Describing the evidence-base for research engagement by health care providers and health care organisations: a scoping review

BACKGROUND

Having a research-engaged health and medical workforce is associated with improvements in clinical outcomes for patients. As such, there has been significant government investment internationally to support health care organisations and services to increase staff engagement with research.

OBJECTIVES

This scoping review sought to provide an overview of the literature describing strategies employed to increase research engagement by health care providers and organisations, and to undertake a qualitative analysis to generate a list of research engagement strategies.

METHODS

A scoping review using systematic search strategies was undertaken to locate peer-review publications and grey literature related to research engagement by health care providers and organisations. Research engagement was defined as a 'deliberate set of intellectual and practical activities undertaken by health care staff and organisations to conduct research'. A database search of electronic records was performed with no limit on publication date. Publications were included regardless of study type (excluding systematic reviews) and categorised as either databased (presenting data or new analysis of existing data) and non-databased (no new data or analyses). Databased publications were further classified according to study type, study design and setting. A qualitative synthesis using a Framework Approach was undertaken with all studies that described a strategy to improve research engagement.

RESULTS

A total of 152 publications were included in this study with 54% categorised as non-databased. Of the databased articles, the majority (72%) were descriptive studies describing prevalence of correlates of research engagement, 17 (25%) described intervention studies where only two were controlled studies. The following research engagement strategies were identified: i) dual skilled team/staff, ii) resources or physical infrastructure, iii) incentives, iv) leadership support of research, v) education/training, vi) networks, vii) forming partnerships or collaborations and viii) overall leadership structure of entity.

CONCLUSIONS

The literature on research engagement is primarily opinion-based and descriptive in nature. To provide the evidence needed to inform strategies, this needs to progress beyond descriptive to more rigorous well-designed intervention research.

Do training and needle-safety devices prevent needlestick injuries? A systematised review of the literature

This systematised review was undertaken to appraise research on the effects of training and the use of needle-safety devices (NSDs) on the prevention of needlestick injuries (NSIs) among health workers, focusing on a European perspective. A literature search from 2007 to 2017 was performed, which identified six studies that investigated the introduction of training and NSDs and their affect on NSIs. The six chosen studies identified that training, as well as the adoption of NSDs, has an impact on preventing NSIs. However, further information is required on the content and mode of delivery of training and on which types of NSDs are most effective at preventing injuries. This will help healthcare workers to understand and implement the most effective strategies to prevent injuries. This article provides a critique of the research approaches used in the six studies.

Research-active clinical nurses: against all odds

AIMS AND OBJECTIVES

To develop a theoretical understanding of factors that impact decisions of clinical nurses to conduct a research study.

BACKGROUND

Only a small percentage of all nurses are research-active and even fewer clinical nurses are research-active. Several researchers have explored barriers to research activity by clinical nurses, but few have examined why, in spite of all odds, some clinical nurses are research-active.

DESIGN

As the purpose of this study was to develop a theoretical understanding of the research-active nurse, a grounded theory approach was used.

METHODS

The sample interviewed for this study consisted of registered nurses (n = 26) who worked in a hospital or ambulatory setting, had daily direct patient contact and had participated as principal investigator on at least one completed clinical nursing research study that was not in fulfilment of an educational requirement. The interviews were digitally recorded and analysed by two researchers using the constant comparative method.

RESULTS

The findings from this study suggest that the conduct of research by clinical nurses was the direct result of a clinical trigger, characteristics and beliefs of the nurse about research and their role in generating knowledge, and the presence of support conditions, such as a research mentor.

CONCLUSIONS

Clinical nurses can and do conduct research, in spite of constraints due to a lack of time, money and/or knowledge, if they have access to research mentors and are practising in a research-supportive environment.

RELEVANCE TO CLINICAL PRACTICE

Nurses at the bedside are in a unique position to identify problems most in need of solutions. Findings from this study provide a foundation upon which to develop and test various programmes that seek to increase the number of clinical nurses who are research-active.

The extended role of the clinical research nurse: Building an evidence base for practice

Increasing numbers of nurses are moving from their direct clinical base to take up posts as clinical research nurses. However, although there are published guidelines about their role responsibilities, little is written about the reality of the role. This paper offers an experiential account into the variety of responsibilities undertaken by CRNs, highlighting the extended role that experienced CRNs may undertake, the transferable skills exhibited and the extent to which traditional boundaries between professionals can continue to be challenged. Role remits are examined in an attempt to show that not only do CRNs possess many of the skills that are highly regarded and respected in specialised clinical nursing but also that they may be well placed within the profession to assist in building the evidence base for practice as nursing continues to develop.

The perceptions and experiences of nurses undertaking research in the clinical setting

Nursing research activity by clinicians has increased in volume in the last few years, due to an increased awareness of the importance of evidence-based practice, the shift of nurse education into higher education establishments and the emergence of new nursing roles which demand research activity as a central domain of the role. This paper will report on the results of a study examining nursing research activity in the UK National Health Service and will present data examining the perceptions and experiences of nurses undertaking research. Forty-eight research-active nurses in five NHS organisations were interviewed. Data were analysed using the Framework approach. Four main themes emerged: perceptions of nursing research, NHS influences, support systems and individual influences. Many factors were identified by nurses that influenced their experiences and perceptions, and nurses frequently reported difficulties in being able to conduct research in the clinical area. Dissemination via publication was rare. Personal sacrifices were common and nurses felt that these were not recognised by managers. Nurses undertaking research need more structured support systems and recognition of the value of nursing research. Individualised help from more experienced researchers for support and to disseminate findings is recommended.

An ethnographic study of nurses' experience with nursing research and its integration in practice

AIM

To report from a study aimed at illuminating how French Registered Nurses experience and engage in nursing research in clinical practice.

BACKGROUND

Nursing research in France is mainly conducted by nurses working at clinical research units rather than by dedicated nurse researchers. Education, i.e. advanced degrees, in the field of nursing research is still in its infancy and not yet consistent with the international context. Outside France, the general perception is that nursing research is a unified part of professional nursing. Consequently, in-depth knowledge about how nurses in a French clinical context might experience and engage in nursing research is still lacking.

DESIGN

The design of this study was influenced by an ethnographic approach as described by the French anthropologists Beaud and Weber.

METHOD

Data, participatory observations, field notes and interviews (n = 6) were collected in a teaching hospital between April-August 2012. The field consisted of a wound-care unit and clinical research units. Collected data were analysed based on Beaud and Weber's description of analysis.

RESULTS

Three beliefs were identified: being a unified part of a research team, being an integral part of 'crosswise - across' activities and being part of research activities.

CONCLUSION/IMPLICATION FOR RESEARCH

Commitment to nursing research was strengthened by patient-related issues. Based on this context, nursing research would likely benefit from the support of a naturalized reciprocity between clinical practice and research.

Embracing a culture in conducting research requires more than nurses' enthusiasm

AIMS

This study explored the perceptions of clinical nurses about their research knowledge and experiences to highlight any gaps in nurse education in supporting research activities in healthcare organisations.

BACKGROUND

Nurses' research activities have been encouraged by moving hospital-based nurse education into higher education institutions whereby there is a stronger emphasis on teaching and developing nursing research at both undergraduate and post graduate levels. They were further encouraged by the introduction of advanced nurse practitioner roles, in the hope to increase opportunities for research participation. Whilst nurses' research activities have been explored in many countries, nurses in Singapore where there is a strong emphasis on evidence-based practice have not been investigated.

METHODS

A mixed-methods exploratory descriptive design, using a questionnaire based on open and closed questions was employed to obtain the views of clinical nurses about their capacity and organisational support in conducting research. The questionnaires were distributed to convenient samples who attended one of the 4 research seminars held on separate occasions between July and August 2011 in Singapore.

RESULTS

A total of 146 nurses were recruited. Whilst nurses demonstrated strong enthusiasm in conducting research, this characteristic feature was not adequate for them to embrace a research culture in organisations. Active participation as co-investigators was not possible in healthcare organisations where skewed distribution of resources towards medical and nurse researchers was perceived.

CONCLUSIONS

The results suggest a need for a significant shift in focus on educational training from imparting research contents to providing opportunities to experience the research process. Organisational support in terms of protected time and financial support ought to be in place for nursing research experience. The findings also demonstrated that in places where organisational support was available, awareness of research opportunities such as educational and organisational support needed to be strengthened. This in turn would enable more nurses particularly those who provide direct patient care to conduct research within the context of the competing nursing practice demands.

Research involvement, support needs, and factors affecting research participation: a survey of Mental Health Consultation Liaison Nurses

The aims of this study were to identify research involvement and support needs of Mental Health Consultation Liaison Nurses (MHCLN) and the factors that affect participation in research. A self-administered, standardized, anonymous questionnaire was distributed to a convenience sample of MHCLN. Frequencies and univariate analyses were calculated to examine relationships between: (i) involvement in a research study by highest qualification and job designation; and (ii) current enrolment in a higher degree study, research goals, and current research involvement by level of research skill. Open-ended responses were collated and summarized. Of the 34 workshop attendees, 32 participated in the survey (response rate 94%). Seventy-five percent of respondents agreed that involvement in research is an expectation of their role; 75% reported no current involvement in research. Over half (53%) of participants reported having research goals over the next 12 months. Those enrolled in postgraduate degrees were more likely to be currently involved in a research project (P=0.013). Commonly reported barriers to research participation were competing commitments and lack of support, resources, confidence, and motivation. This study showed that access to research support and resources, including mentorship and funding, are required to engage these MHCLN in research and to build capacity.

Research Activity in British Clinical Psychology Training Staff: Do We Lead by Example?

Sixty-two members of staff from clinical psychology doctoral training programmes across Britain completed a survey about their level of research output, the extent to which they felt this met their own expectations and job requirements, and how it influenced promotion prospects. In addition, they listed perceived barriers to and facilitators of research activity. There was wide variation in research activity, such that many participants had limited or no publications while a smaller proportion had many. Respondents were as, or more, dissatisfied than satisfied with their publications, submissions and grant applications and over half felt that the number of grant applications failed to meet their expectations. Support from and collaboration with colleagues was the main facilitator for research, while a lack of time was viewed as the main barrier.

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.

A qualitative study of the factors influencing the submission for publication of research undertaken by students

While there is general agreement that research capacity in nursing needs to be increased, there has not been a great deal of attention paid to the possibility of increasing publications by students of research undertaken for dissertations. This is potentially a useful way of increasing the evidence base in nursing. This paper reports a qualitative study undertaken in a School of Nursing in the UK, where supervisors (n=10), students who had published a paper based on their dissertations (n=10), and students who had not published were interviewed (n=10). The findings show that while there is a great deal of enthusiasm for publishing students' work from both students and supervisors, a variety of factors determine whether or not an individual dissertation leads on to a submission for publication. These factors are discussed, and recommendations are made to increase the number of this type of submissions.

Nurses' attitudes toward nursing research at a metropolitan medical center

To support the implementation of a nursing research initiative in a large medical center, we collected baseline data on nurses' attitudes toward nursing research, perception of the institution as a research environment, and personal involvement in research activities. This study replicates that conducted by Rizzuto, Bostrom, Suter, and Chenitz [Predictors of nurses' involvement in research activities. Western Journal of Nursing Research, 16(2), 193-204] in 1994. To better understand the findings, we traced the historical evolution of nursing research through successive American Nurses Association codes of ethics. Our review of the literature presents (in table format) factors that encourage and those that impede nursing research. The study results validate the work of other researchers: nurses' positive attitudes toward research are discordant with their actual involvement in research activities. The data suggest that positive attitudes and perceived institutional support are not enough to increase involvement in nursing research; as such, we describe additional institutional infrastructure and forms of educational support.

The naked researcher. Stripping research down to its bare essentials

The Siobhan Rankin Lecture is given each year at Congress in memory of a previous Chair of the Association. Individuals invited to give this lecture are experts within their chosen fields. In 2005 Professor Judith Tanner was asked to describe her work in encouraging perioperative practitioners to undertake research in clinical practice. This paper is based on Professor Tanner's presentation.