Study design and setting
This interventional study with a pretest-posttest design was conducted in a Nursing School affiliated with Kerman University of Medical Sciences in southeast of Iran.
According to the academic law in Iran, the bachelor's degree includes four years of study and the curriculum is based on a semester system. As a result, students are supposed to pass theoretical and clinical credits in university and educational hospitals, respectively. The participants of this study were students who received no information literacy education. However, the undergraduate nursing curricula at the time of this study included t only 1.5 credits of research in nursing (34 hours in third semester) and one credit of information technology in nursing (26 hours in the first semester). Although basic research skills and the use of computers may be taught, the demands of the nursing curriculum do not allow for more education. These credits do not include any literature searching skills in practice.
Study Population And Sampling
The target population of this study included all undergraduate nursing students (N = 136) in the sixth and eighth semesters. The sample size was 80 participants using the sample size formula. Eighty participants were divided randomly into intervention and control groups (40 students in each group). We equally selected students from each of the semesters. Inclusion criteria included the nursing students who passed credits of research in nursing and information technology in nursing and started learning in the clinical settings. The exclusion criteria included students’ absence in one session, their transfers to another university, guest students, and failure to complete the questionnaires due to any reason. Finally, 79 students completed the questionnaires and one student of the intervention group did not complete the course (response rate = 98.75%).
Instruments
The 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).
The second questionnaire was about information literacy competency for EBP that demonstrate EBP readiness. This questionnaire was part of a valid and reliable questionnaire namely “Perceptions of Nurses of EBP”, which was developed by a team comprising faculty members from Nanyang Technological University, and nursing representatives from Alexandra hospital and National University of Singapore [16, 17]. The information literacy competency for EBP questionnaire was composed of two sections. The first section concerned about the use of different information resources by nurses for patient care and clinical decision-making (19 items), and how often they referred to three different types of information sources: print, electronic and human. These items could be answered on a 5-point Likert scale ranging from "never" to "always". The second section included information searching skills and use of different search features of online databases and web search engines. Searching skills are considered critical for searching relevant research literature or documents. The participants had to answer how often they used several search features, such as headings and search operators (10 items). These items could be answered 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 with items. These items could be answered with yes (one point), no (zero point), and not sure (zero point). Finally, nurses were provided with a hypothetical searching topic (Effect of cigarettes on lung cancer) along with five possible search statements to assess their skills in searching database and their actual skills in developing an effective search statement by using Boolean operators for conducting a search on MEDLINE. They were asked to select the most appropriate search statement for the given topic. Item 4 was a more appropriate search statement than others (Cigarettes OR Smoking OR Tobacco) AND (“Lung Cancer” OR “Lung Tumor” OR “Lung Neoplasm”).
In this study, we used Persian version of the questionnaire, which was validated in Iran [18]. The content validity of the Persian version of questionnaire was approved by experts, and also its reliability was measured with Cronbach's alpha (α = 0.87).
Data Collection
The current study aimed to assess the effect of virtual education on the nursing students’ information literacy competency. Data were collected using an anonymous, self-reported, and electronic questionnaire from March to May 2020. To collect data, the first researcher created groups for each of the intervention and control groups in 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 and WhatsApp groups in pre-test (before course) and posttest stages (one month after the course). Researchers designed the e-questionnaire using Google Document software. Therefore, the questions were prepared and then sent to the students’ e-mails. After the students answered the questions and pressed the OK button, the completed questionnaires were automatically sent to the researcher. The instruction of 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 appropriate time on data collection and determined a deadline to deliver completed questionnaires. In addition, she sent detailed information about how to learn the educational program. Moreover, she coordinated time of educational sessions with participants in the intervention group and reminded them to attend the sessions in the scheduled times. It should be noted that the participants completed questionnaires at e-campus.
Intervention Procedure
Intervention procedure
To prepare and develop the course content, the researchers reviewed the literature about information literacy competency, the link between information literacy and EBP in nursing as well as students’ educational needs [7, 19–23]. They discussed the extracted topics to achieve a consensus concerning goals and contents and teaching strategies. The researchers employed the standards proposed by the Association of College and Research Libraries as a guide for information literacy competency in higher education and selected essential competencies. The curricular content and structure should include the concepts and skills of information literacy to have a holistic view of information literacy and gain those abilities [23]. The researchers also consulted with a multidisciplinary team, including two medical informatics specialists, two nursing faculty members, an expert in the field of medical education, a librarian and two nursing students. The team members provided their experiences and perspectives on required training and competencies of students concerning information literacy competency in EBP, as well as teaching-learning activities and educational programs available to informatics literacy in nursing school. In this step, the topics were developed using focus group discussion and then the team reviewed them for suitability, feasibility, applicability and relevance to the nursing education. Each item of the developed content was frequently reviewed and revised. Having agreed on the information literacy competencies, the researcher drafted the content of training program. This curricular integration also afforded many opportunities for student-centered teaching methods such as evidence-based learning, and inquiry learning. One medical informatics specialist and six nursing faculty members who were not in the research group approved the content validity of the educational content. Finally, two members, one specialized in nursing and the other in medical informatics, taught topics of the course (Table 1).
In short, educational standards (content appropriate to the level of the student, general and behavioral goals, feedback, references, a table of contents, the desired quality of audio-visual elements and compatibility of the content with the society and culture of Iran) and technical standards (connecting the table of contents to the main content, a proper guide, colors appropriate to the background, the ability to search the text, user-friendliness of the final environment, the ability to download and receive content individually) were considered carefully in designing and developing an electronic content. The educational materials were uploaded on the website dedicated to this research for four weeks. The participants of the intervention group had a username and password to use the educational content uploaded on the website. The address of the educational website was declared through the communication channels. Participants were able to access the website off line for a month at any time and place using the assigned passwords. Reminder messages were sent via WhatsApp and SMS to motivate the use of the website. In these reminders, the deadline of the course was also announced.
The communication between students and researchers was established by an internet tool, which allowed instant messaging and group meetings. The researchers designed the website materials in seven modules during four weeks. Materials were prepared in the forms of audio file, PowerPoint slides, video tutorials, and textual help, question and answer, hands-on exercise (with examples of literature search), and homework. Students were required to self-learn course materials, practice exercises, and discuss issues by E-mail or WhatsApp. Students could expand the discussion based on other students’ responses. Assignments included learning journals and literature search, website critiques, discussion on literacy issues such as academic integrity, and project focusing on search. Assignments encouraged a sense of involvement in the use of reference materials. All other assignments were submitted to the instructors and their reflections/corrections on the assignments were sent back to the students via E-mail. The assignments could be resubmitted unlimited times. Students were able to use them through a user and password-protected. Students were expected to exercise knowledge and related skills of information literacy during/upon the completion of the course. This approach shifted the students from teaching and teacher-centeredness to learning and student-centeredness and promoting self-regulation. Furthermore, students were able to share their comments and questions with the instructors and other students. They were encouraged to ask questions and to offer comments. While intervention group was provided with additional materials derived from our training course, the control group did not receive this program. In other words, the two study groups had equivalent conditions and students received the standard courses of nursing curricula with virtual tools at E-campus during the coronavirus pandemic. No academic credit was given to the participants of this study.
Table 1
Main topics presented in the course
Modules | Topics |
1 | -Familiarity with EBP and understanding of what is involved in EBP -Perception of the value and significance of EBP in nursing -Learning of level of skills required for undertaking different EBP activities -Discussing and making a possible work plan by using an example according to the steps of EBP -Understanding what information literacy and its framework are. -Explaining various terminologies related to information literacy. -Familiarity with how information technology can be used in education |
3 | -Introducing and orientating variety of information sources including hard print, electronic and human sources -Developing the skills to obtain e-books, e-journals, and other meaningful information using the library or the Internet -Demonstrating a variety of electronic search capabilities such as the ways to subscribe and receive free articles -Determining the most appropriate methods for accessing information electronically: search engines, interfaces (the database screens), and content available through a given system |
4 | -Developing skills to criticize/evaluate software, hardware and websites -Demonstrating medical and nursing databases such as Current Nursing and Allied Health Literature )CINAHL(, PubMed, Scopus,… -Using search strategies in databases such as PubMed and Scopus - Describing the available information systems (Online formulary, Up to Date, EBSCO,…) -Describing information needed through key concepts and terms -Identifying keywords, synonyms, and related terms for the information needed (Medline, etc) -Searching articles in Persian databases such as Scientific Information Database )SID(, Medlib, Iranmedex, and Magiran |
5 | -Doing 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 etc. -Doing practical exercises. For example, retrieving related articles in databases such as PubMed and Scopus for “Intubate Patient Care” with related keywords and providing search results |
6 | -Demonstrating abilities and gaining proficiency in search of information, management of information, and application of various technological tools in presenting information. -Determining the nature and extent of the information needed -Explaining the risks and constraints of searching the Internet for needed evidence-based information -Using appropriate search language and parameters for selected system |
7 | -Assessing the quantity, quality, and relevance of the search results to determine whether alternative information retrieval systems or investigative methods should be utilized -Evaluating information sources critically and incorporating selected information into their knowledge base and value system -Comparing various information sources to evaluate reliability, validity, accuracy, authority, timeliness, and point of view or bias -Synthesizing conclusions based upon information gathered -Using information effectively for a specific purpose individually or as a member of a team -Evaluating outcomes of the use of information |
Statistical analysis
The data were analyzed using SPSS 21, descriptive statistics (frequency, percentage, mean and standard deviation) 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 was considered ≤ 0.05.