Utilization of Research In Health Care
Whats is Research Utilization
S. Rodgers (1994) defined research utilization as a “process
directed toward the transfer of research-based knowledge into nursing practice”
(p. 907) with the ultimate goals of improving patient care and advancing the
discipline of nursing.
The importance of using research findings in clinical
practice has been discussed for at least 45 years; however, there are
relatively few initiatives actually taking place in clinical or nursing
education settings.
Research Utilization Model
The first research utilization models were developed in the 1970s,
beginning with the Western Interstate Commission for Higher Education in
Nursing (WCHEN) Regional Program for Nursing Research Development (Krueger,
1978).
Other models included the Conduct and Utilization of Research in Nursing
(CURN) project (Horseley, Crane, Crabtree, & Wood, 1983), the
Stetler/Marram model (Stetler, 1994), the Iowa model of research in practice
(Titler et al., 1994), and the retrieval and application of research in nursing
(RARIN) model (Bostrom & Wise, 1994).
This list is not exhaustive; rather
it is a representation of several well-known and referenced models found in the
literature.
The WCHEN model was focused on cross organizational planning and
enhancing the value for research utilization. Nurses from a variety of clinical
agencies were provided with 3 days of research training.
Each clinician would
identify a clinical problem, review the research in that area, and develop a
plan for implementing and evaluating the outcomes of the practice change.
The
annual Communicating Nursing Research conferences also resulted from the
initial WCHEN work group, with emphasis on dissemination of research results
across academic and nursing service settings. There have been 30 conferences
prior to 1997.
The CURN project was a federally funded initiative that focused on
the use of a team approach for reviewing research results related to specific
patient care problems, developing clinical protocols, and then testing the
protocol in an acute care clinical setting.
A key component of research
utilization in this model was replication of previous studies. The focus of the
low a model was similar to that of the CURN project, with particular attention
to developing support for research utilization strategies at the organizational
level. Both models were developed specifically to bridge the gap between
research and practice.
Both recommended that organizational resources such as
personnel, equipment, time, and money be available to sup port the nursing
staff. Policy, procedures, committee structures, and role expectations must
exist in relation to staff involvement in research utilization activities.
Both
models also supported a fundamental belief that research can and must be
applied to practice if patient care is to improve.
The Stetler/Marram model was developed primarily for use at the
individual level and specifically outlined the role clinical specialists have
in facilitating the application of research findings to clinical practice.
The
model includes specific steps related to the need for a sound foundation in the
conduct of research, and what is more important, it demonstrates how to
interpret and validate findings that can be used to change practice.
The RARIN model, funded by a National Library of Medicine grant,
was developed at Stanford University Hospital in Palo Alto, California.
Distinct from the other models, which focused on providing nurse education,
skill building, and organization support strategies, the RARIN model focused on
improving staff access to research findings through the use of computerized
linkages to established research databases.
Training a small set of nurses from
each unit on the use of the computer network and the basics of the research
critique was the other major component. The computer technology provided direct
access to the MEDLINE citation system (including CINAHL) as well as databases
of research abstracts that were written by experts.
Hence, nurses could access
almost any database, via use of the developed tools and technologies, while
working in a patient care unit. The model assumption was based on a belief that
if access to research findings was improved and the findings were represented
in an easily understood yet clinically sound framework, then practicing nurses
would be able to improve patient care.
Barriers and Outcome Results of Model
Outcome results from these and other models have been limited.
Numerous barriers to transferring research-based knowledge into nursing
practice persist. Staff nurses reported the following as barriers to research
utilization:
(a) insufficient skills and knowledge about evaluating research
(b) lack of awareness or access to research
(c) minimal value of research for
practice
(d) insufficient authority to actually change practice
(e) in
sufficient time to read research and to learn research skills and how to
implement changes when necessary
(f) lack of cooperation and support from
administration and other staff
(g) little personal benefit
(h) unclear and
unhelpful statistical representation of results
(i) few replication studies to
determine if sufficient evidence exists to change practice
(j) lack of
access to databases and research literature.
Nurse administrators also reported
barriers, such as
(a) isolation from research colleagues
(b) lack of time
because of heavy workloads
(c) difficulty in reading and interpreting research
findings and statistics
(d) insufficient skills in research critique
( e)
lack of replication studies to determine if practice requires change
(f)
lack of access to data bases and research literature.
Research Utilization Process
Facilitators for the research utilization process have also been
identified. They include
(a) creating practice environments that require
research based clinical standards
(b) providing expert consultation and
activities such as research committees to increase adequacy of research skills
(c) improving access to computerized databases and research literature
(d)
allotting time and money to support conference attendance and participation
(e) developing performance standards that include behavioral expectations to
support research based practice
(f) obtaining grants to support research
projects
Research Utilization and Role of Educators
The literature related to research utilization is almost
exclusively focused on nursing practice environments, with little attention to
how research utilization is introduced into the nursing curricula at all
levels. Research utilization is a critical professional account ability issue
to resolve if the discipline of nursing is to advance.
Therefore, it is
essential for nursing educators to socialize students at all levels to the
value of research utilization and to model the required skills. For example,
most teaching about the research process at the baccalaureate level is isolated
from discussions about actual caregiving and how that care might be improved by
applying research findings.
Graduate students are not adequately prepared for
the integration of research into the care of specific patient populations and
have little preparation in areas of quality improvement and outcomes evaluation
methodologies. Doctoral education continues to be focused on the conduct of
research, with minimal emphasis on how to report results in ways that are
understandable to practicing clinicians.
Although learning a thesis format of
writing is important, it is equally important to learn how to convert jargon
research into useful, specific, and direct reports for clinicians. In addition,
more value and attention should be given to replication research that would
advance results that are more generalizable and easily applied to clinical
practice.
Research Utilization and Health Care
The health care environment is changing rapidly, with increased
attention to out-comes-based practice, evaluating patient outcomes, and
demonstrating cost efficiency and effectiveness. Research utilization must
become a matter of professional accountability for each nurse and every health
care organization .
Nurses must be better prepared to actively participate in
and facilitate research utilization. More attention should be given to
implementing strategies that remove the barriers identified in previous research.
Technology is now available to provide much access to research and relevant
databases; however, there is still need for timely and readable reports of
completed research.
The critical challenge is how students, practitioners, educators,
executives, and researchers can create learning environments in which research
utilization will become an integral part of nursing practice.
When nurse
colleagues share a common vision related to improving the health of our
communities, then research utilization becomes one method to ensure research
based care delivery models, with all nurses accountable for achieving optimal
outcomes.