RESEARCH UTILIZATION

IN NURSING

CLASS 6

Judith Anne Shaw, Ph.D., R.N.

October 21, 2009
 OVERVIEW OF CLASS #6
Nursing Research Utilization

Barriers to Research Utilization

Change, a Positive Strategy for Research

Utilization

Iowa Model for Research-Based Practice

 DEFINE

RESEARCH UTILIZATION
 Consider

Utilization: to make use of, to use

Research utilization: to make use of

research in clinical practice
 Research Utilization

the systematic process by which research-based

knowledge becomes incorporated (or used) into
practice.
 PURPOSE

RESEARCH UTILIZATION

Application of available knowledge to

improve client outcomes.

Validation of existing nursing procedures

and interventions
Evidence-Based Practice
Research Utilization

Important
all levels of nursing
Research Utilization
Nurses in the clinical setting

Promotes critical thinking

Enhances professional self-concept
Ensures safe and reflective practice
Practice based on current, scientific, sound
knowledge
Enrich nurses self-confidence
Researcher

Validates researchers efforts

Provides motivation for scholars to continue
to discover new knowledge
Reinforces professional accountability
Helps uncover new clinical problems for
investigation
Health Care Agency

Cost effective nursing care

High-quality care
Improved client outcomes
Retention and recruitment tool
Professionally satisfied and stimulated
nursing staff
Profession of Nursing

Enhances practice autonomy

Positive professional image
Strengthen professional status
Expands nursings scientific knowledge
base
What does history tell us about research
utilization?

A gap or time lag in the use of new

knowledge in the clinical setting.
 Time Lag
Between Idea & Utilization

can be 10-15 years

(Bostrom & Wise, 1994)
Narrowing the Research-Practice
Gap Through Research Utilization

Step # 1. select a relevant problem area

Problem-focused triggers
Knowledge-focused triggers
 Problem Focused Triggers for
Problem Identification

Evident to nurses in the practice setting

Clinical problems
 Knowledge-Focused Triggers for
Problem Identification

Knowledge obtained from:

Journal clubs
Attending a professional/academic
conference
Reading a scientific paper
 Narrowing the Research-Practice
Gap Through Research Utilization

Step #2. Review the literature

Sufficient quantity
Sufficient quality
Narrowing the Research-Practice
Gap Through Research Utilization

Step # 3. Determine are findings

appropriate to apply in the practice setting?
Criteria for Research Utilization

Utility to nursing
Applicability to practice
Replication
Scientific merit
Client safety
Feasibility
Narrowing the Research-Practice
Gap Through Research Utilization

Step # 4. Written plan to communicate the

research-based intervention or protocol
Narrowing the Research-Practice
Gap Through Research Utilization

Step # 5. Implementation of the planned

innovation

involve all staf

change process
Narrowing the Research-Practice
Gap Through Research Utilization

Step # 6. Evaluation of innovation

what went right?

what went wrong?
what changes are required?
Narrowing the Research-Practice
Gap Through Research Utilization

Step # 7. Dissemination of findings

publishing results of the

research utilization
did it make a diference?
 Problems: using research
findings

Barriers to knowledge use in nursing

Nurse Characteristics
Setting Characteristics
Research Characteristics
Innovation Characteristics
 Barriers to Knowledge Use

Study findings:
do not solve pressing clinical problems
often can not be used in practice
lack replication
communicated primarily to other researchers
not expressed in easily understood terms by
practitioners
Nurse Characteristics

Knowledge

Attitudes

Beliefs
Nurse Characteristics
Knowledge

Two Kinds of Knowledge

1. specific research studies related to practice

setting

2. ability to critique reported research

Nurse Characteristics

Attitudes

Need positive attitude towards research

utilization
Nurse Characteristics

Beliefs

Correct or erroneous beliefs about research

Change often begins with the

articulation of negative beliefs
lack of time
Setting Characteristics

Five characteristics that must be present:

1. Openness to new ideas
2. Interpersonal and information linkages for
open communication
3. Freedom from organizational constraints
4. Supportive leadership
5. Trust to risk possible failure
Research Characteristics

Clearly communicated
Comprehensive
Investigation of pertinent problems
Staff nurses part of the research team
Replication of research studies
Innovation Characteristics

Perceived improvement
Compatibility with present practice
Complexity
Trialability
Observability
How to work together and use Nursing Research
Findings
 Bridging
The Research - Practice Gap

1. Commitment

2. Knowledge of the practice setting structure

3. Planned strategy of change/clinical setting

 Pay-Off
Narrowing the Research-Practice Gap

1. Improved client care

2. Developing the artistry of practice
3. Professional status of nurses
4. Status of nursing within the scientific,
academic, and health service community
5. Societal relevance of professional practice
 Current Conceptions of Research
Utilization

A continuum in terms of the specificity or

diffuseness of the use of knowledge

conceptual instrumental
mid-ground
Research Utilization

Instrumental Utilization:

- base specific actions on research

 Instrumental Utilization

discrete

clearly identifiable attempts

to base some specific action on the
results of research findings
 Conceptual Utilization

Influences nurses thinking about an issue.

Conceptual Instrumental
Mid-Ground
 Conceptual Utilization

Situations in which users (nurses) are

influenced in their thinking about an
issue based on their knowledge of one or
more studies but do not put the
knowledge to any specific documented
use.
 Mid Ground Utilization

Knowledge creep

Decision accretion

Conceptual Instrumental
Mid-Ground
 Mid-Ground Utilization

Partial impact of research findings on

nursing activities

-these nursing actions are based to some

extent on research findings but other
factors are considered.
 Middle Ground
Research Utilization

Knowledge Creep:

-an evolving percolation of research ideas

and findings
 Middle Ground
Research Utilization

Decision Accretion:

-momentum for a decision builds over time based

on accumulated information gained through such
actions as reading, discussions, and meetings
 Research Utilization

Appropriate Goal for Nurses

- all points along the continuum

Conceptual Mid Ground Instrumental

 Knowledge Gap in Nursing
Production & Utilization

A gap does exist in nursing , as well as

other disciplines

Some gap is inevitable given the

imperfection of scientific research as a
means of knowing
 Possible Inflated Gap
Nursing Knowledge

Production & Utilization

1. Technical changes

2. Risk/benefit analysis

3. Non-captured utilization
 Technical Changes

Utilization studies do not always consider

changes that make the knowledge irrelevant.

(may take 2 yr. to publish findings)

 Risk/Benefit Analysis

- the risks for problems if the results are

implemented and prove to be incorrect

(nursing is more conservative versus medicine)

 Non-Captured Utilization

Focus of utilization studies is most often on

instrumental utilization; probably mid
-ground utilization of the continuum not
captured.
 What can... YOU & OTHER NURSES DO?

Student nurses & practicing nurses

think, conceptually use research
findings
regularly read research journals
read critical reviews of research
attend professional conferences
 What can... YOU & OTHER NURSES DO?

Researchers
conduct quality research
replicate
collaborate
disseminate aggressively & broadly (publish)
communicate clearly
 What can... YOU & OTHER NURSES DO?

Scholars & educators

incorporate research findings into the curriculum
note absence of relevant research, when
appropriate
encourage research utilization
prepare integrative research reviews with class
content
 What can... YOU & OTHER NURSES DO?

Administration
foster a climate of intellectual curiosity
offer emotional or moral support for
utilization
reward efforts for utilization
Planned Change
Change Agent

one who works

to bring about
a change
 The Process of Change

Driving Restraining
Forces Forces

Target System

(Adapted from Lewin, K. (1951). Force Field Model)

 Driving & Restraining Forces
Begin the change process by

Analyzing the entire system involved to

identify the forces for and against change

driving forces: push the system toward

change
restraining forces: pull the system away
from change
 Forces

driving forces: push the system toward

change

restraining forces: pull the system away

from change
 Problem
Concern: When the existing restraining
forces are the same or stronger
than the driving forces

Resolution: Use participative change

strategies to reduce the restraining
forces and increase the driving
forces for change to occur.
 Assessing Opposing Forces

Need a thorough knowledge about:

- the target system

- the environment
- the characteristics of the change
- the potential responses to change
 PEOPLE RESIST
CHANGE SOURCES

TECHNICAL

PSYCHOLOGICAL NEEDS

THREATS TO POSITION & POWER

 Change Process

Three Phases:

1. Unfreezing

2. Change

3. Refreezing
 THE CHANGE PROCESS

Unfreezing Change Refreezing

Comfort Discomfort New Comfort

Zone Zone Zone

(diagnostic) (moving) (consolidation

& evaluation of
innovation)
 Unfreezing Phase
Takes deliberate actions to stir things up

1. Creates disconfirmation (feelings of discomfort or

dissatisfaction)
2. Introduces guilt & anxiety (demonstrate unmet goal
or value)
3. Provides psychological safety (sufficient security to
minimize risk)
Unfreezing Phase

At completion of the unfreezing phase:

people feel off-balance

people have hyper-energy
people require direction for
productive action
Changing Phase

Implementation phase of change:

(the target system is unfrozen

& moving towards change)
 Changing Phase
The change agent:

- introduces new information

- encourages the new behavior
- continues the supportive climate
- provides opportunities for ventilation
- provides feedback & clarification of goals
- presents self as trustworthy
- overcomes resistance
ESSENTIAL

KEEPING EVERYONE INFORMED

Refreezing Phase

To stabilize & integrate the change so that it

becomes a regular part of target system

Beginning of the phase: situation still fluid

- the target system could still take another
course than the planned change
Change Agents Action in the
Refreezing Phase
The change agent:
-continues to act as an energizer
-continues to guide new behavior
-increases delegation of responsibilities for
change behavior
-maintain visibility and credibility of change
-increases others responsibility and
decreases leader-managers responsibility
 CHANGE

CONSIDER-

WHETHER YOU THINK YOU HAVE A

CHOICE FOR CHANGE OR THINK YOU
DONT HAVE A CHOICE FOR CHANGE,
YOURE RIGHT
 Iowa Model
for
Research-Based Practice
(Gillis & Jackson, 2002; Farrington, Lang, Cullen, & Stewart; Titler et al.,
2001)
 Iowa Model for
Research-Based Practice

Set of steps
used as a guide
to identify
practice questions
 Iowa Model for
Research-Based Practice

Step #1:

Determine type trigger

to improve practice
through research
(-that will initiate the need for change)

Problem-Focused Knowledge-Focused
 Iowa Model for
Research-Based Practice

Problem-focused triggers

1. Risk management data

2. Process improvement data
3. Internal/External benchmarking data
4. Financial data
5. Identification of clinical problem
 Iowa Model for
Research-Based Practice

Knowledge-focused triggers

1. New research or other literature

2. National agencies or organizational
standards and guidelines
3. Philosophies of care
4. Observation from institutional standards
committees
 Iowa Model for
Research-Based Practice

Step #2:

Identification of relevant literature

 Iowa Model for
Research-Based Practice

Step#3:

Critique and Evaluate Research

for use in Practice
 Iowa Model for
Research-Based Practice

Step #4:

Determine if there is
Sufficient Research Base?

Sufficient Not Sufficient

 Iowa Model for
Research-Based Practice

Step # 5:

If
Sufficient Research Base
 Iowa Model for
Research-Based Practice

Step #5, Sufficient Research Base: PILOT

THE CHANGE IN PRATICE
Select outcome to be achieved
Design Nursing/Multidisciplinary Practice
Interventions
Implement Practice Changes on a PILOT
UNIT
Evaluate process and Outcomes
Modify Intervention as Needed
 Iowa Model for
Research-Based Practice

Step #5, Insufficient Research Base:

Conduct Research

Base practice on other types of evidence

Case Reports
Expert opinions
Scientific principles
Theory
 Iowa Model for
Research-Based Practice

Step #6: Ask-

Is the Change
Appropriate for Adoption
in Practice?
 Iowa Model for
Research-Based Practice

Step #7:
If answer is NO

Continue to evaluate quality of care

and
new knowledge
 Iowa Model for
Research-Based Practice

Step #7:
If answer is YES

Institute the change

in practice
 Iowa Model for
Research-Based Practice

Step #8

Monitor Outcomes

Patient Environment Staff Fiscal

& (Cost)
Family
 Iowa Model for
Research-Based Practice

Step #9:

Disseminate results
Sharing knowledge
and putting knowledge into practice