VOL: 103, ISSUE: 01, PAGE NO: 32
Ven Veeramah, MSc, BSc, DipN, CertEd, RMN, RNT, is principal lecturer, School of Health and Social Care, University of GreenwichThe integration of research findings into practice remains problematic (Parkin and Bullock, 2005) while the use of ...
The integration of research findings into practice remains problematic (Parkin and Bullock, 2005) while the use of research is still poor (Rassool, 2005). Furthermore, it is still unclear how research knowledge is transferred to clinical practice in nursing (Thompson et al, 2005).
A qualitative methodology using semi-structured interviews was used to collect the data. A number of practitioners from several specialties were invited to take part and 10 agreed to participate. The sample consisted of two community mental health nurses, two ward nurses (one medical and one surgical), two community learning disability nurses, one community paediatric nurse, one inpatient mental health nurse, one inpatient learning disability nurse and one midwife. All of them had been practising for more than five years.
The interviews took place between February and March 2004. They were open-ended and interactive and included a number of lead questions. These focused on the extent that research findings were used in practice, asking for examples of where research had informed practice. Participants were asked to identify some of the barriers that have prevented the use of research findings as well as strategies that would increase the use of research findings in practice.
All interviews were tape-recorded. Four interviews were carried out in person at the university, and six were conducted by telephone due to busy schedules and heavy workloads. To maintain uniformity, the author carried out all the interviews.
Tape-recording of interviews and verbatim transcribing of data ensured consistent and accurate recording of the data. Another researcher cross-checked the emerging themes to minimise researcher bias.
All participants stated that they used research findings to inform their practice but not all the time. Some said that they used it quite a lot whereas a few stated that they did so to some extent.
Participants cited examples where they had implemented research findings to inform their practice. These included areas that have been well researched such as wound care, pressure ulcers, mouth care, pain-control, care of urethral catheters, pre-operative fasting and handwashing. There were also other less well-researched areas such as risk assessment and risk management, cognitive behaviour therapy, family interventions and the prevention and management of aggression.
Five interviewees mentioned that there was no time allowed while on duty for staff to go to the library to read relevant research papers. Three people remarked that even if research papers were readily available in the clinical area, there was not enough time during working hours to access and read them. In addition, two participants stated that because of the heavy workload, they felt too mentally exhausted to do any reading after work.
Seven participants argued that there should be protected time in order to allow staff to read relevant research papers as well as to attend journal clubs and research interest groups.
Lack of knowledge on how to search the literature and critically evaluate research was cited by all participants as having prevented not necessarily themselves but some of their colleagues from using research findings in practice. Most of them (eight) stated that there was a need for more research education. This seemed to apply more to staff who trained before research education was introduced to pre- and post-registration curricula.
Nearly all participants (nine) mentioned lack of resources. These included staff shortages, demand on the service and lack of funding both to support staff in enhancing their research knowledge and to implement new therapeutic modalities that research had shown to be more beneficial.
Three participants strongly believed that effective leadership, particularly in the clinical areas, was paramount. Six participants stated that it would help greatly if there was a computer with internet access in the workplace so that staff could download research papers instead of having to travel to the trust or university library.
The majority (eight) mentioned the benefits of sharing information via a journal club or research interest group. Six said sharing ideas through a journal that could be circulated within the organisation would help. However, the most innovative strategy mentioned was the setting up of a database accessible via the intranet so staff could share information about research projects.
All participants emphasised the need for staff to attend research courses so that they could develop or consolidate their research appraisal skills.
Many of the barriers identified are consistent with findings from a number of studies. Lack of awareness of research findings, lack of accessibility of research information, lack of time, and lack of support and cooperation from members of the multidisciplinary team were articulated by some of the participants.
Another notable finding was that staff who trained some years ago were finding it difficult to use research evidence to inform their practice. This indicates clearly that more effort should be directed at this particular group of practitioners to ensure that they receive the necessary education to improve their research-critiquing skills.
Participants mentioned a number of strategies to encourage the use of research findings in practice. These included having a supportive clinical leader, better access to resources and more support from management.
The two strategies that were endorsed by nearly all the participants were the sharing of information through a journal club or research interest group and the need for research education. Although practitioners may be able to think critically and are knowledgeable about research, they might not use research to guide their practice unless ways are identified whereby they can discuss, debate and appraise research as well as translate research findings into practice (Seymour et al, 2003).
One other notable strategy mentioned by a participant was the use of intranet facilities to create databases that would enable staff to disseminate and share research findings. There is no reason why this could not be extended to trusts across the country.
In order to facilitate the use of research findings in practice, nurse and midwifery managers should demonstrate a clear commitment to research. They should ensure that the necessary resources and funds are in place to have intranet and internet facilities available on site so that relevant research papers can be accessed. There should also be protected time for nurses to make use of these facilities. This is especially important for staff who trained when research education was not part of the pre- and post-registration curricula.
Given the current financial situation of most NHS trusts, however, nurses and midwives should take charge of maintaining their professional skills and competencies. This might have to be in their own time and at their own expense.
Researchers have identified several barriers that prevent nurses from incorporating research findings into their practice. These include:
- A lack of awareness of relevant research findings (Hutchinson and Johnson, 2004; Rassool, 2005);
- Lack of knowledge of the research process and lack of skills to access, understand, critically evaluate and implement research findings (Hutchinson and Johnson, 2004; Rassool, 2005);
- Insufficient time available to read, evaluate and implement research findings (Sitzia, 2001);
- Not enough support from the organisation and other healthcare workers as well as a lack of autonomy and authority to change practice (Parahoo and McCaughan, 2001);
- Shortage of colleagues with the expertise to discuss research (Kajermo et al, 2000).
[TX]implications for practice[TX]l Pressure of work and lack of protected time make it difficult for staff to search for and read relevant research papers. Providing access to the internet within the clinical area is helpful.
- Research education is needed particularly for staff who did their training some time ago.
- Effective clinical leaders can help support, guide and motivate staff to use research findings.
- Journal clubs or research interest groups are a useful strategy for increasing evidence-based practice.
This article has been double-blind peer-reviewed.