INTRODUCTION OF THE STUDY:

At no time in the history of healthcare has the professional knowledge required to deliver quality healthcare. The Institute of Medicine defines quality health care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. One source of professional knowledge is randomized controlled trials. “Since the first contemporary randomized controlled trial was conducted more than 50 years ago, the number of trials conducted has grown to nearly 10,000 annually”. Despite an increase in the availability of basic science and clinical research, many healthcare providers do not apply the available evidence. This has lead many organizations to push for the development of evidence-based practice.

Evidence-based practice is described as the integration of individual clinical expertise with the best available external expertise. Clinical expertise refers to the skills the clinician develops over time through clinical experience and practice. External expertise refers to clinically relevant research, particularly patient centered research. While clinical expertise is developed over time, external expertise is not. Research utilization is fundamental to the development of external expertise and evidence-based practice (EBP). Research utilization is the use of research findings to support clinical decision-making.

It is a complex process that occurs primarily at the cognitive level. The process of using research is a situated behavior or practice enacted in the context of the social communities that give it life. Research-based information is read, discussed, critiqued, and potentially used in decision-making. Currently, the health sciences sanction research-based knowledge as the most legitimate form of knowledge and the evidence-based movement is testimony to this. The use of research as a basis for decision making is seen as being rational and objective, thereby leading to better clinical practice

The goal of EBP is to use the highest quality of knowledge in providing care to produce the greatest impact on patients’ health status and healthcare. This entails using the following knowledge sources for care:

1. Valid research evidence as the primary basis of clinical decisions

2. Clinical expertise to best use the research by filling in gaps and tailoring the clinical action to the individual patient’s context

3. Patient choices and concerns for determining the acceptability of research-based care to the individual patient

In clinical decisions, the key criterion for quality of underlying knowledge is certainty. Certainty is the level of sureness that clinical action will produce the intended or desired outcome. To appraises certainty, the practitioner must first uncover the source of knowledge underlying the contemplated clinical action, then appraise the quality of that knowledge

Regardless of the legitimacy of the clinician’s knowledge, the literature contains examples of nurses who fail to utilize research as a practice base. Without the systematic utilization of research, there cannot be evidence-based practice or the quality health care defined by the Institute of Medicine. This has lead many researchers to attempt to identify the barriers to research utilization among nurses.

Despite multiple attempts to identify the barriers to research utilization, research-practice gaps remain. It is difficult to know why these gaps have persisted. While much research on the utilization of research within the practice setting has taken place, it has focused primarily on academic medical centers, practice specific samples, or large groups at multiple sites. It is impossible to provide health services that are consistent with the current professional knowledge without research utilization. Identification of barriers to research utilization specific to a community hospital will allow for program planning removing perceived barriers. This will provide for the facilitation of evidence-based practice, ultimately improving the quality of healthcare. Therefore, the purpose of this study was to identify the barriers to research utilization among nurses practicing in a hospital.

Significance to Nursing

Nurses who fail to base their practice on evidence will be ill equipped to meet the challenges facing them. There is evidence to suggest that patients who receive care based upon the best evidence from the latest well designed clinical studies experience 28% better outcomes than their counterparts who do not. There is also evidence to suggest that providers who utilize evidence-based practice when providing care have higher levels of satisfaction than those who simply provide care that is “steeped in tradition” ( Melnyk and Fineout-Overhol 2005).

It is imperative that the barriers to research utilization in hospitals be identified. Through the identification of barriers to research utilization, valuable information will be gathered that can be utilized as a basis for program planning. Appropriate program planning can assist in the removal of barriers to research utilization, thereby improving the quality of healthcare while increasing provider satisfaction.

Problem statement:

“A study to assess the barriers in using research in practice among nurses working in the hospitals of Pune City”

Objectives of the study:-

1 To assess the barriers in using research in practice.

2 To associate the findings of barriers with selected demographic variables.

RESEARCH METHODOLOGY:

1 Research approach Quantitative Approach

2 Research Design Exploratory survey design.

3 Variables Based on the objectives of the study, the major variables are identified. Barriers and Facilitators are taken as Independent Variable. Qualification and experience are taken as major Demographic variable.

4 Setting: -Hospitals in Pune City.

5 Population and Sample Size: -Staff members working in the hospitals of Pune city. Samples size was 100

6. Sampling technique Non Probability Convenient Sampling.

7. Description of tool: -

Part-1 – Demographic Data

Part-2: 5 point scale: Barriers to use research in practice

Validity and Reliability:

1. Validity of the tool was done by giving the tool to the experts who includes experts from Nursing, Research and Biostatistician.

2. Reliability: Standard rating scale was used (1987, Funk, Champagne, Tornquist and Wiese)

3. Pilot Study: Pilot study was conducted on 1/10^th sample and the study was found to be feasible.

The conceptual framework for this study is E. M. Rogers’ diffusion of innovation. Diffusion research was developed in an attempt to understand human behavior change. Rogers defines diffusion as the “process by which an innovation is communicated through certain channels over time among members of the social system” (Rogers, 1995). There are four main elements involved in the diffusion of innovation. These elements are the innovation, the communication channels, time, and the social system. Rogers defines an innovation as an idea, practice or object that is perceived as new by an individual or other unit of adoption. Communication is the process of sharing information in an attempt to create mutual understanding. The social system is described as a set of interrelated units engaged in joint problem-solving to accomplish a common goal. Members of social systems include individuals, informal groups, and formal organizations (Rogers, 1995,).

Major Findings of the Study:

1. Demographic Characteristics:

a. Qualification: Majority of the respondent were having the qualification GNM (53%), 33% were ANM, 10%were B.Sc. Nsg and 5% were M.Sc. Nursing

b. Total Experience: Majority of the respondents (76%) were having more than 5 years of Experience.

2. Barriers Identified:

A. 68% of respondents said that Physician will not co-operate with implementation.

B. 55% of the respondent perceived administration permission as major barrier.

C. 53% of the respondent’s responded perceived insufficient time to read research as barrier.

D. 52% of respondent said that there is not a documented need to change practice

E. 46% of the Nurse are uncertain whether to believe the result of the research

F. The relevant literature is not compiled at one place is the perceived barrier for 42% of Nurses

G. 42% of the respondent perceived the research has not being replicated is the major barrier

H. The conclusion drawn from the research are not justified said by 39% of respondents as a barrier

I. 35% responded that the nurses does not feel she/he has enough authority to change patient care procedures

J. 34% of the responded perceived Lack of awareness about the research is the barrier

Heather Diane Schoonover has done the similar study in May 2006 in community hospitals in USA. Findings of this study were similar to the present study as greatest barriers to research utilization reported included characteristics of the organization, a lack of authority to change patient care procedures, lack of time to read research, and the lack of awareness of the research.

One note-worthy finding was the number of respondents who replied “no-opinion” or did not indicate a response, particularly to those questions regarding–Methodological inadequacy. This implies that the respondents may not be familiar enough with research to form an opinion regarding methods.

This is further supported by one of the barriers, in which lack of awareness of the research was one of the major cited individual barriers to research utilization.

3. Association with selected demographic Variable:

1. Could not find any significant association as sample size was less and limited to certain hospitals of Pune city. [p value was greater than .05 and Chi square calculated value is less than table value]

But yes, the incredibly high percentage of participants reporting “no-opinion” or leaving an item blank, particularly on certain items under research particularly methodology, relevant literature, suggests the staff lack experience, exposure, and knowledge regarding the availability of current research.

CONCLUSION:

Despite a push for evidence-based practice from regulatory boards and health care professionals alike, and a rapid growth of evidence-based practice with recent years, it appears the barriers to research utilization within the professional practice setting remain unchanged.

Since the development of the BARRIERS Scale in 1991, registered nursing staffs have consistently identified characteristics of the organization as having the most influence over research utilization. As nurses are identifying the organization as a barrier, the organization can be used as a powerful tool to enhance research utilization and evidence-based practice.

REFERENCES:

1. AACN-AONE Task Force on Differentiated Competencies for Nursing Practice (1995). A model for differentiated practice. Retrieved February 11, 2006, from http://www.aacn.nche.edu/ Publications/pdf/DIFFMOD/.PDF

2. Barta, K. (2005). Information-seeking, research utilization, and barriers to research utilization of pediatric nurse educators [Electronic version]. Journal of Professional Nursing, 11(1), 49-57.

3. Burns, N. and Grove, S. K. (2005). The practice of nursing research: Conduct, critique, and utilization (5th ed.). St. Louis, Missouri: Elsevier Saunders.

4. Egerod, I., and Hansen, G. M. (2005). Evidence-based practice among Danish cardiac nurses: A national survey [Electronic version]. Journal of Advanced Nursing, 51, 465-473.

5. Fink, R. Thompson, C., and Bonnes, D. (2005). Overcoming barriers and promoting the use of research in practice [Electronic version]. Journal of Nursing Administration, 35(3), 121-129.

6. Funk, S. G. (2001). BARRIERS to Research Utilization Scale. Retrieved September 19, 2005, from http://www.unc.edu/depts/ rsc/funk/barrier1.html

7. Pravikoff, D. S., Pierce, S. T., and Tanner, A. (2005). Evidence-based practice readiness study supported by academy nursing informatics expert panel. Nursing Outlook, 53(1), 49-50

Received on 28.01.2013 Modified on 02.03.2013

Asian J. Nur. Edu. and Research 3(3): July-Sept., 2013; Page 136-138