For the nursing profession in general, the momentum in research has been increasing greatly in recent years as evidenced by the establishment of the National Center for Nursing Research, the increasing numbers of programs to prepare nurse scientists, and publication of research studies. What is the current state of research in psychiatric nursing?
It has been extensively documented that a widespread gap exists between psychiatric nursing research and practice. Several blocks to clinical research productivity have been identified. These include a lack of administrative support for clinical research, a lack of staff nurse socialization enabling the nurses to interpret and use research, as well as a lack of educational preparation and experience. Other major problems hampering nurses from conducting research include lack of facilities, research funds, and time to conduct research. In addition, there is a general claim that negative attitudes toward research are a factor contributing to lack of involvement in all aspects of nursing research.
Although the literature is replete with references speculating about nurses' attitudes related to nursing research, the majority of opinions are based on conjecture and clinical observation. There is scant empirical data that provides information about psychiatric as well as nonpsychiatric nurses' attitudes toward involvement in and use of nursing research. A study by Fugleberg (1986) compared the attitudes of nurse administrators and staff nurses in nonpsychiatric settings toward nursing research. Findings indicated no significant differences in attitudes between the groups. Although both groups believed that research improves clinical practice and is essential for the development of professional nursing, nursing administrators reported greater involvement in nursing research than staff nurses. Staff nurses most frequently cited involvement in activities associated with research, such as reading professional literature and attending conferences, rather man direct research activities.
According to Bostrom and colleagues (1989), staff nurse involvement in clinical research is dependent on the attitudes nurses hold toward research. Flaskerud (1989) concurs that psychiatric nurses' attitudes toward the research process as well as their own roles have resulted in a parallel between the development of psychiatric/mental health nursing research and nursing research in general.
The purpose of this study was to describe psychiatric nurses' attitudes toward nursing research and their involvement in research activities. Furthermore, this investigation examined whether a relationship existed between research attitudes and involvement and selected demographic variables (ie, professional activities and level of education).
A convenience sample of 92 registered nurses from a large metropolitan psychiatric facility (209 beds) participated in this study. This number represented 5 1% of the total number of RNs employed by this facility (N = 182). The respondents did not differ significantly from the RN population employed in this facility in terms of age and level of education. The ages of sample respondents were distributed as follows: 77% between the ages of 21 and 40; 17% between 41 and 50; and 6% over 50 years of age. The level of education of the sample respondents was: diploma (19%); associate degree (15%); bachelors degree (37%); master's degree (24%); and doctorate (2%).
Both the Probe and Selby's Research Attitude Inventory were distributed to the nursing staff The Probe Nursing Research Questionnaire is a 69-item instrument designed by the authors to gather information about the research attitudes, interests, and activities of nurses (Poster, 1986). The questionnaire is divided into six sections according to the type of information surveyed. These sections include demographic characteristics, research activities, interests and attitudes, professional activities (publishing and presenting papers), and continuing research education preferences.
Content validity was obtained by submitting items on the questionnaire to a panel of four nurse researchers. Three of the members were doctorally prepared nurses; the fourth was master's prepared. Three of the panel members worked in a psychiatric clinical setting. The fourth member was affiliated with an academic institution.
Test-retest reliability was conducted using students (n = 29) enrolled in an undergraduate nursing research course. Test-retest values for Probe items ranged from 58.3 to 100.00. The mean test-retest score was 77.49. (The questionnaire is available from the authors.)
Selby's (1985) Research Attitude Inventory was used to elicit the respondent's attitudes toward research. A Likert-type scale with choices ranging from strongly agree to strongly disagree was used. Subjects were asked to respond to 22 statements related to nurses' interests and feelings about research activities. This questionnaire is reported to have a coefficient alpha of .96 and a split half corrected by the Spearman Brown Prophecy of .97. The Inventory was constructed from a 60-item scale. The scale was pretested on 1 1 nurses, and all items with a power of less than 1 .0 were discarded.
Professional Activities. Descriptive data were collected on the respondents' professional activities. Just over half (57%; 52) of the psychiatric nurses indicated they were not members of any professional organization. Twentyfour percent (22) of the respondents were members of one professional organization. Nineteen percent (18) of the nurses were members of two or more professional organizations.
Twenty-five percent (23) of the psychiatric nurses indicated that they did not read any professional journals on a regular basis. Nearly half of the respondents (49%; 45) reported that they read one or two journals on a regular basis. Twenty-five percent (23) stated that they regularly read three or more professional journals. The majority of journals read by respondents were not related to their specialty but were multispecialty, such as the American Journal of Nursing, which was read by 50% of the nurses.
Respondents were asked to report the number of professional presentations they had delivered over the past 3 years. Sixty percent (55) of the psychiatric nurses indicated that they had not done any; 25% (23) had presented one to two papers; 10% (10) presented between three and 10 papers, and the remaining 4% (4) had done more than 16 presentations. A significant percentage (81%; 94) of the nurses indicated that they had never published an article in a professional journal during their nursing career. Of the 9% (8) who had, six indicated they had previously published two articles or less. Two of the psychiatric nurses reported having published 16 or more articles. These nurses both had doctoral degrees.
Research Interest/Activities. Fortynine percent (45) of the psychiatric nurses indicated that research is an expected activity related to their current position. When asked the ideal percentage of their job they would like to allocate to research, nearly half (49%; 43) reported less than 10%. Ten percent (9) of the psychiatric nurses indicated wanting to spend more than 50% of their job doing research. Responses related to conducting a research study in the coming year represented a broad range of interest: 49% (45) indicated minimal to no interest; 17% (15) indicated moderate interest; and 34% (30) indicated strong interest. Sixty-two percent (57) of the respondents indicated a moderate to strong interest in attending a research conference or workshop in the near future. Thirty-eight percent (35) expressed no interest. Fourteen percent (26) of the nurses surveyed reported current involvement in a research investigation. Of the nurses involved in research activities, only six were principal investigators of the project. Fortytwo percent (11) of the projects were funded by federal or private sources.
Nurses were asked to identify their perceptions of constraints preventing them from being more involved in research. Time was identified most frequently, followed by research not being a work priority. Other constraints reported by respondents included lack of knowledge, lack of skill, lack of funds, feeling intimidated, and lack of administrative support for research.
Research Attitudes. Mean research attitude scores for staffj grouped by educational level, were compared using an analysis of variance followed by Gabriel's Method of Multiple Comparison of Means (Gabriel, 1978). Average scores increased with increased education. Those with master's degrees averaged 3.64, which was significantly greater (p<.05) than the scores for those with bachelors or associate degrees, or nursing diplomas (scores less than 3.16). Although those with doctoral degrees averaged even higher (3.85), they were not significantly higher because there were only two doctorally prepared nurses in the sample. Those who had written a thesis or dissertation had an average research attitude score of 3.73. This was significantly greater (p - .003 by /-test) than 3.23, which was the average score of those who had not written either a thesis or dissertation. The remaining demographic variables (age, gender, race, marital status, and years of employment) were not significantly correlated with research attitude scores.
The findings indicated a large number of nurses were not involved in professional activities beyond the boundaries of their workplace. One can only speculate as to the factors affecting this lack of expansion of professional activities, as this was not assessed in the survey. No other studies surveyed the extramural professional activities of nurses in either psychiatric or other settings that would help to explain this finding. However, these factors may be closely associated with the time constraint identified in this survey as an obstacle to conducting research. Considering the skill and time required to write publishable papers and present papers at professional meetings, the fact that 25% of the nurses had presented at least one paper and 9% had published at least one paper is noteworthy.
Nursing administrators can more effectively increase these activities within an institution by encouraging these successful nurses to be consultants to other nurses as well as to provide time, clerical resources, and encouragement to continue these activities. Courses such as Writing for Publication are another mechanism to enhances nurses' skill, knowledge, and self-confidence. Within this institution, this course is offered biannually and participants are informed of the publication process. In addition, the director of nursing research and education works individually with staff depending on the nurse's needs. Activities range from consulting on developing graphics for a poster session to reviewing and editing drafts of manuscripts.
It was interesting to note that although almost half the nurses felt that research was an expected activity, only 14% reported being involved in a research investigation. The most frequently cited activity of involvement was data collection. The types of data collection activities were not assessed. It is very likely that data collection activities were done for other disciplines in addition to nursing, such as medicine or psychology. The facility in which the study took place is a university teaching hospital with a multidisciplinary approach to patient care, and each discipline has an active research program. It would be instructive to assess this issue further because the experiences of staff nurses with and attitudes toward research may be greatly influenced by other disciplines.
The constraints described by nurses in this study support those described by others, with time being a major barrier, followed primarily by involvement in direct patient care activities. However, it is clear that half the sample believed that less than 10% of their time would be ideally allocated to research activities.
As clearly evidenced in the American Nurses Association Commission on Nursing Research Guidelines for the Investigative Functions of Nurses (1981), research functions are separated according to educational preparation. As found in this study and supported by Fugleberg (1986), the level of educational preparation was positively related to research involvement and positive attitudes. This may be due to the fact that more advanced professional and research skills are learned in graduate programs and elective courses taken by undergraduates. Furthermore, the socialization to the professional role as associated with advanced professional skills does not occur during most undergraduate nursing programs. This is an area that needs further exploration to determine implications for professional development in both the educational and practice settings. This issue is a timely one as the crisis of the nursing shortage becomes more acute and the importance of retention more pertinent.
Research and quality assurance activities have received increased focus in most psychiatric settings during the past few years. In an attempt to clearly delineate nurses' roles in these two closely related areas, job descriptions in this study setting have incorporated tasks in both research and quality assurance. Research as an expected activity is therefore more visible and supported.
Although the status of explicit inclusion of nursing research activities in formal job description in the United States is unclear, it appears that Canadian hospitals have made major gains in this area. Thurston, Tenove, and Church (1990) reported that research roles were included in the job description of staff nurses (70%), unit level managers (89%), and upper level managers (94%) in their sample of 45 teaching hospitals.
A number of strategies have been proposed to assist staff nurses in conducting research and using nursing research results. These methods include role modeling and mentorship (Brogan, 1983; Kramer, 1981), collaboration between researcher and clinician (Barnard, 1980; Feldman, 1980; Jacox, 1980), and involvement in a research consortium (Zalar, 1985). Several nursing programs have been described that have successfully implemented research in their clinical settings (Billie, 1978; Chance, 1980; Egan, 1981; Padilla, 1979). In addition, a wide range of strategies for increasing the appropriate use of nursing research results have also been identified by Stetler's (1989) review of the literature. These strategies are education, research roundtables, visits to sites where research is being conducted, and use of a "research utilization specialist."
The findings of this study have several implications. In terms of research, it would be useful to conduct regional and national studies to assess the research interests, attitudes, and activities of nurses by specialty. This information would provide a national database useful for the development of programs in educational and practice settings as well as for professional policy making.
Several implications for clinical practice can be suggested. A broad-based assessment of nursing staffs research interests, attitudes, and competencies can be gathered on employment. Program development of any research and education department should be based in part on the findings of hospital- wide need assessment surveys. It is likely that most nursing staff have not been taught advanced professional skills, such as writing and public speaking. Both inservice education sessions and individual guided learning experiences can be provided to staff as a means of fostering development of these skills. In addition, a designated nurse editor could provide nursing staff with the continual support and assistance needed to publish both clinical and research papers.
Access to computers and accompanying software is vital. Job descriptions incorporating expected research activities are important but not sufficient to promote such activities. Administrative support in the form of time, statistical support, and clerical support must accompany the expectation so that staff nurses can engage in these activities at a level that is appropriate with their level of education and yet stimulate a more professional and scholarly approach to their nursing practice. It is also important to have a balanced view of the research component of the role of the staff nurse whose major responsibility is the provision of patient care. Therefore, these research findings cannot be used as evidence of a need for increased staff nurse involvement in research simply because the data show these activities to be minimal. Rather, there has to be an interim step that relates the findings to the reality of the clinical patient care setting where many needs compete for the nurses' time and energy.
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