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.
Give your opinion if have any.