RESEARCH FOR REGISTERED NURSES
Criticizing individual practitioners for their lack of research awareness or clinical managers for the low level of research utilization in their area belies a simplistic approach to the problem.
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 (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 (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 (, 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 (2003).
There are several studies focusing on the barriers to research utilization 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.
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 statistical section of a research study could be intimidating to the beginning researcher.
In a nationwide study focusing on the state of research utilization in the United States, it revealed that the culture of healthcare institutions does not value research utilization. The study noted that nurses without a baccalaureate degree did not fully understand or value research, while some of the baccalaureate-prepared nurses who had classes on research in their program complained that the way in which nursing research was taught in the schools turned them off (2003).
These are just some examples that depict the increasing lack oaf awareness and utilization of may health care professionals. 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 evidenced based recommendations for future nursing practice to overcome each of these three barriers.
Nursing has long been urged to base care on research findings rather than tradition and ritual. The rapid growth of doctorally prepared nurse researchers has enabled the scientific base for nursing practice to grow (2004)
There are, however, barriers to utilization of research in clinical settings. This includes individual practitioners for their lack of research awareness or clinical managers for the low level of research utilization. Barriers limit the potential of identifying clinical outcomes in nursing care (, 2004). However, recognizing and acknowledging the existence of these barriers enable to implement change in practice in a timelier manner.
The reasons why nurses do not utilize research evidence in their clinical practice are complex and multi-factorial. Studies focusing mainly on barriers to research utilization noted that the following reasons answer why most nurses so not utilize research: (a) characteristics of the nurse, which revolves around poor knowledge of research; (b) characteristics of the research presentation, with statistical terms beyond the level of the average nurse; and (c) characteristics of the organization settings in clinical areas constitute barriers.
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 (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 (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 (, 2003).
For this paper, three reasons why nurses lack utilization and awareness of research will be discussed. These are: (1) lack of support from administration to implement new practices and fund research, (2) lack of time to investigate research findings, and (3) lack of interest and knowledge on the part of the nurses themselves.
Nurses encounter these three major barriers: lack of time for investigating and implementing research, lack of knowledge on the nurses’ part, and lack of support by the administrators and other health care professionals. All these barriers have been documented in other studies.
The finding that the desire for research utilization among nurse administrators was affected by their lack of support and budget for research from administration, needs closer consideration. Making no budget allowance for research in the nursing division could be seen as reflective of the importance attached to research by the nurse leaders. It is pertinent, however, to note that qualitative comments by the nurses in this 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 (2003).
Under this barrier of lack of support is uncooperative physicians, which seems to be an international problem. This is unfortunate because nurses and physicians work together closely and, in some cases, nurses are dependent on physicians to implement research findings in the any health care setting (2004).
Lack of time to read research articles and to investigate and implement research findings in practice is the second 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 (2004).
Developing a favorable attitude among nurses that encourages the integration of research evidence into nursing practice at the health care setting needs the cooperation of nurse leaders and other health care professionals in the clinical areas.
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 (2003).
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 (2003).
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 (2003).
There are several 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 (2004).
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.
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.
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 lack of time and interest on the part of the nurses to investigate and implement research findings, the lack of support from the health care administration and other health care professionals, and the lack of knowledge of the nurses on the significance of research findings and its implementation. These barriers have to be overcome by the nurses with the help of the administration and other health care professionals.
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.