VOL: 103, ISSUE: 12, PAGE NO: 32-33
Author Dawn Brookes, RGN, BA, MA Ed
Community matron, Ilkeston Health Centre, Ilkeston.
Abstract Brookes, D. (2007) Why nurses do not disseminate academic coursework www.nursingtimes.net
AIM: To investigate whether there is a problem with lack of dissemination of coursework, and discover the prevalence of that problem and identify the reasons and any correlating relationships.
METHOD: A postal questionnaire of378 community nurses in three primary care trusts was carried out in a multicentre, retrospective, cross-sectional, descriptive survey design.
RESULTS: The final response rate was 62% (n=214). The reasons most nurses agreed were responsible for non-dissemination were lack of confidence and time, lack of motivation and lack of awareness of means to disseminate. An open question on the reasons why nurses had disseminated their coursework found support from colleagues/a manager and a desire to encourage changes in practice were major factors. The majority of nurses had generally positive attitudes towards coursework, as most nurses agreed that they should do courses, the high standards of work could benefit others and they should have training on presenting.
DISCUSSION: Although the majority of nurses have positive attitudes towards coursework, there are still large numbers of nurses who do not disseminate their work. Statements nurses are more or less likely to agree with suggest that the reasons for non-dissemination have less to do with negative attitudes towards coursework and more to do with perceived barriers and a lack of awareness of media and means for dissemination.
CONCLUSION: In spite of high standards in nursing education, nurses still have difficulty sharing what they know. The reasons appear to be lack of time and capacity to disseminate their work. But nurses express generally positive attitudes towards coursework and they present some valid reasons for non-dissemination that may warrant further study.
Kinn and Kenyon (2002) suggested that all healthcare professionals should be able to present the results of their professional activities. But with nursing described as a labour intensive and highly complex profession (Lanham, 2003), this might be expecting too much from an already overwhelmed workforce. Historically nurses were not trained to put forward their own work or point of view, orally or in writing (Kinn and Kenyon, 2002). The first part of this study found that the majority of nurses still do not disseminate their work. The purpose of the second part is to examine nurses’ attitudes towards their academic coursework and reasons for dissemination or non-dissemination.
A number of studies have been carried out that look at nurses’ attitudes towards research, often referred to as barriers and facilitators to using research. These studies have been carried out in England (Hicks, 1996; Dunn et al, 1997; Walsh, 1997a; Walsh, 1997b; Ax and Kincade, 2001); Northern Ireland (Parahoo, 2000); USA (Lewis et al, 1998); Sweden (Kajermo et al, 1998; Kajermo et al, 2000); Finland (Oranta et al, 2002) and Australia (Hutchinson and Johnston, 2004). All of the studies except one were quantitative surveys, with samples ranging from 94 to 2,600. Many studies used a validated questionnaire. The results of some of these studies can be seen in Table 1.
The study by Parahoo (2000) would be the most reliable for generalising results. This was due to the large numbers involved and the fact the population covered a wider range than the others, which used mainly single hospital convenience samples. Some 2,600 questionnaires were sent to nurses from 23 hospitals across 14 NHS trusts.
In the study by Hicks (1996), a 13-item attitude scale questionnaire was sent to 500 nurses. This type of scale was adapted for the present study, which considered attitudes of community nurses towards both their work and dissemination, in order to find out if there were any general reasons for not disseminating coursework.
The study followed a multi-centre, retrospective, cross-sectional, descriptive survey design. While the questions ask whether there is a problem with the dissemination of coursework, the study was designed to discover the prevalence of the problem and identify any correlating relationships.
The study population approached was 378 community nurses across three primary care trusts (PCTs).
Data collection tools
A postal questionnaire was used. Postal questionnaires are cheaper and easy to use with large numbers at distances. They provide anonymity and no bias from the interviewer’s influence on the respondent (Polit et al, 2001). The disadvantages are that response rates can be low and questions can be misinterpreted or misunderstood.
Ethical considerations relate to the protection of human participants in research studies (Cerinus, 2001). In this study nurses would be asked to complete a questionnaire relating to their coursework activities and the dissemination of these. In order to obtain factual answers and in order to protect the identity of participants, anonymity would be assured. Consent would be requested in the covering letter and a returned questionnaire would be taken as consent. Ethical approval was granted in July 2004.
Perceptions about academic coursework
A total of 378 questionnaires were posted in the first instance. The final number of responses amounted to 214 (62%). The questionnaire involved the use of Likert scales with statements and five optional responses - from ‘strongly agree’ to ‘strongly disagree’ - for respondents to choose from. The statements offered reasons why coursework may not be disseminated. The responses are shown in two sections. The first are those related to reasons why academic coursework may not be disseminated and the second relates to the attitudes of respondents towards academic coursework. The results of two open questions are also shown.
Reasons why coursework may not be disseminated
Table 2 shows the level of agreement or disagreement (showing a Likert scale of 1 = strongly agree, 5 = strongly disagree) with the statements on reasons and perceptions that explain why coursework may not be disseminated. The mean levels of agreement are shown along with the standard deviation.
One of the open questions asked those respondents who had not disseminated coursework to give reasons for non-dissemination in their own words, if different to those already stated in the Likert scale. There were 39 responses to this question that could be categorised and these are shown in Table 3. Many responses reiterated the statements already covered in other questions and these responses were therefore not included in the coding or in the response numbers.
Some interesting responses to this question highlighted the perceived lack of forums for dissemination, as well as a lack of interest from their fellow professionals. Other common responses were that 23% felt that their work was not good enough and 23% stated they had done coursework for their own benefit.
The second open question asked those respondents who had disseminated coursework to give reasons in their own words on why they had done so. There were 33 responses to this question and these were coded as shown in table 4.
The most common reason given for dissemination was that support from colleagues or a manager had been a major factor in their decision to disseminate (45%). The second most common reason given (33%) was to encourage changes in practice. Some 18% had received a request to disseminate, 15% felt it necessary to do so and 15% felt an obligation to their employer.
Attitudes towards academic coursework
The final part of the questionnaire examined community nurses’ attitudes towards coursework using the same Likert scale as before with rankings from ‘strongly agree’ to ‘strongly disagree’ and a set of statements. The responses are presented in table 5.
The overall response rate from eligible subjects in this study was 62% (n= 214). The study revealed community nurses’ attitudes towards academic coursework were largely positive; this is similar to a study by Hicks (1996) relating to nurses’ attitudes towards research. In the latter study by Hicks and in this one, attitudes towards the study topic were directly linked to dissemination activities. Those with more positive attitudes were more likely to disseminate coursework than those who were less positive.
When the answers to the open questions are taken into consideration, many nurses felt that their work was not good enough to be disseminated.
As suggested by this study, respondents who felt that the coursework had influenced their practice were more likely to disseminate than those who did not. This would make sense as nurses are likely to want to improve practice. What was surprising was that relevance to practice did not seem to make a difference to dissemination rates; neither did funding from an employer or doing a literature review. Policy makers may consider these factors as funding courses does not appear to be sufficient incentive for nurses to disseminate their findings.
Reasons for not disseminating coursework
Like Hicks (1996), it would seem that despite the majority having positive attitudes towards academic coursework, there are still large numbers of nurses who do not disseminate their coursework. When thought was given to the statements about reasons for this activity the majority of the sample disagreed with statements that coursework was not part of the job or was unlikely to influence practice. But there was more likely to be agreement with other statements, such as nurses not having enough time or lacking confidence to disseminate (see table 6).
If this sample were taken as representative of community nursing, it would reiterate that nurses’ reasons for non-dissemination have less to do with negative attitudes and more to do with perceived barriers in the process as well as a lack of awareness of possible ways to disseminate.
The ‘open’ questions used in this questionnaire were found to complement the closed questions and to reinforce the findings. This can be the purpose of using open questions, according to O’Cathain and Thomas (2004). The respondents who answered the open questions (n=64 and n=44) in this study provided some useful additions on what might facilitate dissemination. The majority of those who gave reasons for disseminating coursework (see table 4) related this directly to support from a manager or colleagues. The second most common reason given was more altruistic and related to a desire to encourage changes in practice. The most frequent reason given for non-dissemination (see table 3) was that of a ‘lack of forums’, followed by ‘course taken for own benefit’, ‘did not think the work was good enough’, ‘lack of guidance on how to disseminate’ and ‘lack of interest from other professionals’. Apart from those who did courses for their own benefit, these reasons reinforce the findings on the perceived barriers which seem to be the most common.
It is difficult to see how lack of time, motivation and confidence can really influence the dissemination of academic coursework when the findings of this study suggest that 83% of community nurses produce such work, with 42% producing more than five pieces of work in the six years before the study. This would imply that these nurses are finding the time and the motivation to produce high standards of work (74% gained marks above 60%), and yet they feel they lack the time to disseminate. In spite of this, however, those who produce the most work and those with higher marks are still the most likely to disseminate their work.
Despite the government’s attempts to modernise the NHS, there is currently a shortage of nurses, with only one in eight nurses in 2002 under the age of 30 compared with one in four in 1992 (BBC, 2002). Age made no significant difference to dissemination activities in this study but if nurse shortages continue to rise, this will impact on every area of practice. If clinical governance is to work and nurses are ‘key’ to the success of any modernisation in services, then there may need to be more investment in these key services. Strategies across the NHS need to be put in place to help to improve dissemination at all levels. Some of these might include specific training in relation to dissemination, highlighted as a need by this study.
Attitudes towards dissemination of coursework
Community nurses’ attitudes towards dissemination were generally positive. The majority thought that coursework was relevant and dissemination could help to improve practice. The respondents in this sample felt that nurses should receive training on how to disseminate their coursework and this reinforces some of the reasons for non-dissemination. For example, lack of awareness of possible means and lack of confidence. These results may add further weight to the study by Kinn and Kenyon (2002) where the introduction of presentation skills workshops improved the likelihood of dissemination.
Although nurses stated they lacked confidence in dissemination and half said they also lacked the knowledge to disseminate, 89% of respondents denied they were not as academically able as other healthcare professionals. This may indicate that while some of the perceptions relate to a lack of confidence and motivation, the real reasons might be deeper than those shown in this and other studies. There seem to be some contradictions and enigmas in all the studies around these perceptions and it might be more about changing a culture or belief than simply introducing more training. The Woodhull study on nursing and the media (1997) found that nurses in the US were all but invisible in media coverage of healthcare. This is likely to be as true in the UK, unless nurses begin to embrace dissemination of their knowledge across the board, including their academic coursework findings.
Limitations of the study
The use of a whole population sample improves the ability of the findings to be representative across the country but the response rate and the relatively small sample weakens the case for this. Postal questionnaires are renowned for producing poor response rates and this study only just reached above 60%. This does improve its applicability but it still means that 38% of nurses did not respond. The Likert questionnaires were useful in supplying reasons for non-dissemination.
This study set out to consider reasons for levels of dissemination activities. The findings have suggested that in spite of nurse education being at the highest level it has ever been (Wheeler et al, 2000), nurses still have difficulty sharing what they know. They are still not disseminating information in high numbers and still say that they do not have the time or the capacity to do so. They are, however, generally positive about academic coursework and present some valid reasons for non-dissemination which may warrant further study.
The study highlights the need for nurses to be encouraged to disseminate through a variety of means and to receive training in order to help facilitate this.
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