Most nurse researchers want their findings to contribute to nursing practice, and there is growing interest among nurses

in basing their practice on solid research evidence. RESEARCH UTILIZATION VERSUS EVIDENCEBASED PRACTICE The terms research utilization and evidence-based practice are sometimes used synonymously.Although there is overlap between the two concepts, they are, in fact, distinct. Research utilization (RU), the narrower of the two terms, is the use of the findings from a disciplined study or set of studies. In a practical application that is unrelated to the original research. In projects that have had research utilization as a goal, the emphasis is on translating empirically derived knowledge into realworld applications. EBP involves making clinical decisions on the basis of the best possible evidence. Usually,the best evidence comes from rigorous research, but EBP also uses other sources of credible information. The Utilization of Nursing Research During the 1980s and early 1990s, research utilization became an important buzz word, and several changes in nursing education and nursing research were prompted by the desire to develop a knowledge base for nursing practice. In education, nursing schools increasingly began to include courseson research methods so that students would become intelligent research consumers. In the research area, there was a shift in focus toward clinical nursing problems. These changes, coupled with the completion of several large research utilization projects, played a role in sensitizing the nursing community to the desirability of using research as a basis for practice; they were not enough, however,to lead to widespread integration of research findings into the delivery of nursing care. Research utilization, as the nursing community has come to recognize, is a complex and nonlinear phenomenon that poses professional challenges. THE RESEARCH UTILIZATION CONTINUUM

the start-point of research utilization is the emergence of new knowledge and new ideas. Research is conducted and, over time, knowledge on a topic accumulates. In turn, knowledge works its way into useto varying degrees and at differing rates. Theorists who have studied the phenomenon of knowledge development and the diffusion of ideas typically recognize a continuum in terms of the specificity of the use to which research findings are put. At one end of the continuum are discrete, clearly identifiable attempts to base specific actions on research findings. For example, a series of studies in the 1960s and 1970s demonstrated that the optimal placement time of a glass thermometer for accurate oral temperature determination is 9 minutes (e.g., Nichols & Verhonick, 1968). When nurses specifically altered their behavior from shorter placement times to the empirically based recommendation of 9 minutes, this constituted an instance of research utilization at this end of the continuum. This type of utilization has been referred to as instrumental utilization (Caplan & Rich, 1975). THE RESEARCH UTILIZATION PROCESS: ROGERS DIFFUSION OF INNOVATIONS THEORY

A. Communication channels are the media through which information about the innovation is transmitted,and can include both mass media (e.g., journal articles, the Internet), or individual, face-to-face communication.

Communication is most effective when there are shared beliefs, values, and expectations on the part of the sender and receiver of information. B. Time is a component of the theory in that the process of knowledge diffusion occurs over time; there are varying amounts of time that elapse between the creation of the knowledge and its dissemination, and between knowledge awareness and the decision to use or reject the innovation.

C. The social system is the set of interrelated units that solve problems and seek to accomplish a common goal; diffusion occurs within social systems that vary in their norms and receptivity to innovations Rogers characterized the innovation-adoption process as having five stages: knowledge, persuasion, decision, implementation, and confirmation. During the knowledge stage, individuals or groups become aware of the innovation, and during the persuasion stage, they form a positive attitude toward it. In the decision stage, a choice is made about whether to adopt or reject the innovation. The innovation is actually put into use during the implementation stage. Finally, the effectiveness of the innovation is evaluated during the confirmation stage, and decisions get made about continuation or discontinuation of the innovation. Recent research on utilization has challenged the linear nature of the process, and Rogers himself acknowledges that stages can sometimes be skipped, but the general model has been a useful way to think about the research utilization process in nursing.(eg: Dooks (2001), using Rogers model, explored possible reasons for the research-practice gap among oncology nurses relating to research on pain management.) EVIDENCE-BASED PRACTICE The research utilization/innovation diffusion process begins with an empirically based innovation or new idea that gets scrutinized for possible adoption in practice settings. EBP, by contrast, begins with a search for information about how best to solve specific practice problems. Findings from rigorous research are considered the best possible source of information, but EBP also draws on other sources. A basic feature of EBP is that it deemphasizes decision making based on custom, authority opinion, or ritual. Rather, the emphasis is on identifying the best available research evidence and integrating it with clinical expertise, patient input,

and existing resources. The EBP movement has given rise to considerable debate, with both staunch, zealous advocates and skeptics who urge caution and a balanced approach to health care practice. Supporters argue that EBP offers a solution to sustaining high health care quality in our current cost-constrained environment. Their position is that a rational approach is needed to provide the best possible care to the most people, with the most cost-effective use of resources. Critics worry that the advantages of EBP are exaggerated and that individual clinical judgments and patient inputs are being devalued. Although there is a need for close scrutiny of how the EBP journey unfolds, it seems likely that the EBP path is the one that health care professions will follow in the early 21st century.