Nursing research is vital to the practice of nursing and to the recipients of nursing care. Research has the potential to extend the scientific knowledge base of practitioners, to assist nurses to define the scope of nursing practice, to improve the quality of nursing interventions and patient outcomes, to foster critical thinking and decision-making, to enrich the practice environment, and to identify the unique difference nursing makes in the health status of individuals. This potential however, cannot be realized until research is critically evaluated and appropriately utilized (Tanner, 1987). Research and research utilization are interdependent processes that help further nursing science (Horsley, Crane, Crabtree, & Wood, 1983) and while the conduct of nursing research could justifiably be incorporated into a definition of research utilization, the goal of each of these endeavors differs significantly. The goal of conducting research is directed toward "the production of knowledge that is generalizable beyond the population directly studied" (Horsley, Crane, & Bingle, 1978, p. 5) while the goal of research utilization is "directed toward transfer of specific research-based knowledge into actual practice" (Horsley, Crane, & Bingle, 1978, p. 5).
Despite persistent demands for nursing practice which is research-based, an increase in the number of published and unpublished research studies, and an increase in the number of research-prepared nurses, there remains a large gap between knowledge production and knowledge utilization (Polit & Hungler, 1995). Although there has also been cÜssemination of research findings in the literature and through conferences and presentations, a great deal of nursing research is never utilized in practice (Brett, 1987; Coyle & Sokop, 1990; Ketefian, 1975). Hunt (1987) asserted that "nursing research is largely incomprehensible, unread and unused by practising (sic) nurses" (p. 101) perhaps related in part to a lack of understanding of the research process. Since exposure to research during the nurse's basic nursing educational experience may be limited (Bower, 1994), continuing/staff development educators can play a pivotal role in facilitating utilization of nursing research. By familiarizing themselves with projects and models which provide a framework for research utilization in the clinical setting and identifying the barriers and obstacles to research utilization, continuing/staff development educators will broaden the knowledge base from which they assist nursing staff in the utilization of research findings and innovations.
RESEARCH UTILIZATION PROJECTS AND MODELS
Stetler and Marram (1976) asserted that research findings have little influence on nursing practice because no systematic criteria have been set forth to carry the nurse from critique of the research study through application of the findings. Development of a conceptual model for research utilization would identify assumptions, definitions, rationale, and explicit guidelines, thus formulating a framework for research utilization behavior (Stetler, 1989). Use of such a model would provide a plan to guide the user in bridging the gap between knowledge generation and knowledge utilization. Several research utilization projects and models have appeared in the literature which have been successfully utilized by the nursing community.
Diffusion of Innovations
Rogers (1962) investigated the processes by which an innovation (an idea new to the individual) spreads or diffuses from its source of invention to its ultimate users. He idetit'died the adoption process as the mental process through which an individual passes from first hearing about an innovation through final adoption of that innovation. Rogers (1962) asserted that adoption involves one type of decision-making which encompasses five stages: awareness, interest, evaluation, trial, and adoption.
In the awareness stage, an individual is exposed to an innovation but they lack complete information about that innovation. It is not until the interest stage that the individual seeks additional information about the innovation. At the evaluation stage, the individual mentally applies the innovation to one's present or future situation. Positive reinforcement and encouragement from peers is essential during the evaluation phase to assist the individual in deciding whether or not to implement the innovation. During the trial stage, the individual implements the innovation on a small scale to determine its utility. In the adoption stage, the results of the trial are reviewed and the individual decides whether to continue full use of the innovation.
Rogers (1962) likened the adoption process to a gestational period, noting that there are important time lags between development and implementation of the innovation. The time lapse from awareness of the innovation through adoption of the innovation can span from a few days to several years. Diffusion of innovations has served as a framework for several nursing research utilization projects and models.
The WICHE Project
The Western Interstate Commission for Higher Education (WICHE) initiated one of the first largescale nursing research utilization projects in the United States. The project, directed by Janelle Krueger, drew nurses from various settings together for a series of 3-day workshops designed to tie nursing research to nursing practice. Diffusion of innovations, planned change, and linkage systems (the transfer of innovations from resource systems to user systems) provided the theoretical basis for the project.
Participants in the project were taught to critically evaluate research, identify clinical problems that required research-based solutions, and function as change agents introducing innovations into their practice setting. Some practice innovations emanating from the project involved patient teaching, the institution of primary care, and the restructuring of prenatal teaching clinics. Evaluation of the workshops identified attitude of staff and lack of time, money, and resources as major obstacles. Locating quality research findings that were relevant and significant to nursing practice however, was identified as the most frustrating obstacle encountered (Krueger, 1978).
The NCAST (Nursing Child Assessment Satellite Training) project, directed at the individual nurse practitioner, was designed to assess whether satellite communication technology and interaction between the nurse researcher and nurse practitioner was an efficient means of communicating research findings. Roger's (1962) diffusion of innovations provided the theoretical framework.
King, Barnard, and Hoehn (1981) developed the project and proposed a model to hasten the dissemination of research findings from the nurse researcher to the practicing nurse. The model consisted of four interdependent and interacting components: recruitment, translation, dissemination, and evaluation. Recruitment, the initial phase, assists in defining the target population to whom the research findings are to be communicated. Translation is the process by which research findings are transformed into a format that can be easily understood by practicing nurses. Translation produces an identifiable end product in which each staff nurse has a personal investment. Dissemination is the process of communicating the research findings in an effective and efficient manner. Interaction between learners and researcher-instructor is integral to the process. Evaluation, both formafive and summative, assesses the impact of each of the components of the model on the others.
King, Barnard, and Hoehn (1981) argued that researchers must assume partial responsibility for the dissemination and utilization of their insights. They asserted that researchers should devote a larger portion of their research budget toward translation of findings to practitioners and should make systematic plans from the beginning of their research to disseminate findings.
The CURN (Conduct and Utilization of Research in Nursing) project, developed between 1975 and 1980, was directed by Jo Anne Horsley. Using diffusion of innovations, principles of planned change, and user-resource linkage, the project sought to develop and test a method to transfer research findings into viable nursing practice activities (Horsley, Crane, & Bingle, 1978). In the context of the project, research utilization was viewed as a "systematic series of activities that culminate in the change of a specific nursing practice" and as "an organizational process to be carried out by and for the total nursing staff in a department of nursing" (Horsley, Crane, Crabtree, & Wood, 1983, p. 2).
The research utilization model tested in and emerging from the project consisted of a seven-phase process. These phases included:
1. Systematically identifying patient care problems.
2. Identifying and assessing research-based knowledge to solve identified patient care problems.
3. Adapting and designing the nursing practice innovation.
4. Conducting a clinical trial and evaluation of the innovation.
5. Deciding whether to adopt, alter, or reject the innovation.
6. Developing the means to extend or diffuse the new practice beyond the trial unit.
7. Developing mechanisms to maintain the innovation over time.
As a result of the project, nursing innovations or protocols were developed and published for patient care problems including pressure ulcers, urinary catheterization, pain reduction, structured preoperative teaching, and intravenous cannula change. Though currently out of print, the book Using Research to Improve Nursing Practice: A Guide (Horsley, Crane, Crabtree, & Wood, 1983) serves as an invaluable resource for nurses desiring to use research as a basis for practice.
The Stetler/Marram Model
The Stetler/Marram model first appeared in the literature in 1976 and was developed as a "pragmatic attempt to make research real for students and thus, eventually for practitioners" (Steuer, 1994, p. 15). Though it did not have a specific research basis nor was it based on a specific conceptual framework, it provided nurses with criteria to carry them from critique to application of research findings. The model encompassed three essential phases of critical thinking: validation, comparative evaluation, and decisionmaking. During the validation phase, the research consumer conducts a classical critique of the research study and if the research is deemed valid, prepares a statement "including details of what was found, about whom or what, under what conditions, by whom, when, where, and how" (Stetler & Marram, 1976, p. 560). In the comparative evaluation phase, the consumer evaluates the study for its clinical applicability with respect to four criteria, assessing the feasibility of application in the practice environment. During comparative evaluation, Stetler and Marram (1976) encourage the research consumer to examine the efficacy and theoretical base of current nursing practice to determine if a change in current practice is warranted.
In the decision-making phase, the consumer critically decides among one of three levels of application: nonapplication, cognitive application, or direct application. Nonapplication occurs with the decision to not allow the study to influence future behavior. Nurses, however, may choose to use knowledge gained from the research study to enhance their theoretical approach to nursing (cognitive application) or may choose to utilize the findings as a catalyst to evaluate current practice or as a model for action (direct application).
Change was not the focus of the Stetler/Marram model, but rather it assumed that research utilization is "an integral part of a practitioner's routine decisionmaking/problem-solving activity" (Stetler, 1985, p. 42). The model was practitioner-oriented and the authors asserted that the employing institution may or may not be involved in the nurse's individual use of research.
To make the model more usable, Stetler (1989) converted the model into a tool; the Stetler/Marram Tool for Evaluation of Applicability of Research Findings. The tool, perhaps inspired by checklists developed by the CURN project, consists of a series of questions and forced-choice decisions which coincide with the three phases of the model: validation, comparative evaluation, and decision-making. Prerequisite to using the Stetler/Marram tool however, is a sound knowledge of the research process, the research utilization process, and the area of nursing under review. As such, the tool is best utilized by graduate students, clinical nurse specialists, or others prepared at the master's level (Stetler, 1989).
Several limitations of the Stetler/Marram model were identified by Grinspun, MacMillan, Nichol, and Shields-Poe (1993). They claimed that the model failed to clearly address the role of the staff nurse in identifying clinical practice problems and failed to indicate how changes in practice are to be disseminated throughout the institution. Further, they indicated that the model failed to attend to findings from qualitative studies and implied that research utilization is a linear, unidirectional process. Stetler (1994) also noted that a consistent criticism of the model was the lack of a specific evaluation component but argued that the model has been widely cited, utilized, and modified by those interested in the research utilization process.
The Stetler Model
Li 1994, Stetler presented the Steuer Modei, a refinement and expansion of the original Stetler/Marram (1976) model. The Stetler model incorporated the three phases of the original model (validation, comparative evaluation, and decisionmaking) and added three new phases (preparation, translation/application, and evaluation).
Stetler (1994) noted that previous research utilization models (e.g., CURN) have evolved from a traditional knowledge utilization perspective. Within this traditional perspective, research findings are seen to move from knowledge producer to user through a formal organizational change agent. Institutional policies are formulated and planned change techniques are used for implementation with adoption, not adaptation, of protocols as expected behavior. The revised Stetler Model was strongly influenced by the nontraditional-knowledge utilization literature (Stetler, 1994). Within this viewpoint, research utilization may occur in three forms; instrumental, conceptual, or symbolic.
While these three forms of research utilization may occur simultaneously, instrumental utilization refers to direct adoption or adaptation of innovations. It may involve the development of formal departmental policies and procedures or may be implemented by individuals without input from the organization. Conceptual research utilization occurs when the research influences understanding or the way one thinks about a given topic. Cumulative understanding of a topic may then lead to subtle changes in personal behavior. Symbolic or political utilization occurs when the research is used to legitimize policy or to defend a specific point of view.
The six phases of the Stetler Model (Stetler, 1994) include:
1. Preparation - requires the user to specify the purpose of their research review, be rnmdful of external pressures (e.g., deadlines), and unlike the original model, include any type of research in the literature review.
2. Validation - requires a utilization research critique with accept/reject as endpoints. If the decision is to accept, an "applicable statement of findings'' is developed.
3. Comparative evaluation - utilizes the four criteria, fit of setting, feasibility, substantiating evidence, and current practice to determine clinical applicability.
4. Decision-making - requires an integrated decision based on the initial purpose of the research review. It leads to a decision to use, to consider use, to delay use, or to reject use of the research findings.
5. Translation/application - requires the consumer to rationally form or reform findings into action terms. The focus is on critical thinking and decisionmaking at the practitioner level.
6. Evaluation - involves clarification of expected outcomes with respect to the identified purpose and may incorporate a variety of formal and informal evaluation strategies.
Stetler (1994) envisioned the model "as a prescriptive, practitioner-oriented model designed to mitigate some of the human frailties of decision-making and thus facilitate appropriate, effective, and pragmatic utilization; raise the consciousness of potential users; and increase the role of critical thinking in professional practice" (p. 25).
BARRIERS AND OBSTACLES TO RESEARCH UTILIZATION
If the ultimate goal of nursing research is to improve nursing care, the research will be of little value until the knowledge gained from that research is diffused and incorporated into the delivery of nursing services. While not all research findings warrant utilization and although there is an inevitable time lag between generation and utilization of knowledge, hastening the process of research utilization is essential to prevent the findings from becoming obsolete before reaching the nurse consumer. Three barriers inhibiting the utilization of nursing research have been consistently identified in the literature. These include, availability of research findings, knowledge and attitudes of nurses, and environmental support (Barnsteiner, 1994; Champion & Leach 1989; Funk, Champagne, Wiese, & Tornquist, 1991; Lekander, Tracy, & Lindquist, 1994).
Availability of Research Findings
Miller and Messenger (1978) reported that the problem most frequently encountered when trying to utilize research in practice was the inability to obtain research findings in one's area of interest. Horsley, Crane, Crabtree and Wood (1983) claimed that clinical nursing research reports are not readily available while Nieswiadomy (1993) further asserted that most nursing research studies are never presented or published. While access to research findings is necessary before utilization of knowledge can occur, the number of journals devoted to research; the multitude of local, national, and international research conferences; and the variety of computer networks and databases available seem to provide empirical support that research findings are readily available. The barrier may not be the lack of availability of research reports, but rather the way in which research findings are communicated to clinical practitioners.
While there are those who claim that nurses infrequently read professional journals, Barnsteiner (1994) noted that most research is published in journals which are not widely read by clinical nurses. Studies reported in research journals are "commonly full of research jargon intended for other researchers, not clinicians; they emphasize the reliability and validity of measurements rather than what was actually measured; they focus of the statistical tests performed rather than the meaning of the findings; (and) they rarely indicate what information may be applicable to practice" (Funk, Champagne, Wiese, & Tornquist, 1991). If research findings are to be utilized in clinical practice, then these reports must be published in journals read by clinicians and they must be written with greater emphasis on clear presentation of the findings and "detailed discussion of their utility and feasibility in clinical practice" (Tornquist, Funk, & Champagne, 1989, p. 577).
Knowledge and Attitudes of Nurses
The knowledge base and the attitude of the nurse toward research present real barriers to the utilization of research in the clinical setting. Exposure to research in basic educational programs is varied and may be limited or absent. This limited exposure to research during the educational experience is compounded by: 1) nursing textbooks which often do not indicate whether the information provided is based on research, 2) classroom content which may not incorporate a discussion of research findings, and 3) faculty who may have limited educational preparation in the research process (Burns & Grove, 1987). Therefore, utilization of research after graduation is limited because nursing students are not "enculturated to utilizing nursing research in their practice" (Burns & Grove, 1987, p. 641).
There is also evidence to indicate that nurses are unaware of many research findings. Ketefian (1975) found that only one of the 87 participants in her study was aware of the optimum length of time for placement of oral thermometers, a finding which had been widely published in the nursing literature. Kirchoff (1982) described the lack of diffusion of research findings related to the unnecessary withholding of ice water and rectal temperatures from coronary patients. In a survey of almost 2,000 nurses (Funk, Champagne, Wiese, & Tornquist, 1991), the third most important barrier to research utilization identified was that the nurse was unaware of the research.
Undergraduate educational programs often do not provide adequate information about research to allow graduates to make critical assessments of the research report and informed judgments about incorporating research findings into practice. Further, a lack of active dialogue between nurse researchers and nurse clinicians inhibits not only knowledge of findings, but also the transfer of these findings to clinical practice.
Bower (1994) asserted that under-utilization of research findings is attributable to nurses' attitudes toward and value of research rather than to the availability of research or the ability of the practitioner. Thirty-five percent of nurses in a recent study (Funk, Champagne, Wiese, & Tornquist, 1991) perceived as a barrier to research utilization that the nurse does not see the value of research for practice. In the past, much nursing research has focused on nurses, nursing education, nursing models, and the history of nursing, rather than clinical nursing problems. As problem-solvers, nurses come to expect that research results should have immediate relevance to the practice setting and they come to dismiss the value of research when research findings are not immediately applicable to practice (Lekander, Tracy, & Lindquist, 1994). For those nurses with advanced degrees, the arduous task of completing a thesis or dissertation may foster the attitude that research is an educational requirement leaving the nurse questioning the value of research in the clinical setting (Bower, 1994).
Nursing is a profession steeped in tradition, and resistance to change is widespread. Many nurses feel that they lack the authority to change patient care procedures (Funk, Champagne, Wiese, & Tornquist, 1991) and often will not accept new knowledge until it is sanctioned by leaders in the local social structure (King, Barnard, & Hoehn, 1981). Lack of motivation and incentives to change may further inhibit innovativeness, the degree to which an individual is earlier in adopting new ideas than other members of the social system (Rogers, 1962).
The employment environment is often viewed as an impediment to research utilization. Eight of the top ten barriers to research utilization identified by nurses in a survey conducted by Funk and colleagues (1991) were related to the practice setting. The identified barriers included insufficient time on the job to implement new ideas, lack of physician and administrative cooperation, lack of support from nursing staff, and lack of time to read research. Additional environmental barriers include heavy workload, lack of nurse role models, limited financial resources, insufficient time off to attend conferences, failure to create an atmosphere of contemplation and reflection, and lack of rewards for those exhibiting the intellectual curiosity to challenge the status quo.
IMPLICATIONS AND STRATEGIES FOR CONTINUING/STAFF DEVELOPMENT EDUCATORS
Many have argued that current and sound research-based knowledge is essential if nurses are to practice professionally (Grinspun, MacMillan, Nichol, & Shields-Poe, 1993; Huber, 1994; Lekander, Tracy, & Lindquist, 1994; McGuire, Walczak, & Krumm, 1994). To facilitate the complex process of synthesizing, transforming, applying, and evaluating the incorporation of research findings into practice, the continuing/staff development educator must develop and utilize strategies to overcome the barriers impeding translation of research into practice. The implementation process will vary as each clinical setting is unique, but it may be helpful for the educator to focus on facilitating the availability of research findings, the attainment of knowledge and positive attitudes, and the provision of environmental support.
Facilitating Availability of Research Findings
Research utilization cannot occur if research findings are not available and accessible, for nurses cannot be expected to adopt research findings if they do not know they exist. Brett (1987) found a weak but significant correlation between the number of hours spent weekly reading professional literature and adoption of research findings. Providing written research materials to staff nurses then seems imperative. The continuing /staff development educator could post pertinent research articles on a research bulletin board, develop a research newsletter, and assure that the institution's library subscribes to nursing research journals as well as those focusing on clinical practice. If library resources are limited, nurses might be encouraged to circulate personal copies of journals to which they subscribe. A journal club which meets regularly (e.g., Tibbies & Sanford, 1994), might not only foster reading research articles, but also assist in developing critical appraisal skills necessary for evaluation of findings.
Onsite conferences, teleconferences, and videotapes can also facilitate exposure to research findings. Poster presentations of completed research and related clinical issues could be prominently displayed on individual units, near nursing offices, or adjacent to the employee cafeteria. Further exposure to research findings could be provided by developing a research hotline providing the staff with telephone connections to local universities and teaching hospitals. Citing research findings in policy and procedure manuals and including research in meeting agendas also facilitates staff exposure to research.
Since many units have computers, it might be feasible to provide access to The Online Journal of Knowledge Synthesis for Nursing. The journal is online 24 hours a day and provides continuous publication of new articles within 48 hours of final acceptance. Each article provides a summary of the research, practice implications, and annotated critical references (Barnsteiner, 1994). Subscriptions to the journal are initiated through Sigma Thêta Tau International.
Facilitating Attainment of Knowledge
As many staff nurses may have a limited background in research, the continuing /staff development educator may need to begin by providing staff with educational programs focusing on an overview of the research process. The educator may wish to consult any one of a multitude of nursing research texts, or guidelines published specifically for continuing /staff development educators (e.g., Mottola, 1996) for assistance with identifying appropriate course content.
The process of research utilization logically begins with simultaneously reading the literature and identifying clinical patient care problems. To encourage reflective thinking about clinical practice problems, Grinspun, MacMillan, Nichol, & Shields-Poe (1993) encouraged staff to keep a daily log of practice questions. As an alternative to requesting staff to keep personal journals, a unit log book for clinical problems/questions could be used or a departmental suggestion/question box could be provided.
For utilization to occur, nurses must have not only access to and knowledge of research findings, but also the ability to critically evaluate research for its relevance to practice. Numerous strategies and guidelines to facilitate critical assessment of research studies can be found in the literature. Haller, Reynolds, and Horsley (1979) identified four criteria important to the assessment process including evaluation of scientific merit, assessment of extent of replication of findings, evaluation of clinical relevance, and evaluation of the outcomes of clinical use. Thomas (1990) provided a generalized rating form for critiquing studies, Burns and Grove (1987) identified key questions to assist in analysis, and PoUt and Hungler (1995) provided extensive guidelines for the "critical and intelligent" review of reported research. Equally helpful are the Probability of Adoption Assessment Guide developed by Horsley, Crane, Crabtree and Wood (1983) and the Stetler/Marram Tool for Evaluation of Applicability of Research Findings (Stetler, 1989).
Continuing /staff development educators could also foster the development of unit-based research committees whose purpose is to learn and practice critical assessment of research findings (Long, 1992) and encourage staff with research expertise and advanced degrees to serve as mentors for colleagues. Educators might also encourage interested staff to seek appointment to the institutional research review board. Additionally, the staff development educator may elect to develop a research utilization manual which contains materials and articles pertinent to the utilization process.
Facilitating Attainment of Positive Attitudes and Values about Research
Though attitudes are often difficult to change, the staff" development professional can serve as an effective role model in reaffirming the value of research by incorporating research into their daily practice and teaching. Frequent reference to pertinent research studies when teaching specific procedures verifies the relevance of research findings. Linking research utilization to written departmental goals and objectives, position descriptions, and performance review criteria, further reinforces the value of nursing research. Positive attitudes among new staff members can be fostered by incorporating information about ongoing research utilization programs and the nurse's role in them, as part of the initial orientation program.
Continuing/staff development educators can also create positive attitudes about research utilization by encouraging a spirit of questioning and intellectual curiosity, by not becoming defensive. It might also be instrumental for educators to seek the assistance of staff members who are perceived as decision-makers, innovators, or informal leaders, as positive attitudes among this group may be respected by and influence the opinions of other staff members. Educators can also demonstrate valuing research by exploring ways to provide rewards or recognition for staff attempts at implementation of innovations. Critical thinking, creativity, motivation, and risk-taking behaviors within the parameters of patient safety should also be recognized. Further, as staff members develop clinical innovations, Stevens (1994) recommended exploration of patenting, copyrighting, or commercializing as a means of enhancing the value of those ideas.
Facilitating Environmental Support
Continuing /staff development educators must seek to create a working environment that is open to change. Resistance to change is inevitable as change is often perceived as burdensome and time-consiiming and suggesting a change in procedure may imply deficiencies in current performance. The manner in which planned change is communicated may also lead to resistance. It is essential then, that educators develop effective interpersonal communication patterns and become conversant with theories of planned change.
Nurses must be empowered to believe in their own authority to change and influence nursing practice. Providing emotional, moral, and technical support to staff will enhance their attempts to incorporate research findings in their practice. As physical and monetary resources are necessary for implementation, part of the educational budget could be allocated perhaps, for the purchase of needed research utilization resources including textbooks, journals, consultants, and guest speakers. Incorporation of patient care innovations derived from the research can also be facilitated by assisting staff in adopting or adapting a research utilization model to serve as a guide to implementation.
Educators often serve as a liaison between nursing adininistration and the clinical nursing staff. In this role, the educator can foster environmental support for research utilization by securing adrninistrative sanction for research committees, release time to review the literature or attend research conferences, onsite research conferences, employee recognitions, and research-based policies and procedures. The educator might also convince adrninistrators to provide computers, online services, or other needed resources particularly if implementation of research findings could be shown to be cost effective.
Continuing/staff development educators are pivotal to any research utilization program because they possess the resources to directly influence nursing staff in their provision of patient care. Implementing an enduring program of research utilization however, is a demanding task requiring intellectual rigor and discipline, creativity, clinical judgment and skill, organizational savvy, and endurance (Horsley, Crane, Crabtree, & Wood 1983). This article has sought to provide the continuing/staff development educator with an overview of the research utilization process.
Research utilization projects including the WICHE (Krueger, 1978), NCAST (King, Barnard, & Hoehn, 1981), and CURN (Horsley, Crane, Crabtree, & Wood, 1983) projects were presented and the Stetler/Marram (1978) and revised Stetler (1994) research utilization models were reviewed. Three common barriers impeding research utilization were identified, including availability of research findings, knowledge and attitude of nurses, and environmental support. Finally, effective strategies to overcome the barriers to research utilization were suggested.
- Barnsteiner, J. (1994). The online journal of knowledge synthesis for nursing. Reflections, 29(2), 10-11.
- Bower, F. (1994). Research utilization: Attitude and value. Reflections, 29(2), 4-5.
- Brett, J. (1987). Use of nursing practice research findings. Nursing Research, 36(6), 344-349.
- Burns, N., & Grove, S. (1987). The practice of nursing research: Conduct, critique, and utilization. Philadelphia, PA: W.B. Saunders.
- Champion, V., & Leach, A. (1989). Variables related to research utilization in nursing: An empirical investigation. Journal of Advanced Nursing, 14, 705-710.
- Coyle, L., & Sokop, A. (1990). Innovation adoption behavior among nurses. Nursing Research, 39(3), 176-180.
- Funk, S., Champagne, M., Wiese, R., & Tornquist, E. (1991). Barriers to using research findings in practice: The clinician's perspective. Applied Nursing Research, 4(2), 90-95.
- Grinspun, D., MacMillan, K., Nichol, H., & Shields-Poe, D. (1993, January). Using research findings in the hospital. The Canadian Nurse, 46-48.
- Haller, K., Reynolds, M., & Horsley, J. (1979). Developing research-based innovation protocols: Process, criteria, and issues. Research in Nursing and Health, 2, 44-51.
- Horsley, J., Crane, J., & Bingle, J. (1978). Research utilization as an organizational process. Journal of Nursing Administration, 8, 4-6.
- Horsley, J., Crane, J., Crabtree, M., & Wood, D. (1983). Using research to improve nursing practice: A guide. New York, NY: Grune and Stratton.
- Huber, G. (1994). Clinical nurse specialist and staff nurse: Colleagues in integrating nursing research with clinical practice. Clinical Nurse Specialist, 8(3), 118-121.
- Hunt, M. (1987). The process of translating research findings into nursing practice. Journal of Advanced Nursing, 12, 101-110.
- Ketefian, S. (1975). Application of selected nursing research findings into nursing practice: A pilot study. Nursing Research, 24(2), 89-92.
- King, D" Barnard, K., & Hoehn, R. (1981). Disseminating the results of nursing research. Nursing Outlook, 29(3), 164-169.
- Kirchoff, K. (1982). A diffusion survey of coronary precautions. Nursing Research, 31, 196-201.
- Krueger, J. (1978). Utilization of research: The planning process. Journal of Nursing Administration, 8(1), 6-9.
- Lekander, B., Tracy, M., & Lindquist, R. (1994). Overcoming the obstacles to research-based clinical practice. Maternal-Child Nursing, 5(2), 115-123.
- Long, R. (1992). Research utilization by staff nurses: Successful strategies. Critical Care Nursing Quarterly, 15, 23-28.
- McGuire, D., Walczak, J., & Krumm, S. (1994). Development of a nursing research utilization program in a clinical oncology setting: Organization, implementation, and evaluation. Oncology Nursing Forum, 21(4), 704-710.
- Miller, J., & Messenger, S. (1978). Obstacles to applying nursing research findings. American Journal of Nursing, 78(4), 632-634.
- Mortola, C (1996). Research in nursing staff development. In R. Abruzzese (Ed.), Nursing staff development: Strategies for success (2nd ed.) (pp. 326-45). St. Louis, MO: CV. Mosby.
- Nieswiadomy, R. (1993). Foundations of nursing research (2nd ed.). Norwalk, CT: Appleton & Lange.
- Polit, D., & Hungler, B. (1995). Nursing research: Principles and methods (5th ed.). Philadelphia, PA: J.B. Lippincott.
- Rogers, E. (1962). Diffusion of innovations. New York, NY: The Free Press.
- Stetler, C. (1985). Research utilization: Defining the concept. Image: The Journal of Nursing Scholarship, 17(2), 40-44.
- Stetler, C. (1989). A strategy for teaching research use. Nurse Educator, 13(3), 17-19.
- Stetler, C. (1994), Refinement of the Stetler/Marram model for application of research findings to practice. Nursing Outlook, 42(1), 15-25.
- Stetler, C, & Marram, G. (1976). Evaluating research findings for applicability in practice. Nursing Outlook, 24(9), 559-563.
- Stevens, K. (1994). Patents and the nurse scholar. Part I: The basic philosophy of intellectual property. Reflections, 20(3), 36-38.
- Tanner, CA. (1987). Evaluating research for use in practice: Guidelines for the clinician. Heart and Lung, 16, 424-431.
- Thomas, B. (1990). Nursing research: An experiential approach. St. Louis, MO: C V Mosby.
- Tibbies, L. , & Sanford, R (1994). The research journal dub: A mechanism for research utilization. Clinical Nurse Specialist, 8(1), 23-26.
- Tornquist, E., Funk, S., & Champagne, M. (1989). Writing research reports for clinical authences. Western Journal of Nursing Research, 11, 567-582.