Barriers to research utilisation among forensic mental health nurses

Barriers to Research Utilization in Nursing: A Systematic Review (2002–2021)

Introduction

There is an existing gap between what people learned from theory and what they clinically practiced, as revealed in research studies in nursing. This gap is primarily due to identified barriers in utilizing the research findings in actual nursing practice.

Objective

To present a scientific mapping of the Scopus-indexed literature published from 2002 to 2021, which studied barriers to research utilization in nursing using the BARRIER scale.

Methods

This systematic review utilized bibliometric analysis. One hundred seventy-nine extracted literature from Scopus was manually reviewed, and the study included 53 documents for further analysis.

Results

Remarkably, almost three-fourths of the documents identified setting-related factors as the most common barrier to research utilization in nursing (n = 39, 73.58%). This is followed by presentation-related factors (n = 16.98%) and nurse-related factors (n = 5, 9.43%), respectively. Findings revealed that insufficient time at work in implementing new ideas was perceived as the top barrier in research utilization in nursing.

Conclusion

It is crucial to determine the hindrances to the utilization of research findings. The results of this study establish the connection between research and evidence-based practice which stimulates in meeting the gap in the current nursing practice. Future studies must include research utilization studies that apply tools other than the BARRIER scale.

Forensic mental health nursing and evidence-based practice: a quantitative study

Background: Little is known about the personal, professional and workplace factors that influence evidence-based practice for forensic mental health nurses. Aim: This study describes the sources of practice knowledge for forensic mental health nurses, and the factors that influence the implementation of evidence-based practice. Design: This research study utilised a cross sectional survey design. Methods: All nurses (n = 244) working in one forensic mental health in-patient facility were sent an electronic invitation to complete the Developing Evidence Based Practice Questionnaire. Data was analysed to calculate descriptive statistics. Findings: Fifty-three respondents completed the survey. Respondents reported using experiential knowledge and locally derived sources of information more frequently than research-based evidence to inform their practice. Respondents reported being least skilled at finding, reviewing and using research evidence to change practice. The most frequently rated barriers to evidence-based practice were having insufficient time and resources to both finding and reviewing information and to implement changes in practice. Conclusions: Forensic mental health nurses tend to express a bias towards valuing social or qualitative sources of information to inform practice. Exploring the relationships between individual and organisational factors in the context of forensic mental health is recommended in order to gain further insights into the translation of evidence into practice for forensic mental health nurses. Impact statement: Unique contextual aspects of the forensic mental health environment may influence the implementation of evidence-based practice. Our study highlights that further support, resources and training is required to promote the use of research-based evidence in forensic mental health nursing.

Evidence-Based Practice in Forensic Mental Health Nursing: A Critical Review

METHOD

Literature searches of databases, particularly CINAHL, using key phrases were undertaken.

RESULTS

Some authors argue that there is a lack of evidence in forensic mental health (FMH) nursing, with few randomized controlled trials and other methods providing definitive, generalizable evidence. However, literature searches revealed randomized controlled trials of relevance to FMH nursing, many qualitative studies by FMH nurses, and arguments for clinical experience and knowledge of service users, and the latter's views, as sources of evidence.

DISCUSSION AND IMPLICATIONS FOR NURSING PRACTICE

Research findings can be applied to practice, both directly and indirectly. Examples are given of ways that evidence can be used to inform FMH nursing interventions related to therapeutic ward environments, including communication, therapeutic relationships, preventing retraumatization, and enabling physical health. The complex nature of "evidence" is considered in relation to risk assessment and management.

CONCLUSIONS FOR NURSING PRACTICE

FMH nursing can be based on a wide range of sources of evidence. The types of evidence used in practice depend on individual service users' needs and views. In evaluating evidence, it is necessary to be aware of its complex, diverse nature. A distinction can be made between definitive, widely generalizable research findings and evidence with limited generalizability, requiring FMH nurses' judgments about whether it is applicable to their own area of practice. Recommendations for related education and research are made.

Sources of Knowledge and Barriers of Implementing Evidence-Based Practice Among Mental Health Nurses in Saudi Arabia

PURPOSES

The purposes of this study were to identify the sources of knowledge for nursing practices and to identify the barriers of using "evidence-based practice" (EBP).

DESIGN AND METHODS

Descriptive cross-sectional design was used to collect data from 164 Saudi mental health nurses by completing the Development of Evidence-Based Practice Questionnaire.

FINDINGS

The most frequently used sources of knowledge were relied on social interactions and the nurses' own experiences, while the least frequently used sources were external sources of knowledge and research evidences. Insufficient time to find research reports, difficulty in understanding research reports, and insufficient resources for evidences were the barriers of using EBP.

PRACTICE IMPLICATIONS

The organizations should encourage using EBP by providing adequate time, resources, knowledge, and skills for mental health nurses through conducting workshops and mentoring.

Knowledge, attitudes, practices, and barriers related to research utilization: a survey among pharmacists in Malaysia

Background Research utilization is part of evidence-based practice referring to the process of reviewing and critiquing scientific research and applying the findings to one's own clinical practice. Many studies on research utilization have been conducted with doctors and nurses, but to our knowledge, none have been investigated amongst pharmacists. Objective To assess research utilization and its barriers among pharmacists and identify potential influencing factors. Setting Malaysia. Methods This cross-sectional survey was administered online and by mail to a convenient sample of pharmacists working in hospitals, health clinics, and retail pharmacies in rural and urban areas. Main outcome measure Pharmacists' research utilization knowledge, attitudes, and practices. Results Six hundred surveys were mailed to potential respondents, and 466 were returned (77.7% response rate). Twenty-eight respondents completed the survey online. The respondents' research utilization knowledge, attitudes, and practices were found to be moderate. Research utilization was associated with respondents' knowledge and attitude scores (P < 0.001). When factors related to research utilization were modelled, higher educational level was associated with higher level of research utilization (P < 0.001) while less involvement in journal clubs, more years of service (3-7 years and more than 7 years) were associated with low and moderate research utilization, respectively. The main reported barrier to research utilization was lack of sufficient authority to change patient care procedures. Conclusion Pharmacists' research utilization knowledge, attitudes, and practices can be improved by encouraging pharmacists to pursue higher degrees, promoting active participation in institutions' journal clubs, and introducing senior clinical pharmacist specialization.

Research Utilization among Nurses at a Teaching Hospital in Kenya

INTRODUCTION

In the era of evidence based practice (EBP), health care delivery should be grounded on new or validated knowledge and evidence from research. The aim of the study was to assess research utilization by nurses and the influencing factors at Kenyatta National Hospital (KNH), the largest teaching hospital in Kenya.

METHODS

The study employed a descriptive design that utilized both quantitative and qualitative methods of data collection. It incorporated the Barriers to Research Utilization Scale. It was conducted in six specialized care areas at KNH. Data was collected using questionnaires, Focus Group Discussion and in-depth interviews. Data was analyzed using SPSS version 13 and qualitative data analyzed using themes.

RESULTS

The study found that 20.6% of the nurses were participating in research related to their work and 53.6% of these were implementing research findings to practice. Over 2/3 (70.5%) of the respondents were basing their evidence for practice on the knowledge gained during their nursing school. The three greatest barriers to research utilization were that research reports are not readily available (68.7%), unclear implications for practice (66.5%) and inadequate facilities for implementation (66.4%).

CONCLUSION

It is recommended that sensitization trainings on nursing research/ utilization of findings in nursing practice be established to create awareness, motivate and enhance nurses' abilities and also facilities should be provided to enable implementation.

Barriers to Research Activities from the Perspective of the Students of Isfahan University of Medical Sciences

Introduction:

Necessity to establish a coherent and targeted research context in order to development of any country is increasingly important. But the basic step in creating an effective research context would be enrichment motivation of researchers especially students and resolve barriers of research. Therefore, the purpose of this study was to determine barriers of research activities from the perspective of students of Isfahan University of Medical Sciences.

Methods:

This is research. Data was collected with author made questionnaire. The study sample consisted of students from Isfahan medical university and sample size based on Krejcie and Morgan table was 357. Sampling was Stratified Random. The validity of questionnaire confirmed by Library and information professionals and reliability based on Cronbach’s Alpha was 0.933, respectively. The type of descriptive statistics was (percentage, frequency and mean) and inferential statistics (T-test, ANOVA, one-Sample Statistics) and SPSS software was used.

Findings:

Results showed that the mean of barriers to research activities among students of Isfahan University of Medical Sciences was 3.89 ± 0. 483. The highest mean was related to density of students’ curriculum (4.22± 0.968) and lowest mean related to lack of access to appropriate library resources. Also, the mean of research activities ’s barriers, according to aspects showed that the mean in individual barriers level (4.06±0.635) was more than other aspects: social and cultural aspects (4.01± 0.661), economical aspect (4.04± 0.787) and organizational barriers (3.78±0.503). The lowest mean was related to organizational barriers. Also there is no difference between mean of research activities’ barriers of student of Isfahan University of Medical Sciences with regarded of gender, level of education and college.

Conclusion:

According to results of this research, although, the main barriers between students was individual barriers such as: lack of sufficient familiarity with research methods, insufficient experience in research and lack of familiarity with the terms of the articles in publication, but other aspects like economic, cultural, social and organizational was in bad condition too. Therefore it is suggested that workshops related to research methodologies is executed, like proposal writing, writing articles in university especially for students and administrators support student’s research activities, effectively.

Nurses’ and midwives’ information behaviour: a review of literature from 1998 to 2014

Purpose

– This paper aims to provide an overview of recent literature on nurses’ and midwives’ information behaviour, with a particular focus on sources used and barriers encountered.

Design/methodology/approach

– Comprehensive searching was undertaken and an analysis of the appropriate literature carried out.

Findings

– Practitioners within the nursing profession have a marked preference for interactive and human sources of information. They habitually associate information seeking with professional development rather than with clinical practice. Lack of time is the most frequently reported problem; also, they frequently lack confidence in searching and appraising the professional literature and in applying research in practice. Cultural factors may inhibit information seeking in the workplace, and access to appropriate information technology may be limited.

Practical implications

– As a group, nurses and midwives present significant challenges to health library and information professionals seeking to design services to meet their needs. A perceived lack of access to information resources may be associated with pervasive information literacy skill deficits, with the inability to undertake critical appraisal of material that is retrieved, or with the lack of a workplace culture that is supportive of information seeking. To reach nurses and midwives, more than diligent marketing is required; library and information professionals need to work closely with the holders of nursing and midwifery research, practice development and educational roles within their institutions on “embedded”, specific information initiatives.

Originality/value

– An overview of recent work is presented on the information behaviour of nurses and midwives within developed economies, focusing particularly on the UK. It may be of interest and value to health librarians and to nursing and midwifery educators in facilitating evidence-based practice.

Study on research anxiety among faculty members of isfahan university of medical sciences

Introduction:

One of the most common anxieties in higher education is research anxiety. The purpose of this study was to determine the research anxiety level among the faculty members of Isfahan University of Medical Sciences (IUMS).

Methods:

this was survey- analytical study. The stratified random sampling method was used and a sample of 212 people was selected. For data collection was used a questionnaire. Data were analyzed with descriptive and analytical (T Test, ANOVA and LSD) statistics.

Findings:

The average anxiety research in IUMS was about 3.27 ±0.536. Among factors, highest scores in descending order are related to lack of timely payment of fees (3.97±0.961), the long approval process of proposals and research project reporting (3.86.±0.99) and lack of research efficiency on the part of faculty (3.70±1.00). The lowest scores were related to having insufficient funds to conduct research (2.67±1.08), another’s understanding of inability for researching (2.84±1.192), and unfriendly behavior from journals and research center staffs (2.89±0.802).

Conclusion:

The mean level of research anxiety among faculty members of IUMS was found higher than average. So it’s essential that authorities pay greater attention to the factors that cause research anxiety.

Impact of evidence and health policy on nursing practice

The story of evidence-based practice in nursing is long, with many successes, contributors, leaders, scientists, and enthusiasts. Nurse educators have great advantages offered from a wide variety of educational resources for evidence-based practice. These resources offer students the opportunity to connect their emerging competencies with clinical needs for best practices in clinical and microsystem changes.

Challenges of the health research system in a medical research institute in Iran: a qualitative content analysis

BACKGROUND & AIM

Medical research institute is the main basis for knowledge production through conducting research, and paying attention to the research is one of the most important things in the scientific communities. At present, there is a large gap between knowledge production in Iran compared to that in other countries. This study aimed to identify the challenge of research system in a research institute of medical sciences in Iran.

MATERIALS & METHODS

This was a descriptive and qualitative study conducted in the first 6 months of 2013. A qualitative content analysis was conducted on 16 heads of research centers in a research institute of medical sciences. The required data were gathered using semi-structured interviews. The collected data were analyzed using MAXQDA 10.0 software.

RESULTS

Six themes identified as challenges of research system. The themes included barriers related to the design and development, and approval of research projects, the implementation of research projects, the administrative and managerial issues in the field of research, the personal problems, publishing articles, and guidelines and recommendations.

CONCLUSION

Based on the results of the present study, the following suggestions can be offered: pushing the research towards solving the problems of society, employing the strong executive and scientific research directors in the field of research, providing training courses for researchers on how to write proposals, implementing administrative reforms in the Deputy of Research and Technology, accelerating the approval of the projects through automating the administrative and peer-reviewing processes.

Evidence-based practice: a survey among pediatric nurses and pediatricians

This survey compared the attitude, awareness, and knowledge of pediatric nurses and pediatricians regarding evidence-based practice (EBP). Potential barriers were also investigated. Both nurses and pediatricians welcomed EBP (mean scores are 73.3 and 75.4 out of 100). Overall, 52% of the nurses and 36% of the pediatricians did not know relevant sources of information, and 62% of the nurses versus 19% of the pediatricians did not know common EBP terms. Time constraints and lack of knowledge were considered as major barriers. Recommendations include multilevel training and continuous exchange of information.

Competencies of specialised wound care nurses: a European Delphi study

Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries as to the competencies for specialised wound care nurses that meet international professional expectations and educational systems. Wound care experts including doctors, wound care nurses, lecturers, managers and head nurses were invited to contribute to an e-Delphi study. They completed online questionnaires based on the Canadian Medical Education Directives for Specialists framework. Suggested competencies were rated on a 9-point Likert scale. Consensus was defined as an agreement of at least 75% for each competence. Response rates ranged from 62% (round 1) to 86% (rounds 2 and 3). The experts reached consensus on 77 (80%) competences. Most competencies chosen belonged to the domain 'scholar' (n = 19), whereas few addressed those associated with being a 'health advocate' (n = 7). Competencies related to professional knowledge and expertise, ethical integrity and patient commitment were considered most important. This consensus on core competencies for specialised wound care nurses may help achieve a more uniform definition and education for specialised wound care nurses.

Irish psychiatric nurses' self-reported barriers, facilitators and skills for developing evidence-based practice

Evidence-based practice places an emphasis on integration of clinical expertise with available best evidence, patient's clinical information and preferences, and with local health resources. This paper reports the findings of a study that investigated the barriers, facilitators and skills in developing evidence-based practice among psychiatric nurses in Ireland. A postal survey was conducted among a random sample of Irish psychiatric nurses and survey data were collected using the Development of Evidence-Based Practice Questionnaire. Respondents reported that insufficient time to find and read research reports and insufficient resources to change practice were the greatest barriers to the development of evidence-based practice. Practice development coordinators were perceived as the most supportive resource for changing practice. Using the Internet to search for information was the highest-rated skill and using research evidence to change practice was the lowest-rated skill for developing evidence-based practice. Nurses' precursor skills for developing evidence-based practice, such as database searching and information retrieval, may be insufficient in themselves for promoting evidence-based practice if they cannot find evidence relating to their particular field of practice or if they do not have the time, resources and supports to develop their practice in response to evidence.

Do stakeholders in wound care prefer evidence-based wound care products? A survey in the Netherlands

For several wound products compelling evidence is available on their effectiveness, for example, from systematic reviews. The process of buying, prescribing and applying wound materials involve many stakeholders, who may not be aware of this evidence, although this is essential for uniform and optimum treatment choice. In this survey, we determined the general awareness and use of evidence, based on (Cochrane) systematic reviews, for wound products in open wounds and burns among wound care stakeholders, including doctors, nurses, buyers, pharmacologists and manufacturers. We included 262 stakeholders. Doctors preferred conventional antiseptics (e.g. iodine), while specialised nurses and manufacturers favoured popular products (e.g. silver). Most stakeholders considered silver-containing products as evidence-based effective antiseptics. These were mostly used by specialised nurses (47/57; 82%), although only few of them (9/55; 16%) thought using silver is evidence-based. For burns, silver sulfadiazine and hydrofibre were most popular. The majority of professionals considered using silver sulfadiazine to be evidence-based, which contradicts scientific results. Awareness and use of the Cochrane Library was lower among nurses than among doctors (P < 0.001). Two thirds of the manufacturers were unaware of, or never used, the Cochrane Library. Available compelling evidence in wound care is not equally internalised by stakeholders, which is required to ensure evidence-based decision making.

Exploring decision making in intellectual disability nursing practice: a qualitative study

Due to the dearth of relevant research, intellectual disability nurses may have difficulty identifying sources of evidence on which they can base their clinical decisions. The aim of the present research was to explore how intellectual disability nurses make decisions and how their decisions are influenced by evidence. The method was guided by interpretative phenomenology and the analysis adopted an idiographic approach. Twelve National Health Service intellectual disability nurses in Wales participated in semi-structured interviews. Four key themes were identified: getting to know the person; working as a team; evidence to support decision making; and understanding of evidence-based practice. In the context of the myriad of other professionals involved in caregiving, the nurses conveyed a commitment towards ensuring that the person with intellectual disability is at the centre of decision making. Although using empirical evidence to support practice was acknowledged, these nurses considered person centred decision making to be paramount.

The BARRIERS scale -- the barriers to research utilization scale: A systematic review

Background

A commonly recommended strategy for increasing research use in clinical practice is to identify barriers to change and then tailor interventions to overcome the identified barriers. In nursing, the BARRIERS scale has been used extensively to identify barriers to research utilization.

Aim and objectives

The aim of this systematic review was to examine the state of knowledge resulting from use of the BARRIERS scale and to make recommendations about future use of the scale. The following objectives were addressed: To examine how the scale has been modified, to examine its psychometric properties, to determine the main barriers (and whether they varied over time and geographic locations), and to identify associations between nurses' reported barriers and reported research use.

Methods

Medline (1991 to September 2009) and CINHAL (1991 to September 2009) were searched for published research, and ProQuest^® digital dissertations were searched for unpublished dissertations using the BARRIERS scale. Inclusion criteria were: studies using the BARRIERS scale in its entirety and where the sample was nurses. Two authors independently assessed the study quality and extracted the data. Descriptive and inferential statistics were used.

Results

Sixty-three studies were included, with most using a cross-sectional design. Not one study used the scale for tailoring interventions to overcome identified barriers. The main barriers reported were related to the setting, and the presentation of research findings. Overall, identified barriers were consistent over time and across geographic locations, despite varying sample size, response rate, study setting, and assessment of study quality. Few studies reported associations between reported research use and perceptions of barriers to research utilization.

Conclusions

The BARRIERS scale is a nonspecific tool for identifying general barriers to research utilization. The scale is reliable as reflected in assessments of internal consistency. The validity of the scale, however, is doubtful. There is no evidence that it is a useful tool for planning implementation interventions. We recommend that no further descriptive studies using the BARRIERS scale be undertaken. Barriers need to be measured specific to the particular context of implementation and the intended evidence to be implemented.

Nurses' perceptions of the barriers to and the facilitators of research utilization in Turkey

The aim of this study was to determine nurses' perceptions of the barriers to and facilitators of research utilization in Turkey. Barriers Scale was utilized in the research, and the population was 631 nurses. According to the research results, the first three important barriers were inadequate authority (63.6%), lack of time (54.0%), and insufficient facilities (52.8%). Nurses have perceived the organizational management support as the most important easing factor in their applications (n = 156). It is highly recommended that nurses be trained in research methods and evidence-based practice, that research articles be written more clearly, and that Research and Development centers where nurses could get consultation services be established.

Has the BARRIERS Scale changed nursing practice? An integrative review

AIM

This paper is a report of a review to analyse studies using the BARRIERS Scale to determine (a) if the identification of perceived barriers to research utilization influences nurses' use of research, (b) if the extent of nurses' perceived barriers to research utilization and most frequently cited barriers have changed over the past 15 years and (c) if nurses' most frequently cited barriers to research utilization differ across countries.

BACKGROUND

The BARRIERS Scale has been used to identify nurses' untoward perceptions or barriers to research utilization.

DATA SOURCES

A computer search was conducted using the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, Dissertation Abstracts International and Academic Abstracts to identify relevant literature from 1991 to 2006. The Internet and citations within studies were also searched.

REVIEW METHODS

Studies were included if they were in English, used the entire BARRIERS Scale and reported nurses' responses. Studies were coded for author(s), publication year, country, population, sample size, response rate, the three-most frequently cited barriers, mean per cent of items rated as moderate or greater, and number of items identified as a barrier by 50% or more of respondents. Quality appraisal of the included papers was not performed.

RESULTS

Forty-five studies met the inclusion criteria and predominantly identified the same barriers. No evidence was found that identification of barriers to nurses' use of research influenced nursing practice.

CONCLUSIONS

It appears that there would be minimal benefit from further descriptive research using the BARRIERS Scale. Research is needed to investigate whether relationships exist between perceptions of barriers to nurses' use of research and the use evidence-based practice.

Cochrane reviews of educational and self-management interventions to guide nursing practice: a review

BACKGROUND

The burden of chronic disease on healthcare services worldwide is growing and the increased development of educational interventions which help patients to better manage their own conditions is evident internationally.

OBJECTIVES

This paper reports on findings of a review of Cochrane systematic reviews of interventions designed to improve patients' knowledge and skills to manage chronic disease, with particular reference to nursing contribution and practice.

METHODS

Thirty Cochrane systematic reviews were identified as meeting the inclusion criteria. Data were extracted and summarised.

FINDINGS

The majority of reviews included in this paper were judged by Cochrane reviewers to provide inadequate evidence (n=18, 60%) of the effectiveness of the interventions reviewed. Information on the professional delivering the interventions was often not available, although 77% (23) of reviews mentioned that nurses were involved in a proportion of studies.

CONCLUSION

Educational programmes have definite benefits for patients suffering from asthma and are promising for interventions in areas such as diabetes mellitus, epilepsy and mental health. However, it still is not clear what the active ingredients of many successful interventions are.

Barriers to evidence-based nursing: a focus group study

AIM

This paper reports a study to explore the barriers to evidence-based nursing among Flemish (Belgian) nurses.

BACKGROUND

Barriers obstructing the call for an increase in evidence-based nursing have been explored in many countries, mostly through quantitative study designs. Authors report on lack of time, resources, evidence, authority, support, motivation and resistance to change. Relationships between barriers are seldom presented.

METHODS

We used a grounded theory approach, and five focus groups were organized between September 2004 and April 2005 in Belgium. We used purposeful sampling to recruit 53 nurses working in different settings. A problem tree was developed to establish links between codes that emerged from the data.

FINDINGS

The majority of the barriers were consistent with previous findings. Flemish (Belgian) nurses added a potential lack of responsibility in the uptake of evidence-based nursing, their 'guest' position in a patient's environment leading to a culture of adaptation, and a future 'two tier' nursing practice, which refers to the different education levels of nurses. The problem tree developed serves as (1) a basic model for other researchers who want to explore barriers within their own healthcare system and (2) a useful tool for orienting change management processes.

CONCLUSION

Despite the fact that the problem tree presented is context-specific for Flanders (Belgium), it gives an opportunity to develop clear objectives and targeted strategies for tackling obstacles to evidence-based nursing.

The dissemination and utilization of research for promoting evidence-based practice

Social service practitioners and researchers have long been aware of the gap between research and practice. The evidence-based practice movement has brought increasing attention to the role of empirically based interventions within social service practice, however, effective methods of research dissemination and utilization have received relatively little attention. This article describes factors related to dissemination and utilization of research within human service agency settings, including those factors related to: (1) individual practitioners, (2) the organization, (3) the nature of research, and (4) how research is communicated. The implications of these factors for dissemination and utilization of research are also identified. Ultimately, effective dissemination and utilization of research will involve considerable collaboration between researchers and practitioners. If they are to reach the shared goal of improved interventions and client outcomes, effective collaboration will require both practitioners and researchers to make changes to their practice and to their research.

Predicting research use in nursing organizations: a multilevel analysis

BACKGROUND

No empirical literature was found that explained how organizational context (operationalized as a composite of leadership, culture, and evaluation) influences research utilization. Similarly, no work was found on the interaction of individuals and contextual factors, or the relative importance or contribution of forces at different organizational levels to either such proposed interactions or, ultimately, to research utilization.

OBJECTIVE

To determine independent factors that predict research utilization among nurses, taking into account influences at individual nurse, specialty, and hospital levels.

DESIGN

Cross-sectional survey data for 4,421 registered nurses in Alberta, Canada were used in a series of multilevel (three levels) modeling analyses to predict research utilization.

METHODS

A multilevel model was developed in MLwiN version 2.0 and used to: (a) estimate simultaneous effects of several predictors and (b) quantify the amount of explained variance in research utilization that could be apportioned to individual, specialty, and hospital levels.

FINDINGS

There was significant variation in research utilization (p <.05). Factors (remaining in the final model at statistically significant levels) found to predict more research utilization at the three levels of analysis were as follows. At the individual nurse level (Level 1): time spent on the Internet and lower levels of emotional exhaustion. At the specialty level (Level 2): facilitation, nurse-to-nurse collaboration, a higher context (i.e., of nursing culture, leadership, and evaluation), and perceived ability to control policy. At the hospital level (Level 3): only hospital size was significant in the final model. The total variance in research utilization was 1.04, and the intraclass correlations (the percent contribution by contextual factors) were 4% (variance = 0.04, p <.01) at the hospital level and 8% (variance = 0.09, p <.05) at the specialty level. The contribution attributable to individual factors alone was 87% (variance = 0.91, p <.01).

CONCLUSIONS

Variation in research utilization was explained mainly by differences in individual characteristics, with specialty- and organizational-level factors contributing relatively little by comparison. Among hospital-level factors, hospital size was the only significant determinant of research utilization. Although organizational determinants explained less variance in the model, they were still statistically significant when analyzed alone. These findings suggest that investigations into mechanisms that influence research utilization must address influences at multiple levels of the organization. Such investigations will require careful attention to both methodological and interpretative challenges present when dealing with multiple units of analysis.

Factors influencing the development of evidence-based practice: a research tool

AIM

The paper reports a study to develop and test a tool for assessing a range of factors influencing the development of evidence-based practice among clinical nurses.

BACKGROUND

Achieving evidence-based practice is a goal in nursing frequently cited by the profession and in government health policy directives. Assessing factors influencing the achievement of this goal, however, is complex. Consideration needs to be given to a range of factors, including different types of evidence used to inform practice, barriers to achieving evidence-based practice, and the skills required by nurses to implement evidence-based care.

METHODS

Measurement scales currently available to investigate the use of evidence in nursing practice focus on nurses' sources of knowledge and on barriers to the use of research evidence. A new, wider ranging Developing Evidence-Based Practice questionnaire was developed and tested for its measurement properties in two studies. In study 1, a sample of 598 nurses working at two hospitals in one strategic health authority in northern England was surveyed. In study 2, a slightly expanded version of the questionnaire was employed in a survey of 689 community nurses in 12 primary care organizations in two strategic health authorities, one in northern England and the other in southern England.

FINDINGS

The measurement characteristics of the new questionnaire were shown to be acceptable. Ten significant, and readily interpretable, factors were seen to underlie nurses' relation to evidence-based practice.

CONCLUSION

Strategies to promote evidence-based practice need to take account of the differing needs of nurses and focus on a range of sources of evidence. The Developing Evidence-Based Practice questionnaire can assist in assessing the specific 'evidencing' tendencies of any given group of nurses.

Contextual Factors Influencing Research Use in Nursing

BACKGROUND

Contextual factors are perceived to be significant barriers to research-utilisation-related activity, but little is known about how context impacts on specific research-based decisions, or how the individual interacts with the organisation in the requirement for research-based change.

AIM

This study describes the impact of contextual factors on the practical reasoning of nurse specialists in the construction of policy for practice.

METHODS

Three groups of clinical nurse specialists were observed during a series of meetings convened to construct evidence-based guidelines for nursing practice. Transcripts of the meetings were analysed to identify and categorise the physical, social, political, and economic influences on 31 nursing issues.

FINDINGS

Multiple contextual factors influenced each decision made, with decisions about nursing practice bounded by setting and system considerations, relationships with others in the care team, and resource constraints. Practitioners were involved in weighing up alternative scenarios, contexts, and contingencies for each decision, requiring strategies to adapt and reconstruct the nature of care, to influence others, and to affect organisational decision-making processes.

DISCUSSION

The practical accomplishment of evidence-based practice required diverse skills: translating between evidence and practice; mediating the values, preferences, and working practices of multiple stakeholders; negotiating organisational complexity and the management of boundaries; and coordinating inter-organisational and inter-agency working. Nurse specialists in this study had a significant role in instigating, fuelling, and coordinating policy review, predominantly by communication across professional and organisational boundaries.

IMPLICATIONS/CONCLUSIONS

Clinical specialists acting as organisational boundary spanners require skills in the informal cultural work of organising, facilitating, and maintaining links across professional, team, and organisational boundaries. If their role in the negotiation of evidence-based practice patterns across professional and organisational boundaries is to be successful, wider skills than information management need to be recognised and their development and enactment supported.