Research and quality improvement experience and knowledge: a nursing survey

fox j., bagley l., day s., holleran r. & handrahan d. (2011) Journal of Nursing Management 19 , 623–631
Research and quality improvement experience and knowledge: a nursing survey Aim To assess nursing staff’s background and research and quality improvement (QI) experience. Background In this corporation, participation in research and QI is encouraged, but little is known about nurses’ experiences. Methods A web-based survey was distributed. Nursing staffs from an academic/teaching medical centre and other intra-corporation non-academic facilities were compared. Results Respondents included: 148 (52.9%) medical centre and 132 (47.1%) non-medical centre subjects. Medical centre respondents had a higher proportion previously engaged in research, currently engaged in research and previously engaged in QI. Productivity (grant, published and presented) was low for both groups but statistically lower for the non-medical centre group. Medical centre employees used research resources more often than the non-medical centre. Time was the most frequently mentioned barrier to participation in research and QI initiatives. Conclusions A moderate proportion of respondents had research and QI experience, yet productivity and use of resources was low. Nurses at non-academically focused facilities were in most need of assistance. Familiarizing nurses with resources and providing protected time may increase productivity. Implications for nursing management Developing an infrastructure to support nursing research is a worthy goal. Information about interest and experience of nurses can aid management in determining how to focus financial resources.     

Why do nurses at a university hospital want to quit their jobs?

The aim of the study was to investigate to what extent the registered nurses at a university hospital intend to quit their present jobs and the reasons for this. A total of 833 nurses at a university hospital responded to two mailed, work-environment questionnaires (Quality Work Competence and Huddinge University Hospital Model Questionnaire). About 54% (n = 449) intended to quit and 35% (n = 155) had already taken steps to do so. Main reasons were dissatisfaction with the salary (65%), psychologically strenuous and stressful work (32%), a wish to 'try something new' (28%) and limited opportunities to make a professional career (19%). Nurses who intended to quit ('quitters') rated a higher work tempo (P < 0.001), experienced an increased work-related exhaustion (P < 0.001) and a lower quality of patient care (P < 0.01). They also perceived to a lower degree that their competence was made good use of (P < 0.001) and that they had fewer opportunities of developing their own competence (P < 0.001) and making a professional career. They were less satisfied with the support from their superiors for participating in nursing research and developing projects (P < 0.001). Finally, the 'quitters' knew to a significantly lesser extent (P < 0.001) why they had the actual salary they had, what the salary was based on and what to do to improve it. However, it was found that the hospital still had a 'core group' of highly motivated and dedicated nurses with an unusually high amount of mental energy left. All findings regarding the 'quitters' are factors amenable to interventions.     

Characteristics associated with intent to stay among Quality Improvement nurses

Kim E.K. & Hwang J.I. (2011) Characteristics associated with intent to stay among Quality Improvement nurses. International Nursing Review 58 , 89–95 Aim: The study aims to investigate characteristics associated with intent to stay among Quality Improvement (QI) nurses in Korean hospitals. Background: QI nurses have recently emerged as a new specialty area in the nursing profession in Korea. They have played a major role in coordinating and facilitating hospital‐wide QI activities. However, their frequent turnover degrades the continuity of overall QI programmes and incurs additional costs in human resource management. Methods: A cross‐sectional questionnaire survey was administered to 123 QI nurses in 123 general hospitals. The collected data included their hospital and department characteristics, work demand, job satisfaction, organizational commitment and demographics. The response rate was 94.3% (n = 116). Multiple logistic regression analysis was performed to determine the factors associated with intent to stay. Findings: Only 32.8% intended to stay in their current job. Significant factors associated with intent to stay were affective commitment and work demands. QI nurses with a higher level of affective commitment were more likely to stay [odds ratios (OR) = 2.50], whereas those with higher quantitative work demands in QI education and support were less likely to stay (OR = 0.40). Conclusion: The findings indicated that intent to stay was closely associated with work environment characteristics. Efforts to enhance their affective commitment and support their workload management are needed to increase the retention of qualified and experienced QI nurses.     

Patient acceptance of endovaginal ultrasound.

OBJECTIVE: To assess women's experiences and attitudes regarding endovaginal ultrasound. METHODS: Women attending the obstetrics and gynecology clinics at the University of Florida were asked to complete an anonymous questionnaire. RESULTS: Of respondents who had had a prior endovaginal ultrasound examination, 26% reported that 'it hurt a lot' and 50% reported that 'it hurt a little'. In contrast, only 23% of patients had experienced any pain with a prior abdominal ultrasound (P < 0.001). Multivariate analysis showed that discomfort with a prior vaginal ultrasound was related to patient age category, with less discomfort being experienced with increasing ages (P = 0.001). A history of unwanted sex, sexual or physical abuse, or dyspareunia was not associated with more painful examinations. Most patients were willing to undergo a future vaginal ultrasound investigation if it were recommended by their doctor. Multivariate analysis showed that more willingness was associated with older age category (P = 0.004), a history of dyspareunia (P = 0.03) and bleeding in a current pregnancy (P = 0.005). Of the patients (less than half) who had a preference, most preferred a female sonographer for endovaginal sonography (P < 0.001) and most preferred that a doctor, rather than a nurse or technician, perform the examination (P < 0.001). CONCLUSIONS: The majority of women who had experienced a vaginal ultrasound examination found it somewhat uncomfortable, but almost all women who returned the questionnaire expressed a willingness to undergo endovaginal ultrasound if it were recommended.     

Primary care provider attitudes are associated with smoking cessation counseling and referral

OBJECTIVE: Most primary care providers (PCPs) endorse the importance of smoking cessation, but counseling rates are low. We evaluated the consistency of PCP's attitudes toward smoking cessation counseling and corresponding smoking-cessation behaviors. DESIGN: This was a postintervention analysis of a population-based sample from a group randomized controlled trial to improve adherence to smoking cessation guidelines. SETTING: A total of 18 VA sites in Southwestern and Western United States participated. PARTICIPANTS: A total of 280 PCPs completed a survey at 12 months after the implementation of a smoking-cessation quality improvement (QI) program. Their patients also completed 12- (n = 1080) and 18-month (n = 924) follow-up surveys. INTERVENTION: The quality improvement intervention included local priority setting, quality improvement plan development, implementation, and monitoring. MEASUREMENTS AND MAIN RESULTS: PCPs at intervention sites were more likely to report counseling patients about smoking cessation (P = 0.04) but not referral. PCP attitude toward smoking-cessation counseling was strongly associated with reported counseling (P < 0.001) and with referral (P = 0.01). Other associations with counseling were the perceived barrier "patients are not interested in quitting" (P = 0.01) and fewer years in practice (P = 0.03); other associations with referral were specialty consultation (P < 0.0001) and the perceived barrier "referral not convenient" (P = 0.001) (negative association). PCP attitudes were associated with higher rates of counseling, referral, and program attendance. CONCLUSIONS: PCPs, regardless of intervention participation, had attitudes consistent with their reported smoking-cessation behaviors and more favorable attitudes were associated with higher rates of patient-reported smoking cessation behavior. Findings suggest that PCPs who endorse smoking-cessation counseling and referral may provide more treatment recommendations and have higher patient quit rates.     

Becoming a web-based learner: registered nurses' experiences

AIMS: The purpose of the study was to describe Registered Nurses' experiences when taking a web-based course from either the workplace or home, and the impact of their learning on clinical practice. RATIONALE: Little is known about the web-based learners' experience, particularly when courses are accessed from the nursing practice setting. Even less is known about whether nurses transfer their web-based learning to clinical practice. METHODS: A qualitative design employing focus group interviews was used. Participants included hospital and community nurses from three Canadian provinces and one territory. Data were collected at three points over a 6-month period and analysed using a thematic analysis process. These findings emanate from a larger study using survey method and focus group interviews. RESULTS: The focus group interviews captured the hurdles nurses faced during the first weeks when they struggled with technology, re-framed their views of teaching and adjusted to web-based learning from home and work. These first stressful weeks were followed by a period during which nurses developed relationships with the teacher and peers that enabled them to focus on learning and prevented attrition. Most nurses reported the web course was convenient and that they would be interested and comfortable using technology for learning and work purposes in the future. Six weeks after the course was completed, nurses articulated a number of ways the course had improved their practice. CONCLUSION: Initial weeks in a web-based course can be very challenging for novice Internet users, however, most nurses who completed the course reported a positive learning experience. Nurses, employers and educators should evaluate computer skills, computer access and the learning environment when preparing for web-based learning.     

Evidence-based practice and determinants of research use in elderly care in Sweden

RATIONALE AND OBJECTIVE: Evidence-based practice is a strategic ingredient in today's health care. Despite extensive efforts to produce and disseminate clinical guidelines, research uptake is still a difficult task. In Sweden, elderly care (EC) has shifted from hospital care to community-based care, and the major nursing-staff group in EC has no university education. These and other factors make implementation of evidence-based care particularly challenging in EC settings. The purpose of this study was to identify determinants of research utilization in EC. METHOD: Two questionnaires that cover research utilization and organizational climate were mailed to all staff (n = 132) working in seven EC units. The response rate was 67%. RESULTS: Of all respondents, 28% reported that they used research findings in daily practice (the RU group). Remaining respondents constituted the non-RU group. Significant differences existed between the RU group and the non-RU group as per six individual and six organizational factors. Using logistic regression models, four factors were significantly related to research utilization, namely: attitudes toward research (OR = 5.52, P = 0.004); seeking research that is related to clinical practice (OR = 5.56, P = 0.019); support from unit manager (OR = 4.03, P = 0.044) and access to research findings at work place (OR = 6.65, P = 0.005). CONCLUSIONS: Individual and organizational factors were associated with the use of research in EC. Despite distinguishing conditions in EC settings, identified factors reflect well-known determinants of research use that, as in many other health care contexts, should be considered in the endeavours of evidence-based practice.     

The scope of private practice nursing in an Australian sample

The changing Australian health care system is creating new opportunities for nurses who work directly with clients in private practice settings. This study examines the scope of practice of a cohort of nurses in private practice. In a questionnaire sent to 106 self-employed nurse entrepreneurs, questions were asked pertaining to the participants' scope of practice, their clients, the types of services offered, and their fee structures. Questions about scope of practice were divided into domains of clinical practice, business consultancy, education, and research. Quantitative and qualitative data were collected for a final sample 54 eligible responses. Participants had been in private practice for an average of 7.6 years (range: 1-20) and reported a mean of 21 years of nursing experience (range: 4-42) before entering private practice. Over half held diplomas in specialty areas. Most participants reported clinical practice, consultancy, or education as the primary work domain; research was much less important as a work activity. Nurses reported difficulties with building client base and receiving adequate fees for service, particularly in clinical practice. Increasing awareness within the nursing profession and health sector about various aspects of private practice nursing could improve service quality for their clients.     

Somali and Oromo refugee women: trauma and associated factors

AIM: This paper reports a study identifying the demographic characteristics, self-reported trauma and torture prevalence, and association of trauma experience and health and social problems among Somali and Oromo women refugees. BACKGROUND: Nearly all refugees have experienced losses, and many have suffered multiple traumatic experiences, including torture. Their vulnerability to isolation is exacerbated by poverty, grief, and lack of education, literacy, and skills in the language of the receiving country. METHOD: Using data from a cross-sectional population-based survey, conducted from July 1999 to September 2001, with 1134 Somali and Oromo refugees living in the United States of America, a sub-sample of female participants with clearly identified parenting status (n = 458) were analysed. Measures included demographics, history of trauma and torture, scales for physical, psychological, and social problems, and a post-traumatic stress symptom checklist. FINDINGS: Results indicated high overall trauma and torture exposure, and associated physical, social and psychological problems. Women with large families reported statistically significantly higher counts of reported trauma (mean 30, P < 0.001) and torture (mean 3, P < 0.001), and more associated problems (P < 0.001) than the other two groups. Women who reported higher levels of trauma and torture were also older (P < 0.001), had more family responsibilities, had less formal education (P < 0.001) and were less likely to speak English (P < 0.001). CONCLUSION: These findings suggest a need for nurses, and especially public health nurses who work with refugee and immigrant populations in the community, to develop a more comprehensive understanding of the range of refugee women's experiences and the continuum of needs post-migration, particularly among older women with large family responsibilities. Nurses, with their holistic framework, are ideally suited to partner with refugee women to expand their health agenda beyond the biomedical model to promote healing and reconnection with families and communities.     

Psychiatric nurses' attitudes to antipsychotic depots in Hong Kong and comparison with London

Psychiatric nurses' attitudes to depots have only been explored in the UK. We conducted a cross-sectional attitudinal study for Hong Kong psychiatric nurses and also conducted international comparisons for nurses' views about depots. A pre-existing UK questionnaire on clinicians' attitudes and knowledge regarding depots was updated for the present study. Participants were 98 psychiatric nurses who attended an academic meeting. The majority of respondents had positive views regarding their role in depot administration; most reported that they had sufficient training (84%). However, many did not feel involved in treatment decision making (60%) and other negative views were expressed including: (1) most patients always prefer to have oral (vs. depot) (80%); and (2) force is sometimes required when administering a depot (40%). Interestingly, most reported that patients' friends and family were more accepting of depot (vs. oral) (69%). When compared with a former sample of London community psychiatric nurses, Hong Kong nurses had less favourable patient-focussed attitudes (mean 56% vs. 60%, P = 0.051) and depot-specific attitudes regarding depots (mean 63% vs. 69%, P < 0.001). In conclusion, therefore, international variation exists and encompasses clinical practice aspects for both the patient and the depot formulation per se. Our participants wanted more involvement in treatment decision making.     

A study of the utilization of research in practice and the influence of education

This paper reports part of a multi-phase study which aimed to investigate the extent to which nurses utilize research and to identify factors associated with research utilization. The findings presented examine the influence of education upon research utilization. Firstly, a survey of registered nurses working in general medical and surgical wards in Scotland was conducted. 680/936 (72.6%) nurses returned self-report questionnaires to measure the level of utilization of 14 research based practices and assess the presence of potential influencing factors. This was then followed up through interviews with a sub-sample of nurses. An association was found between a higher educational level and research utilization. The nurses reported that in courses as opposed to study days, they were expected to engage in study and read and complete course work whereas attendance at study days could be an entirely passive experience and was often more of a morale booster. Nurses who read at least one journal regularly, had had more study leave, or had attended research courses also had a higher level of research utilization.     

Utilization of research findings by graduate nurses and midwives

BACKGROUND: There is mounting pressure on nurses and midwives in the United Kingdom to use research findings to inform their practice. However, many still find research difficult to understand and are poorly prepared by education to make use of it. Hence, there is a pressing need to evaluate the research education included in nursing and midwifery curricula. AIM: This paper reports a study assessing the impact of research education on the attitudes towards research and use of research findings in practice by graduate nurses and midwives. METHOD: A cross-sectional survey using a self-completed postal questionnaire was conducted with a sample of 340 nurse and midwife graduates in the South East of England. FINDINGS: A response rate of 51% was obtained. A large number of respondents stated that their critical appraisal (96%) and search skills (87%) had improved following graduation and they reported using research findings in practice (16.8% all the time, 50.5% frequently and 32.6% sometimes). Furthermore, the majority expressed positive attitudes towards research and these were related to the research education received. However, a significant number reported finding statistics difficult to understand, lack of time to read research and limited access to research findings at their place of work. Also, a number of respondents would still like more help with searching the literature, implementing research findings in practice and developing their critical appraisal skills further. CONCLUSION: It is crucial that some of the major barriers to research utilization are addressed at both individual and organizational levels if evidence-based care is to become a reality. Also, health service managers should consider a number of strategies suggested by respondents to increase the use of research findings in clinical settings.     

Medical emergency teams: a strategy for improving patient care and nursing work environments

AIM: This paper reports a study of nurses' perceptions about medical emergency teams and their impact on patient care and the nursing work environment. BACKGROUND: In many acute care hospitals, nurses can summon emergency help by calling a medical emergency team, which is a team of expert critical care professionals adept at handling patient crisis scenarios. Critical care nurses form the core of such teams. In addition, of all the healthcare professionals, nurses are the ones who most often need and call for medical emergency team assistance. METHODS: A simple anonymous questionnaire distributed amongst 300 staff nurses at two sites of an acute care teaching hospital in the United States of America in mid-January of 2005. RESULTS: A total of 248 nurses responded to the survey (response rate = 82.7%). Ninety-three per cent of the nurses reported that medical emergency teams improved patient care and 84% felt that they improved the nursing work environment. Veteran nurses (with at least 10 years of experience) and new nurses (<1 year's experience) were more likely to perceive an improvement in patient care than other nurses (P = 0.025). Nurses who had called a medical emergency team on more than one occasion were more likely to value their ability to call a team (P = 0.002). Nearly sixty-five per cent of respondents said they would consider institutional medical emergency team response as a factor when seeking a new job in the future. Only 7% suggested a change in the team response process, and 4% suggested a change in activation criteria. CONCLUSIONS: Most nurses surveyed had a favourable opinion of the medical emergency team. Our findings suggest that other institutions should consider implementing a medical emergency team programme as a strategy to improve patient care and nurse working environment.     

A comparison of pre-Project 2000 and Project 2000 nurses' perceptions of their research training, research needs and of their use of research in clinical areas

Most of the literature on the research training and education of nurses has focused on teaching strategies. Only a few authors have assessed systematically the impact of research modules or courses on the knowledge and attitudes of nurses. There is a lack of research on nurses' use of research following their preparation. This paper reports on some of the data from a large-scale survey of the utilization of research among nurses in Northern Ireland. In particular, a comparison is made of the perceptions of pre-Project 2000 and Project 2000 qualified nurses of their research training, research needs, and use of research in clinical areas. A questionnaire was distributed to a convenience sample of 2600 nurses from 23 hospitals in 14 Trusts in Northern Ireland. The response rate was 52.6% (n = 1368). The findings show, among others, a shortfall in research preparation of pre-Project 2000 nurses in important aspects of research. While Project 2000 nurses reported receiving more training, they did not report higher rates of research utilization than pre-Project 2000 nurses. Registered mental nurses (RMNs) and registered nurses mental handicap (RNMHs) also reported lower rates of research utilization than registered general nurses (RGNs), despite reporting the same amount of research preparation as RGNs. The implications of these findings are discussed.     

不同人群对护理硕士专业学位能力培养和课程设置认知的比较研究

目的:了解护理专家及硕士研究生主要生源对专业学位研究生能力培养、课程设置和教学方法的认知及差异。方法:采用问卷调查结合访谈法,对40位副高级及其以上职称的从事和熟悉护理工作的专家、147名具有本科学历的临床护士以及177名应届护理本科毕业生进行调查。结果:专家和生源对评估观察能力、护理操作能力、健康宣教能力的认知比较,差异有统计学意义(P<0.01);本科护士对科研能力的需求高于应届毕业生(P=0.006);生源对基础课程和专业课程的学习重视不足(P<0.001);应届毕业生对跨学科交叉课程有较高需求(维度排序第2位);专家和生源对PBL教学法、小组讨论和课堂讲授的认知存在差异(P<0.01)。结论:教育管理者应重视生源的心理需求和思想误区,满足甚至强化其正向需求,纠正、消除其思想误区。     

Barriers to research implementation in two Yorkshire hospitals

Background: the BARRIERS to research utilization scale was developed in the US almost a decade ago (Funk et al. 1991). Since then it has been used in several countries with different, relatively small groups of nurses in different settings. The work reported here is a sub-section of a larger survey of more than 2000 nurses working in acute and community settings in Yorkshire. Results for the hospital-based nurses only are presented here.Aim: the aim of the study was to produce a general picture of the main barriers to the implementation of research findings as reported by hospital nurses and to explore sub-samples in order to identify similarities and differences between them.Method: a census survey of nurses from two hospital trusts was undertaken. The BARRIERS questionnaire was sent by mail to 1984 nurses, with a response rate of 36% (n =712).Results: the greatest area of concern focused on resources. This included time and facilities for implementation and cooperation from colleagues, in particular medical colleagues. Inadequate authority to make changes and incomprehensible statistical analyses were also major barriers. Night nurses and older nurses reported greater difficulties with the accessibility of research and had more negative views of the benefits of research for practice.Conclusions: the provision of time, facilities and peer support appeared to be needed, in keeping with other UK-based studies of hospital nurses using the BARRIERS scale. Nurses needed authority to make changes to practice. Furthermore, there was a need for training to improve nurses’ understanding of statistics, as well as statistics being presented more clearly and with greater explanation. The current drive for evidence-based practice makes the use of an instrument such as the BARRIERS scale to measure the progress of nurses with research implementation highly desirable.     

医院合同护士工作价值观现状及相关因素的研究

目的了解医院合同护士工作价值观的现状及其工作需求,为管理部门进行有效的护理人力资源管理提供依据。方法使用工作价值观问卷对成都市7所三级综合医院的979名合同护士进行问卷调查。结果合同护士工作价值观维度排在前3位的依次为人际关系、成就动机和经济报酬;不同年龄的合同护士对经济报酬的重视程度有差异（P=0．004）,不同婚姻状况的合同护士对社会交往维度的重视程度有差异（P=0．005）,不同工作年限的合同护士对经济报酬、安全稳定和社会交往3个维度的重视程度有差异（P〈0．01）,不同职称的合同护士对智力刺激维度的重视程度有差异（P=0．030）。结论人际关系、个人成就和经济报酬在合同护士价值体系中占有重要地位,年龄、婚姻状况、工作年限和职称对合同护士的工作价值观有影响。     

The impact of higher education for post-registration nurses on their subsequent clinical practice: an exploration of students' views

In recent years there has been a large increase in the number of qualified nurses in the United Kingdom, who have raised the academic level of their nursing qualification to diploma level or above. Correspondingly, there has been little research that assesses the value of post-registration education offered by universities. In particular, there is a paucity of research regarding the effects of courses on the subsequent clinical practice of participants. Studies of post-registration education appear to be small scale and limited in scope. This paper examines the views of diplomates as to the effect of a Diploma in Professional Studies in Nursing course on clinical practice. A questionnaire was sent to all nurses (n = 169), from the first seven cohorts, who successfully completed the course. A response rate of 66.8% (n = 113) was achieved. The respondents reported themselves to be more questioning, more able to apply research findings and to have a wider knowledge for practice following completion of the course. The findings are discussed, limitations of the study addressed and recommendations for further research are made.