Research Utilization in Nursing

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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

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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 utilization (2) direct research utilization involving the direct use of findings in giving patient care and therefore analogous to instrumental utilization (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

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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

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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 Replicate 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 Communicate clearly 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 following Strategies; 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 Rarely Sometimes 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