A perfect partnership for research practice
By Therese Boyd
Research & Teaching at Penn State Altoona
A pregnant woman is admitted to the hospital in the late stages of labor. After she has the baby, the nursing staff asks if she intends to breast-feed or bottle-feed her newborn. The new mother says she has read so many pros and cons on the Internet that she is not sure which is best for her baby and herself. The nurses want to give her the most up-to-date information without bias. Where can the best information be found?
Every time a patient arrives in a hospital, the nurses face a new set of challenges. As nurses’ knowledge of a patient grows, procedures are set and then followed. But sometimes an unexpected situation occurs, one for which even the most experienced nurses may need to find more information through research.
At Penn State Altoona, nursing students are taught to follow “evidence-based practice,” a rigorous approach that combines knowledge founded on experience with careful research to provide the right answer for a problem. For the past three years, Assistant Teaching Professor Cathy Dillen and Alessia Zanin-Yost, reference and instruction librarian and liaison to the nursing department, have been collaborating to develop the best way to help students apply evidence-based practice so they are prepared for the unexpected.
Using a phenomenological approach, Dillen and Zanin-Yost’s initial efforts were based on observing and talking to the students to gain as much information as possible. “We tried different things to determine what type of research approach was best for this group of students,” Zanin-Yost says. “Nurses have specific situations, and they have to find a solution to help that patient. Where can they find the answer to their questions? How does this new information impact their existing knowledge, the protocols in place, and their practice? Nursing students need more exposure on how to find evidence-based research.” A nursing professor and a librarian can be the perfect combination to help make that happen.
“Our partnership works really well,” Zanin-Yost continues. “We have a very open communication. I question Cathy on something and she explains it. Our collaboration is not merely talking about the library session. We talk about assessment, we talk about active learning, and about pedagogy. There is always a conversation. If students are not able to do as we expect, we question our own practice, we look for examples that would fit the needs of our students.” That relationship also benefits the students: “They see how we work as a team in and out of the classroom. Students who have spoken to previous cohorts learned they can come to me. To help them became very important to me.”
The experience also gave Zanin-Yost a taste of a nursing student’s life. “By the time they come to me at night they are brain dead. I think I am a person with a lot of patience and empathy, but working with nursing students, I had to increase these qualities. Helping a student succeed is not merely helping them pass a class. To me, it is the whole package—the emotional, psychological, and physical factors. Sometimes, when I know a student has had only four hours of sleep I say, ‘hey, maybe you should go to bed now instead of talking to me about research.’ I admire the nursing students’ tenacity, diligence, and wanting to excel.”
Dillen and Zanin-Yost taught the students the PICO (Patient, Intervention, Comparison, Outcome) process, used in evidence-based practice, to frame and answer a clinical or health care–related question. “So many times we do things the same old way,” Dillen says. “By defining the PICO question, you know what literature you need to examine.” The PICO approach requires the student to formulate a specific question based on the patient’s needs, which ultimately makes it faster to find the right answer. “The PICO process,” Dillen adds “is what they will use as nurses.”
In addition to figuring out the right approach to research, Dillen and Zanin-Yost realized that the students did not have enough practice with using research skills. Initially, research instruction encompassed a single hour, attendance was voluntary, and yet “they all came,” says Zanin-Yost. The expansion of the research instruction came about because the students were asking many questions. Zanin-Yost notes, “Because of time issues with students we decided to make [research instruction] a component of the class as four hours of clinical.” Therefore, the research instruction evolved into a three-part workshop. In the first hour, students learn how to use the library’s resources, especially the medical databases, which is then followed by more detailed instruction on how to research, and finally hands-on work where students begin to formulate their research and look for information to use in their papers.
Achievements by the nursing students prove the success of Dillen and Zanin-Yost’s methods. With the encouragement and guidance of their instructors, this year the largest number of nursing students participated in the poster presentations at Penn State Altoona’s Undergraduate Research and Creative Activities Fair. “We had to teach them a new set of skills—how to make and present the information in a poster format. They needed the skills to explain medical terminology as you would to a lay person, which was a challenge to several of them,” Zanin-Yost says.
The students not only prepared their own posters but also critiqued those of their classmates. Stephanie Knaub’s “Cardiovascular Disease: It’s Not Just a Man’s Disease Anymore,” mentored by Nursing Instructor Cindy Bowman, was awarded first place in the Nursing category; Abby Stedding on “Breastfeeding or Bottle-Feeding in Regards to Immunity Development,” mentored by Instructor in Nursing Julie Decker, placed second; in third place was Stephanie Knaub, Maddie Duty, Rachael Kuntz, and Alyson Eck’s entry, “Nursing Concepts to Consider Before Starting an Elderly Patient on Antidepressants,” which was mentored by Dillen.
Speaking of all the nursing students who participated in the poster presentation, Zanin-Yost says, “The students went through the research process just like a nurse would do, without the implementation. We were so proud of them. These students graduated in May with strong research skills, but also with confidence to talk to anyone about medical protocols and procedure, and a new set of communication skills.” The instructors are also looking to a larger future for their students. “We wanted them to be able to talk to a different audience while they are researching, and show them the importance of sharing their knowledge with others. We are hoping they are going to become active in the nursing world.”
Dillen sees a larger world for the nurses as well: “They can take what they’ve learned to any area of nursing—research, presentations, committees, self-efficacy. We tell them don’t just get a procedure book and write it up. Find new research findings and present that to your colleagues.”
Based on their experiences, Dillen and Zanin-Yost now firmly state that “education has reached a point at which neither librarians nor instructional faculty can adequately teach the research process in isolation of each other.” To spread that message they presented “Students and Research Needs: When Small Changes DO Make a Difference” at the West Virginia Library Association’s 2018 conference.
The instructors intend to continue this partnership, working together to figure out the best ways to teach, to communicate, and to help their students improve, while changing their methods as needed. As Zanin-Yost says, “Success is not just measured by academics, it’s a holistic approach.”
First place: Stephanie Knaub, “Cardiovascular Disease: It’s Not Just a Man’s Disease Anymore,” mentored by Instructor in Nursing Cindy Bowman.
Second place: Abby Stedding, “Breastfeeding or Bottle-Feeding in Regards to Immunity Development,” mentored by Instructor in Nursing Julie Decker.
Third place: Stephanie Knaub, Madelyn Duty, Rachael Kuntz, and Alyson Eck, “Nursing Concepts to Consider Before Starting an Elderly Patient on Antidepressants,” mentored by Assistant Teaching Professor Cathy Dillen. Pictured are Rachel Kuntz and Madelyn Duty.