The value of research-based nursing practice has been expressed by the time, energy, and money invested by the nursing profession to increase research productivity. The emphasis in the 1980s was to increase funding for the conduct of research and to increase research based journals which could support the dissemination of findings. An implicit outcome of nursing research activities was that the findings would be used in nursing practice (Bums & Grove, 1993). Knowledge rapidly expanded, but use of the findings did not keep pace. Even with increased generation and dissemination of research findings, a limited amount of this knowledge has been applied in practice (Closs & Cheater, 1994; Kirchkoff, 1983).
The American Nurses' Association (ANA) (1989) continues to emphasize that nurses at any educational level have a role in nursing research. The role of nurses with associate degree preparation is identifying problems, assisting with data collection, and utilizing research findings in practice with supervision. The role of bachelor's prepared nurses is to critique research findings for use in practice and utilization of findings in practice. The role of nurses with advanced education is to collaborate on projects, provide clinical expertise, and conduct research.
The foundation of research utilization models such as the Conduct and Utilization of Research in Nursing (CURN) project (Horsley, Crane, Crabtree, & Wood, 1983) is that nurses have the skill necessary to identify and synthesize research findings for clinical practice solutions. Besides being able to access the research literature, which may be an issue in itself, nurses must be able to critique study findings for clinical application. Using the ANA model (1989), bachelor's prepared nurses should be able to do this. But implicit to this proposition is that nurses have had courses in their bachelor's programs that have prepared them to do so. Some may have had the classes, and some may actually be prepared, but perhaps few have the knowledge, skill, or confidence to actually do so in the current health care environment. To better understand these issues, this descriptive exploratory study was conducted to describe research involvement of nurses in clinical practice and to determine if involvement was consistent with the ANA model.
All Kaiser Permanente nurses throughout the Northern California Region were invited to attend a Regional Nursing Symposium held in March of 1993. A nursing research utilization survey was distributed to all attendees with an invitation to complete the survey during the symposium. The survey consisted of 6 demographic items to describe participants; 15 items asking participants the number of times they had participated in various research activities; 10 items asking participants to rate their interest in future research activity participation; 9 items asking if certain values, skills, or resources would assist with research utilization; 1 item asking participants to rank their comfort using research; and 8 items asking participants their opinion of what a research committee's role might be. The survey questions were written by members of a research committee based on current literature and the overall survey was thought to have content validity.
PRIOR RESEARCH PARTICIPATION
Survey completion implied informed consent to participate. Of the approximately 1,290 nurses present, 753 (58%) from 29 health care facility locations completed the survey. The nurses who participated were mostly from hospital-based positions (n = 241, 59%) and clinic based positions (n = 158, 39%). Most nurses held Staff Nurse II positions (n = 342, 50%) (between entry level positions and clinical expert as defined by a career ladder) or were in supervisory, managerial, or educational positions (n = 246, 37%). Nurses in Staff Nurse III positions, those defined as clinical experts in their area of specialty, represented 13% (n = 92) of the participants while the Staff Nurse I nurses (entry level) comprised only 1% (n = 6). The nurses had from 1 to 48 years of nursing experience with a mean of 19 years.
The majority of respondents had a bachelor's degree or higher education with bachelor's for 48% (n = 340), and a master's or doctorate for 24% (n = 171). Fifteen percent (n = 107) of the respondents obtained bachelor's degrees in disciplines other than nursing. For the remaining 27% (n » 193), the highest education was a diploma (n = 87, 12%) and associate degree (n = 106, 15%). Data were not available to compare education levels between those who participated and those who did not.
DESCRIPTION OF RESEARCH INVOLVEMENT
Prior Participation in Any Research Activity
Nurses were asked to describe their participation in any research activities, nursing or otherwise. The mean and median number of times they had participated in a research activity were both less than or equal to two. The percentage who had participated in each listed activity varied (Table 1).
Nurses were most likely to have collected data for a study. Only 23% (n = 153) had not done so. Research findings had been applied in practice at least once by 69% (n = 446) even though only 49% (n = 318) had taken a formal nursing research course. Most nurses had no prior formal research experience such as participating on a research committee, replicating a study, writing grant proposals, teaching research, or consulting on research.
Nursing Research Activities in the Past Year
Nurses were asked how often they were involved in specific research activities related to nursing practice in the past year. A wide range of responses were noted (from 0 to 100 times); therefore, the mean, standard deviation, and median are presented for each activity (Table 2).
Comfort Level for Utilization in Practice
Nurses were asked how comfortable they were using research in their practice. On a three-point Likert scale, 29% (n = 196) stated they were not comfortable, 53% (n = 365) stated they were comfortable, and 18% (n = 123) stated they were very comfortable.
RESEARCH PARTICIPATION IN THE PAST YEAR
INTEREST IN FUTURE PARTICIPATION
Interest in Specific Research Activities
Interest in future participation of listed research activities was rated using a 4-point Likert scale (1 as not interested, 2 as neutral, 3 as interested, and 4 as very interested). Nurses were most interested in applying findings in practice - 86% (n = 530) were either interested or very interested. They were least interested in designing studies, writing proposals, or teaching others about research. The percentages of those responding as either interested or very interested were used to rank order the responses (Table 3).
Facilitation of Research Utilization
When asked if certain values, skills, or resources would assist in research utilization, all were assessed as helpful. Between 86% (n = 520) and 98% (n - 593) responded positively: It would benefit patients; it made practice more efficient; it would improve cost effectiveness; more time for using research; access to research resources; learn how to identity relevant research findings; research literature was available on units; and learn how to evaluate a research article. The one item that received a slightly lower response (n = 478, 79%) was "if research use was an expectation of job performance." To examine if this was related to either the type of position or level of education, chisquare analyses were conducted using the variables of highest degree and type of position. Neither analysis was statistically significant.
Role of the Nursing Research Committee
Possible research committee activities were ranked in order of importance. Educational forums on current clinical issues was the most important committee activity selected by the majority of respondents (almost double all other responses). Workshops on how to conduct research was the second priority. Other priorities in rank order included the following: workshops on how to use research; brown bag discussions of current articles; unit-based clinical research consultants; review proposals for research studies; and provision of resources for research conduction.
RESEARCH UTILIZATION INVOLVEMENT AND HIGHEST EDUCATION LEVEL
To examine the relationship of highest attained education level on research utilization, the participants were clustered by highest degree (those without a bachelor's, a bachelor's group, and a graduate group for those with master's or doctorate degrees). Chi-square statistics were used in those analyses. Those nurses with a bachelor's degree or higher were clearly different from those without, as they were more involved and interested in research activities and had more research experience. The nurses' highest education level significantly explained variation in interest in research activities and comfort with using research findings in practice. As education increased, interest and comfort increased. The percentage of nurses who were not comfortable was 41% (n - 30) for diploma nurses, 38% (n = 37) for associate, 30% (n - 92) for bachelor's, and 15% (n = 24) for master's or doctorate. Interest in attending a nursing research class was not statistically significant - nurses at all education levels were interested. Chi-square values (?2), ? values for statistical significance, and Cramer's V (the percentage of response variance explained by education) are provided (Table 4).
CHI-SQUARE ANALYSIS: RESEARCH UTILIZATION BY EDUCATION LEVEL
Highest level of education was also statistically significant for current job position (chi-square 181, p<.0000). Of the Staff Nurse I nurses, 50% (n = 3) had undergraduate degrees and none had graduate degrees. Of the Staff Nurse II nurses, 51% (n = 171) had bachelor's degrees and 9% (n = 29) had graduate degrees. Staff Nurse III nurses were very similar, as 50% (n = 45) had bachelor's degrees and 9% (n = 8) had graduate degrees. Of the supervisors, managers, and educators, 50% (n = 121) had graduate degrees and 44% (n ~ 106) had bachelor's degrees.
DISCUSSION AND RECOMMENDATIONS
These data did support the ANA model (1989) of progressive involvement in research utilization and research conduct. A relationship exists between educational preparation and research utilization and involvement in research activities. Throughout the data, education impacted both interest levels and experience. Nurses with higher nursing education were more comfortable using research in practice. These findings were similar to Lacey's (1994) in the United Kingdom.
The median number of times nurses participated in nursing research activities in the past year reflected little usage of research findings for direct patient care or translation into nursing practice, even though the nurses were reading research articles and sharing them. This suggests barriers to research utilization. Closs and Cheater (1994) proposed three prerequisites for effective utilization: a positive research culture; interest from those with the potential to utilize findings in practice; and wide-ranging support from managers and peers. This study demonstrated interest, but culture and support factors were not examined. It would appear that a positive research culture exists within the Kaiser Permanente environment. Bostrum and Su ter (1993) also surveyed California nurses (N= 1,588) and found that 16% had used research to change nursing practice in the past 6 months, and 23% had done so in the past. This compared to 69% of the Kaiser nurses who stated they had applied research findings in practice in the past.
Educational objectives for teaching research must include the attitude of appreciation and enthusiasm for research utilization (Phillips, 1986). While it is important to teach critique and how to conduct research, more attention needs to be placed on the value of research utilization. While practicing nurses may be expected to implement research findings, they may not have the educational preparation required to do so. If research-led decision making and practice are to be fostered and sustained, nurses must be assertive and able to effectively manage change and conflict in the process. Lacey (1994) also found many nurses in the United Kingdom were not sufficiently confident to challenge their colleagues and make a case for change. The research utilization work of Funk, Champagne, Wiese, and Tornquist (1991a, 1991b) also supports this. A survey of 1,000 clinicians found that 8 of the top 10 barriers to utilization were related to the setting and administration, including lack of authority to change practice, insufficient time on the job, and lack of support. Ninety-four percent of the Kaiser nurses also stated that more time for using research would assist in utilization.
Clinical settings should use nurses with higher education as mentors and role models to demonstrate the value of research utilization. Although these nurses may need assistance to prepare for research mentorship, they may be untapped assets that already exist throughout organizations. For those nurses who are not comfortable using research in practice, introductory classes on the research process and research utilization should be offered. Substantial interest existed in taking research classes (n = 419, or 67%, were interested or very interested). This would assist nurses in the application of research findings to patient care and nursing practice once the culture demonstrates this value. Research committees within clinical settings could provide "how to" classes on research and use of research for current clinical topics. Study participants expressed considerable interest in becoming involved in these research activities.
Schools of nursing and academic settings should establish collaborative relationships to share their research resources with clinical settings in their communities. Tornquist, Funk, and Champagne (1995) suggest that we must join researchers and clinicians to reconnect research conduct and use in practice. Within the current financially constrained environment, both schools and clinical agencies may need to collaborate to continue research efforts. Collaborative projects, which foster team work, must be encouraged among students and faculty, as well as among academic and clinical agencies. And most important, those teaching must role model research utilization both in schools and clinical settings.
- American Nurses' Association (1989), Education for participation in nursing research. Kansas City, MO: Author.
- Bostrum, J., & Suter, W.N. (1993). The utilization of research findings in clinical nursing practice. Journal of Nursing Staff Development, 9, 28-34.
- Burns, N., & Grove, S.K. (1993). The practice of nursing research: Conduct, critique, and utilization. Philadelphia: Saunders.
- Closs, S.J., & Cheater, RM. (1994). Utilization of nursing research: Culture, interest, and support. Journal of Advanced Nursing, 19, 762-773.
- Funk, S.G., Champagne, M.T., Wiese, R.A., & Tornquist, E.M. (1991a). Barriers: The barriers to research utilization scale. Applied Nursing Research, 4, 39-45.
- Funk, S.G., Champagne, M.T., Wiese, R.A., & Tornquist, E.M. (1991b). Barriers to using research findings in practice: The clinician's perspective. Applied Nursing Research, 4, 90-95.
- Horsley, J.A., Crane, ]., Crabtree, M.K., & Wood, D.J. (1983). Using research to improve nursing practice: A guide, CURN Project. New York: Grune & Stratton.
- Kirchkoff, K.T. (1983). Using research in practice: Should staff nurses be expected to use research. Western Journal of Nursing Research, 5, 245-247.
- Lacey, E.A. (1994). Research utilization in nursing practice: A pilot study, journal of Advanced Nursing, 19, 987-995.
- Phillips, L.R. (1986). A clinician's guide to the critique and utilization of nursing research. Norwalk, CT: Appleton-Century-Crofts.
- Tornquist, E.M., Funk, S.G., & Champagne, M.T. (1995). Research utilization·. Reconnecting research and practice. AACN Clinical Issues, 6, 105-109.
PRIOR RESEARCH PARTICIPATION
RESEARCH PARTICIPATION IN THE PAST YEAR
INTEREST IN FUTURE PARTICIPATION
CHI-SQUARE ANALYSIS: RESEARCH UTILIZATION BY EDUCATION LEVEL