Developing information literacy: a key to evidence-based nursing

© 2001 International Council of Nurses

Keywords

Education, Evidence-

Based Practice,

Information Literacy,

Programme Evaluation

Developing information literacy:

a key to evidence-based nursing

A. Shorten1 RN, CM, BN, MSc, M. C.Wallace2 RN, BA, GradDipEd(Nursing),MEd and P. A. Crookes3 RN, RNT, BSc(Nursing) PhD

1 Lecturer, Department of Nursing, University of Wollongong, Wollongong, NSW, Australia2 Lecturer, Department of Nursing, University of Wollongong, Wollongong, NSW, Australia3 Associate Professor and Head, Department of Nursing, University of Wollongong, Wollongong, NSW, Australia

Abstract

This report describes the evaluation of a curriculum-integrated programme

designed to help students develop an awareness of the nursing literature, the

skills to locate and retrieve it, and skills required in its evaluation; in other

words ‘information literacy’. Positive changes in student performance on objective

measures of information-literacy skills were revealed as well as a significant

increase in the levels of confidence of the student in performing those skills.

Students who had undertaken the information-literacy programme (‘programme’

students) performed better on a range of objective measures of information

literacy, as well as reporting higher levels of confidence in these skills, than

students who had not participated in the programme (‘non-programme’

students). Evaluation of this programme provides evidence of the potential

usefulness of a curriculum-integrated approach for the development of

information-literacy skills within nursing education. With these underlying skills,

students will be better equipped to consolidate and extend their key information-

literacy skills to include research appreciation and application. These are vital for

effective lifelong learning and a prerequisite to evidence-based practice.

Correspondence address:

Allison Shorten, Department

of Nursing, University of

Wollongong, Northfields Ave.,

Wollongong, NSW 2522,

Australia

Tel.: +61-242-213-964

Fax: +61-242-213-137

E-mail:

[email protected]

86

Original article

Background

‘Nursing practice is based on a mixture of research,

anecdote, tradition, theory and hunch’ (Wallace

et al. 1997; p. 147). The education of undergraduate

nursing students has tended to reinforce the

‘ritual’by placing high value on traditional scientific

authority and adherence to well-established clini-

cal protocols and routine practices. A similar

perspective also characterized medical education

(Evidence-Based Medicine Working Group 1992).

However, this approach to education does not equip

graduates for future practice in current healthcare

contexts. In the new millennium, healthcare envi-

ronments will increasingly demand nurses to be

flexible, innovative and ‘information literate’ pro-

fessionals, able to solve complex patient problems

by utilizing the best available evidence.

A demand for safe and effective healthcare

requires nurses to develop the necessary skills in

Developing information literacy 87

© 2001 International Council of Nurses, International Nursing Review, 48, 86–92

order to incorporate research findings into practice.

To accomplish this, nurses require the skills to

access, appreciate and apply pertinent research

findings to their practice (Crookes & Davies 1998;

pp. xi–xiii) and therefore it is essential that the

nursing workforce is ‘information literate’ (Wallace

et al. 1999; p. 137).

There are a number of definitions of ‘information

literacy’ (Bruce 1992; Weaver 1993; Fox et al. 1996;

Cheek & Doskatsch 1998), many derived from

that provided by the American Library Association

(ALA):

To be information literate, a person must be able

to recognize when information is needed and

have the ability to locate, evaluate, and use effec-

tively the needed information (American Library

Association. Presidential Committee on Infor-

mation Literacy 1989, p. 1).

Therefore, information-literacy skills are prer-

equisite to an evidence-based approach to nurs-

ing practice and a confident approach to lifelong

learning.

The idea of information literacy in the nurse edu-

cation context is based on the notion that nursing

students can develop the ability to appreciate

research if they are given opportunities and

incentives to do so. The curriculum-integrated

information-literacy programme in the Bachelor of

Nursing course at the University of Wollongong was

designed to assist students to learn how to become

research connoisseurs, by developing an ability to

access and appreciate relevant research findings

and, in time, apply these skills to their future clinical

practice.

Methods

The intervention

In order to initiate an innovative programme such

as this, an interdisciplinary partnership was estab-

lished with the faculty librarian, who had the neces-

sary skills and shared an interest in this develop-

ment. A ‘curriculum-integrated’ model was selected

for the information-literacy programme. A ‘cur-

riculum-integrated’ approach is one in which the

development of skills and knowledge is integrated

into the teaching, learning and assessment of cur-

riculum objectives and content (Wallace et al. 1999;

p. 137). It therefore differs from knowledge trans-

mission through stand-alone or discrete subjects or

through training programmes offered outside the

formal curriculum.A more complete account of the

programme development and its structural details

can be found in Wallace et al. (1999) and is pre-

sented in Table 1. The contribution of the faculty

librarian to the programme is detailed in Faricy

(1997). A series of lectures and laboratory/tutorial

sessions was presented by the faculty librarian and

members of the ‘teaching team’. Students were pro-

vided with an accompanying programme of three

specific ‘library-based’ learning activities and com-

plementary assessment tasks, which were directly

related to the content area of their ‘fundamental

clinical nursing’ subject.

1 Learning/Assessment Task 1 provided the stu-

dents with opportunities to familiarize themselves

with the library catalogue and location of different

types of resources and appropriate referencing

protocols.

2 Learning/Assessment Task 2 introduced the

concept of using electronic databases to access rele-

vant current literature.

3 Learning/Assessment Task 3 provided the stu-

dents with opportunities to learn skills in critical

analysis of the material they found as a result of

Learning/Assessment Task 2.

In essence, the curriculum-integrated approach

ensured that the skills and activities were (Wallace

et al. 1999; p. 139):

• taught as incremental components,

• transferable to other parts of the students’ acade-

mic and professional lives,

• structured in such a way as to assist the student to

experience success (and therefore maintain moti-

vation and develop confidence),

• rewarded directly, and transparently linked

to successful achievement of assessment tasks,

and

• relevant to the requisite knowledge and skills,

thus strengthening extrinsic motivation.

Bruce (1992) refers to Mellon’s (1986) work on

‘library anxiety’ and points out that having to deal

88 A. Shorten et al.


with ‘unfamiliar technology’ compounds feelings of

incompetence in students. The teachers who imple-

mented and evaluated the curriculum-integrated

information-literacy programme had a strong

philosophical stance that the purpose of the pro-

gramme was more than merely to provide the stu-

dents with skills and knowledge for the develop-

ment of information literacy. They considered that

if students felt confident in their electronic database

searching then they would be more likely to ‘give it a

go’ and that this experience of learning would lead

to competence.Great care was taken by all the teach-

ing staff, and in particular by the faculty librarian, to

ensure that the teaching and learning activities were

designed in such a way as to enhance the likelihood

that students would encounter ‘successful search-

ing’ as their first experience of the library’s elec-

tronic databases. This necessitated:

• careful planning of the teaching sessions,

• adequate teaching staff support during classes,

and

• editing of assessment tasks so that library

resources (e.g. databases, journal holdings) comple-

mented assignment requirements.

Table 1 Information-literacy programme structure

Learning Activity 1. In the scheduled lecture time of week 2 of the Autumn session, the Faculty Librarian provides a lecture

on how to read and understand the components of a bibliographic citation in order to find a library item. In week 2

tutorials the students have scheduled time in the library to undertake Assessment Task 1. The tutors are available to assist

with any questions and the Faculty Librarian is ‘on alert’ for troubleshooting activities during this scheduled library time.

Assessment Task 1. Each student is given a list of some items that are held in the library. There are a number of different lists

so that students are compelled to carry out at least part of this task on their own. Students are not given the full citation

except perhaps for those relating to journal articles. Instead they are given clues. This assignment has been structured so

that students need to find items in a variety of locations within the library. Because this library research exercise is framed

as a series of questions, it requires students to think about information rather than merely to record it for later use.

Learning Activity 2. A second information-literacy lecture is provided in week 5 of the Autumn session. The title of this

lecture is ‘Search Strategies’. The Faculty Librarian demonstrates the development and implementation of a search strategy

related to specific assignment topics set for this particular subject. This lecture can involve reinforcement of certain aspects

of the use of the library catalogue, use of databases and indexes. The tutors allocate tutorial time to the development of a

search strategy and there is structured time available in the library.

Assessment Task 2. The assessment task the students complete involves:

1 Submitting a copy and a critique of a library search strategy developed in Learning Activity 2. Students are expected to

develop an ability to evaluate their own intellectual processes and plan strategies to become more effective and efficient

users of resources.

2 Locating and reading and providing a list (in the specified reference style) of 10 items found in the library as a result of

the search strategy.

Learning Activity 3. Within tutorials students are provided with short articles from mainstream magazines, and are asked to

describe the article in general terms then list as many positive features (strengths) and as many negative features

(weaknesses) as they can. Students are then assisted to develop their ‘point-form’ notes into sentences and paragraphs. As a

result of this exercise, students are able to write one general summary statement of their observations about the article and

support this summary statement with reference to the strengths and weaknesses they have identified.

Assessment Task 3. This involves the students in undertaking a critical analysis of five of the items found as a result of the

above search. Students will utilize the skills of criticism and analysis developed in Learning Activity 3 to critically analyse

five of the resources located as a result of Learning Activity 2. This assignment is submitted in ‘essay’ format and constitutes

a preliminary version of possible future literature reviews. Assignment presentation and the fundamental aspects of essay

writing are dealt with in a co-requisite subject.

Wallace, M. C., Shorten, A., Crookes, P., McGurk, C. & Brewer, C. (1999) Integrating information literacies into an undergraduate

nursing programme, Nurse Education Today, 9, 136–141. Reproduced with permission from Harcourt Publishers, Ltd.



The evaluation

The purpose of the evaluation was to determine the

extent of student development of information-

literacy skills and changes in student confidence

level in searching for information. The evaluation

therefore addressed both cognitive and affective

domains in the assessment of students’achievement

of information-literacy skills (Fox et al. 1996). Pre-

and postprogramme questionnaires were distrib-

uted to the cohort of first-year students who under-

took the programme. The postprogramme ques-

tionnaire was also administered to a cohort of

second-year nursing students who had not under-

taken the information-literacy programme. It must

be kept in mind that this study was essentially a

programme evaluation rather than a classical piece

of experimental research. Although all first-year

Bachelor of Nursing students had to undertake

the information-literacy programme, they were not

compelled or offered incentives to return the ques-

tionnaires. Essentially, students volunteered to

provide this information about their skills and

knowledge. Given that the authors were relying on

the goodwill of the student participants, the ques-

tionnaire return rates of between 57 and 82% were

considered excellent. Demographic information

indicated that the ‘programme’ and ‘non-

programme’ cohorts were comparable in most

respects. In fact, the only variable that differed

between the two groups was age where, as expected,

the second-year students were on average 1 year

older than the first-year students. A more detailed

description of the evaluation methodology and

associated improvements in student performance

of objective measures in information literacy can be

found in Wallace et al. (2000).

The current report acknowledges the changes

in performance of objective measures, whereas

Wallace et al. (2000) focused specifically on the

changes in student self-confidence in information-

literacy skills, and described differences in student

attitude to searching tasks between those who

undertook the programme and those who did not.

The student assignments integrated within the

programme and linked to Learning Task 3 were

designed to assess skills in comprehension and cri-

tique of research. Assessment of such assignments,

although consistent in criteria, constitutes a more

subjective type of evidence and therefore associated

findings should be interpreted with caution.

These assignments were assessed using criteria that

reflected the objectives of:

• understanding the key messages of the selected

articles,

• critically analysing the usefulness of the source

materials, and

• supporting their critical analysis using logical

argument and evidence.

Results

Of the ‘programme’ students enrolled, 78% (n =108) returned preprogramme questionnaires and

57% (n = 71) completed postprogramme question-

naires. Eighty-two per cent of enrolled students (n =72) from the non-programme cohort returned

questionnaires.

Student performance on objective measures

of their information-literacy skills

To assess student skill in library catalogue searching

as well as interpretation of bibliographic citations,

objective questions were administered and res-

ponses scored. Skills ranged from simple operation

and navigation of electronic library catalogues to

the eventual location and retrieval of specific

journal articles on relevant clinical nursing topics.

‘Programme’ students scored higher in the ‘post-

programme’ assessment in terms of their ability to

use the library catalogue and to locate relevant

nursing resources. In addition, ‘programme’ stu-

dents performed better than ‘non-programme’ stu-

dents for these same objective measures of informa-

tion literacy. With a possible maximum score of five

(100%), the mean score of the ‘programme’

students – 3.41 (68%) – was significantly better than

that of the ‘non-programme’ students – 2.36 (47%),

(P < 0.0.001).

The interpretation of ‘bibliographic citation’

items were scored out of a possible maximum of

12 (100%). There was no significant difference

between the mean score of the ‘programme’



students – 11.1 (92.5%) – and that of the ‘non-pro-

gramme’ students – 10.8 (90%), (P = 0.7036). It was

judged that ‘programme’ students had attained

these skills to a level at least equivalent to students 1

year their senior.

Difference in self-assessed confidence in

searching tasks between those who undertook

the programme and those who did not

c2 analysis was used to examine whether there was a

relationship between being in a group that received

the information-literacy programme, and students’

self-assessed level of confidence in using a range

of information-literacy skills. For most of the

searching tasks, group differences were significant.

However, the self-assessment of confidence in some

of the skills necessary to carry out a search using

electronic databases was similar for ‘programme’

and ‘non-programme’ cohorts.

The skills where similar levels of confidence were

reported included:

• accurately identifying key words in an assign-

ment question,

• selecting appropriate subject-specific dictionaries

and thesauri to define key terms, and

• using these skills to produce a comprehensive

search strategy.

For all other information-literacy skills evaluated,

c2 analysis revealed a positive relationship between

undertaking a curriculum-integrated information-

literacy programme and high levels of student self-

confidence. Table 2 lists those skills in which

‘programme’students reported higher levels of con-

fidence than ‘non-programme’ students. Examples

of relevant search-related skills are included in

Table 2.

Figure 1 illustrates the pattern of responses that

students of the non-programme and programme

groups provided when asked to self-assess their level

of confidence in combining electronic database

searches. This pattern of response is typical of those

obtained when students were asked to self-assess

their level of confidence in the search strategies

listed in Table 2.

Development of skills in research appreciation or

critique was assessed using a set of tailored marking

criteria. Student performance of Assignment Task 3

suggested that the majority of ‘programme’ stu-

dents were able to demonstrate an ability to describe

the purpose of a piece of research, identify its

strengths and weaknesses, and justify an opinion

formed about that research using evidence and

logical argument. Anecdotal reports from teaching

staff who were unfamiliar with the programme and

its objectives indicated that skills in research tended

Table 2 Searching tasks for which ‘programme’ students are more likely than ‘non-programme’ students to rate themselves as confident

Searching task Examples c2

Using a database to carry out a search Consolidates and extends those skills used to search the university library catalogue 22.14*

Choosing a suitable database Requires student to identify which database(s) (e.g. APAIS, MEDLINE, CINAHL) would 22.14*

provide the best sources of information for a particular assessment task

Constructing a search by defining terms Identifying key words: ‘handwashing’, ‘infection control’ and ‘nurses techniques’ from the 31.68*

and key words assignment topic “Handwashing can assist in infection control. What techniques do nurses

need to follow?”

Combining searches Requires the student to use the Boolean operators of AND, NOT and OR to confine or 39.27*

extend two or more ‘simple’ searches

Refining a search by broadening, limiting Using the truncated term nurs* to retrieve any records relating to nurses, nursing, nursing 32.54*

or using truncation homes, etc.

Using database features such as ‘limit fields’, Limiting the year of publication to ‘1997–99’ year of publication, etc. 27.61*

Selecting and downloading appropriate Using information such as the ISSN and abstract selecting the most useful resources and 35.17*

references/sources in a question saving the search to disk, emailing it, or printing a hard copy

*d.f. = 4, P < 0.001.



to be better in ‘programme’ students than in ‘non-

programme’ students. In addition, it was perceived

that these skills tended to persist throughout the 3

years of the student undergraduate programme.

Discussion and conclusions

The apparent relationship between this educational

programme and the successful development of fun-

damental information-literacy skills and student

confidence in information searching confirms

the potential value of the ‘curriculum integrated’

approach. This evaluation provides evidence of sta-

tistically significant differences in self-confidence

between students who had undertaken the

information-literacy programme (‘programme’

students) and those who had not (‘non-programme’

students). Our educational philosophy, and there-

fore one of the assumptions under which we oper-

ated,was that the development of student self-confi-

dence was a necessary precursor to, and an integral

component of, student motivation and skill devel-

opment. Confirmation of students’ knowledge,

understanding and skill in information searching

was achieved by evaluating the student assignments.

The curriculum-integrated information-literacy

programme described in this report is merely the

first step towards equipping students to be effective

connoisseurs of research. This programme provides

the foundations for a systematic approach to

seeking resources for learning. The programme

aims to increase students’ awareness of available

research; assists students to start to develop skills for

accessing available research through electronic data

sources; and guides students in their first steps

towards an appreciation of research findings. It is

well recognized that a large part of what teachers

seek to change in students has to do with their atti-

tudes. Enticing a student to approach the task of

learning itself, or to consider a particular issue in a

different way, can be the start of an enduring change

for that student.

Future research is required to reveal models of

‘best practice’ in information-literacy development,

as well as assessing ‘long-term’ effectiveness of both

information-literacy skills and student/practitioner

self-confidence in utilizing them. A longitudinal

follow-up of ‘programme’ students, now in their

final year of study, has confirmed that the changes in

student skill and confidence level persisted at least

until the final year of study (Brewer 1999). Nursing

educators need to accept the challenge to contribute

to the development of nursing practitioners who

can meet the demands of the new millennium,

armed with the best available evidence and the skills

to find that evidence.

Fig. 1 Level of confidence in combining searches using electronic databases.



Acknowledgements

The authors gratefully acknowledge the advice of

statistical consultants Dr Chandra Gulati, Dr Ken

Russell and Dr David Steele, as well as the data man-

agement skills of Ms Vicki Kendrick and the logisti-

cal support provided by Associate Professor, Patrick

Crookes. The development and evaluation of the

Information Literacy Programme was financed by

The University of Wollongong Educational Strate-

gic Development Fund.

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Documents

Developing information literacy: a key to evidence-based nursing