Perceived barriers and facilitators to implementing research findings in the Irish practice setting

Construct validity and reliability of the BARRIERS scale in the Spanish context

OBJECTIVE

To establish the construct validity of the Spanish version of the BARRIERS scale.

METHOD

Methodological study of validation of a measurement instrument based on data from previously published studies. The study population consisted of nurses from the Basque Health Service and the Canary Health Service. The following variables were extracted and unified: Years of professional experience, possession of a specialist nursing degree, possession of a doctorate, type of activity performed by the professional and field of work. For construct validation, a confirmatory factor analysis (CFA) was performed based on the initial model proposed for the scale and RASCH analysis. A polychoric correlation matrix, factor extraction by unweighted least squares and PROMIN oblique rotation were used. For the RASCH analysis, the Joint Maximun Likelihood estimation (JMLE) method was used; the fit of the items and persons were estimated by means of outfit - Unweighted Mean Square fit statistic (UMS) and infit -Weighted Mean Square Fit Statistic (WMS), as well as the reliability and separation of items and persons.

RESULTS

A total of 1200 nurses and midwives made up the final validation sample (n = 1200), with a mean professional experience of 21.22 ± 9.26 years. The CFA presented a good fit to the data (KMO = 0.935 [95% CI: 0.921-0.945]), changing the factorial assignment in 6 items, while 5 items received factorial scores in more than one factor. The fit values for the 4-factor solution were RMSEA = 0.026 [95% CI: 0.026-0.027] and GFI = 0.991 [95% CI: 0.986-0.991]. In the RASCH analysis most items presented infit-WMS and outfit-UMS values with a good fit.

CONCLUSIONS

The Spanish version of the BARRIERS scale has adequate construct validity although there are changes in the assignment of items to the dimensions compared to the original model. The RASCH analysis indicates adequate fit for both persons and items.

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.

Nurse Practitioners' Implementation of Evidence-Based Practice Into Routine Care: A Scoping Review

BACKGROUND

Implementation of evidence-based practice (EBP) is essential for ensuring high-quality health care at minimum cost. Although all nurses have a responsibility to implement EBP at an individual patient level, nurse practitioners (NPs) as clinical leaders have additional responsibilities in leading and collaborating with transdisciplinary teams to implement EBP across patient groups and embed practice change into routine care.

AIM

To explore the factors affecting the implementation of EBP into routine care by NPs. Specifically, to examine NP beliefs, levels of EBP implementation, and barriers and enablers to EBP implementation into routine care.

METHODS

A scoping review was conducted using the Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) framework. The electronic databases CINAHL, Medline, and PsycINFO were searched for studies published between 2009 and 2018 along with gray literature and reference lists of included articles. Abstracts and studies were screened using predefined eligibility criteria. Data extraction was undertaken using a standardized framework and data synthesis completed.

RESULTS

Seven studies were included in the review. Findings indicated NPs valued EBP and believed it to be important in standardizing patient care. NPs' implementation of EBP was found to be relatively low overall. It was not possible to fully determine the extent to which NPs implemented EBP into routine care. NPs experienced similar barriers to EBP implementation as do nurse generalists such as lack of time, lack of EBP competence, lack of support from colleagues and managers, and inadequate resources. In particular, NPs identified collaborative practice issues as factors affecting EBP implementation. Identified barriers included physician-driven practice and the need to maintain professional and political boundaries. Supportive collaborative relationships and having professional confidence were identified facilitators.

LINKING EVIDENCE TO ACTION

An exploration of NPs' experience of interprofessional collaboration when implementing EBP into routine care is needed to identify requirements for support in this area.

Evaluation of Facilitators and Barriers to Implementing Evidence-Based Practice in the Health Services: A Systematic Review

BACKGROUND

Evidence-based practice (EBP) is an ambition for health service administrators. We aimed to systematically review the major relevant articles in case of barriers and facilitators to implementing evidence-based practice in health services.

MATERIALS AND METHODS

The type of study was a systematic review. We searched the libraries and online sources such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, Scopus, Science Direct, Cochrane Library, and Google scholar. We used keywords included "Evidence-Based Practice", "Evidence-Based Management", "Healthcare", "Care Management, Evidence-Based Healthcare Management", "Health Care", Health", "Barrier", "Facilitator", policy and "Evidence-Based Healthcare".

RESULTS

In total, 12 studies were included. Several barriers and facilitators were recognized through the included papers, the factors such as organization support and a helpful education system improved skills, knowledge, and confidence to EBP. The outcomes of studies were identified as the employ of the internet as a highest-rated skill for increasing EBP quality.

CONCLUSION

Generally, the results showed health service administrators should first identify barriers of EBP then transferred them to facilitators to the implementation of proper and efficient EBP.

Perceptions of physicians in Saudi Arabia on the use of international clinical guidelines for managing primary insomnia

INTRODUCTION

While there are no national clinical guidelines for managing primary insomnia in Saudi Arabia, there are also no published studies of physicians' perceptions of and attitudes towards using international guidelines. The objective of this study was to explore the knowledge, perceptions, and attitudes of physicians practising in Saudi Arabia about using international guidelines for managing insomnia.

METHODS

A qualitative study using in-depth, face-to-face, and semi-structured interviews with 15 physicians held in July 2017 at a tertiary care hospital in Jazan, the distal south-western province in Saudi Arabia. Interviews were audio-recorded, transcribed verbatim, coded using the qualitative software NVivo11 and analysed thematically. Data saturation was assumed as no new understandings of the broad thematic issues were produced by the last three interviews.

RESULTS

Themes identified were: Knowledge, Resistance, Barriers and Facilitators. Participants acknowledged their lack of awareness of available guidelines and their lack of training and education about Cognitive Behavioural Therapy for Insomnia (CBT-I). They highlighted a lack of education for patients about insomnia and its treatment. Beliefs about dependence on hypnotics and the inappropriateness of international guidelines for Saudi Arabia inclined many to resist using them. Inability to document diagnosis and consultations due to limited time and lack of suitable electronic systems, lack of suitably trained practitioners for referral for CBT-I, and lack of accountability for practice were identified as key barriers to following international guidelines. Development of national guidelines was the most important facilitator suggested by participants.

CONCLUSIONS

The health authorities in the government of the Kingdom of Saudi Arabia (KSA) should improve general public awareness about sleep disorders and provide focused training for specialists and technologists. Above all, KSA needs its own nationwide guidelines for treating sleep-disorders based on evidence-based clinical trials, consistent with its history, culture, socioeconomic conditions and traditions.

Important factors for effective patient safety governance auditing: a questionnaire survey

Background

Audits are increasingly used for patient safety governance purposes. However, there is little insight into the factors that hinder or stimulate effective governance based on auditing. The aim of this study is to quantify the factors that influence effective auditing for hospital boards and executives.

Methods

A questionnaire of 32 factors was developed using influencing factors found in a qualitative study on effective auditing. Factors were divided into four categories. The questionnaire was sent to the board of directors, chief of medical staff, nursing officer, medical department head and director of the quality and safety department of 89 acute care hospitals in the Netherlands.

Results

We approached 522 people, of whom 211 responded. Of the 32 factors in the questionnaire, 30 factors had an agreement percentage higher than 50%. Important factors per category were ‘audit as an improvement tool as well as a control tool’, ‘department is aware of audit purpose’, ‘quality of auditors’ and ‘learning culture at department’. We found 14 factors with a significant difference in agreement between stakeholders of at least 20%. Amongst these were ‘medical specialist on the audit team’, ‘soft signals in the audit report’, ‘patients as auditors’ and ‘post-audit support’.

Conclusion

We found 30 factors for effective auditing, which we synthesised into eight recommendations to optimise audits. Hospitals can use these recommendations as a framework for audits that enable boards to become more in control of patient safety in their hospital.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3577-9) contains supplementary material, which is available to authorized users.

Midwives' Attitude and Barriers of Evidence Based Practice in Maternity Care

OBJECTIVES

Midwives have a crucial role in providing optimal care for pregnant women. One of the most important policies for quality improvement in maternity care is implementation of evidence-based practice. However, the application of evidence-based practice within the maternity health care setting faces many challenges. The purpose of this study was to describe Iranian midwives' attitude and perceived barriers of evidence based practice in maternity care.

METHODS

In this descriptive, cross-sectional study, a census sample of 76 midwives from two public hospitals and urban health centers in Torbat Heydariyeh, a city east of Iran were surveyed. Data collection tools were two reliable and valid questionnaires that measure midwives' attitudes and barriers of implementation of evidence-based practice. Data were analysed using SPSS version 16.

RESULTS

The mean age and years of experience were 29.30 ± 4.86 and 5.22 ± 4.21 years, respectively. The mean score of attitude was 40.85 ± 4.84 (range = 30-60). This study also found time constraints (2.70 ± 0.92), inadequate facilities (2.64 ± 0.72), non-compilation of literature in one place (2.59 ± 0.92), lack of cooperation of physicians (2.48 ± 1.06) and the feeling of inadequate authority (2.45 ± 0.88) as the top five barriers to implementing EBP.

CONCLUSION

Survey participants demonstrated a positive attitude toward EBP. Organisational comprehensive strategies such as time efficiency, adequate material and human resources, familiarity with organisations such as the Cochrane Collaboration and managerial support for increasing professional legitimate authority are recommended to promote the use of Evidence-Based Practice in Iran.

Implementation of motor learning principles in physical therapy practice: Survey of physical therapists' perceptions and reported implementation

INTRODUCTION

The field of motor learning (ML) plays a pivotal role in physical therapy (PT), and its implementation has been shown to improve intervention outcomes. The objective of this study was to assess physical therapists' ML-related self-efficacy, self-reported implementation, and environmental workplace factors. An additional aim was to report the psychometric properties of a questionnaire that was developed to assess the above-mentioned constructs.

METHODS

An observational, cross-sectional survey was completed by 289 physical therapists (average age: 38.7 (9.7), with 11.3 (9.7) years of experience and 74% female). Construct validity, internal consistency, and test-retest reliability were tested. The main outcome measures were the scores of the three scales of the questionnaire, referring to self-efficacy in ML, implementation of ML principles, and workplace environment features.

RESULTS

The questionnaire had sound psychometric qualities. Respondents perceived ML as an integral part of PT. ML-related self-efficacy and implementation of ML principles were moderate (2.95/5 (0.7) and 3.04/5(0.8), respectively). PT practice had a significant effect on ML-related self-efficacy (p = 0.035) and implementation (p = 0.0031). Respondents who had undergone ML training in their graduate program reported higher ML-related self-efficacy (p = 0.007). Respondents who had postgraduate training in ML reported significantly more extensive implementation (p = 0.024). Lack of knowledge and lack of time were perceived as the major barriers to implementation.

CONCLUSIONS

Level of self-efficacy might be insufficient to support the systematic implementation of ML principles in practice. Addressing impeding individual- and organizational-level factors might facilitate ML self-efficacy and implementation. Postgraduate education facilitates ML implementation.

Evidence- based medicine performance among health care providers in Iranian hospitals: A nationwide survey

Background: Evidence- Based Medicine (EBM) refers to the ability and skill in the use and integration of the best evidence obtained from repeatable bias-free clinical trials with the patients' preferences and conditions. Considering this fact that few large-scale studies have been done in this field in Iran, the present study aimed at comprehensively reviewing the status of EBM performance among health care providers in Iranian hospitals. Methods: This cross-sectional study was conducted during 2014 and 2015. Study participants consisted of 2800 health care providers (physicians, nurses, midwives, and paramedical personnel) in active hospitals in Iran. Data collection tool was a self-made questionnaire. Content validity of the questionnaire was improved by comments of 10 experts. The reliability of the questionnaire was assessed using test-retest method (α= 0.85). Results: The results revealed that only 12.7% and 15.8% of the participants were highly familiar with EBM databases and terminologies, respectively. Most participants believed that EBM-related workshops and practical involvement in EBM-related programs and activities can have a more effect on the improvement of EBM performance. Most participants had a positive view of the EBM. About 47% of the participants reported that their EBM knowledge and skills is high. Among the demographic variables, there were only significant relationships between work experience and attitude, gender and attitudes, and between knowledge and skills (p<0.05). Conclusion: According to the results of the present study, it seems that holding EBM-related workshops and practical participation in EBP-related programs and activities as well as improving facilities such as manpower, equipment, and access can have a significant effect on improving EBM- related activities.

Implementation in nursing and midwifery. A scoping review / Implementationsprojekte in der Pflege und Hebammenarbeit. Scoping review

Background

Evidence-based expertise in nursing and midwifery is growing but is not automatically turned into practice. The importance of implementation research is therefore increasing. International research results on factors facilitating implementation have not yet been sufficiently presented.

Objective

This scoping review will explore the findings on successful preparation, realisation and maintenance of interventions in nursing and midwifery.

Method

Based on an existing systematic approach, relevant data bases were accessed to identify original studies relating to implementation research in nursing and midwifery. The process of study selection and the characteristics of the included studies were charted.

Findings

In the four reviews and 38 studies which met the inclusion criteria, various factors leading to successful implementation are identified. Based on the included studies, four facilitating factors can be pinpointed: (1) workplace culture (16 entries), (2) leadership culture (28 entries), (3) resources (4 entries), and (4) training (22 entries). Depending on the specific phase of the implementation process (preparation, realisation, or maintenance), these factors will vary in importance.

Conclusion

This scoping review provides an orientation for the field of implementation research and it maps the design, themes and results of the studies included. It should be noted that few studies take into consideration the relevant theories, as well as the influence that the researchers and the target group may have on the implementation process, or provide an exact description of the setting in which the implementation takes place.

Knowledge, skills, and attitudes to implementing best practice in hospitals in Central Vietnam

BACKGROUND

Although nurses recognize the importance of evidence-based practice (EBP) to improve health outcomes, they still find its implementation complex. Successful EBP requires nurses to have the knowledge and expertise to appraise and critically apply evidence into practice.

OBJECTIVES

The study sought to identify Central Vietnam nurses' knowledge, skills, and attitudes to implementing EBP.

METHODS

A cross-sectional descriptive research design was implemented to identify nurses' ability to conduct EBP in two large hospitals in Central Vietnam. A total of 234 nurses returned completed surveys. Data were analyzed with descriptive and inferential statistics.

RESULTS

Nurses in Central Vietnam were not prepared for undertaking EBP. Only 29.5% of the respondents said they were familiar with the term EBP. Although they embraced a positive attitude toward EBP, they felt less confident to implement this innovation. Many failed to engage with research and still relied most heavily on informal information to guide their practice.

IMPLICATIONS

The evidence obtained from this study supports the need for an education intervention to develop nurses' knowledge and skills of research and research usage.

An Analytic Review of Clinical Implications From Nursing and Psychosocial Research Within Swedish Pediatric Oncology

The purpose of this manuscript is to analyze researchers' suggestions for clinical implications of their findings as stated in recent published articles on nursing and psychosocial research within the setting of Swedish pediatric oncology. Identified categories included staff awareness of the effects of child illness on families; systems for care improvement; provision of quality of care, education and support; and empowerment of children and families. In order to be able to realize these clinical suggestions, expanded research is needed as well as continued education and support for staff.

Barriers to and facilitators of research utilization: a survey of registered nurses in China

AIMS

This survey aims to describe the perception of barriers to and facilitators of research utilization by registered nurses in Sichuan province, China, and to explore the factors influencing the perceptions of the barriers to and facilitators of research utilization.

METHODS

A cross sectional survey design and a double cluster sampling method were adopted. A total of 590 registered nurses from 3 tertiary level hospitals in Sichuan province, China, were recruited in a period from September 2006 to January 2007. A modified BARRUERS Scale and a Facilitators Scale were used. Data were analyzed with descriptive statistics, rank transformation test, and multiple linear regression.

RESULTS

Barriers related to the setting subscale were more influential than barriers related to other subscales. The lack of authority was ranked as the top greatest barrier (15.7%), followed by the lack of time (13.4%) and language barrier (15.0%). Additional barriers identified were the reluctance of patients to research utilization, the lack of funding, and the lack of legal protection. The top three greatest facilitators were enhancing managerial support (36.9%), advancing education to increase knowledge base (21.1%), and increasing time for reviewing and implementing (17.5%), while cooperation of patients to research utilization, establishing a panel to evaluate researches, and funding were listed as additional facilitators. Hospital, educational background, research experience, and knowledge on evidence-based nursing were the factors influencing perceptions of the barriers and facilitators.

CONCLUSIONS

Nurses in China are facing a number of significant barriers in research utilization. Enhancing managerial support might be the most promising facilitator, given Chinese traditional culture and existing health care system. Hospital, educational background, research experience and knowledge on evidence-based nursing should be taken into account to promote research utilization. The BARRIERS Scale should consider funding and involvement of patients in research utilization.

Implementation of evidence-based practice across medical, nursing, pharmacological and allied healthcare professionals: a questionnaire survey in nationwide hospital settings

Background

Implementation of evidence-based practice (EBP) is regarded as core competence to improve healthcare quality. In the current study, we investigated the EBP of six groups of professionals: physicians, nurses, pharmacists, physical therapists, technicians, and other allied healthcare personnel.

Methods

A structured questionnaire survey of regional hospitals throughout Taiwan was conducted by post in 2011. Questionnaires were mailed to all healthcare workers of 11 randomly selected hospitals. Linear and logistic regression models were used to examine predictors for implementing EBP.

Results

In total, 6,160 returned questionnaires, including 645 from physicians, 4,206 from nurses, 430 from pharmacists, 179 from physical therapists, 537 from technicians, and 163 from other allied healthcare professionals, were valid for the analysis. Physicians and pharmacists were more aware of EBP than were the other professional groups (p < 0.001). Positive attitudes toward and beliefs in EBP were significantly lower among nurses than in the other groups (p < 0.001). Physicians had more sufficient knowledge and skills of EBP than did the other professionals (p < 0.001); in addition, they implemented EBP for clinical decision-making more often and perceived fewer personal barriers to EBP (p < 0.001). Multivariate logistic regression analyses showed that EBP implementation was associated with the following characteristics of participants: EBP training, having a faculty position, academic degree, one's profession, and perceptions (beliefs, attitudes, knowledge, skills and barriers).

Conclusions

This study depicts various levels of EBP implementation among medical, nursing, pharmacological, and allied healthcare personnel. There were significant differences in their implementation of EBP. We observed that certain factors were associated with EBP implementation, including personal backgrounds and perceptions toward EBP. The data suggest that strategies for enhancing EBP implementation should differ for various groups of professionals.

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.

Improving student supervision in a Norwegian intensive care unit: a qualitative study

The purpose of the study was to investigate intensive and critical care nurses' experiences of an empowerment program in the context of their role as student supervisors. Multistage focus group interviews were carried out and qualitative content analysis was performed in several steps. The overall results highlighted the need for strategies aimed at ensuring quality. The emerging themes were time, leadership and shared responsibility. Enough time promoted motivation, learning and reflection. Obligations to the student limited their leisure time and family life, and imposed some limitations during working hours. Leadership was perceived as crucial and leaders should act as strategic managers of development. The balance between "shared responsibility" and one supervisor in charge of one student was highlighted. There is a need to strengthen and improve the system of student supervision. There is a need to allocate time for learning and reflection. Who is responsible for the students must be clearly defined in the hospital, the university and in the intensive care unit, and it must be communicated.

Spanish nurses' attitudes towards research and perceived barriers and facilitators of research utilisation: a comparative survey of nurses with and without experience as principal investigators

AIMS AND OBJECTIVE

To examine attitudes towards research and perceived barriers and facilitators of research utilisation in clinical practice in a broad cross-section of Spanish nurses.

BACKGROUND

Nurses' attitudes towards research are critical in determining whether study findings are used to improve practice.

DESIGN

Cross-sectional comparative survey in Hospitals, Primary Care Centres and University-affiliated schools of nursing.

METHODS

Surveys were completed by 917 nurses: 69 who received funding from the Spanish national agency (1998-2004) and a nationally representative sample of 848 nurses who did not have the same research experience (the Comparison group). Two instruments (BARRIERS and Attitudes towards nursing research) were translated and culturally adapted for use in Spain. A descriptive analysis of demographic and practice characteristics was performed. Total scale scores, as well as subscale scores, were computed and compared across the two groups using one-way analysis of variance (anova) and multivariate analysis of variance (manova) with post hoc tests. Pearson product-moment correlation coefficients were computed between the total tool scores and subscales measuring barriers and attitudes in both groups.

RESULTS

The investigators differed from other nurses on several demographic and work characteristics (more males, older age and more likely to work a fixed day shift schedule). On the whole, investigators showed more favourable attitudes but perceived several elements as posing greater barriers to research utilisation than the Comparison groups. Across all respondents, issues related to the quality of research were rated as the greatest barriers to research utilisation, followed by organisational barriers, barriers involving the communication of findings and finally, those related to nurses' values, awareness and skills.

CONCLUSIONS

Very similar profiles of perceptions and attitudes regarding research were found in these samples of Spanish nurses relative to those from other countries in earlier reports. Nurses who had experience conducting research demonstrated more favourable research-related attitudes and perceived barriers differently than those without such experience.

RELEVANCE TO CLINICAL PRACTICE

Understanding different organisational and experience perspectives is important to identify challenges and opportunities to ensure research utilisation in clinical practice.

Nurses' wishes, knowledge, attitudes and perceived barriers on implementing research findings into practice among graduate nurses in Austria

AIMS

To identify and describe nurses' wishes, needs, knowledge and attitudes to nursing research, as well as perceived barriers to and facilitators of research utilisation in nursing practice in Austria.

BACKGROUND

Research results are not always used in daily nursing practice, despite their potential to improve nursing care quality. A variety of factors impede their implementation and use. Nurses' wishes about research utilisation have scarcely been reported. No data are available yet from an Austrian perspective.

DESIGN

Descriptive and exploratory cross-sectional survey.

METHODS

The study was conducted in an Austrian university hospital in May 2007, including all graduate nurses (n=1825). One thousand and twenty-three nurses returned the self-reported questionnaire. Descriptive analysis was performed initially, then group comparisons (diploma <2001, ≥2001) were computed inferentially using the chi-square test.

RESULTS

Nurses' most frequently indicated wishes regarding research implementation were adequate information, structural availability and professional support. Special points of interest were topics concerning nursing phenomena and interventions. Nurses' needs related to education in nursing science/research and its implementations were indicated as being predominantly of an introductory manner. Overall, nurses' attitudes tended to the negative. The top three named barriers to research utilisation were lack of time (69·9%), lack of information/knowledge (45·4%) and lack of interest (25·9%). Ten statistically significant differences were found between nurses of the two compared diploma groups.

CONCLUSIONS

Participating nurses perceived a lack in sufficient education/information and adequate organisational support, impeding them to use research results in daily practice.

RELEVANCE TO CLINICAL PRACTICE

The results provide important insights into the matter of nurses' needs regarding the use and/or implementation of research results in practice, as well as about the promotion of positive attitudes towards research and its utilisation. These findings are of special interest to nurse educators, employers and countries introducing nursing science to improve the clinical outcomes for patients.

Recognizing the evidence and changing practice on injection sites

Evidence-based practice requires the integration of the best available evidence in conjunction with clinical expertise to make decisions about patient care. At times new research and evidence will contradict established or traditional methods and clinical textbooks: this is in the nature of progress, and the challenge lies in disseminating this new evidence throughout the profession as quickly and widely as possible. The nursing literature cites a number of barriers to evidence-based nursing, and notes that the research evidence for clinical practice utilization does not always percolate down to the clinical setting. This article considers the attitudes of nurses to evidence that challenges traditional practice, focusing in particular on conventional and contemporary best practice regarding injection sites. Nurses in clinical practice continue to use and instruct student nurses in the use of the dorsogluteal (the large gluteal muscle in the buttocks) injection site as the site of choice for intramuscular injections, despite abundant evidence regarding the complications associated with using this site. Advancing the use of the ventrogluteal (located in the hip) injection site is a challenge, primarily owing to nurses' lack of familiarity with its anatomical landmarks and the published evidence on its benefits. The authors of this article present the current evidence on the dorsogluteal and ventrogluteal intramuscular injection sites in an attempt to assist nurse decision-making and guarantee the integration of evidence-based knowledge in order to improve patient care.

Barriers to research utilisation by staff nurses in a university hospital

AIM

To identify self-reported perceptions of the barriers to research utilisation by Turkish staff nurses working in a university hospital and to ascertain whether involvement in research-related activities influenced their perception of the barriers.

BACKGROUND

Research utilisation in nursing has been a prominent concern for the last 30 years. While investigators in several countries have identified nurses' perception of barriers to research utilisation, this is the first study to investigate such barriers in Turkey.

DESIGN

This is a descriptive, cross sectional study with a sample of 329 staff nurses working in a university hospital. Two instruments were used; a demographics questionnaire that investigated research activities and the Barriers Scale to measure perceptions. An additional item, 'studies are published in English' was added to the scale.

RESULTS

The lack of time to implement new ideas was the most frequently, 84·5%, perceived barrier. The second most frequently perceived barrier was difficulty in reading English. The top six barriers were all related to the setting. Additionally, research-active nurses found insufficient time less of a barrier but unawareness of research findings and being isolated from knowledgeable colleagues as greater barriers to research utilisation.

CONCLUSIONS

Turkish nurses' perception of barriers is similar to the findings in other countries, i.e., that the top six barriers were related to setting. Language barrier compares similarly with studies in other countries that investigated this variable.

RELEVANCE TO CLINICAL PRACTICE

The gap between theory and practice in nursing can be minimised by identifying strategies to increase research utilisation in clinical settings. Such strategies can also improve patient care outcomes.

Factor structure of the geriatric institutional assessment profile's professional issues scales

The Geriatric Institutional Assessment Profile (GIAP) is a self-administered survey of hospital nurses, designed to assess a hospital's readiness to implement geriatric programs. A sample of 2,211 direct care RNs in 24 hospitals was randomly split in half to analyze the Geriatric Professional Issues scales of the GIAP, using one sample for exploratory factor analysis and one for confirmatory factor analysis. An exploratory factor analysis of the six Geriatric Professional Issue scales (staff disagreement, staff/family/patient disagreement, use of geriatric services, perceived legal vulnerability, perceived upsetting behaviors, and burden of upsetting behaviors) demonstrated very good internal consistency both as a whole (Cronbach's alpha coefficient = 0.90) and as individual factors (0.94, 0.91, 0.92, 0.89, 0.85, and 0.81, respectively). The six factors were validated in a half randomly selected sample, with a root-mean-square error of approximation fit index of 0.07 and the normed and non-normed fit indices both 0.8, all indicating adequate fit of the six-factor model.

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.

Comparison of evidence-based practice between physicians and nurses: a national survey of regional hospitals in Taiwan

INTRODUCTION

Although evidence-based practice (EBP) has been widely investigated, few studies compare physicians and nurses on performance.

METHODS

A structured questionnaire survey was used to investigate EBP among physicians and nurses in 61 regional hospitals of Taiwan. Valid postal questionnaires were collected from 605 physicians and 551 nurses during February to May 2007.

RESULTS

Physicians were more aware of EBP than nurses. Although both groups had high recognition of belief in and favorable attitudes toward EBP, their knowledge of and skill in EBP were relatively low. When compared with nurses, physicians were more willing to support the promotion of EBP implementations in clinical services. Physicians' knowledge and skills regarding the application of EBP principles were greater than nurses. Furthermore, physicians more often accessed the on-line evidence-retrieval databases, including the Cochrane Library. The most commonly ranked barriers to EBP applications for both groups included lack of designated personnel, lack of convenient kits, limited basic knowledge of EBP, and time. In general, nurses generated more barriers than physicians.

DISCUSSION

There were significant discrepancies between physicians and nurses in their awareness of, attitude toward, knowledge of, skill in, behavior toward, and barriers regarding EBP. In implementing EBP, strategies to overcome barriers and provide on-line evidence-retrieval systems should differ for physicians and nurses.

Barriers to research utilization among registered nurses practicing in a community hospital

Researchers have explored the barriers to research utilization in practice, yet community hospitals have been largely omitted from these studies and the research-practice gap remains. The aim of this study was to identify the barriers to research utilization among registered nurses practicing in a community hospital. In January of 2006, 376 registered nurses working in a community hospital in Washington State were invited to complete the 29-item Barriers to Research Utilization Scale. Twenty-one percent participated in this descriptive study. Barriers reported include lack of authority to change patient care procedures, lack of time to read research, and lack of awareness of research. Organizational strategies that can be used by staff development professionals to influence research awareness and utilization are discussed.

Iranian nurses' constraint for research utilization

Background

This paper identifies the views of Iranian clinical nurses regarding the utilization of nursing research in practice. There is a need to understand what restricts Iranian clinical nurses to use research findings. The aim of this study was to identify practicing nurses' view of aspects which they perceived constrain them from research utilization that summarizes and uses research findings to address a nursing practice problem.

Methods

Data were collected during 6 months by means of face-to face interviews follow by one focus group. Analysis was undertaken using a qualitative content analysis.

Results

Findings disclosed some key themes perceived by nurses to restrict them to use research findings: level of support require to be research active, to be research minded, the extent of nurses knowledge and skills about research and research utilization, level of educational preparation relating to using research, administration and executive challenges in clinical setting, and theory-practice gap.

Conclusion

This study identifies constraints that require to be overcome for clinical nurses to actively get involved in research utilization. In this study nurses were generally interested to use research findings. However they felt restricted because of lack of time, lack of peer and manager support and limited knowledge and skills of the research process. This study also confirms that research utilization and the change to research nursing practice are complex issues which require both organizational and educational efforts.

Dissemination of research-based knowledge in an intensive care unit-a qualitative study

BACKGROUND

A gap exists between best evidence and best practice in intensive care units. The aim of this study was to investigate different aspects of intensive care nurses' and physicians' inter- and intraprofessional collaboration, with focus on factors associated with standardised weaning from mechanical ventilation.

METHODS

A qualitative design was used for implementing research-based knowledge into multistage focus group discussions. Data were analysed by means of qualitative content analysis.

RESULTS

One main theme emerged: The need for strategies aimed at improving quality control of care, and three sub-themes: 'Interprofessional learning', 'Quality control of care', and 'Teamwork and communication'. The multistage focus groups were perceived as an important interprofessional arena for improving quality of care. Improvement projects and research dissemination must be regarded as vital parts of the organisation's ongoing development work. Management was perceived as crucial for success.

CONCLUSION

Interprofessional research dissemination was perceived as important both in the creation of a common understanding and in knowledge development. Managers should make use of the valuable knowledge possessed by bedside professionals in their strategic planning. There is a need to allocate time for learning and reflection to provide a safe practice environment.

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.