Clinical Skill Acquisition

Contents lists available atScienceDirect Nurse Education in Practice journal homepage:www.elsevier.com/locate/nepr Original research In what ways does online teaching create a positive attitude towards research in nursing students studying a first year evidence-based practice undergraduate subject online? Alan Ramsay ∗, Kristin Wicking, Karen Yates James Cook University, College of Healthcare Sciences, Australia ARTICLE INFO Keywords: Attitude Research Evidence based practice Nursing Students ABSTRACT Nursing research teaching is seen as central to nurse education and practice, but the impact of exposure to research teaching on students' attitudes towards research remains unclear. The aims of this study were to explore the attitudes towards research of undergraduate nursing students, before and after exposure to research teaching online. A further aim of this study was to better understand students' attitudes towards research, to inform future teaching strategies. This descriptive quasi-experimental study used pre-semester and post-semester data col- lected by means of an online questionnaire. The Attitudes Towards Nursing Research Scale measured student attitudes via 18 Likert items that assessed four domains: Research Abilities, Usefulness of Research, Personal Interest in Research and Using Research in Clinical Practice. There were no statistically signi ficant changes in the overall Attitude Towards Research Scale. Individual item analysis did show statistically signi ficant changes in two items: Understanding of research terminology increased (p = 0.001), but Intention to conduct research decreased (p = 0.035). This study generated evidence on attitudes of nursing students toward research before and after their exposure to a research subject. Research teaching online may be insu fficient to effect a change in student nurses ’attitudes towards research. Summary of Relevance: Issue: Research is a foundational topic in undergraduate nursing curricula, but students often find the topic to be challenging to learn, while academics find it challenging to engage students in learning about research.What is Already Known: A validated instrument, Attitudes Towards Research, can be used to ascertain if teaching a ffects attitudes.What this Paper Adds: Overall attitudes of first year, second semester students did not change after experiencing a semester long introductory research subject. However, two item statements did show a statistically signi ficant change, in disparate directions. Understanding of Research Terminology increased, while Intention to Conduct Research decreased. 1. Introduction Developing an interest in research, is one of the central objectives of undergraduate nurse education ( Worcester et al., 2008;Clark et al., 2009 ;McCurry and Martins, 2010 ;Polit and Beck, 2018 ). As an evol- ving profession, incorporating research into nursing was seen as a vital transition point. Counterintuitively, for some, perceptions of research were often intermingled with a sense of anxiety and fear, often in the absence of an understanding of what research actually was ( Halcomb and Peters, 2009 ;Hagen et al., 2013; Warkentin et al., 2014 ). Despite this negativity towards research within some elements of the profes- sion, having a sound understanding of research is regarded by em- ployers and peers as a valued attribute of a modern registered nurse ( McCloskey, 2008 ;Breimaier et al., 2011 ). It is against this paradox of a profession which both respects and fears research that nurse academics are charged with educating nursing students regarding nursing re- search. There is little research into the e fficacy of exposure to nursing re- search teaching in precipitating attitudinal change toward research. This study set out to answer the research question: Do students ’atti- tudes towards research change post completion of an EBP subject and if so in what direction? The speci fic aims of this study were to explore baseline attitudes and changes in attitude towards research following exposure to nurse research teaching. A further aim of this study was to create a foundation, a better understanding of student attitudes to re- search, upon which academics can formulate more e ffective, innovative teaching strategies. https://doi.org/10.1016/j.nepr.2020.102744 Received 18 April 2019; Received in revised form 20 January 2020; Accepted 21 February 2020 ∗Corresponding author. James Cook University, Cairns Campus, Queensland, 4875, Australia. E-mail address: [email protected] (A. Ramsay). Nurse Education in Practice 44 (2020) 102744 1471-5953/ © 2020 Elsevier Ltd. All rights reserved. T 2. BackgroundExposing undergraduate nursing students to teaching which allows them to gain familiarity with searching, finding and analysing research literature has been the mainstay of preparing nursing students to translate evidence and research into the clinical setting. Research is often seen as a threshold subject which forms the foundation upon which such evidence translation takes place, in addition to encouraging students to more broadly integrate their developing theoretical knowledge with clinical skill acquisition ( Erkin et al., 2017;Hazel and Joyce, 2004; Moreno-Casbas et al., 2011; Morris and Maynard, 2007; Pashaeypoor et al., 2016). There is much written about online teaching in undergraduate nursing programs in term of its e ffectiveness. There is less written about creating attitude change towards research online. The external delivery mode challenges educators to create authentic and meaningful learning experiences. The educator who plies their trade in the virtual environment also has the challenge of somehow persuading learners to stay motivated and active in their learning in the absence of face-to-face teaching. Strickland et al. (2012)explored the e ffi cacy of podcasts to create meaningful and authentic relationships between educator and learner. They suggested that innovative use of podcasts can capture the essence of that face-to-face teaching modality whilst still capitalising on the flexibility and convenience of the online platform. Mollon et al. (2012) who tracked pre- and post-intervention descriptive quantitative surveys of 609 clinical healthcare sta ffin the USA found that their intervention of merely placing modules online, with no follow up or summative assessment linked to it, did little to improve engagement levels with online education. It is clear that with online delivery, high levels of negativity towards research ( Halabi and Hamdan-Mansour, 2012 :Sidebotham et al., 2014 ), the perceived dif- fi culty or challenge of teaching research ( Gagnon et al., 2013: Sidebotham et al., 2014) and the greater potential for learner disen- gagement ( Gagnon et al., 2013 :Mollon et al., 2012 ) presenta further challenge to educators to be more creative and thoughtful when plan- ning and developing research teaching materials. Findings of Halabi and Hamdan-Mansour (2012) andStrickland et al. (2012) suggest for students there is a link between motivation, attitude and satisfaction and the likelihood of future engagement with research, and that educators planning nursing research teaching de- livery should not merely concentrate purely on the content. When this is viewed against the backdrop of the pre-semester anxiety towards research, it becomes clear that the literature was suggesting that atti- tude and knowledge were both very important factors in helping stu- dents to view nursing research more positively ( Hart et al., 2008: Sidebotham et al., 2014). Although the Strickland et al. (2012)study had a special focus on the use of enhanced teaching strategies in teaching research, their findings suggested a proportional relationship between motivation to learn, satisfaction, and the perceived clinical relevance of their research studies. Some of the evidence has con flicting messages about the sig- ni ficance of students preexisting negative feelings towards research. Mollon et al. (2012) tend to suggest that prior levels of education are a more signi ficant predictor of better attitude, knowledge and skills around research than students' attitude towards research alone. There is a broader message here about knowing one's audience, with Mollon et al. (2012) suggesting that obtaining baseline levels of research knowledge, skills and attitude should be included in the planning of nursing research teaching events. Less optimistically, Mollon et al. (2012) also suggest that online education is “not e ffective in improving the practice, attitudes, and knowledge/skills regarding evidence-based practice ”(p. 417). A consensus appears of a general sense of student anxiety, fear and negativity towards research ( Hart et al., 2008;Feldman and Levin, 2013 ;Sidebotham et al., 2014 ). This consensus would suggest that the design of future research teaching should be responsive to a potential student bias against research ( Arthur and Wong, 2000;Ax and Kincade, 2001 ;Björkström and Hamrin, 2001; Dobratz, 2003;Halabi and Hamdan-Mansour, 2012 ). There is a gap in the existing evidence con- cerning the e ffectiveness of teaching research online and its potential in fluence on students ’attitudes towards research. 3. Methods 3.1. Design/Instrument This descriptive quasi-experimental study used pre-semester and Table 1 Attitudes towards research questionnaire. Question Strongly disagreeDisagreeAgreeStrongly agree 123 4 1 Evidence Based Practice is di fficult 2 I would like to conduct research 3 I see value in being taught reading/utilizing research 4 My nursing/midwifery academic team are engaged in research 5 Research is irrelevant to patient care 6 Research develops our profession 7 Research develops professional respect 8 I will use research after graduation 9 Reading research is di fficult 10 I am able to identify research-able problems 11 Research improves patient care 12 I understand research terminology 13 I am interested in conducting a research project 14 I am confident in participating in a research study 15 I am confident in my ability to design a research study. 16 I am confident in my ability to analyse data 17 I am confident in my ability to interpret data 18 I enjoy discussing research Domain Questions relating to each domain Research Abilities 1214 1516 17 Usefulness of Research 23 67 11 Personal Interest in Research 413 18 Using Research in Clinical Practice 1(R)5 (R) 89 (R) 10 A. Ramsay, et al. Nurse Education in Practice 44 (2020) 102744 2 post-semester data collected by questionnaire (Table 1). Initially de- signed, developed and deployed by Halabi and Hamdan-Mansour (2012) , the questionnaire is used in this study with permission from the questionnaire's creators. Halabi and Hamdan-Mansour (2012) mailed their self-administered questionnaire to 612 undergraduate nursing students at one of the largest universities in Amman, Jordan. The Attitudes Towards Nursing Research Scale, which is infl uenced by the work of Funk et al. (1991) on barriers to research utilisation, probes the participants attitude towards research using a 4 point Likert Scale. Negatively in flected questions had their Likert scores reversed (Questions 1, 5 & 9). The higher the score the more positive the attitude towards research. Student attitudes toward research were explored by identifying and assessing four domains: Research Abilities, Usefulness of Research, Personal Interest in Research and Using Research in Clinical Practice. The internal consistency of the survey questionnaire in this study was assessed using Statistical Package for the Social Sci- ences (SPSS) for Windows (version 23) giving a Cronbach's Alpha of .86 for all items. Halabi and Hamdan-Mansour (2012) reported a Cronba- ch's Alpha for all items of 0.74. Students were not tracked individually from pre semester to post semester. This lack of tracking, along with the fact that the ordinal data from the pre and post samples were essentially independent samples from the same population, made the Mann-Whitney Utest the most appropriate statistical test. The data from this study did not conform to normal distribution. Nonparametric testing comparing the pre-semester group to the post-semester group was conducted for all individual questions, the four domains and a total for all domains, using Mann Whitney Utest and are reported in Table 6. Where the questions were phrased negatively, questions 1, 5, and 9, the Likert score was reversed. 3.2. Ethical issues This study was accepted by the university's Human Research Ethics Committee, approval number H6664. The principle researcher was also the lecturer delivering the intervention, the Introduction to Evidence Based Practice subject. To mitigate any perceived coercion, the email invitations to complete the online survey were emailed by one of the secondary researchers who was not involved in any way with first year students. Anonymity was assured with no personal details being re- quested or gathered in the survey process. Participation in the survey was voluntary and students were reassured that not participating would not impact on their studies. 3.3. Setting and sample The population for this study were first year undergraduate Bachelor of Nursing Science student nurses at a regional university in Australia. From the cohort of 410 first year students 64 (15.6%) stu- dents responded to the pre-intervention invitation and completed the survey ( Table 2). Thirty Four (8.4%) of the 403 students who remained in the subject at the end, completed the post-intervention survey. 3.4. Intervention This research study's intervention was the exposure of students to the ‘Introduction to Evidence Based Practice ’subject. This subject is o ff ered in Semester Two of the students' first year of the three year Bachelor of Nursing Science degree, and this subject is delivered in a fully online mode for all students, regardless of course enrolment mode. Completion of this Bachelor of Nursing Science course quali fies a graduate for entry into the profession as a Registered Nurse with the Australian Health Practitioner Regulation Agency (AHPRA). This sub- ject introduces concepts of EBP and research, and Table 3lists the subject learning outcomes. Students develop and consolidate knowl- edge and skills in identifying and sourcing evidence for their practice. Various sources of evidence for practice are investigated, including the library, electronic databases and Internet. The traditions of quan- titative, qualitative and mixed methods research are introduced, with a focus on the language of research. Translating evidence to inform practice is also discussed. From this learning, students begin the pre- paration for nursing practice in a world where health care services are in fluenced by various factors, dynamic and constantly changing. See Table 4 for the content of the subject Introduction to Evidence Based Practice. 3.5. Data collection Participants were recruited via email. The invitation email from one of the secondary researchers contained an URL link which allowed them to participate in an online survey hosted on the Qualtrics plat- form. Three separate invitations to complete the pre survey were emailed in the two weeks prior to start of the teaching period. Once the semester commenced, the Pre survey became unavailable. Similarly, three post semester invitation emails were sent on the Monday fol- lowing the end of the teaching period and again on the Friday of that week, and the following Monday. The post semester survey was open for three weeks following the end of the study period. 3.6. Data analysis Data from the Qualtrics survey was imported in to SPSS 23 statis- tical data analysis program. Mann Whitney U testing was used to gauge any change in student responses from pre to post semester. Such testing re flected the ordinal data set, from a 4 point Likert scale, and followed the previous use of the Scale by its originators Halabi and Hamdan- Mansour (2012) . 4. Results 4.1. Demographic characteristics As shown in Table 5completions of both pre-semester and post- semester surveys numbered 64 and 34 respectively. Approximately 56% of respondents to the pre-semester survey were under 25 years old, with a similar demographic pro file in the post semester participants (57%). These age and gender pro files are congruent with those for the popu- lation of 410 students, as per data routinely collected subject level Table 2 Progress of survey Participants. A. Ramsay, et al. Nurse Education in Practice 44 (2020) 102744 3 demographics. 4.2. AnalysisAnalysis using SPSS Mann Whitney U testing showed there was no change in the students' Total Attitude Towards Nursing Research Scale following their exposure to the intervention. There was a statistically signi ficant change in the response pattern in question 2: ‘I would like to conduct research ’. Students responses became more negatively in flected over the course of the semester. This broadly suggested that students had become less interested in conducting research themselves in the future. Also there was a statistically signi ficant increase in the score for question 12, the student's self-reported understanding of research ter- minology. 5. Discussion Evidence from the study reported here suggests that students bene fited from developing their skills in the area of research termi- nology but in doing so their appreciation of the Usefulness of Research, their own Personal Interest in Research, their Research Abilities and their con fidence in Using Research in Clinical Practice remained largely unchanged. This contradicts existing evidence from within the profes- sion of nursing, which suggests that even those who self-report a high appreciation of research, actually report low estimates of their own knowledge in research ( Mehrdad et al., 2008;Moreno-Casbas et al., 2011 ;Halabi and Hamdan-Mansour, 2012 ;Rachmawati et al., 2017 ). There are some broad similarities here with the descriptive com- parative study by Erkin et al. (2017) where one cohort had taken part in research education and a second cohort had not, and reported that post education attitude levels were similar across both groups. The study reported here and that by Erkin et al. (2017)confirm that attitudinal change towards research is not easily achieved by educational inter- ventions. Attitude is a complex concept, and shifting attitudes in a desired direction may require more than traditional educational inter- ventions. The findings reported here suggest that teaching nursing students online about research did not improve their scores on the overall Attitude Towards Nursing Research Scale, nor did they improve on any of the four domains within the Scale. There is existing evidence that suggest online delivery could have had some signi ficant in fluence on the results. Mollon et al. (2012) had similar experiences from which they concluded that online teaching was not an e ffective method of introducing research. Gagnon et al. (2013)discovered that the use of online learning with face-to-face did not improve e ffectiveness of teaching research when compared to face-to-face alone. This would suggest that the results reported here must be viewed with considera- tion of the online delivery mode of the intervention. The findings reported here suggest that the students had no change overall in their regard for research. Ax and Kincade (2001)reported that students themselves disagreed with having research training in the early semesters of their education due to the anxiety and loss of moti- vation it created. That study also reported students being aware of a resistance towards research from quali fied nurses, nurse managers and themselves, a finding which Ax and Kincade (2001) suggested should be tackled by equipping students with strategies to deal with such re- sistance. The same study also went on to describe bene fits that may be derived from creating repeated links between research and other nur- sing subjects. This would suggest that incorporating elements of re- search within and between curriculum subjects may be as important as the semester timing of any research subject ( Moch et al., 2010; Zeleníková et al., 2014 ;Malik et al., 2017). Nurses appreciate the impact of research on their work but lack the con fidence or motivation to engage with it in a meaningful way ( Bennasar-Veny et al., 2016 ;Erkin et al., 2017 ;Khair et al., 2012 ; Mehrdad et al., 2008 ). This is echoed by evidence that the majority of nurses agree that knowledge of research skills should be part of their role, yet only a minority ever get involved in research, sometimes de- spite having speci fic research objectives, or goals of their own ( Darbyshire, 2008 ;McMaster et al., 2013). Sustaining the next gen- eration of nurse researchers, both in terms of number and diversity, is predicated on the motivation of new nurses into the profession, and avoiding them viewing research as being in the “too hard basket ” ( Darbyshire, 2008 , p. 3238). 5.1. Simple One of the findings of this study was that students reported that they felt less inclined to conduct research in the future following their se- mester of teaching. This broadly fits in with the narrative that teaching students about nursing research does not result in a positive change in their attitude towards research ( Bennasar-Veny et al., 2016;Erkin et al., 2017 ;Khair et al., 2012 ;Mehrdad et al., 2008 ). Discouraging students from becoming active in research is a finding of concern, and one which has been shared by others in this field ( Halcomb and Peters, 2009; Hart et al., 2008; Mehrdad et al., 2008; Mollon et al., 2012). More broadly, the study reported here further establishes that the student attitudinal Table 3 Subject learning outcomes. Subject Learning Outcomes 1 Explain the links between nursing knowledge and experience, including the role research plays in nursing practice 2 Demonstrate the ability to search for and identify current nursing literature and research 3 Identify the key elements of nursing research and how it applies to contemporary nursing practice 4 Describe how qualitative and quantitative research processes contribute to knowledge growth and in fluence nursing practice 5 Explain how evidence impacts on nursing knowledge and practice, including how it e ffects and initiates practice change 6 Demonstrate critical thinking and re flective practice approaches in the application of new knowledge to nursing practice Table 4 Content of Introduction to Evidence Based Practice (per week). One Introduction to Research Six Knowledge Translation Two Quantitative Research Seven Indigenous Insights Three Qualitative Research Eight Research Application Four Mixed Methods Research Nine Research Ethics Five Appraising Research Ten Research & Knowledge: The future. Table 5 Demographics of respondents. Gender Pre-semester Post-semester Subject Cohort Frequency Frequency Male 7.8% ( n= 5) 5.9% ( n= 2) Male 13.4% Female 92.2% ( n= 59) 94.1% ( n= 32) Female 86.6% Total 64 34 Age Age 17-25 56.3% ( n= 36) 55.9% ( n= 19) 15 –24 66.4% 26-35 23.4% ( n= 15) 29.4% ( n= 10) 25 –34 22.3% 36-45 12.5% ( n= 8) 14.7% ( n=5) 35 –44 8.2% 46-55 7.8% ( n=5) 0%( n=0) 45–59 3.1% A. Ramsay, et al. Nurse Education in Practice 44 (2020) 102744 4 Table 6 Mann-WhitneyUtest: attitudes towards research pre and post semester by Domain. Domain Pre-Semester Median IQR Post-Semester Median IQR Pre Post Median Difference Mann-Whitney U ZAsymp.Sig (2 Tailed p- value Research Abilities (possible range 5 –20) 13 (11:15) 14 (12:15) 1 846.000−1.830 .067 Usefulness of Research (possible range 5 –20) 16 (15:19) 16.5 (14.75:18) 0.5 1047.500-.306 .760 Personal Interest in Research (possible range 3 –12) 9 (7:9) 8(7:9.25)−1 974.500-.868 .385 Using Research in Clinical Practice (possible range 5 –20) 15 (14:16) 15 (14:16) 0 1029.000-.448 .654 All Domains (19 –92) 52(49:56) 53 (49:58) 1 1006.000-.613 .540 Mann-Whitney Utest: attitudes towards research pre and post semester by Question Question Pre-Semester Median IQR Post-Semester Median IQR Pre Post Median Difference Mann-Whitney U ZAsymp.Sig (2 Tailed) p- value Research is di fficult 3(2:3) 3 (2:3) 0 1000.000-.733 .464 I would like to conduct research 3(3:3) 3 (2:3) 0 836.0002.112 .035* I see value in being taught Research 3(3:4) 3 (3:4) 0 1012.000-.651 .515 My nursing academic team are engaged in research 3 (3:3) 3(3:4) 0 988.500-.866 .387 Research is irrelevant to patient care 4(3:4) 4 (3:4) 0 1029.000-.499 .618 Research Develops our Profession 4(3:4) 4 (3:4) 0 1045.5001.336 .712 Research develops professional respect 3(3:4) 4 (3:4) 1 929.0001.336 .181 I will use research after graduation 3(3:4) 3 (3:4) 0 1073.000-.127 .899 Reading research is di fficult 3(2:3) 2 (2:3)−1 911.5001.476 .140 I am able to identify researchable problems 3(2:3) 3 (3:3) 0 882.5001.894 .058 Research improves patient care 3(3:4) 3 (3:4) 0 1067.000-.180 .857 I understand research terminology 2.5(2:3) 3 (3:3) 0.5 678.003.439 .001* I am interested in conducting research 3(2:3) 2 (2:3)−1 864.5001.819 .069 I am con fident in participating in a research study 3(2:3) 3 (3:3) 0 945.5001.208 .227 I am con fident in my ability to design a research study 2 (2:3) 2(2:3) 0 1010.500-.658 .511 I am con fident in my ability to analyse data 3(2:3) 3 (2:3) 0 1030.500-.515 .607 I am con fident in my ability to interpret findings 3 (2:3) 3 (2:3) 0 1014.000-.657 .511 I enjoy discussing research 3(2.25:3) 3 (2:3) 0 976.000-.975 .329 n Number of Valid Cases 6434 *Statistically Significant p ≤0.05. A. Ramsay, et al. Nurse Education in Practice 44 (2020) 102744 5 response to teaching about research is at worst negative and at best neutral.Research and attitude are complex notions. Jung (1971)described attitude in terms of a concept of the readiness to act. This has a parti- cular poignancy in the teaching of research. This study set out to gauge, in part, any change in that readiness to act. At the very core of all research teaching should be the intent of motivating the learner to develop patterns of behaviour, to act in ways which are underpinned by research and evidence ( Funk et al., 1991;Hart et al., 2008;Halcomb and Peters, 2009 ;Mehrdad et al., 2008 ;Mollon et al., 2012). Even when there is a change in attitude it does not always precipitate any beha- vioural change ( Melnyk, 2002); but, asMehrdad et al. (2008) argue, there remains a primary need to help nurses believe that care based on research does result in positive outcomes for patients. Despite educa- tors ’desire to know that their teaching makes a di fference, the evidence from this study suggests that teaching research does not necessarily improve their overall attitude towards research. 5.2. Strength and limitations This study provided an opportunity to test the English version of an instrument that was originally developed in Arabic. It demonstrated strong psychometric properties in an Australian, English speaking sample (Cronbach's alpha of 0.86). The generalization or interpretation of the findings here need to be considered against the response rate and overall size of the sample. Sixty-four and 34 students from an original cohort of 410 completed the pre and post semester survey respectively. Also, the data collection did not track individual participants and their change in attitude through the semester, due to the decision to provide anonymity to protect the participants in a vulnerable relationship with the principle investigator. An exit block was added to the post semester questionnaire which only permitted those who self-reported that they had completed the pre semester survey, to continue on to complete the post semester survey. No data was collected to assess the e ffect of other teaching, events or experiences that students may have had during the semester which could have in fluenced these results. The online nature of the teaching should also be seen as a limitation of this study. This study did not capture the shape, or dimensions of any in fluence of the online teaching method on the results. The method of convenience sampling used may indicate that preconceived views or attitudes towards research could have in fluenced students' decision to participate or not. Furthermore, the composition of the questionnaire, which for example has a negatively in flected first question which sug- gests ‘Evidence based practice is di fficult ’, needs to be considered. Further use of this tool should explore the sequencing and phrasing of the questions and the in fluence these factors may have on the results. 6. Conclusion The findings of this study indicate no change in students' overall attitude toward research over the course of the semester, as measured by the total score on the Attitude Towards Research Scale l. Additionally, in each of the four domains, Research Abilities, Usefulness of Research, Personal Interest in Research and Using Research in Clinical Practice, there were also no statistically signi ficant di fferences in students' attitudes. In two individual questions, there were statisti- cally signi ficant di fferences, with an increase in students ’perceived understanding of research terminology, and a decrease in their desire to conduct a study. The implications of this study for those involved in the teaching of research in nursing is that there is no certainty that teaching students about research will necessarily improve their attitude about research. There is a suggestion here that even when there is no change in attitude towards research there is some bene fit in knowledge outcomes from formal teaching in this area. Educators need to consider ways of teaching research that can help foster changes in attitudes in students that make them better motivated and more interested in research. As a basic, first recommendation, future research should replicate this study in other populations and with larger samples. Also, future research could broaden the scope of this study and explore the educational barriers that exist that preclude students from embracing research and its impact on their practice. 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Faculty perception of the e ffectiveness of EBP courses for graduate nursing students: perception of e ffec- tiveness of EBP courses. Worldviews Evidence-Based Nurs. 11 (6), 401 –413. https:// doi.org/10.1111/wvn.12068 . Alan Atholl Ramsay : Alan Ramsay is a Registered Nurse, Cardiac Nurse and an ex- perienced academic/lecturer teaching into James Cook University's Bachelor of Nursing Science program. Starting his academic career in 2012, his teaching has focussed on Evidence Base Practice and Professional Development within Nursing, in addition to contributing more broadly throughout the undergraduate program. Now based in Cairns in Queensland, his teaching has been in fluenced by the pedagogies of Blended Learning and technology mediated learning which has been partly due to working remotely, both clinically and academically, in The Torres Strait. He has an interest in the in fluence of digitally enhanced teaching methods on students' attitudes towards various elements of their professional and clinical development. Kristin Wicking: Dr Wicking's career has spanned both inpatient and outpatient nursing practice; teaching, leadership, and staff development roles in outpatient and higher education settings; and academic roles in both the USA and Australia. Dr Wicking has led or participated in research teams and supervised numerous research students across a variety of methodologies and topic areas, with a primary focus on student, staff and patient education, particularly around chronic conditions. Karen Yates : Dr Yates is an experienced researcher, Deputy Academic Head for Nursing & Midwifery, and Deputy Director of the WHO Collaborating Centre for Nursing & Midwifery Education & Research Capacity Building. Dr Yates has experience in teaching undergraduate and postgraduate nursing and midwifery students and has a strong re- search interests in nursing and midwifery education and new graduate workforce. A. Ramsay, et al. Nurse Education in Practice 44 (2020) 102744 7