2) what participation in the project had meant to theward; and (3) suggestions regarding improvements of the CMBP. Inaddition, the four RNs were asked to write diaries during theproject in order to get their experiences and reflections as partici-pants in the project. Only two of them responded to this request.

Data analysis

Descriptive statistics (frequencies) were computed within eachof the following groups of participants: (1) second-year students;(2) third-year students; and (3) RNs. In this computation the twohighest response choices (to a very high degree and to quite a highdegree) were combined, as were the two lowest response alter-natives (very little and not at all) (Table 1).

The answers from open-ended questions and the diaries wereanalysed by means of thematic content analysis (Burnard, 1996; Eloand Kyngäs, 2008) by the first author (JF). After reading the respec-tive text as awhole, itwasdivided intomeaningful units related to the

Please cite this article in press as: Foss, J.E., et al., A model (CMBP) for collaresearch utilization in students’ clinical placements: A pilot studyj.nepr.2013.11.008

research questions about collaboration and facilitation, learning, andimpact on nursing care. Thereafter the meaningful units were codedand categorized. During the whole process of analysis the researchgroup discussed the understanding and labelling of codes and cate-gories until consensus was reached (Lincoln and Guba, 1995).

Ethical considerations

The project was carried out according to the ethical guidelinesfor nursing research in Nordic countries (Northern Nurses’Federation, 2003). The approval to the project was obtained fromthe Faculty Board and the director of the hospital. The RNs andstudents participated voluntarily in the pilot study after giving theirinformed consent.

Findings

The students’ experiences regarding collaboration and facilita-tion, learning and impact on nursing care are presented in Table 1.The students’ answers from the open-ended questions about whattheir participation had meant to them and to the ward, and pro-posals for improvement of the CMBP, are presented under theheading, “learning”. Finally, the nurses’ experiences based on thequestionnaire and the diaries are presented.

The students’ experiences

Collaboration and facilitation

All second-year students and almost all of the third-year stu-dents (95%) reported that their collaboration with the RNs whoserved as key-persons had worked well. All of the third-year stu-dents, and over half of the second-year students (58%) reported thatthe CMBP was anchored on the ward to a very high/quite highdegree. Most third-year students (89%) reported that they had beengiven the facilitation they needed during the project. From thesecond-year group somewhat fewer were of this opinion (71%).

Learning

Almost all (95%) of the third-year students and more than two-thirds (69%) of the second-year students reported that the CMBPhad contributed to a valuable learning experience. A majority ofboth groups of students (74 and 95%, respectively) also answeredthat the CMBP had increased their understanding of the need forresearch utilization in nursing care to a very high/quite high degree.

boration between university college and nursing practice to promote, Nurse Education in Practice (2013), http://dx.doi.org/10.1016/

J.E. Foss et al. / Nurse Education in Practice xxx (2013) 1e7 5

The second-year students scored lower than the third-year groupon the question about the impact of the CMBP on the learningenvironment in the ward. Both second- and third-year studentsmade comments about experiencing personal growth. Second-yearstudents did not cite concrete examples of what that growth hadmeant to them, while third-year students commented that it hadincreased their understanding of their own responsibility to utilizeresearch in their clinical nursing practice. They also believed thatnurses on thewards had gained new knowledge about best practicefor the patients in focus.

Both second- and third-year students stated in their commentsthat the CMBP should be implemented in every clinical placementof the bachelor education. The inclusion of other relevant pro-fessionals in the project was mentioned as another possibleimprovement area.

Impact on nursing care

Sixty-five percent of the third-year students, compared totwenty-five of the second-year students, reported that the CMBPhad contributed to a change in the clinical nursing practices on theward to a very high/quite high degree. Eighty-four percent of thethird-year students and forty-one of the second-year students re-ported that the CMBP had contributed to increased quality in pa-tient care to a very high/quite high degree. In the comments, thispositive impact could be described as an increased focus on oralhygiene when caring for patients who could not address their ownneeds, and nurses’ increased awareness of patients’ needs whenthey were suffering from nausea.

The nurses’ experiences

In the questionnaire the RNs (n¼ 4) scored the highest responsecategory (to a very high degree) on all questions with one excep-tion. This concerned collaboration with students, where one nursedid not answer.

The nurses’ experiences captured in the open-ended questionsin the questionnaire (n ¼ 4) and the diaries (n ¼ 2) are describedbelow in the categories: ‘collaboration and facilitation’, ‘learning’and ‘impact on nursing care’.

Collaboration and facilitation

A thorough planning and scheduling of the project was stressedas important for collaboration between the nursing college and thewards. Such a planning was seen as imperative to render it possiblefor the RNs to serve as ‘key persons’. The RNs’ collaboration withthe group leader and the nursing students was described asinspiring, and valuable. Their own contribution to the project wasseen as high, and the RNs considered that the students had regar-ded them as resources due to their nursing experience and abilityto work systematically. At the onset of the project they had takenon a leadership role for the students as they led the discussions andshared their experiences and observations with the students inrelation to the improvement areas and the patient groups in focus.As the work progressed, their role changed slightly, and both thegroup leader and the students became more important. As thestudents quite recently had studied research methods at thenursing college they contributed significantly to the group learningwith regard to computer-based literature search, and in the sub-sequent appraisal of the articles.

The diaries revealed two different conditions for the RNs tomeetin order to function as key persons. One nurse had to negotiatewithher colleagues in order to find time off for the project, while theother one reported that her headnurse arranged time for the project

Please cite this article in press as: Foss, J.E., et al., A model (CMBP) for collaresearch utilization in students’ clinical placements: A pilot studyj.nepr.2013.11.008

within her working schedule. The RNs appreciated the CMBPmodelsince itwas experienced as interesting and realistically planned, andtheir participation in the EBP process was reported as mainly pos-itive. The process of searching for literature together with the stu-dents was described as varying from great satisfaction when they‘found a great amount of relevant articles’ to frustration when theystruggled hard but found none. They recommended that time usedfor training and searching for scientific articles should be twoconsecutive days, instead of one afternoon aweek that had been therule. They thought that their knowledge about searching, readingand appraising research articles would have increased even more ifthey had been able to focus on this more intensely. The support thatthey had received throughout the project from the group leaderwasexperienced as both necessary and highly appreciated. During thesearch and critical appraisal of research literature this collaborationand support was seen as especially important, since the groupleader had the academic knowledge and experience which thenurses themselves were lacking.

Learning

The RNs reported that their research knowledge had increasedand this had improved their professional awareness. Theyexpressed that they had learned more than they had expected, andthey could more easily conduct a literature search and read scien-tific articles now. Thus, they thought they would be better super-visors to students. The RNs reported that their participation in theproject had positively affected their attitudes to research utiliza-tion, and that they would base their clinical work on ‘Best Practice’in the future. Their attitudes towards students had also changed,and they realized that students were a valuable resource to beregarded as ‘partners rather than as a strain in our daily work’. Theythought that working in the EBP process had improved both theirown and students’ skills in critical appraisal.

Impact on nursing care

Use of the CMBP model was considered to contribute positivelyto nursing practice. During the five steps of the EBP process, dis-cussions had been initiated among the nurses on the wards aboutnursing practice and research. These discussions were consideredto contribute to increased knowledge and an attitude changeamong the nurses in the wards with regard to research utilization.The RNs had realized that behavioural change among nursingpersonnel takes time and they stressed the importance ofcontinuing the EBP work also after the end of the project.

Discussion

The overall intention of this project was to improve nurses’ andnursing students’ use of research findings in the students’ clinicalplacements by means of collaboration between the nursing collegeand the hospital. Findings from the follow-up of this first applica-tion of the collaborative model (CMBP) indicated that this collab-oration had been beneficial. This finding is well in accordance withfindings of previous studies (Stones and Rowles, 2007; McCormack,2011), which support the positive impact of collaboration betweenthe nursing academy and clinical nursing practice. The nurses andmany of the students involved as ‘key persons’ reported that theyhad gained valuable learning, and increased their understanding ofresearch utilization and its importance for nursing practice. Theyalso thought that the quality of nursing care had improved after theimplementation of the research findings. In addition, both nursesand students reported personal growth after participating in theproject. However, the findings showed that the RNs and the third-

boration between university college and nursing practice to promote, Nurse Education in Practice (2013), http://dx.doi.org/10.1016/

J.E. Foss et al. / Nurse Education in Practice xxx (2013) 1e76

year students scored higher than the second-year students on thethree categories designed to measure learning. The reason for thiscould probably be found in the way the second-year students wereinvolved in the CMBP. They arrived on the wards when the projecthad been going on for 20 weeks and were involved only in step fiveof the EBP process. This means that they did not take part in theother steps of the process, of which step one is meant to inspire andcreate understanding of the need for change in clinical practice.Kitson et al. (1996) underlined that involvement is important in theinitial step of the EBP process as this provides motivation for thecoming changes. The findings also showed that many of thesecond-year students reported that the CMBP was anchored on theward only to a small extent, while a great majority of the third-yearstudents, who had been involved in the project from the beginningthought that it was anchored to a high extent. Taken together, thesefindings highlight the need for serious discussions about howsecond-year students can be involved in the CMBP.

Researchers have stressed the imperative need for support fromthe leaders at all organizational levels when starting develop-mental projects aimed at EBP (Henderson and Winch, 2008;Dogherty et al., 2010; O’Byrne and Smith, 2010). Since the deci-sion to work with the CMBP in our project had been made throughan agreement between the university and the hospital, full supportwas given from the top level of leadership at both institutions. Alsothe head nurses on the wards were participating voluntarily, whichmay illustrate their interest and concern for supporting their nursesin the attempt to reach ‘best practice’ on theward. The group leaderfrom the university college was chosen to be the strong link be-tween nursing education and nursing practice responsible for thetransfer of information between the parties involved, and for thefacilitation of the different steps in the EBP process. Despite thesepositive preconditions, some deficiencies were found related tocollaboration and facilitation, e.g. concerning planning of time, andsupport to the RNs who served as key persons. This again illumi-nates how complex and demanding it is to transfer research find-ings into practice, as has been stated so many times during the lastdecades (Kitson et al., 1998; Rycroft-Malone et al., 2009, Kitsonet al., 2011).

Studies have highlighted the ward leader’s central role in theEBP process as a ‘change agent’ and facilitator (Melnyk et al., 2004;Henderson et al., 2009; Sandström et al., 2011), since they are ex-pected to provide time for ongoing projects, and be encouragingand supportive, and thereby establish a good learning environmenton the ward. Other studies have reported about heavy workloadand many tasks put on the ward leader’s shoulder, where the re-sponsibility for improvement of nursing care by means of researchutilization has been added during the last decade. Studies have alsosuggested that nurse leaders need education and knowledge inresearch utilization themselves (Johansson et al., 2010). Animprovement of our model would be to include the head nurses inthe ‘steering group’ to provide them a real ‘ownership role’ of theEBP process on their ward. In addition, the ‘steering group’ couldserve as a collegial group support, something which has been foundto be of great importance in strengthening nurse leaders in theirmulti-dimensional role (Alleyne and Jumaa, 2007; Davis and Burke,2012). This would probably increase their facilitating opportunitieswhen they strive for ‘Best Practice’.

There is agreement in the research utilization literature aboutthe importance of facilitation through all the steps of the EBPprocess (Harvey et al., 2002; Rycroft-Malone et al., 2004). Ac-cording to the four RNs and most of the students in our study thesupport given by the nurse lecturer (group-leader) from thenursing college was experienced as valuable. The evaluationrevealed that the nurses and the students as ‘key persons’ neededfacilitation particularly in their appraisal of research literature

Please cite this article in press as: Foss, J.E., et al., A model (CMBP) for collaresearch utilization in students’ clinical placements: A pilot studyj.nepr.2013.11.008

(step three), as they were rather unfamiliar with doing this. Thusour findings could support the recommendation of Milner et al.(2005) to use nurse lecturers as facilitators in the EBP process.Since nurse lectures are both trained pedagogues, have compe-tence in leadership and group dynamics, and knowledge about thedifferent steps of the EBP process, this qualifies them well to befacilitators. Larkin et al. (2007) claims that research utilization inclinical nursing practice depends on well-designed and rigorousresearch. To secure the quality of the research literature used inour project, a librarian introduced and facilitated the search forliterature, assisted by the group-leader. The RNs experienced thatthey could perform their search easier than before. As our findingsfrom the RNs questionnaires consistently showed the highestresponse alternative on all the questions, this might, despite thefew number of participants, support the conclusion of Larrabeeet al. (2007) that participating in the EBP process improves atti-tudes towards research utilization.

The ultimate goal of using the EBP process in clinical practice isto obtain the best possible quality of nursing care for the patients(Fineout-Overholt et al., 2005; Boström et al., 2009). The evaluationof this pilot study, however, primarily focused on nursing students’and nurses’ experiences of using the CMBP in which the EBP pro-cess was embedded, and only secondarily on the outcome relatedto quality of care. The findings showed that the RNs, a majority ofthird-year students and less than half of the second-year studentsconsidered that the CMBP had positively influenced the nursingquality. Despite this, considerably fewer students in the respectivegroups thought that the use of the CMBP had brought changes inpractice. As these two findings are inconsistent, they must beinterpretedwith great caution.What might be suggested is that ourfindings illuminate the need for students’ involvement in thewholeEBP process in order to fully understand its value and impact onnursing quality.

Methodological considerations

This study was a small-scale pilot study, performed in only onehospital in Norway and involving only a small number of partici-pants. Only 55% (n ¼ 38) of the students answered the question-naire, which is a relatively low response rate. The questionnaireprovided limited written data. Two open-ended questions allowedthe participants to express more reflection. Some questions wereleft un-answered, especially concerning changes in nursing prac-tice and quality of patient care. Only two RNs wrote diaries. Withsuch a small amount of data the findings must be interpreted withgreat caution.

Another apparent weakness found was that the staff nurses onthe wards were directly involved only in step one and step four ofthe EBP process. In the remaining steps, the key persons and thefacilitators carried out all the work, supported by the group-leader.Even though theymade recurrent attempts to keep their colleaguesinformed about the current status of the EBP process, the findingssuggested that the project was not fully visible and not a concernfor all nurses on the ward. To influence all nurses’ interest inresearch utilization, they should have beenmore explicitly involvedin all of the steps of the EBP process (Winch et al., 2005). Since theworkload for nurses is a great hindrance for research utilization(Fink et al., 2005; Hutchinson and Johnston, 2006), the involvementof all nurses could be organized through a continuous, systematicreport of the on-going work in ward meetings once a month.

Final reflections

Despite the limitations of this pilot study, the findings indicatethat the CMBP has a potential to be a useful model for teaching RNs

boration between university college and nursing practice to promote, Nurse Education in Practice (2013), http://dx.doi.org/10.1016/

J.E. Foss et al. / Nurse Education in Practice xxx (2013) 1e7 7

and students EBP. Both students and RNs recommended that theCMBP could be used in every clinical part of the nursing educationto support academic learning and increase research utilization.However, further refinement of the model is needed followed by amore comprehensive implementation and evaluation.

References

Alleyne, J., Jumaa, M.O., 2007. Building the capacity for evidence-based clinicalnursing leadership: the role of executive co-coaching and group clinical su-pervision for quality patient services. J. Nurs. Manage. 15, 230e243.

Barrett, D., 2006. The clinical role of the nurse lectures: past, present and future.Nurse Educ. Tod. 27 (5), 367e374.

Björkström, M., Hamrin, E., 2001. Swedish nurses’ perceptions of research anddevelopment within nursing. J. Adv. Nurs. 34, 706e714.

Björkström, M.E., Johansson, L.S., Hamrin, E.K.F., Athlin, E., 2003. Swedish nursingstudents’ attitudes to and awareness of research development within nursing.J. Adv. Nurs. 41 (4), 393e402.

Boström, A., Ehrenberg, A., Gustavsson, J.P., Wallin, L., 2009. Registered nurses’application of evidence-based practice: a national survey. J. Eval. Clin. Prac. 15(6), 1159e1163.

Burnard, P., 1996. Teaching the analysis of textual data: an experiential approach.Nurse Educ. Tod. 16, 279e281.

Davis, C., Burke, L., 2012. The effectiveness of clinical supervision for a group ofward managers based in a district general hospital: an evaluation study. J. Nurs.Manage. 20, 782e793.

Danielsson, A., Sundin-Andersson, C., Hov, R., Athlin, E., 2009. Norwegian andSwedish preceptors’ views of their role before and after taking part in a groupsupervision program. Nurs. Health Sci. 11 (2), 107e113.

Dogherty, E.J., Harrison, M.B., Graham, I.D., 2010. Facilitation as a role and process inachieving evidence-based practice in nursing: a focused review of concept andmeaning. Worldviews Evid.-Bas. Nurs. Sec. Quart., 76e89.

Elo, S., Kyngäs, H., 2008. The qualitative content analysis process. J. Adv. Nurs. 62 (1),107e115.

Estabrooks, C.A., Floyd, J.A., Scott-Findlay, S., O’Leary, K.O., Gustha, M., 2003. Indi-vidual determinants of research utilization: a systematic review. J. Adv. Nurs. 43(5), 506e520.

Fineout-Overholt, E., Melnyk, B.M., Schultz, A., 2005. Transforming health care fromthe inside out: advancing evidence-based practice in the 21st century. J. Prof.Nurs. 21 (6), 335e344.

Fink, R., Thompson, C., Bonne, D., 2005. Overcoming barriers and promoting the useof research in practice. J. Nurs. Admin. 35 (3), 121e129.

Flesner, M.K., Miller, L., McDaniel, R., Rantz, M., 2006. From nursing process tonursing synthesis: evidence-based nursing education. In: Malloch, K., Porter-O’Grady, T. (Eds.), Evidence-based Practice in Nursing and Health Care.

Gerrish, K., Asworth, P., Lacey, A., Bailey, J., Cooke, J., Kendall, S., McNeilley, E., 2006.Factors influencing the development of evidence-based practice: a researchtool. J. Adv. Nurs. 57 (3), 328e338.

Harvey, G., Loftus-Hills, A., Rycroft-Malone, J., Titchen, A., Kitson, A., McCormack, B.,Seers, K., 2002. Getting evidence into practice: the role and function of facili-tation. J. Adv. Nurs. 37, 577e588.

Helse- og Omsorgsdepartementet, 2001. Lov om helsepersonell (Law for HealthPersonnel) (in English). http://www.lovdata.no/all/nl-19990702-064.html(accessed 28.07.13.).

Henderson, A., Winch, S., 2008. Commentary. Managing the clinical setting for bestnursing practice: a brief overview of contemporary initiatives. J. Nurs. Manage.16, 92e95.

Henderson, A., Winch, S., Holzhauser, K., 2009. Leadership: the critical successfactor in the rise or fall of useful research activity. J. Nurs. Manage. 17, 942e946.

Hov, R., Aronsen, S., Berg, K.E., Foss, J., Lysberg, K., Martinsen, F., Rørhus, G.H.,Steinseth, E.B., 2005. Kunnskap for og i praksis e en ny modell forgjennomføring av praksisstudier ved HSE (Knowledge for and in Practice e aNew Model for Students Clinical Placements at Hedmark University College).Høgskolen i Hedmark. (in Norwegian).

Hutchinson, A., Johnston, L., 2006. Beyond the barriers scale: commonly reportedbarriers to research use. J. Nurs. Admin. 36 (4), 189e199.

Please cite this article in press as: Foss, J.E., et al., A model (CMBP) for collaresearch utilization in students’ clinical placements: A pilot studyj.nepr.2013.11.008

Johansson, B., Fogelberg-Dahm, M., Wadensten, B., 2010. Evidence-based practice:the importance of education and leadership. J. Nurs. Manage. 18, 70e77.

Kajermo, K.N., 2004. Research Utilization in Nursing Practice e Barriers and Facil-itators. Department of Nursing, Karolinska Institutet, Stockholm.

Kitson, A., Ahmed, L.B., Harvey, G., Seers, K., Thompson, D., 1996. From research topractice: one organizational model for promoting research-based practice.J. Adv. Nurs. 23, 430e440.

Kitson, A., Harvey, G., McCormack, B., 1998. Enabling the implementation ofevidence-based practice: a conceptual framework. Qual. Health Care 7 (3), 149e158.

Kitson, A., 2004. The state of the art and science of evidence-based nursing in UKand Europe. Worldviews Evid.-Bas. Nurs. 1 (1), 6e8.

Kitson, A., Rycroft-Malone, J., Harvey, G., McCormack, B., Seers, K., Titchen, A., 2008.Evaluating the successful implementation of evidence into practice using thePARIHS framework: theoretical and practical challenges. Implement. Sci. 3 (1).

Kitson, A., Silverston, H., Wiechula, R., Zeitz, K., Marcoionni, D., Page, T., 2011.Clinical nursing leaders’, team members’ and service managers’ experiences ofimplementing evidence at a local level. J. Nurs. Manage. 19, 542e555.

Larkin, M., Griffith, C., Capasso, V., Cierpial, C., Gettings, E., Walsh, K., O’Malley, C.,2007. Promoting research utilization using a conceptual framework. J. Nurs.Admin. 37 (11), 510e516.

Larrabee, J., Sions, J., Fanning, M., Withrow, M., Ferretti, A., 2007. Evaluation of aprogram to increase evidence-based practice change. J. Nurs. Admin. 37 (6),302e310.

Leach, M.J., 2006. Evidence-based practice: a framework for clinical practice andresearch design. Int. J. Nurs. Prac. 12, 248e251.

Lincoln, Y.S., Guba, E.G., 1995. Naturalistic Inquiry. Sage, Beverly Hills, CA.McCormack, B., 2011. Engaged scholarship and research impact. Integrating the

doing and using research in practice. J. Res. Nurs. 16 (2), 111e127.McSharry, E., McGloin, H., Frizzel, A.M., Winters-O’Donnel, L., 2010. The role of the

nurse lecturer in clinical practice in the Republic of Ireland. Nurse Educ. Prac. 10(4), 189e195.

Melnyk, M.B., Fineout-Overholt, E., Fishbeck, F.N., Hong, L., Small, L., Wilcox, L.,Kraus, R., 2004. Nurses’ perceived knowledge, beliefs, skills, and needsregarding evidence-based practice: Implications for accelerating the paradigmshift. Worldviews Evid.-Bas. Nurs. Third Quart., 185e193.

Milner, F.M., Estabrooks, C.A., Humphrey, C., 2005. Clinical nurse educators asagents for change: increasing research utilization. Int. J. Nurs. Stud. 42, 899e914.

Northern Nurses Federation, 2003. Ethical guidelines for nursing research in Nordiccountries. Vård i Norden 23, 2e5.

O’Byrne, L., Smith, S., 2010. Models to enhance research capacity and capability inclinical nurses. A narrative review. J. Clin. Nurs. 20, 1365e1371.

Perry, R.N.B., 2009. Role modeling excellence in clinical nursing. Nurse Educ. Prac. 9,36e44.

Robertson, R., Jochelson,K., 2006. Interventions thatChangeClinical Behavior:Mappingthe Literature. http://www.nice.org.uk/media/AF1/42/HowToGuideKingsFundLiteratureReview.pdf (accessed 27.07.13.).

Rosswurm, M.A., Larrabee, J.H., 1999. A Modell for change to evidence-basedpractice. J. Nurs. Schol. 31 (4), 317e322.

Rycroft-Malone, J., 2004. The PARIHS framework e a framework for guiding theimplementation of evidence-based practice. J. Nurs. Care Qual. 19 (4), 297e304.

Rycroft-Malone, J., Harvey, G., Seers, K., Kitson, A., McCormack, B., Titchen, A., 2004.An exploration of the factors that influence the implementation of evidenceinto practice. J. Clin. Nurs. 13, 923e924.

Rycroft-Malone, J., Kitson, A., Harvey, G., McCormack, B., Seers, K., Titchen, A.,Estabrooks, C., 2009. Ingredients for change: revisiting a conceptual framework.Qual. Safe Health Care 11, 174e180.

Sandström, B., Borglin, G., Nilsson, R., Willman, A., 2011. Promoting the imple-mentation of evidence-based practice: a literature review focusing on the roleof nursing leadership. Worldviews Evid.-Bas. Nurs. Fourth Quart., 212e223.

Stones, C., Rowles, C.J., 2007. Nursing students can help support evidence-basedpractice on clinical nursing units. J. Nurs. Manage. 15, 367e370.

Wangensteen, S., Johansson, I.S., Björkström, M.E., Nordström, G., 2010. Criticalthinking dispositions among newly graduated nurses. J. Adv. Nurs. 66 (10),2170e2181.

Winch, S., Henderson, A., Creedy, D., 2005. Read, think, do!: a method for fittingresearch evidence into practice. J. Adv. Nurs. 50 (1), 20e26.

boration between university college and nursing practice to promote, Nurse Education in Practice (2013), http://dx.doi.org/10.1016/