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Helping nurses to interpret and evaluate research

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VOL: 98, ISSUE: 05, PAGE NO: 38

Jane Richardson, BA, PGCE, MSc, is a research fellow at the Primary Care Sciences Research Centre;Elizabeth Boath, PhD, BA, is head of the Centre for Health Policy and Practice, Staffordshire University; andAlison Metcalfe, PhD, BSc, RGN, is nursing and midwifery research fellow at the Research Institute, Birmingham Heartlands Hospital

Research knowledge is becoming increasingly important in the NHS, especially since the introduction of clinical governance. Graduate recruits are likely to have some understanding of how to interpret experimental data because most degree courses have a research component. However, people who are entering nursing via vocational training may not have any knowledge or experience of research methods and evaluation.

Research knowledge is becoming increasingly important in the NHS, especially since the introduction of clinical governance. Graduate recruits are likely to have some understanding of how to interpret experimental data because most degree courses have a research component. However, people who are entering nursing via vocational training may not have any knowledge or experience of research methods and evaluation.

Many courses focus on developing the skills necessary for conducting research, but the ability to read and understand research is an area of training that is often neglected. All health care professionals should be research-literate, so that they are able to assess and assimilate study findings to support evidence-based practice.

There is also a need to change negative attitudes towards research in the NHS. Fundamental and deep-seated resistance to research in primary health care teams has been highlighted, along with little understanding as to what constitutes research (Hicks et al, 1996). Without a common understanding of the need for and the potential of research, there is little hope of promoting a research culture within the NHS.

To address some of these issues a 10-week research awareness course was designed. Non-graduate health care professionals working in North Staffordshire attended the course, which aimed to teach students how to locate and critically appraise research papers. This article focuses on changes in participants' knowledge of and feelings towards research.

Over 20 years ago the difficulty of reading and understanding research was identified as one of the main barriers to using research (Miller and Messenger, 1978). Other studies have shown that health care professionals lack access to research findings, have insufficient skills to evaluate research and do not have the necessary computer-based search skills (Walczak et al, 1994; Funk et al, 1991). Other problems include:

- A lack of time to read (Lacey, 1994);

- Uncertainty over whether or not to believe research results;

- A lack of confidence in evaluating the quality of research (Mayhew, 1993); and

- Difficulty in understanding the jargon used in research articles (Walsh, 1997).

Overcoming barriers
Eldridge and South (1998) indicate that even short courses can be successful in changing attitudes to research. Hicks et al (1996) have highlighted the need for 'attitude change' programmes to encourage health professionals to take the first step towards research awareness. Ways of encouraging students to become more aware of the value of research have already been identified, such as special courses, mixing with other disciplines to discuss issues more broadly, being directed to useful literature and being shown how to read critically (Chenoweth, 1998).

Awareness course
The research awareness course was developed as a joint venture between the Primary and Community Care Research Initiative at Keele University, North Staffordshire Combined Healthcare NHS Trust and North Staffordshire Hospital NHS Trust. It was funded by the Shropshire & Staffordshire Education and Training Consortium. Three tutors (the authors) ran the course, using seminar-style teaching, class discussion, practical exercises and sessions with outside tutors. To encourage multidisciplinary learning and develop links across primary and secondary care, the course was open to any staff working in the North Staffordshire area.

Many of the barriers to understanding research, described above, were accounted for in the design and content of the course. For example, the course was free and was run at different times and on different days so that it would fit in with the students' work and family commitments.

The main approaches in research and data collection techniques were discussed, including issues such as ethics, health economics and basic statistics. Other sessions explored reading and critically appraising research articles, and included definitions of commonly encountered jargon. One of the aims of the course was to enable students to carry out an effective literature search and understand what facilities are available to them. As part of the assessed coursework students carried out their own literature search, following tuition from library staff.

Subjects were introduced in short lectures and followed up with pair/group problem-based exercises that were designed to consolidate learning through student participation. The tutors aimed to create a relaxed atmosphere to encourage student participation.

Part of the course evaluation involved gathering the students' perceptions of their own research knowledge and feelings towards research at the beginning and end of the course.

A self-completed questionnaire was given to course participants on their first and final session. Students were told that there were no right or wrong answers and that anyone could refrain from completing the questionnaire if they wished. Anonymity was ensured by randomly assigning a code number to each student, which was written on the questionnaire.

The questionnaire requested brief details of participants' professional backgrounds and reasons for attending the course. The students were asked to rate their research knowledge in 10 areas on a scale of one to four where one was 'agree strongly' and four was 'disagree strongly'.

In the final questionnaire they were asked to list the three main things they had learnt on the course.

Student profile
All 82 participants completed the questionnaire at the beginning of the course and 69 (84%) at the end. Most students were from a nursing background, followed by the therapy professions, with small numbers attending from health promotion, support and audit. Just over half (53.7%) of the participants had been nurses for over 15 years and only six (7.3%) participants had been working for less than five years.

Reasons for attending
The reasons students gave for attending the course can be summarised as follows:

- Wanting to study for further qualifications;

- A general desire to know about research and research terminology, to consolidate previously learnt skills or to carry out a research project;

- Work-related reasons, including the perceived need for evidence-based practice and to improve services to patients/clients and students;

- Personal development, for example, 'to see what I could do - I haven't done any courses or studying for 20 years'.

As might be expected, by the end of the course participants' self-assessed knowledge had increased in all 10 areas assessed. At the start of the course, participants were generally more confident in three areas: the differences between audit and research, ethical issues in research and carrying out a literature search. At the end, their knowledge had increased considerably in these three areas (up to 99% for ethical issues and 100% for the difference between audit and research).

Initially, students were least knowledgeable about specific aspects of research, such as distinguishing between dependent and independent variables and recognising different types of research model. At the end, most could distinguish dependent and independent variables, but only just over half felt able to recognise different research models.

It is interesting to examine the answers concerning the three main things participants felt they had learnt on the course. First, most said they had gained skills in critical appraisal. They now know that not all published research is good, the principles to use for critical appraisal and how to evaluate the usefulness of papers for practice.

Second, they had gained skills in literature searching and using library resources and were aware of where they could get help if they needed it. Ninety-seven per cent felt confident in searching on electronic databases, such as CINAHL and Medline. This was one area where considerable progress had been made.

Third, participants reported an increased understanding of research terminology or jargon; knowledge of different research approaches and methods; general awareness of research issues; a basic understanding of statistics; and an appreciation of the importance of research in connection with practice. A few felt that they could now carry out a small research project, although this was not an explicit aim of the course. Finally, many students said that the course had given them increased self-confidence and a positive attitude towards research.

Just over half of the participants had been working for more than 15 years, with only six working in health care for less than five years. This was as expected, since newer entrants would have entered the profession as graduates, received basic research training, and not felt the need for the course. Although research-based culture is needed throughout the organisation, it is interesting to note that only one manager came on the course.

The students' self-assessment highlighted areas for improvement, for example, recognition of different research models. The course did not go into great detail about each individual methodology, so students who began to read more widely may have come across more jargon. It was assumed that by the end of the course students would have the skills to find out the meaning of any research term they did not recognise.

The fact that most students felt able to design a small-scale research project by the end of the course may reflect an increased confidence in research. Although attendance at the course was good, absences from sessions may account for some of the gaps in knowledge reported. Absences reflect the difficulties of combining a course with work and other responsibilities.

Although this course was able to break down the barriers of access, readability and critical appraisal, further work is needed that looks at the organisational and practical barriers to using research. Previous research (Champion and Leach, 1989) has shown that positive attitudes towards research have led to the use of research findings.

Research (Walczak et al, 1994) shows that most nurses rarely attend research-based lectures or take research-related courses. But following the research awareness course some participants have started to attend local research seminars, a few have begun degree courses and several are carrying out small-scale research projects. Courses, such as the one pioneered in North Staffordshire, may be the first step towards developing a research culture within primary and secondary care.

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