Unit XiByDileep Kumar Post R.N BSc.N, C.H.NIlmiya Institute of Nursing, Karachi : Continuum along with research utilization can occur.
Steps of the research utilization process
Strategies to promote the utilization of nursing
Scales Unit XiByDileep Kumar Post R.N BSc.N, C.H.NIlmiya Institute of Nursing, Karachi 1 Research Utilization : Research Utilization Definition
It is the process of synthesizing, disseminating and using research generated knowledge to make an impact on or change in the existing practices in society.
It refers to the use of some aspect of a study in a clinical application unrelated to the original research.
It is noted that progress in utilizing the results of nursing research has proceeded slowly-too slowly for many, who are anxious to establish a scientific base for nursing action
The emphasis is on translating empirically derived knowledge into real-world applications. 2 The Utilization of Nursing Research : The Utilization of Nursing Research During 1980s & early 1990s, research utilization became an important buzz (ring) word.
Several changes in nursing education and nursing research were encouraged to develop a knowledge base for nursing practice.
In education, nursing schools increasingly began to include courses on research methods
In the research arena (field), there was a shift in focus toward clinical nursing problems. 3 Continue… : Continue… These changes, coupled with the completion of several large research utilization projects, played a role in sensitizing the nursing community to the desirability of using research as a basis for practice
Research utilization, as the nursing community has come to recognize, is a complex and nonlinear 4 The Research Utilization Continuum : The Research Utilization Continuum Emergence of research findings on a topic (innovations) Evaluation/ integration of findings: Best research evidence Efforts to use findings in practice (RU) 5 The Research Utilization Continuum : The Research Utilization Continuum 1. Emergence of research findings on a topic:
The start-point of research utilization is the emergence of new knowledge and new ideas.
Research is conducted and, over time, knowledge on a topic accumulates.
In turn, knowledge works its way into use—to varying degrees and at differing rates. 6 2. Evaluation/ integration of findings : 2. Evaluation/ integration of findings It involves the partial impact of research findings on nursing activities.
It is frequently the result of a slow evolutionary process that does not reflect a conscious decision to use an innovative procedure but rather reflects what Weiss (1980) termed knowledge creep and decision accretion.
Knowledge creep (move slowly) refers to developing “percolation/exposure” of research ideas & findings.
Decision accretion(accumulation) refers to the manner in which momentum for a decision builds over time based on accumulated information gained through readings, informal discussions, meetings etc. 7 3. Efforts to use findings in practice (RU) : 3. Efforts to use findings in practice (RU) Estabrooks (1999) recently studied research utilization & found evidence to support three distinct types of research utilization:
(1) indirect research utilization
involving changes in nurses’ thinking &
therefore analogous (similar) to conceptual
(2) direct research utilization
involving the direct use of findings in giving
patient care and therefore analogous to
(3) Persuasive (convincing) utilization
involving the use of findings to persuade others
(typically those in decision making positions) to
make changes in policies or practices relevant
to nursing care. 8 The Research Utilization Process : The Research Utilization Process Several theorists have developed models of how knowledge gets disseminated and used.
Rogers’ (1995) Diffusion of Innovations Theory is most noteworthy that has influenced several research utilization projects in the nursing community
He assumed that knowledge diffusion is an evolutionary process by which an innovation is communicated over time to members of a social system.
The key elements in this process, all of which influence the rate and extent of innovation adoption, include the following: 9 Continue : Continue The innovation is the new idea, practice, or procedure that, if adopted, will result in changes; the nature of the innovation strongly affects decisions about adoption.
Communication channels are the media through which information about the innovation is transmitted, and can include both mass media (e.g., journal articles, the Internet), or individual, face to face communication. Communication is most effective when there are shared beliefs, values and expectations on the part of the sender and receiver of information. 10 Continue : Continue Time is a component of the theory in that the process of knowledge diffusion occurs over time; there are varying amounts of time that elapse between the creation of the knowledge and its dissemination, and between knowledge awareness and the decision to use or reject the innovation.
The social system is the set of interrelated units that solve problems and seek to accomplish a common goal; diffusion occurs within social systems that vary in their norms and receptivity to innovations. 11 Steps of the Research Utilization process : Steps of the Research Utilization process Rogers characterized the innovation—adoption process as having five stages: knowledge, persuasion, decision, implementation, and confirmation.
During the knowledge stage, individuals or groups become aware of the innovation,
During the persuasion stage, they form a positive attitude toward it.
In the decision stage, a choice is made about whether to adopt or reject the innovation.
The innovation is actually put into use during the implementation stage.
Finally, the effectiveness of the innovation is evaluated during the confirmation stage, and decisions get made about continuation or discontinuation of the innovation. 12 Steps of the Research Utilization process : Steps of the Research Utilization process Research utilization is a multiple step process that involves;
Determining the research knowledge ready for use in practice
Persuading (convincing) nurses to use this knowledge
Making a decision to use the knowledge in practice
Implementing the knowledge to change practice
Determining the outcomes from making the research based change in practice. 13 Strategies to promote the research utilization of Nursing : Strategies to promote the research utilization of Nursing Strategies for researchers
Researchers should implement to foster
better adoption of their research Results;
Do high quality research
Adequate scientific basis for introducing
innovations or for making changes
Researchers must make a real commitment to
replicating studies and publishing the results
of those efforts
Collaborate with practitioners
Researcher should seek opportunities
to exchange ideas for research problems with
nurse clinicians, involve them in actual
conduct of research. 14 Strategies for researchers : Strategies for researchers Disseminate Aggressively
To report results in specialty journals
Disseminate study findings at conference, workshops attended by nurse practitioners
Researchers present the results of research
project in a way that is readily
comprehensible to all non-researchers
Suggest clinical implications
Researcher should suggest how the results of
their research can be utilized by practicing
Nurses 15 2. Strategies for practicing Nurses and N/Students : 2. Strategies for practicing Nurses and N/Students Nurses should engage in following strategies
Read widely and critically
Attend professional conferences
Learn to expect evidence that a procedure is effective
Seek environments that support research utilization
Become involved in a journal club
Collaborate with a nurse researcher
Pursue (follow) and participate in institutional utilization projects
Pursue appropriate personal utilization projects 16 3. Strategies for administrators : 3. Strategies for administrators Administrator should engage in
Foster (promote) a climate of intellectual curiosity (interest)
Offer emotional and moral support
Offer financial and or resource support for utilization
Reward efforts for utilization 17 Barriers to Utilizing Nursing research : Barriers to Utilizing Nursing research Barriers to the research utilizing in nursing can be largely grouped into four categories relating to the characteristics of the source of barrier;
Research Related Barriers:
Lack of solid base for study/studies
Dearth of reported replications of studies
Nurse Related Barriers
Lack of research knowledge
may not have positive attitude towards research
Some opposition to introducing innovations in practice setting. 18 Barriers to Utilizing Nursing research : Barriers to Utilizing Nursing research Organizational Barriers
Organizational climate is simply not conducive to research utilization
Insufficient time on the job to implement new ideas
Lack of resources for research utilization
Barriers Related to Nursing Profession
Difficult to encourage clinicians & researchers to interact & collaborate
Lack of communication between researchers and practitioners
Lack of enough authority to change patient care procedures
The historical baggage
Shortage of appropriate role models 19 Scales : Scales The scale, a form of self-report, is a more precise means of measuring phenomena than the questionnaire
Most scales measures psychosocial variables
Scaling techniques can be used to obtain self-reports on physiological variables such as Pain, Nausea or Functional capacity.
The various items on most scales are summed to obtain a single score which referred as summated scales 20 Types of Scales : Types of Scales Rating scales:
Are the crudest form of measure using scaling techniques.
List an ordered series of categories of a variable and is assumed to be based on an underlying continuum
A numerical value is assigned to each category
The subtlety (refinement)of the distinctions among categories varies with the scale
Often used in observational measurement to guide data collection 21 Example of Rating scale “used to measure nature of nurse-patient communications” : Example of Rating scale “used to measure nature of nurse-patient communications” Note: Following 3 questions are a part
of above mentioned study;
Nurses come into my room
Whenever I call them
Frequently just to speak or check on me
When nurse enters my room, I would prefer that he/she
Talk very little
Talk only when necessary
Talk only about casual things
Be willing to listen or discuss what concerns me 22 2. Likert Scale : 2. Likert Scale Designed to measure the opinion or attitude of a subject
Contains number of declarative statements with a scale after each statement
Most commonly used scaling technique
Original version of the scale consisted of five categories
Number of categories may range from four to seven
Values are placed on each response, with a value 1 on the most negative response and a value of 5 on the most positive response
Response choices on I most commonly address agreement, evaluation or frequency 23 Example of Likert scale : Example of Likert scale 24 Semantic Differential Scales : Semantic Differential Scales Measures attitude and beliefs
Consist of two opposite adjectives with a 7-point scale between them
Subject is asked to select one point on the scale that best describe his/her view of the concept being examined
Values of 1 to 7 are assigned to each space, with 1 being the most negative response and 7 being the most positive response
Values for scales are summed to obtain one score for each subject 25``` Example of Semantic Differential Scales : Example of Semantic Differential Scales 26 Visual Analogue Scales : Visual Analogue Scales Is a line that is 100 mm long, with right angle “stops” at either end
Line may be oriented horizontally or vertically
Bipolar anchors (secure/fasten) are placed beyond either ends of the line
They include entire range of sensation possible for phenomena being measured e.g. all & none, best & worst, no pain & most severe pain
Subject is asked to place a mark through the line to indicate intensity of the stimulus
Used to measure pain, mood, anxiety, alertness, craving for cigarettes, quality of sleep, attitudes toward environmental conditions, functional abilities and severity of clinical symptoms 27 No pain Most severe
Pain References : References Burns, N., and Grove, S.K. (2007). “Understanding Nursing Research; building an evidence based practice” 4th edition, New Delhi, Elsevier.
Polit, D.F., and Bech, C.T. “Nursing Research; principles and Methods” 7th edition, LWW.
Polit, D.F., and Hungler, B. P. (1993). “Essentials of Nursing Research; Methods, Appraisal, and Utilization” 3rd edition, J.B. Lippincott Company, Philadelphia. 28