Breimaier, H. E., Halfens, R. J. G., & Lohrmann, C. (2010). Nurses’ wishes, knowledge, attitudes and perceived barriers on implementing research findings into practice among graduate nurses in Austria. Journal of Clinical Nursing, 20, 1744-1756.
This article represents a study that was carried out by Helga Breimaier, Ruud Halfens and Christa Lohrmann to identify the extent to which evidence-based practice is utilized and to elucidate any possible factors that enhance or hinder the application of research findings in improving patient care. The authors were drawn from the health care field, with Helga Breimaier being a PhD candidate and a teacher and researcher at the Medical University of Graz.
Ruud Halfens is a professor in the faculty of health, medicine and life sciences at the Maastricht University and also works in the department of nursing science at Witten/Herdecke University. Christa Lohrmann is a professor and departmental head in the Institute of Nursing Science at the Medical University of Graz. They are, thus, distinguished intellectuals in the health care field. This study may be considered to be representing the actual wishes, needs, knowledge, and perceptions of the nurses regarding nursing research (Breimaier, Halfens & Lormann, 2010).
Brief Summary
Most nurses do not utilize research findings in their practice, despite the importance of these findings in enhancing the quality of patient care. It is against this background that the researchers sought to establish the nurses’ expectations, needs, awareness and perceptions towards nursing research, in addition to assessing the possible challenges of enablers to the application of research in the nursing field in Austria. The research was carried out in an Australian university hospital and it targeted all graduate nurses in this facility, totalling 1825, although only 1023 nurses participated. The research was a cross-sectional survey in design, employing self-report questionnaires. The data generated were analyzed through descriptive and inferential methods such as the chi-square tests.
From the study, Breimaier, Halfens and Lormann found out that nursing practitioners mostly preferred to have sufficient information, a favourable environment and professional support to utilize research in their practice. The nurses showed particular interest in areas touching on phenomena and interventions. The researchers demonstrated that the nursing practitioners’ needs about the level of knowledge in nursing research were mostly at the basic level. Most of the nurses’ attitudes towards the practical use of research were negative. The researchers, therefore, concluded that poor organization support and insufficient knowledge were the major challenges in the utilization of research findings in nursing practice.
Theoretical Dimensions of the Study
Relevance and significance of the study
The study by Breimaier, Halfens and Lormman follows the persistent call for nursing practitioners to be actively involved in health care innovation. Many studies have emphasized the need for evidence-based nursing practice, and the need for nurses to demonstrate that their practice meets quality patient care. Nursing research is an important field in health care when used appropriately, hence the need to gain an understanding of how nurses utilize research and any factors that determine the level of utilization.
Conceptual Framework and its Appropriateness
Breimaier, Halfens and Lormann based their study on a variety of literature which argues in favour of the utilization of research results to inform nursing care decisions as an important aspect in the provision of quality care founded on current scientific information. The researchers also extensively explored literature that depicts the poor utilization of research-based information in nursing practice. They borrowed concepts from the study findings that showed that nursing practitioners frequently failed to integrate evidence-based practice in their profession. Further, the researchers cited the work of other researchers who had demonstrated the poor utilization of scientific research in the nursing practice.
Breimaier, Halfens and Lormann also established their study on various findings that had demonstrated that a significant proportion of health care delivery falls short of the best scientific practice, while almost a third of it is not necessary. This also informed the researchers’ decisions to make a detailed study on the level of research utilization in nursing practice and the possible factors impeding the utilization. This study objective was in agreement with the suggestion for the need to investigate more dimensions in nursing practice that could help in improving the quality of nursing care (Breimaier, Halfens & Lormann, 2010).
The researchers also point to the lack of data that shows the needs of nursing practitioners in applying research findings, while at the same time they refer to the studies that advance the need for appropriate support to enhance research. In addition, the researchers demonstrate from the literature that the nursing practitioners have insufficient knowledge to implement research in practice, while perceptions and other factors related to environmental constructs also influence the utilization of research. This, therefore, formed a basis for the researchers’ decision to extrapolate on the needs, perceptions and factors that influence the utilization of research by the nurses.
Breimaier, Halfens and Lormann, therefore, suitably merge their study topic in the wider contextual framework relating to utilization of scientific evidence in nursing practice and can be deemed as appropriate in enhancing nursing knowledge. The extensive literature reviews as adopted by these researchers are also essential in enhancing the credibility of the study findings (Fink, 2000).
Congruence between Research Question and Methods Used
To design the study tools relating to the utilization of research in nursing, the researchers borrowed from the studies that proposed the use of simple and standard questions, which may generate responses to depict the utilization or may demonstrate the concepts arising from the utilization of research (Breimaier, Halfens & Lormann, 2010). The theoretical framework as adopted in this study also helps in defining the research topic as being dynamic and requiring deeper description, thus demonstrating that the use of qualitative methodologies was appropriate since they enable the research to be effectively controlled (Fink, 2000).
Study Methodology and Validity
Study design
The study by Breimaier, Halfens and Lormann was a cross-sectional survey in design, employing both descriptive and exploratory techniques. This study design was appropriate since it allows for the collection of empirical data and can cover a huge population. This makes it possible to have data from a representative sample, making the study more generalizable. However, this design generally does not produce detailed data on the research topic and is associated with a low response rate, potentially affecting subsequent analysis (Loiselle et al., 2010).
Study population and sample
The study was carried out in a university hospital in Austria and it involved all graduate nurses willing to participate and who were fluent in the German language. In total, 1825 graduate nurses were targeted but those who accepted represented 56 per cent of the study population (Breimaier, Halfens & Lormann, 2010). This low rate of response decreases the generalizability of the study results.
The researchers also selected the sample through convenience sampling, focusing on only one hospital. The use of convenience sampling could affect the validity of the study due to possible biases, whereas focusing on one particular setting makes it difficult to extend the study findings into other settings (Fink, 2000). However, the researchers used a large sample size and, therefore, this may be considered to have enhanced the study’s validity.
Collection of data
The study used self-report questionnaires to collect data for three weeks. These questionnaires had been used previously in a study that was investigating the perceptions of the workforce towards employing research results in their practice. The questionnaires, therefore, had been assessed on different psychometric areas by competent researchers. The instrument was, thus, designed to meet validity issues. The instruments had also been subjected to a pilot study and, therefore, any notable errors such as in wording had been corrected.
Breimaier, Halfens and Lormann modified the original instrument by translating it into German and adjusting it to the Australian context. Translating and calibrating the questionnaires was essential in making the results valid and reliable, given that the instrument has initially been used in a population different from the Australian context. The carrying out of a pilot study helped in enhancing the face validity of the questionnaires, while content validity was assured by the involvement of nursing experts in redesigning the instrument.
The questionnaires were also framed to include both open-ended and closed-ended queries. This framework enhanced the validity of the study since it allowed for the collection of individual needs of the nurses while avoiding being suggestive. However, the use of open-ended questions is predominantly associated with high rates of missing data, limiting the interpretation and analysis of the data (Fink, 2000). The instrument was also redesigned to include a Likert scale to capture the perception of nurses towards nursing research.
Data analysis and presentation
Data analysis was conducted through content and descriptive techniques. The responses generated by the open-ended questions were analyzed for their content, allowing reliable classification into various patterns and themes. Statistical packages were then used to analyze data generated by the closed-ended questions, thus allowing for estimation of frequencies, percentages and X2-tests. The researchers had therefore designed appropriate tools for all the items under study, facilitating the comprehension of study questions. This subsequently enhanced the reliability and validity of the interpretations made. However, the use of descriptive statistics limits the generalizability of the results (Loiselle et al., 2010).
The researchers used tables and statistical measures like percentages to present the study findings. These methods of data presentation are simple and thus the results can be easily understood.
Ethical Dimensions
Breimaier, Halfens and Lormann adhered to the appropriate research ethics since they sought the approval of the study from the university’s ethics committee before administering the questionnaires. Participation in the study was voluntary and it can be considered that those participants who responded to the questionnaires had consented to the study. This is one of the major requirements when conducting any study involving human subjects. The researchers had earlier briefed the nurses about the study and, therefore, had full knowledge of all the issues about the study (Breimaier, Halfens & Lormann, 2010).
Interpretive Dimensions
Study findings
The study results showed that 77 per cent of the participants rarely utilized research in their practice as compared to 4.5 per cent who reported applying them regularly. The major wishes of nurses about research utilization were reported to be sufficient knowledge of the research results, structural issues like time and manpower, professional assistance and applicability of the research in day-to-day practice.
A significant proportion of the participants were for advanced training in research, preferably through the sponsorship of their employers. Most participants expressed the need for training in areas such as the role of research in the nursing profession, utilization of research findings, and foundations of nursing research among others. The nurses also showed special interest in evidence-based information relating to nursing phenomena and interventions in aspects like, “ulcer, fall or communication, wound management, dementia and psychosocial areas” (Breimaier, Halfens & Lormann, 2010: 1749).
In addition, the researchers demonstrated that a significant proportion of the nurses required introductory knowledge on research utilization, though some wanted in-depth knowledge on the same. Regarding knowledge, 32.8 per cent of the participants concurred that research-related areas were incorporated in their basic training while a majority of them reported that key research aspects like, “interpretation scientific articles, evidence-based practice, statistics and use of libraries and databases” (Breimaier, Halfens & Lormann, 2010: 1749) were missing in the basic nursing curriculum.
The researchers also found out that more than half of the nurses in the study had positive perceptions towards the use of research in practice. Nevertheless, the researchers also showed that almost half of the participants were opposed to the idea of turning nursing into a research-based profession. Those participants opposed to the utilization of research in nursing cited time and lack of information as the major impediments. About 60 per cent of participants were against the use of research experience as a measure of one’s merit for promotion (Breimaier, Halfens & Lormann, 2010).
The researchers identified the major obstacles to the utilization of research in nursing to be time constraints, insufficient knowledge, and lack of morale. The major enablers in the utilization of research as brought out in this study were sufficient knowledge, adequate time and availability of information. The researchers, therefore, identified that sufficient knowledge and a favourable environment were the main factors that can enhance the utilization of research in nursing as proposed in the literature. The researchers demonstrate that the nurses do not have sufficient and current knowledge and competency to deliver quality healthcare.
Study Conclusion and Implications
Breimaier, Halfens and Lormann concluded that many nurses were not well equipped for professional practice, with a significant proportion unable to utilize research in day-to-day practice. The researchers put into perspective the needs of nurses such as supportive environment, knowledge and utilization of research to circumnavigate obstacles in utilizing research in practice. The study is relevant to nursing practice as it offers significant information concerning the needs of nurses in their education. It also avails information that could be used as a basis for promoting evidence-based nursing.
Strengths of the Study
The researchers had recruited a large study population, therefore, eliminating possible biases arising from poor response rate.
Limitations of the Study
The study had a low response rate, thus the interpretation by the researchers cannot be said to be very accurate. The focus of the study in only one hospital renders the study findings inapplicable to all settings while missing data affected the response to the issues under investigation (Breimaier, Halfens & Lormann, 2010).
Conclusion
In general, the researchers tried to enhance the validity of the study by recruiting a large sample size thus the study findings can, to a greater degree, be applied in nursing practice. The study instruments were also appropriately designed, and translation was essential to make the questionnaire relevant to the study population. The carrying out of a pilot study on a different category of nurses also allowed the researchers to ensure that the questionnaire met the desirable validity and reliability measures.
References
Breimaier, H. E., Halfens, R. J. G., & Lohrmann, C. (2010). Nurses’ wishes, knowledge, attitudes and perceived barriers on implementing research findings into practice among graduate nurses in Austria. Journal of Clinical Nursing, 20, 1744-1756.
Fink, A. N. (2000). The role of the researcher in the qualitative research process. A potential barrier to archiving qualitative data. Qualitative Social Research, 1(3). Web.
Loiselle, C. G., Profetto-McGrath, J., Polit, D. F., & Beck, C. T. (2010). Canadian essentials of nursing research, 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins.