Norwegian nurses' perceived barriers and facilitators to research use

AORN Journal,  March, 2004  by Jorunn Hommelstad,  Cornelia M. Ruland

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For decades, researchers have explored the extent to which nurses use research findings in their practice. (1) Despite different programs and strategies to enhance use of research findings, a gap between theory and practice still exists. (2,3) The quantity and quality of nursing research related to clinical practice has increased, but the growth in research has not been paralleled by a comparable growth in the use of research findings in nursing practice. (2,3)

There are several reasons why perioperative nurses should implement research findings. Using research increases the quality of nursing care' and provides increased efficiency in patient care, (4) as well as personal and professional growth for nurses. (1) Norwegian perioperative nurses are required by the government to work in accordance with scientific knowledge. (5) Patients and their relatives increasingly expect nurses to incorporate research findings into their everyday practice, and the International Council of Nursing requires that nursing practice be evidence based. (6) The OR continues to become more technologically challenging, and perioperative nurses must combine use of new technology with knowledgeable and safe patient care so patients do not experience complications.

Several studies have revealed barriers to the use of research findings in nursing practice. (1,7-18) Although a number of investigations on research use have been conducted among clinical nurses (1,7,8,10,12-14,16,17) and nurse leaders, (9,12) only one investigation was conducted among perioperative nurses. (11) The perioperative setting is different from other clinical settings, and one could assume that perioperative nurses perceive barriers that nurse leaders and nurses in other specialties do not. Barriers to research use can vary among different settings; few studies have examined obstacles in the OR, so it is important to identify barriers perceived by perioperative nurses. The aim of this study, therefore, was to investigate which barriers and facilitators Norwegian perioperative nurses perceive in relation to the use of research findings. The research questions asked were as follows.

* What barriers and facilitators to research use do perioperative nurses perceive in their practice?

* Are perioperative nurses aware of current research findings relevant to their practice?

* What are perioperative nurses' attitudes toward research use?

* Do perioperative nurses have supportive colleagues?

* Do perioperative nurses possess the competence to use research findings?

LITERATURE REVIEW

Nursing practice has a short history of basing patient care on research findings. Researchers have argued that nurses base patient care on traditions more than on scientific knowledge. (2) Literature reviews consistently point to the difficulty of transferring research findings into practice. (19,20) Research use in nursing practice is increasing, but there are variations in the level of research use based on nurses' educational levels and the culture within the hospital. (21)

Several researchers have identified possible barriers to research use. One group of researchers developed the BARRIERS Scale, which is based on the Diffusion of Innovations model, (22) to measure perceived barriers to implementing research findings. (1) The scale was classified into four factors that were believed to hinder research use, including characteristics of the nurse, characteristics of the setting, characteristics of the research findings, and characteristics of communication/presentation.

These researchers asked 924 clinical nurses and 414 nurse managers about perceived barriers and facilitators and found that the greatest barriers were insufficient time to implement research findings and read research reports, lack of authority, and uncooperative colleagues. Nurse administrators perceived clinical nurses' lack of awareness of research findings as a greater barrier than did the clinical nurses themselves. (1) The response rate was 40%.

This study has been replicated many times. (7-10,12-18) The most frequently identified barriers among these studies were lack of authority, (7,10,12,13,15,16,18) insufficient time to implement research findings, (7,8,12-18) uncooperative physicians, (8,12-18) and incomprehensible statistical analyses. (7,8,12-18) These barriers appear to be consistent internationally; however, the rank order of the barriers differs to a certain degree among countries. Lack of support and authority are greater barriers in the United States and Ireland than in Australia, the United Kingdom, and Sweden. Swedish and Finnish nurses perceive the English language as a great barrier. (10,17) These studies, however, had limitations, such as measurement by self-report and poor response rates.

Another researcher conducted a study using qualitative and quantitative methods among acute care nurses in three hospitals in northern England. A cross-case analysis involved interviews, observation, document audit, and Q sort of perceptions of barriers to research use. One hundred eight nurses were interviewed, of whom 61 also were observed, and 122 nurses participated in the Q sort exercise. Nurses were observed to determine whether what nurses say they do correlates with what they actually do. The statements used in the Q sort were based on the interviews and observations. The acute care nurses perceived problems in interpreting and using research findings, which were seen as too complex, and they believed the research findings lacked clinical credibility. They perceived lack of organizational support, and some nurses lacked the skills and motivation to use research findings. (23)