Study Protocol| Population Medicine
Providing a teaching and learning open and innovative
toolkit for evidence-based practice to nursing European
curriculum (EBP e-Toolkit): Project rationale and design
Evridiki Patelarou1,2, Konstantinos Vlasiadis3, Mariusz Panczyk1,4, Jakub Dolezel1,5, Darja Jarosova1,5, Joanna Gotlib1,4, Brigita
Skela-Savič1,6, Daniela Mecugni1,7, Stefano Finotto1,7, Maria Ruzafa-Martinez1,8, Antonio Jesús Ramos-Morcillo1,2, Athina
Patelarou1,2
AFFILIATION Sciences, University of Modena and Reggio Emilia, Degree Course in
1 European Nursing Centre for Learning Evidence-Based Practice Nursing, seat of Reggio Emilia, Reggio Emilia, Italy
(ENCLEBP), Murcia, Spain 8 College of Nursing, University of Murcia, Murcia, Spain
2 Department of Nursing, Faculty of Health Sciences, Hellenic
Mediterranean University, Heraklion, Greece CORRESPONDENCE TO
3 Dental Clinic, General University Hospital of Heraklion, Heraklion, Greece Evridiki Patelarou. Department of Nursing, Faculty of Health Sciences,
4 Department of Education and Research in Health Sciences, Faculty of Hellenic Mediterranean University, 71414 Crete, Greece. E-mail:
Health Sciences, Medical University of Warsaw, Poland
5 Department of Nursing and Midwifery, Faculty of Medicine, University
of Ostrava, Ostrava, Czech Republic KEYWORDS
6 Angela Boškin Institute for Research in Healthcare Sciences, Angela evidence-based practice, competence, curriculum, nursing
Boškin Faculty of Health Care, Jesenice, Slovenia
7 Department of Surgery, Medicine, Dentistry and Morphological Received: 4 August 2020, Accepted: 8 October 2020
Popul. Med. 2020;2(November):39 https://doi.org/10.18332/popmed/128272
ABSTRACT curricula and to produce the acquisition of EBP competence
Evidence-based practice (EBP) is an instrument of great earlier in professional life. The project is organized along four
utility in making clinical decisions in nursing care, improving major outputs, and a dissemination and sustainability plan
the quality of nursing care and patients’ health outcomes. has been set up. A mixed method research constitutes the
There is no European framework for EBP competency, main methodological approach applied in the project. This
and no guidelines for EBP teaching. The general concept of methodology requires the active participation of all research
the project ‘Providing a Teaching and Learning Open and groups, partners, steering committee, nursing students, and
Innovative Toolkit for Evidence-based Practice to Nursing educators, in the project. The use of the EBP e-Toolkit will
European Curriculum: (EBP e-Toolkit)’ is to fill this gap in increase nurses’ and nursing students’ level of EBP competence
Nursing education across Europe and to foster and harmonize by formulating specific guidelines to be implemented in EBP
the teaching and learning of EBP in the European nursing teaching.
INTRODUCTION staffing decisions must be evidence-based5. In addition, the
Evidence-based practice (EBP) is a problem-solving approach European Federation of Nurses Associations developed
to clinical decision-making that integrates the best available a Competency Framework (CF), based in the European
scientific evidence with clinical experience and patients’ Directive 2013/55/EU, that establishes the minimum
preferences and values1. EBP is an instrument of great utility educational requirements for nurses responsible of general
in making clinical decisions in nursing care, helping to reduce care. This CF includes as a core competence: ‘to implement
healthcare costs2 and variability in clinical practice, improving the scientific findings for evidence-based practice’6. Moreover,
quality of nursing care practice and patients’ health outcomes3, the importance of education in EBP is recognized by WHO in
and increasing job satisfaction of nursing professionals4. the technical guide for Member States, which gives ‘European
EBP has been declared as a professional responsibility strategic directions for strengthening nursing and midwifery
and central characteristic of the work of nurses by the towards Health 2020 goals’7.
International Council of Nurses, which highlights that nurse Nevertheless, the incorporation of EBP into clinical
Published by European Publishing. © 2020 Patelarou E. et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non
Commercial 4.0 International License. (http://creativecommons.org/licenses/by-nc/4.0)
1
, Study Protocol| Population Medicine
nursing has been slow and remains a challenge to the along four major outputs, including a dissemination and
profession. Across different countries, research results sustainability plan that will start when the project has
have revealed a very restricted level of EBP implementation been set up. A mixed method research constitutes the
among nurses 8-10. There are multiple barriers for the main methodological approach that will be applied in the
relatively slow paradigm shift to EBP across the globe, project. This methodology allows researchers to apply the
including inadequate EBP knowledge and skills, lack of value most appropriated methods in the project and depends
for and misperceptions about EBP, inadequate EBP resources, on target groups (nursing students, educators, clinical
administrative support and organizational culture, lack of mentors) and the specific objectives of each output. This
authority to change patient care procedures, insufficient methodology implies the active participation of all research
numbers of EBP mentors within both academic and clinical groups, partners, steering committee, nursing students, and
environments, and negative attitudes toward research as educators.
a result of the manner in which students have been taught The partnership of this project involves six countries and
this content in their academic programs11. Also, available institutions among countries with specific leadership of
evidence indicates that lack of knowledge, confidence in the project’s individual outputs and activities, as presented
teaching EBP, information and literacy skills, time, resources, in Table 1. The purpose of Output 1 (Slovenia, Czech
frameworks for curricula and support are all barriers Republic, Greece, lead partners) is to achieve a general
experienced by nurse educators12. Job satisfaction, values picture on teaching EBP in nursing curricula across Europe
of activism and professionalism, and competencies aimed and to establish a basis for developing and defining EBP
at the development and professionalization of nursing are competencies for nurses. The main objective of Output
also significant factors for EBP beliefs and implementation 2 (Italy, lead partner) is to support nursing students and
for employed nurses13,14. nurses’ educators by providing them with materials,
There are limited resources to support EBP in European resources and means to learn and practice EBP. Output 3
Nursing Curricula. There is no European framework for EBP (Poland, lead partner) aims to design the teaching and learning
competency, and no guidelines for EBP teaching. The project open access online materials for EBP (EBP e-Toolkit) and to
‘Providing a Teaching and Learning Open and Innovative develop an innovative EBP education intervention based on
Toolkit for Evidence-based Practice to Nursing European the findings of Outputs 1 and 2. Output 4 (Spain, lead partner)
Curriculum: (EBP e-Toolkit)’ therefore aims to fill this gap in aims to test and validate the EBP e-Toolkit as an innovative
Nursing education across Europe. approach on teaching EBP among partner countries.
The general concept of the EBP e-Toolkit project is to All of the partners have substantial experience teaching
foster and harmonize the teaching and learning of EBP EBP for a nursing degree and in research on EBP education.
in the European nursing curricula and to produce the The activities have already been agreed upon and distributed
acquisition of EBP competence earlier in professional life among partners. So, responsibilities are divided amongst
that can be continued for lifelong self-directed learning also partners based on their skills and expertise to lead and
among nurse educators and clinical mentors. Consequently, contribute to the specific activities. Overall, in recognition
the nursing students and nurse educators (both academic of the diverse expertise across the partner institutions, the
nursing teachers and clinical mentors supervising students in collaborative nature of all aspects of design and delivery is
the clinical placement) are the target groups of this project15. central to the project.
The specific objectives of EBP e-Toolkit project are the
following: Output 1: Development of guidelines on the
1. To analyze the current situation of EBP in European recommendations for teaching and learning EBP to
Nursing Curricula. Nursing European Curricula
2. To agree on a European EBP competency framework. Output 1 will involve three activities.
3. To develop guidelines on the recommendations for
teaching and learning EBP to the European Nursing Curricula. Activity 1.1
4. To develop joint curricula and an EBP e-Toolkit For the purposes of Activity 1.1, a common protocol used
(including an e-course and open educational resources) among partners will be developed in order to collect data
with a pedagogical strategy for learning and training EBP regarding teaching and learning EBP in nursing curricula
in nursing oriented to undergraduate nursing students and among participating countries. All relevant information will
professional nurses. be collected through an e-survey developed for the purposes
5. To validate the innovative educational intervention of the project. Following data gathering and analysis, a report
using EBP e-Toolkit among nursing students and nurse will be developed that will provide information related to
educators (academic and clinical mentors). teaching EBP in participating countries. This report will
describe the past and present situation of EBP teaching in
METHODS each partner’s institution, including mode of delivery of
The project will be carried out over 3 years and organized lectures, student activities, and assessment methods.
Popul. Med. 2020;2(November):39
https://doi.org/10.18332/popmed/128272
2
Providing a teaching and learning open and innovative
toolkit for evidence-based practice to nursing European
curriculum (EBP e-Toolkit): Project rationale and design
Evridiki Patelarou1,2, Konstantinos Vlasiadis3, Mariusz Panczyk1,4, Jakub Dolezel1,5, Darja Jarosova1,5, Joanna Gotlib1,4, Brigita
Skela-Savič1,6, Daniela Mecugni1,7, Stefano Finotto1,7, Maria Ruzafa-Martinez1,8, Antonio Jesús Ramos-Morcillo1,2, Athina
Patelarou1,2
AFFILIATION Sciences, University of Modena and Reggio Emilia, Degree Course in
1 European Nursing Centre for Learning Evidence-Based Practice Nursing, seat of Reggio Emilia, Reggio Emilia, Italy
(ENCLEBP), Murcia, Spain 8 College of Nursing, University of Murcia, Murcia, Spain
2 Department of Nursing, Faculty of Health Sciences, Hellenic
Mediterranean University, Heraklion, Greece CORRESPONDENCE TO
3 Dental Clinic, General University Hospital of Heraklion, Heraklion, Greece Evridiki Patelarou. Department of Nursing, Faculty of Health Sciences,
4 Department of Education and Research in Health Sciences, Faculty of Hellenic Mediterranean University, 71414 Crete, Greece. E-mail:
Health Sciences, Medical University of Warsaw, Poland
5 Department of Nursing and Midwifery, Faculty of Medicine, University
of Ostrava, Ostrava, Czech Republic KEYWORDS
6 Angela Boškin Institute for Research in Healthcare Sciences, Angela evidence-based practice, competence, curriculum, nursing
Boškin Faculty of Health Care, Jesenice, Slovenia
7 Department of Surgery, Medicine, Dentistry and Morphological Received: 4 August 2020, Accepted: 8 October 2020
Popul. Med. 2020;2(November):39 https://doi.org/10.18332/popmed/128272
ABSTRACT curricula and to produce the acquisition of EBP competence
Evidence-based practice (EBP) is an instrument of great earlier in professional life. The project is organized along four
utility in making clinical decisions in nursing care, improving major outputs, and a dissemination and sustainability plan
the quality of nursing care and patients’ health outcomes. has been set up. A mixed method research constitutes the
There is no European framework for EBP competency, main methodological approach applied in the project. This
and no guidelines for EBP teaching. The general concept of methodology requires the active participation of all research
the project ‘Providing a Teaching and Learning Open and groups, partners, steering committee, nursing students, and
Innovative Toolkit for Evidence-based Practice to Nursing educators, in the project. The use of the EBP e-Toolkit will
European Curriculum: (EBP e-Toolkit)’ is to fill this gap in increase nurses’ and nursing students’ level of EBP competence
Nursing education across Europe and to foster and harmonize by formulating specific guidelines to be implemented in EBP
the teaching and learning of EBP in the European nursing teaching.
INTRODUCTION staffing decisions must be evidence-based5. In addition, the
Evidence-based practice (EBP) is a problem-solving approach European Federation of Nurses Associations developed
to clinical decision-making that integrates the best available a Competency Framework (CF), based in the European
scientific evidence with clinical experience and patients’ Directive 2013/55/EU, that establishes the minimum
preferences and values1. EBP is an instrument of great utility educational requirements for nurses responsible of general
in making clinical decisions in nursing care, helping to reduce care. This CF includes as a core competence: ‘to implement
healthcare costs2 and variability in clinical practice, improving the scientific findings for evidence-based practice’6. Moreover,
quality of nursing care practice and patients’ health outcomes3, the importance of education in EBP is recognized by WHO in
and increasing job satisfaction of nursing professionals4. the technical guide for Member States, which gives ‘European
EBP has been declared as a professional responsibility strategic directions for strengthening nursing and midwifery
and central characteristic of the work of nurses by the towards Health 2020 goals’7.
International Council of Nurses, which highlights that nurse Nevertheless, the incorporation of EBP into clinical
Published by European Publishing. © 2020 Patelarou E. et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non
Commercial 4.0 International License. (http://creativecommons.org/licenses/by-nc/4.0)
1
, Study Protocol| Population Medicine
nursing has been slow and remains a challenge to the along four major outputs, including a dissemination and
profession. Across different countries, research results sustainability plan that will start when the project has
have revealed a very restricted level of EBP implementation been set up. A mixed method research constitutes the
among nurses 8-10. There are multiple barriers for the main methodological approach that will be applied in the
relatively slow paradigm shift to EBP across the globe, project. This methodology allows researchers to apply the
including inadequate EBP knowledge and skills, lack of value most appropriated methods in the project and depends
for and misperceptions about EBP, inadequate EBP resources, on target groups (nursing students, educators, clinical
administrative support and organizational culture, lack of mentors) and the specific objectives of each output. This
authority to change patient care procedures, insufficient methodology implies the active participation of all research
numbers of EBP mentors within both academic and clinical groups, partners, steering committee, nursing students, and
environments, and negative attitudes toward research as educators.
a result of the manner in which students have been taught The partnership of this project involves six countries and
this content in their academic programs11. Also, available institutions among countries with specific leadership of
evidence indicates that lack of knowledge, confidence in the project’s individual outputs and activities, as presented
teaching EBP, information and literacy skills, time, resources, in Table 1. The purpose of Output 1 (Slovenia, Czech
frameworks for curricula and support are all barriers Republic, Greece, lead partners) is to achieve a general
experienced by nurse educators12. Job satisfaction, values picture on teaching EBP in nursing curricula across Europe
of activism and professionalism, and competencies aimed and to establish a basis for developing and defining EBP
at the development and professionalization of nursing are competencies for nurses. The main objective of Output
also significant factors for EBP beliefs and implementation 2 (Italy, lead partner) is to support nursing students and
for employed nurses13,14. nurses’ educators by providing them with materials,
There are limited resources to support EBP in European resources and means to learn and practice EBP. Output 3
Nursing Curricula. There is no European framework for EBP (Poland, lead partner) aims to design the teaching and learning
competency, and no guidelines for EBP teaching. The project open access online materials for EBP (EBP e-Toolkit) and to
‘Providing a Teaching and Learning Open and Innovative develop an innovative EBP education intervention based on
Toolkit for Evidence-based Practice to Nursing European the findings of Outputs 1 and 2. Output 4 (Spain, lead partner)
Curriculum: (EBP e-Toolkit)’ therefore aims to fill this gap in aims to test and validate the EBP e-Toolkit as an innovative
Nursing education across Europe. approach on teaching EBP among partner countries.
The general concept of the EBP e-Toolkit project is to All of the partners have substantial experience teaching
foster and harmonize the teaching and learning of EBP EBP for a nursing degree and in research on EBP education.
in the European nursing curricula and to produce the The activities have already been agreed upon and distributed
acquisition of EBP competence earlier in professional life among partners. So, responsibilities are divided amongst
that can be continued for lifelong self-directed learning also partners based on their skills and expertise to lead and
among nurse educators and clinical mentors. Consequently, contribute to the specific activities. Overall, in recognition
the nursing students and nurse educators (both academic of the diverse expertise across the partner institutions, the
nursing teachers and clinical mentors supervising students in collaborative nature of all aspects of design and delivery is
the clinical placement) are the target groups of this project15. central to the project.
The specific objectives of EBP e-Toolkit project are the
following: Output 1: Development of guidelines on the
1. To analyze the current situation of EBP in European recommendations for teaching and learning EBP to
Nursing Curricula. Nursing European Curricula
2. To agree on a European EBP competency framework. Output 1 will involve three activities.
3. To develop guidelines on the recommendations for
teaching and learning EBP to the European Nursing Curricula. Activity 1.1
4. To develop joint curricula and an EBP e-Toolkit For the purposes of Activity 1.1, a common protocol used
(including an e-course and open educational resources) among partners will be developed in order to collect data
with a pedagogical strategy for learning and training EBP regarding teaching and learning EBP in nursing curricula
in nursing oriented to undergraduate nursing students and among participating countries. All relevant information will
professional nurses. be collected through an e-survey developed for the purposes
5. To validate the innovative educational intervention of the project. Following data gathering and analysis, a report
using EBP e-Toolkit among nursing students and nurse will be developed that will provide information related to
educators (academic and clinical mentors). teaching EBP in participating countries. This report will
describe the past and present situation of EBP teaching in
METHODS each partner’s institution, including mode of delivery of
The project will be carried out over 3 years and organized lectures, student activities, and assessment methods.
Popul. Med. 2020;2(November):39
https://doi.org/10.18332/popmed/128272
2
