Research Article
Using Information Practices of Nurses to Reform
Information Literacy Instruction in Baccalaureate Nursing Programs
Anne R. Diekema
Assistant Professor,
Department Chair, and Instruction Librarian
Gerald R. Sherratt Library
Southern Utah University
Cedar City, Utah, United
States of America
Email: annediekema@suu.edu
Elizabeth (Betsy) S. Hopkins
Nursing and Communication
Disorders Librarian
Harold B. Lee Library
Brigham Young University
Provo, Utah, United States
of America
Email: betsy_hopkins@byu.edu
Brandon Patterson
Technology Engagement
Librarian
Spencer S. Eccles Health
Sciences Library
University of Utah
Salt Lake City, Utah, United
States of America
Email: b.patterson@utah.edu
Nena Schvaneveldt
Assistant Librarian,
Education Librarian
Spencer S. Eccles Health
Sciences Library
University of Utah
Salt Lake City, Utah, United
States of America
Email: nena.schvanevelt@utah.edu
Received: 30 May 2019 Accepted: 12 Oct. 2019
2019 Diekema, Hopkins, Patterson, and Schvaneveldt. This
is an Open Access article distributed under the terms of the Creative Commons‐Attribution‐Noncommercial‐Share Alike License 4.0
International (http://creativecommons.org/licenses/by-nc-sa/4.0/),
which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly attributed, not used for commercial
purposes, and, if transformed, the resulting work is redistributed under the
same or similar license to this one.
DOI: 10.18438/eblip29588
Abstract
Objective - Seeking
information is a key element of evidence based
practice and successful healthcare delivery. Significant literature exists on
both the information seeking behaviour of
professional nurses and information literacy teaching methods, but scarce evidence
connects nurses’ information behaviour and
environments with their education. This study sought to use data from nursing
alumni to answer the following research questions: What are the current
information practices of professional bachelor’s-prepared nurses? How do
recently-graduated nurses suggest that their education could have better
prepared them to find and evaluate information in the workplace?
Methods - The researchers conducted a descriptive study using a
59-item survey instrument with a variety of question formats including
short-answer, multiple choice, Likert, and open response. The researchers
distributed the survey to baccalaureate nursing alumni who graduated in
2012-2017 from four universities in the state of Utah in the United States.
Results - Nurses seek
practical information primarily to provide informed patient care, while also
clarifying medical situations and expanding their health care knowledge. They
frequently consult nursing colleagues and physicians when seeking information.
The majority of nurses consult electronic health records daily. Respondents
described time as the biggest barrier to accessing information. They requested
authentic, clinically-focused scenarios, training on freely-accessible
resources, and more explicit teaching of lifelong learning skills, such as
critical thinking.
Conclusion - Information literacy education should prepare student
nurses for the fast-paced information environment they will face in the
workplace. This means incorporating more patient-focused scenarios, freely
available quality resources, and time-based activities in their education. The
researchers suggest areas to prepare nurses for information seeking, including
problem-based clinical scenarios, building guides with databases accessible for
free or little cost, and added emphasis on critical thinking and self-motivated
learning.
Introduction
Preparing nurses for evidence based
practice involves incorporating clinical expertise, the patient’s preferences,
and the “best available external evidence” (Sackett, Rosenberg, Gray, Haynes,
& Richardson, 1996, p. 72). Perhaps the most difficult challenge in
incorporating evidence into practice is the exponential growth of health care
knowledge. An increase in published knowledge means more information to sort
through, and when nurses cannot find reliable information quickly, evidence based patient care is diminished (Clarke et al.,
2013). Information literacy is a critical part of evidence
based practice in a progressively more complex information environment,
as it provides a framework to manage, retrieve, evaluate, and use information
effectively. The Association for College & Research Libraries (2015)
defines information literacy as “the set of integrated abilities encompassing
the reflective discovery of information, the understanding of how information
is produced and valued, and the use of information in creating new knowledge
and participating ethically in communities of learning.” Not surprisingly, the
American Association of Colleges of Nursing (2008) recognizes information
literacy as a component of liberal education of baccalaureate-level nurses.
Given the great importance of nurses’ ability to obtain evidence based
information, and a lack of research connecting information behaviour
with information literacy instruction, librarians from four universities in the
state of Utah in the United States aimed to better understand information
practices of professional nurses to improve information literacy instruction in
baccalaureate nursing programs. The researchers wanted to place instruction in
the context of evidence based practice to prepare
nursing students for professional information seeking.
Literature Review
Prior to conducting the study, the researchers reviewed
the literature for recent data on information literacy education of nursing
students, as well as the information practices of nurses.
Information literacy is being taught to nursing students
with varying levels of success. While information literacy is important, it is
also difficult to teach and assess effectively, and at times outcomes are only
moderately improved (Farrell, Goosney, &
Hutchens, 2013; Moreton & Conklin, 2015). According to a survey of
instruction librarians, information literacy programs in higher education are
often limited to first year instruction, although discipline-specific
instruction for undergraduates is also available (Julien, Gross, & Latham,
2018). The standards and frameworks available to librarians to teach
information literacy fall short in teaching clinical information seeking, as
they fail to capture the social and transformative aspects of information
literacy (Lupton & Bruce, 2010). For example, the standards for nursing
appear to consider extensive library research as the norm while practicing
nurses often have more immediate information needs that require quick
turnaround times. Further, nursing students fail to see the connection between evidence based practice and their clinical experience (Aglen, 2016). One way to reinforce information literacy
skills is to incorporate them throughout the curriculum as it may better
prepare students for professional practice (Flood, Gasiewicz,
& Delpier, 2010; Phelps & Hyde, 2018).
Nursing students are eager to gain more information on patient care, database
training, and computer skills, especially the primary database in nursing,
CINAHL (Dee & Stanley, 2005; Duncan & Holtslander,
2012).
As nursing students transition to work in a clinical
setting, they mimic the practices they will likely take on as practicing nurses
- namely, they rely heavily on peers and electronic materials, although newer
nurses tend to rely more heavily on print resources (Dee & Stanley, 2005; Wahoush & Banfield, 2013). Nurses seek information most
frequently for patient care and in novel situations, such as a patient
presenting with an atypical symptom (Newman & Doran, 2012; O’Leary & Ni
Mhaolrúnaigh, 2012; Younger, 2010). Practicing
nurses’ reliance on colleagues and general Internet searches as their first and
second sources of information, respectively, are well documented in the
literature (Alving, Christensen, & Thrysøe, 2018; Argyri, Kostagiolas, & Diomidous,
2014; Baro & Ebhomeya,
2013; Clarke et al., 2013; Majid et al., 2011; Marshall, West, & Aitken,
2011; Newman & Doran, 2012; O’Leary & Ni Mhaolrúnaigh,
2012). Familiarity and proximity may play a large role in these preferences:
using proprietary databases is time consuming and requires access and training,
whereas speaking with colleagues is a normal occurrence (Gilmour, Huntington,
Broadbent, Strong, & Hawkins, 2012; Marshall et al., 2011).
However, nurses and nursing students experience several
barriers and frustrations to seeking and accessing information: a lack of
computer skills or, more specifically, database searching skills (Argyri et al., 2014; Dee & Stanley, 2005; Intas et al., 2016); frustration with choosing the right
words or phrases to query information resources (Duncan & Holtslander, 2012); lack of access to computers or Internet
connections (Raj, Sharma, Singh, & Goel, 2015; Sarbaz,
Kimiafar, Sheikhtaheri, Taherzadeh, & Eslami, 2016);
and resistance to evidence based practice (Kahouei, Babamohamadi, Panahi, & Zadeh, 2013). Nurses and
students need better training using mobile technology, including apps, in
clinical, classroom, and laboratory settings (Baro
& Ebhomeya, 2013; Majid et al., 2011; Raman,
2015). A lack of time was the barrier most frequently reported by nurses (Argyri et al., 2014; Baro & Ebhomeya, 2013; Kumaran & Chipanshi,
2015; Majid et al., 2011). These barriers are not unique to nursing; they are
commonly reported in literature for many health sciences professions. Lack of
knowledge and time are compounding barriers: when a nurse is ignorant about or
resistant to evidence based practice, they are
unlikely to seek evidence to improve their practice. A lack of time would also
make learning new skills or technologies more difficult. If a nurse fails to
see the connection between accessing information and patient care, they are
less likely to invest the time to change their thinking. Finally, when
searching for evidence is not built into the professional nursing workflow,
searching falls by the wayside (Alving et al., 2018).
No study connected information seeking behaviour to the teaching of information literacy skills
explicitly by asking nurses how well their nursing education prepared them for
the professional information environment.
Aims
In an effort to improve information literacy education of
nursing students, this study answers the following research questions: What are
the current information practices of professional bachelor’s-prepared nurses?
How do recently-graduated nurses suggest that their education could have better
prepared them to find and evaluate information in the workplace?
Methods
Study Concepts and Scope
For the purposes of this study, nurses are defined as
practicing registered nurses (RNs) with at least a bachelor’s degree in nursing
(BSN). The authors defined
The study was limited to surveying the perceptions of
nursing alumni who 1) graduated with baccalaureate degrees in nursing (i.e.
Bachelor of Science in Nursing) between 2012-2017 from one of four Utah-based
institutions, and 2) were employed as a nurse while participating in the study.
The researchers elected to do a cross-institutional study in order to study
patterns of nurses educated statewide, as well as to increase the sample size.
The four represented institutions include two public (Southern Utah University
and the University of Utah) and two private universities (Brigham Young
University and Roseman University of Health Sciences), two of which are small
(i.e., an enrollment of fewer than 10,000 students) and two are large (i.e.,
enroll at least 20,000 students).
Data Collection and Analysis
A 59-item survey instrument was developed, tested, and
administered using Qualtrics to capture data from the large group of nursing
alumni (see Appendix A). The researchers chose the survey as a data collection
tool to reach a large number of geographically dispersed respondents with a set
of standardized questions. Survey question topics and themes were informed by
questionnaire-based research studies on nurses’ and nursing students’
information behaviour (Argyri,
Kostagiolas, Diomidous,
2014; Baro & Ebhomeya,
2013; Intas et al., 2016; Kumaran & Chipanshi, 2015; Majid et al., 2011; O’Leary & Ni Mhaolrúnaigh, 2012; Sarbaz,et
al., 2016; Wahoush & Banfield, 2014),
specifically those studies which included their survey instruments (Dee &
Stanley, 2005; Farrell, Goosney, & Hutchens,
2013; Pravikoff, Tanner, & Pierce, 2005). The
survey questions, in a variety of formats including multiple choice and
open-ended questions, were pre-tested and revised where necessary to prevent
misinterpretation and bias. The survey was sent to librarians, nursing faculty,
and practicing nurses, and testers’ feedback was incorporated into the survey
prior to its deployment. The survey consisted of eight sections: Introduction
and consent; Demographics and current employment situation; Information needs;
Information sources; Information environment at workplace; Barriers to finding,
accessing, and evaluating information; Education & instruction; and Exiting
the survey. Approval of the study was obtained from all four institutional
review boards.
An email from each nursing dean, chair, or alumni office
was sent to their respective nursing alumni asking them to participate in the
upcoming survey. Within a week of this message, each nursing program graduate
received an email link to the survey, which opened on November 13, 2017. A
total of 1,926 invitations were distributed. Alumni received up to four
reminders if their survey response had not been received within a specific
timeframe. Respondents who did not graduate from one of the four institutions
(e.g., because they were given the survey link through a forwarded email) or
did not currently work as a nurse were routed to exit the survey. No questions
were required, so response rates fluctuated from question to question. After
completing the survey, respondents had the option to leave the survey and go to
another page to leave their contact information to enter one of ten $20 Amazon
gift cards. Gift cards were funded by a research award from the Nursing and
Allied Health Resources Section of the Medical Library Association.
Preceding data analysis, all identifying information
including names and contact information were removed to ensure anonymity of
respondents. The results of the open-ended questions were analyzed for emergent
themes using the qualitative method of analytical coding, where codes emerged
from the data (Richards, 2009). Researchers did an initial round of coding for
all responses to an open-ended question. In a second pass through these
responses, more detailed codes were added and codes were normalized where
needed. In a final round of coding, the codes were grouped into themes.
Results
What are the Information Practices of Professional
Bachelor’s-Prepared Nurses?
To answer the first research question, the researchers examined
demographics of the group, reasons nurses seek information, source types used,
and information access and barriers.
Demographics
Out of the 1,926 total invitations sent, 349 respondents
completed the survey, resulting in a response rate of 18.1%. Most respondents
graduated within two years of the study with at least half having two or more
years of employment as a nurse. Ninety-six percent of respondents’ highest
degree completed was a Bachelor’s in Nursing and 14% were currently enrolled in
a graduate nursing degree program (see Table 1). While this study focused on
nurses trained at a baccalaureate level, fourteen respondents earned a master’s
degree, doctorate or other degree. It is likely that they earned these other
degrees in the time since completing their BSN. These nurses, who only made up
only 4% of all respondents, were included in the analysis as it did not appear
education level made for drastically different responses.
Table
1
Demographic
Characteristics of Graduated Nurses who Responded to Survey
|
|
N |
Percent |
|
Nurses
completed survey |
349 |
---------- |
|
Graduation
year |
|
|
|
2012 |
36 |
10.32 |
|
2013 |
60 |
17.19 |
|
2014 |
58 |
16.62 |
|
2015 |
74 |
21.20 |
|
2016 |
81 |
23.21 |
|
2017 |
39 |
11.17 |
|
Years
of employment as a nurse |
|
|
|
0 |
39 |
11.17 |
|
1 |
83 |
23.78 |
|
2 |
75 |
21.49 |
|
3 |
71 |
20.34 |
|
4+ |
81 |
23.21 |
|
Highest nursing degree
obtained |
|
|
|
Bachelor’s |
334 |
95.70 |
|
Master’s |
8 |
02.29 |
|
Doctorate |
5 |
01.43 |
|
Other |
1 |
00.28 |
Reasons
Nurses Seek Information
The top reasons survey respondents reported seeking
information were: (a) “To answer patient questions” (85%), (b) “To determine
best practices for patient care” (70%), (c) “To consult clinical practice
guidelines” (70%), (d) “To check clinical procedures” (70%), and (e) “To
interpret laboratory data” (67%).
Respondents answered an open-ended question about how
they used information to move beyond a recent moment at work where they
struggled to make sense of a situation. From 131 responses to the question, the
researchers identified seven core themes. These were: seeking information to help
or educate patients (40%), clarifying medical situations (19%), expanding
health care knowledge (13%), verifying medications (11%), clarifying hospital
safety and policy procedures (8%), checking measurements, data, and labs (5%),
and clarifying treatment plans (4%).
Only two print sources were used at least daily by more
than 10% of the nurse participants: policy & procedures manuals (12%) and
paper fact sheets / handouts (15%). When asked about information sources,
respondents reported most frequently using electronic health records, which may
include links to external information sources, with daily usage reported in
almost three out of four cases (72%). Far fewer use general search engines
daily (39%) and websites with medical information (23%). Respondents reported a
number of other electronic sources, including mobile apps (e.g., UpToDate,
Lexicomp, Micromedex, and Epocrates), specific
hospital resources (e.g., hospital handbooks, policies, and/or guidelines), and
other websites (e.g., Center for Disease Control (CDC), Association of periOperative Registered Nurses (AORN), Associated Regional
and University Pathologists (ARUP)). As interpersonal sources, nursing
colleagues and physicians are used most frequently, with at least daily use for
70% and 62% of respondents, respectively. Table 2 shows survey respondent data
for selected sources based on a 6-point Likert scale on frequency of electronic
and interpersonal source use.
Table
2
Selected
Sources Based on Frequency of Use
Values:
1 = never, 2 = rarely, 3 = monthly, 4 = weekly, 5 = daily, 6 = multiple times a
day
|
Grouping |
Source
Type |
1 |
2 |
3 |
4 |
5 |
6 |
|
Electronic |
|
|
|
|
|
|
|
|
|
EMR |
13 |
11 |
24 |
43 |
64 |
166 |
|
|
General
Search |
21 |
30 |
53 |
92 |
75 |
48 |
|
|
UpToDate |
62 |
54 |
74 |
83 |
29 |
19 |
|
|
Medical
Websites |
21 |
46 |
73 |
107 |
55 |
17 |
|
|
PubMed |
64 |
79 |
92 |
65 |
15 |
5 |
|
|
Google
Scholar |
114 |
77 |
71 |
38 |
18 |
1 |
|
|
CINAHL |
151 |
100 |
47 |
18 |
2 |
0 |
|
|
E-books |
163 |
87 |
47 |
14 |
4 |
0 |
|
Interpersonal |
|
|
|
|
|
|
|
|
|
Nursing Colleagues |
8 |
13 |
24 |
53 |
103 |
112 |
|
|
Physicians |
3 |
13 |
31 |
77 |
117 |
83 |
|
|
Pharmacists |
7 |
25 |
43 |
101 |
94 |
53 |
|
|
Allied
Health Workers |
29 |
55 |
62 |
79 |
71 |
27 |
|
|
Social
Workers |
47 |
71 |
65 |
77 |
42 |
21 |
|
|
Medical
Librarians |
214 |
71 |
21 |
12 |
0 |
0 |
A series of survey questions
addressed access to information sources, as well as barriers that prevent
efficient and effective access. Several questions allowed respondents to check
all options that apply; percentages add up to more than 100% in those cases. In
total, 64% of respondents have access to information sources through their
employers, either because the employers provided the sources themselves or
could get them upon request. Other sources included local libraries (21%),
personal membership(s) in professional organizations or societies (17%),
personal purchases (11%), and professional contacts outside of the workplace
(10%). The great majority of nurses used work computers (89%) and personal
phones (58%) to access clinical information at work.
Respondents reported that they
needed information in a number of clinical environments, including team
meetings (48%), clinical rounds
(45%), but mostly chairside or bedside (86%). Respondents are generally able to
access information where they need it, reporting access as follows: team
meetings (46%), clinical rounds (38%), and chairside or bedside (78%). Some of
the other situations where respondents said they needed information included
educating other nurses, during phone calls with patients, or when verifying the
purpose of prescrib
Most respondents (59%) reported that time constraints
were a moderate or substantial barrier to accessing information. Other moderate
to substantial barriers included lack of training on using information sources
(24%), cost (21%), lack of expertise or training in accessing information
(19%), lack of access to technology (12%) and lack of training in technology
(13%). In the open-ended responses, time and access emerged as the most common
barriers to seeking information. For example, one respondent stated: “on our unit, time constraints are a HUGE
barrier.” This response was typical of the comments on access: “My worksite does not provide access to
databases which require subscriptions, so I find myself mainly utilizing free
resources such as pubmed [sic] and google scholar
[sic].”
How Do Recently-Graduated Nurses Suggest That Their
Education Could Have Better Prepared Them to Find and Evaluate Information in
the Workplace?
To answer the second research question, the researchers
looked at respondents’ answers to how they find and evaluate information
generally, how they do this in the course of their work, confidence level in
search and evaluation skills, and how their schooling could have better prepared
them for information seeking at their workplace.
How Nurses Learned
to Find and Evaluate Information
The researchers asked respondents to rank the importance
of where they learned to find information on a five-point scale (important,
somewhat important, neutral, somewhat unimportant, unimportant). Ninety-three
percent of respondents ranked self-taught skills as either important or
somewhat important. Similarly, on-the-job training was deemed at least somewhat
important by 88% of respondents. Nursing school faculty also had a strong
impact on teaching respondents to find information, with 84% reporting that it
was important or somewhat important, and nursing school librarians were found
important by 53% of respondents.
Finding and
Evaluating Information at Work
When nurses need help searching for information at work,
proximity seemed to be a major factor. Eighty-nine percent of the respondents
answering this question consulted their nursing colleagues within the
workplace, while 59% consulted other healthcare colleagues in their workplace.
Similarly, respondents sought help for evaluating sources from their immediate
nursing colleagues (90%), or from other healthcare professionals in their
workplace (63%).
Confidence in
Search and Evaluation Skills
A series of questions asked respondents to evaluate their
confidence in finding, evaluating, sharing and explaining information based on
a five-point scale (Completely confident=4, Very confident=3, Moderately
confident=2, Somewhat confident=1, Not at all confident=0). When averaging the
values, most were moderately confident in their ability to share information
with others (x̄=3.26), evaluate the quality of the information (x̄=3.21), find information (x̄=3.16) and explain information
needs (x̄=3.07). Interestingly, respondents’ confidence levels
declined with their ability to understand the issues surrounding information,
such as ethical use and copyright (x̄=2.70).
How Nursing
Education Could Have Better Prepared Nurses for Information Seeking
When the survey asked how their education could have
better prepared respondents for information seeking, respondents provided a
wealth of information. Of the 151 responses on this question, 17 had no
suggestions and didn’t explicitly mention whether the respondent felt prepared
or not. Of the 135 remaining responses, 50 respondents (37%) mentioned they
were either satisfied or happy with their preparation in this area. A thematic
analysis of all 91 responses with suggestions revealed suggestions for
improvement in four different categories: specific information literacy skills
(41%), teaching methodology (24%), resources (35%), and miscellaneous (16%).
Note that some responses fit multiple categories.
The researchers categorized the 37 suggested information
literacy skills based on The ACRL
Information Literacy Standards for Nursing (Association of College &
Research Libraries, 2013): information need (3%), information access (62%),
evaluation (24%), information use (27%), ethics and legal issues (0%). In
addition, the researchers added a miscellaneous category (22%). Information
access skills were by far the largest category. Many respondents requested
instruction in resources outside of typical nursing and medical databases,
specifically quality sources that are freely available on the Internet. A
representative comment was: “Teach us
more places to get free, good information.” On evaluation, respondents
specifically wanted more practice, as well as more instruction on evaluating
non-academic sources. Respondents also suggested additional instruction on
information use. Some mentioned wanting instruction on reading and skimming
research; others wanted more practice using sources to find answers and to
solve problems. Interestingly, no respondents suggested more preparation on
using information legally and ethically, an area in which they reported having
lower confidence. Skills mentioned in the miscellaneous category were better
knowledge of statistics, building critical thinking and lifelong learning
skills.
Over two-thirds of the 22 suggestions to improve
approaches to teaching information skills spoke clearly for using real-life
scenarios. For example, one respondent stated: “Giving students a scenario "Patient" with a complicated
diagnosis/history/problem and having them look up evidence, even in a made-up
evidence-based-practice manual of a made-up facility could be good practice.” Respondents
also suggested factoring in other real-life aspects such as time constraints
and realistic assignments, like creating care plans. Several comments
recommended teaching information seeking and research skills in tandem with
clinical experiences rather than in isolation in the classroom.
A third of comments about resources addressed the issue
of losing access to subscription databases after graduation, as in this
comment: “More in depth training of
resources available outside of school.” Others also stressed that they
don’t have time to do actual research but need to have access to free online
(24%) and vetted (18%) resources that allow them to quickly (15%) look up
information they need. Respondents also suggested teaching a variety of sources
(18%) including proprietary and other commercial sources (15%) they would be
likely to use when practicing: “more
education on apps and tools on the internet that you can use, and also ones
typically used by hospitals through the EHR.”
The remaining comments included suggestions for more and
earlier instruction in the course of study (27%), more one-on-one time with the
librarian (13%), and more organized and interesting library sessions (13%).
Discussion
Nurses’ Information
Use Patterns
The information use patterns of the surveyed nursing
alumni were mostly in line with findings in the literature (Newman & Doran,
2012), with two exceptions. The use of print sources was much lower in the
current study than previously reported by Dee and Stanley (2005). The drop in
the use of print resources is likely explained by the fourteen-year time
difference between the studies. In addition, the electronic health record as a
frequently used source has not been reported elsewhere; this may reflect the recent
adoption of electronic health records across healthcare systems.
Because they are motivated to
provide the best patient care, nurses use information to question orders,
ensure procedures are correct, seek clarification on diagnoses and treatments, and
answer patient questions. When they are unsure, nurses speak to another medical
professional (likely a nurse) and/or look up the answer. Nurses use readily
available tools, including electronic medical records, local colleagues, and
general Internet searches.
Time is of the essence and a lack of access to
information can create a frustrating barrier to success. Though most of the
nurses in this study had some access to databases through work, many wanted
access to the same resources available during nursing school. To many, losing
their information privilege (Hare & Evanson,
2018) was not something they had anticipated but a common frustration among
college graduates (Head, 2016). A recent hashtag on Twitter, #NoJournalsNoEBP, has highlighted this situation for nurses
and other health professionals (Cogan, 2019).
Implications for Information Literacy Instruction
In an ever-evolving clinical environment, it is important
that nurses’ information skills match their patient-focused care preferences
(Forster, 2015). Nursing students would benefit from developing critical
thinking skills in order to quickly locate and evaluate information based on
novel situations that prompt information seeking in their work.
Figure
1. Researchers’ suggested areas for preparing nurses for information seeking.
This study has significant implications for nursing information
literacy instruction to facilitate knowledge transfer to the clinical setting.
Conforming to the problematic research assignments described in Head and
Eisenberg (2010), information literacy education in nursing is often focused on
subscription-based article databases and finding sources for research paper
assignments that span several weeks. While some respondents indicated that
research-focused coursework was valuable to learn the research process, this
survey showed that this type of information seeking is rare in the workplace.
Nurses need to be prepared to access reliable information quickly during the
course of their daily work. The researchers propose three new areas of
emphasis: clinical scenarios, teaching beyond academic sources, and lifelong
learning.
First, respondents indicated a desire for more active
learning and clinical situations in information literacy sessions: they want
instruction to mirror real life experience more closely.
Second, teaching should not focus solely on traditional
academic sources. Nursing students need to know what sources will be available
to them after graduation; instruction sessions near the end of the program and
research guides for alumni will provide resources and guidance to new nurses.
Students should be familiar with freely-available resources that provide
reliable information (e.g., PubMed, Google Scholar). In addition, information
literacy skills need to be taught in a way that encourages transferability from
the academic environment to the professional one (Kuglitsch,
2015).
Third, it is important to teach and stimulate critical
thinking skills and the importance of lifelong learning. Generic evaluation
skills are often taught by librarians in general university curricula. Nursing
students need further instruction on evaluating information in their
professional context (Sleutel, Bullion, &
Sullivan, 2018), especially because many of them turn to general Internet
searches instead of academic sources. In addition, self-taught skills and
on-the-job mentoring were very important to nurses. Educators can empower
nursing students to teach themselves and each other when they encounter a new
resource or interface. Educators should also introduce nursing students to
colleagues as potential information sources and increase awareness of helpful
co-workers such as hospital librarians. This type of interpersonal information
seeking should not be considered a least-effort approach but rather
quality-driven, seeking out trusted experienced colleagues (Xu, Tan, &
Yang, 2006; Hertzum, 2014).
Implications for Partnering with Nursing Faculty
As the findings show, nursing faculty are important in
teaching students to both find and evaluate information. Faculty subject
expertise is essential to developing students’ skills and is complemented by
librarians’ expertise in teaching information literacy. Faculty wishing to
implement more authentic information seeking into their curricula partner with
librarians on their campus to deliver expert instruction in this area,
especially targeting using information in clinical scenarios (Haines & Horrocks, 2006). Because information-seeking behaviours are built and reinforced over time, librarian
involvement in scaffolding information literacy throughout curricula is more
effective and engaging than having librarians present only at orientation or in
a research-focused course (Johnson-Grau, Archambault, Acosta & McLean,
2016).
Librarians, while experts in information literacy, are
not necessarily adept at developing authentic cases for either classroom or
simulation instruction. The researchers encourage librarians to collaborate
with nursing faculty to ensure their examples are specific and authentic to
increase student engagement and learning (Carder, Willingham, & Bibb,
2001). Librarian involvement goes beyond research assignments; teaching
students to seek information to inform care plans, answer patient questions, or
resolve conflicting medical information would be useful in developing the
skills the students will need in patient care. In involving nursing faculty in
the creation of guides to curate resources in support of these activities,
librarians can enhance the quality of their resources.
Since interpersonal sources are often consulted, it is
important to help students learn how to critically evaluate information they
learn from colleagues (Hertzum, 2014).
Bachelor’s-prepared nurses may be new to healthcare and orienting them to the
wide variety of colleagues they will join, along with the information they can
provide, is important. New nurses may be unaware that many hospitals have
librarians who can assist with medical information searches (Dee & Stanley,
2005). Educating new nurses about the availability of librarians who can
perform expert searches rapidly can free up nurses’ time to provide patient
care. The respondents had no problem contacting other health professionals for
answers to their discipline-specific questions, e.g., asking pharmacists for
drug information, medical
Study Limitations
All participating nurses received their education in the
state of Utah and the majority were employed within the region. This limited
geographic range might have affected the study results. It also should be noted
that the response rate for this study was low, perhaps because busy nurses were
intimidated by the estimated time commitment. In addition, the survey was long
and not all participants completed all questions. Regrettably, the survey did
not specifically ask nurses about their use of online or mobile apps as an
information resource.
Conclusion
Through a survey, the researchers elucidated nurses’
information-seeking behaviour and elicited
suggestions for better preparation for finding and evaluating information. The
results indicate discrepancies between the information environments of nursing
school and professional nursing.
Correspondingly, changes are necessary in nursing information literacy
instruction to prepare nurses for the professional information environment.
Emphasizing clinical scenarios, teaching beyond traditional academic sources,
and encouraging lifelong learning skills will ensure students learn relevant, transferable
skills in authentic settings. Lives depend on nurses delivering the best
healthcare possible; it is imperative that librarians and educators enable
nursing students to use information in the most effective way.
Acknowledgements
This work was supported in part by an award from the
Nursing and Allied Health Section of the Medical Library Association. The
authors acknowledge Phil Roché, Erin Wimmer, Kyle O’Sullivan, and the Harold B. Lee Library
Assessment & Usability Department, specifically Holt Zaugg
and Brian Roberts, and the nursing administration and alumni from our four
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