Staff Nurses' Use of Research to Facilitate Evidence-Based Practice

Sunday, 27 July 2014: 8:30 AM

Linda H. Yoder, PhD, MBA, RN, AOCN, FAAN
Nursing Aministration and Healthcare Systems Management, The University of Texas at Austin School of Nursing, Austin, TX
David Curk McFall, MSN, RN
Nursing, The University of Texas at Austin School of Nursing, Austin, TX

Purpose: The literature indicates that bedside nurses in the United States continue to lack the desire and ability to integrate evidence into their practice for a variety of reasons. The purpose of this study was to: (1) determine registered nurses (RNs) use of research findings in their practice within an acute care hospital system, (2) determine what types of knowledge RNs used in their practice, and (3) determine what personal, professional, and organizational factors enhanced or hindered research utilization (RU) by RNs in the multi-hospital system.

Methods: A cross-sectional, descriptive, on-line survey design was used. Approval for the study was obtained from the health system’s institutional review board. This study took place in a 10 hospital health system located in a metropolitan city. Of the 10 hospitals, eight are acute care facilities, one is a regional children’s hospital, and one is an acute care psychiatric hospital. Four of the hospitals are Magnet hospitals and the others are Pathway to Excellence hospitals. All RNs across the hospital system received an email invitation to participate in the survey, which was available on the organizational intranet for eight weeks. The electronic survey was accessible to RNs at work and from home. The survey consisted of 54-items grouped into five sections. Section one consisted of 12 questions asking about the four types of RU: (1) overall, (2) direct, (3) indirect, and (4) persuasive. Section two of the survey consisted of 23 questions regarding demographic and professional characteristics of the participants. Section three consisted of six questions about nurses’ use of knowledge in practice, including attitudes toward research and sources of knowledge about practice. Section four consisted of one question aimed at identifying factors that influenced nurses’ decisions to apply research findings in practice. Section five contained nine questions about organizational resources available to support research. The survey also contained two open-ended questions asking the participants to list: (1) research findings they used in their practice in the last 12-months, and (2) professional and organizational factors that enhanced or hindered RU by registered nurses in the hospital system. 2900 registered nurses were invited to participate; 1112 nurses provided usable surveys, for a response rate of 38%. The focus of this presentation is the 794 staff nurses who responded to the survey and provide beside patient care at least 50% of the time.

Results: Most of the nurses (88%; n = 695) were females whose highest level of education was a baccalaureate degree (49%; n = 380) or an associate degree (37%; n = 295). Most of the nurses had been RNs for at least 10 years (50%; n = 387). The knowledge the nurses reported they relied on the most for their practice came from their personal experience with patients, policies and procedures, physician colleagues, and nursing peers. Despite the fact that a variety of resources were available for nurses to locate research findings and conduct evidence-based practice (EBP), they reported the same problems that were reported in other studies over the last two decades. They cited barriers such as: lack of paid time to conduct reviews of the literature, an inability to understand the research literature because it seems too complex, and the inability to synthesize research findings to formulate a practice change. However, the nurses attitudes about RU/EBP were positive overall, but they expected unit based educators, clinical nurses specialists, and nurses in nonbeside care roles to collect and synthesize the research for them.

Conclusion: There continue to be many opportunities to inform, educate, and assist staff nurses with RU/EBP implementation. Despite nursing leaders’ desire to have nurses at the bedside participate in development of EBP practices, RNs continued to cite the same barriers that have repeatedly been reported in other studies: lack of time, lack of resources, and lack of knowledge. The bedside nurse is functioning in a complex healthcare environment with an ever increasing amount of research directed at improving quality and safety practices. However, due to unit or hospital-based cultures and barriers, they often continue to want others, such as masters prepared nurses, to read and synthesize the evidence and convince them of the benefit to patients before they will adopt new evidence-based practices.