Review of research findings suggesting nurses overreport their use of research
- 1Department of Nursing and Applied Clinical Studies, Canterbury Christ Church University, Kent, UK
- 2University of Wollongong, NSW, Australia
- 3East Sussex Healthcare NHS trust, Canterbury Christchurch University, Kent, UK
- 4The Institute of Nursing Research, University of Ulster, Belfast, UK
- 5School of Nursing Midwifery and Indigenous Health, University of Wollongong, NSW, Australia
- Correspondence to Jan Dewing
Department of Nursing, Canterbury Christchurch University, North Holmes Road, Bingley Court, Canterbury, Kent CT12SW, UK;
Implications for practice and research
■ The authors suggest nurses may have been overreporting the use of research in their practice thus implying evidence-based practice is not advancing as rapidly as desired.
■ Its appears nurses in leadership positions make more use of research than staff nurses.
■ Standardised measures in research are needed to assess how much research and the quality of research is used by nurses and its impact on patient care outcomes.
■ Research of this type needs more rigorous methodologies and methods.
It is assumed that nursing care based upon research evidence will lead to better outcomes for patients. A research-practice gap has been identified and it may take years for evidence to be incorporated into practice. This paper examines the extent to which nurses use research in clinical practice.
A systematic review of published and grey literature. Thirteen online databases were searched for reports of experimental and non-experimental designed studies written in English or Scandinavian languages by March 2008. Case reports and non-systematic/narrative literature reviews were excluded. A quality score was applied, and the extent of research use (low use, moderate-low use, moderate-high use and high use) calculated.
12418 citations yielded 133 potentially relevant papers, of which 55 met the inclusion criteria. Most were from North America (71%) and from acute settings (80%). Most papers reported moderate-high research use. They found no significant differences in the extent of research used by nurses since 1981.
Squires et al believe that nurses' use of research has not changed overthe past 25 years hence they examine alternative explanations for their finding. They critique the methods used in the studies as well as the measures used. They discuss the theoretical, methodological and measurement issues and complexities involved in attempting to determine the extent and impact of research use on patient outcomes. The researchers make some sound recommendations for future research in this area. In the section on quality assessment, it would have been useful to provide more of a coherent rationale for why the two assessment tools were used. It would appear that Estabrook's measure encompasses the broader context of factors that impact on nurse's uptake of research and therefore, this appears more appropriate to current climate and practices. Nurses' poor use of research may be related to changes in the education of nurses over the past 10 years where undergraduate nurses, in many countries, have been discouraged from undertaking systematic review and primary research at undergraduate level. Furthermore, there has been a dilution of methods at postgraduate level with more emphasis on systematic review, meta-analysis and change management projects rather than primary research. These points are not discussed in the review. The authors make recommendations regarding the need to “attempt to causally associate research use scores with practice improvements and/or improved patient outcomes. This may be a long-term aim or alternatively, it may seem unrealistic or even simplistic to consider such a causal relationship exists. The authors acknowledge that there is a need to benchmark for comparison purposes as well as enabling researchers and decision makers to evaluate the effect of different levels of research use on patient outcomes. They conclude that “Until we have accurate and reliable measures of research use, it will not be possible to know, with any degree of certainty, whether intervention efforts are increasing nurses' use of research”. It is clear that future theoretical development work is needed to construct and test frameworks based on measurement theory. There has been an emphasis, across healthcare, on the importance of getting research evidence produced, synthesised, disseminated and used in practice. The prominence ascribed to research evidence has meant the relative neglect of other forms of evidence in the delivery of healthcare, in terms of making these available for critical scrutiny and public review. Thus, the potential interaction of research evidence with contextual, individual practitioner and patient variables (as is promoted in models of evidence-based practice (EBP)) has been disregarded. In this study, the terms EBP and decision-making were excluded from the search. EBP models require care to be both person-centred and evidence-based, hence practitioners need to draw on and integrate multiple sources of propositional and non-propositional knowledge informed by a variety of evidence bases. Furthermore, these processes are not acontextual – the melding of this evidence base occurs within complex, multi-faceted clinical or care environments. Dopson et al1 conclude “there are multiple interpretations by different stakeholders, varying by individuals within one group, by group and by profession”. (p. 42). This indicates that, while research evidence is important to delivering evidence-based care, it is less certain and less value free than is sometimes acknowledged. More specifically, there is a need to translate and particularise evidence in order to make sense of it in the context of caring for individual patients. Research evidence, although crucial to improving patient care, may not on its own inform practitioners' decision-making.2 3 We still have a long way to go in fully understanding what influences nurses' use of research in practice, and this paper has identified the need to improve the measurement tools and research methods to inform this work.