Medical Educators' Perceptions of Research Culture in a Faculty of Health Sciences: A South African Study

Phenomenon: In South Africa, as with many other developing countries, a call has been made for institutions of higher learning to participate in more research and set the pace for societal transformation. At the Faculty of Health Sciences (FoHS), University of the Free State (UFS), numerous strategic efforts are focused on supporting and stimulating research. An essential prerequisite for the success of these vital efforts is to be aware of the research culture within the academic faculties. A peculiarity of medical colleges in South Africa is that medical faculties are in partnership with the government through the academic training hospitals; hence, staff appointment occurs through a joint structure with both the provincial Department of Health and the National Health Laboratory Services. So far, no known study has investigated research culture in this context (joint staff appointment). Approach: This study included elements of case study evaluation and improvement-oriented evaluation. We distributed to 242 educators a structured questionnaire to obtain perceptions of aspects of research, research processes, and existing research culture in the FoHS, UFS. Suggestions on how to improve the research culture also were obtained. The structured questionnaire was self-administered, consisted of closed and open-ended questions grouped into five main sections, and was distributed electronically and manually (hard copy) to participants. Findings: One-hundred-eleven questionnaires were returned (46% response rate). Motivation to do research varied by school and included career advancement (77%, School of Allied Health Professions); change the situation (80%, Academic support); develop individual skillset (67%, School of Nursing) and improve patient care (62%, School of Medicine). Perceived factors affecting research culture included limited funding and allocated time for research, minimal leadership support for research, and absence of research-related support structures as well as minimal teamwork/collaboration. Frustration was the most reported (negative) emotion (25%). Participants suggested that encouraging teamwork among staff, reducing workload to allow time for research, establishing a mentorship program, providing training on deficient skills, and more support from leadership would improve research culture. Insights: This present study reveals some of the factors that impact negatively on research, research culture, and productivity in a medical college in a resource-limited setting. While the benefits of joint staff appointment cannot be overemphasized, our findings highlight that the complex interplay between employers/stakeholders result in poorly executed joint appointment scheme/models (i.e., competitive approach) and creates numerous challenges that negatively impact research productivity and research culture. Recommendations suggested herein can be implemented by the FoHS and other medical colleges in similar contexts to improve research productivity and foster an enabling research culture.

The Importance of Context and Organization Culture in the Understanding of Nurses' Barriers Against Research Utilization: A Systematic Review

BACKGROUND

Numerous studies have explored nurses' perceived barriers to research utilization. In this study, considerations of how to break down the barriers are discussed in order to find new ways to develop and strengthen evidence-based practice.

AIMS

The objective of the study was to identify nurses' perceptions of barriers to research utilization in clinical practice between the years of 2000 and 2018 and across continents by reviewing studies that used the Barriers to Research Utilization (BARRIERS) scale (Appl Nurs Res, 4, 1991, 39).

DESIGN

A systematic review of observational studies based on Joanna Briggs specific guidelines.

METHODS

A systematic search to identify and select eligible studies was conducted in PubMed, CINAHL, PsycInfo, and SCOPUS during January 2019. Google Scholar was also searched to identify additional studies using the Funk et al. (Appl Nurs Res, 4, 1991, 39) BARRIERS scale. An instrument for quality appraisal was constructed for this paper by combining two similar and previously used cross-sectional study checklists (Int J Sociol Soc Policy, 23, 8, 2003; Implement Sci, 5, 32, 2010). Descriptive statistics were performed using IBM SPSS Statistics (version 25).

RESULTS

The 27 included studies were conducted in 16 countries across five continents and 11,276 nurses participated. Seven of the top 10 barriers were comprised of organizational factors. These organizational barriers were consistent over time and the five continents, with 56% of the listed top 10 barriers falling under the organizational category. From the year 2000 to 2008, the majority of the studies were conducted in Europe and Australia. However, for the next 10 years (2008-2018), the majority of studies were conducted in Asia, Africa, and North America.

LINKING EVIDENCE TO ACTION

To break down the nurses' barriers to research utilization, our future practice and research focus will be to conduct intervention studies focusing on the effect of facilitators and contextual environment, as well as developing nursing research cultures in clinical practice with support from the nursing management.

Cultural adaptation and validation of an instrument on barriers for the use of research results

Objective

to culturally adapt The Barriers to Research Utilization Scale and to analyze the metric validity and reliability properties of its Brazilian Portuguese version.

Method

methodological research conducted by means of the cultural adaptation process (translation and back-translation), face and content validity, construct validity (dimensionality and known groups) and reliability analysis (internal consistency and test-retest). The sample consisted of 335 nurses, of whom 43 participated in the retest phase.

Results

the validity of the adapted version of the instrument was confirmed. The scale investigates the barriers for the use of the research results in clinical practice. Confirmatory factorial analysis demonstrated that the Brazilian Portuguese version of the instrument is adequately adjusted to the dimensional structure the scale authors originally proposed. Statistically significant differences were observed among the nurses holding a Master's or Doctoral degree, with characteristics favorable to Evidence-Based Practice, and working at an institution with an organizational cultural that targets this approach. The reliability showed a strong correlation (r ranging between 0.77 and 0.84, p<0.001) and the internal consistency was adequate (Cronbach's alpha ranging between 0.77 and 0.82).

Conclusion

the Brazilian Portuguese version of The Barriers Scale was valid and reliable in the group studied.

A cross-cultural investigation into the dimensional structure and stability of the Barriers to Research and Utilization Scale (BARRIERS Scale)

Background

It is important that scales exhibit strong measurement properties including those related to the investigation of issues that impact evidence-based practice. The validity of the Barriers to Research Utilization Scale (BARRIERS Scale) has recently been questioned in a systematic review. This study investigated the dimensional structure and stability of the 28 item BARRIERS Scale when completed by three groups of participants from three different cross-cultural environments.

Method

Data from the BARRIERS Scale completed by 696 occupational therapists from Australia (n = 137), Taiwan (n = 413), and the United Kingdom (n = 144) were analysed using principal components analysis, followed by Procrustes Transformation. Poorly fitting items were identified by low communalities, cross-loading, and theoretically inconsistent primary loadings, and were systematically removed until good fit was achieved. The cross-cultural stability of the component structure of the BARRIERS Scale was examined.

Results

A four component, 19 item version of the BARRIERS Scale emerged that demonstrated an improved dimensional fit and stability across the three participant groups. The resulting four components were consistent with the BARRIERS Scale as originally conceptualised.

Conclusion

Findings from the study suggest that the four component, 19 item version of the BARRIERS Scale is a robust and valid measure for identifying barriers to research utilization for occupational therapists in paediatric health care settings across Australia, United Kingdom, and Taiwan. The four component 19 item version of the BARRIERS Scale exhibited good dimensional structure, internal consistency, and stability.

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.

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.

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.

Has the BARRIERS Scale changed nursing practice? An integrative review

AIM

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

BACKGROUND

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

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSIONS

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

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

AIM

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

BACKGROUND

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

METHODS

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

FINDINGS

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

CONCLUSION

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

Beyond the BARRIERS Scale: commonly reported barriers to research use

The evidence-based practice movement has highlighted the importance of translating research evidence into practice. However, the gap between research and practice points to the existence of significant barriers to research use. To identify the most commonly cited barriers to the use of research in practice, the findings arising from studies that used the Barriers to Research Utilization Scale are examined. Based on these findings, the authors discuss and make recommendations to assist nurse administrators in overcoming universally reported barriers to research use.

Contextual Factors Influencing Research Use in Nursing

BACKGROUND

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

AIM

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

METHODS

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

FINDINGS

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

DISCUSSION

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

IMPLICATIONS/CONCLUSIONS

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

Exploratory factor analysis of the research and development culture index among qualified nurses

AIMS AND OBJECTIVES

This paper presents the exploratory factor analysis of a rating instrument for assessing the strength of organizational Research and Development (R&D) culture.

BACKGROUND

Despite nursing's limited research capacity, the discipline is capitalizing upon opportunities to become involved in research and is making strong progress. Within the context of the debate on nursing research capacity, the R&D Culture Index was developed as a means of appraising R&D culture within health care organizations.

DESIGN

Factor analysis was carried out on data collected from 485 nursing staff. The method of extraction was Principal Components Analysis with oblique rotation.

METHODS

The Index was developed from the findings of qualitative research conducted with NHS staff. Eighteen items, encompassing the main themes from the data, were initially included in the Index. This pilot instrument was distributed to nursing staff within three different types of NHS Trust. Factor analysis resulted in rejection of two items and the analysis was repeated using the remaining 16 items.

RESULTS

Three latent factors were extracted accounting for 58.0% of the variance in the data. The factors were: R&D Support, describing the perceived support within the working environment for R&D activity; Personal R&D Skills and Aptitude, describing an individual's perception of their ability towards R&D activity; and Personal R&D Intention, describing an individual's willingness to engage in R&D activity. Each factor had good internal reliability, as did the overall index.

CONCLUSION

The R&D Culture Index provides an efficient means of assessing the strength of an organization's R&D culture in a way that captures the role of the individual practitioner and the organizational environment.

RELEVANCE TO PRACTICE

These findings suggest that the continuing promotion of R&D within health care organizations is dependent upon a multi-faceted approach that addresses the learning needs of the organization as well as those of the individual practitioners.

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

BACKGROUND

Studies have consistently demonstrated that nurses are increasingly recognizing the role research has to play in their daily practice. Despite this recognition the actual application of research findings in the practice setting is still poor. To date, the barriers to implementing research findings in the Republic of Ireland's practice setting have not been explored empirically. This study sought to address this gap.

AIMS

The aims of this study were to ascertain what Registered Nurses practising in the Republic of Ireland perceive as barriers to the implementation of research findings in the practice setting and to explore what they perceive would facilitate them in using research findings in their daily practice.

DESIGN

Cross-sectional survey.

METHODS

A non-probability strategy was employed with all Registered Nurses who commenced a nursing-focused academic course accredited by the University of Dublin, Trinity College, between September 2001 and February 2002 invited to participate. The ethical rights of the participants in terms of anonymity, privacy and informed consent were assured through a number of mechanisms. Data were collected via the Barriers scale.

FINDINGS

Eight of the top 10 ranked barriers were organization centred. The top barrier was a perception of insufficient authority to instigate change in the practice setting. The perceived key facilitators to implementing research findings included protected time for retrieval and evaluation of research findings, instrumental support from management, informed supportive personnel in the practice settings and accessible educational opportunities to augment critical reading skills.

RELEVANCE TO CLINICAL PRACTICE

The Irish Government is committed to provide the people of Ireland with an evidence-based health service. From a nursing perspective the findings of this study indicate that a number of strategies have to be introduced or enhanced in the practice settings before this commitment can be realized.

Bridging the divide: a survey of nurses' opinions regarding barriers to, and facilitators of, research utilization in the practice setting

BACKGROUND

Many researchers have explored the barriers to research uptake in order to overcome them and identify strategies to facilitate research utilization. However, the research-practice gap remains a persistent issue for the nursing profession.

AIMS AND OBJECTIVES

The aim of this study was to gain an understanding of perceived influences on nurses' utilization of research, and explore what differences or commonalities exist between the findings of this research and those of studies that have been conducted in various countries during the past 10 years.

DESIGN

Nurses were surveyed to elicit their opinions regarding barriers to, and facilitators of, research utilization. The instrument comprised a 29-item validated questionnaire, titled Barriers to Research Utilisation Scale (BARRIERS Scale), an eight-item scale of facilitators, provision for respondents to record additional barriers and/or facilitators and a series of demographic questions.

METHOD

The questionnaire was administered in 2001 to all nurses (n=761) working at a major teaching hospital in Melbourne, Australia. A 45% response rate was achieved.

RESULTS

Greatest barriers to research utilization reported included time constraints, lack of awareness of available research literature, insufficient authority to change practice, inadequate skills in critical appraisal and lack of support for implementation of research findings. Greatest facilitators to research utilization reported included availability of more time to review and implement research findings, availability of more relevant research and colleague support.

CONCLUSION

One of the most striking features of the findings of the present study is that perceptions of Australian nurses are remarkably consistent with reported perceptions of nurses in the US, UK and Northern Ireland during the past decade.

RELEVANCE TO CLINICAL PRACTICE

If the use of research evidence in practice results in better outcomes for our patients, this behoves us, as a profession, to address issues surrounding support for implementation of research findings, authority to change practice, time constraints and ability to critically appraise research with conviction and a sense of urgency.

The Yorkshire BARRIERS project: diagnostic analysis of barriers to research utilisation

The study identified barriers to research implementation experienced by nurses, midwives and health visitors in five trusts and one health authority in Yorkshire, UK. Funk et al. (Appl. Nurs. Res. 4(1) (1991a) 39, Appl. Nurs. Res. 4(2) (1999b) 90) developed the BARRIERS to research utilisation questionnaire over 10 years ago, but no replication, in size (n = 1989) and extent, of that study appeared to have occurred. The staff population (n = 4501) were sent the BARRIERS questionnaire. 44.6% (n = 2009) were returned. Findings suggested nurses need time to read and apply research; authority to change practice; critical appraisal skills, an understanding of statistics and support of managers and peers (particularly doctors) to achieve successful practice change.

Barriers to research implementation by community nurses

This article presents the community findings from a study of nurses in community and acute settings using Funk et al's Barriers to Research Utilization Scale (Barriers) (Funk et al, 1991a), which aimed to identify the main barriers to implementing research in practice. The Barriers questionnaire was sent to all nurses working in three community trusts in Yorkshire (n=2327), and practice nurses in one Yorkshire health authority (n=190). A 51.5% response rate gave a sample of 1297 nurses. The top two barriers were reported to be lack of time and resources. There were significant differences between sub-samples, e.g. older women perceived more barriers than younger colleagues, and practice nurses had particular problems with the cooperation of GPs. Factor analysis generated four new factors different from those found by Funk et al (1991a) (shown in brackets): benefits (nurse characteristics); quality (research characteristics); accessibility (presentation of the research characteristics) and resources (setting characteristics). Recommendations include developing nurses' critical appraisal skills so that, given more time and adequate resources, research findings might be judiciously implemented in practice.