Research utilization: an overview

Identifying international barriers and facilitators to research utilization

PURPOSE

To define research utilization (RU) and identify barriers and facilitators to RU in nursing practice.

METHODS

An international integrative review of 42 studies was conducted related to barriers and facilitators of RU.

RESULTS

Following a review of the research that met the inclusion criteria, the author identifies common themes related to the implementation of research into clinical practice and the challenges surrounding RU.

CONCLUSION

Despite consistently perceived barriers to research among nurses from different geographic, cultural, and clinical backgrounds, practice changes are typically out of their hands. Further research is necessary to gauge perception among the nursing associations, regulatory bodies, healthcare organizations, policy makers, and managers responsible for implementing these changes.

Nurses' perceptions of research utilization in a corporate health care system

PURPOSE

To explore selected characteristics of nurses based upon educational level (masters, baccalaureate, associate degree/diploma), years of experience, and hospital position (management, advanced practice, staff nurse) that might affect perceived availability of research resources, attitude towards research, support, and research use in practice.

DESIGN

A descriptive nonexperimental mailed survey design was used for this study.

METHODS

Nurses in five hospitals within a corporate hospital system were surveyed using the Research Utilization Questionnaire (RUQ). The RUQ was used to measure nurses' perceptions of research utilization in the four dimensions of perceived use of research, attitude toward research, availability of research resources, and perceived support for research activities.

FINDINGS

ANOVA was used to analyze the data. Statistically significant differences (p<.001) were found in the perceived use of research, attitude toward research, availability of research resources, and perceived support for research activities based on educational level and organizational position. No significant differences were found in the perception of nurses based on years of experience.

CONCLUSIONS

The results of this study have implications for staff nurses, administrators, advanced practice nurses, and educators working in hospital systems. The different perceptions based upon educational level and hospital position can be integrated and used at all levels of nursing practice to promote research utilization and evidence-based practice initiatives within the organizational structure.

CLINICAL IMPLICATIONS

The results of this study have nursing implications within administration and for nursing practice. The different perceptions that were found based upon educational level and hospital position can be positively integrated and used by administrators and by nurses all levels of nursing practice to promote research utilization and evidence based practice initiatives within the organizational structure.

A Successful Teaching Strategy for Applying Evidence-based Practice

Evidence-based practice (EBP) is the conscientious use of the best evidence contained in the literature to guide healthcare decisions. The authors describe how their baccalaureate program prepares its graduates to be successful in implementing EBP in their nursing practice. Outcomes of sustained student projects in agency settings are presented. They posit that bachelor of science in nursing students, agency personnel, and faculty can lead practice innovations supported by EBP.

Urinary incontinence in pregnancy and the puerperium

OBJECTIVE

To describe the incidence of urinary incontinence (UI) during pregnancy and the puerperium and to identify potential contributing factors.

DESIGN

A descriptive correlational design, using participant interviews and reviews of the existing medical records to determine the incidence of UI in pregnancy and the puerperium and to examine relationships between and among several variables. The variables included parity, episiotomy, use of forceps/vacuum extractor, type of anesthesia, prolonged Stage II labor, and race. Data were collected via two personal interviews and review of medical records. The first interview was conducted during the recruitment of each participant; the second was a telephone interview conducted 4 to 6 weeks postpartum. Data collected from the medical records included obstetric history, weeks of gestation, and estimated date of delivery. Data were entered into data files for analysis with SPSS 8.0 and summarized with descriptive statistics.

SETTING

A secluded area of a university teaching hospital prenatal clinic.

PARTICIPANTS

A convenience sample of 50 pregnant women, at least 18 years old, who received their care at a large university hospital prenatal clinic in the southeastern part of the United States.

RESULTS

First Interview (N = 50). More than half (62%; n = 31) of the sample reported some degree of involuntary urine loss during their pregnancy. The racial distribution of those reporting UI was the following: white (70%; 21 out of 30); African American (44%; 8 out of 18); Hispanic/Asian (100%; n = 2). Among the participants who experienced UI (n = 31), 76% (n = 23) reported that their health care provider never asked if they were experiencing any UI symptoms. Second Interview (n = 24). Only 48% of the initial participants could be contacted for the second interview because of changes in residence or telephones being disconnected with no forwarding number. Of the women in this sample who reported UI during the first interview (59%; n = 14), 7 (50%) continued to experience UI 4 to 6 weeks postpartum. The 2 remaining participants who reported UI 4 to 6 weeks postpartum (22%) had not experienced UI during pregnancy. Of the participants experiencing postpartum UI, 77% (n = 7) were white. Almost half of the participants with postpartum UI were ages 35 or older (44%; n = 4). Among the participants reporting episiotomy (n = 4), 3 (75%) reported having UI 4 to 6 weeks postpartum.

CONCLUSIONS

Study results support the conclusion that childbirth, specifically vaginal birth, is a major factor in developing UI in the early postpartum period. Age, race, and use of episiotomy appear to be contributing risk factors.

Making evidence-based practice a reality in your institution

There are many barriers to ensuring that nursing practice is based on research evidence. This article provides several resources to help the practicing nurse identify what evidence is available upon which to make practice changes. Additionally, strategies for supporting change are discussed and a case study of one particular evidenced-based change--1:1 support by nurses for women in labor--is examined.

Replication research: a purposeful occupation worth repeating

It is common for researchers to request at the end of their published studies, the urgency for further studies to be completed. Unfortunately there are very few published studies that have replicated original studies. The purpose of this article is to provide a framework for understanding issues related to replication research that will assist occupational therapy researchers, clinicians, managers, students and educators to realize the importance of implementing and publishing replication research to establish evidence-based practice. Various areas related to replication research are explored. In addition, a computerized literature search using the search term 'replication' was completed. Only four articles published between 1982-1998 were discovered. This article concludes with recommendations to ensure replication studies are included in the occupational therapy literature and utilized in clinical practice.

Cochrane pregnancy and childbirth database: resource for evidence-based practice

The Cochrane Pregnancy and Childbirth database is an ongoing meta-analysis of evidence documenting effective health care practices for childbearing women and their neonates. It is proving invaluable to nurse educators, researchers, clinicians, and administrators working in a variety of health care delivery settings. Evidence-based nursing practice that is safe and effective can enhance rather than overpower pivotal and celebratory life events such as childbirth.

An appraisal of research utilization across the United States

The success of research utilization (RU) is a function of how well it has been incorporated into the cultural norm of the organization. The authors describe current and future nursing research utilization activities in various clinical agencies across the United States and identify barriers and facilitators to those activities. The most frequent RU projects focused on pressure ulcers and pain management. Barriers included lack of resources, organizational culture, change, and nurses' education. Facilitators were leadership commitment, available resources, and a supportive organizational culture.

An experience with "research by committee"

The Nursing Research Committee of a community hospital describes the difficulties and unexpected pitfalls encountered during an attempt to conduct "research by committee." The steps of the process, from initial development of a research question through research design and implementation and termination of the project, are related. A retrospective analysis of the difficulties encountered serves as a basis for recommendations to others who might consider research by committee. Although a valid means for conducting research, the experiences of this committee indicate how forces, in their control and beyond their control, might influence completion of a project.

Pushing techniques during labor: issues and controversies

The lack of support for spontaneous bearing down versus directed pushing efforts, varying opinions on the determination of readiness for pushing, and the prevailing use of prolonged breath holding associated with pushing during labor are aspects of second-stage labor management that continue to be areas of contention among physicians and nurses. A discussion of current practice outcomes surrounding these controversies from the AWHONN Second Stage Labor Research Utilization Project conducted in 1994-1995 is presented in view of the available research literature. In addition, recommendations for future nursing research are identified.

Strategies for designing a research utilization project with labor and delivery nurses

The background and development of the second National AWHONN Research Utilization Project on Second Stage Labor Management that was conducted in multiple sites within the United States and Canada are presented. On the basis of the results of the project, recommendations for designing other research utilization projects are discussed.

Organizing and documenting lactation support of NICU families

A documentation tool designed for use by lactation consultants in the neonatal intensive-care unit provides an efficient and complete method for recording the progress of the mother and infant. It incorporates the research base into interventions that begin during the early postpartum period and continue through the preterm infant's hospital stay. The system for using this tool helps consultants in giving comprehensive and timely lactation support.

Paving the way: stepping stones to evidence-based nursing

Evidence-based practice is an emerging paradigm in health care. This paper outlines the main features of this paradigm and its potential value to nursing. Evidence-based practice is based on a conceptual framework that examines the extent of evidence available in support of particular clinical practices. The Quality of Evidence Ratings adapted by the National Health and Medical Research Council (NHMRC) from the United States Preventive Services Task Force are discussed, and the strengths and weaknesses of different categories of evidence are highlighted. Potential barriers to implementation of research into practice are identified. The authors suggest that legal, ethical, economic and humane imperatives oblige nursing to develop evidence-based practice as one of several viable contributions to nursing knowledge. Suggestions for analysing current research and for the planning of the direction of future nursing research are made.