Understanding barriers to basing nursing practice upon research: a communication model approach

Research-active nurses' perceptions of the barriers to undertaking research in practice

The aim of the study was to identify how a small group of research-active clinical nurses perceived and overcame the reputed 'barriers' to carrying out research in practice. The nursing literature on research implementation tends to focus on barriers that prevent nurses engaging in research. This study takes a different approach and focuses instead on how some nurses manage to succeed despite the difficulties.

A purposive sample of 12 research-active nurses from one trust was recruited to the study. The small sample was a reflection of the comparatively small number of clinical practitioners involved in research activity. Interviews and rating scales were used to explore the practitioners' attitudes to research in general as well as barriers to research identified through earlier studies. The nurses studied did not consider the commonly perceived barriers to undertaking research to be 'barriers' - some nurses saw them as 'excuses'. The only barriers the nurses acknowledged were staffing, cost and lack of support, but they surmounted these by their determination to carry out their research studies and publish. The study suggests that the main kind of support needed by nurses who want to carry out research is that offered by facilitators, who give them confidence to carry out research and publish their findings.

Research-based practice: myth or reality? A review of the barriers affecting research utilisation in practice

A research-practice gap still exists despite the promotion and strategies for research-based practice by governments and nursing organisations. Hunt (1981 Journal of Advanced Nursing 12:101-110) and Walsh and Ford (1989 Nursing rituals: research and rati onal action. Butterworth-Heinemann) report a wealth of anecdotal evidence to support the failure of nurses to use research in practice. A body of evidence confirms that the number of identified barriers to research utilisation is great. Drawing on the wo rk of Rogers (1983 Diffusion of innovations. The Free Press, New York) or the Barriers Scale (Funk et al. 1991a Applied Nursing Research 4(1):39-45), many authors (Dunn et al. 1997 Emergency Nurse 5(2):24-27; Walsh 1997a 1997b Nursing Standard 11(19):34- 37; 1997c Nursing Standard 11(29):34-39; Kajermo et al. 1998 Journal of Advanced Nursing 27(4):798-807; 2000 Journal of Advanced Nursing 31(1):99-109; Parahoo 2000 Journal of Advanced Nursing 31(1):89-98) have structured the barriers into sub-groups: the characteristics of the organisation, of the adopter, of the communication and of the research. Several studies reveal that the actual 'setting' poses the greatest barrier to the utilisation of research. Walsh (1997b) describes this as a paradox, in othe r words: practice is perceived as the biggest obstacle to change in practice. A systematic approach to research utilisation is outlined aimed at targeting these specific identified barriers, and third level institutes and practice settings are urged to c onsider strategic and focused approaches to the development of research plans.

Mental Health Professionals’ Perceived Barriers and Benefits, and Personal Concerns in Relation to Psychiatric Research

Aim: Mental health professionals can contribute to generating a strong evidence base for policy and practice in psychiatry. An insight into their perception of psychiatric research is important for planning support strategies. This study explored healthcare professionals’ perceptions of barriers, benefits and concerns about psychiatric research in a Singapore psychiatric hospital. Materials and Methods: Self-administered questionnaire was employed to collect socio-demographic data and opinions on research. Likert scale was used for the responses and descriptive statistics and ordinal regression were used for data analysing. Results: 93.8% respondents perceived “contribution to medical knowledge/ public health” to be a major benefit of conducting research. 86.7% respondents felt that “learning experience” was important. “Prestige/publication” (52.7%) and “financial gain” (76%) were perceived to be unimportant. “Clinical load of patients”, “lack of skilled personnel to assist in research” and “insufficient funding” were identified as important barriers by 72.4%, 70.6% and 68.9% respondents. “Time constraints”, “patient and family readiness to research participation”, “insufficient training” and “concerns about patient welfare” are major concerns while conducting research. Conclusion: To the study team’s best knowledge, this is the only study of mental health professionals’ perceptions on psychiatric research. It is useful for strategising research planning and enhancing the research culture in the hospital. Key words: Healthcare professionals, Mental health research, Research planning strategies

Use of the innovation-decision process teaching strategy to promote evidence-based practice

The purpose of this article is to describe the innovation-decision process teaching strategy (I-DPTS) based on the model of diffusion of innovations [Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press]. A goal of baccalaureate nursing education is to develop competencies required for evidence-based practice. Such practice merges clinician expertise, patient preferences, and critical evaluation of the literature to improve patient outcomes and reduce health care costs [Melnyk, B. M. (2005). A primer on evidence-based practice. Paper presented at the Purdue School of Nursing Seventh Annual Helen R. Johnson Leadership Conference, West Lafayette, IN]. Several strategies to promote evidence-based practice have appeared in the literature. However, when they are examined in light of the innovation-decision process (Rogers, 2003), they do not address all the essential steps for adoption to occur. The I-DPTS allows students to achieve competencies necessary to overcome barriers associated with implementing best practices. This strategy was successfully implemented in a senior-level introductory nursing research class. Community representatives identified practice issues that could be addressed by student groups. After conducting a search of the literature, students analyzed the evidence, determined best practice based on the evidence, and developed a policy for implementation in clinical settings. At course end, representatives were invited to attend oral and poster presentations. Use of the I-DPTS better prepares students to implement best practice as they embark on their professional careers.

Pressure-relieving equipment: promoting its correct use amongst nurses via differing modes of educational delivery

AIMS AND OBJECTIVES

To examine the impact of written and verbal education on bed-making practices, in an attempt to reduce the prevalence of pressure ulcers.

BACKGROUND

The Department of Health has set targets for a 5% reduction per annum in the incidence of pressure ulcers. Electric profiling beds with a visco-elastic polymer mattress are a new innovation in pressure ulcer prevention; however, mattress efficacy is reduced by tightly tucking sheets around the mattress.

DESIGN

A prospective randomized pre/post-test experimental design.

METHODS

Ward managers at a teaching hospital were approached to participate in the study. Two researchers independently examined the tightness of the sheets around the mattresses. Wards were randomized to one of two groups. Groups A and B received written education. In addition, group B received verbal education on alternate days for one week. Beds were re-examined one month later. One researcher was blinded to the educational delivery received by the wards.

RESULTS

Twelve wards agreed to participate in the study and 245 beds were examined. Before education, 113 beds (46%) had sheets tucked correctly around the mattresses. Following education, this increased to 215 beds (87.8%) (chi2 = 68.03, P < 0.001). There was no significant difference in the number of correctly made beds between the two different education groups: 100 (87.72%) beds correctly made in group A vs. 115 (87.79%) beds in group B (chi2 = 0, P = 0.987).

CONCLUSIONS

Clear, concise written instruction improved practice but verbal education was not additionally beneficial.

RELEVANCE TO CLINICAL PRACTICE

Nurses are receptive to clear, concise written evidence regarding pressure ulcer prevention and incorporate this into clinical practice.

'Working from the inside': an infrastructure for the continuing development of nurses' professional clinical practice

AIM

This paper describes how the nursing executive of a tertiary referral facility revisited their management structures and responsibilities to create a new, sustainable infrastructure that supports research and education at the core of nursing practice and not at the periphery.

BACKGROUND

Nursing executive and senior management groups are charged with the ultimate responsibility of ensuring the highest possible quality nursing care within their facility. In the current health care climate the aim for best practice conflates with evidence-based practice that can be notoriously difficult to achieve due to the many barriers to integrating research findings into practice.

KEY ISSUES

Research and education activities have been established as fundamental to core business under a simple evidence-based practice model.

CONCLUSION

The value of a synthesis between the clinical areas with the nursing education and research division has been recognized to better achieve the goal of improved services.

Barriers in implementing research findings in cancer care: the Greek registered nurses perceptions

This study explored Greek nurses' perceptions of the barriers to research utilization faced in every day practice. The barriers between nurses working in cancer and general hospitals, as well as between those employed at central and provincial hospitals were compared. The study used a cross-sectional design and data were collected using the "Barriers Scale" (Funk et al., 1991a, Applied Nursing Research, 4, 39-45). A convenience sample of 301 nurses was randomly selected from 12 hospitals in Greece. The two key barriers identified were related to the 'availability of research findings'. English language was perceived to range between moderate and major barrier for the vast majority of participants (n = 231, 78%). Nurses surveyed indicated the presentation of research findings as the greatest barrier while the characteristics of nurses themselves were perceived as the least important one. No significant differences were found between types of hospitals (cancer/general) and geographical areas (central/provincial). Some differences, however, were observed in relation to specific items of the scale such as feeling isolated from 'research-knowledgeable' colleagues and having insufficient time to implement new ideas. The observations reported here appear to agree with the findings in mainstream literature. The results suggest that more emphasis should be given in research methodology, statistics and critical appraisal skills at all levels of nursing education, and that efforts should be made towards increasing research availability and creating supportive environments for implementation of research findings.

Utilization of research findings by graduate nurses and midwives

BACKGROUND

There is mounting pressure on nurses and midwives in the United Kingdom to use research findings to inform their practice. However, many still find research difficult to understand and are poorly prepared by education to make use of it. Hence, there is a pressing need to evaluate the research education included in nursing and midwifery curricula.

AIM

This paper reports a study assessing the impact of research education on the attitudes towards research and use of research findings in practice by graduate nurses and midwives.

METHOD

A cross-sectional survey using a self-completed postal questionnaire was conducted with a sample of 340 nurse and midwife graduates in the South East of England.

FINDINGS

A response rate of 51% was obtained. A large number of respondents stated that their critical appraisal (96%) and search skills (87%) had improved following graduation and they reported using research findings in practice (16.8% all the time, 50.5% frequently and 32.6% sometimes). Furthermore, the majority expressed positive attitudes towards research and these were related to the research education received. However, a significant number reported finding statistics difficult to understand, lack of time to read research and limited access to research findings at their place of work. Also, a number of respondents would still like more help with searching the literature, implementing research findings in practice and developing their critical appraisal skills further.

CONCLUSION

It is crucial that some of the major barriers to research utilization are addressed at both individual and organizational levels if evidence-based care is to become a reality. Also, health service managers should consider a number of strategies suggested by respondents to increase the use of research findings in clinical settings.

Appraisal Skills as a Public Health Competency for Evidence-Based Care

With the demand for evidence-based practice, a greater need for health professionals' research expertise has emerged. Insufficient knowledge and inadequate competencies in research methods have been identified as barriers. Training endeavors to increase students' research awareness have been extensive. The study detailed in this article examines three research modules aimed at increasing health professionals' research knowledge. The effects that four demographic dimensions (gender, disability, ethnic group, and age bracket) and five educational parameters (academic term, mode of study, nature of module, qualification aim, and entry qualification) have on student contentment are investigated. According to these parameters, there were no differences in students' performance on the research modules. However, there were significant differences in satisfaction with the module administration, content, integration, and assessment procedures; the module team and university resources; and the module relevance and stimulation.

Barriers to research utilisation: the clinical setting and nurses themselves

The advance of the evidence-based practice (EBP) movement has been evident in almost every Western country and health system over the past two or three decades, fuelled by an ever-rising demand on resources. Nurses at all levels are increasingly expected to address the key challenge of EBP, which is to use research evidence in a conscientious, explicit and judicious way when making decisions about patient care. The main aim of the paper is to encourage nurses to embrace the challenge of EBP. First, as background, this paper presents key findings from the limited body of research which has examined barriers to research utilisation in the nursing context. Nurses generally feel there are many barriers, with primary barriers being lack of time, lack of relevant skills, poor team-working and several aspects of nursing 'culture' (ritualistic care, no authority and no incentives). Some conceptual models in implementation of research findings are introduced, and a summary presented of key areas which nurses need to address when considering research utilisation.

Barriers to research utilization: the clinical setting and nurses themselves

The advance of the evidence-based practice (EBP) movement has been evident in almost every Western country and health system over the past two or three decades, fueled by an ever-rising demand on resources. Nurses at all levels are increasingly expected to address the key challenge of EBP, which is to use research evidence in a conscientious, explicit and judicious way when making decisions about patient care. The main aim of the paper is to encourage nurses to embrace the challenge of EBP. First, as background, this paper presents key findings from the limited body of research which has examined barriers to research utilization in the nursing context. Nurses generally feel there are many barriers, with primary barriers being lack of time, lack of relevant skills, poor team-working and several aspects of nursing 'culture' (ritualistic care, no authority and no incentives). Some conceptual models in implementation of research findings are introduced, and a summary presented of key areas which nurses need to address when considering research utilization.

On donkeys, ingratiates, thinkers and...clinical development units

Clinical Development Units celebrate nurses as thinkers and nursing as a highly skilled professional activity. They are typified by the exploration and development of therapeutic, consumer-focused and research-based practice and participatory governance. Establishing and maintaining them, therefore, can be problematic in health care facilities typified by centralism, autocracy and nurses' disempowerment. In this type of facility nurses are treated like donkeys and/or ingratiates. What CDUs are, the standards nurses in them strategically and systematically pursue and their achievements to date will be discussed. In addition,some sociopolitical impediments to their development will be identified together with recommendations for their successful establishment and maintenance.

Implementing evidence-based practice in infection control

Evidence-based practice is seen as a way of providing more effective health care and is considered to be vital in the current healthcare climate. However, in many areas of practice, and specifically in infection control, there is often little or no evidence to back or refute certain practices. This article looks at ritualistic practices, interventions with indirect evidence to support them and practices with overwhelming evidence in their favour which are not always followed. It is concluded that nurses need to integrate the best available evidence with clinical judgment and ensure that available evidence is disseminated appropriately.

Barriers to using research evidence in nursing practice

Barriers to using research evidence in nursing practice The nursing profession has long recognized the importance of research as an essential basis for its development. More recently, the movement supporting evidence-based practice has brought this point into focus. However, relatively little research has been conducted to identify factors that interfere with the ability of nurses to base their practice on research evidence. Using factor analysis procedures, barriers to the use of research evidence in practice which were perceived to be present by 400 registered nurses working in an Australian hospital, were grouped under four main factors. These were accessibility of research findings, anticipated outcomes of using research, organizational support to use research and support from others to use research. The most important factor was perceived to be organizational support, particularly in relation to providing time to use and conduct research.

Perceptions of research utilization: comparisons between health care professionals, nursing students and a reference group of nurse clinicians

The study reported in this paper was carried out to investigate a group of nursing teachers' (n=37), nursing students' (n=166), nursing administrators' (n=33) and physicians' (n=127) perceptions of barriers to and facilitators of nurses' use of research findings in clinical practice. The results were compared with the corresponding figures for a reference group of nurse clinicians (n=237). The Barriers Scale and a questionnaire for the demographic issues were used for data collection. The organization and the communication of research were seen as barriers to research utilization by the nursing teachers, students and administrators in agreement with the nurse clinicians. The nurses' research-related competence and awareness were seen as barriers by the nursing teachers, students and administrators to a greater extent than by the nurse clinicians themselves. The physicians perceived barriers to a lesser extent than the other groups did. The students' perceptions were closest to the nurse clinicians, while the physicians' perceptions differed most. Education to increase the nurses' knowledge of research and to develop their competence to evaluate research results, increased resources for education, more staff, support from the administration and research presented in a user-friendly way were the most frequently suggested facilitators. The nurses' isolation from knowledgeable colleagues with whom to discuss the research was seen as a barrier by the majority of the participants. This indicates a need for positions in clinical practice for nursing researchers, in order to promote a research-based, nursing practice.

Practice development: ambiguity in research and practice

Practice development activity occupies an ambiguous position in relation to both clinical practice and research. In practice, it is seen at times as an added extra to normal work despite arguably being an inherent part of professional practice. In research, it fails to demonstrate the rigour of being generalisable because of its explicit location in a specific care environment. The study reported in this paper explored the implications of this ambiguity for practitioners who seek to develop health care practice. Ten focus groups were held with health care researchers and practitioners concerning the processes of developing practice in the North East of England. The results demonstrate how people manage themselves and the uncertainty that surrounds the use of research in clinical practice. The paper argues for an appreciation of reflexive forms of research, such as action and practitioner research, which do not disassociate research and practice and in which practitioners have a role in knowledge creation as well as knowledge implementation.

Barriers to nurses' use of research: an Australian hospital study

Although research is recognised as an essential basis for nursing knowledge and practice development, there is considerable agreement that nurses do not use research as often as they could. The question is, what factors are perceived by nurses in Australia to interfere with their ability to use research in their clinical practice? Using factor analysis procedures, barriers to the use of research by 149 nurses working in an Australian hospital were grouped under three main factors, viz. the perceived usefulness of research to clinical practice; the perceived ability of the practitioner to generate change to practice based on research and the accessibility of research to the practitioner. The three most frequently cited barriers to using research were insufficient time on the job to implement research findings, insufficient time to read research and a lack of awareness of research findings. In order to improve the ability of nurses to apply research to their practice, fundamental changes need to occur within the education system, so as to improve the teaching of research to students of nursing and qualified practitioners, within the health care system where nursing research is expected to be applied and among clinical nurses.

Implementation of clinical guidelines for female urinary incontinence: a comparative analysis of organizational structures and service delivery

The aim of the study was to explore and compare the development of continence services in two contrasting trusts. The first was a community trust which had initiated a top-down purchaser-led continence service. The second was a combined acute and community trust which had introduced a bottom-up, organic continence service based on staff development. The research used a qualitative, interpretative design. Evidence-based guidelines for female urinary incontinence (FUI) were analysed and key organizational features elicited. These were used to frame and analyse 20 semi-structured interviews with a range of community-based professionals who provided a service to women suffering from urinary incontinence. The interviews identified practitioner knowledge and awareness of the evidence pertaining to the management and treatment of FUI and also the features of the organizational structure of service provision in their locality which facilitated or constrained the implementation of evidence-based treatment in this area. The findings suggest that evidence-based guidelines were more closely adhered to in practice, in the trust using organic approaches to service development. Top-down, purchaser led approaches were more prescriptive and circumscribed the scope of professional practice. This adversely affected access to services for women suffering from urinary incontinence. Organic approaches to service development produce more flexible, responsive services. It is difficult, however, to integrate this approach with strategic planning as the flexibility required maybe incompatible with managerial responsibilities for defining roles and organizational functions.

Clinical Development Units (Nursing): the western Sydney approach

On 24 September 1997 Western Sydney Area Health Service and the University of Western Sydney, Nepean (Australia) launched a network of nine Clinical Development Units (Nursing). The approach taken towards the development of CDU(N)s in western Sydney differs substantially from those taken elsewhere in terms of preparation for CDU(N) leadership and the role of CDU(N) criteria in the designation ('accreditation') process. The rationale underpinning the western Sydney approach, together with details of a leadership preparation programme, are discussed.

Developing a nursing research culture in the university and health sectors in Western Sydney, Australia

The context for the development of a research culture in both the health and education sectors in Australia is similar to that in other developed countries. Contextual factors, especially those resulting from increasing fiscal constraint, militate against improved research productivity for nurses in both university and health sectors. Despite this, however, an impressive range of initiatives have been designed and introduced, both unisectorally and intersectorally, in the last 14 months to expedite the development of a nursing research culture in Western Sydney. The former include, in the University of Western Sydney (UWS), reward systems for research productivity and development, the funding of Designated Research Groups and Faculty Research Support Units. In the health service they include the funding of a Clinical Development Unit (Nursing)--CDU(N)--leadership program and the provision in 1997-98 of seed funds for research projects to be undertaken in the CDU(N)s. Intersectoral initiatives include the joint funding of four 'clinical' nursing Chairs, other sub-professorial positions and a 'flagship' series of nursing research seminars. All these initiatives will be described, together with an assessment of their impact to date, in terms of (1) research productivity, (2) improved intersectoral relationships and (3) heightened visibility and appreciation of nursing and nursing research.

Establishing evidence-based practice: issues and implications in critical care nursing

Evidence-based practice is the application of the best available empirical evidence, including recent research findings to clinical practice in order to aid clinical decision-making. The implementation of these findings is vital for optimizing patient outcomes, improving clinical practice, providing cost-effective high quality care and enhancing the credibility of nurses. The use of research findings to improve practice has been discussed and promoted for the last 20 years. The author argues that Rogers' theoretical model of the Diffusion of Innovations may prove useful in understanding the problem of the slow diffusion of the application of research evidence in clinical nursing practice. Many authors have discussed potential barriers to using research in clinical practice in order to facilitate utilization of findings. However, recent studies all document that a gap between research findings and their implementation in clinical practice still exists. This appears to hold true across a variety of practice settings, including nurses working in critical care. The diffusion of innovations in current critical care nursing practice at each stage of Rogers' theory will be examined, with recommendations given to facilitate the establishment of evidence-based practice (EBP).

What do registered nurses and midwives feel and know about research?

This research is in the form of a quantitative study aimed at discovering 'What registered nurses and midwives feel and know about research'. Data were gathered on a fixed response questionnaire, with open spaces for comments to support the results with written factual qualitative evidence. The questionnaire was directed towards obtaining results associated with 'Attitudes' towards research; 'Understandings' about research, and 'Obstacles' to implementing research. A sampling technique was used in which a total population of 765 registered nurses and midwives working in this district general hospital were involved in the study. The results demonstrate (inferential statistics chi-square and correlation tests) that registered nurses and midwives are largely in agreement with research based practices, although understanding about research is minimal and dependent on grade, length qualified, shifts and numbers of hours worked.

Induction: moving from the specific to the general

Classically, the scientific method comprises two main processes: deduction (theory testing) and induction (theory building). In this article, the main emphasis is on theory building and the Meleis (1991) model is described to illustrate some of the steps and stages involved.