Assessing The Effect Of Virtual Education On Information Literacy .
(2021) 21:48Shamsaee et al. BMC Med Inform Decis RCH ARTICLEOpen AccessAssessing the effect of virtualeducation on information literacycompetency for evidence‑based practiceamong the undergraduate nursing studentsMaryam Shamsaee1, Parvin Mangolian shahrbabaki2 , Leila Ahmadian3 , Jamileh Farokhzadian4*and Farhad Fatehi5,6AbstractBackground: Information literacy competency is one of the requirements to implement Evidence-Based Practice(EBP) in nursing. It is necessary to pay attention to curricular development and use new educational methods such asvirtual education to strengthen information literacy competency in nursing students. Given the scarcity of the studieson the effectiveness of virtual education in nursing, particularly in Iran, and the positive university atmosphere regarding the use of virtual education, this study investigated the effect of virtual education on the undergraduate nursingstudents’ information literacy competency for EBP.Methods: This interventional study was performed with two groups of intervention and control and a pretest andposttest design. Seventy-nine nursing students were selected and assigned to the intervention or control groups byrandom sampling. Virtual education of the information literacy was uploaded on a website in the form of six modulesdelivered in four weeks. Questionnaires of demographic information and information literacy for EBP were used tocollect data before and one month after the virtual education.Results: The results showed no significant difference between the control and intervention groups in all dimensionsof information literacy competency in the pre-test stage. In the post-test, the virtual education improved dimensionsof information seeking skills (t 3.14, p 0.002) and knowledge about search operators (t 39.84, p 0.001) in theintervention groups compared with the control group. The virtual education did not have any significant effect on theuse of different information resources and development of search strategy with assessing the frequency of selectingthe most appropriate search statement in the intervention group.Conclusion: Virtual education had a significant effect on information seeking skills and knowledge about searchoperators in nursing students. Nurse educators can benefit from our experiences in designing this method for theuse of virtual education programs in nursing schools. Given the lack of effectiveness of this program in using differentinformation resources and development of search strategy, nurse educators are recommended to train informationliteracy for EBP by integrating several approaches such as virtual (online and offline) and face-to-face education.Keywords: Electronic-learning, Information literacy, Evidence-based nursing, Nursing students, Virtual learning*Correspondence: j.farokhzadian@kmu.ac.ir; farokhzadian2010@yahoo.com4Nursing Research Center, Kerman University of Medical Sciences, POBox 7716913555, Haft‑Bagh Highway, Kerman, IranFull list of author information is available at the end of the article The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, whichpermits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to theoriginal author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images orother third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit lineto the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutoryregulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of thislicence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Shamsaee et al. BMC Med Inform Decis Mak(2021) 21:48BackgroundEvidence-based practice (EBP) has been accepted asan important concept in nursing and is quickly becoming the norm for effective nursing practice globally [1].EBP is a decision-making approach to patient care thatintegrates the most current and valid research findings,the nurse’s clinical expertise, the client’s values and preferences, and available resources in making decisions.The benefits of EBP include nurses’ improved practicalknowledge, patient-centered care with better patient outcomes, reduced occurrence of adverse events, reducedpatient care costs, and health facility [2, 3].Scientific evidence for EBP can be obtained by systematic and structured searches in retrieval systems, bibliographic databases, and clinical guidelines, which requireretrieval skills in database searching and informationliteracy competency [2, 4]. Information literacy competency is the ability to recognize when information isneeded, determine the amount of information needed, toretrieve information efficiently, and to evaluate, classify,and store information sources [5]. Information literacycompetency is the ability to develop appropriate researchquestions, perform a search, appraise the relevant literature, and evaluate the transferability of research evidenceinto clinical practice and we know that it is critical toapply EBP successfully [6, 7].Establishing information literacy competency in nursing students is vital for the promotion of EBP [8]. Nurseeducators should develop nursing students’ competencies for EBP and then motivate them to deliver the highest quality of care using EBP [9]. Applying the effectivestrategies for teaching EBP competencies in theory andpractice, they also have a fundamental role in developing information literacy competency among students [3].Unfortunately, efforts to raise nursing students’ information literacy in the past years have had minimal success because experts and educators could not agree oneffective strategies for nursing education and teachingof nursing information literacy [10]. Consequently, thereare gaps in the integration of information literacy competency into nursing education [11]. In some studies, nursing students and newly graduated nurses reported thatthe training they received in nursing schools were insufficient, and they were not competent in almost all areasof informatics. These studies suggested that informationliteracy competency had to be improved through informatics curricula [11–13]. Moreover, researchers havereported that nursing schools do not have a standardfor the type and complexity of computer skills requiredfor nursing students. [14]. They also reported that factors and barriers affecting a student’s information literacy competency including, lack of information literacyin curriculum, confusing definitions of informatics, andPage 2 of 11nurse educators’ lack of informatics skill all might contribute to the student’s competency [13]. A systematic review reported that a lack of critical appraisal andadvanced literature search skills might contribute to thenegative attitudes towards EBP, which can be minimizedby appropriate teaching of these skills [6].It is noteworthy that there is an ongoing transition fromtraditional teaching and learning to more self-directedlearning in nursing education due to the development ofthe Internet, learning platforms, and new technology [15]and change of the student population to digital natives.However, researchers have paid less attention to teachingstrategies such as online teaching/learning and blendedlearning about information literacy competency in Asiancountries [10]. In addition, we are entering into a newphase of the evolution in academia and higher education known as “online and digital universities”. Digitalization in higher education allows streaming lectures onlineor enables professors and students to interact throughvirtual education [16]. Virtual education is a novel educational approach, which can facilitate simple and inexpensive access to educational resources and servicesthrough communication technologies (e.g., electronicdevices) regardless of time and place [17].Literature review showed that few studies implementeda training program to improve information literacy competency among students and reported that students’information literacy competency increased after a training program. For example, Liou et al. tried to develop ablended course to improve nursing students’ information literacy competency in Taiwan. The majority of students with a positive perception of the teaching strategiesexpressed that they understood more about informationliteracy and applied information literacy skills in nursing[10]. A meta-analysis in Iran showed that virtual education was as effective as traditional education. Amongdifferent educational technologies, multimedia education, e-learning, and computer-mediated learning hadsignificant effects on medical education. The educationaltechnologies were more effective in the virtual education groups compared with the controls without virtualeducation [17]. Another study proposed various strategies for the incorporation of EBP competencies intoundergraduate nursing education. Nurse educators canuse strategies such as debates, social media, simulations,learning modules, game-based learning, workshops andtraining sessions. None of these strategies are superior toothers in terms of teaching EBP [3].Problem statementHealth care in Iran has markedly improved over thelast 25 years. The Iranian health care system aims to beevidence-based and patient-centered, which requires
Shamsaee et al. BMC Med Inform Decis Mak(2021) 21:48Page 3 of 11This interventional study with a pretest–posttest designwas conducted in a Nursing School affiliated with Kerman University of Medical Sciences in southeast of Iran.The bachelor’s degree in Iran includes theoretical andpractical courses in 8 semesters over four years in theuniversity and educational hospitals. The undergraduatenursing curricula at the time of this study included 1.5credits of research in nursing (34 h in third semester) andone credit of information technology in nursing (26 h inthe first semester). According to the current curricula,the participants of this study did not receive educationsrelated to information literacy competency.The second questionnaire was about information literacy competency for EBP, which was part of a questionnaire namely “Perceptions of Nurses of EBP” and wasdeveloped in the previous studies [18, 19]. This questionnaire composed of two sections. The first section concerned about the use of different information resourcesby nurses, including electronic, printed, and humansources (19 items). These items could be answered ona 5-point Likert scale ranging from "never" to "always".The second section included information searching skillsand use of different search features of online databasesand web search engines (10 items) on a 5-point Likert scale ranging from "never" to "always". In addition,nurses’ knowledge about Boolean /Connectors (‘OR ‘,AND’, ‘NOT’ or ‘AND NOT) and Proximity (e.g. W/nn;PRE/nn) operators was assessed. These items could beanswered with yes (one point), no (zero point), and notsure (zero point). Finally, nurses were provided with ahypothetical searching topic (Effect of cigarettes on lungcancer) along with five possible search statements. Theywere asked to search MEDLINE using Boolean operators and select the most appropriate search statement forthe given topic. Item 4 was the most appropriate searchstatement among the 5 available items (Cigarettes ORSmoking OR Tobacco) AND (“Lung Cancer” OR “LungTumor” OR “Lung Neoplasm”).We used the Persian version of the questionnaire in thisstudy, which was validated in Iran. The content validityand reliability (α 0.87) of the Persian version of questionnaire was approved by experts [7].Study population and samplingData collectionThe target population of this study included all undergraduate nursing students (N 136) in the sixth andeighth semesters. The sample size was 80 participants byusing the sample size formula that were divided randomlyinto intervention and control groups (40 students in eachgroup) and equally selected from each of the semesters.Inclusion criteria included the nursing students whopassed credits of research in nursing and informationtechnology in nursing and started learning in the clinicalsettings. The students who were transferred to anotheruniversity or failed to complete the questionnaires forany reason and guest students were excluded. Finally, 79students completed the questionnaires and one studentof the intervention group did not complete the course(response rate 98.75%), (Fig. 1).Data were collected by using an anonymous, selfreported, and electronic questionnaire from March toMay 2020. To collect data, the first researcher createdgroups for each of the intervention and control groupsin WhatsApp. Informed consent was obtained from students enrolled in the course two weeks before the program. All students in this study had e-mail addresses;therefore, link of questionnaire was sent to e-mails andWhatsApp groups in pre-test (before course) and posttest stages (one month after the course). The instructionof how to fill out the questionnaires was sent to participants’ e-mails and WhatsApp groups. To attain the highest response rate, the first researcher spent appropriatetime on data collection and determined a deadline todeliver completed questionnaires. In addition, she sentdetailed information about how to learn the educationalprogram. Moreover, she coordinated time of educationalsessions with participants in the intervention group andreminded them to attend the sessions in the scheduledtimes. It should be noted that the participants completedquestionnaires at e-campus.ongoing improvement of the quality of health care professional education. Nursing students need to be prepared for EBP competencies. Insufficient attention hasbeen paid to teaching of information literacy competencyin virtual nursing education, especially in middle- andlow-income countries. Furthermore, virtual learningstrengthens the traditional approaches to education, butthere is no evidence of the evaluation of this method.Assessment of the students’ information literacy competency for EBP after virtual education can help adjustcurricula to students’ educational needs. Regarding theimportance this issue and the scarcity of the related studies in Iran, this study aimed to evaluate the impact of atraining program on information literacy for EBP amongthe undergraduate nursing students in Iran.MethodsStudy design and settingInstrumentsThe instrument used in this study consisted of two questionnaires. The first one was about the nursing students’demographic information such as gender, age, so on(Table 2).
(2021) 21:48EnrollmentShamsaee et al. BMC Med Inform Decis MakPage 4 of 11Assessed for eligibility (n 80)Excluded (n 0) Not meeting inclusion criteria (n 0) Declined to participate (n 0) Other reasons (n 0)AllocationRandomized (n 80)AnalysisFollow-UpAllocated to intervention (n 40) Received allocated intervention (n 40) Did not receive allocated intervention (givereasons) (n 0)Allocated to control (n 40) Received allocated intervention (n 40) Did not receive allocated intervention (givereasons) (n 0 )Lost to follow-up (give reasons) (n 0)Lost to follow-up (give reasons) (n 0)Discontinued intervention (give reasons) (n 1)Discontinued intervention (give reasons) (n 0)Analysed (n 39) Excluded from analysis (give reasons) (n 0)Analysed (n 40) Excluded from analysis (give reasons) (n 0)Fig. 1 Flow diagram of the study, representing data collection points for the intervention group and the comparison groupIntervention procedureTo prepare and develop the course content, theresearchers reviewed the literature about information literacy competency and the link between information literacy and EBP in nursing [10, 20–24]. Theydiscussed the extracted topics to achieve a consensusconcerning goals and contents and teaching strategies.The researchers employed the standards proposed bythe Association of College and Research Libraries asa guide for information literacy competency in highereducation and selected essential competencies [24].The team members provided their experiences andperspectives on required training of students concerning information literacy competency for EBP, as well asteaching–learning activities and educational programsavailable to informatics literacy in nursing school. Thiscurricular integration also afforded many opportunities for student-centered teaching methods such asevidence-based learning, and inquiry learning. Onemedical informatics specialist and six nursing facultymembers who were not in the research group approvedthe content validity of the educational content. Finally,two members, one specialized in nursing and the otherin medical informatics, prepared topics of the course(Table 1).The educational materials were uploaded on the website dedicated to this research in form of six modulesduring four weeks. The participants of the intervention
Shamsaee et al. BMC Med Inform Decis Mak(2021) 21:48Page 5 of 11Table 1 Topics presented in the modules and students’ participation rate in each educational modulesModules TopicsMissed (%) Completed (%)1Familiarizing with EBP and understanding of what is involved in EBPPerceiving the value of EBP in nursingLearning the level of skills required for undertaking different EBP activitiesDiscussing and making a possible work plan by using an example according to the steps of EBPUnderstanding information literacy and its frameworkExplaining various terminologies related to information literacyFamiliarizing with how information technology can be used in education1(2.50)39(97.50)2Introducing and orientating variety of information sources including hard print, electronic and humansourcesDeveloping the skills to obtain e-books, e-journals, and other meaningful information using the library orthe InternetDemonstrating a variety of electronic search capabilities such as the ways to subscribe and receive freearticlesDetermining the most appropriate methods for accessing information electronically: search engines, interfaces (the database screens), and content available through a given system2(5.00)38(95.00)3Developing skills to criticize/evaluate hardware, software, and websitesIdentifying keywords, synonyms, and related terms for the information needed (Medline, etc.)Describing information needed through key concepts and termsDemonstrating medical and nursing databases such as Cumulative Index to Nursing & Allied Health Literature (CINAHL), PubMed, Scopus, Using search strategies in databases such as PubMed and ScopusIntroducing Up to Date, EBSCO, Searching articles in Persian databases such as Scientific Information Database)SID(, Medlib, Iranmedex, andMagiran1(2.50)39(97.50)4Doing simple and advanced search, and conducting limited search based on the publication year, full text,keywords, Medical Subject Headings (MeSH), and using search operators such as AND, OR, NOT and etcDoing practical exercises. For example, retrieving related articles in databases such as PubMed and Scopusfor “Intubate Patient Care” with related keywords and providing search results3(7.50)37(92.50)5Demonstrating abilities and gaining proficiency in search of information, management of information, andapplication of various technological tools in presenting informationDetermining the nature and extent of the information neededExplaining the risks and constraints of searching the Internet for needed evidence-based informationUsing appropriate search language and parameters for selected system3(7.50)37(92.50)6Assessing the quantity, quality, and relevance of the search results to determine whether alternative information retrieval systems or investigative methods should be utilizedEvaluating information sources critically and incorporating selected information into their knowledge baseand value systemComparing various information sources to evaluate reliability, validity, accuracy, authority, timeliness, andpoint of view or biasSynthesizing conclusions based upon information gatheredUsing information effectively for a specific purpose individually or as a member of a teamEvaluating outcomes of the use of information1(2.50)39(97.50)group had a username and password to use the educational content uploaded on the website. The addressof the educational website was declared through thecommunication channels. They were able to access thewebsite off line at any time and place. Reminder messages were sent via WhatsApp and SMS to motivatethe use of the website. The communication betweenstudents and materials were prepared in the forms ofaudio file, PowerPoint slides, video tutorials, and textual help, question and answer, hands-on exercise (withexamples of literature search), and homework. Studentswere required to self-study course materials, practiceexercises, and discuss issues by E-mail or WhatsApp.Assignments included learning journals and literaturesearch, criticizing website, discussing literacy issuessuch as academic integrity, and doing a search-basedproject. Assignments encouraged a sense of involvement in the use of reference materials. All other assignments were submitted to the instructors and theirfeedbacks were sent to the students via E-mail. Theassignments could be resubmitted unlimitedly. Whileintervention group was provided with additional materials derived from our training course, the controlgroup did not receive this program.Statistical analysisThe data were analyzed by using SPSS 21, descriptivestatistics (frequency, percentage, mean and standard
Shamsaee et al. BMC Med Inform Decis Mak(2021) 21:48Page 6 of 11deviation) and inferential statistics (independent samples t-test, paired t-test, McNemar-test, and chi square).The Kolmogorov–Smirnov test showed that the data followed a normal distribution. The significance level wasconsidered 0.05.ResultsDemographic and professional informationTable 2 shows demographic and professional informationof the study participants. Based on the chi-square test, nosignificant difference was found between the intervention and control groups in demographic and professionalinformation (Table 2). Data analysis indicated homogeneity of the participants in the two study groups at the baseline in all dimensions of the information literacy for EBP.Use of different information resourcesAccording to Table 3, the pretest phase showed no significant difference in the mean scores of use of different information resources between the intervention(2.70 0.57) and control (2.63 0.44) groups (t 1.39,p 0.17). The results also showed that the control andintervention groups rarely used the electronic information resources with no change at posttest comparedwith pretest. However, no significant difference wasobserved between the intervention (2.53 0.54) andcontrol (2.71 0.60) groups in the use of different information resources in the posttest (t 1.33, p 0.18). Inaddition, the paired t-test showed no significant changein the use of different information resources between theintervention and control groups at posttest comparedwith pretest.Information searching skillsThe pretest phase showed no significant difference inthe mean scores of information searching skills anduse of the different search features between the intervention (2.33 0.74) and control (2.45 0.64) groups(t 0.68, p 0.50). However, a significant difference wasobserved between the intervention (2.58 0.31) and control (2.17 0.58) groups in terms of information searching skills and use of the different search features in theposttest (t 3.14, p 0.002). In addition, the pairedt-test showed that searching skills and use of the different search features statistically significantly decreasedin the control group in posttest compared with pretest(Table 4).Knowledge about search operatorsThe pretest phase showed no significant differencebetween the intervention (0.37 0.09) and control(0.25 0.08) groups in the mean scores of knowledgeabout search operators (t 1.54, p 0.12). However, astatistically significant improvement was observed inthe intervention group (0.67 0.07) compared with thecontrol group (0.34 0.17) in terms of knowledge aboutsearch operators in the posttest (t 8.39, p 0.001). Inaddition, the paired t-test showed no significant difference in the control group’s knowledge about search operators at posttest compared with pretest (Table 5).Table 2 Comparison of demographic and professional information of the nursing students between the interventionand control groupsVariablesGenderMarital statusWork experience in clinical setting (yr)Attendance at nursing research coursesAttendance at computer skills coursesAttendance at information literacy coursesWillingness to use electronic databases andelectronic istic)χ2(p- 501845.00Student h1436.80924.30
Shamsaee et al. BMC Med Inform Decis Mak(2021) 21:48Page 7 of 11Table 3 Comparison of the mean scores of the use of different information resources for patient care and clinicaldecision-making between intervention and control groups at pretest and posttestInformation resourcesPrintedElectronicHumanTotalaPaired t-testbIndependent t-testMean differenceStatistic ta & p2.64 1.100.072.70 0.722.60 0.49 0.10t 0.96p 0.34Interventiont 0.81P 0.422.36 0.73t 0.30p 0.762.27 0.74 0.09Control2.56 0.752.51 0.59 0.05Statistic tb &pt 1.19p 0.23t 1.60P 0.11TimePretestPosttestGroupsM SDM SDIntervention2.57 0.64ControlStatistic tb &pIntervention2.66 0.522.62 0.92 0.04Control2.87 0.682.84 0.65 0.03Statistic tb &pt 1.50p 0.14t 1.54p 0.132.53 0.54 0.17Control2.63 0.442.71 0.600.08Statistic tb &pt 1.39P 0.17t 1.33P 0.18Intervention2.70 0.57t 0.73p 0.47t 0.88p 0.38t 0.40p 0.69t 0.25p 0.80t 0.25p 0.80t 0.53P 0.60t 0.48p 0.63Table 4 Comparison of the mean scores of information searching skills and the use of different search featuresbetween intervention and control groups at pre- and posttestvariableInformation searchingskillsaPaired t-testbIndependent t-testMean differenceStatistic ta & p2.85 0.310.522.45 0.642.17 0.58 0.28t 2.40p 0.02t 0.68p 0.50t 3.14p 0.002TimePre testPost testGroupsM SDM SDIntervention2.33 0.74ControlStatistic tb &pAssessing development of search strategy with assessingthe frequency of selecting the most appropriate searchstatementThe students were given a supposed subject “Effect ofcigarettes on lung cancer” to assess their skills in developing an effective search statement by using Booleanoperators. For simplicity, the certain search features, suchas truncations, proximity operators and extensive synonyms were avoided. The students were asked to chooset 2.36p 0.02the most appropriate statement among five possiblesearch statements. The pretest phase showed no significant difference between the intervention (41%, n 16)and control (25%, n 10) groups in frequency of selecting the most appropriate search statement (X2 2.30,p 0.13). In the posttest, the frequency of selectingthe most appropriate search statement (41%, n 16)did not change in the intervention group, but it significantly decreased in the control group compared with
Shamsaee et al. BMC Med Inform Decis Mak(2021) 21:48Page 8 of 11Table 5 Comparison of mean scores of knowledge about search operators between intervention and control groupsat pre- and posttestVariableTime GroupsKnowledge about searchoperatorsaPaired t-testbIndependent t-testMean differenceStatistic ta &p0.67 0.070.300.25 0.080.34 0.170.09t 5.08p 0.001t 1.54p 0. 12t 8.39p 0. 001PosttestPretestM SDM SDIntervention0.37 0.09ControlStatistic tb &pTable 6 Comparison of frequency of selecting the mostappropriate search statement in intervention and controlgroups at pretest and posttestVariableSelecting the mostappropriate searchstatementGroupsPosttestPretestn (%)n (%)Intervention 16 (41)16 (41)Control8 (20)10 (25)Statisticb & p X2 2.30,p 0.13aMc Nemar-testbchi square testX2 4.12,p 0.04Statistica &P 1.10p 0.62intervention group (20%, n 8), (X2 4.12, p 0.04). Inaddition, the McNemar-test showed that frequency ofselecting the most appropriate search statement had nosignificant change in the control group at posttest compared with pretest (Table 6).DiscussionThis study evaluated the effect of virtual education onthe undergraduate nursing students’ information literacycompetency for EBP. The results showed that the educational program did not improve significantly the useof different information resources and its dimensions(printed, electronic, and human resources) in the students of the intervention group. The researchers did notfind similar interventional studies whose results supportthe present study. However, several studies [9, 25–28]showed a positive effect of the educational interventionson the use of information resources.Moreover, the results showed that the control andintervention groups rarely used the electronic information resources, and this educational program could notmotivate students in the intervention group to u
into clinical practice and we know that it is critical to apply EBP successfully [6, 7]. Establishing information literacy competency in nurs-ing students is vital for the promotion of EBP [8]. Nurse educators should develop nursing students' competen-cies for EBP and then motivate them to deliver the high-est quality of care using EBP [9].
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
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