Research for Registered Nurses - Essay Example

Research for Registered Nurses Introduction Nursing work involves decision making regarding the care of the patients. Decision making in clinical practice is a composite of integrated academic knowledge and individual skills. However, recently with availability of easy access to internet even in the workplace, the practicing nurses can access best available clinical evidence from external sources. By clinical evidence, it is meant evidence that can be gathered from systemic research. In the current scenario of medical management of different conditions, it is expected that healthcare professionals will work as a part of the multidisciplinary team in order to ensure appropriate and best care. Two relevant skills are important for making contribution in the clinical care in such scenarios. These are ability to examine the evidence in support of the proposed course of treatments and the ability to use the evidence in practice. However, extracting evidence from research is not easy so it can be used straightforward for clinical decision making. Although it is a commonly held idea that comprehending the research finding is what is necessary, but those who have tried this in practice know very well that finding a relevant evidence for facilitating decision making is not that easy (McDonnell, 2004). Usable evidence must support a proposed clinical activity and clinical intervention so the course of treatment can be modified. Familiarity with research process and research methods are two important requisites for a healthcare professional, and they should at the baseline be able to search the requisite information through a comprehensive, rigorous, and methodologically valid search ultimately assisting them to select and deliver the most effective care. Rationale and Background Stone and Rowles (2007) indicated that as far as nursing is concerned, most research has demonstrated that there are barriers to use research findings in practice, and the main reason is a gap of knowledge in research methods and deficiency in critical appraisal skills. A realistic, problem-based structured approach to find and evaluate research could solve the problem. Along with that, there must be approaches to have academic learning on research methodologies. Although there has been argument that evidence is lacking in all fields of nursing and in many cases review and implementation of evidence is not straightforward, it is clear that nurses most often do research for finding evidence with less than optimal methodological rigour. It has also been complained that the workload prevents the nurses to have adequate time to engage in research activity. Nursing as a profession is nascent, and lack of maturity of the science might have prevented practice guided by robust evidences from research (Stone and Rowles (2007). Focus Question Given these different views, it is necessary to find out the truth about nursing research, and consequently, doing a systemic literature review would be the best possible option with the focus question, what are the barriers of evidence based practice in nursing What could be the possible solutions Methodology Based on these focus questions, there were a set of inclusion criteria developed for finding relevant articles for this review. The articles which were included were all on evidence based practice in nursing, which identified the barriers to implement a process of finding relevant literature, evaluating and extracting evidence, categorizing evidence, and applying them in practice. It was expected that there would be certain number of studies in each of these themes along or in combination. The literature available in the University database will only be included which were relatively recent published within the period of last 5 years in English language will be included. It was also expected that many of these studies will also focus on evidence based nursing in different specialities. Since specialty-oriented nursing research evidence may have specific pitfalls or positive points specific to that practice, it was decided that only evidence-based practice literature generally applicable to nursing will be included. Since the issues are general and may be applicable across the globe, it was also decided that there would be no geographical barriers for selection of the study. Recent evidence is mostly available in journal articles which have good databases accessible through the university library, and therefore, despite the fact that evidence based practice had been the topic of discussion in many books, apart from semantic references, as far as practicable, only primary research articles would be used. Thus established the inclusion and exclusion criteria, based on the themes, a set of keywords were generated. The campus library had access to databases, which revealed numerous studies on this specified area of nursing practice. To build a scientific basis of evidence, a comprehensive literature search was undertaken and then evaluated critically. For the purpose of the review of literature, to support the rationale, need, and continuation of the project, this author conducted a literature search across databases. Those accessed for information included: CINHAL, Medline and Pubmed along with the Google Scholar internet search engine. Moreover MEDLINE, EMBASE, and CINAHL and Cochrane databases were searched to identify relevant literature. Apart from these, printed journal articles were also hand searched from references of the initially selected articles. The search for the relevant literature began with identification of the key words. The rationale, background, and the focus question served as the guide for these key words. Then through application of Boolean logic, a combination of key words were generated which were used for searching the abstracts of the initially identified articles. This served to narrow down the articles, where a detailed search was conducted. The key words that were used were "evidence", "practice", "nursing", "evidence-based practice" and "nursing", "barriers", "barriers to research", "nurses", "healthcare professionals", "common barriers", "known strategies", "research utilisation", "clinical practice", "clinical setting", "enhancement", "application", and "implementation." Based on these out of initially identified 85 articles, only five articles contained all necessary elements of the inclusion criteria and terminology. Once the articles were retrieved, Burns and Grove's (2005) four-phased approach was used to critically review these studies, which were "skimming, comprehension, analysis and synthesis of sources." The findings from the review of literature have been presented below. Review of Literature Common Barriers to Research Utilisation Fink et al. (2005) indicated their findings from different studies that despite having positive attitudes towards research and need for evidence base in professional practice, majority of the nurses do not incorporate these findings in their practice. Some of the factors that have been identified are lack of administrative support and mentorship, belief regarding lack of authority to change practice, inadequate knowledge on basic research methodology, inability to understand statistical data to derive significance, and inadequate time at work to be able to implement change in practice through a rigorous process such as this (Fink et al. 2005). Retsas (2008) in his study examined the perceptions of 400 registered nurses in Australian Hospitals to identify the factors that might have been interfering with the ability of the nurses tio incorporate research evidence into their practice. Through a factor analysis approach, the four main identified factors were lack of accessibility of research findings, negatively anticipated outcomes of using research, deficiency of organizational support to use research and evidence, and inadequate support from other professionals to use research. The most important perceived factor was lack of organizational support, specifically when these nurses could not find enough time to use and conduct research due to severe workload (Retsas 2008). Koehn and Lehman (2007) in their review cite findings from other studies that indicate that there have been consistent findings regarding barriers to utilisation of research evidence in nursing practice across studies. One important reason is that in contrast to other professions related to clinical healthcare practices, nursing profession is resistant to incorporate new ways, and their practice is traditionally based on prior experience and intuition, rather than on validation. Many nurses lack knowledge on research, skills and understanding about the research methodologies. The lack in scientific ways of conducting research is further aggravated by their lack of computer and library learning (Koehn and Lehman 2007). Pravikoff et al. (2005) identified the institutional barriers to evidence-based practice. Some of the important organizational barriers were lack of financial resources due to other high-priority goals, lack of interest of the administrators, lack of support, and lack of research consultants. In this context, since in many studies organizational barriers were perceived by the nurses to be the most important ones in implementation, some contextual factors within the organization were also identified which involve the leadership, the culture, and the evaluation process. Some other related and relevant factors are lack of alignment to practice due to lack of cooperation from the administration and physicians since they would not want to implement the evidence emerging from nursing research. Sometimes, the other staff may not be supportive enough for implementation adding to the disadvantages created by lack of facilities. Moreover, it was quite frequently observed that the framework of the research may be too out of the way limiting generalizability to the practice setting (Pravikoff et al. 2005). Paramonczyk (2005) in her review of American, Canadian, and Australian studies on barriers of utilisation of research in clinical practice from the nursing perspectives used the Barriers to Research Utilisation Scale to identify that organizational characteristics were the most important barriers in research utilisation in evidence based practice. Although it was perceived that there is some contribution from the personal characteristics of the nurses, nurses viewed these to be insignificant barriers, although it can be argued that this is just an attempt on the part of the nurses to abdicate responsibility (Paramonczyk 2005). Known Strategies to Enhance Research Utilisation in Clinical Setting Studies indicated that organizational efforts to close the gap between research and practice may handle the organizational barriers effectively. There have been proposals of different models of practice that by default needs incorporation of research into practice. There is also a perceived need for using organisational culture that promote evidence seeking and utilization. Measures to create supportive environment, measures to address the knowledge barriers, need for a strong and supportive leadership and mentorship, provision of time to conduct research within the rostered time, fiscal incentives, provision for staff education on research use, and routine performance expectations in research use are some of the known strategies (Fink et al., 2005). Although nurses perceive personal characteristics to be a less important barrier, preparation of the nurses in the nursing programmes on skills related to utilisation of research and principles of evidence-based practice are deemed to be most important strategies. The nurse executives thus would have an added responsibility to remediate the professional knowledge and skill gaps. The strategy could be transmission of information that satisfaction in profession is related to improved patient outcomes, and this can be improved through application of knowledge through evidence. Some individual determinants of nurses may need to be changed, the most important of which are a positive research attitude which has been correlated to intentions to seek knowledge and utilise research in the clinical settings. These would involve changes in beliefs and attitudes, involvement in research activities, education, and professional characteristics (Koehn and Lehman, 2007). Change in Leadership Attitude as a Strategy The senior nurses and the mentors would be encouraged to attend workshops on evidence based practice and clinical research, and there would be organisational mandates to apply the learning in practice, so at work, they may encourage the staff nurses to look for preintervention evidence and suggest changes in practice which can be implemented through a discussion among peer groups. Role of Health Professionals as a Change Agent Three important abilities are crucial for implementation of evidence-based practice across different levels of services, awareness about current literature, ability to evaluate the quality of evidence from available research, and capability to implement them in practice. Nurses' commitment to serve the patients also should include commitment to deliver optimal care based on evidence, which are new and emerging in their areas of practice. Most modern day practice environments accept evidence base to be one of the important components; however, it is unfortunate that even now in nursing practice, evidence is hardly implemented. The need for evidence-based practice is further accentuated by the fact that people want to maintain status quo by nature. Thus most professionals including nurses tend to follow conventional practice based on previous learning. In many a cases, the clinicians tend to take impression based on one study, as a methodology for collecting evidence which is not valid. The search for evidence on the contrary is a rigorous research process in this age of rapidly evolving knowledge. The current state of affairs needs ability to capture and summarise available information and put them into perspective of clinical scenario (McDonnell, 2004). The demand of the health systems on the healthcare professionals including the nurses is now tremendous, and there would invariably be huge workload in the practice area. This leads to a situation of time constraint for them to be able to evaluate their practice. To add to this overwhelming nature of practice, there is also evidence that consumers have increased expectations along with policies and political influences on the structure of the healthcare systems have made the scenario more difficult. This level of difficulty has been accentuated further by rapid influx of information relevant to virtually every area of healthcare practice (Crookes and Froggatt, 2004). Conclusion Clearly, evidence-based practice is a journey towards scientific practice from past practice and personal opinions. It replaces outdated knowledge by evidence established through randomised controlled trials or meta-analysis. If all clinicians are required to follow the principle of justification of practice through evidence, nursing should not be out of this shift in practice method. For nursing specifically, the Polit and Beck view may be considered authentic, evidence-based practice is actually a research process to find the best evidence from literature to address problems encountered in clinical practice. In the next step, this process involves evaluation and integration of other evidences and then implementing these evidences in practice, so the best clinical decision may be made. This would need a rigorous research to be evaluated, but other sources of credible information may be incorporated in this process. However, despite the very positive implications, nurses often fail to find out relevant evidence and apply them in practice. In this study evidence of failure to utilise evidence from research would be sought in order to find the reasons of such inhibitions and solutions to these inhibitions against evidence-based practice. Reference Burns, N., & Grove, S. K. (2005). The practice of nursing research: Conduct, critique, & utilization (4th ed.). Philadelphia: Saunders. Crookes, P and Froggatt, T (2004). techniques and strategies for translating research findings into health care change practices: Change agents, in PA Crookes and S Davies (eds.) Reseach into Practice: essential Skills for Reading and Applying Research in Nursing and Healthcare, 2nd Edn., bailliere Tindall, Edinburg. 210-217 Fink, R., Thompson, CJ., and Bonnes, D., (2005). Overcoming barriers and promoting the use of research in practice. Journal of Nursing Administration; 35(3): 121-9. Koehn, ML. and Lehman, K., (2007). Nurses' perceptions of evidence-based nursing practice. Journal of Advanced Nursing 62(2), 209-215 McDonnell, A 2004, 'Factors which may inhibit the application of research findings in practice and some solutions', in Research into practice: essential skills for reading and applying research in nursing and health care, P Crookes & S Davies (eds), Bailliere-Tindall, Edinburgh, p. 185. Paramonczyk, A., (2005). Barriers to implementing research in clinical practice. Can Nurse; 101(3): 12-5. Pravikoff DS., Tanner AB., and Pierce, ST., (2005). Readiness of US nurses for evidence-based practice. American Journal of Nursing 105(9), 40-51. Retsas, A. (2008). Barriers to using research evidence in nursing practice. Journal of Advanced Nursing; (31) 3, 599 - 606 Stone, C. and Rowles, CJ., (2007) Nursing students can help support evidence-based practice on clinical nursing units. J Nurs Manag; 15(3): 367-70. Read More