'Barriers of Research Utilization for Nurses\r'

'C L I N I C A L N U R S I N G IS S U E S Bridging the take off: a work of nurtures’ ideas understanding restrictions to, and facilitators of, search employ in the enforce stage oscilloscope Alison Marg art Hutchinson BAppSc, MBioeth PhD Candidate, niminy-piminy Centre for treat Practice look, give lessons of assist for, University of Melbourne, Australia Linda Johnston BSc, PhD, Dip N Professor in Neonatal nurse inquiry, Royal Children’s Hospital, Melbourne, and Associate Dir el electroshock therapyroshock therapyor, Victorian Centre for breast feeding Practice inquiry, Melbourne, Australia Submitted for publication: 4 serve 2003 Accepted for publication: 29 distinguished 2003Correspondence: Alison M. Hutchinson School of care for University of Melbourne 1/723 Swanston St Carlton, VIC 3053 Australia name: ? 61 3 8344 0800 E- ring mail: [email&# adept hundred sixty;protected] com H U T C H I N S O N A . M . & J O H N S T O N L . ( 2 0 0 4 ) daybook of clinical breast feeding 13, 304â€315 Bridging the divide: a survey of take ins’ smells regarding breastworks to, and facilitators of, f all uponk manakin in the songula setting Background. to a greater extent seekers arrive at explored the ramparts to look for white plague in order to oercome them and expose st set outgies to facilitate investigate piss come on.However, the look†coiffure intermission re master(prenominal)s a resolved national for the treat profession. Aims and objectives. The aim of this reputation was to take place an understanding of perceive in? uences on take ins’ workout of inquiry, and explore what differences or commonalities exist amongst the ? ndings of this interrogation and those of studies that draw been conducted in various countries during the past 10 years. Design. makes were surveyed to beset their opinions regarding roadblocks to, and facilitators of, look for design se ssion.The instrument comprised a 29- particular authorise explorenaire, titled Barriers to search form of well behaveds and services crustal plate (BARRIERS musical de home plate leaf), an ogdoad- compass point scale of facilitators, provision for respondents to temper special barricades and/or facilitators and a serial publication of demographic questions. Method. The questionnaire was administered in 2001 to tout ensemble protects (n ? 761) running(a) at a major statement infirmary in Melbourne, Australia. A 45% reply rate was achieved. Results. Greatest restraints to look into exercise report entangle sequence constraints, want of awargonness of accessible question lit, insuf? ient agency to switch put on, light skills in detailed appraisal and privation of stick up for holdation of explore ? ndings. Greatest facilitators to enquiry practice describe include on tap(predicate)ness of more cadence to review and fulfill look ? ndings, availability of more pertinent look into and colleague embolden. Conclusion. One of the n in whatever case soon striking features of the ? ndings of the present consume is that perceptions of Australian carrys atomic number 18 remarkably consistent with inform perceptions of harbours in the US, UK and northerly Ireland during the past decade. relevance to clinical institutionalize.If the ingestion of interrogation establish in execute results in reveal outcomes for our endurings, this behoves us, as a profession, to head issues ring live for go a gullation of seek ? ndings, potentiality to 304 O 2004 Blackwell make Ltd clinical criminal maintenance for issues Barriers to, and facilitators of, search workout shift confide, snip constraints and ability to critic to separately oney appraise explore with conviction and a sense of urgency. cardinal words: barriers to inquiry example, facilitators of look for use, investigate dissemination, qu ery carrying out, investigate utilizationIntroduction and background For all everywhere 25 years seek utilization has been discussed in the hold in books with maturation enthusiasm and amid increasing c every give way(predicate)s for the workout of look into ? ndings in exert. Additionally, the distinguish- ground make out movement, which emanated in the early 1990s (Evidence-Based Medicine Working classify, 1992) has mellowedlighted the grandeur of incorporating look into ? ndings into practice. justmore, controversy meet the attainment of superior status has resulted in an outgrowth aw argonness of the look at for a search- found corpse of humpledge to underpin breast feeding practice.Gennaro et al. (2001, p. 314) compete: utilise look into in practice non lonesome(prenominal) bene? ts patients moreover withal streng in that locationfores c ar for as a profession. If breast feeding is truly a profession, and non dependable a chew over or a n occupation, suck ins cave in to be able to continually valuate the c be they give and be responsible for providing the best possible c ar. Evaluating nurse c are means that nurses too stick out to pass judgment breast feeding search and determine if in that respect is a better way to win care. Twelve years prior, Walsh & Ford (1989) warned that the nonrecreational integrity of breast feeding was threatened by dependence upon screw-based practice.Similarly, Winter (1990, p. 138) cautioned that conduct of nursing practice in this manner is ‘the antithesis of nonrecreationalism, a barrier to independence, and a detriment to property care. ’ Winter in that locationfore, recommended that nurses ‘evaluate their status as enquiry consumers, to identify problems in this area, and to gird means to better uptake look into ? ndings’ (p. 138). Evidence-based practice, which should comprise the single- cherishd assist of broad ranging sour ces of evidence, including the clinician’s expertise and patient preference (Sackett et al. , 1996), includes the substance ab ingestion of enquiry evidence as a subset (Estabrooks, 1999).ordered with the classi? cation of knowledge utilization, 3 types of query use have been outlined (Stetler, 1994a,b; Berggren, 1996). The ? rst is described as ‘instrumental use’ and involves acting on look ? ndings in explicit, direct ways, for mannikin application of question ? ndings in the victimisation of a clinical pathway. The second is termed ‘ abstract use’ and involves employ enquiry ? ndings in less speci? c ways, for example ever-changing thinking. The ? nal type of interrogation use, described as ‘symbolic use’, involves the use of question results to patronise a predetermined position.The nursing books is replete with examples of limited use of look in practice and word surrounding comprehend barriers to look utilization ( endure, 1981; Gould, 1986; Closs & Cheater, 1994; Lacey, 1994). Despite this, the phenomenon of the investigateâ€practice scuttle, the prisonbreak in the midst of the conduct of question and use of that investigate in practice, confronts an issue of major sizeableness for the nursing profession. M all searchers have explored the barriers to search uptake in order to overcome them and identify strategies to facilitate look for utilization (Kirchhoff, 1982; MacGuire, 1990; backlash et al. 1991a,b, 1995b; Closs & Cheater, 1994; Hicks, 1994, 1996; Lacey, 1994; Rizzuto et al. , 1994; Hunt, 1996; Walsh, 1997a,b). Hunt (1981) suggested that nurses fail to utilize research ? ndings because they do non know more or less them, do non understand them, do non believe them, do non know how to get into them, and are non allowed to use them. match to Hunt (1997), the barriers to research utilization and, therefore, to evidence-based practice fall into ? ve main categories: research, rile to research, nurses, operation of utilization and nerve.Self-reported utilization of research is one order that has frequently been enforced to elicit the finish of research utilization. Responses to selected research ? ndings have been use to elicit and explore respondents’ awareness and use of respective ? ndings (Kete? an, 1975; Berggren, 1996). many researchers have likewise undertaken to investigate, through ego-reporting, the opinions of nurses’ in regard to barriers to research utilization in the practice setting. ricochet et al. (1991b) explored research utilization in the US use a postal questionnaire titled the Barriers to seek practice session graduated table (BARRIERS outgo).Their purpose was to develop a pecker to assess the perceptions of clinicians, administrators and academics in regard to barriers to research utilization in clinical practice. Rogers’ (1995) impersonate of ‘diffusion of innovatio ns’, a speculative framework, which describes the process of intercourse, through certain impart at bottom a social network, of an idea, practice or object over date, was use to develop a 29- compass point scale. The questionnaire was sent out to a random sample of 5000 members of the American Nurses’ Association with a resulting answer rate of 40%. 305O 2004 Blackwell Publishing Ltd, daybook of clinical nurse, 13, 304â€315 A. M. Hutchinson and L. Johnston On the entropy generated, reverberate et al. (1991b) undertook an preliminary eventor compend, to elicit a quadruple- operator bow which closely corresponded with Rogers’ (1995) ‘diffusion of innovations’ military position. The components translated into characteristics of the adopter comprising the nurse’s research values, skills and awareness; the agreement incorporating setting barriers and limitations; the innovation including qualities of the research; and communi cation including lendableness and intromission of the research. tokens associated with the clinical setting, a characteristic of the organization, were comprehend as the main barriers to research utilization. These include the views that nurses lack suf? cient place to use potpourri; nurses have insuf? cient condemnation to go through qualify; and there is a lack of cooperation from medical cater. Approximately 21% of the respondents in this interpret were classi? ed as administrators. Over common chord quarters of the items on the BARRIERS Scale were rated as big(p) or guard barriers by over fractional the administrators. The administrators identi? d parts relating to the nurse, the organizational setting and the video display of research among the smashingest barriers. Overall, they cited the organizational setting as the broadest barrier to research use. Approximately 46% of the respondents were classi? ed as clinicians (nurses working in the clinical setting ). The clinicians overpoweringly identi? ed meanss associated with the organizational setting as being the capaciousest barriers to research utilization. They rated all eight ingredients associated with the setting in the blanket 10 barriers to research utilization.The clinicians rated comprehend ‘lack of place to change patient care procedures’, ‘insuf? cient period on the muse to implement new ideas’ and being ‘ unsuspecting of the research’ as the spinning fleet trio barriers to research utilization. The BARRIERS Scale ( squint et al. , 1991b) has been used extensively since it was authentic in 1991, as one method to explore the perceived in? uences on nurses’ utilization of research ? ndings in their practice. At least 17 studies that occupied the BARRIERS Scale to elicit opinions of nurses regarding barriers to research utilization in practice have been reported in the nursing literature.Most studies reported the barri ers in flagrant order harmonize to the percentage of respondents who rated items as moderate or owing(p) barriers. Insuf? cient time to take aim research and/or implement new ideas was rated in the top third barriers in 13 studies (Funk et al. , 1991a, 1995a; Carroll et al. , 1997; Dunn et al. , 1997; Lewis et al. , 1998; Nolan et al. , 1998; Rutledge et al. , 1998; Retsas & Nolan, 1999; Closs et al. , 2000; Parahoo, 2000; Retsas, 2000; Grif? ths et al. , 2001; fen et al. , 2001; Parahoo & McCaughan, 2001).A perceived lack of authority to change patient care procedures was reported in the top three barriers in eight studies (Funk et al. , 1991a; Walsh, 1997a; Nolan 306 et al. , 1998; Closs et al. , 2000; Parahoo, 2000; Retsas, 2000; Marsh et al. , 2001; Parahoo & McCaughan, 2001). In eight studies, the item ‘statistical analyses are not understandable’, was cited in the top three barriers (Funk et al. , 1995b; Dunn et al. , 1997; Walsh, 1997a,b; Rut ledge et al. , 1998; Parahoo, 2000; Grif? ths et al. , 2001; Marsh et al. , 2001). ‘ short-staffed facilities for carrying into action’ was cited in the top three barriers in ? e studies (Kajermo et al. , 1998; Nolan et al. , 1998; Retsas, 2000; Grif? ths et al. , 2001; Marsh et al. , 2001). Finally, the item ‘lack of awareness of research ? ndings’ was reported in the top three barriers in four studies (Funk et al. , 1991a, 1995a; Carroll et al. , 1997; Lewis et al. , 1998; Retsas & Nolan, 1999). It is acknowledged that these studies comprised varying populations of nurses, engaged differing sampling methods, used sample sizes ranging from 58 to 1368 respondents and resultant chemical reaction rates shedd from 27 to 76%.In some studies, baby recasting of a limited egress of items in the tool had been undertaken. Furthermore, some studies included and 28 of 29 barrier items included in the master copy BARRIERS Scale. cipher analysis, a statis tical technique aimed at trim the number of variables by grouping those that relate, to form sex actly independent subgroups (Crichton, 2001; Tabachnick & Fidell, 2001), was undertaken in a limited number of these studies. In the UK, Dunn et al. (1997) tried and true the element mystify proposed by Funk et al. (1991b), utilize con? rmatory element analysis, a complex statistical technique used to test a heory or present (Tabachnick & Fidell, 2001). Attempts to load each item onto a single identi? ed cistron were implant to be unsuccessful and they concluded that the US cast was in purloin for their data. Closs & Bryar (2001) come on explored the rightness of the BARRIERS Scale for use in the UK through beta chemical element analysis. The sit down identi? ed included the pursuit four brokers: bene? ts of research for practice, quality of research, accessibility of research, and resources for execution of instrument. Finally, Marsh et al. (2001) teste d, utilize con? matory element analysis, a revise version of the BARRIERS Scale. The revision comprised minor changes in wording such as reversal of the term ‘administrator’ with the term ‘ coach-and-four’. A fixings structure that was not possible to interpret resulted and they concluded that the model proposed by Funk et al. (1991b) was not back up and had limited subscale daring in the UK setting. In the light of these ? ndings and those of Dunn et al. (1997), Marsh et al. (2001) suggested that the work out model arising from the original BARRIERS Scale was not preserve in the international context.However, in Australia, Retsas & Nolan (1999) undertook an exploratory factor analysis resulting in a three-factor etymon comprising: (i) nurses’ perceptions close the usefulness of research in O 2004 Blackwell Publishing Ltd, diary of clinical nursing, 13, 304â€315 clinical nursing issues Barriers to, and facilitators of, research ut ilization clinical practice, (ii) generating change to practice based on research, and (iii) accessibility of research. A get together, in Australia, a four-factor ascendant arose from an early(a) exploratory factor analysis undertaken by Retsas (2000).The resulting factors were fantasyualized as: accessibility of research ? ndings, anticipated outcomes of using research, organizational support to use research, and support from early(a)s to use research. Given these ? ndings in the Australian context, an exploratory factor analysis was employed in the present study to explore what model would arise from data generated using the BARRIERS Scale. The aim of the present study was to gain an understanding of perceived in? uences on nurses’ utilization of research in a particular practice setting, and explore what differences or commonalities exist between the ? dings of this research and those of studies which have been conducted during the past 10 years in various countries ar ound the world. This study was undertaken as part of a too larger study designed to explore the phenomenon of research utilization by nurses in the clinical setting. The congeneric importance of barrier and facilitator items and the factor model arising from this data depart in? uence cultivation of future stages of this larger study. who then took righteousness for statistical distribution. It cannot be guaranteed, however, that this process in fact resulted in all nurses receiving the questionnaire.The questionnaire included the 29-item BARRIERS Scale in access to an eight-item facilitator scale and a serial of demographic questions. The respondents were asked to return sinless questionnaires in the addressed envelope supplied, by either placing them in the internal mail or placing them in the ‘return’ loge supplied in their ward or department. proceeds of completed questionnaires implied consent to participate and all responses were anonymous. aspect The setting for this study was a 310-bed major precept hospital fling specialist services in Melbourne, Australia. SampleApproximately 960 nurses work in the organization. All Registered Nurses working during the 4-week distribution time frame were invited to complete the questionnaire. This self-selecting, public convenience sample therefore, excluded nurses on leave at the time of the study. The study The research question addressed in this study was: What are nurses’ perceptions of the barriers to, and facilitators of, research utilization in the practice setting? Instrument The questionnaire comprised three slits. The ? rst section contained the 29 randomly ordered items from the Barriers to Research Utilization Scale (Funk et al. 1991b), which respondents were asked to rate, on a four-point Likert type scale, the extent to which they believed each item was a barrier to their use of research in practice. The options included 1 ? ‘to no extent’, 2 ? ‘to a curt extent’, 4 ? ‘to a moderate extent’ and 5 ? ‘to a large extent’. A ‘no opinion’ ? 3 option was also presumption. The respondents were then asked to nominate and rate (1 ? greatest barrier, 2 ? second greatest barrier, and 3 ? thirdly greatest barrier) the items they considered to be the top three barriers.Further to this, the respondents were given the fortune to list and rate, according to the above-mentioned Likert scale, any additional items they perceived to be barriers. The second section of the survey contained eight items (Table 4), which respondents were asked to rate according to the extent to which they considered them to be a facilitator of research utilization using the Likert scale described above. The respondents were also asked to nominate and rate, from 1 to 3, the items they considered to be the three greatest facilitators of research utilization.Again, the respondents were given the probability to list and rat e, according to the 307 Method A survey design was chosen to elicit opinions of nurses. This method was selected because the ‘BARRIERS Scale’, a validated questionnaire, based on the work of Funk et al. (1991b), and designed to elicit nurses’ views about barriers to, and facilitators of, research utilization in their practice, was found to have high reliability. Approval to use the tool was gained from the authors. Permission was also given to include questions crafted by the investigators to elicit nurses’ opinions about facilitators of research utilization.Approval to conduct the project was sought and apt(p) by the hospital research ethics committee to ensure the rights and dignity of all respondents were protected. Nurses working during the 4-week survey distribution time frame (n ? 761) were invited to complete the self-administered questionnaire. It was intended that every nurse receive a in person addressed envelope containing the questionnaire an d a self-addressed return envelope. To facilitate this, the envelopes were hand delivered to a put up nurse on each ward or department O 2004 Blackwell Publishing Ltd, daybook of clinical care for, 13, 304â€315A. M. Hutchinson and L. Johnston Likert scale, perceived facilitators not listed in the survey. Section 3 of the survey included a series of demographic questions. Validity inwardness rigorousness, i. e. whether the questions in the tool accurately pace what is sibylline to be visord (LoBiondo-Wood & Haber, 1998), of the instrument was support by the literature on research utilization, the research utilization questionnaire developed by the have a bun in the oven and Utilization of Research in breast feeding Project (Crane et al. , 1977), and data self-contained from nurses. Input was also gained from experts in the ? ld of research utilization, nursing research, nursing practice and a psychometrician to establish vista validity, i. e. whether the tool appea rs to measure the innovation intended (LoBiondo-Wood & Haber, 1998), and content validity from an extensive list of potential items. Those items for which face and content validity were established were retained. Further to originaling of the instrument, two additional items were included and some minor rewording of other items resulted. The BARRIERS Scale has been found to have good reliability, with Cronbach’s alpha coef? ients of between 0. 65 and 0. 80 for the four factors, and item- aggregate cor similaritys from 0. 30 to 0. 53 (Funk et al. , 1991b). Cronbach’s alpha is a measure of internal consistency, which is think to the reliability of the instrument. A Cronbach’s alpha of ‡0. 7 is considered to be good. Internal consistency is the extent to which items in the scale measure the same concept (LoBiondo-Wood & Haber, 1998). Item append correlations refer to the human relationship between the question or item and the total scale make believe (LoBiondo-Wood & Haber, 1998). entropy analysisData analysis was performed using statistical software package for the Social Sciences (version 10. 0; SPSS Inc. , Chic ago, IL, the States) software. Frequency and descriptive statistics were employed to describe the demographic characteristics of respondents. compend of these data indicated that a wide cross section of nursing staff responded to the questionnaire. broker analytic procedures were employed to reduce the 29 barrier items to factors. The ‘no opinion’ responses (coded to be in the centre of the scale) were included in the factor analytic procedure, on the soil of statistical advice.Suitability of the data for undertaking factor analysis is determined by examen for sampling adequacy and sphericity. The Kaiserâ€Meyerâ€Olkin Measure of sampling Adequacy at 0. 83 was in excess of the recommended value of 0. 6 (Kaiser, 1974), indicating that the 308 correlations or factor fills, which r e? ect the skill of the relationship between barrier items, were high. The bartlett pear test of sphericity at 2118. 3 was statistically signi? cant (P < 0. 001). On the basis of these results, factor analysis was considered appropriate.The factor analysis method employed consisted of asterisk division analysis (PCA), a method of minify a number of variables (barrier items) to groupings to aid description of the underlying relationships between the variables (Crichton, 2000) whilst capturing as lots of the variance in the data as possible. PCA revealed eight components with an eigenvalue exceeding one, indicating that up to eight factors could be retained in the ? nal factor solution. Inspection of the scree plot of ground, a plot of the variance encompassed by the factors, failed to provide a clear indication for the number of factors to include.Eight factors were considered too many to be meaningful, thus factor solutions from two to seven factors were explored. A soluti on comprising four factors was considered nearly meaningful. Examination of the factor loadings was then undertaken to determine which items belonged to each factor. Consistent with the procedure employed by Funk et al. (1991b), items were considered to have loaded if they had a factor loading of 0. 4 or more. Varimax rotation, a statistical method employed to simplify and aid interpretation of factors, was then applied.Whilst factor analysis assists in reducing the number of variables to groupings and aids in interpretation of the underlying structure of the data, it does not identify the congeneric importance of individual items. Thus, while one factor may account for the largest get of variance in the factor solution it does not mean that the items inside that factor are the greatest barriers to research utilization. In order to determine the relative signi? cance of each barrier item, the number of respondents who reported them as a moderate or great barrier was mensurable a nd items were social stationed accordingly.Additional barriers get into by participants were grouped thematically. Similarly, to determine the relative signi? cance of each facilitator item, the number of respondents who reported them as a moderate or great facilitator was calculated and items were siteed accordingly. Additional facilitators put d protest by participants were grouped thematically. Results Demographics A total of 317 nurses returned the questionnaires, representing a 45% response rate, assuming that all nurses did, in fact, receive a personally addressed envelope. The age range of respondents was 43 years (minimum ? 1 years, O 2004 Blackwell Publishing Ltd, journal of clinical nursing, 13, 304â€315 Clinical nursing issues Barriers to, and facilitators of, research utilization utmost ? 64 years) while the range in years since registration was 42 years. The demographic characteristics of the nurses (Table 1) were consistent with those of the State of Victoria ’s nursing workforce (The Australian be of health and benefit, 1999). agent analysis A four-factor solution was selected as the most appropriate model arising from PCA of the 29 barrier items. This accounted for 39. % of the total variance in responses to all barrier items. The factor groupings including the loading for each barrier item and the titles allocated to each factor are included in Table 2. According to the correlation coef? cient or factor loading measure of ‡0. 4, two items, ‘research reports/articles are not published libertine comme il faut’, and ‘the research has not been replicated’, failed to load on any of the four factors. Table 1 Nurse demographics (n ? 317) Variable Gender manly Female Missing Age (years) get a line Registered Nurse (years) Clinical experience (years) age since most late(a) quali? ation Highest quali? cation Division 2 certi? cate for registration Division 1 hospital certi? cate for registration T ertiary diploma/ tip for registration Specialist nursing certi? cate grad diploma get the hang by coursework Masters by research Others (including rearing and instruction quali? cations) Missing Principle job function Clinical Administrative Research genteelness Others Missing Research experience Yes No Missing N (%) Mean (SD) 24 (7. 6) 291 (91. 8) 2 (0. 6) 33. 8 (9. 73) 12. 6 (9. 95) 11. 35 (8. 8) 4. 28 (6. 52) 14 (4. 4) 23 (7. 3) 104 (32. 8) 26 34 9 1 87 (8. 2) (10. 7) (2. 8) (0. 3) (27. ) agent 1, comprising eight items with loadings of 0. 73 to 0. 43, includes items relating to characteristics of the organization that in? uence research-based change. Eight items loaded onto factor 2 with loadings of 0. 66 to 0. 40. These items are associated with qualities of research and potential outcomes associated with the carrying out of research ? ndings. factor 3 with seven items loading 0. 60 to 0. 41, relates to the nurse’s research skills, beliefs and voice limitations. work out four refers to communication and accessibility of research ? ndings onto which ? ve items loaded 0. 67 to 0. 42.The four factor groupings comprising setting, nurse, research and presentation, generated in the US study 10 years ago (Funk et al. , 1991b), were similar to groupings that arose from factor analysis in the present study (Table 2). Cronbach’s alphas were calculated for each factor generated. For factors 1â€3 the alpha coef? cients were 0. 75, 0. 74 and 0. 70, respectively, demonstrating good reliability. The alpha coef? cient for factor 4 was lower at 0. 54. The total scale alpha was 0. 86, which indicates that the scale can be considered reliable with this sample. Item-total correlations ranged from 0. 1 to 0. 60. Although a low correlation between some items and the total nominate was evident, deleting any of these items would have resulted in a decrease in reliability of the scale. Relative importance of barrier and facilitator items The percentage s of items perceived by nurses’ as great or moderate barriers are summarized in Table 3. The respondents were also given the opportunity to list and rate any additional perceived barriers not included in the questionnaire. About 27% (85) of respondents put d ingest a total of 174 barriers. However, analysis revealed that only 11% (36) of respondents actually identi? d additional barriers. The remainder had reiterated or reworded barrier items already included in the tool. The additional barrier items listed by respondents were grouped into themes, which included funding, organizational commitment, research training, slaying strategy and professional responsibility. The percentages of items perceived by nurses’ as great or moderate facilitators are summarized in Table 4. The respondents were also given the opportunity to list and rate additional perceived facilitators. Eighteen per cent (57) of respondents took the opportunity to record a total of 90 facilitators. Of these, 7. % (24) actually identi? ed additional facilitators whereas the remainder had rephrased or repeated items already included in the tool. Consistent with the themes identi? ed for the additional barriers were funding, organizational commitment, active participation in research 309 19 (6. 0) 252 28 6 10 15 6 (79. 5) (8. 8) (1. 9) (3. 2) (4. 7) (1. 9) 207 (65. 3) 105 (33. 1) 5 (1. 6) O 2004 Blackwell Publishing Ltd, diary of Clinical care for, 13, 304â€315 A. M. Hutchinson and L. Johnston Table 2 BARRIERS Scale factors and factor loadings US factor groupings Factor loadings Communalities Factor 1 Factor 2 Factor 3 Factor 4Barrier item Factor 1: Organizational in? uences on research-based change Physician pull up stakes not cooperate with writ of execution Administration allow not allow implementation The nurse does not steps she/he has overflowing authority to change patient care procedures The facilities are inadequate for implementation Other staff are not supportiv e of implementation The nurse feels results are not generalizable to own setting The nurse is unwilling to change/ punish new ideas Factor 2: Qualities of the research and potential outcomes of implementation The research has methodological inadequacies The literature reports con? cting results The conclusions pull from the research are not justi? ed The research is not applicable to the nurse’s practice The nurse is changeful whether to believe the results of the research The research is not reported clearly and readably Statistical analyses are not understandable The nurse feels the bene? ts of changing practice will be minimal Factor 3: Nurses’ research skills, beliefs and role limitations The nurse sees little bene? for self The nurse does not feel fitting of evaluating the quality of the research there is not a documented demand to change practice The nurse does not see the value of research for practice The keep down of research drill is overwhelming The nurse is isolated from cozy colleagues with whom to discuss the research There is insuf? cient time on the job to implement new ideas Factor 4: Communication and accessibility of research ? dings Research reports/articles are not readily accessible Implications for practice are not do clear The nurse is unaware of the research The relevant literature is not compiled in one place The nurse does not have time to read research setting Setting Setting Setting Setting Setting Nurse 0. 55 0. 52 0. 42 0. 42 0. 34 0. 39 0. 36 0. 73 0. 71 0. 56 0. 54 0. 53 0. 49 0. 43 0. 09 0. 10 0. 06 0. 11 0. 17 0. 30 0. 01 A0. 02 A0. 01 0. 31 A0. 04 0. 19 0. 23 0. 41 0. 09 A0. 04 0. 05 0. 33 0. 02 0. 01 A0. 09 Research Research Research innovation Research launching PresentationNurse 0. 46 0. 38 0. 44 0. 43 0. 46 0. 33 0. 33 0. 46 0. 17 0. 11 0. 11 0. 22 0. 27 0. 11 A0. 04 0. 36 0. 66 0. 59 0. 57 0. 55 0. 53 0. 49 0. 47 0. 40 0. 03 0. 12 0. 30 A0. 13 0. 32 0. 18 0. 03 0. 38 0. 00 0. 04 A0. 05 0. 25 0. 07 0. 19 0. 32 A0. 14 Nurse Nurse Nurse Nurse * Nurse Setting Presentation Presentation Nurse Presentation Setting 0. 57 0. 45 0. 35 0. 55 0. 29 0. 31 0. 38 0. 45 0. 47 0. 33 0. 25 0. 31 0. 23 A0. 04 A0. 04 0. 15 0. 05 0. 31 0. 28 0. 01 0. 06 A0. 04 0. 13 0. 22 0. 39 0. 26 0. 14 0. 47 A0. 01 0. 11 A0. 17 0. 00 0. 31 0. 09 0. 3 A0. 14 0. 60 0. 58 0. 57 0. 55 0. 51 0. 42 0. 41 0. 00 A0. 09 0. 16 0. 13 0. 26 0. 04 0. 21 0. 09 A0. 04 0. 15 0. 16 0. 31 0. 67 0. 60 0. 54 0. 45 0. 42 Two items, ‘research reports/articles are not published fast exuberant’ and ‘the research has not been replicated’, did not load at the 0. 4 take in this analysis. *The item, ‘the amount of research entropy is overwhelming’ failed to load on any factor in the Funk et al. model. process †experience, strategy to ensure project completion, implementation strategies, and professional attitude.Discussion The present study generated a four-factor solution with simil arities to that produced in the US by Funk et al. (1991b) and in the UK by Closs & Bryar (2001). The ? rst factor comprises characteristics of the organization and re? ects health professional and other resource support for change 310 associated with the implementation of research ? ndings. More broadly, the theme ‘organizational commitment’ identi? ed following analysis of the additional perceived barriers listed by respondents, appears to be associated with this factor.Organizational commitment, many respondents felt, would facilitate mobilisation of resources to promote change. Factor 2 relates to qualities of research and potential outcomes associated with the implementation of research ? ndings. This factor re? ects the nurse’s reservations about reliability and validity of research ? ndings and conclusions, O 2004 Blackwell Publishing Ltd, diary of Clinical breast feeding, 13, 304â€315 Clinical nursing issues Table 3 BARRIERS Scale items in egre gious order Barriers to, and facilitators of, research utilization Barrier items The nurse does not have time to read research There is insuf? ient time on the job to implement new ideas The nurse is unaware of the research The nurse does not feel she/he has enough authority to change patient care procedures Statistical analyses are not understandable The relevant literature is not compiled in one place Physicians will not cooperate with the implementation The nurse does not feel adapted of evaluating the quality of the research The facilities are inadequate for implementation Other staff are not supportive of implementation Research reports/articles are not readily available The nurse feels results are not generalizable to own setting The amount of research information is overwhelming Implications for practice are not made clear The research is not reported clearly and readably The research has not been replicated The nurse is isolated from knowledgeable colleagues with whom to di scuss the research Administration will not allow implementation The research is not relevant to the nurse’s practice The literature reports con? icting results The nurse feels the bene? s of changing practice will be minimal The nurse is ambiguous whether to believe the results of the research Research reports/articles are not published fast enough The nurse is unwilling to change/try new ideas The research has methodological inadequacies The nurse sees little bene? t for self There is not a documented request to change practice The nurse does not see the value of research for practice The conclusions drawn from the research are not justi? ed Reporting item as moderate or great barrier (%) 78. 3 73. 8 66. 2 64. 7 64. 1 58. 7 56. 1 55. 8 52 52 50. 8 50. 8 45. 7 45. 5 43. 3 41. 3 41 35 34. 4 34 31. 9 30. 9 30. 6 29. 4 25. 5 23. 3 22. 1 17 13. 8 Item mean score (SD) 4. 06 3. 9 3. 64 3. 51 3. 56 3. 51 3. 41 3. 3 3. 23 3. 16 3. 19 3. 09 3. 07 3. 0 3. 01 3. 16 2. 76 2. 88 2. 67 2 . 87 2. 52 2. 58 2. 81 2. 34 2. 85 2. 25 2. 27 1. 9 2. (1. 21) (1. 3) (1. 4) (1. 39) (1. 32) (1. 26) (1. 33) (1. 39) (1. 3) (1. 29) (1. 35) (1. 26) (1. 35) (1. 22) (1. 25) (1. 14) (1. 49) (1. 18) (1. 28) (1. 11) (1. 3) (1. 29) (1. 21) (1. 34) (1. 0) (1. 26) (1. 24) (1. 21) (1. 02) Responding ‘no opinion’ or non-response (%) 0. 9 1. 6 1. 6 0. 9 3. 8 13 7. 6 3. 5 8. 8 6. 3 6. 3 3. 5 6. 9 5 8. 2 26. 1 3. 8 19. 6 4. 4 18. 9 3. 5 4. 7 25. 2 2. 2 32. 5 3. 5 8. 5 1. 6 21 Table 4 Facilitator items in rank order Reporting item as moderate or great facilitator (%) 89. 6 89. 5 84. 8 82. 3 82. 0 81. 4 81. 3 78. 2 anatomy (%) responding ‘no opinion’ or non-response 8 (2. 5) 6 9 6 10 (1. 8) (2. 8) (1. 8) (3. 2)Facilitator item Increasing the time available for reviewing and implementing research ? ndings Conducting more clinically cerebrate and relevant research Providing colleague support network/mechanisms forward-looking nurture to increase your research knowledge base Enhancing managerial support and encouragement of research implementation Improving availability and accessibility of research reports Improving the understandability of research reports Employing nurses with research skills to serve as role models Item mean score (SD) 4. 52 (0. 93) 4. 39 4. 21 4. 11 4. 15 (0. 94) (1. 02) (1. 13) (1. 08) 4. 12 (1. 11) 4. 16 (1. 1) 4. 04 (1. 22) 5 (1. 5) 8 (2. 5) 9 (2. 9)O 2004 Blackwell Publishing Ltd, journal of Clinical treat, 13, 304â€315 311 A. M. Hutchinson and L. Johnston in addition to bene? ts of use of ? ndings in practice. Factor 3 boil downes on characteristics of the nurse. In particular, this factor is associated with the nurse’s beliefs about the value of research and their research skills, in addition to the limitations of their role. The fourth factor is interested with characteristics of communication. The focus of this factor centres on access to research ? ndings and understanding of the implications of ? ndings . The issues encompassed within this factor re? ect organizational barriers to access, and research presentation barriers.These factors are congruent with the concepts characterized in Rogers’ (1995) model of ‘diffusion of innovations’, including characteristics of the adopter, organization, innovation and communication, on which the BARRIERS Scale was developed. Two barrier items, ‘research reports/articles are not published fast enough’ and ‘the research has not been replicated’, failed to load suf? ciently onto a factor and were subsequently discarded. Exclusion of these items from the model re? ects their minimal signi? cance in relation to the underlying dimensions of the factors. That these items were ranked 23 and 16, respectively, is not surprising because they become less relevant when there is a perceived lack of time to read research and implement change as re? cted in the top two nominated barriers to research utilization. It is also primal to note that over one quarter of respondents selected the ‘no opinion’ option or failed to respond to twain of these items, which further suggests their lack of importance to respondents. The bulk of respondents in this study rated approximately 40% of the barriers items as moderate or great barriers. This is compared with the majority of nurse clinicians in the US (Funk et al. , 1991a) and nurses in the UK (Dunn et al. , 1997), who rated about 65% of the barrier items as moderate or great barriers. Overall, this group of Australian nurses perceived there to be fewer barriers to esearch utilization than their colleagues in the UK or US, with a mean score of 43. 7% of respondents rating all the barriers as moderate or great. In the UK (Walsh, 1997a) and the US (Funk et al. , 1991a) mean scores of 59. 8 and 55. 7%, respectively, re? ect the proportion of respondents who rated all barriers as moderate or great. contingent in? uences such as time, populat ion, nursing education programmes should be acknowledged when considering these comparisons. Content analysis of the data comprising additional perceived barriers elicited ? ve new themes respondents associated with barriers to research utilization. revise of the instrument to re? ect the themes identi? d and changes that have occurred over the past 10 years may be warranted to achieve a more valid scale for the setting in which it was used in this study. The addition of items consistent with changes in the availability of technological resources, information availability and use, and education may enhance the content validity of the scale. The rank of perceived barriers in practice resulting from this study showed considerable consistency with rankings reported in other studies, as antecedently discussed. The top three barriers reported in 12 other studies fell within the top 10 barriers identi? ed in this study. Furthermore, two of the top three barriers in an additional two stud ies fell within the top 10 barriers identi? ed in the present study. The barrier item ‘there is insuf? ient time on the job to implement new ideas’ was reported within the top three barriers in 13 studies, including this and other Australian study (Retsas, 2000). When Spearman’s rank order correlation coef? cients were generated to compare the rank ordering of perceived barriers, a bulletproof positive correlation between this and some(prenominal) other studies was evident (Table 5). Whilst acknowledging differences in nursing populations, sample size, sampling methods, response rates, and minor variations in item wording and number, this suggests a large degree of consistency regarding pick out Funk et al. (1991a) Funk et al. (1995a) Dunn et al. (1997) Rutledge et al. (1998) Lewis et al. (1998) Kajermo et al. (1998) Retsas & Nolan (1999) Parahoo (2000) Retsas (2000) Closs et al. 2000) Parahoo & McCaughan (2001) Grif? ths et al. (2001) Location USA USA UK USA USA Sweden Australia Northern Ireland Australia UK Northern Ireland UK r 0. 866 0. 779 0. 835 0. 816 0. 879 0. 719 0. 884 0. 837 0. 801 0. 762 0. 799 0. 912 P 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 0. 000 Coef? cient of termination (%) 75 61 70 66 77 52 78 70 64 58 64 83 Table 5 Barrier rank order correlations 312 O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304â€315 Clinical nursing issues Barriers to, and facilitators of, research utilization nurses’ perceptions of the relative importance of the barrier items. Marsh et al. 2001) however, caution against international comparisons with the original US data because changes in nursing education and roles, technology, funding and collaboration with other disciplines since then, may invalidate such comparisons. Nonetheless, contempt these changes, the ? ndings of the present study have consistencies with not only the US data of 1991 but also more recent st udies in the US, UK, Sweden, Northern Ireland and Australia (Table 5). Thus, notwithstanding the increasing whim of the evidence-based practice movement in recent years, the pursuit of professional status by the nursing profession, the move of nursing education to the tertiary sector, increased access to self-opinionated reviews and research databases, the research†practice gap persists.In the light of the plethora of research and theoretical literature on the researchâ€practice gap and issues surrounding research utilization, it is of concern that nurses’ perceptions of the barriers to research utilization appear to remain consistent. In particular, issues surrounding support for implementation of research ? ndings, authority to change practice, time constraints and ability critically to appraise research continue to be perceived by nurses as the greatest barriers to research utilization. This raises primary(prenominal) questions. Firstly, do such perceptions re? ect the reality of contemporary nursing? Or rather, do they represent un challenged, traditionally held and ? rmly intrench beliefs, which are founded on an understanding of nursing in a socio-historic context that is no longer relevant? If such perceptions do, in fact, re? ct the reality of flowing day nursing practice, despite the changes and come along that have been made in health care and nursing over the last decade, it behoves us, as a profession, to address the issues related to time, authority, support and skills in critical appraisal with conviction and a sense of urgency. contextual issues including the socio-political environment, organizational glossiness and interprofessional relations need to be taken into serious consideration when exploring and formulating potential strategies to overcome these barriers. The hospital in which this study was conducted has since undertaken to explore and develop strategies to address and overcome barriers to, and reinforce and st rengthen facilitators of research utilization highlighted in the ? ndings. ther studies using the BARRIERS Scale, may re? ect a response mold. That is, nurses with a positive attitude to research may have been more plausibly to complete the questionnaire. Internal consistency, the extent to which items in the scale measure the same concept (LoBiondo-Wood & Haber, 1998), of the tool was reasonable, although not as high as that reported by Funk et al. (1991b). For seven items, more than 10% of the respondents nominated ‘no opinion’ or failed to respond. Furthermore, this study was conducted in one organization; the ? ndings are therefore context speci? c, which makes it dif? cult to interpolate to other settings. However, there is consistency over ime and between countries in regard to nurses’ perceptions of the barriers to research utilization. Conclusion In order to gain an understanding of perceived in? uences on nurses’ utilization of research in a particular practice setting, nurses were surveyed to elicit their opinions regarding barriers to, and facilitators of, research utilization. Many of the perceived barriers to research utilization reported by this group of Australian nurses are consistent with reported perceptions of nurses in the US, UK and Northern Ireland during the past decade. Time was the most important barrier perceived by nurses in this study, which is re? ected by responses to the items, ‘the nurse does not have time to read research’ and ‘there is insuf? ient time on the job to implement new ideas’, resulting in them being ranked as the top two barriers to research utilization. Consistent with this ? nding was the ranking of facilitator item ‘increasing the time available for reviewing and implementing research ? ndings’ as the most important facilitator to research utilization. The employment of qualitative research methods, such as observation and interview, will contribute further to our knowledge about barriers to, and facilitators of, research utilization by nurses by allowing deeper exploration of experiences, perception and issues faced by nurses in the utilization of research in their practice.Fundamental questions about whether nurses’ perceptions actually re? ect the reality of the current context of nursing need to be further investigated. upcoming research should also examine issues surrounding the use of time by nurses. Questions exploring how practically additional time nurses require in order to read the relevant literature and how nurses can be given more time to implement new ideas, need to be addressed. Issues related to nurses’ perception of their authority to change patient care procedures, the support and cooperation afforded by doctors and others, the facilities and availability of resources, and their skills in critical appraisal, also require further 313 LimitationsReporting bias associated with the self -report method raises questions about the extent to which the responses accurately represent nurses’ perceptions of the barriers to research utilization. The low response rate achieved in this study, although consistent with response rates reported in some(prenominal) O 2004 Blackwell Publishing Ltd, Journal of Clinical Nursing, 13, 304â€315 A. M. Hutchinson and L. Johnston exploration. Investigation of the information-seeking behaviour of nurses, the means by which they gain and synthesize new research knowledge and the way in which they apply that knowledge to their decision making, will further contribute to our understanding of the researchâ€practice gap phenomenon.Measurement of the actual extent of research utilization by nurses in the practice setting presents a major challenge for researchers in this ? eld. Acknowledgements The authors thank Sandra Funk for her consent to use the BARRIERS Scale for the purpose of this study. We craving to acknowledge and than k the nurses who completed the questionnaire. The authors also wish to acknowledge the statistical economic aid provided by Ms Anne Solterbeck, Statistical Consulting Centre, surgical incision of Mathematics and Statistics, The University of Melbourne. Contributions Study design: LJ, AMH; data analysis: AMH; manuscript preparation: AMH, LJ; literature review: AMH. 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