Barriers to using research findings in practice: The clinician’s perspective

Journal Club Article: Funk, S. G., Champagne, M. T., Wiese, R. A., & Tornquist, E. M. (1991). Barriers to using research findings in practice: The clinician’s perspective. Applied Nursing Research4(2), 90-95. [abstract]

In 1991, Funk and colleagues highlighted the progress made in the quantity, quality and new areas of nursing research being instigated.  This paper produced the BARRIERS scale, which has been used as a validated tool to further investigate research in nursing in different settings and countries.

Aim: To determine clinicians’ perceptions of the barriers to using research findings in practice and to solicit their input as to what factors would facilitate such use.

Method:  Questionnaires to 5000 selected full time working nurses based on five educational strata (those with diplomas, associate degrees, bachelor’s, master’s, and doctoral degrees). 40% completion of the questionnaire.

Nice touch part: “Each questionnaire included an individual packet of coffee and a letter inviting the recipient to take a few moments to relax and complete the questionnaire”.

BARRIERS scale: 28-item scale requires respondents to rate the extent to which they think each item is a barrier to nurses’ use of research to alter or enhance their practice. Responses are circled on a 4-point scale (I, to no extent; 2, to a little extent; 3, to a moderate
extent; and 4, to a great extent).

The scale is divided into four subscales:

  1. characteristics of the nurse (related to the nurse’s research values, skills, and awareness).
  2. characteristics of the setting (related to the barriers and limitations perceived in the work setting).
  3. characteristics of the research (methodological soundness and the appropriateness of conclusions drawn from the research).
  4. characteristics of the presentation of the research and its accessibility.

Results:  “Insufficient time on the job to implement new ideas was cited most frequently, with lack of support from administration and physicians following closely behind.

The two greatest barriers were the nurse’s not feeling that she/he had “enough authority to change patient care procedures” and “insufficient time on the job to implement new ideas,” both of which are barriers of the setting.

The characteristics of the setting were rated among the top 10 barriers. They included lack of cooperation and support from physicians, administration, and other staff; inadequate facilities for implementation; and insufficient time to read research.”

The characteristics of the nurse in recognising the limits of their knowledge and skills to review and conduct research.

Summary: Nurses need to use and understand research to deliver evidence based practice. Research improves critical thinking and clinical decision making in clinicians. There are numerous barriers that hinder the use of research in the clinical setting, mainly linked to culture and traditional leadership hierarchies.

Limitation: The world and healthcare has changed since 1991, so aspects such as technology and the mass of information may lead to questions of validity for the BARRIERS scale, despite it’s historic use. Take a read of this systematic review by Kajermo et al. (2010). It may also help to understand the drivers of change, which can then be replicated in other settings to increase nurses involvement in research.

Resources

The Barriers Scale. (2018). The BARRIERS to Research Utilization Scale. UNC.edu

Kajermo, K. N., Boström, A. M., Thompson, D. S., Hutchinson, A. M., Estabrooks, C. A., & Wallin, L. (2010). The BARRIERS scale–the barriers to research utilization scale: A systematic reviewImplementation Science5(1), 32.

Nursing Research Process: A Quick Guide

I am currently learning how to use SPSS for statistical analysis to enable some basic statistical analysis to be conducted in nursing research projects. The aim is to be able to run initial data analysis on small clinical focused projects and try to support other nursing colleagues in their project ideas (#community of practice). Understanding more about the data process and how to choose the correct statistical method is a complex process and an ongoing learning objective. Below are some introductory resources that may help you plan your project and provide helpful tips on how to save your data set, analyse the data, create demographic and result tables. Access to a statistician remains key, as they provide so much expertise and understanding around data analysis, and they provide a robustness to the results process. If you have useful research resources please post them in the comment section below and we can develop this post as an ongoing research resource for nurses. As I use SPSS on further projects, more resources will be added into this page.

The Research Question

Consider something that inspires, interests or annoys you- motivation is key, especially if the project is done in own time. Or a quality measure that will help change and enhance practice.

Background

Conduct a literature review to explore the background scientific findings on your topic and then provide a rationale for your study. Why is it important to conduct? Set out your aims and objectives, also any hypothesis if required. When analysing the evidence base, use expert resources such as Joanna Briggs Institute critical appraisal tools.

Study Design

Consider your topic and what data needs to collected to meet the aims and objectives. Will this be a quantitative or qualitative study?

Ethics

Before your collect any data, check in with your hospital or university ethics committee to see what level of ethics your project sits under. Be prepared for some form filling and some unique wordology. If you delve further into the history of ethical standards, be prepared for some moving and challenging cases.

Data Collection 

Prepare a data file, this will depend on the software you have access to. So far the easiest and cheapest way I have found is to use Xcel that can then normally be uploaded into a stats software package (accessed on a University computer) and you can use formula’s from this program to obtain most of the basic stats you will need for a first draft data analysis. Remember, have the variable along the x axis (across the top) and participant number along the y (down the side). Determine and define your variables, also create a code book to label any values. Borrow a book that can guide you through the research steps and the software program. This is the one I used: Pallant, J. (2013). SPSS survival manual. McGraw-Hill Education (UK). If you are a student, check with your university IT team to see what software you can access or download onto your personal computer.

Statistics

Get inspired by Florence Nightingale, who was much more than just the lady and the lamp. You will need to describe the setting, participants and statistical methods. Again a book with statistical advice on how to choose, run and review your result findings will be required, such as Tabachnick & Fidell (2007) Using multivariate statistics. Ideally have a statistician to mentor you through the process.

Results

Return to your literature review and see what types of figures and tables were published in the results sections and replicate this format so you can then compare your results to previous literature. Do the same with the demographic tables, helps determining if mean or median should be used (median more robust I hear you say).

Add these key results and link in with context of background discussion.  What are the implications from your findings, and also any limitations of the study.

Publication Time

Thinking around the bigger picture of healthcare research and publications. Positive or negative data results, we only see a biased picture in that often only positive trials are published so they are what influence healthcare practice.

Pick a journal that fits in with your topic or methodology. Check in with the publisher author guides if you aim to publish, and they will provide clear outlines for structure, content and referencing style.

Resources

Joanna Briggs Institute. (2017). Critical appraisal tools.

Pallant, J. (2013). SPSS survival manual. McGraw-Hill Education (UK).

Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics. Allyn & Bacon/Pearson Education.