The research potential of practice nurses

Challenges and strategies for conducting research in primary health care practice: an integrative review

BACKGROUND

Providing accessible and high-quality patient-centered healthcare remains a challenge in many countries, despite global efforts to strengthen primary health care (PHC). Research and knowledge management are integral to enhancing PHC, facilitating the implementation of successful strategies, and promoting the use of evidence-based practices. Practice-based research in primary care (PC-PBR) has emerged as a valuable approach, with its external validity to diverse PHC settings, making it an effective means of translating research findings into professional practice.

OBJECTIVE

To identify challenges and strategies for conducting practice-based research in primary health care services.

METHOD

An integrative literature review was conducted by searching the PubMed, Embase, Scopus, Web of Science, and Lilacs databases. The research question, guided by the PICo framework, directed the execution of study selection and data extraction. Data analysis followed the RAdAR method's three phases: pre-analysis, data analysis, and interpretation of results.

RESULTS

Out of 440 initially identified articles, 26 met the inclusion criteria. Most studies were conducted in high-income countries, primarily the United States. The challenges and strategies for PC-PBR were categorized into six themes: research planning, infrastructure, engagement of healthcare professionals, knowledge translation, the relationship between universities and health services, and international collaboration. Notable challenges included research planning complexities, lack of infrastructure, difficulties in engaging healthcare professionals, and barriers to knowledge translation. Strategies underscore the importance of adapting research agendas to local contexts, providing research training, fostering stakeholder engagement, and establishing practice-based research networks.

CONCLUSION

The challenges encountered in PC-PBR are consistent across various contexts, highlighting the need for systematic, long-term actions involving health managers, decision-makers, academics, diverse healthcare professionals, and patients. This approach is essential to transform primary care, especially in low- and middle-income countries, into an innovative, comprehensive, patient-centered, and accessible healthcare system. By addressing these challenges and implementing the strategies, PC-PBR can play a pivotal role in bridging the gap between research and practice, ultimately improving patient care and population health.

Validation of the Evidence-Based Practice Competence Questionnaire for Nursing Students: A Cross-Sectional Study in Greece

(1) Background: evidence-based nursing has been widely adopted by healthcare facilitators, and it is predicated on the connection between research evidence and clinical practice. The knowledge and implementation of evidence-based practice (EBP) depend on a variety of long-established barriers and attitudes. The purpose of this study was to translate and validate the Greek version of the evidence-based practice competence questionnaire (EBP-COQ) and test it on a sample of Greek undergraduate nursing students. (2) Methods: a cross-sectional analysis was conducted on data obtained between November 2018 and January 2019. A convenience sample of 320 Greek undergraduate nursing students participated in a survey to examine the psychometric properties of the tool. The reliability and validity of the tool was examined. Cronbach’s coefficient alpha was used to determine the scale’s internal consistency reliability. (3) Results: the EBP-COQ was translated and validated. The estimated Cronbach’s alpha was higher than 0.70 for all scales. Of the participants, 22.5% were men and 77.5% were women, while 31% of them were in their final year of nursing education. A total of 61% of the students stated that they had not participated in an EBP seminar in the past. High Spearman’s correlation coefficients were found for “Knowledge in EBP” with “Personal attitude towards EBP” (rs = 0.329, p < 0.001). (4) Conclusions: the Greek version of the EBP-COQ is a valid instrument that can be used in the Greek population. It provides information about attitude, knowledge and skills in the EBP approach.

[Perception of the quality of nursing research in a public hospital]

BACKGROUND AND OBJECTIVES

Nurses, as health professionals, play an important role in research, as progress in care and treatment could not be made without it. The aim of this study is to analyse the perception by nurses of the current research system in the whole of their hospital and, second, study how this perception varies according to their research profile, as well as their level of satisfaction and commitment to the organisation in which work.

MATERIAL AND METHOD

A cross-sectional descriptive study was conducted in a third level hospital with a convenience sample of nurses with more than 6 months experience. The Group of Experts of the III Forum of Science of the Lilly Foundation questionnaire was used, adapting it to the characteristics of the population. The purpose of the questionnaire was to collect the perception and assessment, real and ideal, that nurses have on research. Univariate and bivariate analyses were performed using the Student t-test.

RESULTS

In the sample of 295 nurses, the perception and assessment of the current situation of nursing research, its impact, its recognition, and its integration with nursing work were well below the ideal scores, obtaining statistically differences (P<.001). There was a significance in the values that recognise that more research is needed by nursing staff, the impact and recognition by management, and synergy with the pharmaceutical industry (P<.001). The level of satisfaction did not affect the assessment, the commitment of the nurses if it influenced their assessment of the research. No differences were found between the ICU staff and the other departments as regards the perception and assessment of nursing research.

CONCLUSIONS

Nurses take the research as part of their functions and mention that the state of the research is very much improved. A support infrastructure is needed to strengthen research in care, as well as real recognition by institutions.

Practitioner research: An approach to developing research capacity in primary care

The development of research capacity is a priority in healthcare. However, little information is available on the outcomes of different approaches to capacity-building. This paper provides a description of the approach taken in a primary health care (PHC) project (Teamcare Valleys) to support the development of research skills by PHC practitioners. The 35 practitioners were all experienced nurses, midwives, health visitors, GPs, practice managers and health promotion specialists. Research capacity development was supported by colleagues with experience in a range of research approaches in PHC and social science research.

A case study was designed to examine the impact of the capacity-building process on the development of research and other skills. Data were collected at the end of the three-year project and five years later to identify the development of research skills and their utilisation in subsequent posts. Evidence indicates that the practitioner researchers developed considerable skills in research and associated areas; for example, in methods of research dissemination. However, their subsequent utilisation of these skills resulted from their own motivation rather than from being a requirement of subsequent posts. It is concluded that development of practitioner research skills needs to be supported by a career strategy enabling clinical research careers in the NHS.

Nurses' experiences of participation in a research and development programme

AIMS AND OBJECTIVES

To describe clinical nurses' experience of participating in a Research and Development (R&D) programme and its influence on their research interest and ability to conduct and apply nursing research.

BACKGROUND

To stimulate nurses' research interest and to overcome barriers for building research capacity in nursing, there is a need for sustainable research programmes. A two-year programme was designed for nurses, to take part in both an academic education for master and research seminars and workshops to conduct a research project from idea to publication.

DESIGN

A qualitative approach using using focus group interviews.

METHODS

Registered nurses (n=12) with a bachelor's degree in nursing, participated. Data were collected in focus group interviews, after one year and when the programme ended. Content analysis was used to analyse the data.

RESULTS

The findings consist of two themes: being a traveller in the world of nursing research, which included three categories, and experiencing professional growth as a result of nursing research training, in both cases focusing on the experience of students involved in a cohesive programme which included four categories: discovering new dimensions of clinical nursing practice; selected and confirmed; supported by professional others; development of professional self-concept.

CONCLUSIONS

To support early career researchers, there is a need for strong leadership, an organisational and supportive infrastructure underpinning research capability building in nurses. In this context, research strategies, programmes and collaboration between leaders of academia and clinical institutions appear to be essential.

RELEVANCE TO CLINICAL PRACTICE

The R&D programme illustrates an effective way of stimulating nurses' lifelong learning by building the capacity to conduct and apply nursing research in clinical practice. The structure of the programme can be used as a model in other contexts.

Practice nursing in Australia: A review of education and career pathways

BACKGROUND

Nurses in Australia are often not educated in their pre registration years to meet the needs of primary care. Careers in primary care may not be as attractive to nursing graduates as high-tech settings such as intensive or acute care. Yet, it is in primary care that increasingly complex health problems are managed. The Australian government has invested in incentives for general practices to employ practice nurses. However, no policy framework has been developed for practice nursing to support career development and post-registration education and training programs are developed in an ad hoc manner and are not underpinned by core professional competencies. This paper reports on a systematic review undertaken to establish the available evidence on education models and career pathways with a view to enhancing recruitment and retention of practice nurses in primary care in Australia.

METHODS

Search terms describing education models, career pathways and policy associated with primary care (practice) nursing were established. These search terms were used to search electronic databases. The search strategy identified 1394 citations of which 408 addressed one or more of the key search terms on policy, education and career pathways. Grey literature from the UK and New Zealand internet sites were sourced and examined. The UK and New Zealand Internet sites were selected because they have well established and advanced developments in education and career pathways for practice nurses.Two reviewers examined titles, abstracts and studies, based on inclusion and exclusion criteria. Disagreement between the reviewers was resolved by consensus or by a third reviewer.

RESULTS

Significant advances have been made in New Zealand and the UK towards strengthening frameworks for primary care nursing education and career pathways. However, in Australia there is no policy at national level prepare nurses to work in primary care sector and no framework for education or career pathways for nurses working in that sector.

CONCLUSION

There is a need for national training standards and a process of accreditation for practice nursing in Australia to support the development of a responsive and sustainable nursing workforce in primary care and to provide quality education and career pathways.

Renegotiating roles as part of developing collaborative practice: Australian nurses in general practice and cervical screening

This paper reports the findings from an action research study that used a reflective group method to work with nurses in general practice recently credentialed as cervical screeners. The research aimed to develop a new model of practice nurse service delivery within a multidisciplinary team. Findings demonstrated that poor interdisciplinary collaboration created barriers to changing the role of the practice nurse. Key themes identified were: renegotiating their roles, identifying and negotiating gendered patterns of cervical screening, and the effect of multidisciplinary teams and interdisciplinary collaboration on practice nurse retention. Recommendations from this study address the need for improved piloting of new initiatives and an increase in continuing professional development for practice managers who are potential change agents.

Nursing competency and organizational climate as perceived by staff nurses in a Chinese university hospital

Nursing competency is important to ensure patient safety and improve the quality of nursing care. Based on competency-based human resource management strategies, the organizational climate can positively influence nursing competency. However, a review of the literature indicated that there were no studies about the relationship between nursing competency and organizational climate in the People's Republic of China. This descriptive, correlational study examined the relationship between nursing competency and the organizational climate. The sample consisted of 243 staff nurses who completed the questionnaire worked at one university hospital in Liao Ning Province. The findings showed that there was a significantly moderate positive relationship between nursing competency and organizational climate. The study results suggested that Chinese nurse managers should maintain and provide a positive organizational climate to improve nursing competency.

The struggle to develop nursing research in Turkey

BACKGROUND

Little is known internationally about nursing research in Turkey. The development of nursing research would, however, provide a distinctive perspective on health needs and service provision. To understand the development of nursing research in Turkey, the development of nursing research in other countries might be analysed.

AIM

To describe the development of nursing research and education in Turkey in a European context.

FINDINGS

The evolution of nursing research in Europe is discussed and the importance of setting nursing research priorities described. Different countries in the world are then examined for the development of nursing research and priorities. Finally, the development of nursing education, nursing research and priorities in Turkey are analysed and discussed in the context of the political and social background.

CONCLUSION

The development of Turkish nursing research may still be insufficient in relation to the development of nursing research in Europe, but it is following global developments. Over the past years, there has been an increased interest in nursing research and Turkish nurses work hard to produce work for international publication.

[Difficulties and opportunities for research as perceived by nurses in Asturias (Spain)]

OBJECTIVE

To identify, through communicative consensus, the difficulties and opportunities for research perceived by nurses in Asturias (Spain).

METHOD

The Regional Ministry of Health and the Health Service of Asturias made an open call and 80 nurses from all fields (clinical, teaching, and management) were assigned to 10 groups. Using a nominal group technique, these nurses identified and prioritized the difficulties and opportunities they perceived for research. Through independent pairs, the research group analyzed the content of the contributions made.

RESULTS

In order of priority, the difficulties perceived were related to training deficit, lack of resources, lack of available time, little acknowledgement and support, and professional idiosyncrasy and sociology. The opportunities perceived were grouped into training opportunities, material resources -when known to exist-, support from experts, access to information resources, the existence of financial support, and time available when working in primary care.

CONCLUSIONS

The nurses identified the difficulties and opportunities that should be taken into account if strategies to stimulate nursing research are to be established. The situation should continue to be analyzed in order to provide possible solutions to the difficulties encountered, especially those related to professional idiosyncrasy and sociology.

Interdisciplinary researching: exploring the opportunities and risks of working together

The aim of this paper is to explore the issues that present both opportunities and risks when working in an interdisciplinary research project. As the research context changes in the social reform environment, some scientists suggest it is time to forge new scientific working relationships, to open up the boundaries between disciplines. Interdisciplinary research is an alternative approach for nurses who might develop different ways of working with health researchers from other disciplines. The ideas in this paper come from a larger, grounded theory study on interdisciplinary teamwork. The changing research context, the meaning of interdisciplinary working, collaboration, and competence, integrating different disciplinary perspectives, interprofessional learning opportunities, and the relevance for nurses are explored in relation to interdisciplinary researching. Interdisciplinary researching is complex and potentially risky; however, it does offer nurses the opportunities for professional growth, development, and research work satisfaction. Many nurses are already well-trained researchers and might consider developing roles as interdisciplinary research project managers as well.

An exploration of factors which constrain nurses from research participation

AIM

The aim of this study was to explore practising nurses' views on factors which they perceived constrained them from research participation.

BACKGROUND

Many studies reviewed in the literature have taken a quantitative approach and have concentrated on why nurses do not use research findings in their practice. Of these studies a few included constraints to research use. However, with the development of national research strategies for nursing and the drive for the profession to develop its own research base, there is a need to understand what constrains clinically practising nurses from taking up opportunities to either develop their own research or participate in research studies.

DESIGN AND METHOD

Data were collected during June and July 2004 by means of two focus groups (n=7) followed by single interviews (n=7). Analysis was undertaken using a thematic approach aided by N-Vivo 2.0.

RESULTS AND DISCUSSION

In this study, findings revealed six key themes perceived by nurses to constrain from research participation: 'Level of support nurses require to be research active', 'Nurses' attitudes to undertaking/participating in research', 'The extent of nurses knowledge about research', 'Skills to undertake research' and 'Level of educational preparation relating to undertaking/participating in research'.

CONCLUSIONS

In this study, nurses were generally receptive to participating in research. However, they felt constrained because of lack of time, lack of peer support and limited knowledge and skills of the research process.

RELEVANCE TO CLINICAL PRACTICE

What is already known on this topic: studies into nurses and research have predominantly taken a quantitative approach; many studies have aimed to elicit the extent of nurses' use of research findings.

WHAT THIS STUDY ADDS

this study adds a qualitative perspective; although findings are not generalizable, they support quantitative study findings into this subject; identifies constraints that require to be overcome for practising nurses to actively get involved in research studies.

Collaboration in the Emergency Department: an innovative approach

Recently an innovative collaborative Nurse Research Consultant position between Curtin University of Technology and Joondalup Health Campus was established. The position was considered to be essential to ensure the development and implementation of evidence-based nursing practice in the Emergency Department (ED). This paper presents the findings of an explorative qualitative research study that identified how the Nurse Research Consultant position fulfilled the needs of emergency nurses in the area of research and development. The study also highlighted factors that impacted on the ED nurses' ability to utilise and conduct research. A questionnaire was developed and distributed to all of the nursing staff in the ED. Following analysis of the questionnaires semi-structured interviews were conducted with 10 registered nurses. Content analysis was utilised to identify themes from the interviews. Data analysis of the interviews identified four main themes: enabling the research process, hindering the research process, assisting the research process and expanding the Nurse Research Consultant role. The findings highlighted that ED nurses are reluctant to become involved in research because of a perceived lack of knowledge, skill level, time and motivation. However, most nurses considered that the Nurse Research Consultant, formal education, cultural change, access to resources and involvement in research activities as mechanisms to assist them to contribute in research activities.