RESEARCH UTILIZATION IN NURSING
Health care is continually changing in the way health care professionals like individual practitioners and clinical managers organize and deliver care to the patients. For this reason, health care knowledge must continuously grow and expand to keep health care approaches relevant, current and appropriate. Without new knowledge, health care professionals cannot improve techniques for therapies and even management.
One important source of knowledge is research. Research is viewed in most professional circles as necessary for the continuous development of the scientific body of knowledge, which is the hallmark of a profession. The essence of evidence-based practice is the provision of quality and cost-effective health care to the health consumer (Olade, 2003).
Research provides a solid foundation on which health care professionals base their practice. The scientific knowledge base for professional health care practice is developed through scholarly inquiry of the research literature, use of existing research findings, and the actual conduct of research (Potter & Perry, 2004).
There are many other reasons why nurses should implement research findings. Using research increases the quality of nursing care' and provides increased efficiency in patient care, as well as personal and professional growth for nurses. Most nurses are required by individual governments to work in accordance with scientific knowledge. Patients and their relatives increasingly expect nurses to incorporate research findings into their everyday practice, and most nursing councils all over the world require that nursing practice be evidence based. The health care setting continues to become more technologically challenging, and nurses must combine use of new technology with knowledgeable and safe patient care so patients do not experience complications (Ruland, 2004).
The gap between research and its translation to practice in the healthcare arena became a focus for policy discussion in some healthcare organizations in the last decade. Studies have continued to reveal that the gap between research and practice seems to be most obvious in the nursing profession. It is disheartening, however, to note that regardless of the millions of dollars spent on funding clinical research, the integration of the findings into practice has been relatively slow among nurses (Olade, 2003).
There have been previous attempts at improving research utilization among nurses worldwide. The disparity in the conduct of research and its integration into practice became an international nursing concern. Various groups are made in the attempts at reducing the research conduct and utilization gap.
Integrating the findings of research to improve clinical practice should be a vision for most health care professionals - the nurses, who form the largest proportion of care providers at the bedside. There is a need to search for the missing link between the dissemination and implementation of research findings for evidence-based practice among nurses (Olade, 2003).
Today, nurses are actively generating, publishing, and applying research in practice to improve client care an enhance nursing’s scientific knowledge base (Kozier & Erb, 2004). Research provides a solid foundation on which health care professionals base their practice. The scientific knowledge base for professional health care practice is developed through scholarly inquiry of the research literature, use of existing research findings, and the actual conduct of research (Potter & Perry, 2004).
The purpose if this paper is to identify the main reasons why nurses do not utilize research in their practice; discuss three of these reasons and why they exist; and make evidence based recommendations for future nursing practice to overcome each of these three barriers.
Reasons that nurses do not utilize research in their practice
Although research and evidence based practices are recommended, there are many factors that hinder such. Although interest in research-based practice seemed to be present among a majority of the health care professional population, the reality of the situation suggests that it is not occurring as frequently as desired. The reasons why nurses do not utilize research evidence in their clinical practice are complex and multi-factorial.
Barriers limit the potential of identifying clinical outcomes in nursing care (Potter & Perry, 2004). However, recognizing and acknowledging the existence of these barriers enable to implement change in practice in a timelier manner.
There are several studies focusing on the barriers to research utilization and awareness among nurses but few on attitudes toward research. Researchers noted that where ability was higher, attitudes toward research activities were more positive, and vice versa. Attitude and availability of research reports were related to research utilization.
In particular, barriers to research utilization revealed by studies include nurses' lack of time and independence in the organization, together with lack of support from nurse managers. Organizational characteristics were noted to present one of the greatest barriers to nursing research utilization in the practice setting (Phillips, et al, 1998). The conclusions of many previous studies revealed that, in addition to the limitations in the workplace settings, the resistance among more senior nursing staff and the research values and skills of the nurses were important in research utilization (Olade, 2003).
Most of these studies, however, have been conducted with samples consisting of nurses working mostly in urban settings, but the more one ventures out of the large urban medical centers, the less one hears about research and its utilization. Studies on nurses working in rural areas is paramount, if we are to "leave no nurse behind" in our professional struggle for evidence-based practice (Olade, 2003).
The reasons why nurses do not utilize research evidence in their clinical practice are therefore complex and multi-factorial. Nurses encounter these three major barriers and all these barriers have been documented in other studies. Studies focusing mainly on barriers to research utilization noted that the following reasons answer why most nurses so not utilize research:
(1) Lack of published research on specific clinical issues
(2) Traditional nursing education and administration philosophies
(3) Lack of clinical resources e.g. time, money
The first reason why there is an increasing lack of research utilization among nurses is the lack of published research on specific clinical issues. The absence of published research on specific clinical issues could be a major barrier to research utilization. In addition, published research may have limitations (eg, sample size, design) that restrict the ability to generalize results to clinical practice settings. Nurses may lack experience reading and critiquing research reports and may have difficulty interpreting study designs and statistical findings. These factors are compounded by the fact that many research projects--especially theses and dissertations--never are published or presented, making their findings inaccessible to staff nurses (Nicoll, 1997). Without being introduced to the available research, nurses are unable to evaluate the results and carry out the recommendations.
Traditional nursing education and administration philosophies are the second barrier for the increasing lack of research utilization by nurses. The implementation of nursing practice research in the nursing environment can be hindered by administration philosophies and non-research-oriented nursing education. Therefore, nurse administrators should actively promote research utilization. The ability to critique and understand clinical research reports may be lacking or traditional clinical nursing practices may be accepted unconditionally (Nicoll, 1997).
Traditional nursing education and administration philosophies also may present barriers to research utilization. Entry-level nursing programs place varying degrees of importance on research and research utilization. Many of today's experienced staff nurses did not study research during their basic nursing programs and have not had opportunities to do so through continuing education programs. Only since the late 1970s have most nursing baccalaureate programs have begun including specific research content in their curricula. Even today, few associate degree nursing programs provide research content (Nicoll, 1997). Making no budget allowance by the administration for research in the nursing division could be seen as reflective of the importance attached to research by the nurse leaders.
It is pertinent to note that qualitative comments by the nurses in one study who were utilizing research showed that support by the administrators was an encouraging facilitator in their use of scientific findings in their practice settings. This supports previous studies that revealed one of the most effective facilitators for research utilization was the increased support and encouragement from administrators (Olade, 2003).
Lack of clinical resources like time to read research articles or lack of money to investigate and implement research findings in practice is the third barrier. This is congruent with findings of other studies. One researcher found that time was an important factor to improve research use in clinical practice.
Perioperative nurses in one study reported that heavy activity and workload gave them neither time nor energy to do research-related activities. The administrative requirement to improve efficiency and long waiting lists press the surgical team to treat more patients. This pressure, acute procedures, and lack of personal resources increase nurses' workload. Perioperative nurses have no authority to administer their time at work, and the possibility of finding time for research activities in practice depends on nurse leaders. Only nurse leaders can organize the OR team so that perioperative nurses have on-duty time to perform research activities (Ruland, 2004).
Evidenced-base recommendations for overcoming three causes
Nursing professional development is a very important aspect of the nursing profession. It is a lifelong process and it does not stop once nurses get a job. There should be active participation by nurses in learning activities that assist in developing and maintaining their competence, enhance their professional practice, enhance the quality of patient care that they can offer, and support achievement of their career goals. Therefore, the lack of awareness and utilization of research is a hindrance to nursing professional development. The causes for the increasing lack of research utilization must be given solutions.
It is interesting to note the enthusiasm with which research results are presented in nursing conferences locally, nationally, and internationally. However, it becomes very frustrating when the wide gap between the enthusiastically presented research findings and what actually occurs in clinical practice remains for many years after the dissemination of such evidence reports and clinical guidelines. The existence of the gap between research and practice should continuously be a concern for researchers/educators and nurse administrators (Olade, 2003).
It is time for nurses to stop projecting nursing research as an academic exercise and start perceiving it as a scientific base for evidence-based practice. There is a need to stress support for nursing research as one of the important means of providing scientific evidence for practice in every forum for nurse executives (Olade, 2003).
It is recommended that nurses have to be given study days for the lack of time they have in research investigation and implementation. Competence in the research process, statistics, and research methodology can help nurses argue for use and evaluation of research findings. This may improve support and collaboration from the physicians and other health care administrators.
To determine whether research findings can be used as a basis for nursing practice, the nurse should consider the scientific worth of the study, the substantiating evidence provided in other studies, the similarity of the research setting to the nurse’s own clinical practice setting, the status of current nursing theory, and factors affecting feasibility of application.
Developing a favorable attitude among nurses that encourages the integration of research evidence into nursing practice at the health care setting is recommended to help overcome the lack of awareness and utilization of some nurse in research. This needs the cooperation of nurse leaders and other health care professionals in the clinical areas. When barriers to research utilization are identified, nurse administrators, clinicians, and researchers can design and implement specific strategies to overcome these obstacles. These strategies may be specific to staff members, facilities, or situations. Other strategies include providing staff nurses with time to read research reports and having experts available to help staff nurses interpret and critique research findings (Nicoll, 1997).
Educators and administrators in healthcare organizations need to create collaborative strategies that emphasize the importance of research in enhancing evidence-based practice in the clinical setting, especially in the rural areas. Whatever approach is taken, if we are to improve nursing practice through scientific evidence, it will take the commitment and collaboration of educators/researchers, clinicians, and administrators to see that no nurse is left behind in the march toward evidence-based practice (Olade, 2003).
Each of the nurses and health care professionals alike therefore has a responsibility to know and use the latest research related to their respective clinical practice. Surgical and medical nurses should see to it that they are up-to-date with the current research findings in their field. They can do this by reading research journals or actively participate in research studies. Evidence-based practice synthesize research findings, make recommendations, and ultimately be able to come up with better quality of patient care. Every patient deserves best practice regardless of the practice setting and every nurse has the responsibility to know the best practice for the clients under his or her care.
Evidence-based practice move nursing professionals towards providing the best care for their clients. This is not only true for the nurses but for other health care professionals as well who are in the front line of providing care to individuals. What is best for the patient more often is best for the health care practitioners and the clinical setting. The utilization and awareness of research in nursing profession is a basis for scholarly and professional decision making in clinical practice and is essential in providing competent, efficient, and state-of-the-art nursing care.
Nurses in all health care settings must continue to seek knowledge by taking time to review research and practice findings, critique research studies, and discuss with fellow nurses the implications of using and not using new knowledge in nursing practice.
Nursing research is important and it addresses issues that are important to the discipline of nursing. Nurses must therefore be aware and use research findings in there practice. Acquisition and application of new knowledge is very important in contributing to nursing practice and patient care.
Advances in care through research are meaningless unless they reach nurses at the point of care. Nurses should utilize these research findings if they are to improve the quality of care that they offer to their clients. Nurses must therefore read publications like journals and textbooks and other source which contain research reports in nursing and other related fields in the provision of health care.
Unfortunately, there are many barriers that prevent the nurses from utilizing these research finding. Among these are the (1) Lack of published research on specific clinical issues, (2) Traditional nursing education and administration philosophies, and (3) Lack of clinical resources e.g. time, money. These barriers have to be overcome by the nurses with the help of the administration, educators and other health care professionals.
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