The effect of staff nurse participation in a clinical nursing research project on attitude towards, access to, support of and use of research in the acute care setting

The purpose of this study was to determine the effect of participation in research on staff nurses' attitude towards, access to, perceived support of and reported use of research in practice. Six medical surgical units in a southeastern Ontario teaching hospital were randomly assigned to receive 3 different levels of exposure to research: high, low and usual. On the high participation units, a clinical research group consisting of the investigator and interested nurses (n = 18) critiqued research literature related to an important clinical issue (i.e., patterns of sleep) and designed and implemented a clinical research study. On the low participation units, a similar clinical research group (n = 10) met once and were involved, solely, in the design and implementation of the clinical research protocol. On the control units, there were no formalized research groups or activities. All registered nurses (n = 235), including the research group participants, on the 6 units were surveyed with a research utilization questionnaire (RUQ) pre and post participant intervention. The RUQ scores were higher on the high participation units at baseline and post intervention in comparison to the low and control units. Nurses who participated directly in the clinical research groups (high and low) reported similar RUQ scores post intervention and higher scores in comparison to all nurses. All RUQ scores were higher post intervention. Nurses with clinical expertise but minimal research expertise participated meaningfully in clinical research. While participation had an individual effect there was no unit effect, suggesting other factors, such as organizational support and culture, are important determinants of research use.     

泰安市综合医院不同学历护士组织支持感调查研究

目的 探讨泰安市综合医院不同学历护士组织支持感（perceived organizational support,POS）现状及其影响因素,为政府制定政策和科学管理提供依据.方法 采用护士组织支持感量表对泰安市各级综合医院1000名护士进行问卷调查.结果 泰安市综合医院的护士POS得分为3.39,低于中国知识员工POS水平；情感性支持维度得分（3.29±1.05）分,低于工具性支持性维度得分（3.67±0.93）分,差异有统计学意义；护士的POS水平有随学历增高而降低的倾向.结论 泰安市综合医院护理人员的POS偏低,尤其是情感性支持维度；学历越高的护士其POS越低.医院管理者应根据护理人员不同学历进行培养及分配岗位,这对提高护理水平和稳定护理队伍具有重要的意义.     

中医医院护士组织气氛与职业获益感现状及其影响因素分析

目的：调查中医医院护士组织气氛和职业获益感的现状,分析其影响因素。方法：选择天津市 3所三级甲等中医医院在职护士共200名,采用一般资料调查表,护士组织气氛感知,护士职业获益感量表进行调查。结果：中医医院护士的组织气氛总分为（80.41±19.54）分,职业获益感为（100.79±21.38）分;多元回归结果显示,婚姻、工作年限、夜班是组织气氛感知主要影响因素（P<0.05）;职称、文化程度是职业获益感的主要影响因素（P<0.05）;Person相关分析结果显示护士组织气氛与职业获益感呈正相关（P<0.05）。结论：中医医院护士组织气氛和职业获益感均处于中等水平,积极的组织气氛有助于提升其职业获益感,护理管理者应根据护士不同工作年限、职称、文化程度采取不同的管理方式,发挥各层级护士潜能,提升中医临床护理质量,从而促进中医护理的发展。     

Nurses' experiences of research utilization within the framework of an educational programme

This paper explores nurses' reflections on their experiences of disseminating and implementing research findings in clinical practice within the framework of an educational programme. Ten registered nurses, all in clinical practice, participated in a research-orientated educational programme with the aim of facilitating the dissemination and implementation of research findings in clinical practice. Thus, the programme contained different activities designed to disseminate and implement research findings in the participants' wards. Focus groups were used to collect data and a qualitative content analysis was performed. The main themes that were developed were: organizational and leadership issues; acquiring a new role; responses and reactions by others; and orientation to research. Organizational and leadership issues, nurses' interest in research, nurses' reading habits, and support and feedback from their head nurses and other managers and from their nursing colleagues and physicians were seen as important. This study confirms that research utilization and the change to research-based nursing practice are complex issues which require both organizational and educational efforts.     

Barriers to paediatric nurses' research utilization

BACKGROUND: A number of studies have investigated barriers to research utilization among nurses in various countries, and standardized scales have been validated to study this. Reported barriers have been categorized as individual, organizational and environmental, with organizational characteristics generally accounting for more variance. However, information about research utilization among paediatric nurses is lacking. AIM: The objective of the research reported here was to investigate barriers to research utilization and relationships between those barriers and participation in research, self-reported research utilization and education among paediatric nurses. DESIGN: A survey of all nurses in a paediatric teaching hospital; 176 nurses (33.3%) responded. Two standardized measures were used, the Barriers Scale and the Edmonton Research Orientation Scale. RESULTS: Lack of time to read research was the most frequently cited barrier to using research and administrators not allowing implementation was the least frequently cited. Characteristics of the communication and of the setting were more likely to be cited as barriers to research use than were characteristics of the nurse. Nurses who reported higher levels of actual research use were slightly less likely to see characteristics within themselves as barriers. Those who had taken a course about reading or using research were more likely to see the organization as a barrier. Barriers to research use were not associated with self-reported understanding of research. CONCLUSIONS: These results are congruent with previous findings that implementing research in practice is a complex process. They indicate that individual nurses' knowledge about research may not be as important as the process by which organizations implement research. However, the Barriers Scale measures general perceptions about barriers to research utilization and not nurses' specific experiences with barriers to implementing particular research.     

Critical care nurses' participation in ethical decision making

Critical care staff nurses' participation in ethical decision making was studied in relation to the perceptions of environmental social support of 45 female staff nurses. Data obtained measured perceived environmental social support from six organizational subgroups and individual participation in ethical decision making. Validity and reliability testing was done on the instrument. When involved in an ethical situation, critical care nurses perceived low levels of environmental social support from hospital administrators, nursing administrators, and physicians. Co-workers were consistently perceived as most supportive across all aspects of social support. The majority of the nurses surveyed (74%) reported that ethical decisions were made by physicians or with reference to hospital policy, and that there were limited roles for individual, family, or nurse participation in such decision making. It was concluded that critical care nurses perceive a lack of free agency necessary to engage in ethical decision making in hospital environments or to act in an advocacy role in such situations.     

Faculty practice and roles of staff nurses and clinical faculty in nursing student learning.

The perceptions of staff nurses and clinical nurse faculty on the roles they play in nursing student learning were examined. The study also sought to explore how faculty practice status affected these perceived roles. Nursing schools with generic baccalaureate nursing programs in the middle Atlantic region composed the study population. A convenience sample of two schools that expected their undergraduate clinical faculty to engage in faculty practice and two schools that did not expect faculty practice participated in the study. Clinical faculty members (15) and nursing education administrators (4) from each school participated, as well as staff nurses (22) and nursing service administrators (4) from each school's related hospital. Focus groups and individual interviews were conducted. Manifest and latent content analyses were used to examine the issues. Staff nurses who worked with practicing faculty reported fewer instances of role overload, conflict, and ambiguity than when they worked with nonpracticing faculty. Lack of clear communication and delineation of expectations among administrators, staff, faculty, and students were cited as major factors in perceived role problems. Administrators, faculty, and staff nurses viewed high student/faculty ratios as a causative factor in the faculty's inability to meet all teaching objectives with students.     

Hospital and parish (county) utilization of master's-prepared nurses in Louisiana

Recent regulation in Louisiana involving advanced practice nursing, combined with new educational standards at the Master's level established by the Louisiana State Board of Nursing, prompted a statewide survey of hospitals and parish health units. The purpose of the survey was to determine whether and to what extent Master's-prepared nurses were being used in Louisiana and to identify the importance placed on role functions and activities generally associated with the advanced practice nurse (APN). The survey included open-ended questions concerning expectations about future hirings and perceptions of future roles and duties of the Master's-prepared nurse as well as suggestions to educators on what is needed to better prepare nursing students at the Master's level. Results from this exploratory survey provide information on APN utilization with implications for nursing educators and administrators as well as APNs.     

Research utilization in nursing practice — a pilot study

A low research base and inadequate research utilization are seen as obstacles to acquiring credible professional status for nursing. During recent years there has been some debate, both in Europe and in North America, about the extent to which nurses base their practice on research. This paper reviews recent empirical studles about research utilization, then goes on to describe a small pilot study carried out in the UK to attempt to measure research utilization among general nurses at F/G grade. A large-scale, generalizable survey using sirmlar methods is proposed to build on the knowledge gained from the pilot study. Tentative findings are put forward that show a positive attitude towards research among British clinical nurses. Specialist nurse advisors and research-based protocols are helpful to nurses in accessing research literature. The biggest deterrent to research utilization appears to be lack of perceived autonomy — some nurses feel unable to challenge medical colleagues and organizational managers and so fail to make use of research findings available to them. Significant differences are found between the two hospitals studied in the characteristics of their nursing staff, particularly in relation to their research awareness and degree of perceived autonomy.     

Staffing in acute hospital wards: part 1. The relationship between number of nurses and ward organizational environment

This paper is one of two that explores relationships between nursing staff resources, ward organizational practice and nurses' perceptions of ward environments. Here we examine relationships between staff numbers, care organization and nursing practice. A subsequent paper examines the effects of grade mix and staff stability. The data were collected in the mid-1990s from a nationally representative sample of 100 acute hospital wards and 825 nurses. Our analyses provide important insights for managers seeking to achieve the strategic aims set out in Working Together, and subsequent National Health Service (NHS) policy placing emphasis on making the best use of nurses, focussing on mobilising their knowledge, skills and talents within the context of extended work roles. Findings show that number of nurses is associated not only with ward organizational systems but also with a range of care processes and staff outcomes which hitherto have been linked only to ward organizational systems. The latter have been identified as providing different opportunities for developing multidisciplinary working and nurses' autonomy but the central importance of having an adequate number of staff to achieve these aims has been largely overlooked in research. Having fewer nurses was associated with both hierarchical ward organizational structures and hierarchical attitudes to care provision, denoting lower standards of nursing practice. A larger nursing complement was significantly associated with devolved organizational structures but no link was established between more staff and higher standards of nursing practice. When there were more staff there was a positive association with nurses' perceptions of multidisciplinary collaboration, their ability to cope with workload and job satisfaction. Employing an adequate number of nurses to provide care is clearly beneficial for nurses themselves. Patients are also likely to benefit from a lower incidence of 'hierarchical practice' associated with having a low nurse/bed ratio within a ward.     

456名临床护士工作场所灵性现状及影响因素分析

目的 调查三级甲等医院护士工作场所灵性现状及其影响因素,以期为护理管理者制订提高护士工作场所灵性的干预措施提供参考。方法 采用便利抽样法,选取天津市8所三级甲等医院的456名护士为研究对象,采用一般资料调查表、工作场所灵性量表、护士组织支持感量表及个人-组织契合度量表进行问卷调查。采用多元线性回归分析护士工作场所灵性的影响因素。结果 护士工作场所灵性总分为（99.08±24.54）分,护士工作场所灵性与组织支持感总分、个人-组织契合度总分呈正相关（r=0.720,r=0.768,均P<0.01）;多元线性回归分析显示,性别、学历、每月夜班次数、对护理工作的态度、组织支持感及个人-组织契合度进入回归方程（P<0.01),可解释总变异的64.3%。结论 456名护士工作场所灵性处于中等水平,性别、学历、每月夜班次数、对护理工作的态度、组织支持感及个人-组织契合度是护士工作场所灵性的主要影响因素。护理管理者可通过提高护士的组织支持感及个人-组织契合度水平,以提高其工作场所灵性水平,进而稳定护理人才、提高护理质量。     

Nurses' skill level and access to evidence-based practice

Integrating evidence-based practice into the culture of an acute care hospital requires assessment, planning, and intervention by nursing leadership. The authors discuss a statewide study that assessed the skill level of nurses in obtaining evidence for their nursing practice, using computers and databases, as well as evaluating the perceived availability of resources in their hospitals to access evidence.     

Using the worldwide web to improve children's pain care

AIM: This paper describes a three-year project, the aims of which were to disseminate information regarding the assessment and management of children's pain, to reach consensus on the essential elements of pain assessment for children and to track nurses' perceived changes in pain assessment and management practices in hospital settings over time. BACKGROUND: Despite the availability of research, guidelines and standards, paediatric nurses inconsistently practice evidence-based pain management. PROJECT METHODS: Nurses attending the 5th International Symposium on Paediatric Pain were invited to a workshop to discuss best practices and consider ways to share information regarding the assessment and management of children's pain. A website was designed and participants provided hospital guidelines, exchanged information via the Internet and completed periodic surveys. CONCLUSION: Web-based resources were positively received. Consensus regarding the essential elements of pain management was achieved, but nurses identified organizational and resource restraints as barriers to achieving best practices. Surveys identified perceived increases in some hospital and ward level resources and activities to improve children's pain care. Sharing of information related to children's pain management and benchmarking of practice should be encouraged. Consensus building and networking may facilitate change, but organizational commitment is also required for successful implementation of new practices.     

Nursing students can help support evidence-based practice on clinical nursing units

AIMS: A research study was designed to explore whether research utilization projects underwent by student nurses could have an impact on nursing practice on clinical nursing units. BACKGROUND: The use of evidence-based practice is becoming essential for nursing managers and nursing staff, but there are many barriers to implementing research findings in practice. Student nurses can be used to assist when staff nurses do not have time during the work day. METHODS: Baccalaureate nursing students completed a research utilization project during their final comprehensive clinical experience. Telephonic interviews were conducted with the students' preceptors 5 months after the students' clinical experience, to obtain their perceptions of the impact of the student project on the nurses' knowledge and practice. RESULTS: The staff nurse preceptors reported the projects were well received with the primary impact of the projects being to educate the nursing staff and patients and thus improve the level of nursing practice on the clinical units. CONCLUSIONS: Student research utilization projects are one way to save time for staff nurses and increase their awareness of current research findings.     

Perceptions of research utilization: comparisons between health care professionals, nursing students and a reference group of nurse clinicians

The study reported in this paper was carried out to investigate a group of nursing teachers' (n=37), nursing students' (n=166), nursing administrators' (n=33) and physicians' (n=127) perceptions of barriers to and facilitators of nurses' use of research findings in clinical practice. The results were compared with the corresponding figures for a reference group of nurse clinicians (n=237). The Barriers Scale and a questionnaire for the demographic issues were used for data collection. The organization and the communication of research were seen as barriers to research utilization by the nursing teachers, students and administrators in agreement with the nurse clinicians. The nurses' research-related competence and awareness were seen as barriers by the nursing teachers, students and administrators to a greater extent than by the nurse clinicians themselves. The physicians perceived barriers to a lesser extent than the other groups did. The students' perceptions were closest to the nurse clinicians, while the physicians' perceptions differed most. Education to increase the nurses' knowledge of research and to develop their competence to evaluate research results, increased resources for education, more staff, support from the administration and research presented in a user-friendly way were the most frequently suggested facilitators. The nurses' isolation from knowledgeable colleagues with whom to discuss the research was seen as a barrier by the majority of the participants. This indicates a need for positions in clinical practice for nursing researchers, in order to promote a research-based, nursing practice.