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Use of research by staff nurses:organizational support and expectations Varcoe, Colleen Marie 1994

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USE OF RESEARCH BY STAFF NURSES:ORGANIZATIONAL SUPPORT AND EXPECTATIONSbyColleen Marie VarcoeR.N., The Royal Columbian Hospital School of Nursing, 1973B.S.N., The University of British Columbia, 1979M.Ed., The University of British Columbia, 1987A THESIS SUBMIIThD IN PARTIAL FULFILMENT OFTHE REQUIREMENTS FOR THE DEGREE OFMASTER OF SCIENCE IN NURSINGinTHE FACULTY OF GRADUATE STUDIESSchool of NursingWe accept this t esis as conf rming to the required standardTHE UNIVERSITY OF BRITISH COLUMBIAApril, 1994ØColleen Marie Varcoe, 1994In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature)____________________________Department of_________________The University of British ColumbiaVancouver, CanadaDate /qDE.6 (2/88)IIAbstractThis descriptive correlational study was designed to describe British Columbian staff nurses’reports of organizational expectations and support for research use, nurses’ own expectations oftheir use of research, and actual research use by staff nurses. The study was further designed toinvestigate relationships between nurses’ use of research and their expectations of themselves,their employers’ expectations, and their reports of organizational support for research utilization.The study compared the levels and relationships between these research predictor and outcomevariables for groups of diploma and baccalaureate prepared nurses working in hospitals ofdifferent sizes. Crane’s (1989) conceptual framework for research utilization guided this study.A stratified random sample (n=450) of nurses with diploma and baccalaureate education wasselected from staff nurses working in medical-surgical and critical care areas of hospitals ofdifferent sizes in British Columbia. A questionnaire modified from the work of Clarke (1991) wasmailed. Responses were obtained from 183 nurses (42%), a sample comprised of 45% diplomaeducated nurses and 54% baccalaureate educated nurses. The sampling strategy also resulted inrepresentation from hospitals of different sizes which were categorized as small (<250 beds),medium (250-499 beds) and large (>500 beds).The nurses in the sample had very positive attitudes toward research and had highexpectations of themselves to use research in practice. There were no differences betweeneducational groups regarding interest in research and expectations, but the baccalaureate nursesheld a significantly higher value for research and had more research experience than the diplomanurses.The nurses’ opinions of their organizations varied considerably with organizational size, withthe support and expectations for research utilization generally increasing with hospital size.Opinions of the research climate were generally low and the number of infrastructures reported111per hospital was low. The staff nurses believed that nursing department value for research wasreasonably high, but not as high as the nurses’ own value for research using the same scale. Thestaff nurses reported that the head nurse and director expectations to use research were fairlyhigh, but not as high as the nurses’ own expectations.The nurses reported moderate levels of general use of research and of use of specificfmdings, indicating that their practice was not predominantly research-based. There were nodifferences in research use between educational levels or between nurses from hospitals ofdifferent sizes. General use of research was correlated with all of the nurses’ individualcharacteristics and change factors (r=O.41-O.51) but was not correlated with any of theorganizational characteristics or change factors. In contrast, the use of specific fmdings had asignificant positive correlation with the organizational change factor of research climate (r=O.33)and the number of research-related infrastructures (r=O.31), but was not correlated with any ofthe individual characteristics or change factors. There was a low significant correlation betweenthe general use of research and use of specific findings (r=O.38). Although the organizationalfactors varied by hospital size and correlated with the use of specific findings, the use of specificfindings did not vary by hospital size.The relationships between the organizational and individual factors and research utilizationoutcomes were generally as predicted, providing support for Crane’s conceptual framework. Thestudy suggests that nursing practice is not predominantly research-based and that organizationalfactors influence the use of specific research. The study offers understanding of factorsinfluencing research use that may serve as the basis for strategies that build on nurses’ positiveattitudes and values for research and modify organizational barriers to research-based practice.ivTable of ContentsAbstractTable of Contents ivList of Tables viiList of Figures xAcknowledgements xiCHAPTER ONE: IntroductionBackground to the Problem and Problem Statement 1Purpose of the Study 3Definition of Terms 3Conceptual Framework 4Research Questions 11Significance of the Study 11Theoretical Significance 12Practical Significance 12Organization of Thesis Content 12CHAPTER TWO: Literature ReviewWhat is Research Utilization? 14Investigations of Research Utilization in Nursing 15Levels of Research Use in Nursing 16Factors Influencing Research Utilization in Nursing 21Characteristics of Research-based Knowledge 21Personal and Professional Characteristics 23Individual Change Factors 29Organizational Characteristics 31Interaction of Individual and Organizational Factors 36Summary 37CHAPTER THREE: MethodsStudy Design 38Sample 38Instrumentation 41The Original Instrument 41Modifications to the Instrument 42The Final Instrument 44Data Collection Procedures 48Data Analysis 49VAssumptions 50Limitations 50Ethical Considerations 52CHAPTER FOUR: ResultsSample Characteristics 53Education and Years Since Graduation 54Employment 54Gender and Age 56Research Question 1: What are the Nurses’ Values for, Interest in andExperience with Research? 57Value for Research 57Interest in Research 58Research Experience 60Research Question 2: What are Staff Nurses’ Expectations of Themselvesfor Using Research Findings in Practice? 62Research Question 3: What are the Perceived Organizational Expectationsto Use Research Findings in Practice? 64Research Question 4: What is the Perceived Level of OrganizationalSupport For Using Research Findings in Nursing Practice? 68Value of Research 68Research Climate 69Organizational Infrastructure 71Research Question 5: What is the Reported Level of Research Utilization? 73General Use of Research 73Use of Specific Research Findings 75Research Question 6: What is the Difference Between PerceivedOrganizational Expectations and StaffNurses’ Expectations for Use of ResearchFindings in Nursing Practice? 77Research Question 7: What are the Relationships between PerceivedOrganizational Expectations and Staff NurseExpectations of Themselves and the Use ofResearch Findings? 77Research Question 8: What is the Relationship Between the Nurses’Perceptions of Organizational Support forResearch Utilization and Use of Research Findings? 80Ancillary Findings 81Demographics 81Relationships Among Research-related Characteristics of the Individual Nurse 81Relationships Among Organizational Characteristics 83Relationships Between Individual and Organizational Characteristics andResearch Utilization 84Discussion 87Sample Characteristics 87viIndividual Factors 90Research Experience 90Staff Nurses’ Value for Research 91Interest in Research 92Expectations for Using Research 95Organizational Factors 96Infrastructures 96Nursing Department Value for Research 98Expectations of Staff Nurses Perceived to be Held by Key Individuals 99Research Climate 102Research Utilization Outcomes 104General Use of Research 104Use of Specific Research Findings 106Comparison of Findings by Nurses’ Educational Level 108Comparison of Findings by Hospital Size 109Relationships Between Individual and Organizational Factorsand Research Utilization 111Individual Factors 111Organizational Factors 114Research Utilization Outcomes 116Theoretical and Methodological Considerations 117Summary 118CHAPTER FIVE: Summary, Conclusions, and ImplicationsSummary of the Research Project 122Conclusions 130Implications for Nursing Theory, Practice and Education 131Implications for Further Research 134References 138Appendix A: R.N.A.B.C. Electoral District Structure 143Appendix B: Research Utilization in Nursing Practice Questionnaire 145Appendix C: Letter to Participants 154Appendix D: Optional Form to Receive Summary of Results 156Appendix E: Correlations Between Educational Level and Hospital Size and Study Variablds58viiList of TablesTable 1: Conceptualizations Used in Nursing Research Utilization Studies 5Table 2: Summary of Studies of Research Utilization in Nursing 17Table 3: Summary of Empirical Support for the Influence of Personaland Professional Characteristics on the Use of Research 26Table 4: Summary of Empirical Support for the Influence of Organizational Factorson the Use of Research Findings in Nursing Practice 33Table 5: Factorial Study Design with Groups by Education and Hospital Size 38Table 6: Sampling Strategy Using Four Stratified Populations 40Table 7: Modifications of Instrument by Section 44Table 8: Relationship of Study Variables and Sections on Modified Questionnaire 46Table 9: Sample by Education and Hospital Size 53Table 10: Years Since Most Recent Graduation 55Table 11: Part and Full-time Employment by Educational Level 55Table 12: Age Distribution by Educational Level 56Table 13: Value of Research Scores by Education 58Table 14: Value of Research by Education and Hospital Size 58Table 15: Distribution of Interest Scores by Education and Hospital Size 59Table 16: Percentage of Agreement with Research Interest Statements 60Table 17: Interest in Research by Education and Hospital Size 60Table 18: Research Experience by Education for Five Most Frequent Experiences 61Table 19: Research Experience by Education and Hospital Size 62Table 20: Distribution of Own Expectations to Use Research by Education 63Table 21: Expectations of Self by Education and Hospital Size 63Table 22: Expectations Scores of Key Individuals as Viewed by the Staff Nurse 65viiiTable 23: Distribution of Staff Nurse Perceptions of Head Nurse Research Expectations 66Table 24: Staff Nurse Perceptions of Head Nurse Expectations by Educationand Hospital Size 66Table 25: Summary of MANOVA for Staff Nurse Perceptions of Head NurseExpectations by Group 66Table 26: Staff Nurse Perceptions of Nursing Director Expectations byEducation and Hospital Size 67Table 27: Staff Nurse Perceptions of Nursing Director Expectations by Group67Table 28: Distribution of Perceived Nursing Department Value for Research byEducation and Hospital Size 68Table 29: Nursing Department Value for Research by Education and Hospital Size 69Table 30: Distribution of Research Climate Scores by Education and Hospital Size 70Table 31: Research Climate Scores by Education and Hospital Size 70Table 32: Summary of MANOVA for Research Climate by Group 70Table 33: Distribution of Organizational Infrastructures Scores byEducation and Hospital Size 72Table 34: Number of Organizational Infrastructures by Education and Hospital Size 72Table 35: Summary of MANOVA for Organizational Infrastructure by Group 72Table 36: Percentage of Responses Regarding General Use of Research 74Table 37: Distribution of General Use of Research by Education 75Table 38: General Use of Research by Education and Hospital Size 75Table 39: Distribution of Use of Specific Findings 76Table 40: Use of Specific Findings by Education and Hospital Size 77Table 41: Pearson Correlation Matrix Between Expectations and Use of Research 78Table 42: Pearson Correlation for Organizational Support and Use of Research 80Table 43: Correlation Matrix for Study Variables 82ixTable 44: Comparison of Staff Nurses Research interests from the Perspectiveof the Staff Nurse and Key Hospital Personnel 94Table 45: Comparison of the Value of Nursing Research from Three Perspectives 99Table 46: Comparison of Expectations from Current Study and from Clarke (1991) 101Table 47: Comparison of Response to Research Climate Statements byStaff Nurses and Key Nursing Department Personnel 103Table 48: Correlations Between Educational Level and Hospital Size and Study Variablesl58xList of FiguresFigure 1: Conceptual Framework of Variables Associated withResearch Utilization in Nursing - From Crane (1989) 7Figure 2: Current Study Variables within the Conceptual Framework 10Figure 3: Correlations Between Expectations and Research Use 79Figure 4: Correlations Between Individual Factors 83Figure 5: Correlations Between Organizational Factors 84Figure 6: Correlations Between Individual and Organizational Factors andResearch Utilization Outcomes 85Figure 7: Correlations Among Organizational and Individual Factors andResearch Utilization Outcomes 86xiAcknowledgementsMy sincere appreciationTo my husband, Jim, for putting up with me, doing the diagrams, polishing the surveyand drying my tears;To my children, Aaron, Alex and Megan, for their independence, tolerance and justbeing wonderful;To my chief advisor, Ann Hilton, for her expert guidance, patience, enthusiasm,commitment, high standards, and the occasional boot in the butt;To my friend, Debbie Hollands, for her support, encouragement, humour, and frequentdoses of practical perspective;To Heather Clarke, for her expertise, enthusiasm, commitment, positive feedback andspeedy long-distance turn around during her sabbatical;To Jinny Hayes, for her encouragement, faith, confidence and great editing;Thank you all.1CHAPTER ONEIntroductionBackground to the Problem and Problem StatementWe can’t give our patients any narcotics for fifteen minutes before they leavethe recovery room. By the time they get to the ward, they are really in painand that’s when they have to move onto the bed. Then the ward nurse, youknow, has to get report and admit the patient and then maybe get the patientsomething for pain. So, sometimes it’s an hour or so before they getsomething for pain.Why? Oh, because. The guidelines and our unit policy.., which is crazy,because the peak effect of the IV narcotics we use is about seven and a halfminutes... and we know that once the patient really gets in pain, then it’s hardto get control of the pain again.Recovery Room Nurse, 1992Research-based practice is a professional hallmark to which nursing aspires. Although it isdifficult to ascertain the degree of use, research is not thought to be widely used in nursingpractice (Bircumshaw, 1990; Bock, 1990; Brett, 1987; Briones & Bruya, 1990; Champion &Leach, 1989; Hunt, 1987; MacGuire, 1990; Mercer, 1984; Winter, 1990). Efforts to deal withthis difficult problem have included research utilization development projects (e.g., Conduct andUtilization of Research in Nursing Project, 1980-1983; King, Bernard & Hoehn, 1981). Theyhave also included empirical studies of the use of specific practices (Brett, 1987; Coyle & Sokop,1990; Ketefian, 1975; Kirchoff, 1980; Linde, 1989, Winter, 1990) and empirical studies of thefactors influencing dissemination, communication and use of findings (Champion & Leach, 1989;Crane, 1989; Funk, Champagne, Wiese & Tomquist, 1991b).The factors affecting the use of research in nursing practice are not clearly understood. Thecategories of influential factors that have been considered are: 1) characteristics of researchfindings, 2) characteristics of individual research users, 3) characteristics of organizations, and4) characteristics of the nursing profession. In the utilization research, these characteristics have2been treated as discreet and disconnected variables, with most studies focusing on thecharacteristics of individuals and limited attention to the study of organizational factors.The focus on the characteristics of individuals assumes the problem to be due to failure ofindividual nurses. The results have been mixed regarding the influence of individualcharacteristics. To date, the individual characteristics that have received empirical support asinfluential on research utilization include attitudes toward research, reading specific journals,attending research conferences, learning practice through nursing school or continuing education,and research responsibilities at work. Other characteristics such as the type of education, numberof degrees, participation in continuing education, research experience and courses, and years ofnursing experience were not supported as influential.This investigator has observed that nurses base their practice on organizational policies andare not encouraged to question or change those practices. Further, nurses seem to encounterconsiderable opposition when attempting to change their practice. During interviews, nursespractising in a recovery room said that they question many of their practices but that the rulesare hard to change. This investigator began to wonder if research-based practice is really expectedwithin organizations and whether or not the influence of the organizations within which nurseswork is more powerful than the characteristics of the individual nurse.The influence of organizational factors has had limited attention and has been dealt with asa secondary concern within studies that focus on the characteristics of individual nurses (e.g.,Brett, 1986; Champion and Leach, 1989; Coyle & Sokop, 1990; Crane, 1989; Funk et al., 1991b;Kirchoff, 1982; Linde, 1989). Most factors have been considered in single studies. Researchershave studied organizational characteristics of hospital size and research support mechanisms, butresults were inconclusive. The influence of expectations on research-based practice has not beenpublished prior to this study. Organizational support and expectations for research use requires3investigation. Specifically, the influence of organizations on the use of research findings innursing practice requires further study; also, the interaction between organizational characteristicsand the characteristics of individual users of research should be examined.Nursing research aims to improve the quality of patient care and to make nursing care morecost-effective. Research-based practice is essential for professionalism, accountability, the deliveryof quality patient care, and cost-effectiveness of nursing practice (Bircumshaw, 1990). If nursingpractice is to become research-based, the influential factors must be understood. If organizationsare highly influential, then strategies for organizational change must be added to strategies aimedat improving the quality of research and improving the individual nurse’s ability to use research.Understanding the influence of organizational support and expectations will assist the nursingprofession to develop organizational strategies.Purpose of the StudyThe purpose of this study was to describe the levels of organizational expectations andsupport for research use according to the nurse, levels of nurses’ expectations of themselves, andlevels of research use by diploma and baccalaureate prepared nurses working in hospitals ofdifferent sizes in British Columbia. An additional purpose was to investigate the relationshipsbetween nurses’ use of research and their expectations of themselves, their perspectives of theiremployers’ expectations, and organizational support for research utilization.Concevtual FrameworkIn the following section, the conceptual models which have been used in studies of researchutilization will be discussed. Crane’s conceptual model, is emphasized because of the directionit provides for this study.Only two models have been used in the reported empirical investigations of researchutilization (see Table 1). Kirchoff (1982), Brett (1987), Coyle and Sokop (1990), Linde (1989)4and Winter (1990) used Roger’s (1983) diffusion model; Crane (1989) used a model developedfor the Conduct and Utilization of Research in Nursing (CURN) project (1980-1983) based onthe work of Havelock (1969). Research utilization projects, including the CURN project and theNursing Child Assessment Satellite Training (NCAST) project, have also used models based onthe work of Rogers or Havelock (Crane, 1985a; Crane 1985b; Stetler, 1985).Table 1Conceptualizations Used in Nursing Research Utilization StudiesPUBLICATION AUTHOR CONCEPTUALIZATIONYEAR1975 Ketefian not specified1982 Kirchoff Rogers1986/87/89 Brett Rogers1989 Linde Rogers1989 Champion & Leach not specified1989 Crane Havelock1990 Coyle & Sokop Rogers1990 Winter Rogers1991 Funk et al. not specifiedRogers (1983) specifically focuses on the diffusion of innovations or “ideas which areperceived as new” (p. 13). His five-step innovation-decision process, in which an individualdecides to adopt or reject an innovation, corresponds to the phases identified by Lewin’s (1952)change theory (Reinhard, 1988; Welch, 1990). The individual begins to understand an innovationand develops attitudes toward it. In this process, a decision to accept or reject the innovation ismade and implementation follows; finally, the individual confirms whether the decision wascorrect and may choose to reverse the decision. The innovation is communicated over time to5members of the social system.While Rogers acknowledges the organizational context and includes both individual andcollective decisions, the adoption of an innovation is conceptualized as an individual decision andthus, the model does not emphasize organizational factors. Referring to the use of Rogers’ modelin the study of nursing research utilization, Romano (1990) noted that “the classical diffusionmodel, although helpful in some respects, is inappropriate to the study of the complexity ofmulti-faceted health care organizations. Previous studies may have resulted in inconclusivefindings because the ‘wrong’ questions were asked using the ‘wrong’ organizational perspective”(p. 20).The findings from several studies illustrate the limitations of the classical diffusion approach.Brett (1987) interpreted Kirchoff’s (1982) findings as supporting the notion that “nurses awareof the innovation were also more likely to be in the persuasion or implementation stages” (1987,p. 344). However, Kirchoff actually found that “reading or being aware did not affect howimportant the nurses thought the (coronary) restrictions were or how frequently they reportedpractising the restrictions” (p. 200). Both Brett (1987) and Coyle and Sokop (1990) found nurseswho used innovations were not necessarily persuaded that the innovation should be used. Brettestimated that 23% of the nurses adopted practices without persuasion. These findings suggestthat the decision to implement an innovation in practice is more complex than can be explainedby the diffusion model.During work with the Conduct and Utilization of Research in Nursing (CURN) project(1980-1983), Crane used Havelock’ s (1969) linkage model that incorporated organizationalchange factors, individual change factors and the organizational context. In her 1989 study offactors affecting the use of research-based knowledge, Crane also used this model. She concludedthat organizational factors are more influential predictors of research use than individual factors,6and modified the framework to denote a direct relationship between organizational factors andoutcomes (see Figure 1). She removed the direct path between individual change factors andoutcomes that had existed in the original version of the framework, concluding that “individualchange factors affect research utilization outcomes only as they are mediated by organizationalchange factors” (1989, p. 196).Charactensticsof Research-basedKnowledgeIndividualChange FactorsPersonal andProfessionalCharacteristicsResearchOrganizational UtilizationChange Factors OutcomesOrganizationalContextFigure 1: Conceptual Framework of Variables Associated withResearch Utilization in Nursing. From Crane (1989)7Crane’s framework provides a basis for the current study because it uses the categories ofinfluencing factors suggested in the literature, suggests relationships between those factors, andemphasizes the importance of the organization. A brief review of the components of Crane’sframework illustrates their relationship to the categories in the literature and explains how theyhave guided this study.The characteristics of research-based knowledge in this model correspond to the“characteristics of research findings” category of influential factors cited in the literature. Cranedefines these characteristics as including the innovation itself as well as instruction related to theuse of the innovation, means for communicating knowledge about the innovation, and supportand consultation regarding the use of the innovation. The characteristics of research-basedknowledge were not the focus of this study. However, innovations selected and studied by others(Brett, 1986; CURN, 1980-1983; Coyle & Sokop, 1990) were used in the current study to explorethe use of specific research findings.The personal and professional characteristics represent the attributes of the individual nursethat might influence the way in which research-based knowledge is used. Crane studied personaland professional attributes which included 1) age, 2) education, 3) cosmopoliteness (the degreeto which the person is oriented outside of the immediate social system), 4) extent of opinionleadership (the ability to influence other’s opinions), and 5) work-related research experience andexperience with change. Although personal and professional characteristics were not the focusof this study, the nurse’s age, education and research experience were examined.The individual change factors are attitudes and behaviours that are expected to change as aresult of the interaction between the research-based knowledge and the personal and professionalcharacteristics of the individual. Crane states that these change factors are related to theindividual’s awareness of a need for research-based knowledge, readiness to use research-based8knowledge, assessment of and willingness to use available resources, and willingness to change.In the current study, the individual’s awareness of a need for research-based knowledge andreadiness to use research-based knowledge were conceptualized as the individual’s perceptionsof the value of research, interest in using research and expectations of self for using research inpractice. The individual’s assessment of available resources was also considered.Organizational change factors are similar to individual change factors except that they arecharacteristics of the organization. Crane views these factors as representing a general state withinthe organization or as representing the views of a few key individuals within the organization.Therefore, for the purposes of this study, two change factors (the value of research andexpectations of staff nurses to use research as viewed key individuals in the organization) wereconsidered as reported by the staff nurse. In addition, the general research climate within theorganization was measured. These organizational change factors were studied as reported by thestaff nurse.Organizational context is viewed by Crane as those organizational variables that are notamenable to change through the level of effort associated with practice change. According toCrane, the organizational context encompasses specific strategies to increase the use of researchsuch as the integrative mechanisms studied by Brett (1986). For the current study, theorganizational infrastructure for research utilization was the major variable considered within theorganizational context. As infrastructures may be related to the size of the organization (Horsleyand Crane, 1986) different sizes of hospitals were considered.Finally, Crane defines the outcomes of research utilization to be at both the individual andthe organizational level. The individual-level outcomes are defined as including both cognitiveand behavioral use of research-based knowledge, the diffusion of knowledge to others, anddiscontinuation of outdated practices. In the current study, the research utilization outcomes9considered were general use of research and use of specific findings at the individual level.In summary, Crane’s model provides a framework which describes the relationships amongthe variables of interest in this study by focusing on the organization as well as on the individualnurse and therefore will be used to guide this research. Figure 2 summarizes the specific variablesconsidered in this study within the context of the conceptual framework.Characteristicsof Research-basedKnowledgeIndividualChange Factors• value• interestPersonal and• expectationsProfessionalCharacteristics I 4 Research• education Organizational Utilization• research experience Change Factors Outcomes• value • general use• expectations • use of specific• climate findingsOrganizationalContext• size• infrastructuresFigure 2: Current Study Variableswithin the Conceptual Framework.10Research OuestionsFor the purposes of the study, eight research questions were posed.Among staff nurses with different educational backgrounds working in adult critical care ormedical-surgical units in British Columbia acute care hospitals of different sizes:1. What are the nurses’ values for, interests in and experiences with research?2. What are the nurses’ expectations of themselves for using research findings in practice?3. What are the perceived organizational expectations to use research findings in practice?4. What is the perceived level of organizational support for using research findings in nursingpractice?5. What is the reported level of research utilization?6. What is the difference between perceived organizational expectations and staff nurses’expectations of themselves for use of research findings in nursing practice?7. What is the relationship between perceived organizational expectations and staff nurseexpectations of themselves and the use of research findings?8. What is the relationship between the nurses’ perceptions of organizational support forresearch utilization and use of research findings?Defmition of TermsFor the purposes of this study, the following defmitions are used:Research Utilization: “A process directed toward the transfer of specific research-basedknowledge into practice for the purpose of solving an identified nursing care problem” (Crane,1985, p. 262). The process of research utilization is the process of using the findings (products)of research, and as such is distinguished from the process of conducting research. The termresearch utilization will be used interchangeably with the phrase “use of research in practice”.Innovation: An innovation is a change that is perceived as new (Rogers, 1983). Roger’s thinking11has been highly influential in the nursing research literature and the term innovation is commonlyused as equivalent to research-based change. Within this study, research utilization is equatedwith adoption of an innovation because research utilization implies a change in thinking(cognitive application) or practice (behavioral application) based on research (Crane, 1989).Infrastructures: Organizational features which support research-based nursing practice includingstructures (positions, committees), services (space, secretarial, computers), time, communicationsystems and consultation (Clarke & Joachim, 1993).Expectations: The behaviour that is anticipated and required in a specific role by the personfulfilling that role or by others (Hardy & Hardy, 1988).Own Expectations: The behaviour that a nurse anticipates and requires of herself or himselfwhen fulfilling the staff nurse role.Organizational Expectations: The behaviour that is anticipated and required of the staff nurseby those holding superior work relationships with the nurse. In this study, these expectations aremeasured from the perspective of the staff nurse.Value For Research: The attitudes regarding the usefulness and worth of research to nursing.Research Interest: Attitudes regarding participating in the research process and using researchfindings.Significance of the StudyThe results of this study add to understanding of the factors influencing research use innursing and offer direction regarding strategies and further study to promote research-basedpractice. Specifically, this study examines the influence of expectations for using research, whichhas not been previously examined, and organizational support for research use, which hasreceived limited attention.This study contributes to understanding the relationship between nurses and the organizations12in which they practice. It furthers understanding regarding the effect of that relationship on theuse of research findings in practice and increases understanding of organizational barriers toresearch utilization. Because random sampling was used to select participants from the populationof staff nurses working in British Columbia (B.C.), the results are generalizable to staff nursesin medical, surgical or critical care areas in B.C. Because of the similarity of health care acrossCanada, the results also should be useful to nurses in other provinces.Theoretical SignificanceThe theoretical understanding of the use of research and theory in nursing practice hasfocused on the individual nurse. This study contributes to an understanding of the problem fromthe perspective of the context of practice. The results of this study can be used as a basis forfurther study of the influence of organizational factors on research utilization.Practical SignificanceThis study offers individual nurses a better understanding of the factors that may influencetheir own practice. It also provides direction for educators and organizations to enhance the useof research fmdings in practice.Organization of Thesis ContentThis first chapter has introduced the background and purpose of the study and the reasonsfor selecting the problem for study. Crane’s (1989) conceptual framework and the rationale forits selection has been outlined. The research questions have been stated and the significance ofthe study, assumptions, limitations and ethical considerations described.In the second chapter, a review of the literature is presented to describe research utilizationand to describe previous investigations of research utilization in nursing and their findingsregarding levels of research use and influencing factors.The third chapter describes the methods used, including the design, the sampling strategy,13the survey instrument, the data collection procedures, and data analysis. The limitations,assumptions and ethical considerations are also discussed.The results are presented in the fourth chapter. The sample characteristics are described ingeneral and in relation to each of the research questions. Ancillaiy findings are also presented.The findings are then discussed in relation to the conceptual framework, the methods andprevious research.Finally, in chapter five the study is summarized, conclusions are drawn and implications forpractice, education and further research are offered.14CHAPTER TWOLiterature ReviewThe literature is reviewed in three sections. First a general description of research utilizationis provided. Second, investigations of research utilization in nursing and the level of research usefound in the studies are described. Third, the conceptual literature and empirical findingsregarding factors influencing research use in nursing are discussed.What is Research Utilization?Research utilization is a specific form of knowledge utilization (Loomis, 1985). Carper(1978), Chinn (1985) and Belenky, Clinch, Goldberger and Tarule (1986) propose that there areseveral ways of knowing, only one of which is through empirically validated research.Consideration of this led Stetler (1985) to argue that nursing should not assume that all practicecan be based on research findings. Nursing should, however, seek to understand how and whenresearch “can most effectively promote scientific practice within the framework of the broaderconcept of knowledge and its utilization” (p. 44).Loomis (1985) differentiates between three utilization processes. Knowledge-driven processesoccur when information is generated and a use is sought for that information. In problem-drivenprocesses, a need is identified in practice and a solution is sought. Finally, there are utilizationprocesses that involve a “reciprocal dialogue” between users who generate problems and theresource system that generates the solutions.The term research utilization has been used variously to encompass the use of researchfindings in practice, the use of the research process in practice (i.e. the conduct of research), orboth (Horsley, Crane & Bingle, 1978; Stetler, 1985). As this study focuses on the use of researchfindings in practice, but not on the conduct of research, the more limited meaning is used andresearch utilization is considered to be the use of research-based knowledge in practice.15The influence of Rogers’ theory of diffusion of innovation on understanding nursing researchutilization can be seen throughout the nursing literature in the frequent use of the term“innovation” as interchangeable with “research finding”. Crane (1989) argues that becauseresearch utilization implies a change in thinking (cognitive application) or practice (behavioralapplication) based on research, research utilization can be equated with adoption of an innovation.In summary, research utilization is a specific form of knowledge utilization in which findingsfrom research are implemented in practice. Research utilization processes involve interactionbetween research generation and research use. Research utilization may result in cognitive orbehavioral change in practice and such change has been equated with adoption of an innovation.Investigations of Research Utilization in NursingMany nursing authors have decried the gap between research fmdings and practice(Bircumshaw, 1990; Bock, 1990; Brett, 1987; Briones & Bruya, 1990; Champion & Leach, 1989;Hunt, 1987; MacGuire, 1990; Mercer, 1984; Winter, 1990). The nature of this gap was illustratedby Davis and Simms (1992) who examined two common nursing practices: changing intravenous(IV) tubing and Z-track injection technique. Although the research findings related to the optimalfrequency of changing IV tubing were well substantiated and replicated, the findings were notimplemented in practice. In contrast, the results of a single study concerning the Z-track injectiontechnique had received widespread dissemination in textbooks and implementation in practice.These cases exemplify the complex, sometimes unquestioned relationship between practice andresearch in nursing. In some instances validated practices have not been implemented; in otherinstances dubious research findings have been used (e.g., Hunt, 1987).Literature on the use of research findings in nursing is largely conceptual. To date, twelveempirical investigations have been published (see Table 2, p. 18). Of these, eight (Brett, 1987,1989; Coyle & Sokop, 1990; Crane, 1989; Ketefian, 1975; Kirchoff, 1982; Linde, 1989; Winter,161990) explored the relationship between the use of specific research findings and influencingfactors. The remaining four (Alcock, Carroll & Goodman, 1990; Champion & Leach, 1989; Funk,Champagne, Wiese & Tornquist, 1991b; Miller & Messenger, 1978) surveyed the opinions ofnurses regarding their perceptions of influencing factors. With the exception of Linde’s (1989)pre-test/post-test design, all studies were cross-sectional, descriptive surveys, characterized bymoderate to large sample sizes. Six of the twelve studies used random selection. It is importantto examine reports about the levels of research use and the factors that influence them.Levels of Research Use in NursingStudies that report levels of research utilization confirm the suspicion that research findingsare not widely used in nursing practice. Ketefian (1975) is cited as completing the first empiricalstudy regarding the gap between nursing research and practice (Brett, 1987; Coyle & Sokop,1990; Polit & Hunger, 1991). She studied the extent to which one validated and widely reportedresearch finding (correct placement time for oral temperatures) was used by nurses in practice.She found that only one out of 87 nurses knew the correct placement time.In a second study conducted in 1982, Kirchoff examined the discontinuation of coronaryprecautions among practising nurses. Although earlier research was conclusive that precautionswere not necessary, Kirchoff found that the majority of nurses continued to use the twoprecautions studied. Kirchoff also found that reading about coronary precautions and awarenessof research did not affect how important the nurses thought the restrictions were or howfrequently they used them.Table2SummaryofStudiesofResearchUtilizationinNursingDATEAUTHORPURPOSESAMPLEFINDINGS1975Ketefiantodetermineextenttowhichonen=87.onlyonenurseknewthecorrectplacementtimeresearchfinding(correctplacementconveniencesampleof•education,yearssincegraduation,andfrequencyoftimefororalthermometers)impactedR.N.sfrommanysettingsperformingthepracticedidnotmakeadifference.practice1978Miller&toidentifyproblemsnursesencountern=215•abilitytoobtainfindingswasmostimportantMessengerwhentryingtouseresearchfindingsrandomlyselectedfrom.organizationalproblemsweretheothertopthreeprofessionalassociation1982Kirchofftoassesstheimpactofthepublishedn=524•contrarytoresearch,restrictionswerecommonlystudiesonthepracticesofrestrictingstratifiedsampleenforced(icewater76.3%;rectaltemp.64.7%)icewaterandmeasurementofrectalrandomlyselectedfrom•unitpolicywasthemostfrequentoriginofthetemperatureswithcoronarypatients202hospitalsofvariousrestrictionsizes•yearssincegraduation,readingjournalsandhospitaltypeandsizecorrelatedwithawarenessofresearch•readingorawarenessofresearchdidnotaffecthowimportantthenursesthoughttheresthctionswereorfrequencyofuse.1987/Bretttodeterminenursesawarenessof,n=216•3495%wereawareofdifferentinnovations1986persuasionabout,anduseof,14randomsampleof.28-92%werepersuadedinnovationsshouldbeusednursingresearchfindingsmedical/surgicalandICU.31-93%usedinnovationsatleastsometimesstaffnursesselectedfrom•specificjournalsandhoursreadingcorrelatedwithalarger(n=274)stratifiedusesamplefromhospitalsofdifferentsizesTable2:SummaryofStudiesofResearchUtilizationinNursing(continued).DATEAUTHORPURPOSESAMPLEFINDINGS1989/Bretttoexploretherelationshipbetweenn=216•neitherhospitalsizenorintegrativemechanismshad1986organizationalintegrativemechanismsrandomlyselectedsampleasignificanteffectonadoption,butinteractiondid(activitiesandstructuresthatofmedical/surgicaland•innovationadoptionscoreswerehigherinlarge,thenpotentiallyincreaseinformationflow)ICUstaffnursesselectedsmall,thenmediumhospitalsandnursesadoptionofinnovationsfromalarger(n=274)•insmallhospitals,conductingresearchandexposurestratifiedsamplefromtopublicationswerepositivelyrelatedtoadoptionsmall,mediumandlarge•inlargehospitals,allmechanismswerenegativelyhospitalscorrelatedtoadoption1989Cranetoidentifykeyfactorsassociatedwithn=74•thepublicationgroupengagedinbehavioraluseofclinicaluseofresearch-basedconveniencesampleof34knowledgemorethantheconferencegroup;forknowledgedisseminatedbymeansofnurseswhoattendedcognitiveandgeneraluse,groupsdidnotdiffertwomethodsandtoexploretheresearchconferencesin•position-relatedresearchexperiencewasrelatedtoinfluenceofpersonalandprofessional1981-1982and40nursescognitiveuseofnewknowledgecharacteristics,thenatureofwhoreadpublicationsof•noneoftheother24possiblecorrelationsbetweenknowledge,individualandresearchatapproximatelypersonalandprofessionalcharacteristicsandtheuseorganizationalchangefactorsthesametimeofknowledgeweresignificant•individualneedsandresourcesweretheonlyindividualcharacteristicsassociatedwithuse.28of30possiblecorrelationsbetweenorganizationalchangefactorsandresearchuseweresignificant•ofallthepredictorvariables,onlyorganizationalchangefactorsweresignificantlycorrelatedwithuseofknowledgeinpatientcare1989Champion&toidentifyvariableswhichweren=59•attitude,availabilityoffmdings,andsupportofkeyLeachperceivedasrelatedtotheuseofconveniencesampleofadministratorswererelatedtotheuseofresearchresearchinaclinicalareanursesfromvariousclinicalareasinacommunityhospital00Table2:SummaryofStudiesofResearchUtilizationinNursing(continued).DATEAUTHORPURPOSESAMPLEFINDINGS1989Lindetodeterminewhichofthreelevelsofn=185allthreelevelsofcommunication(reading;readingcommunicationaboutaspecificpurposivesampleofandin-service;reading,in-serviceandadministrativepracticeinnovation(deepbreathingnursesfromthreegeneralsupport)weresignificantlyassociatedwithchangeinandcoughingbeforepainmedication)surgeryunitsateachofnursingpracticecreatedchangeinnursingpracticetwohospitals1990Wintertoidentifysourcesofresearchn=186.56.5%ofnursesusedrelaxationtherapyinpracticeknowledge,todetermineifaconveniencesampleof•learningaboutfindingsinnursingschoolorrelationshipexistedbetweensourcesnursesfromdiversecontinuingeducationprogramscorrelatedwithuse;offindingsanduseoffindingsinclinicalareasinninelearningthroughjournals,massmediaorpeersdidnotpracticeandtoexaminetheinfluencedifferenthospitalswho•age,experience,educationlevel,clinicalareaandofindividualcharacteristicsonuseofknewaboutrelaxationsocioeconomicstatuswerenotsignificant.findingsrelatedtorelaxationtherapytherapy1990Coyle&todeterminetheextentofadoptionofn=113.28-94%wereawareofthedifferentinnovationsSokop14research-basedpracticesrandomsampleof.7-91%werepersuadedmedicalsurgicalandICU.28-90%usedtheinnovationatleastsometimesnursesfrom10mediumsizedhospitals1990Alcock,todescribestaffnurses’research-n=178•nursesvaluedresearchandwereinterestedinCarroll&relatedvalue,interest,expectations,proportionalrandomresearch,buthadlittleresearchexperienceGoodmanexperience&perceptionsofsampleofstaffnurses•nurseshadlowopinionsoforganizationalclimateorganizationalclimatefromteachingandnon-•mostnursesexpectedthemselvestouseresearch,butteachinghospitals,publicnottobeinvolvedindatacollectionordoingresearchhealthandhomecare1991bFunk,todetermineclinicians’perspectivesn=924•greatestbarrierswerenursesfeelingthattheydidnotChampagne,ofthebarrierstousingresearchstratifiedrandomsamplehaveenoughauthoritytochangepatientcareandWiese&findingsinpracticeandtosolicitfromeachoffiveinsufficienttimetoimplementnewideasTomquistinputregardingfactorsthatwouldeducationalstrata•alleightorganizationalitemswereamongtop10facilitateresearchuse(diploma,AD,BSN,barriersMSNandPhD)•administrativesupportwasmostfrequentlyidentifiedasfacilitatingresearchuse20More recently, Brett (1987) studied the diffusion of 14 innovations reported in the literature,including the innovations identified through an earlier project (CURN, 1980-1983). Using Roger’s(1983) stages of diffusion, Brett found that nurses’ awareness of innovations varied (34%-95%)depending on the innovation. Nurses also varied in the extent to which they were persuaded thatthe innovations should be used (28-92%) and the extent to which they used the innovations (31-93%). For example, 31% of nurses used deliberate nursing interventions for pain, whereas 93%used closed sterile urinary drainage. On average, the innovations were used by 61% of the nursesat least some of the time. Five of the innovations were used at least sometimes by 70% of thenurses, which Brett interpreted as well diffused. She interpreted four innovations, which wereused by less than 40% of nurses, as poorly diffused.Coyle and Sokop (1990) studied the 14 innovations previously examined by Brett (1987) andobtained similar results. They found that the extent to which nurses used the innovations variedfrom 28-90% depending on the innovation.Crane (1989) compared the use of findings by two groups of nurses who learned about theCURN project innovations by attending conferences or reading research-based publications.Overall, the groups were similar in cognitive use of new knowledge, but the group who read theresearch-based publications had higher behavioral use of new knowledge. However, the researchutilization scores were unique to her study, preventing comparison with the percentages reportedin other studies.Winter (1990) studied the use of relaxation therapy research and found that 56.5% of thenurses used the findings in practice. She interpreted this as being distinctly higher than thefindings of others. However, the percentage is remarkably similar to the 61% average found byBrett (1987), whom she cited, and the 54% average found by Coyle & Sokop (1990). It is alsointeresting that Winter excluded all nurses who did not already know about relaxation therapy21from her study, effectively including only those who were already at the awareness stage ofdiffusion. When Coyle and Sokop excluded nurses who were not aware of findings, they foundthat 71-100% used the innovations under study.The few studies that report levels of research utilization use different approaches so thatcomparisons can be made only with caution. However, these studies illustrate that well-documented and published findings are not widely used in practice.Factors Influencing Research Utilization in NursingStudies of research utilization in nursing have focused on describing the levels of researchuse and the factors influencing different levels of use. As noted earlier, influential factors havebeen categorized as being related to the characteristics of 1) the innovation, 2) the individualuser, 3) organizations (Champion & Leach, 1989; Horsley & Crane, 1986) and 4) the professionof nursing (Pout & Hunger, 1991). Crane (1989) applied Havelock’s (1969) change theory tonursing research utilization to incorporate these factors within a model and to suggestrelationships between the factors. As noted earlier, Crane reformulates the categories as being1) characteristics of the research-based knowledge, 2) personal and professional characteristics,3) individual change factors, and 4) organizational context and change factors. The conceptualliterature and empirical results are reviewed within these categories.Characteristics of Research-Based Knowledge. The first category of factors are those relatedto the research that generates the findings. It has been suggested that the availability, quality,suitability, and communication of research findings influence the extent to which research willbe used in practice. Various nursing authors have speculated about and researched the influenceof these characteristics.Hunt (1981) states that the first problem in nursing research utilization is that much of theresearch required to substantiate practice simply has not been done. Hunt and others (e.g., Bock,221990; Chinn, 1985; MacGuire, 1990) argue that even in areas where research has been done, thework is fragmented, replication is rare, and small sample sizes limit generalizability. Hunt (1987)states that it is ethically unsound to think that nurses should change practice based on oneresearch article and that some traditional practices and o1d wives tales” have sound rationaleswhile some research may be erroneous (and even fraudulent). Even when valid research resultsare available, they may not be suitable for application to practice. Suitability depends on therelative advantage compared to existing practice, the complexity of the innovation, compatibilitywith the practice setting, the possibility of reversing the change, and the observability of theinnovation and its consequences (Horsley & Crane, 1986).Another set of factors pertains to the dissemination of research to potential users. Mercer(1984) and Bock (1990) note that literature aimed at clinicians is fragmented and focuses ontechnical skills; whereas, journals that report research aim at academics. Further, these authorsand Briones and Bruya (1990) note that research reports are not always written in an easilyunderstood manner and implications are not always clear or even presented. Finally, the timefrom research to publication may be lengthy, requiring up to three years for journal publicationand up to ten years for publication in books.Two reported studies that investigated the influence of the characteristics of innovations onresearch utilization examined the availability and communication of research. In their survey ofnurses, Champion and Leach (1989) found that nurses’ reports of the availability of findings weresignificantly related to self-reported use of research findings. Linde (1989) used three differentmethods to communicate findings related to a specific innovation and found that all threemethods resulted in significant change in nursing practice.Miller and Messenger (1978) found that the most frequently cited obstacle to using researchin practice was that of obtaining research findings. In addition, the finding of significant23relationships between the type of journals read and research utilization (Brett, 1986, 1989; Coyle& Sokop, 1990) supports the idea that dissemination methods are influential. However, thefindings of Brett (1987), Coyle and Sokop (1990) and Kirchoff (1982) illustrate that knowingabout research does not determine use and that individuals can use research findings withoutbeing persuaded of their value.In summary, the characteristics of research-based knowledge which influence researchutilization arise from limitations in the availability and communication of useful researchfindings. These variables are related to the production and dissemination phases of the researchprocess and, according to Kirchoff (1991), are primarily the responsibility of researchers. Whilethese characteristics seem to be important, the relationship between knowing about researchfindings and using findings does not appear to be simple or straightforward. The characteristicsof research-based knowledge are not sufficient to explain the levels of use of research in nursing.Personal and Professional Characteristics. TI researchers generate useful findings andcommunicate understandably, then the next factors to consider are those related to the ability ofthe nurse to use research findings. Individual personal characteristics have received the mostattention in nursing research (see Table 3, p. 25), with the attitudes, knowledge and behaviourof individual nurses being examined.There are three reasons that studies of research use in nursing have focused on theindividual: 1) categories of factors influencing research have been discussed as discrete divisions,2) the conceptual model commonly used is the diffusion model, which focuses on the individual,and 3) most innovations studied have been within the control of the individual nurse.Criteria used to select the innovations studied by Brett (1986, 1989), Crane (1989), Coyleand Sokop (1990), and Winter (1990) specified that the innovations had to be suitable forimplementation by the individual nurse. Those studied by Ketefian (1975) and Linde (1989) also24were within the control of the nurse. The study of such innovations purposely focuses on theindividual nurse but limits study of the influence of organizational factors. It is interesting thatthe one study which investigated innovations (discontinuation of coronary precautions) that wereunder multi-disciplinary control identified an organizational factor (hospital policy) as the majorsource of influence (Kirchoff, 1982). Kirchoff also found that physicians had more influence onnursing practice than did nurses with regard to discontinuing one of the two precautions studied.The specific personal and professional characteristics are thought to include the attitudes,education, research education and research experience of individual nurses. Each of thesecharacteristics has been explored in two or more studies. In addition, single studies examinemethods of learning about research findings, sources of knowledge, and other miscellaneouscharacteristics.Attitudes of individual nurses are thought to influence the use of research. Grinspun,MacMillan, Nichol, and Shields-Poe (1992) suggest that negative attitudes toward research limitsthe use of research in nursing. Hunt (1987) speculates that a major barrier to research use is thatnurses tend to view themselves as victims rather than initiators of change; others (Crane, 1989;Pout & Hunger, 1991) concur that perceptions of self are barriers to research-based practiceamong nurses. Hunt (1981) suggests that nurses do not use research findings for five reasons:1) they don’t know about them; 2) they don’t understand them; 3) they don’t believe them; 4)they don’t know how to apply them; and 5) they are not allowed to use them.Several studies have described nurses attitudes toward research. Alcock et al. (1990)surveyed 178 staff nurses in Ontario and found 70-92% agreement with statements regarding thevalue of research to nursing. Using a similar scale, Clarke (1992) surveyed B.C. hospitals andasked key individuals responsible for research to express their level of agreement with statementsregarding the value of research for nursing. All of the statements received over 85% agreement.25Clarke and Joachim (1993) used the same scale to survey schools of nursing in B.C. and foundsimilar support for the value of research. In all three studies the most supported statements wererelated to the value of research in solving practice problems, while the value of enhancing cost-effectiveness received least support.To date, only one study has specifically examined the relationship between attitudes ofnurses toward research and the use of research. Champion and Leach (1989) surveyed 59 nursesworking in a community hospital. Using a Likert scale, they found that attitude toward researchrelated significantly to self-reported use of research findings. There have been no otherinvestigations of attitude reported, although the findings regarding persuasion about innovations(Brett, 1987; Coyle & Sokop, 1990) may be related to attitudes toward research.The educational background of nurses is the personal characteristic which has been moststudied. Of five studies which examined the relationship between type of education and the useof research in practice, none found a significant relationship (Brett, 1987; Coyle & Sokop, 1990;Crane, 1989; Ketefian, 1975; Winter, 1990). Similarly, participation in continuing education orstudy toward a degree were not found to have a significant relationship to research use (Brett,1987; Coyle & Sokop, 1990; Kirchoff, 1982). In addition, Brett (1987) found no relationshipbetween the number of degrees held and the level of research use. Studies of the influence of thenumber of years since graduation has yielded conflicting results (Ketefian, 1975; Kirchoff, 1982;Brett, 1987).Table3SummaryofEmpiricalSupportfortheInfluenceofPersonalandProfessionalCharacteristicsontheUseofResearchCHARACTERISTICSUPPORTEDASINFLUENCINGNOTSUPPORTEDASRESEARCHUSEINFLUENCINGRESEARCHUSEATTITUDEToResearchChampion&Leach(1989)EDUCATIONTypeofEducationKetefian(1975)Brett(1987)Crane(1989)Coyle&Sokop(1990)Winter(1990)NumberofDegreesBrett(1987)YearsSinceKirchoff(1982)Ketefian(1975)GraduationBrett(1987)ContinuingKirchoff(1982)EducationBrett(1987)Coyle&Sokop(1990)StudyTowardaBiett(1987)DegreeCoyle&Sokop(1990)RESEARCHResearchExperienceCrane(1989)Champion_&_Leach_(1989)ResearchCourseBrett(1987)Coyle&Sokop_(1990)ResearchinWorkCrane(1989)Table3:SummaryofEmpiricalSunortfortheInfluenceofPersonalandProfessionalChrttrc(nntiniii’CHARACTERISTICSUPPORTEDASINFLUENCINGNOTSUPPORTEDASRESEARCHUSEINFLUENCINGRESEARCHUSELEARNINGReadingSpecificKirchoff(1982)ABOUTJournalsBrett(1987)FINDINGSCoyle&Sokop(1990)HoursSpentReadingKirchoff(1982)Coyle&Sokop(1990)Brett(1987)AttendanceatCoyle&Sokop(1990)ResearchConferencesSOURCEOFNursingSchoolWinter(1990)KNOWLEDGEContinuingWinter(1990)EducationJournals,MassWinter(1990)MediaorPeersPERSONAL!YearsofNursingChampion&Leach(1989)PROFESSIONALExperienceCoyle&Sokop(1990)Winter(1990)ProfessionalKirchoff(1982)MembershipChangeExperienceCrane(1989)InfluenceoverCrane(1989)OthersAgeWinter(1990)SocioeconomicWinter(1990)StatusClinicalSpecialtyWinter(1990)CosmopolitenessCrane(1989)-128Nurses’ limited knowledge of research is also thought to be a possible barrier to the use ofresearch in practice. The findings of Brett (1987) and Coyle and Sokop (1990) suggest thatresearch courses and research experience do not influence the use of research in practice. Variousauthors offer discussions that may illuminate the relationship between research education andresearch utilization. Grinspun et aL (1992) speculate that a lack of education regarding researchutilization per se is a barrier to research use. Hunt (1987) argues that the practice of treatingresearch as a specialized subject is compartmentalized, mechanistic, inappropriate and ineffective.Mercer (1984) notes that research training focuses on identifying weaknesses so that nurses maynot be educated to evaluate the usefulness of findings. These authors suggest in different waysthat it is the nature of research education which may explain the lack of use of research findingsin practice.Sources of research-related knowledge, other than formal education, appear to have a greatereffect. Coyle and Sokop (1990) found that attending research conferences was significantlyrelated to the use of research and Crane (1989) found that nurses who had researchresponsibilities in their work used more research findings.Brett (1987), Coyle and Sokop (1990) and Kirchoff (1982) found that reading specificjournals such as Nursing Research andJ had a significant relationship with the use of findings.This is congruent with Bock’s (1990) suggestion that nurses’ lack of reading and the types ofjournals read are barriers to research utilization. However, the importance of this finding isobscured by the conflicting findings regarding influence of the amount of time spent reading(Brett, 1987; Coyle & Sokop, 1990; Kirchoff, 1982) and by the finding that less than 71% ofnurses were interested in reading research (Alcock et al., 1990). In addition, Winter’s (1990)study of the use of relaxation research found that learning about relaxation therapy in nursingschool or through continuing education was significantly associated with its use, whereas learning29through journals, peers or mass media was not.The relationship between the number of years of nursing experience and the use of researchfindings has been examined in three separate studies and found to be not significant (Champion& Leach, 1989; Coyle & Sokop, 1990; Winter, 1990). In addition, single studies have considereda wide variety of professional and personal characteristics. Professional membership (Kirchoff,1982) experience of change, cosmopoliteness and influence over others (Crane, 1989), age,socioeconomic status and clinical specialty (Winter, 1990) were studied and found not significantin their relationship to research use (see Table 3).Pout and Hunger (1991) state that some issues are broader than the characteristics of theindividual nurses that comprise the nursing profession. Like others (e.g., Crane, 1989; Hunt,1987), they cite poor professional self-concept as a barrier to research-based practice. Further,they speculate that the lack of appropriate role models, relationships between researchers andpractitioners characterized by minimal opportunity for collaboration and communication, andinfrequent attention by researchers to issues of importance to clinical practice are barriers toresearch utilization in nursing. To date, research has not addressed these factors.In summary, while nurses’ attitudes and knowledge are thought to influence individualbehaviour regarding research utilization, only positive attitudes toward research, having researchresponsibilities at work, and attending research conferences are supported by the research cited.Study of the influence of reading journals has produced conflicting results. The majority ofpersonal and professional characteristics, such as type of education, participation in continuingeducation, and research education have not explained levels of research use.Individual Change Factors. Crane (1989) specifies the individual change factors that shethinks are important to the use of research in nursing. These are the attitudes and behaviours thatare expected to change as a result of the interaction between the research-based knowledge and30the personal and professional characteristics of the individual. Crane states that these changefactors are related to the individual’s awareness of a need for research-based knowledge,readiness to use research-based knowledge, assessment of and willingness to use availableresources, and willingness to change.Several studies have described nurses’ interest in research. Bostrom, Malnight, MacDougalland Hargis (1989) surveyed 720 nurses at a large teaching hospital and found that both diplomaand baccalaureate educated nurses were interested in conducting research. Alcock et al. (1990)found that staff nurses were interested in research, especially in finding answers to specificquestions, knowing the results of workplace studies and changing practice based on findings.Studies by Clarke (1992) and Clarke and Joachim (1993) described interest in research from theperspective of personnel responsible for research in health care agencies and in schools ofnursing. In health care agencies, nurses were perceived to be most interested in finding answersto practice problems, knowing the results of research in their areas and in using results inpractice. Nurses in hospitals were perceived to be less interested than nurses working incommunity health or home care. Similar patterns of response and levels of interest were foundin schools of nursing.Crane (1989) studied individual change factors and found a significant correlation betweenthe individual’s need for new knowledge, readiness to use research and resources and the use ofknowledge and research utilization activities. Individual resistance to change was negativelycorrelated with the use of new knowledge, as was expected. However, she found that thesefactors accounted for very little of the variance in use of knowledge and suggested thatorganizational factors overwhelm individual change factors. Although further study of individualchange factors is warranted, it is clear that research utilization is complex and that individualfactors alone provide insufficient explanation.31Organizational Characteristics. If the nature of research findings and the characteristics ofthe individual users of research do not explain the use of research fmdings in nursing practice,then the organizations in which nurses practice must be considered. Hunt’s (1987) statement thatnurses do not use research findings because “they are not allowed to use them” reflects theperception that nurses work in organizations in which they have limited control over theirpractice (p. 193). The organizational characteristics that researchers have considered includegeneral perceptions of support (Champion & Leach, 1989; Crane, 1989; Funk et al., 1991b);levels of communication of innovation with and without organizational support (Linde, 1989);hospital size, type and location (Brett 1986, 1989; Kirchoff, 1982); organizational change factors(Crane, 1989), organizational personnel and integrative mechanisms for research (Brett, 1986,1989); and policies (Brett, 1987; Coyle & Sokop; Kirchoff, 1982). These factors will be discussedin terms of theoretical perspectives and empirical findings (see Table 4, p. 33).Mercer (1984) theorized that the organization was a critical factor influencing researchutilization and noted that “when few resources are available and when nurses have no voice inpolicy for the delivery of care, creativity and testing of ideas are rarely visible. There is noincentive for ‘bucking the system’ and certainly there are few rewards” (p. 47). This suggests thatthere is a discrepancy between the professional ideal of research-based practice and organizationalstructure and goals.Alcock et al. (1990) surveyed staff nurses regarding the research climate and found that only41% of nurses thought that they were encouraged to question practice, 44% found nursingadministration supportive and 48% thought they were encouraged to develop effective andefficient practice. Clarke (1992) described the research climate in health care agencies from theperspective of personnel responsible for research and found perceptions of greater support. Forexample, 96% of hospital personnel thought that staff nurses were encouraged to question32practice. However, the presence of infrastructures and strategies to support research-relatedactivities received low levels of agreement from respondents in all settings.Surveying a convenience sample of community hospital nurses, Champion & Leach (1989)examined the relationship of attitude toward research, availability of findings, and organizationalsupport to research utilization. They found that while attitude and availability of findings weresignificantly related to research utilization, organizational support was not. However, furtheranalysis revealed that support from specific administrators (e.g., nursing director and unitdirector) was significantly related. This supports assertions that attitudes of key people in theorganization are critical (Bircumshaw, 1990; Horsley & Crane, 1986).Funk, Champagne, Wiese, and Tomquist (1991b) surveyed 924 nurses using the Barriersto Research Utilization Scale (Funk, Champagne, Wiese & Tornquist, 1991a) and found thatnurses perceived organizational characteristics to be the greatest barriers to research use.Insufficient time on the job and nurses’ lack of authority to change patient procedures were thetwo greatest barriers identified. All eight items related to the organization were rated among thetop ten barriers to research use. These barriers included a lack of cooperation and support fromphysicians, administrators and other staff, and inadequate facilities to implement change. Thissupports others’ earlier speculations that power is an influential organizational factor and that thelack of control of nursing practice is a major barrier to the use of research in practice (Briones& Bruya, 1990; Hunt, 1981; Mercer, 1984).In her 1987 action research study of research utilization, Hunt illustrated that theimplementation of valid research findings requires an organizational rather than an individualapproach. Her description of the attempt to change preoperative fasting times offered a classicexample of the organizational barriers to the use of research findings. In spite of conclusiveresearch and agreement from medical staff, innovations could not be implemented due to factorsTable4SummaryofEmpiricalSupportfortheInfluenceofOrganizationalFactorsontheUseofResearchFindingsinNursingPracticeORGANIZATIONALFACTORSSUPPORTEDASINFLUENCINGNOTSUPPORTEDASUSEOFFINDINGSINFLUENCINGUSEOFFINDINGSGENERALCHARACTERISTICS:Funketal(1991b)CHANGEFACTORS:Crane(1989)KEYADMINISTRATORSUPPORT:Champion&Leach(1989)HOSPITALCHARACTERISTICS:•HospitalSizeKirchoff(1982)Brett(1987,1989)•HospitalTypeandLocationKirchoff(1982)Brett(1987,1989)•NursingSchoolAffiliationBrett(1987,1989)PERSONNELCHARACTERISTICS:•#ofCNS,BSN,MSNandnon-nursingMastersBrett(1987)-weakcorrelation•#ofDiploma,AD,andnon-nursingbachelorsBrett(1987)•EducationofdirectorBrett(1987)INTEGRATIVEMECHANISMS:•ExposuretopublicationsBrett(1989)-positivelycorrelatedinsmallhospitals;negativelycorrelatedinlargehospitals•DoingresearchBrett(1989)-positivelycorrelatedinsmallhospitals;negativelycorrelatedinlargehospitals•Conferences&presentationsBrett(1989)-negativelycorrelatedinlargehospitals•ResearchdutiesinworkBrett(1989)-negativelycorrelatedinlargehospitals•InducementstolearnBrett(1989)-negativelycorrelatedinlargehospitalsPOLICY:•UnitpolicyBrett(1987)•PerceptionofunitpolicyKirchoff(1982)Brett(1987)Coyle&Sokop(1990)34such as perceived unpredictability in the operating room slate, change in duties related to foodtrays, and inadequate food preparation resources.In a study of nurses who learned about innovations through journals or attending conferences,Crane (1989) found that organizational factors were more influential than individual factors onthe use of new knowledge in patient care and the generalized use of new knowledge. In fact, asnoted, Crane concluded that the organizational factors overwhelm individual characteristics andshe consequently modified her model to illustrate that individual characteristics were onlyinfluential to the extent that they were mediated by organizational characteristics.Linde (1989) examined the effects of three different levels of communication about a specificinnovation related to post-operative deep breathing and coughing: Level 1) written material,Level 2) written material plus in-service education and Level 3) written material, in-services, andadministrative commitment to use the protocol. Although all types of communication wereassociated with a significant change in nursing practice, there was no significant differencebetween levels two and three. However, as the nurses in both hospitals studied had a quitepositive attitude toward the administration, the addition of support for the specific innovationstudied may not have had an appreciable effect.Horsley and Crane (1986) predicted that organizational factors would be related to the goals,structure, and size of the organization. They proposed that organizations that would be associatedwith innovation would be those in which clear goals were written, but that employees woulddetermine the means of goal achievement. However, studies reported to date have not examinedorganizational goals in relation to research use.Horsley and Crane speculated that decentralized structures would be more innovative inimplementing change, although centralized structures would be more effective. However,researchers have not considered organizational structure in the studies reviewed. Horsley and35Crane also theorized that the extent to which the organizational structure legitimized innovation(through position descriptions, goals and objectives) would determine the degree of innovation.In her 1986 study of integrative mechanisms, Brett (1987, 1989) considered some of theselegitimizing mechanisms. However, Brett found no clear relationship between the hypothesizedintegrative mechanisms (attending conferences, having a research resource person and committee,incentives for using research, availability of research publications, and conducting research) andthe use of research in practice. Furthermore, actual hospital policies were not related to use ofresearch findings, but nurses’ perception of the existence of a policy was significantly related touse! Coyle and Sokop (1990) confirmed these findings.Although Horsley and Crane (1986) theorized that innovativeness would be related toorganizational size, they pointed out that factors such as financial, human, and material resourcesvary with size of facility and are likely to be influential. Kirchoff (1982) considered theorganizational variable of hospital size by stratifying her sample by the number of hospital beds(<100 beds, 100-199, 200-299, 300-399, 400-499 and >499 beds). She found a weak butsignificant correlation between large urban hospitals (>499 beds) and cessation of specificcoronary precautions. Brett (1986, 1989) focused her study on the organizational integrativemechanisms for research utilization. Using a sample of hospitals stratified by size (<250 beds,250-500 and >500 beds), she compared the level of integrative mechanisms and use of researchin nursing practice. Brett found that although it was not statistically significant, larger hospitals(>500 beds) had a higher percentage of nurses adopting innovations, followed by small hospitals(<.250 beds), and then medium hospitals (250-500 beds).Additional organizational factors have been suggested as influential. Pout and Hunger (1991)propose that organizational resistance to change, organizational climate, and resources forresearch projects or implementation would influence research utilization. Briones and Bruya36(1990) also suggest that organizational resources such as leave and release time, journal clubs,focused grand rounds, in-service education, and hiring of nurses active in clinical research, wouldinfluence nursing research utilization. Briones and Bruya (1990) theorized that positive sanctions,including recognition, rewards, and clinical ladders, are possible organizational influences. Poutand Hunger (1991) also propose that the reward system (recognition and evaluation) influencesresearch use. Alcock et al.(1990) and Clarke (1992) have described levels of some of thesefactors from the perspective of the staff nurse and nurses responsible for research, and the workof Crane (1989) suggests that levels of organizational factors may influence research use.Studies of organizational integrative mechanisms and general support for research, levels ofcommunication and hospital size have yielded conflicting and inconclusive results. Organizationalfactors are influential, but the specific factors and the strengths of their influences remainunknown. The influence of organizational resources and expectations for research are suggestedas important, but their influence on research use has not been studied.Interaction of Organizational and Individual Factors. The factors influencing researchutilization have been described in the literature and discussed by researchers as discretecategories. Evidence is surfacing that there is interaction between the categories that may helpexplain utilization practices. Specifically, the relationship between the nurse and the organizationin which the nurse practices may be influential.The observation that nurses view themselves as victims of change and are “not allowed” touse findings suggests that barriers to research use are related to the organizational context inwhich nurses practice. Although the innovations studied by Brett (1986, 1989) and Coyle andSokop (1990) were purposely selected to be within the control of the individual nurse, theindividual’s perception of hospital policy significantly correlated with persuasion about and useof innovations, supporting the idea that organizational factors are important. That support from37key individuals within the organization influenced the use of research findings (Champion &Leach, 1989) further suggests an interaction between the organization and the individual. Crane’s(1989) conclusion that organizational factors overwhelm individual factors is the strongestindicator that study of research utilization in nursing must include examination of the interactionbetween the organization and the individual.SummaryThe literature demonstrates that there is a gap between the research-based knowledgegenerated in nursing and the use of that knowledge in practice. The factors influencing researchutilization are identified as being related to the characteristics of research findings, individualusers, and organizations. However, the limited research has yielded mixed results regarding bothindividual and organizational characteristics. To date, the individual-related characteristics thathave received empirical support include attitudes toward research, reading specific journals,attending research conferences, learning practice through nursing school or continuing education,and research responsibilities at work. Researchers have studied organizational characteristics ofhospital size and research support mechanisms, but results are inconclusive. Although theliterature suggests that the organization is a significant determinant of research utilization, thenature of the relationship between organizational variables and research utilization is unknown.Furthermore, the effect of the relationship between the individual and the organization onresearch utilization is not understood. Since the specific influence of organizational and individualexpectations for the use of research-based knowledge in nursing practice has not been explored,this study focuses on expectations as well as organizational support in exploring the relationshipsbetween organizational and individual factors and research use.38CHAPTER THREEMethodsThis chapter describes the study designed to explore the relationships between organizationaland individual factors and research utilization. The design is followed by a description of thesampling procedure, the instrument used, the data collection procedures and the data analysis. Theassumptions, limitations and ethical considerations are also described.Study DesignA descriptive correlational design was used because this area of investigation is undevelopedand relationships are being questioned. A 2 x 3 factorial design controlled for education andhospital size (see Table 5). A sample size of 30 nurses per cell was desirable to provide adequatepower for analysis (Cohen, 1988).Table 5Factorial Study Design with Groups by Education and Hospital SizeSmall Hospitals Medium Hospitals Large Hospitals(<250 beds) (250-500 beds) (>500 beds)Diploma R.N. n=30 n=30 n=30Baccalaureate n=30 n=30 n=30DegreeSampleIt was anticipated that the survey would yield a return rate of less than 50% and that thereturn would not be equal from the different groups. Therefore, it was estimated that 75 nursesper group should be surveyed. A stratified random sample of 450 registered nurses was selectedfrom the population of all staff nurses currently employed in adult critical care or medicalsurgical areas of acute care hospitals in British Columbia (B.C.). To limit the possible effect of39differences between types of health care organizations, only nurses employed in acute carehospitals were surveyed. In order to use the specific innovations studied by Brett (1986), Crane(1989) and Coyle & Sokop (1990), the sample was selected from nurses employed in adultcritical care or medical-surgical areas. Therefore, the inclusion criteria were:1. The nurse must be currently registered as a practising nurse with the Registered NursesAssociation of British Columbia (R.N.A.B.C.).2. According to the 1993 R.N.A.B.C. registration data, the nurse must be working in a staffnurse position in a medical-surgical or adult critical care area of an acute care hospital.It is noteworthy that earlier studies (Brett, 1987; Coyle & Sokop, 1990; Crane, 1989;Keteflan, 1975; Winter, 1990) did not find differences in research use between educational levels.However, unlike earlier reported studies, this study was based on a Canadian sample for whomeducational experience and the influence of education may be different. Also, Alcock et al.(1990) found significant differences in the value for research, interest in research, expectationsand research experience between nurses with baccalaureate degrees and nurses with diplomaeducation. Therefore, it was important to control for educational level and to ensure that therewere sufficient nurses with baccalaureate degrees in the final sample. Because approximately 12%of nurses in British Columbia have baccalaureate degrees, the sample was stratified.While the findings of Kirchoff (1982) and Brett (1986, 1989) were not conclusive regardingthe relationship of hospital size to research utilization, there is sufficient interest in the literatureregarding this variable to consider it potentially important. Therefore, the sample was alsostratified to control for hospital size. It was not possible to identify hospitals by size, but it waspossible to identify R.N.A.B.C. districts in which different sizes of hospitals predominate.Because there are fewer nurses working in small hospitals, the greatest challenge was to samplenurses from small hospitals and more especially baccalaureate nurses from small hospitals.40In order to obtain the stratified sample using the specified criteria within the limitations ofthe demographics of the population of nurses in B.C., four populations were initially identified:1. R.N.s with diploma education living in R.N.A.B.C. districts where smaller hospitalspredominate (North Vancouver Island, Powell River, and Gulf Islands District; NortheastDistrict; Northwest District; and Kootenays District - see R.N.A.B.C. Electoral DistrictStructure, Appendix A).2. R.N.s with baccalaureate degrees living in R.N.A.B.C. districts where smaller hospitalspredominate (as above).3. R.N.s with diploma education living in all other R.N.A.B.C. districts, which includelarge, medium and small-sized hospitals.4. R.N.s with baccalaureate degrees living in all other R.N.A.B.C. districts (as above).Table 6Sampling Strategy Using Four Stratified PopulationsPOPULATION POPULATION SAMPLESIZE SIZER.N.s with diploma education in districts where 1,135 60smaller hospitals predominate.R.N.s with diploma education living in all other 5,492 165districts.R.N.s with baccalaureate degrees in districts 60 60where smaller hospitals predominate.R.N.s with baccalaureate degrees living in all 585 165other districts.TOTAL 7,272_[ 450As shown in Table 6, a random sample of 450 nurses was drawn from each of thesepopulations. This strategy was employed to sample a sufficient number of nurses with41baccalaureate degrees working in small hospitals while sampling other populations evenly. Thetotal of the four populations represent the number of nurses who met the sample criteria out ofthe 32,554 nurses in all districts of B.C.InstrumentationFor the purpose of this study, the investigator adapted the Nursing and Research in ClinicalPractice (NRCP) questionnaire (Clarke, 1991). The original questionnaire will be described,followed by a description of the changes. Finally, a description of the final instrument andestimates of internal consistency for each of the scales for this sample will be provided.The Original InstrumentThe NRCP was chosen for the present study because 1) a review of reported empiricalstudies revealed that the NRCP is the only previously used instrument that addresses the variablesof interest, 2) other published instruments were tailored to and used in single studies, 3) therewere few measures of reliability and validity for any of the previously used instruments, and 4)the NRCP has been used with organizations in the same geographical locations as the currentstudy, providing a basis for future comparisons.Based on the questionnaires by Alcock, Carroll and Goodman (1990), Thurston, Tenove &Church (1987), Davies & Eng (1991), and the R.N.A.B.C. position statement on nursing research,Clarke developed the NRCP to survey nurses with primary responsibility for research in agenciesthroughout British Columbia. The questionnaire was developed to 1) identify the characteristicsof the organizational research climate, 2) identify infrastructure supports for research, 3) identifyfuture directions for research and, 4) identify current research activities in nursing. Thequestionnaire focuses on a broad range of research-related activities in clinical nursing practice.Questions address both organizational support for research and expectations of staff nurses,attitudes toward research and responsibilities for research. Of primary relevance to the current42study were the sections of the questionnaire developed by Alcock et al.The five scales developed by Alcock et al. from the literature were subjected to expertreview and pilot tested with 19 nurses. They reported high internal consistency for the five scales(value of nursing research, expectations, interest in nursing research, research experience andorganizational climate) with alpha coefficients of 0.81, 0.71, 0.87, 0.79 and 0.78, respectively.Clarke’s modification of these scales and the other portions of the questionnaire were reviewedby a panel of experts for face and content validity. Although the questionnaire has been used indata collection throughout the province (Clarke, 1992; Clarke & Joachim, 1993), estimates ofvalidity and reliability are not yet available.Modifications to the InstrumentThe instrument was adapted again for the purposes of this study (see Appendix B). Themodifications involved dividing any questions that contained two ideas, making wordingappropriate to the staff nurse perspective and eliminating any sections not applicable to staffnurse positions. Questions in the original instrument regarding expectations of staff nurses to useresearch were expanded to ask what staff nurses expected of themselves and what they thoughtothers in the organization expected of staff nurses regarding the use of research in practice. Inthe original instrument, general questions regarding the use of research findings were in severaldifferent sections throughout the instrument. These questions were reorganized into a singlesection to obtain the staff nurse’s perspective. Similarly demographic and hospital data werereorganized and items specific to the staff nurse were added (e.g., education level).The Clarke version operationalized all of the study variables except for the use of specificfindings. The modifications adapted the wording for use with nurses in staff positions, addedspecific findings as a measure of research use and added the appropriate demographic questions.Table 7 summarizes the comparison between the Clarke version and its modification. The43relationships between the variables of the current study and the questions on the modifiedquestionnaire and the Cronbach alpha for each sub-scale are shown in Table 8.Table 7Modifications of Instrument by SectionSection Content Modification1 perceived value of noneresearch in nursing2 perceived role in noneresearch (expectations)3 perceived organizational noneresearch climate4 interest in research none5 research experience none6 use of research fmdings questions reorganized from other sections of thein practice original questionnaire7 use of specific findings questions added from Brett (1986)8 infrastructure support for noneresearch9/10 hospital! demographic questions reorganized from other sections of thedata original questionnaire and from literatureUse of Research Findings. A final major modification was made to include questionsregarding the use of specific findings in practice. The questions were taken from the instrumentdeveloped by Brett (1986). Ten specific research findings were chosen from the fourteeninnovations initially studied by Brett (1986). Two innovations (changing intravenous sites andlactose-free tube feedings) eliminated because recent technological and practice changes orresearch have made these innovations redundant or questionable. Using communication skills toascertain patient pain seemed very general and was not used. The question regarding closedurinary drainage was also not included because the findings of Brett (1986) and Coyle and Sokop(1990) suggest that this practice is well diffused and probably can no longer be considered an44innovation.For her original study, Brett selected the innovations by reviewing refereed research journals,published between 1978 and 1983, for practices that met the following inclusion criteria:1) results could be implemented by individual nurses;2) innovations were relevant to medical-surgical or critical care areas;3) at least one other publication replicated or corroborated the initial study;4) the original study or the replication was conducted on clinical subjects.Brett assumed the validity of the research results by virtue of publication in a refereed journal.In spite of using these liberal criteria, Brett found only nine practices which met the criteria andadded research-based protocols developed through the CURN project.During a pilot test, Brett obtained a Cronbach’s alpha coefficient of 0.82 as a measure ofinternal consistency for the total scale. The test-retest reliability was established by obtaining aPearson’s correlation of 0.83 for the total scale. During the main study, the coefficient was 0.95for the total scale. The Cronbach’s alpha for the sub-scales (one for each practice) ranged from0.67 - 0.97. While Brett examined the stage of diffusion (awareness, persuasion, and use) foreach innovation, the current study asked only the extent to which each innovation was used bythe nurse in his or her practice. Therefore, in the current survey, the nurses were only asked torespond to the question from Brett’s scale which asked about the extent of use of each finding.The instrument was formatted in a visually appealing manner with large boxes for responses.The instrument was presented in a booklet format for easy reading and given a bright blue cover.The modified instrument was pilot tested using a convenience sample of eight nurses who workin critical care areas. Feedback on the content and appearance of the questionnaire was verypositive. The average time for completion was 18 minutes. Suggestions about clarity of thequestions were used to create the final version of the survey.45The Final InstrumentThe final instrument consisted of 10 sections or sub-scales. During the current study,Cronbach alphas for the scales ranged from 0.79-0.92, indicating satisfactory internal consistency.Each of the sub-scales of the final instrument will be briefly described.Section 1: Value of Research. The nurses’ value for the use of research in nursing practicewas measured by asking the nurses to express their level of agreement with six statementsregarding the value of research to nursing. Statements regarding the value of research to theeffectiveness of nursing decisions and interventions, public accountability, responding to newdevelopments in health care and using resources were included. The minimum possible score wassix (strong disagreement with all value statements); the maximum possible score was 24 (strongagreement with all value statements). The Cronbach’s alpha for this scale was 0.85.The statements regarding the value of research were also used to determine the nurses’perception of their nursing department value for research. The minimum possible score was 6(strongly disagree with all value statements); the maximum possible score was 24 (strongly agreewith all statements). For this scale, the Cronbach alpha was 0.92.Section 2: Perceived Role in Research (Expectations). The nurses were asked to express theirlevel of agreement with six statements regarding expectations that they held regarding their ownuse of research in nursing practice. They were also asked to express their level of agreement withthe same questions to indicate their opinion regarding the expectations of the staff nurse held bykey nursing personnel. Therefore, there were sub-scales for the expectations of self, andexpectations thought to be held by the head nurse, clinical instructor, clinical nurse specialist andnursing director. The minimum score possible for each sub-scale was 6 (strong disagreement withall expectations) and the maximum score possible was 24 (strong agreement with allexpectations). The Cronbach’s alphas for the sub-scales were as follows: self 0.79, head nurse460.85, clinical instructor 0.85, clinical nurse specialist 0.79 and nursing director 0.89.Section 3: Research Climate. The 11 statements regarding the research climate includedquestions about encouragement and recognition for nurses and interest in research by others. Theminimum score possible was 11 (strong disagreement with all statements) and the maximumscore possible was 44 (strong agreement with all statements). The Cronbach alpha for this scalewas 0.90.Section 4: Interest in Research. The nurse’s interest in research was measured by requestingthe nurses to express their level of agreement with ten statements regarding interest in research-related activities. The minimum score possible was 10 (strong disagreement with all intereststatements); the maximum score possible was 40 (strong agreement with all interest statements).The Cronbach alpha for this scale was 0.91.Section 5: Research Experience. The nurses were asked to indicate whether or not they hadany of 18 different research experiences. They were asked to respond “yes” or “no” to each ofthe experiences that ranged from taking research courses, to using findings to change practice,to being a principal investigator. The minimum score possible was zero (no experiences) and themaximum score possible was 18 (all experiences).Section 6: General Use of Research. The nurses were asked to rate each of 10 statementsrelated to general use of research on a four-point scale from “not, at all” to “always”. Theminimum score possible was 10 (“not at all” for all statements); the maximum score possible was40 (“always” for all 10 statements). The Cronbach alpha for this scale was 0.87.Section 7: Use of Specific Research Findings. The nurses were asked to rate whether theyused ten specific findings “never”=l, “sometimes”2, or “always”=3. Because it was anticipatedthat all practices would not be used in all settings, they were asked to indicate when practiceswere not applicable. The ten specific findings chosen for the final instrument included 1) givingTable8RelationshipofStudyVariablesandModifiedInstrumentVARIABLESECTIONSUB-SCALE#ofITEMSALPHAPersonalandProfessional5•Ownresearchexperiences11CharacteristicsIndividualChangeFactors1•Ownvalueofresearchinnursing60.854•Owninterestinresearch100.912•Ownexpectationstouseresearch60.79OrganizationalContext8•Organizationalinfrastructuresforresearch27OrganizationalChange1•Perceivedorganizationalvalueofresearch60.92Factors3•Organizationalresearchclimate110.902•Perceivedroleinresearch:expectationsofheadnurse,6headnurse=0.85clinicalinstructor,6instructor=0.85clinicalnursespecialist,6CNS=0.79directorofnursing.6director=0.89ResearchUtilization6•Generaluseofresearchfindings100.87Outcomes7•Useofspecificfindings100.87Demographics9•Hospitalsizeandunittype210•Age,gender,education&workofnurse448sensory information to patients before diagnostic procedures, 2) mutual goal setting with patients,3) giving patients sensory information pre-operatively, 4) providing planned preoperativeteaching, 5) monitoring oral temperature electronically during oxygen administration, 6) conecturine testing technique, 7) using knowledge of activities which increase intracranial pressure, 8)using preoperative relaxation techniques, 9) using dorsogluteal injection technique and 10)catheter clamping prior to removal of urinary catheters. The Cronbach’s alpha for this scale was0.87.Section 8: Organizational Infrastructure for Research. The infrastructures for research withinthe organization were measured by asking the nurses to identify those infrastructures such aspolicies, job descriptions, committees, resources and personnel available in their hospitals tosupport research. They were asked to respond “yes”, “no”, or “don’t know” to indicate whetheror not 27 different aspects of infrastructure existed. “Yes” responses were counted to calculatethe infrastructure score. The minimum score possible was 0 (no supports); the maximum scorewas 27 (all supports).Sections 9 & 10: Hospital and Demographic Data. The nurses were asked to indicate the sizeof hospital and type of unit they worked in to ensure that the selection criteria were met for eachrespondent. Demographics including gender, age, education and years since graduation were alsocollected.Data Collection ProceduresThe R.N.A.B.C. generated a stratified random sample of nurses using the inclusion criteria.To preserve the anonymity of the respondents, staff at R.N.A.B.C. labelled and mailed the surveypackages. A letter was enclosed explaining the purpose of the study, how the sample wasobtained, and the use of the data (see Appendix C). The letter also emphasized provisions forconfidentiality and the importance of the participant’s responses. A self-addressed, stamped49envelope was included. The package also contained an optional form to indicate that theparticipant would like to receive a summary of results (Appendix D). To maintain anonymity,directions on this form indicated that it could be returned separately by mail or fax, or that itwould be separated from the questionnaire if mailed. The form was copied in bright yellow tofacilitate separation.A second mailing was done using strategies suggested by Gordon and Stokes (1989) toincrease the return rate. Four weeks after the initial mailing, the return rate declined and areminder was mailed by the R.N.A.B.C. to the entire sample except for those who had returnedthe optional form with their name and address completed. The reminder also thanked those whohad already responded. Six weeks after the reminder and ten weeks after the initial mailing athird mailing was done. At this time, the return rate had declined again and there was a lowerreturn rate from nurses with diploma education. Therefore, letters were sent only to the nurseswith diploma education who had not returned the optional form.Data AnalysisData from the questionnaires were coded and entered into the computer program SYSTATfor analysis. The data were “cleaned’ by hand and by running bar graphs of each variable toidentify erroneous coding. Eleven of the 183 nurses who responded specified areas such as therecovery room, chemotherapy, medical diagnostics and acute gerontology. These nurses were recoded into the specified categories. One nurse was eliminated from the sample as she worked inobstetrics.Missing data were handled in the following manner. For six item Likert scales, if a nurse hadnot responded to more than two items in a scale, the scale for that nurse was excluded fromanalysis. If the nurse had not responded to one or two items, a neutral score (2.5) was assignedto those items. For all remaining scales, if a nurse had not responded to 80% of the items, the50scale was excluded from analysis for that nurse. Again, neutral scores were assigned to missingdata for scales that were retained for analysis.Scores for each variable were computed for each respondent. Total scores and subgroupscores were computed for each variable. Descriptive statistics including the mean, standarddeviation, and range of the scores for staff nurses of different educational levels and hospitalsizes were used to analyze all variables and the first five research questions. Factorial analysisof variance was used to compare the groups on each of the research question variables. For eachvariable, multiple analysis of variance (MANOVA) was used to identify the effect of1) educational level, 2) hospital size, and 3) the interaction effect of education and hospital size.The significance level for MANOVA was set at 0.05.The sixth question was tested using a t-test to compare the difference between organizationalexpectations and the staff nurses’ expectations of themselves. Because this area of research isundeveloped, a two-tailed test was used (Munro & Page, 1993). The seventh research questionwas tested using a Pearson Correlation Coefficient to describe the relationship betweenexpectation scores and the use of research findings. Similarly, for determining the relationshipbetween the nurses’ perceptions of organizational support for research use and use of researchfmdings, a Pearson Correlation Coefficient was computed. For all statistical tests a significancelevel of 0.05 was used.The analysis was carried out as planned, but additional bivariate correlations were computedto examine relationships that were not addressed by the research questions.AssumptionsThis study was based on the assumption that the respondents would answer truthfully. Inaddition, it was assumed that the respondents would ascribe similar meanings to the surveyquestions as the researcher.51In using the innovations previously identified and studied by Brett (1986) and studied byCoyle and Sokop (1990), it was assumed that the innovations were still relevant to currentnursing practice. The innovations were originally selected as being within the control of theindividual nurse and as being appropriate to practice in medical, surgical or critical care areasand it was assumed that this continued to be true.LimitationsAlthough a strong design and random sampling were employed, a limitation of this study wasthat non-responders might differ from responders. Responders might have been motivated torespond because they were more interested in research. Furthermore, health care is currentlyundergoing significant reform and change in B.C., with moves toward regionalization, a lack ofsecurity in senior nursing management positions, and contention between physicians andgovernment being a few of the influencing factors. This climate of change might have influencedresponders and non-responders in unknown ways.Although it was assumed that respondents would answer truthfully, the study was limited bythe extent to which it is reasonable to draw inferences from what people say in a survey to whatthey do in real life.Because it was assumed that nurses in leadership positions would have influence on staffnurses, the study only examined the expectation of nurses and did not examine the expectationsof other potentially influential people such as peers, physicians or non-nursing administrators. Thestudy did not attempt to examine who controls nursing practice and focused on innovationswithin the control of individual nurses.Although nurses who work part-time may differ from nurses who work full-time in ways thatwould affect the use of research in practice, both full-time and part-time nurses were surveyed.Nurses who work part-time might have less access to existing organizational supports, less52contact with key personnel and less personal commitment to the profession. Conversely, nurseswho work part-time might be engaged in more study and have a greater commitment to theprofession. However, these possible differences were not controlled in this study, other thanidentifying those who are employed full or part-time.A further limitation was presented by the selection of innovations to serve as a measure ofthe use of specific research findings. Although the innovations selected were assumed to berelevant to the current practice of most nurses in medical, surgical and critical care areas, theywere limited to ten innovations. This prevented study of more specialized or recent innovations.Ethical ConsiderationsThe study was approved by the researcher’s committee, the R.N.A.B.C., and the Universityof British Columbia’s Behavioral Sciences Screening Committee for Research and Other StudiesInvolving Human Subjects. Participants were informed about the purpose of the study in a letterwhich stated that participation was voluntary and that the completion and return of thequestionnaire indicated consent to participate (Appendix C, p. 154). The letter further stated thatindividual replies were confidential and that the respondent was anonymous to the investigator.Information regarding the respondent’s identity or the name of employer was not requested.Because the R.N.A.B.C. mailed the surveys and subsequent reminders, the respondents remainedanonymous to this investigator.In this chapter the design of the study has been described. The strong descriptive design anduse of random sampling add strength to the study. In its third revision, the instrument is a validand reliable measure of the factors under investigation. The data collection procedures insureconfidentiality and enhance the return rate. In the next chapter, the research findings arepresented and discussed.53CHAPTER FOURResultsIn this chapter, the sample characteristics are described and discussed in terms of theparticipants’ representation from educational levels and hospital sizes, gender, age, andemployment. The results are presented in relation to each of the research questions and discussedin relation to the conceptual framework, the methods, previous research, and the limitationsinherent in the study.Sample CharacteristicsThe initial sample was comprised of 450 nurses, but eight surveys were undeliverable andfour were returned uncompleted. Of the 442 delivered surveys, 184 (42%) were returnedcompleted. One response was not used because the nurse was not working on a medical-surgicalor critical area and thus did not meet the sample criteria. The final sample was thereforecomprised of 183 nurses.The sample was stratified to obtain responses from an equal number of nurses withbaccalaureate and diploma education working in hospitals of different sizes. Table 9 illustratesthe sample composition by group.Table 9Sample by Education and Hospital SizeSmall Hospitals Medium Hospitals Large Hospitals Not Total(<250 beds) (250-500 beds) (>500 beds) Reported (%)Diploma n=25 n=33 n=24 1 83 (45%)BSN n=33 n=33 n=30 2 98 (54%)Not 1 1 2(1%)ReportedTotal 59 67 54 3 18354The response rate for nurses with diploma education was 37%; the response rate for nurseswith baccalaureate education was 44%. The response rate by hospital size is not known becausethe composition of the initial sample by hospital size was not known. The response rate providedgroups of unequal size, but as the largest to smallest group size ratio was less than 1.5(33/24=1.38), analysis of variance could be used (Stevens, 1990).Education and Years Since GraduationOf the 181 nurses who specified their educational level, a total of 83 nurses indicated thatthey had diploma education only; 98 nurses indicated that they had a baccalaureate degree innursing. Of the nurses with baccalaureate degrees, 41 had received a diploma prior to theirdegree. Five nurses had baccalaureate degrees in other disciplines. Of these five, two werediploma nurses, two were baccalaureate nurses and one did not specify nursing educational level.One nurse with a baccalaureate degree in nursing also had a masters degree in nursing. The yearssince graduation from diploma programs ranged from 0-34 years with a mean of 13.9 years (seeTable 10). The years since graduation from baccalaureate programs ranged from 0-36 years, witha mean of 8 years. The majority of the sample graduated less than ten years ago.EmploymentAs shown in Table 9, the sample contained nurses employed in small (59), medium (67) andlarge (54) hospitals. Of those who indicated the amount they worked, 49% (88) worked full-timeand 51% (93) worked part-time. The breakdown of part and full-time employment by educationallevel is shown in Table 11.55Table 10Years Since Most Recent GraduationYears Frequency Frequency Frequency Total (%)Diploma Diploma & BSN BSN only0 - 5 22 25 13 60 (33%)6 - 10 15 6 22 43 (23%)11-15 6 4 7 17 (9%)16-20 9 2 7 18(10%)21-25 6 0 2 8 (4%)26-30 7 0 1 8 (4%)31-36 5 0 1 6 (3%)Not Specified 13 4 4 21 (12%)Total 83 41 57 181(100%)*Table 11Part and Full-time Employment by Educational LevelEducation Level Full-time Part-time or Casual TotalEmployment (%) Employment (%)Diploma 35 (42%) 48 (58%) 83Baccalaureate 53 (54%) 45 (46%) 98Total 88 93 181**sp1e total of 181, due to 2 participants who did not report educationThe survey was sent to nurses who indicated on RNABC data that they were employed inadult critical care or medical-surgical areas. In the final sample, 55 (30%) of the nurses indicatedthat they worked in medical areas, 33 (18%) in surgical areas, 27 (15%) in medical/surgical areasand 66 (36%) in critical care areas. One nurse did not specify unit type.56Gender and AgeOf the 182 nurses who reported their gender, 179 were female, 3 were male. In terms of agethe range was 22-57 years and the mean age was 36 years, with the majority between 22 and 42years of age for both diploma and baccalaureate nurses. The diploma nurses tended to be older(mean=38.0) than the baccalaureate nurses (mean=34.5).Table 12Age Distribution by Educational LevelAge (Years) Education Not Diploma (%) BSN (%) Total(%)SpecifiedNot Specified 1 3 (1.6%) 1 (0.5%) 5 (3%)22-28 1 15 (8.0%) 20 (11.0%) 36 (20%)29-35 18 (10.0%) 35 (19.0%) 53 (29%)36-42 21 (11.0%) 29 (16.0%) 50 (27%)43-49 13 (7.0%) 11 (6.0%) 24 (13%)50-57 13 (7.0%) 2 (1.0%) 14 (8%)Mean(SD)[Range] 38.0(9.3) [22-57] 34.5 (6.8)[23-56]Total 2 83 98 183(100%)In summary, the final sample was comprised of 183 staff nurses working in medical-surgicalor critical care areas of acute care hospitals in B.C. The nurses in the sample were predominantlyfemale and were between 22 and 57 years of age, with the majority being under 35 years of age.The nurses were almost evenly divided between part time and full time work. The stratifiedrandom sampling strategy yielded similar sized subgroups of nurses with baccalaureate anddiploma education working in small, medium and large hospitals.In the following section the results related to each research question will be presented andanalyzed using descriptive and parametric statistics.57Research Question 1: What are the Nurses’ Values for, Interest in and Experience with Research?The staff nurses’ value for research, interest in research and research-related interests weremeasured using separate sub-scales.Value For ResearchValue for the use of research in nursing practice was measured by asking the nurses toexpress their level of agreement with six statements regarding the value of research in enhancingthe nursing profession. The minimum score possible was six (strong disagreement with all valuestatements); the maximum score possible was 24 (strong agreement with all value statements).For five statements regarding the value of research in enhancing nursing decisions,interventions and public accountability, 89 - 98% of the nurses agreed or strongly agreed. Thesixth statement regarding the value of research in enabling nurses to use resources moreefficiently received less support, with only 77% of nurses agreeing.The scores for the sample ranged from 12-24, with a mean of 20.3 and standard deviation(SD) of 2.99. The disthbution of scores were different for diploma and baccalaureate degreenurses as baccalaureate nurses tended to have higher scores (see Tables 13 and 14). Multipleanalysis of variance (MANOVA) identified a significant difference in value scores betweeneducational levels (F=5. 11; p=O.03), with baccalaureate nurses having higher value scores thandiploma nurses. No significant differences were detected between hospital sizes (F=0.43; p=0.65)and no interaction effect was noted (F=1.33; p0.27).58Value Score Diploma BSN Total (%)12/13 2 2 2 (1%)14/15 5 3 8 (4%)16/17 16 11 27 (15%)18/19 19 15 34 (19%)20/21 18 20 38 (21%)22/23 16 23 39 (22%)24 9 24 33 (18%)Total 83 98 181 (100%)**sple total of 181, due to 2 participants who did not report educationTable 14Value of Research by Education and Hospital SizSmall Hospitals Medium Hospitals Large Hospitals Total MeanMean (SD) [range] Mean (SD) [range] Mean (SD) [range] (SD) [Range]Diploma 19.5 (3.2) [14-24] 19.5 (3.2) [14-24] 19.8 (2.9) [15-24] 19.7 (2.9) [14-24]BSN 21.4 (2.8) [15-24] 20.1 (3.1) [13-24] 20.6 (3.1) [12-24] 20.7 (3.0) [12-24]Total 20.5 (3.1) [14-24] 20.0 (2.9) [13-24] 20.2 (2.9) [12-24] 20.3 (3.0) [12-24]Interest in ResearchInterest in research was measured by requesting the nurses to express their level ofagreement with ten statements regarding their interest in research-related activities. The minimumscore possible was 10 (strong disagreement with all interest statements); the maximum scorepossible was 40 (strong agreement with all interest statements).For the entire sample, the scores ranged from 10 to 40, with a mean of 30.7 (SD=5.9). VeryTable 13Value of Research Scores by Education59few nurses had a score of less than 24 (see Table 15) suggesting a high level of agreement bymost nurses. Most individual statements also received a high level of agreement (see Table 16).Interests directly related to nursing practice, such as finding answers to specific nursing problemsand using research results to change practice, received the highest agreement. The least supportedarea of interest was conducting research outside of work assignments.As shown in Table 17, the interest scores by group were very similar. MANOVA wasconducted to compare the groups regarding their interest in research. There were no significantdifferences between the groups by hospital size (F=O.33; p=O.72) or education (F=O.Ol; p=O.93).Table 15Distribution of Interest Scores by Education and Hospital SizeResearch Diploma Baccalaureate Total(%)InterestScore Small Medium Large Small Medium Large10-14 0 1 0 0 0 0 1 (0.5%)15-19 0 0 0 0 0 0 020-24 0 0 3 2 2 4 11 (6.0%)25-29 8 10 10 12 7 7 54 (31.0%)30-34 11 13 6 9 11 9 59 (34.0%)35-40 6 8 4 10 13 10 51 (29.0%)Total 25 32 23 33 33 30 176 (100%)Table 16Percentage of Agreement with Research Interest Statements*Rank Interest in: Disagree! Strongly Agree! StronglyDisagree Agree1 using the results of research to change practice 3% 97%2 finding answers to specific problems 3% 96%2 knowing results of research projects conducted 3% 96%in my area of practice3 knowing the results of research projects 5% 91%conducted in my organization4 determining what differences research-based 10% 89%practice makes5 reading research studies 15% 83%6 participating in research projects of others 17% 82%7 discussing research studies 22% 76%8 conducting research as part of a work 26% 73%assignment9 conducting research even if it is not part of a 41% 57%work assignment* Percentages do not total 100% due to missing dataTable 17Interest in Research by Education and Hospital SizeSmall Hospitals Medium Hospitals Large Hospitals Total MeanMean (SD) [range] Mean (SD) [range] Mean (SD) [range]Diploma 31.3 (3.7) [25-38] 30.8 (5.7) [10-40] 29.9 (5.0) [20-40] 30.8BSN 31.5 (5.2) [20-40] 32.3 (5.2) [21-40] 31.4 (5.1) [22-40] 31.7Total Mean 31.3 31.5 30.7 31.2Research ExperienceThe nurses were also asked about their experience with research. They were asked torespond “yes” or “no” to 18 different research experiences that ranged from taking research6061courses, to using findings to change practice, to being a principal investigator. The minimumscore possible was zero (no experiences) and the maximum score possible was 18 (allexperiences).Overall, the nurses did not have a great deal of research-related experience. For the entiresample, the scores ranged from 0 to 17, with a mean of 5.8 (SD=3.3). The most commonexperience was completing questionnaires for research. The frequency distribution for the top fiveexperiences is shown in Table 18. The remaining 13 experiences were indicated by less than 50%of the nurses. For all but one experience, the baccalaureate nurses had more experience than thediploma nurses. Five diploma nurses and three baccalaureate nurses indicated that they hadobtained funding from non-hospital sources to conduct research. The summary statistics by groupare provided in Table 19.Table 18Research Experience by Education for Five Most Frequent ExperiencesRank Experience Diploma BSN Total(% diploma) (% BSN) (% total)1 Completed questionnaires for research project 60 (72%) 94 (96%) 154 (84%)2 Attended conferences where research findings were 52 (63%) 74 (76%) 126 (69%)included in presentations3 Attended conferences where research studies were 45 (54%) 66 (67%) 111 (61%)presented4 Taken a course in statistics 14 (17%) 87 (89%) 101 (55%)5 Taken a course in research methods 12 (14%) 87 (89%) 99 (54%)Analysis of variance revealed a significant difference in experience between diploma andbaccalaureate nurses (F=40.05; p=O.OO), with baccalaureate nurses having more researchexperience. There was no significant difference by hospital size (F=1.10; p=OL3O) and nointeraction effect was noted (see Table 19).62Table 19Research Experience by Education and Hospital SizeSmall Hospitals Medium Hospitals Large Hospitals Mean TotalMean (SD) [range] Mean (SD) [range] (SD) [range] MeanDiploma 4.5 (3.4) [0-12] 3.6 (2.4) [0-10] 4.6 (2.7)[1-10] 4.2BSN 7.2 (3.7) [0-17] 6.8 (2.3) [2-13] 7.4 (3.2) [2-16] 7.1Total Mean 6.0 5.1 6.2 5.8In summary, the first research question was answered by examining the responses toquestions regarding the nurses’ value for research, interests in research and research experience.Overall, the nurses expressed considerable value for and interest in research, but did not have agreat deal of research experience. Baccalaureate nurses had significantly higher value for researchand more research experiences than diploma nurses, but there were no differences in researchinterest between educational levels. There were no statistically significant differences in interest,value or experience between nurses from hospitals of different sizes.Research Questions 2: What are Staff Nurses’ Expectations of Themselvesfor Using Research Findings in Practice?The nurses were asked to express their level of agreement with six statements regardingexpectations that they held regarding their own use of research in nursing practice. The minimumscore possible was 6 (strong disagreement with all expectations) and the maximum score possiblewas 24 (strong agreement with all expectations). The range for the sample was 6-24 with a meanof 18.2 (SD=3.6). As shown in Table 20, few nurses had scores below 12 and the distributionof scores by education was similar, suggesting a moderately high level of expectation by mostnurses.63Table 20Distribution of Own Exoectations to Use Research by EducationOwn Expectation Score Diploma BSN Total (%)6-12 3 2 5 (3%)13-18 42 44 86 (50%)19-24 36 47 83 (47%)Table 21Expectations of Self by Education and Hospital SizeSmall Hospitals Medium Hospitals Large Hospitals TotalMean (SD) [Range] Mean (SD) [Range] Mean (SD) [Range] Mean (SD) [Range]Diploma 18.2 (2.6) [12-241 18.8 (3.0) [14-24] 17.6 (3.3) [10-24] 18.3 (3.0) [10-241BSN 19.6 (2.5) [15-24] 18.1 (3.7) [6-241 18.9 (3.0) [13-24] 18.8 (3.1) [6-24]Total 18.9 (2.6) [12-24] 18.4 (3.3) [6-241 18.3 (3.2) [10-24] 18.2 (3.6) [6-24]As shown in Table 21, the group scores were similar. Analysis of variance demonstratedthat there was no significant difference in expectations of self between the groups by education(F=2.O1; p=O.l6) or by hospital size (F=0.66; p=0.52).The six expectations received varying degrees of agreement. Most nurses agreed or stronglyagreed that they expected themselves to “critically question the effectiveness of daily nursingpractice” (90%) and that they “apply research fmdings to clinical practice” (93%). Promoting aclimate that supports colleagues’ research received 85% agreement (agree/strongly agree) andbeing involved with collecting data for nursing research studies received 87% agreement.However, conducting research and being involved with collecting data for non-nursing researchreceived less agreement; 50% and 56%, respectively.In summary, the nurses generally had high expectations of themselves to use research,64although there was variability in the scores. There was no difference by educational level orhospital size, but individual nurses varied and responses to specific expectations varied.Research Question 3: What are the Perceived Organizational Expectationsto Use Research Findings in Practice?Organizational expectations were measured by asking the nurses to express their level ofagreement with six statements of expectations held by key individuals within nursing in theirorganization. The statements were the same as those used to rate expectations of self. The nurseswere asked their level of agreement about the degree they thought their head nurse, instructor,clinical nurse specialist (CNS) and nursing director held particular expectations.Table 22 shows the expectation scores for the key individuals for the entire sample. Thenumber of responses varied as many indicated “Not Applicable” for CNS and/or instructors, anda few respondents indicated “Not Applicable” for head nurses or nursing directors. In addition,some nurses did not complete the expectations of others; leaving blanks, inserting question marks,and occasionally adding explanations. For example, one nurse wrote “we rarely see our nursingdirector, and I really don’t know what her expectations are”. As noted earlier, missing data werehandled by excluding the scales in which the individual nurse had not responded to more thantwo items in a scale and by assigning a neutral score when the nurse had not responded to oneor two items. Because of the small number of responses regarding the CNS and instructor, theseitems were excluded from further analysis.Most of the nurses responded to the statements regarding the expectations of their headnurse (88%) and nursing director (82%). Fewer nurses (56%) responded regarding their view ofexpectations held by instructors. Very few nurses (3 1%) responded regarding clinical nursespecialists. Those who responded were mostly from large hospitals.65Table 22Expectation Scores of Key Individuals as Viewed by the Staff NurseNumber Expectation ScoreResponding(% sample) Mean SD RangeHead Nurse 161 (88%) 17.8 3.4 6-24Director 149 (82%) 17.7 4.1 6-24Instructor 100 (56%) 19.3 3.4 6-24CNS 56 (31%) 18.8 3.1 11-24Tables 23, 24 and 25 presents the distribution, group scores and analysis of variance of theexpectations that the staff nurses believed their head nurses held; Tables 26 and 27 present thedistribution and group scores for expectations the staff nurses believed their nursing directorsheld. The nurses perceived the expectations of the head nurses and the director of nursing to besimilar, as illustrated by the mean and distribution. Analysis of variance detected a statisticallysignificant difference between the perceived expectations of head nurses from hospitals ofdifferent sizes (F=3.03; p=O.05) and an interaction effect between hospitals and level of education(F=3.39; p=0.04.). There were no differences between educational levels (F=0.59; p=O.45). Thisdemonstrated that the baccalaureate nurses thought that their head nurses’ expectations werehigher in medium and large hospitals, but that diploma nurses thought their head nurseexpectations were highest in medium hospitals.For the perceived expectations of nursing directors, analysis of variance also detected asignificant difference between nurses from hospitals of different sizes (F=5.20; p=O.Ol). However,there was no interaction effect (F=1.54; p=O.22), or difference between educational levels(F=O.47; p=O.87).66Table 23Distribution of Staff Nurse Perceptions of Head Nurse Research Expectations*Expectation Diploma BaccalaureateScoreSmall Medium Large Small Medium Large Total6 0 0 0 2 0 0 27-12 2 0 2 3 1 1 913-18 11 12 15 15 18 14 8519-24 8 17 5 5 13 12 61Mean 17.9 18.9 17.0 15.9 18.1 18.5(SD) (3.9) (3.0) (2.7) (4.4) (3.0) (3.0)[Range] [8.5-24] [13-24] [12-23] [6-23] [11-23] [11-24]Total Mean 18.1 [ 17.6 f 17.8* partial sample used due to missing dataTable 24Staff Nurse Perceptions of Head Nurse Expectations by Education and Hospital SizeSmall Hospitals Medium Hospitals Large Hospitals TotalMean (SD) [range] Mean (SD) [range] Mean (SD) [range] Mean (SD) [Range]Diploma 17.9 (3.9) [8.5-24] 18.9 (3.0) [13-24] 17.0 (2.7) [12-23] 18.1 (3.2) [8.5-24]BSN 15.9 (4.4) [6-23] 18.1 (3.0) [11-23] 18.5 (3.0) [11-241 17.6 (3.6) [6-23]Total [ 16.8 18.5 17.8 17.8 (3.4) [6-241Table 25Summary of MANOVA for Staff Nurse Perceptions of Head Nurse Expectations by GroupSource Sum of Squares (SS) Degrees of Freedom Mean F-ratio P value(DF) SquaresEducation 6.68 1 6.68 0.59 0.45Hosp.Size 68.77 2 34.38 3.03 0.05Hosp*Educ 77.02 2 38.51 3.39 0.04Error 1715.48 164 11.3667Table 26Staff Nurse Perceptions of Nursing Director Expectations by Education and T-losnital Size*Expectation Diploma Baccalaureate TotalScoreSmall Medium Large Small Medium Large6 2 0 0 2 0 0 47-12 4 2 1 2 1 1 1113-18 6 8 11 12 17 9 6319-24 6 15 9 6 9 17 62Mean 15.5 18.9 18.1 16.4 17.4 19.0(SD) (5.0) (4.2) (3.4) (2.7) (2.7) (3.2)[Range] [6-22] [7-24] [10-23] [6-24] [11-22] [11-24]Total Mean 17.8 17.7 ] 17.6* partial sample used due to missing dataTable 27Staff Nurse Percenflons of Nursing Director Exoectaflons by Education and Hosnital SizeSmall Hospitals Medium Hospitals Large Hospitals TotalMean (SD) [range] Mean (SD) [range] Mean (SD) [range] Mean (SD) [Range]Diploma 15.5 (5.0) [6-22] 18.9 (4.2) [7-24] 18.1 (3.4) [10-23] 17.8 (4.4) [6-24]BSN 16.4 (2.7) [6-24] 17.4 (2.7) [11-22] 19.0 (3.2) [11-24] 17.7 (3.9) [6-23]Total 15.9 18.1 18.6 17.6 (4.1) [6-241In summary, the nurses thought that the expectations of head nurses and directors weresimilar, with differences in expectations between nurses from hospitals of different sizes.Interestingly, with regard to head nurse expectations, there was a significant interaction effectwith a difference in the perception of nurses of different educational levels from hospitals ofdifferent sizes. For perceptions of nursing director expectations there were no significantdifferences between nurses of different educational levels.68Research Question 4: What is the Perceived Level of Organizational Supportfor Using Research Findings in Nursing Practice?Organizational support for research was measured in three ways. First, the nurses were askedto express their level of agreement with six statements regarding the value of research within thenursing department. Second, they were asked to express their level of agreement with 11statements regarding the research climate in their organization. Third, they were asked to identifythe research-related infrastructures available in both their organizations and their nursingdepartments.Value of ResearchThe statements regarding the value of research within the nursing department were the samestatements as those that the nurses responded to when rating their own value for research. Theminimum score possible was 6 (strongly disagree with all value statements); the maximum scorepossible was 24 (strongly agree with all statements). For the sample, the scores ranged from 8-24,with a mean of 19.5 (SD=3.3). Most of the nurses agreed or strongly agreed with most statements(see Table 28).Table 28Distribution ofPerceived Nursing Department Value for Research by Education and Hospital SizeNursing Diploma Baccalaureate TotalDepartmentValue Score Small Medium Large Small Medium Large8-11 0 1 0 2 0 0 312-15 3 0 1 7 3 1 1516-19 11 11 10 13 15 10 7020-24 9 20 11 10 13 17 80Total 23 32 22 32 31 28 168* partial sample used due to missing data69Table 29Nursing Department Value for Research by Education and Hospital SizeSmall Hospitals Medium Hospitals Large Hospitals TotalMean (SD) [range] Mean (SD) [range] Mean (SD) [range] Mean (SD) [Range]Diploma 18.7 (3.4)[12-241 20.6 (2.9) [11-241 20.1 (2.9) [15-24] 19.8 (3.1) [11-24]BSN 18.2 (4.3) [8-24] 19.4 (2.9) [14-24] 20.6 (3.2) [12-241 19.3 (3.6) [8-24]Total 18.3 (3.9) [8-24] 19.9 (2.9) [11-24] 20.3 (3.1) [12-24] ( 19.5 (3.3) [8-24]The scores were lower in small hospitals, larger in medium hospitals and largest in largehospitals (see Table 29). Analysis of variance indicated a significant difference in the perceivednursing department value for research between hospital sizes (F4.96; p=O.Ol). There was nodifference between educational levels (F=0.58; p=0.4.5) and no interaction effect noted (F=0.70;p=0.5O).Research ClimateThe 11 statements regarding the research climate included questions about encouragementand recognition for nurses and interest in research by others. The minimum score possible was11 (strong disagreement with all statements) and the maximum score possible was 44 (strongagreement with all statements). For the overall sample, the scores ranged from 11-44 with a meanof 25.9 (SD=6.8). Most of the scores were between 21-30 (see Table 30). Any disagreement withall statements would produce a score of 22, suggesting a low opinion of the research climate.The climate scores were higher for medium hospitals than for small hospitals and highestfor larger hospitals (see Table 31). Multiple analysis of variance illustrated that there was asignificant difference in climate score between hospitals of different sizes (F=2.41; p=0.00), butno significant difference between educational levels (F=0.06; p=O.30). No interaction effect wasdetected (see Table 32).70Table 30Distribution of Research Climiite Scores by EducationResearch Diploma Baccalaureate Total(%)ClimateScore Small Medium Large Small Medium Large11-15 3 3 0 7 1 1 15 (9)16-20 5 2 0 6 5 0 18(11)21-25 6 7 5 9 10 8 45 (27)26-30 2 11 6 6 7 13 45 (27)31-35 2 7 9 4 9 4 35 (21)36-40 0 2 2 0 0 3 7(4)41-44 0 0 1 0 0 1 2(1)Total 18 32 23 32 32 30 167 (100)Table 31Research Climate by Education and Hospital SizeSmall Hospitals Medium Hospitals Large Hospitals TotalMean (SD) [Range] Mean (SD) [Range] Mean (SD) [Range] Mean (SD) [Range]Diploma R.N. 22.0 (6.1) [11-34] 26.6 (6.8) [11-36] 30.7 (5.6) [21-42] 26.8 (7.0) [11-42]BSN 21.7 (6.8) [1 1-341 26.0 (5.6) [15-34] 28.5 (6.0) [14-44] 25.2 (6.70 [11-44]Totalf_21.425.5 f 29.1 25.9 (6.8) [11-44]Table 32Summary of MANOVA for Research Climate by GroupSource Sum of Squares (SS) Degrees of Freedom Mean F-ratio P value(DF) SquaresEducation 41.03 1 41.03 1.07 0.30Hosp.Size 1558.70 2 779.35 20.30 0.00Hosp*Educ 28.03 2 14.01 0.37 0.70Ermr 6295.16 164 38.39and Hospital Size71Organizational InfrastructureThe infrastructures for research within the organization were measured by asking the nursesto identify those infrastructures such as policies, job descriptions, committees, resources andpersonnel available in their hospitals to support research. They were asked to respond “yes”, “no”,or “don’t know” to indicate whether or not 27 different aspects of infrastructure existed. “Yes”responses were counted to calculate the infrastructure score. The minimum score possible wasO (no supports); the maximum score was 27 (all supports).Over 33% of all responses were “don’t know” responses. For the sample, the scores rangedfrom 0-27, with a mean of 7.2 (SD=6.3). Over half of the nurses reported that fewer than 6 ofthe 27 possible infrastructures were present (see Table 33). The most frequently identifiedinfrastructures were library supports and ethics committees, which were identified by 119 and112 nurses, respectively. However, the ethics committees identified were not necessarily relatedto research as only 64 nurses identified research review committees and only 18 nurses identifiedcombined research and ethics committees. All remaining infrastructures were identified by fewerthan half of the nurses.Analysis of variance illustrated that there was a significant difference in the number ofinfrastructures between hospitals of different sizes (F=2.41; p=O.OO), with larger hospitals havingsignificantly greater support for research than medium or small hospitals (see Tables 34 and 35).There was a tendency for the BSN group to report higher organizational support (p=O.O8)72Table 33Distribution of flrc1ni7it1nn1 Infrastructure Scores byOrganizational Diploma BaccalaureateInfrastructurescare Small Medium Large Small Medium Large Total (%)0 6 3 2 10 1 0 22(12)1-6 13 16 6 14 14 6 69 (39)7-11 5 11 8 4 11 7 46 (26)12-16 1 1 3 2 3 11 21 (12)17-21 0 2 5 3 2 6 18 (10)22-27 0 0 0 0 2 0 2 (1)Total 25 33 24 33 33 30 178 (100)* partial sample used due to missing dataTable 34Mean Number of Organizational Infrastructures by Education and Hospital SizeSmall Hospitals Medium Hospitals Large Hospitals TotalDiploma 3.5 6.2 10.0 5.7BSN 5.1 7.8 11.5 8.0Total Mean 4.4 7.0 10.9 7.3Table 35Summary of MANOVA for Organizational Infrastructure by GroupSource Sum of Squares (SS) Degrees of Freedom Mean F-ratio P value(DF) SquaresEducation 108.58 1 108.58 0.06 0.08Hosp.Size 1114.00 2 557.15 2.41 0.00Hosp*Educ 0.01 2 0.00 0.00 1.00Ermr 5785.60 171 33.83Education and Honit1 Si7e*73In summary, from the staff nurses’ perspective, the nursing department’s value for research,the research climate within the organization and the infrastructures available to support researchwere significantly different by hospital size. Nursing department value was fairly high, opinionsof organizational climate were low and few infrastructures were identified in most hospitals.Value, climate and infrastructure were lowest in small hospitals, higher in medium hospitals andhighest in large hospitals. There were no differences in the nurses’ perceptions by educationallevel, although there was a tendency for baccalaureate nurses to report more infrastructures.Research Question 5: What is the Reported Level of Research Utilization?The level of research utilization was measured in two ways. First, the nurses were asked torate their general use of research. Second, they were asked about the use of specific researchfindings.General Use of ResearchThe nurses were asked to rate each of 10 statements related to general use of research ona four-point scale from “not at all” to “sometimes” to “frequently” to “always”. The minimumscore possible was 10 (“not at all” for all statements); the maximum score possible was 40(“always” for all 10 statements). For the entire sample, the scores ranged from 10-38, with amean of 22.7 (SD=4.91). All of the statements were rated at least “sometimes” by at least 80%of the nurses (see Table 36). The most strongly supported statement was regardingcommunication of concerns about the effectiveness of practices to colleagues. The use of researcharticles to support questioning practice and the identification of hospital policies based onresearch were the least supported statements.74Table 36Percentage of Responses Regarding General Use of ResearchRank Item Not At All Sometimes Frequentlyor Always1 I communicate concerns about the 2% 41% 57%effectiveness of practices tocolleagues2 I critically question daily practices for 2% 55% 43%effectiveness3 I implement nursing care on the basis 10% 51% 39%of current research findings4 I am familiar with current research 10% 65% 25%relevant to my area of nursing5 I change practice based on research 11% 58% 31%6 I evaluate the results of changed 13% 44% 43%practice7 I can identify the research basis for 16% 58% 26%my common daily practices8 I can identify hospital 18% 55% 26%policies/procedures that are not basedon current research9 I can identify hospital 20% 51% 29%policies/procedures that are based oncurrent research10 I use research articles to support my 20% 54% 26%questioning of daily practicesThe distribution of scores for general use of research by the nurses’ education is illustratedin Table 37. Table 38 illustrates the mean scores by education and hospital size. MANOVA wasused to test the differences in use of research between the groups. There were no significantdifferences between the groups by education (F=1.85; p=0.67) or hospital size (F=0.29; p=O.75).75Table 37Distribution of General Use of Research by EducationGeneral Use of Diploma BSN Total (%)Research Score10-15 5 4 9 (5%)16-20 22 28 50 (28%)21-25 30 41 71 (39%)26-30 19 17 36 (20%)3 1-35 6 6 12 (7%)36-40 0 2 2 (1%)Total 82 98 180 (100%)Table 38General Use of Research by Education and Hospital SizeSmall Hospitals Medium Hospitals Large Hospitals TotalMean (SD) [range] Mean (SD) [range] Mean (SD) [range] Mean (SD) [Range]Diploma 22.5 (5.0) [15-33] 22.5 (5.6) [12-35] 22.8 (4.0) [15-29] 22.6 (4.9) [12-35]BSN 23.8 (6.3) [10-38] 22.7 (4.1) [16-32] 22.3 (4.1) [17-33] 22.9 (4.9) [10-38]Total 23.2 (5.7) [10-38] 22.5 (4.9) [12-35] j 22.5 (4.0) [15-33] 22.7 (4.9) [10-38]Use of Specific Research FindingsThe nurses were asked to rate whether they used 10 specific findings “never”=l,“sometimes”=2, or “always”=3. Because it was anticipated that all practices would not be usedin all settings, they were asked to indicate when practices were not applicable. Three of thefindings were rated as “not applicable” by over 30% of nurses. The “not applicable” practiceswere then excluded when calculating the percentage of use and the overall scores. The score forthe use of specific findings was the average score of applicable practices.As shown in Table 39, the use of specific findings varied. With one exception (catheter76clamping), each finding was used at least sometimes by 50% of the nurses. Giving sensoryinformation prior to diagnostic tests was used most frequently (at least sometimes by 96% ofnurses for whom the practice was applicable). Giving sensory information prior to surgicalprocedures and mutual goal setting were also used at least sometimes by 95% of nurses. Anaverage of 77% of nurses used the findings at least sometimes.Table 39Distribution of Use of Specific Research FindingsRank Research Area Not Applicable Never(%) Sometinies(%) Always(%) Total Use(%) (C+D/B÷C+D=A B C D %ofapplicable)1 sensory infonnation 10 (5%) 7 (4%) 65 (36%) 101 (55%) 166 (96%)before diagnostics2 mutual goal setting 10 (5%) 9 (5%) 101 (55%) 63 (34%) 164 (95%)3 sensory infonuation 35 (19%) 8 (4%) 59 (32%) 81 (44%) 140 (95%)pre-operatively4 planned preop. 61 (38%) 20 (11%) 35 (23%) 67 (37q0) 102 (84%)teaching5 electronic oral 32 (17%) 29 (16%) 37 (20%) 85 (46%) 122 (79%)temperature duringoxygen6 urine testing 66 (36%) 25 (14%) 51 (28%) 41 (22%) 92 (79%)7 activities which 54 (30%) 34 (19%) 36 (20%) 59 (32%) 95 (74%)increase intracranialpressure8 preop. relaxation 36 (20%) 45 (25%) 69 (38%) 33 (18%) 102 (69%)9 dorsogluteal 34 (19%) 69 (38%) 46 (30%) 34 (19%) 80 (54%)injection technique10 catheter clamping 21 (15%) 83 (45%) 58 (32%) 21 (15%) 79 (49%)For the sample, the scores ranged from 1.0-3.0, with a mean of 2.15 (SD=0.36). Table 40presents the scores by group. When tested with analysis of variance, there were no significantdifferences between groups by education (F=0.06; p=O.67) or hospital size (F=2.4; p=0.09).77Table 40Use of Specific Findings by Education and Hospital SizeSmall Hospitals Medium Hospitals Large Hospitals TotalMean (SD) [range] Mean (SD) [range] Mean (SD) [range] Mean (SD) [Range]Diploma 2.1 (0.37) [1.4-2.9] 2.1 (0.04) [1.0-2.71 2.3 (0.28) [1.9-2.9] 2.2 (0.36) [1.0-2.9]BSN 2.1 (0.34) [1.6-3] 22 (0.36) [1.4-3.0] 2.2 (0.36) [1.5-3.01 2.2 (0.35) [1.4-3.0]Total 2.1 (0.35) [1.4-3] 2.1 (0.38) [1.0-3.0] 2.2 (0.32) [1.5-3.0] 2.2 0.35) [1-3.0]The levels of research utilization did not differ by hospital size or educational level whenmeasured as general use of research or as use of specific findings. There was considerablevariation in the level of support for different statements regarding general use of research andvariation in the use of different findings.Research Ouestion 6: What is the Difference Between Perceived Organizational Expectationsand Staff Nurses’ Expectations for Use of Research Findings in Nursing Practice?The difference between the organizational expectations and the nurses’ expectations ofthemselves was tested using t-tests. The mean difference between head nurse expectations(M=17.8) and the nurses’ own expectations (M=18.2) was 0.87. There was a significantdifference between these expectation scores (t=2.381, p=O.O2) Similarly, the mean differencebetween nursing director expectations (M=17.7) and the nurses’ expectations was 0.77. Thisdifference was also statistically significant (t=2.60 p=0.Ol). The nurses’ expectations ofthemselves were significantly higher than the expectations of the key individuals in theemploying hospitals.Research Question 7: What are the Relationships between Perceived OrganizationalExpectations, Staff Nurse Expectations of Themselves, and the Use of Research Findings?Pearson’s Correlation Coefficients were calculated to describe the relationships between the78expectations of self and the expectations of the key individuals. To describe the relationshipbetween the expectations and use of research, correlations were calculated between expectations(head nurse, director and self) and use of research (general and specific). Table 41 provides thecorrelations for each of these relationships.Table 41Pearson Correlation Matrix between Expectations and Use of ResearchHead Nurse Director Own General Use Use of SpecificExpectations Expectations Expectations of Research FindingsHead Nurse 1.00ExpectationsDirector 0.67*** 1.00ExpectationsOwn 0.42*** 0.26*** 1.00ExpectationsGeneralUseof 0.16** 0.13 0.51***ResearchUse of Specific 0.08 0.24** 0.24*** 0.48*** 1.00Findings** p<O.01p<0.01As shown, all relationships among the expectations perceived to be held by differentindividuals were statistically significant. In interpreting the strength of the correlations andjudging the practical significance of the correlations, Munro and Page’s (1993) classification wasused in which 0.26-0.49 is considered a low correlation, 0.50-0.69 is considered moderate, 0.70-0.89 is considered a high correlation and 0.90-1.00 is very high. Although they may bestatistically significant, correlations below 0.26 are not considered to indicate any correlation ofpractical significance and therefore were not included in the interpretation. All of the correlationsabove 0.26 were statistically significant at the 0.001 level or higher.The relationship between the perceived expectations of the head nurse and the director was79moderate (r=O.67). The relationship of the nurse’s own expectations to perceived head nurseexpectations was moderate (r=0.42), and to perceived director expectations was low (r=O.26).The relationship between the nurses’ reported general use of research and use of specificfindings showed a moderate, statistically significant correlation (r=0.48). The relationshipsbetween expectations and the use of research were not as strong as the relationships among theexpectations perceived to be held by various people or between the two measures of researchutilization. There were no correlations between the perceived expectations held by head nursesand the general use of research (rO. 16) or the use of specific findings (r=0.08). There were alsono correlations between the perceived expectations of nursing directors and the general use ofresearch (r=O.13) or the use of specific findings (r=0.24). The nurses’ own expectations correlatedmoderately with their own reported general use of research (r=O.51). The nurses’ expectationsdid not correlate with their reported use of specific findings (r=0.24).0.50 to 0.69Nursing Director Expectations r = 0.26 to 0.490.67Head Nurse Expectations 0.26 Use of Specific Findings0.420 510.38Nurse’s Own Expectations General Use of ResearchFigure 3: Relationships Between Expectations and Research UseIn summary, as shown in Figure 3, the organizational expectations (head nurse and nursingdirector expectations) were moderately inter-correlated and had low correlations with the nurses’80own expectations. The nurses’ own expectations were moderately correlated with the general useof research but not with the use of specific findings. The general use of research had a lowcorrelation with the use of specific findings.Research Question 8: What is the Relationship Between the Nurses’ Perceptions ofOrganizational Support for Research Utilization and Use of Research Findings?To describe the relationship between organizational support and the use of research,correlations were also calculated. All of the relationships were statistically significant except forthose between the nursing department’s perceived value for research and the use of researchfindings (general and specific). However, using the categories offered by Munro and Page (1993),it can be seen that there were correlations of practical significance among the measures oforganizational support (nursing department value for research, research climate and organizationalinfrastructures). Two measures of support (climate and infrastructures) correlated with the useof specific findings, but none correlated with general use of research. There was also a moderatecorrelation between the two measures of research use.Table 42Pearson Correlation Matrix for Organizational Support and Use of ResearchGeneral Use of Use of Specific Perceived Nursing OrganizationalResearch Findings Department Value ClimateGeneral Use of 1.00ResearchUse of Specific Findings 0.48*** 1.00Perceived Nursing 0.06 0.15 1.00Department ValueOrganizational Climate 0.18* 0.34*** 0.49*** 1.00Infrastructures 0.20** 0.36*** 0.31*** 0.63**** p<0.5** p<O.O1*** p<O.00181Ancillary FindingsOther analyses were performed to identify relationships among variables not addressed bythe research questions. Relationships among the demographics and between the demographics andthe study variables were examined. Relationships among the individual characteristics, among theorganizational characteristics and between individual and organizational characteristics and theresearch utilization outcomes were also examined. The correlations are summarized in Table 43.Again, interpretation of the strength of the correlations was done using Munro and Page’s (1993)classification. Furthermore, all of the correlations above 0.26 were statistically significant at leastat the 0.001 level or higher.DemographicsAge correlated strongly with years since graduation for both diploma nurses (r=0.88) andmoderately for baccalaureate nurses (r=c60). However, as shown in Table 43, age and years sincegraduation did not correlate with any of the other study variables.Relationships Among Research-related Characteristics of the Individual NurseThe research related characteristics of the nurse included the nurses’ interest in, value forand experience with research and the nurses’ expectations to use research in practice. As shownin Figure 4, there were significant correlations between most of these characteristics. Expectationsof self were moderately correlated with research interest and the nurses’ own value for research,and showed a low correlation with research experience. The nurses’ own value for research wasalso moderately correlated with research interest. Research experience showed a low correlationwith research interest and with expectations to use research.Table43CorrelationMatrixforStudyVariablesAGE=Nurses’ageYEARSYearssincegraduationEXSELF=Nurses’ownexpectationstouseresearchINTEREST=Nurses’interestinresearchEXPER.=Nurses’researchexperienceOWNVALUENurses’ownvalueforresearchCLIMATE=OrganizationalclimateINFRA.=OrganizationalInfrastructuresNDEPT.VALUE=NursingdepartmentvalueforresearchEXP.HEADNURSE=HeadnurseexpectationsofstaffnurseEXP.DIRECTOR=NursingdirectorexpectationsofstaffnurseGENERALUSE=GeneraluseofresearchUSEOFFINDINGS=UseofspecificfindingsAGEYEARSEXSELFINTERESTEXPER.OWNCLIMATEINFRA.NDEPT.EXP.EXP.GENERALVALUEVALUEHEADNURSEDIRECTORUSEAGE1.00YEARS0.84***1.00EXSELF-0.110.141.00INTEREST-0.06-0.020.60100EXPER.-0.10-0.080.29***0.31***100OWN-0.10-0.000.52***0.46”0.141.00VALUECLIMATE0.01-0.100.20*0.090.060.161.00INFRA.-0.01-0.010.140.110.27***0.050.63***1.00NDEP.0.010.020.060.05-0.120.230.49***0.29***1.00VALUEEXP.HEAD-0.060.130.42***0.11-0.070.010.49***0.30”0.47***1.00NURSEEXP.0.04-0.010.26”’0.04-0.150.020.56***0.35***0.56***0.67***1.00DIRECTORGENERAL0.020.010.51***0.50”0.37’’*0.41***0.18*0.24***0.050.160.131.00USEUSEOF0.110.210.2S’0.23’0.15*0.130,33***0.31***0.140.060.24*0.38***FINDINGS*p<0.05**p<0.01***p<0.0010O t%)83Figure 4: Correlations (r>O..26) Between Individual CharacteristicsRelationships Among Organizational CharacteristicsThe organizational characteristics that were measured included the expectations of keyindividuals and organizational support as identified by the research climate, the nursingdepartment value for research and the research infrastructures. Relationships among thesevariables were examined and are illustrated in Figure 5. The perceived expectations of the nursingdirector correlated moderately with the expectations of the head nurse, the nursing departmentvalue for research and the research climate. A low correlation was found between the nursingdirector expectations and infrastructure. The perceived head nurse expectations showed a lowcorrelation with the nursing department value for research and the research climate. There wasa low correlation between the nursing department value for research, the research climate andinfrastructures.r= 0.50 to 0.69r = 0.26 to 0.49Expectations to Use ResearchValue for Research 0.60 Research Experience•4•%%%% 0.46 0_ 0.31Interest in Research ..‘Head Nurse Expectations0.67r= 0.50 to 0.69r = 0.26 to 0.490.350.63Figure 5: Correlations (r>O.26) Between Organizational Characteristics84Relationships Between Individual and Organizational Characteristics and Research UtilizationThe relationships between the characteristics described above and the research utilizationoutcomes were also examined using correlations (see Figure 6). Only two organizationalcharacteristics (research climate and infrastructure) showed a low correlation to the use ofspecific findings. None of the individual factors correlated significantly with use of specificfindings. None of the organizational characteristics but all of the individual characteristicscorrelated with general use of research. Interest in research and expectations for using researchin practice were moderately correlated with general use; the nurses’ value for research andresearch experience showed a low correlation with general use.Organizational Research Climate --.. r = 0.50 to 0.69r = 0.26 to 0.49Organizational Infrastructures-Use of Specific Findings0.38Nurses’ Value for ResearchNurses’ Expectations to Use ResearchNurses’ Research InterestNurses’ Research ExperienceFigure 6: Correlations (r>O.26) Between Individual and OrganizationalCharacteristics and Research Utilization Outcomes85In summary, the personal and professional characteristics and individual change factors wereinter-related and correlated with the general use of research as reported by the nurses. Theorganizational characteristics and change factors were also inter-related and correlated with theuse of specific findings. The organizational factors were not related to the individual staff nursefactors, except for the correlation between the nurses’ own expectations to use research and theperceived expectations of head nurses and nursing directors, and the correlation between researchexperience and reported organizational infrastructures. The use of specific findings were relatedonly to organizational factors, whereas the second measure of research utilization (general useof research) was related only to individual factors. These two measures of research utilizationwere also correlated. These correlations are summarized in Figure 7.Finally, correlations between educational level and hospital size and the study variables wereobtained. These correlations are summarized in Appendix E (p. 157). As anticipated from earlieranalyses, educational level only correlated significantly with research experience and the nurses’own value for research. Hospital size only correlated significantly with research climate, thenumber of infrastructures, and the perceived expectations of the nursing directors.The results of this survey were intriguing and in many ways unexpected. However, closeexamination of earlier research reveals that this study builds significantly toward a betterunderstanding of the factors influencing the use of research in nursing practice.r = 0.50 to 0.69r = 0.26 to 0.49 — —Figure 7: Correlations among organizational and individual factors andrORGANIzATIONAL I_40EXIIII N. D. — — — ——III IIIIIIIIIIIIIIISSSSS4.S ‘SUSE OFSPECIFICFINDINGSI86CC,)m0-I,m()m>:uC)IIIII-JDO>zVALUEIII IIII,III’IIOWN1GENERALEXPECTATIONS- USE OFS — —S— RESEARCH4. — — — _ — —— — —— — —SSSSS44II4.INTERESTISI —S I —% EXPERIENCEresearch utilization outcomes.87DiscussionIn this section, the results are discussed in relation to the theoretical framework, otherresearch studies and methodological problems inherent in the study. First, the characteristics ofthe sample are discussed. The remainder of the discussion is organized by the conceptualframework. Each component of the framework is discussed under the headings of individualfactors, organizational factors and research utilization outcomes. The levels of each factor andthe relationships within each component are discussed. After the results have been discussed inrelation to each of the components, the relationships between the components are discussed.Sample CharacteristicsBecause the sample was purposefully stratified by educational level and hospital size thesample likely represents, in a reasonable way, nurses with both diploma and baccalaureateeducation and nurses who work in hospitals of varying sizes. Because of the stratification, agreater proportion of the sample than would be found in the target population were nurses withbaccalaureate education. In the sample, 54% of the nurses had baccalaureate degrees. In 1991,15% of nurses in British Columbia held baccalaureate degrees, while only 8.5% of nursesworking in B.C. hospitals as staff nurses held baccalaureate degrees (Statistics Canada, 1991).Statistics were not available for the proportion of nurses working in hospitals of different sizes.However, Kazanjian, Pulcins and Kerluke (1992) found that 37% of nurses working in Canadianacute care hospitals worked in non-urban areas. This compares reasonably with the 32% of nursesin the sample who worked in small hospitals and supports the assumption that the sample isrepresentative of nurses working in hospitals of varied sizes.Although the response rate was higher for baccalaureate nurses (44%) than diploma nurses(37%) despite a third mailing to diploma nurses only, the overall response rate was satisfactory.The return rate of 42% was similar to the 44% return rate obtained by Alcock et al. (1990) in88a similar survey in Ontario. The return rate may indicate a lack of interest in research on the partof the non-respondents. The number of non-respondents causes concern and limits thegeneralizability of the findings as it is not possible to know how the non-responders differed fromthe responders or how the non-responders in each educational level differed. The difference inresponse rates may reflect a difference in the attitudes of baccalaureate nurses and diploma nursestoward research. This is partially supported by the finding of a significant difference between theeducational groups in their reported value for research, although reported interest in research wasnot significantly different.Clarke (1992) reported that telephone interviews conducted to increase the response rate forher survey regarding research in clinical practice revealed that nursing administrators did notparticipate because of a lack of time, resources and a lack of knowledge regarding the researchprocess. In the current survey, written comments suggested that these factors were also barriersto participation for the staff nurses. Three of the four nurses who returned their surveysincomplete added letters explaining that they did not know enough about research to respond.The employment status of the current sample was that 49% of the nurses worked full timeand 51% worked part time or casual. Kazanjian, Pulcins and Kerluke (1992) estimated theemployment status of nurses in British Columbia using data from nine groupings of hospitals.They found that 79% of nurses worked full time in urban areas and 62% worked full time innon-urban areas. The lower levels of full time employment in the current sample than in thefindings of Kazanjian et al. may be due to the fact that they did not use a random sample, thefact that there were nearly two years between their data collection and the current survey or thepossibility that the non-respondents in the current study worked full time. The respondents in thissample may be different by employment; nurses working part time may have more time or bemore willing to respond to a survey. Finally, the stratified approach in the current study may89have resulted in greater representation from small hospitals in non-urban areas, although thiswould not account for all of the difference. The employment status of the nurses in the currentstudy was remarkably different from those in the study by Alcock et a!. (1990). They found thatonly 9.6% of respondents were working part-time compared to national estimates of 38% part-time employment at that time.Kazanjian et al. (1992) reported 1.4 times as many nurses were employed in medical andsurgical areas than in critical care areas. In the current sample, 1.7 times as many nurses wereemployed in medical-surgical areas. This likely reflects differences in responders and non-responders and differences between the studies as described above.In terms of other major demographic factors, the sample was reasonably representative. Inthe sample, 1.6% were male while 2.9% of registered nurses in B.C. are male (Canadian Centrefor Health Services and Policy Research, 1993). Comparing the age distribution of the samplewith the age distribution of registered nurses in B.C. indicates that the sample distribution issimilar but that the respondents are younger than the general population of B.C. nurses. In thesample, 38% of the nurses were 25-34 years of age, whereas only 24% of the nursing populationin B.C. is in that age range. The sample had similar numbers of nurses in the 35-44 year category(37% compared to 35%). There were only 15 (8%) respondents 50 and over and there were norespondents over 57, whereas 12% of B.C registered nurses are 55 and over. Although the sampleis younger than the overall nursing population, it is likely representative of medical-surgical andcritical care nurses practising in acute care. The data from the Canadian Centre for HealthServices and Policy Research (1993) included the ages of nurses working in all areas as well asnurses who were unemployed or who were not employed in nursing. There were no dataavailable regarding years since graduation to use for comparison.Although a random sample was used in the current study, stratification and differences90between responders and non-responders led to a final sample that was more representative ofbaccalaureate nurses, nurses who work part time and nurses working in medical-surgical areasthan of the population of staff nurses working in B.C. acute care hospitals. The sample wassimilar in gender and age to the underlying population.Individual FactorsThe individual factors include personal and professional characteristics and individualchange factors. In addition to the demographic characteristics, the professional characteristics ofresearch experience and the individual change factors of the nurses’ own value for research,interest in using research, and expectations of self for using research in practice were considered.The individual nurse’s assessment of available resources was also considered, but will bediscussed under organizational change factors.Research Experience. Although the research-related experience of baccalaureate nurses wassignificantly greater than that of diploma nurses, the experience of the overall sample was low.As noted earlier, most of the difference between educational levels could be accounted for by thefact that most of the baccalaureate nurses had taken research and statistics courses (89%),whereas diploma nurses had not (14% and 17%, respectively). Most of the nurses had five orfewer research experiences. It was discouraging to note that the most frequently reported researchexperience was completing questionnaires, meaning that the nurses had more experience withbeing the subjects of research than with learning about, participating in or implementing researchfindings. However, it is possible that the experience of completing questionnaires was frequentlyreported because the nurses included participating in the current study as an experience.These fmdings are similar to those of Alcock et al. (1990) who surveyed nurses in Ontario.They found the same rank order among the experiences but found lower levels for allexperiences. The lower levels of experience may be explained because Alcock et al. used a91sample comprised of 26% baccalaureate nurses.These findings are also very similar to the findings of Clarke and Joachim (1993) in theirsurvey of B.C. schools of nursing. A key individuals with research responsibility in each schoolgave his or her opinion of faculty in relation to research. Using a tool derived from theinstrument which was the basis of the current study, Clarke and Joachim found that the mostfrequently reported research experiences of faculty were completing questionnaires, followed bycourses in research or statistics and attending conferences. Very few schools reported that facultyhad other research experiences such as being a principal investigator, being a research assistant,writing proposals or obtaining funding for research.The findings of the current study are, however, quite different from those of Clarke (1992)who used the same items to survey key hospital personnel regarding nurses’ research relatedexperience. Only “a few” nurses were perceived to have each of the research experiences, withthe exceptions of completing questionnaires and changing practice based on research, which wereestimated to have been experienced by more than a few, but still less than a quarter of nurses.The differences between the low levels of staff nurse research experience perceived by keyhospital personnel in Clarke’s study and the higher levels reported by the staff nurses in thecurrent study may be partially due to differences between responders and non-respondents. It maybe that the respondents to this survey were different from non-responders in their level ofresearch experience. However, even if none of the non-respondents had any research experience,more than one quarter of the diploma nurses surveyed would have had experience completingquestionnaires and attending conferences. Therefore, the differences in experience betweenClarke’s study and the current study must also be partially explained as a difference between thekey hospital personnels’ perception of staff nurses and the staff nurses’ perception of themselves.92Staff Nurses’ Value For Research. While the baccalaureate nurses had a significantly highervalue for research than the diploma nurses, value for both groups was high, with the means being20.7 and 19.7 on scores with a possible range of 6-24. Alcock et al. (1990) found a similar rankorder of support for statements, with value for solving patient care problems receiving 92%support and cost-effectiveness receiving 73%, compared to 98% and 77% in the current study.However, they found a slightly lower level of support for all value statements, most notably 70%support for public accountability compared to 89% in the current study. As in the current studythey also found that baccalaureate nurses had significantly higher value for research. Thedifferences between the studies are not remarkable and may be due to slight provincial variations,elapsed time between studies, increased media attention to public accountability, different samplecomposition or chance.The support for value statements in the current survey is very similar to the findings ofClarke’s (1992) study. Clarke surveyed nurses responsible for research in hospitals and found thatthe value statements related to enhancing nursing decisions, effectiveness, and interventions andpublic accountability received agreement from over 90% of those surveyed. In the current survey,these same statements received 92-98% agreement. The statement regarding enabling nurses touse resources efficiently was also the least supported statement, although it received 86%agreement from those responsible for research in Clarke’s study compared to 77% agreementfrom staff nurses in the current study.These findings are also very similar to the findings regarding faculty value for research asreported by Clarke and Joachim (1993). They found that the strongest agreement (mean=3.9;range=1-4) was with the statement that research improves the effectiveness of nursing and theleast supported statement (mean=3.6) was that “research-based knowledge assists nurses to usescarce resources more efficiently”. The findings are also similar to those of Bostrom, Malnight,93MacDougall, and Hargis (1989), who found that the most supported statement was that researchfindings that are advantageous to patient care can be implemented.In the current survey, the statement “research findings enable nurses to use scarce resourcesmore efficiently” was frequently commented upon. One nurse wrote “nursing does not havecontrol of health care practices” and others circled the word “scarce” and/or put question marksbeside the statement. This indicates that the statement itself was problematic and open to differentinterpretations. Responses to this statement, intended to measure the nurse’s value for research,were confounded by questions of whether or not resources were actually scarce and to whatextent nursing had control over resource utilization.The nurses in this sample valued research, with baccalaureate nurses having greater valuefor research than diploma nurses. The findings are comparable to the value for research expressedby staff nurses in other surveys and by key personnel in hospitals and schools of nursing in B.C.Interest in Research. All the nurses’ interest in research was high, with no significantdifference between baccalaureate and diploma nurses. The nurses were most interested in usingresearch in practice, in solving specific problems, and in their own areas of practice. The resultswere also encouraging because the nurses had a reasonably high interest in reading anddiscussing research and in participating in research. They were least interested in conductingresearch themselves, which seems reasonable given their level of educational preparation andexperience with research.The results are very similar to the findings of Alcock et al. (1990). The percentages ofsupport reported by Alcock were within 10 percentage points of the current study on all intereststatements, with the exception of interest in reading research studies and conducting research aspart of work (see Table 44). Alcock reported that 71% were interested in reading compared to83% in the current study, and that 85% were interested in conducting research compared to 73%94in the current study. Alcock et al. found a significant difference between educational levels,which was not found in the current study. Again, the differences may be due to provincialdifferences, different economic conditions, and differences in the sample composition.Table 44Comparison of Staff Nurse Research Interests from the Perspective of Staff Nurses and KeyHospital PersonnelInterest in: Percent Agreement (Agree Percent Interested+ Strongly Agree) by Staff estimated by KeyNurses HospitalPersonnelCurrent Study Alcock et Clarke (1991)al. (1990)using results to change practice 97% 88% 25%-50%finding answers to specific problems 96% 94% 25%-50%knowing results (own area/ own organization) 96%,91% * 96% 25%-50%determining differences research-based practice makes 89% 25%reading/discussing research studies 83%176%* 71% <25%participating in research projects of others 82% 84% 25%conducting research as part of work 73% <25%conducting research not as part of work 57% 45% few*two separate items were used in the current survey; one item in Clarke (1992)The results are also remarkably similar to the reported interests of faculty (Clarke &Joachim, 1993). Clarke and Joachim found that key individuals in nine schools of nursingreported that three quarters or more of their faculty were interested in using research results tochange practice, but only four schools reported that the same number of their faculty wereinterested in conducting research, even when it was part of their work assignment. It appears thatthe staff nurses in this sample are more interested in using research, and almost as interested inconducting research, as nursing faculty in B.C., as perceived by the heads of their schools.95However, the interest level among faculty might be considerably higher if the faculty themselvesself-reported rather than the report being from the perspective of a single individual within theirschool.In Clarke’s (1992) survey, respondents from hospitals used the same scale to estimate theproportion of staff nurses who held various research-related interests. The research interest resultsare compared in Table 44. It is evident that this sample of staff nurses reported a higher levelof interest than key hospital personnel perceived staff nurses to have. Hospital personnel mayunderestimate the research interest of staff nurses or the staff nurses may have responded in amore socially desirable direction than their true interests indicate, or both. Again, differencesbetween the research interests of respondents and non-respondents are not known.Interest in research among nurses in this sample was encouragingly high and similar toearlier estimates. It is especially remarkable that although the diploma nurses had less researchexperience and lower value for research, their interest was as high as the interest of baccalaureatenurses. The staff nurses compare favourably with available estimates of the research interests offaculty and compare reasonably with hospital respondents’ perceptions of staff nurse interest.Expectations for Using Research. Overall, the nurses in this sample had high expectationsof themselves to use research regardless of their educational level or the size of hospital theyworked in. Again it is interesting that diploma nurses had as high expectations of themselves asthe baccalaureate nurses. Clearly expectations directly related to practice were more stronglysupported than the conduct of research. This was congruent with the expressed interest statementsin which direct practice statements were most strongly supported. However, it is remarkable thatover half of the nurses expected themselves to actually conduct research. This finding seemedsurprisingly high.It is of particular interest that while 93% of nurses expected themselves to use research96findings to change practice, only 80% agreed that they use research articles to support practicechange. These findings are congruent with the conclusion based on a research review thatresearch publications have a limited effect on physicians’s use of research (Lomas, 1993).The expectations to use research reported by nurses in this study are again very similar tothose of Alcock et al. (1990). They found similar high levels of expectation and strongest supportfor practice-related expectations. However, unlike the current study, they found differencesbetween education levels.Despite little research experience, the nurses’ value for research, interest in using researchand expectations of self for using research were high in this sample regardless of educationallevel and hospital size. Ancillary findings illustrate that these individual factors are also inter-correlated, which seems reasonable. Although it might be argued that these responses weresocially desirable, the range and standard deviation suggest wide variability in individual scoresand the lower responses to specific items and to items regarding the actual use of researchsuggest that social desirability was not a significant concern in this study.Organizational FactorsThe organizational factors included the infrastructures to support research and theorganizational change factors of organizational research climate, nursing department value ofresearch and key individuals’ expectations of staff nurses to use research. One of the anticipatedlimitations of this study was the fact that the organizational change factors would be reportedonly from the perspective of staff nurses. Fortunately, the survey by Clarke (1992) used the sameitems and scaling to obtain the opinions of key nursing personnel in health care organizations andprovides an excellent comparison to the opinions of the staff nurses regarding the organizationalchange factors.97Infrastructures. The organizational infrastructures such as research related policies,committees, personnel, and resources, varied significantly by hospital size, with the number ofsupports increasing by an average of 2.6 between small and medium hospitals and by an averageof 3.9 between medium and large hospitals. There was a statistically significant correlation(r=O.40) between hospital size and the presence of research-related infrastructures. This seemsreasonable as hospital resources are likely to increase with size.It was disappointing that the most commonly identified supports (library services, ethicsconmiittees, and mission statements) are general supports that are not specific to researchactivities. Overall, 33.4% of the responses were “Don’t Know”, indicating that the staff nurses’awareness of infrastructures was low. Over 26% of the nurses did not know whether there wasa separate nursing research department, division, or council in their organization or whether theirown job descriptions contained research responsibilities.Although the difference was not significant, baccalaureate nurses tended to report a highernumber of organizational infrastructures. This tendency may be related to an increased awarenessof the infrastructures due to greater research experience or might be related to a different attitudetoward research by baccalaureate nurses as indicated by their higher value for research. Anotherpossibility is that the baccalaureate nurses might be attracted to hospitals that have more research-related infrastructures regardless of hospital size.The number of infrastructures did not correlate with any of the personal or professionalcharacteristics or change factors, except for a low correlation with research experience. Thissupports the earlier suggestion that increased experience with research made the nurses moreaware of what organizational supports were available. This correlation also highlights one of themajor methodological limitations of the study: all variables are measured from the perspectiveof the staff nurse. In this case, the organizational infrastructures reported are only those that are98known to the staff nurse. However, this limitation is also a strength because the infrastructuresthat are unknown to the staff nurse are unlikely to impact practice.Nursing Department Value of Research. The value for research that the staff nurses reportedas being held by the nursing department was reasonably high (mean=19.5; range=8-24), but notas high as the nurses’ own value for research (mean=20.3; range=12-24). The nursing departmentvalue for research was significantly different by hospital size, with the scores increasing fromsmall to medium hospitals and from medium to large hospitals. This contrasts with the nurses’own value for research in which there were no differences between hospital sizes. Again, thesignificant difference between hospital sizes is reasonable given that resources for research andassociations with universities are likely to increase with hospital size, and the difference iscongruent with the differences in infrastructures found between hospitals of different sizes.The high levels of support for the nursing department’s value for research in enhancingnursing’s effectiveness, accountability, decision-making, interventions and responsiveness weresimilar in emphasis to the findings of regarding the value statements of those responsible forresearch in hospitals (Clarke, 1992). The statement regarding enabling nurses to use resourcesefficiently was also the statement least supported by respondents to Clarke’s survey, although itreceived 86% agreement (see Table 45).The degree of agreement with value statements tended to be lower when reported by thestaff nurse than when reported by hospital personnel, but otherwise the similarity is remarkable.This suggests that both the staff nurses and the key hospital nursing personnel have a high valuefor research. The nurses seemed to think that their nursing departments have a fairly high valuefor research and the perception of this value increases with hospital size.99Table 45Comparison of the Value of Nursing Research from Three PerspectivesStatement About Mean Score (% agreement)Value of ResearchNurses’ Own Nursing Department Value Value Reported by Key NursingValue Reported by Staff Nurse Personnel (Clarke, 1992)improve effectiveness 3.57 (98%) 3.32 (92%) 3.55 (95%)enhance 3.47 (95%) 3.31 (92%) 3.49 (93%)accountabilityvalidate practice 3.43 (93%) 3.29 (90%) 3.55 (96%)decisionscreate innovative, 3.32 (89%) 3.21 (87%) 3.51 (94%)scientific interventionsrespond to 3.40 (93%) 3.24 (90%) not surveyeddevelopmentsuse resources 3.04 (77%) 3.05 (76%) 3.25 (86%)efficientlyExpectations of Staff Nurses Perceived to be Held by Key Individuals. The staff nurses inthis sample believed that expectations held by their head nurses and nursing directors weresimilar. As agreement with all expectation statements would have resulted in a score of 18, themean of 17.8 for head nurses and 17.7 for nursing directors suggests that there was bothagreement and disagreement with the statements. The nurses’ own expectations were significantlyhigher than those perceived to be held by the head nurses and directors. Inspection of the scoresfor instructors (mean=19.3) and clinical nurse specialists (mean=18.8) indicate that the scoreswere also higher than perceived expectations by head nurses and directors, and may have beenhigher than the nurses’ expectations, but the small number of respondents precluded analysis.There were no differences in the reported expectations by the educational level of the nursesreporting. However, there was a difference between the perceived expectations of head nursesfrom hospitals of different sizes and an interaction effect between hospitals and level of100education. The apparent relationship between the perceived level of expectation and hospital sizewas not simple. From baccalaureate nurses, head nurse expectations for small hospitals receivedthe lowest scores, followed by medium, then large hospitals. However, from diploma nurses,large hospitals received the lowest scores and medium hospitals received the highest scores. Thisindicates that the staff nurses’ perception of head nurse expectations in hospitals of different sizesvary by educational level. For baccalaureate nurses, the perceived expectations increase withhospital size; for diploma nurses, the perceived expectations are highest in medium sizedhospitals, lower in small hospitals and lowest in large hospitals. The pattern for baccalaureatenurses follows the pattern of other organizational factors. The pattern for diploma nurses is moredifficult to explain. It may be that larger hospitals have more baccalaureate nurses resulting ina greater perceived or actual contrast between nurses from different educational levels.For the nurses’ reported expectations of nursing directors, there was also a significantdifference between hospitals of different sizes. Although no interaction effect was detected, thepattern of reported expectation of the nursing directors was similar for baccalaureate nurses asexpectation scores increased with hospital size. For diploma nurses, nursing director expectationscores were again highest for medium-sized hospitals. However, this was followed by largehospitals and then small hospitals. Because the interaction effect was not statistically significant,it can only be concluded that nursing director expectations are reported higher as hospital sizeincreases by both diploma and baccalaureate nurses. The increase in perceived expectations seemsreasonable and is congruent with the increase in research infrastructures and climate by hospitalsize.Although the expectations were reported by the staff nurses, the pattern of response issimilar to the expectations reported by key nursing personnel (Clarke, 1992). Because the samescale was used, the reported expectations from the current study can be compared with the101expectations reported by Clarke (see Table 46).The rank order of research expectations is different and the mean scores of the staff nurses’perceptions of the expectations of key individuals are lower than the expectations as reported toClarke by key individuals. However, there is a greater similarity between the staff nurses’perceptions of themselves and the expectations reported by Clarke than between the other setsof expectations. Inspection of these scores suggests that the staff nurses’ perceptions of nursingdirectors expectations are lower than, but similar to those reported by hospital personnel. It alsosuggests that the expectations of nursing personnel are more similar to the nurses’ ownexpectations than the nurses think.Table 46Comparison of Expectations from Current Study and from Clarke (1992)Expectation Mean Item Score (Rank)StatementOwn Head Nurse Nursing Director ExpectationsExpectations Expectations Expectations Reported by KeyReported by Staff Reported by Staff Hospital PersonnelNurse Nurse (Clarke, 1992)apply findings to 3.40 (1) 3.21 (1) 3.10 (2) 3.29 (2)practicecritically question 3.39 (2) 3.19 (2) 3.04 (4) 3.35 (1)practicepromote research 3.28 (3) 3.13 (3) 3.14 (1) 3.20 (3)climatecollect data for 3.18 (4) 3.10 (4) 3.05 (3) not surveyednursing researchcollect data for non- 2.69 (5) 2.63 (5) 2.62 (6) not surveyednursing researchconduct research 2.58 (6) 2.63 (6) 2.72 (5) 2.38 (4)The staff nurses perceive the expectations of the head nurses and nursing directors to belower than their own expectations. This finding is corroborated by Clarke’s report of expectationswhich are also lower than the staff nurses’ own expectations. Expectation scores vary with102hospital size, and educational level appears to affect perception of expectations, especially withregard to head nurse expectations. The perceived head nurse and nursing director expectationswere correlated with the nurses’ own expectations, but not with any other individual characteristicor change factor. Both perceived head nurse and nursing director expectations correlated with allof the organizational variables.Research Climate. The low opinion of research climate and significant difference betweenhospital sizes are consistent with the low estimates of infrastructure and the lower levels of otherorganizational factors reported by nurses from smaller hospitals. Crane (1989) measuredorganizational climate and organizational resources and reported the mean scores for nurses usingtwo different dissemination methods. However, she did not report the range of scores and did notcompare hospital sizes.The climate statements in the current study were ranked in a similar manner as the samestatements in Clarke’s (1992) survey of B.C. hospitals. In the current study, 74% of nurses agreedthat they are encouraged to question their nursing practices and three other statements receivedover 50% agreement. However, the seven remaining statements received less than 50%agreement. The climate scores tended to be higher and there was a higher percentage ofagreement with all statements when reported by key personnel in Clarke’s study than whenreported by staff nurses in the current study or in the study by Alcock et al. (1990).A comparison of staff nurses opinions of climate in the current study and the study byAlcock et al. with Clarke’s findings is summarized in Table 47. This comparison indicates thatClarke’s nursing department leaders tended to have higher estimates of the climate with regardto staff nurses (encouragement to question, use findings, conduct research and recognition) thanthe staff nurses themselves. Conversely, the staff nurses seem to give higher estimates of theavailable supports (support strategies, interest from other staff nurses and students) than do the103personnel responsible for those supports. It seems that nurses in these samples tended to be morecritical of areas with which they were most familiar.Table 47Comparison of Response to Research Climate Statements by Staff Nurses and Key NursingDepartment PersonnelResearch Climate Statement Staff Nurse Mean Staff Nurse OrganizationalScore (Percent Percent Personnel Mean ScoreAgreement) Agreement (Percent Agreement)_________________(Alcock, 1990) Clarke, 1992Nurses are encouraged to question 2.90 (74%) 41% 3.51 (97%)nursing practicesNurses are encouraged to use 2.70 (62%) 48% 3.21 (85%)research findingsThere are strategies to support 2.57 (58%) * 2.21 (36%)research activitiesOther staff nurses are interested 2.54 (57%) * 2.28 (34%)in researchOther disciplines are interested in 2.31 (46%) 69% 2.52 (53%)research collaborationNurses who participate in 2.32 (43%) 38% 2.63 (56%)research receive recognitionNurses are encouraged to conduct 2.32 (42%) * 2.72 (60%)research studiesStudents conduct research studies 2.27 (42%) * 2.12 (32%)Professors conduct research 2.16 (35%) * 2.06 (27%)studiesPhysicians support nursing 2.15 (35%) 38% 2.19 (30%)researchProfessors are available to 2.03 (29%) 41% 2.03 (25%)consult, advise, collaborate*Statements not comparableThe responses were very similar in both B.C. studies regarding support from nursingprofessors and physicians. However, the responses regarding nursing professors are likely to berelated to the fact that most of the hospitals (especially small hospitals) were not likely to have104nursing professors associated with them. The similarity in the mean scores of the two statementsabout nursing professors, in both the current study and the study by Clarke, suggests that nursingprofessors who are seen to conduct research are also seen to be available for consultation. Thisconclusion is different from that of Clarke (1992) who concluded that professors who conductresearch are not necessarily seen by those responsible for research in hospitals as available forconsultation.The research climate scale was somewhat problematic as it contained items that overlappedwith items covered under infrastructures (e.g. strategies for support, professors to consult).Furthermore, items such as the two regarding nursing professors automatically gave a larger scoreto larger hospitals which were more likely to be associated with nursing schools.In summary, staff nurses’ reported the research climate to be low, with the scores beinglowest in small hospitals. The climate scores tended to be lower than, but similar to, scoresobtained from hospital personnel regarding staff nurses and from personnel in schools of nursingregarding faculty.The fact that all of the organizational factors increased with hospital size supports theassumption that research resources, supports and expectations increase as hospital size increases.The fact that all of the organizational factors were inter-correlated suggests that the staff nurse’sview of nursing within the organization is cohesive. It may also reflect real cohesiveness andinterrelationships with regard to research within nursing organizations. The relationships betweenthese factors also support the conceptual framework, as anticipated relationships were supported.Research Utilization OutcomesResearch utilization outcomes included the nurses’ opinions of their own general use ofresearch and their ratings of their frequency of using specific research based practices. Previousstudies have used specific practices as measures of research use.105General Use of Research. As rating all statements as “sometimes” would result in a scoreof 20, the mean of 22.7 for this sample suggests that the nurses thought they used research tosome extent. One of the limitations of this study is the fact that it is difficult to interpret what“sometimes” meant to the nurses and impossible to know to what extent nurses were biasedtoward giving a socially favourable response. The distribution of the scores illustrates that thescores of most nurses were clustered around this mean and that, as only 8% had scores higherthan 30, few nurses responded “always” to any of the statements. There was no reporteddifference between respondents from different educational levels or different sizes of hospital,but there was considerable variation in the responses to different items.The fact that statements regarding the actual implementation and evaluation of practicebased on research were less well supported than statements regarding questioning practice andcommunication of concerns suggests that assessment of research-based practice is done morethan implementation of research-based practice. It was discouraging to note that the least wellsupported statement was about the use of research articles to support questioning of practice. Oneof the limitations of this study (as with any survey) was that the nurses’ perceived basis forquestioning practice was not identified.The statements regarding the identification of hospital policies were also problematic. It wasimpossible to know if the nurses could or could not identify policies based on research becausethe policies themselves were or were not based on research, or because the nurse did not knowthe research support well enough to evaluate the basis of the policies. These statements thereforemay reflect the nurses’ knowledge or the status of policies.The response to the use of research in general appears to be more favourable than theresponse to the use of specific findings. This may be partially due to the fact that, as Lomas(1993) points out, research-based practice is not the “black and white” implementation of findings106but rather decisions in grey areas. Lomas criticized research on medical decision-making forfocusing on the use of clear and unambiguous findings. Similarly, research on the use of findingsin nursing practice has focused on unambiguous findings and therefore may not have accuratelyportrayed research-based nursing practice. Measuring general use of research may captureconviction about application in general, or cognitive application of research, rather than specificbehavioral change. Alternatively, the statements about use of research in general ask the nurseto make broad generalizations about practice and might be expected to be more positive. Thismeasure may simply be another measure of the nurses’ attitudes toward research rather than anactual estimate of practice behaviour.The general use of research seemed to be similar regardless of the nurses’ educational levelor hospital size. The nurses reported using research to some extent and tended to focus onquestions and concerns about practice rather than on the actual use of research to improvepractice. General use of research correlated with the use of specific findings and with all of theindividual factors but none of the organizational characteristics.Use of Specific Research Findings. Of the ten specific findings that were used as a measureof the use of research in practice, nine were used at least sometimes by over half the nurses. Thefindings were used at least sometimes by 49% - 96% (average of 77%) of nurses. This level ofuse is comparable to the findings of Brett (1987) who found that 31% - 93% (average of 61%)of nurses used the 14 findings she studied, and Coyle and Sokop (1990) who found that 26%-93% (average of 54%) used the same 14 findings. It is important to note that the ten findingsused in this study were the same as those used by Brett and by Coyle and Sokop.One explanation for the higher percentage of use in the current study is that the numberof years between studies may have allowed the findings to become more well known. In addition,four of the practices were eliminated, which may have resulted in findings which are more well107known or more appropriate to current practice. Another explanation is the fact that neither Brettnor Coyle and Sokop identified whether or not practices were applicable to the nurses’ practice.When Coyle and Sokop excluded nurses who were not aware of findings, they found that 71-100% used the innovations under study. Similarly, Winter (1990) found that 56.5% of nurses whoknew about relaxation therapy research used the findings in practice. Although the nurses in thecurrent study were not asked if they were aware of the specific findings, the opportunity toindicate that the fmdings were not applicable may have partially served the same purpose.Interpreting the practical significance of the level of use of specific findings is difficult,partially because of the limitations of the study. The survey approach did not permit identificationof the reasons for non-use of findings. There was no possibility of finding out whether nurses didnot use a particular finding because of a lack of knowledge or lack of persuasion on the part ofthe nurse, or for some other reason. Other possible reasons for non-use of findings include 1) thefindings might not be applicable to a specific patient, 2) organizational policy may preclude use,3) norm or job descriptions may preclude use, or 4) more recent innovations may have made theinnovation out-dated. Given these possibilities, it may be that an average use of 77% could beconsidered high. Although other studies have measured use in a similar manner, none of theauthors have attempted to establish what an ideal level of use might be.The percentage of nurses who found that the specific research findings were not applicablewas interesting. Urine testing was rated ttNot Applicable” by 36%, and comments that bloodglucose monitoring had replaced urine testing were frequently added to the survey. Althoughsome nurses may not nurse preoperative patients, it is difficult to explain why three items relatedto preoperative preparation (relaxation, teaching, and giving sensory information) were rated “NotApplicable” at different rates (20%, 38% and 19%, respectively). It was also difficult tounderstand why 5% of nurses considered mutual goal setting and giving sensory information108before diagnostic procedures “Not Applicable”. The survey approach limited obtainingexplanations for these findings.This measure of specific research utilization was similar to the general use of research interms of there being no differences between nurses of different educational levels or in hospitalsof different sizes. The two measures of research utilization were correlated, although weakly. Itseems that the nurses’ individual characteristics and change factors influenced their general useof research which may have moderated the organizational influences on the use of specificfindings.Comparison of Findings by Nurses’ Educational LevelEducation was a major professional characteristic on which all other research utilizationpredictor and outcome variables were compared. Nurses with baccalaureate degrees hadsignificantly more research related experience and had significantly higher scores on their valuefor research. Most of the difference in research experience was due to the large number ofbaccalaureate nurses who had taken statistics and research methods courses. It may be that thegreater research experience of baccalaureate nurses provided opportunities for those nurses todevelop more value for research. The difference in value for research may also account for thehigher response rate from baccalaureate nurses regarding the use of research. However, therewere no significant differences between the groups on the other individual change factors ofresearch interest or expectations to use research.Bostrom, Malnight, MacDougall and Hargis (1989) report similarities and differencesbetween baccalaureate and diploma nurses in terms of interest and attitudes toward research andpreparedness for conducting research. However, because their group sizes were greatly unequal(only 13% baccalaureate degrees) and no statistical analysis of the findings was reported, theirfindings cannot be compared with the current sample.109Alcock et al. (1990) found that baccalaureate nurses reported higher research experience andvaluing of research. However, these authors additionally found that baccalaureate nurses hadhigher interest in research and higher research expectations, not confirmed in the current study.Again, Alcock et al. used greatly unequal group sizes: 74% diploma nurses and 26%baccalaureate nurses and had a different sample composition in terms of variety in place ofemployment and part and full time employment.The two groups in the current survey also reported similar views of their organizations, asthere were no differences by educational level in nursing department value for research,organizational climate, or organizational expectations to use research. Although the baccalaureategroup tended to report higher organizational infrastructures, the difference was not significant.There were also no differences between educational level in the reported general use ofresearch or use of specific findings. Champion and Leach (1989) measured nurses’ self reportedgeneral use of research and also did not find education to be significant predictor. These concurwith Brett (1987), Crane (1989), Coyle and Sokop (1990), Ketefian (1975) and Winter (1990).Overall there was little difference between baccalaureate and diploma nurses in this study inresearch utilization predictor or outcomes variables. The only differences noted betweeneducational levels were in research experience, which may be a direct consequence of educationalexperiences, and value for research, which may be related to greater research experience. Thisstudy supports earlier findings that educational level is not a significant predictor of researchutilization.Comparison of Findings by Hospital SizeIt was anticipated that the organizational characteristic of hospital size would influence otherorganizational characteristics and change factors. Differences between hospital sizes were foundfor all of the organizational change factors and the organizational infrastructures. The perceived110nursing department value of research, the research climate, infrastructures and expectations bykey individuals for staff nurses to use research were all significantly different by hospital size.All of these variables increased as hospital size increased from small, to medium, to large. Therewere, however, no differences in any of the personal or professional characteristics, or individualchange factors between nurses working in hospitals of different sizes. There were no differencesin the value for research, interest in research, research experience or expectations of self. Therewere also no differences in general use of research or use of specific findings between nursesfrom hospitals of different sizes. This suggests that while increased organizational resources resultin more support and higher expectations for research, the research-related attitudes, values andbehaviours of nurses practising in those hospitals are not significantly affected.Previous studies have presented conflicting results regarding the influence of hospital sizeon the use of research. Kirchoff (1982) found a difference in hospital sizes related to the use ofcoronary precautions, whereas Brett (1987, 1989) did not find a difference between hospital sizeand the use of 14 specific findings. Kirchoff also found a difference in the use of the specificfinding and the hospital type (state, private) and location (urban, rural), whereas Brett did not.These studies classified hospital sizes differently, with Kirchoff having six categories and Bretthaving three. The categories used by Brett were used in this current study, but the type andlocation of hospitals were not considered. It may be that differences would have been found inthe current study if finer categories were used. There may have been differences amongrespondents within the small hospital category in the current study, as responses indicated thatthese nurses were from hospitals as small as 14 beds and as large as 250 beds. As infrastructuresand climate increases with hospital size, it could be anticipated that even greater variation wouldbe seen if smaller categories were used.None of the personal or professional characteristics or research utilization outcomes were111significantly different by hospital size; all of the organizational factors were significantly differentby hospital size.Relationships Between Individual and Organizational Factors and Research UtilizationThe factors within the three components of individual factors, organizational factors andresearch utilization outcomes were seen as interrelated. The relationships between thesecomponents are discussed in this final section.Individual Factors. The individual factors assessed the demographics as well as thepersonnel and professional factors that served as study variables. While the demographic variablesdid not correlate with any of the study variables, all individual factors were interrelated andcorrelated with the general use of research. The nurses’ own expectations also correlated withreported head nurse expectations, and research experience correlated with reported infrastructures.The age of the nurses did not correlate with any of the study variables except with the yearssince graduation. To date, only Winter (1990) has reported on the relationship of age to researchutilization. She did not find any significant differences related to age.It was also noted that the years since graduation did not correlate with any of the studyvariables. Thirteen of the diploma nurses and eight of the baccalaureate nurses did not report theiryears since graduation. As these nurses were in a wide variety of age categories and reportedtheir ages, the omission of this information did not seem to be related to age. Previous studiesthat considered years since graduation have produced conflicting results. Kirchoff (1982) founda significant relationship between years since graduation and the use of coronary precautionswhereas Ketefian (1975) found no difference in the use of correct temperature technique andBrett (1987) found no difference in the use of 14 specific findings by years since graduation. Itis also relevant to note that previous studies (Champion & Leach, 1989; Coyle & Sokop, 1990;Winter, 1990) have not found significant differences in research utilization in relation to years112of nursing experience.The lack of significant relationships between age and years since graduation and researchutilization outcomes questions the influence of both education and experience. One possibleexplanation for the lack of a relationship is that because the majority of nurses in the samplegraduated within the past 10 years, variation in the time since graduation and thus, variation inthe quality and content of education, may not have been sufficient to show differences in researchutilization variables. However, it seems that the range in years should have been sufficient todemonstrate a difference if experience as an important time-related predictor of researchutilization. Another explanation is that education has a lasting effect or little effect on researchutilization, either of which would result in little difference in research use over time. This studyadds to growing evidence that age and years since graduation are not predictors of research use.In the current study, research experience had a low correlation with the nurses’ expectationsof themselves to use research, interest in research, and general use of research findings, but didnot correlate significantly with any of the other study variables. As noted earlier, although theyhad higher research experience, the baccalaureate nurses did not have higher expectations orinterest in research or higher reported use of research. Baccalaureate nurses had higher valuescores, but value and research experience did not correlate for the sample or for the subgroupsby educational level.Alcock et al. (1990) found significant low correlations between research experience andresearch interest (r=0.41). However, in contrast to the current study, Alcock et al. did not finda correlation between experience and expectations, but did find a low correlation with researchvalue (r=0.36). Other studies (Crane, 1989; Champion & Leach, 1989) have considered researchexperience only in relation to the use of specific fmdings, and have found no significantrelationships. In the current study, there was no significant correlation between research113experience and the use of specific findings. Crane (1989) found a significant relationship betweenhaving specific research responsibilities at work and the use of specific findings. However, in thecurrent study, few nurses had any experience with research beyond courses or attendingconferences, so this comparison could not be made. The findings of this study suggest thatresearch experience is related to increased expectations to use research, interest in research andreported general use of research but, in agreement with earlier studies, is not related to the useof specific findings.The nurses’ value for research had a moderate correlation with expectations to use research;a low but significant correlation with interest in research; a low correlation with general use ofresearch findings; but no relationship with the use of specific findings. Alcock et al. (1990) foundthat value for research correlated with experience (r=0. .45), research interest (r=0.54) andexpectations (r=0.36). Champion and Leach (1989) also found a significant correlation (R=O.65)between attitudes toward research and self-reported general use of research and found thatattitude accounted for 42% of the variance in general research use.Interest in research was moderately correlated with expectations to use research and showeda low correlation with value for research and research experience. All of these correlations werealso found by Alcock et al. (1990). The nurses’ own expectations were moderately correlatedwith value for and interest in research and showed a low correlation with experience. Thestrongest correlations with research utilization outcomes were those between the nurses’ interestand expectations and general use. Again these findings are congruent with those of Championand Leach (1989) regarding the relationship of attitude and general use of research. This studyadds to evidence that attitude is positively related to the use of research.The personal and professional characteristics of education and age did not seem related toother research-related characteristics or to research utilization outcomes. However, the nurses’114research experience appeared to be related to individual change factors and general use ofresearch. The individual change factors of interest, value and expectations were inter-correlatedand correlated with research experience. These four factors are related to general use of researchfindings, but not to the use of specific findings.Organizational FactorsThe nurses’ assessment of the expectations of head nurses and nursing directors correlatedwith their own expectations, but none of the other organizational factors correlated withindividual factors. None of the organizational factors correlated with general use of research, buttwo of the organizational factors, infrastructure and research climate, correlated with the use ofspecific research findings.The correlations between expectations suggests that the nurses have cohesive views of theirpractice and to some extent think that their practice is congruent with the expectations of others.Neither their assessment of nursing director expectations nor head nurse expectations correlateddirectly with research utilization outcomes suggesting that the perceived expectations of keyindividuals may not have a direct effect on practice. Champion and Leach (1989) also found nocorrelation between the nurses’ reported use of research and their opinions of others until theydid correlations with specific administrators. However, because they studied a single communityhospital, their results pertain to specific key individuals rather than key roles. The current surveydetected a difference between organizational expectations and nurses’ expectations of themselves,but did not clarify the complex relationship between expectations and research utilizationoutcomes. It did, however, add to understanding and show the complexity of the situation.Infrastructures were related to other organizational characteristics and change factors andseemed to be related to research utilization outcomes, especially the use of specific findings. Thenumber of infrastructures were correlated with all of the organizational variables and with the use115of specific research findings. The correlation between infrastructures and the general use ofresearch was too low to be considered (r=0.24). However, correlations by hospital size revealedthat the correlation became stronger as hospital size increased from small (r=0.09; p=O.49), tomedium (r=0.36; p=O.OO), to large (r=0.42; p=O.OO). This suggests that research-relatedinfrastructures may affect the use of specific practices more strongly than they affect the nurses’opinions of their general use of research.Brett (1989) found conflicting relationships when examining specific infrastructures. Shefound that in small hospitals, mechanisms to support nurses doing research and exposure topublications was positively correlated with the use of findings. However, she found that in largehospitals these same infrastructures and those intended to promote attendance at conferences andpresentations, performing research duties in work and inducements to learn were negativelycorrelated with the use of specific findings. It is also relevant to note that Brett (1987) and Coyleand Sokop (1990) all indicated that perception of hospital policy was related to the use ofspecific findings. It is therefore not surprising that the nurses’ perceptions of organizationalinfrastructures were related to the use of specific findings.Similarly, the research climate correlated with all of the organizational characteristics andchange factors and with the use of specific research findings, but did not correlate with generaluse of research. The research climate had a fairly high correlation with infrastructure (r=0.63) andseveral of the items seemed to overlap with infrastructure, suggesting that the research climateand infrastructures are closely related and may be defining the same construct.The low correlation of infrastructures and climate and the absence of a correlation betweenthe other organizational factors and research utilization outcomes does not mean that theorganizational context is not influential. The nurses who responded to the survey added revealingcomments. One nurse stated, “Our hospital is very rigid and backwards in regards to116administration. The new head nurse is trying hard to develop (a research climate), but it’s likebanging your head against a brick wall”. Another nurse made the comment, “Don’t make wavesattitude” referring to research climate. Another nurse wrote, “If my hospital involved moreresearch it would improve nursing and patient care 100%”.Several nurses commented on the difficulty of using research-based practice within thecurrent practice setting. For example, a nurse wrote, “As an RN who works on a ward I find itdifficult to answer these questions. Being short staffed, we don’t have time for research in ourwork day”. Others suggested that the context of practice was broader than the context addressedby the study. For example, one nurse commented that “people in this town won’t accept it(referring to changing nursing practice based on research)”, and several other respondents madecomments on the lack of nursing control over resources and decisions.There was a wide range and considerable variability in the research climate andinfrastructure scores, suggesting a wide range of opinion and a wide range of organizationalsupport for research. The nurses’ individual characteristics may mediate the influence of theorganization on research practice, thus obscuring the relationship.Research Utilization OutcomesThe two measures of research use were correlated. General use of research correlated withall of the personal and professional characteristics and change factors but none of theorganizational characteristics. The use of specific findings was correlated with two of theorganizational variables (organizational infrastructure and research climate), but did not correlateto any of the personal or professional variables. Although research climate and infrastructuresvaried by hospital size and correlated with the use of specific findings, the use of specificfindings did not vary by hospital size. It seems that both individual and organizationalcharacteristics are related to the use of research, but that individual factors influence how nurses117perceive their general use of research, whereas organizational factors influence the use of specificpractices. The relationship between the nurses’ individual factors and general use suggests thatthe nurses’ values, attitudes and expectations are congruent with their perceived behaviour. Inother words, the nurses see themselves generally practising as they expect themselves to and incongruence with their values and interests. The relationship between the organizational factorsand the use of specific findings suggests that the organizational infrastructure and climate is moreinfluential in the use of specific findings than individual factors are. This finding is congruentwith the findings that the perception of hospital policy influences the use of specific findings(Brett, 1987; Coyle & Sokop, 1990). Previous lack of attention to organizational variables mayexplain the inconclusive findings regarding the predictors of use of specific findings. Finally, thefact that the use of specific findings did not vary with hospital size but correlated with researchclimate and infrastructures which did vary by hospital size, suggests that the individual factorsmay mediate the influence of the organizational factors on the use of specific findings.Theoretical and Methodological ConsiderationsThese research results support the components and relationships proposed in the conceptualframework. The findings support Crane’s (1989) conclusion that individual factors are not directlyrelated to the use of specific findings. Rather, organizational factors have a direct influence onthe use of specific findings and individual factors mediate the influence of organizational factors.However, the findings also suggest a relationship between individual factors and general researchuse, which was not proposed in the model by Crane. Previous studies, including Crane’s, haveexamined the use of specific findings, but not the general use of research.The results of this study confirm, complement, and extend previous research fmdings. Thelevel of research use is similar to that of previous studies. The influence of individual factorssuch as education, attitude and experience were similar to previous studies. The findings118regarding the influence of organizational factors supports the work of Crane (1989), Clarke(1992) and Clarke and Joachim (1993) in clarifying the understanding of the importance oforganizational value, climate and infrastructure. The findings regarding the influence ofexpectations extends understanding of the influence of both individual and organizational factors.This study has inherent limitations common to survey research. Specifically the differencesbetween respondents and non-respondents was not known and the organizational expectations andsupports were reported from the perspective of the staff nurse. However, the impact of theselimitations is lessened by the stratified random sample, reasonable sample size and theopportunity to compare the findings with those of Alcock et al. (1990), Clarke (1992) and Clarkeand Joachim (1993) obtained using a similar instrument and comparable geographical areas.Additional limitations were related to hospital size categories, the measurement of researchuse and problems with individual items on the survey. The categories of hospital sizes werebroad, possibly limiting the detection of differences in research use between sizes. This problemmay have been especially important regarding the small hospital category. The measurement ofresearch utilization was also problematic. First, research use was measured from the perspectiveof the nurse. Second, the general use of research may have only been another measure of attitude.Third, measurement of the use of specific findings was limited to practices which have varyingapplicability and there was no means of clarifying the meaning of responses or the reasons fornon-use. Finally, the survey had some items that were clearly difficult to interpret and there wasno way to clarify responses.SummaryIn this study, the sample consisted of 183 staff nurses working in medical-surgical andcritical care areas of hospitals of different sizes in British Columbia. The stratified samplingresulted in a sample which consisted of 45% diploma educated nurses and 54% baccalaureate119educated nurses. The representation from educational levels and hospital sizes yielded subgroupsthat were sufficiently similar in size to permit the use of analysis of variance. The sample wassimilar to the population of nurses in B.C. in terms of gender and age, but was purposefullystratified to over represent baccalaureate educated nurses and nurses working in medical-surgicalor critical care settings.While the response rate (42%) was adequate for a mail survey, the response rate differed byeducational level and it was not known how the non-respondents differed from respondents.Overall, the nurses in the sample had very positive attitudes toward research and had highexpectations of themselves. There was little difference between educational preparation, with onlyresearch experience and value for research showing significant differences. Individual factors andresearch utilization outcomes did not vary with hospital size; however, the nurses’ opinions oftheir organizations varied considerably with organizational size and with organizational support,and expectations for research utilization generally increasing with hospital size. The nursesreported moderate general use of research and of use of specific findings at levels that arecomparable to or better than previous findings. Education does not seem to significantly influenceresearch utilization. Individual factors seem to influence general use of research whereasorganizational factors influence the use of specific findings. Organizational size influences theresearch-related organizational characteristics but does not influence the use of specific researchfindings.The relationships between the individual factors, organizational factors and researchutilization outcomes had a definite pattern. All of the organizational factors varied with hospitalsize, whereas none of the individual factors did. None of the organizational factors varied withthe nurses’ educational levels whereas the individual factors of value for research and researchexperience were higher for baccalaureate nurses. All of the individual factors were inter-related120and all of the organizational factors were inter-related, however, there was little correlationbetween individual and organizational factors. The only correlations between individual andorganizational factors were the correlation between respondents’ reports of head nurseexpectations and their own expectations to use research and the correlation between the nurses’research experience and perception of organizational infrastructures. In terms of researchutilization outcomes, the general use of findings was related to individual factors and the use ofspecific findings was related to organizational factors. All of the individual factors were relatedto general use of research and there were no differences between nurses of different educationallevels or hospital sizes. Only two organizational characteristics (research climate andinfrastructure) and none of the individual characteristics correlated with the use of specificfindings.This study supports the conceptual framework proposed by Crane (1989) and suggests meritin adding the concept of general use of research. The results confirm previous findings regardinglevels of research use and the influence of individual factors such as education, attitude, andexperience. The findings about the influence of organizational factors increases understanding ofthe importance of organizations communicating value, setting climate and providing infrastructuresupport for research, and offers new understanding regarding the influence of nurses’ expectationsin this regard.The major limitations of this study include the unknown differences between respondentsand non-respondents and the fact that organizational factors were reported from the perspectiveof the staff nurse. However, the stratified random sample, reasonable sample size and theopportunity to compare the findings with similar studies strengthened the validity andgeneralizability of the study.In this chapter, the survey results have been presented, analyzed and discussed. In the next121chapter, the study will be summarized and the implications for nursing practice, education andresearch that arise from this study’s conclusions will be presented.122CHAPTER FWESummary, Conclusions, and ImplicationsThis study was designed to describe the levels of organizational expectations andsupport for research use, levels of nurses’ expectations of themselves to use research, andlevels of research use by staff nurses. The study was further designed to investigate therelationships between nurses’ use of research and their expectations of themselves, how theyperceived their employers’ expectations and organizational support for research utilization.The study compared the levels and relationships between these research predictor andoutcome variables for groups of randomly selected diploma and baccalaureate prepared nursesworking in hospitals of different sizes. In this final chapter, the study is summarized and theconclusions are presented. The implications for nursing practice, education and research arealso presented.Summary of the Research ProjectA review of the literature revealed that previous studies had focused on the influence ofthe characteristics of individual nurses on the use of specific research-based practices (Brett,1987; Coyle & Sokop, 1990; Ketefian, 1975; Kirchoff, 1980; Linde, 1989, Winter, 1990) andon the factors influencing dissemination, communication and use of findings (Champion &Leach, 1989; Crane, 1989; Funk, Champagne, Wiese & Tornquist, 1991b). Mostinvestigations of the influence of organizational factors on the use of research were limitedto secondary consideration within studies that focused on the characteristics of individualnurses (Brett, 1986; Champion & Leach, 1989; Coyle & Sokop, 1990; Crane, 1989; Funket a!., 1991 b; Kirchoff, 1982; Linde, 1989). The organizational characteristics of hospital size123(Brett, 1987; Kirchoff, 1980) and research support mechanisms (Brett, 1989; Crane, 1989)were studied, but results were inconclusive. Other studies (Champion & Leach, 1989; Coyle& Sokop, 1990; Funk et al., 1991b; Linde, 1989) each considered different organizationalcharacteristics, and thus their findings were not confirmed. The only organizationalcharacteristic which was consistently shown to influence the use of research in practice wasthe perception of unit policy (Brett, 1986; Coyle & Sokop, 1990; Kirchoff, 1982). Theseresearchers found a relationship between the perception that a policy existed regarding aspecific practice and the use of that practice, regardless of whether there was an actual policyin existence.More recently, organizational infrastructures and expectations for research have beendescribed from the perspective of key individuals responsible for research activities in healthcare organizations and schools of nursing (Clarke, 1992; Clarke & Joachim, 1993) and fromthe perspective of staff nurses (Alcock et a!., 1990). However, no research has been reportedregarding the influence of organizational support or expectations on research-based practice.The purpose of this study was to investigate the organizational support and expectations forresearch and their influence on the use of research findings in nursing practice from theperspective of the staff nurse.Crane’s (1989) conceptual framework guided this study to focus on the influence of theorganizational context, organizational change factors, individual characteristics, and individualchange factors on research utilization outcomes. The contextual variables considered werehospital size and research-related infrastructures. The organizational change factors includedthe nursing department’s value for research, the expectations for research-based practice124perceived to be held by key nursing personnel, and the organization’s research climate. Theindividual characteristics included demographics and the nurses’ education and researchexperience. Finally, individual change factors included the nurses’ own value for research,interest in research and expectations to use research in practice. This researcher viewed thesevariables as predictors of research utilization outcomes. The research outcomes consideredwere the nurses’ views of their general use of research and their use of ten specific findingsidentified in earlier studies (Brett, 1987; Coyle & Sokop, 1990).This descriptive correlational survey was conducted using a stratified random sample ofstaff nurses working in British Columbia. The sample was stratified by educational level(diploma and baccalaureate) and by district to obtain responses from nurses working inhospitals of different sizes. Four hundred and fifty (450) nurses were surveyed by mail. Allparticipants completed the Research Use in Nursing Practice instrument modified from Clarke(1991). Consent to participate was assumed by the nurses returning the completed survey.Descriptive and parametric statistics were used to analyze the data.Responses were obtained from 183 staff nurses (42%) who worked in medical-surgicaland critical care areas of hospitals of different sizes in British Columbia. The stratifiedsampling resulted in 45% diploma educated nurses and 54% baccalaureate educated nurses.The sampling strategy also resulted in representation from hospitals of different sizes whichwere categorized as small (<250 beds), medium (250-499 beds) and large (>500 beds). Therepresentation from educational levels and hospital sizes yielded subgroups that weresufficiently similar in size to permit comparisons between groups and the use of analysis ofvariance.125The sample was similar to the population of nurses in B.C. in terms of gender, but waspurposefully stratified to over-represent baccalaureate nurses and to limit the study to nursesworking in medical-surgical or critical care settings. The sample was also more representativeof nurses working part-time than of the population of staff nurses working in B.C. acute carehospitals. The sample was younger than the overall population of nurses in B.C., but waslikely similar in age to nurses currently employed, especially those employed in acute carehospitals. While the response rate (42%) was adequate for a mail survey, the responsediffered by educational level. It was not known how the non-respondents differed fromrespondents. This posed the greatest limitation for the study.The nurses in the sample had very positive attitudes toward research and had highexpectations of themselves to use research in practice. The nurses had high value for research(mean=20.3; SD=2.99; possible range=6-24), high but varied interest levels (mean=30.7,SD=5.9; possible range=lO-40) and high expectations of themselves to use research(mean=18.2; SD=3.6; possible range=6-24). There were no differences between educationalgroups with regard to interest and expectations, but the baccalaureate nurses held asignificantly higher value for research. There was also a difference in research-relatedexperience, with the baccalaureate nurses having significantly more experience than diplomanurses. Overall, the nurses had little research experience (mean of 5.8 experiences per nurse;SD=3.3) and most of the difference was due to courses taken by baccalaureate nurses.Despite little research experience, the nurses’ values for research, interests in researchand expectations of self for using research were high in this sample regardless of educationallevel and hospital size. Although Alcock et al. (1990) found greater differences between126educational levels, the findings regarding in individual factors in the current study wereotherwise remarkably similar to previous research (Clarke, 1992; Clarke & Joachim, 1993;MacDougall & Hargis, 1989).The nurses reported moderate levels of general use of research (mean 22.7; SD=4.91;possible range 10-40) and of use of specific findings (average of 77% use at least“sometimes”) that were comparable to or better than previous findings (eg. Brett, 1987; Coyle& Sokop, 1990; Winter, 1992) but difficult to evaluate in terms of adequacy. As withprevious studies (Brett, 1987; Crane, 1989; Coyle & Sokop, 1990; Ketefian, 1975; Miller andMessenger; 1978; Winter, 1990) there were no differences in research utilization outcomesbetween educational levels and no differences were found between nurses from hospitals ofdifferent sizes.General use of research was correlated with all of the nurses’ individual characteristicsand change factors (r—0.37-0.51) but was not correlated with any of the organizationalcharacteristics or change factors. In contrast, the use of specific findings had significant lowpositive correlations with the organizational change factor of research climate (r=0.33) andthe number of research-related infrastructures (0.31), but was not correlated with any of theindividual characteristics or change factors. There was a low significant correlation betweenthe general use of research and use of specific findings (r=0.38). These findings wereinterpreted as indicating that general use did not measure the same behaviour as the use ofspecific findings. Nurses’ opinions regarding their general use of research may be useful, ormay simply be another estimate of attitude toward research rather than an estimate ofresearch-related behaviour.127The nurses’ opinions of their organizations varied considerably with organizational size,with the support and expectations for research utilization generally increasing with hospitalsize. The value for research that the staff nurses believed was held by the nursing departmentwas reasonably high (mean=19.5; SD=3.3; possible range 6-24), but not as high as the nurses’own value for research on the same scale (mean=20.3). The value for research wassignificantly different by hospital size, with value scores increasing from small to mediumhospitals and from medium to large hospitals. This contrasted with the nurses’ own value forresearch where there were no differences between hospital sizes.The staff nurses reported that the head nurse and director expectations to use researchwere fairly high (mean=17.7 and 17.8), but not as high as the nurses’ own expectations (mean18.2). The perceptions of nursing director expectations reported by the staff nurses werelower than, but similar in distribution and order of importance, to those reported by keyindividuals in hospital settings (Clarke, 1992). The nurses’ own expectations correlated withtheir perceived head nurses’ expectations, but not with the directors’ expectations. Thereported organizational expectations were lowest in small hospitals and highest in largehospitals, with the perception of expectations held by head nurses being influenced by thenurses’ educational level.The research climate was generally reported as low (mean=25.9, SD=6.8, possiblerange=1 1-44) and the number of infrastructures reported was low (mean=7.2 infrastructuresper organization). Opinions of the research climate were consistent with the findings of otherstudies by Alcock et a. (1990), Clarke (1992) and Clarke and Joachim (1992). The researchclimate and infrastructures were lowest in small hospitals and highest in large hospitals.128Organizational climate and infrastructures seemed to be the strongest factors influencingthe use of specific findings. This finding is congruent with earlier findings (Brett, 1986;Coyle & Sokop, 1990; Kirchoff, 1982) that perceptions of unit policy were influential onpractice. As with the other organizational factors, the climate and infrastructure werecorrelated with all of the organizational characteristics (r=0.49-0.56 and r=O.29-0.56,respectively). In addition, both the climate and infrastructures were inter-correlated (r=0.63)and correlated with the research utilization outcome of use of specific findings (r=0.33 and0.31, respectively). However, although these organizational factors varied by hospital size andcorrelated with the use of specific findings, the use of specific findings did not vary byhospital size. Whereas Crane thought that organizational factors overwhelmed individualfactors, the findings of the current study were interpreted as suggesting that nurses’ individualcharacteristics mediate the influence of organizational factors.The relationships between organizational and individual factors and research utilizationoutcomes were as predicted by Crane’s (1989) conceptual framework. The individual changefactors were inter-related (r=0.46-0.60) and correlated with the general use of research asreported by the nurses (r=0.4 1-0.51). The organizational change factors were also inter-related(r=O.47-0.67) and climate correlated with the use of specific findings. The organizationalfactors were not related to individual factors, except for the correlation between the nurses’own expectations to use research and the perceived head nurses’ expectations, and thecorrelation between research experience and reported organizational infrastructures. The useof specific findings was only related to organizational factors, whereas the second measureof research utilization (general use of research) was only related to individual factors. The129two measures of research utilization outcomes were also correlated. These findings wereinterpreted as providing support for Cranes’ conceptual framework.The major factors limiting the study were methodological concerns with the surveyinstrument, the fact that organizational factors were measured from the perspective of thestaff nurse and the low response rate. The internal validity of the study was limited by thefact that the organizational characteristics and change factors were reported from theperspective of the staff nurse. However, this can be viewed as a strength in that perceptionsof organizational supports and expectations are likely to be more influential on research-related behaviour than the presence of supports or expectations as perceived by others.Furthermore, comparison with the work of Clarke (1992) reveals that the perceptions of thestaff nurses were reasonably similar to those of key individuals in hospitals.The generalizability of this study is limited by the potential differences betweenrespondents and non-respondents. The non-respondents may have been significantly differentthan respondents in attitudes and expectations toward research and in levels of research use.However, the random selection, reasonable sample size and similarity of the sample to thepopulation of staff nurses makes it reasonable to generalize the patterns of relationshipsobserved in the study. The random selection makes it reasonable to generalize to staff nursesworking in medical surgical or critical care areas of hospitals in B.C. Given the similarity ofhealth care systems in Canada, it is also reasonable to generalize to other provinces. Becausethe sample was stratified, it is also reasonable to generalize to both baccalaureate and diplomaeducated nurses. Therefore, in the following section, conclusions which arise from this studyare presented.130ConclusionsBased on the limitations, the following conclusions seem reasonable. The first set ofconclusions that can be reached from this study pertain to the individual nurses’characteristics: their value for, interest in, experience with and expectations for using research.Nurses’ interests in research and expectations of themselves to know and use researchfindings seem to be similar regardless of educational level or hospital size. Nurses areespecially interested in knowing research results relevant to their area of practice, findinganswers to specific nursing problems and using research results to change practice. Nursesexpect themselves to use research, especially to critically question practice and to applyfindings to practice. Nurses who have baccalaureate education seem to hold higher value forresearch and have more research experience than nurses with diploma education.A second set of conclusions can be reached regarding the influence of individual factorson the use of research in practice. Nurses’ values for, interests in, experiences with andexpectations to use research seem to influence nurses’ perceived general use of research.These characteristics do not seem to directly influence the use of specific findings, but maymediate the influence of the organization on the use of specific findings. Educational leveldoes not appear to make a significant difference to the levels of general use of research orthe use of specific findings.This study also permits conclusions regarding nurses’ perceptions of organizationalchange factors. Nurses perceive the organizational climate and support for research to be low,especially in small hospitals. However, nurses perceive the organizational expectations for theuse of research to be fairly high but this varies with hospital size and lower than nurses’131expectations of themselves.Conclusions regarding the impact of the organizational context and change factors arenot easily drawn. While organizational size does not seem to influence nurses’ individualcharacteristics or use of research, organizational supports and expectations are higher in largerhospitals. Organizational climate and support do not appear to be related to general use ofresearch, but are related to the use of specific findings. These organizational variables werethe only factors which correlated with the use of specific findings. The results suggest thatorganizational climate and support are the strongest factors influencing the use of specificfindings.Conclusions regarding research utilization outcomes are also difficult to reach. Nurses’opinions of their general use of research appear to be related to the values, interests,experiences and expectations they hold regarding research. Nurses’ use of specific findingsare related to the presence of positive organizational factors. Neither general use nor use ofspecific findings were as high as would be ideal for a profession which aspires to beresearch-based. The findings suggest implications for the promotion of research-based nursingpractice.Implications for Nursing Theory, Practice and EducationThis study builds upon earlier research which has shown that nursing practice is notpredominantly research-based. However, this study reveals that both diploma educated andbaccalaureate educated nurses value, are interested in, and expect themselves to use researchin practice. This study also illustrates that the organizational context in which nurses practiceis influential. Theory, practice and education could be enhanced by the understandings offered132by this study.First, theory about research-based practice should be based on a more complexunderstanding of research, practice, and organizations. Nurses from education, research, andpractice need to understand that the factors influencing research-based practice are not limitedto the characteristics of the individual nurse. This study has demonstrated that organizationalinfluences need to be considered and modified to enhance research-based practice. Therefore,research-based practice must be thought of as a complex, multi-factorial situation that isinfluenced by the organizational practice setting as well as by the individual practitioner. Theconceptual framework used in this study could be used as a basis for understanding practiceand for educating nurses as well as for guiding future research. In addition to considering thegeneration, communication and evaluation of research findings, theories of research utilizationneed to focus on the implementation of research findings in practice.Second, nurses need to be educated to enhance the use of research in practice. The factthat education has not been shown to have a significant impact on research-based practiceshould not be interpreted as meaning that research-related education is not valuable. It maybe that the amount of research education that nurses receive is insufficient to have an impactor that the methods of teaching and/or the focus of research education have not beeneffective. It could also be that research utilization is not or has not been taught (H. Clarke,personal communication, April 6, 1994). It may also be that organizational factors limit theimpact of the individual nurse and his or her education. However, the findings that nurses areespecially interested in research activities that are directly related to their practice and specificpractice areas suggest that an integrated approach to teaching research (in addition to or rather133than the separate course approach) would likely be beneficial. These findings also supportrecent emphasis on research utilization in baccalaureate education. The findings furthersuggest that nursing education at both diploma and baccalaureate levels should build practice-related research activities into curriculum. For example, the research related to basic nursinginterventions should be introduced to beginning level students. The findings also suggest thatmore emphasis on research utilization in graduate programs is warranted. In introductorynursing courses and throughout their education, nurses should be required to evaluate thefindings from research to guide their practice. As noted by Akinsanya (1994), research shouldbe brought to the centre of basic nursing education.Third, practice environments need to promote research-based practice. As argued bySpence (1994), changes in education are unlikely to have an impact unless there are changesin practice organizations. The findings of this study illustrate that nurses are interested inresearch activities that are directly related to their practice. This suggests that expectationsfor research-based practice could be built formally into clinical practice requirements throughjob descriptions and performance appraisal systems, and that research activities directlyrelated to practice would be expectations that are acceptable to staff nurses. Additionalsupports, such as in-service education or consultative services, in the environment could targetenhancing research-based practice.The low perceptions of climate and support for research could be enhanced, especiallyin smaller hospitals. Although different supports for research in different sizes of hospitalswould be reasonable, hospital administrators could evaluate what their expectations are andhow their expectations will be supported. If a hospital is committed to research-based nursing134practice, the extent of that commitment should be reflected in the communication of thoseexpectations and the support available.The variation and discrepancies between organizational expectations and nurses’expectations for research use suggest that organizations could make expectations explicit andcommunicate expectations clearly. The frequency with which the nurses did not know whatresearch supports were available suggests that organizations could focus on communicatingthe available supports to staff nurses.Implications for Further ResearchThe findings of this study suggest implications regarding instrumentation, conceptualframeworks and methods to be used in further studies of research utilization. The findingsalso suggest further research that needs to be done.In terms of instrumentation, the results suggest that measuring general use of researchprovides different information than that obtained by measuring the use of specific findings.Although general use of research may only be another measure of the nurse’s attitude towardresearch, this suggests that the measurement of research-based nursing practice should not belimited to the implementation of specific findings. The scale measuring general use ofresearch should be further developed and refined.The high percentage of nurses who found the specific research findings “not applicable”to their practice indicates that methods of measuring research utilization must be more currentand specific to the nurses area of practice. Research findings in more specific areas ofpractice should be reviewed to identify research that is ready for implementation. This wouldprovide a better measurement of research utilization outcomes. The current study used135specific findings that were considered to be clearly appropriate for implementation as ameasure of research use. Further work also needs to be done to measure the use of researchwhere findings are not clear or are ambiguous. Research needs to explore how nurses can anddo incorporate research findings in making decisions about nursing practice. Finally, studiesto date have focused on reported use of research, but have not explored the relationshipbetween these reports and actual behaviour. Methods of measuring the actual implementationof research findings in practice must be sought. Triangulation through multiple data collectionmethods, such as observation and interviews, would be useful.Crane’s conceptual model guided the study in a useful and productive manner. Theresults support the framework and suggest that further work using it would be valuable. Themodel could now be tested using techniques such as LISREL. The data obtained in this studymay be useful for such testing.The survey approach used in this study prevented follow-up with the nurses to clarify andunderstand responses to questions and to explore the organizational context in which thenurses practice. For example, the influence of different levels of congruence between nurses’expectations and their perceptions of employer expectations or between their ownexpectations and their use of research could not be explored. The survey approach alsoprevented identification of factors influencing the use of research utilization from theperspective of the nurse. Further study using qualitative approaches would allow a deeperunderstanding of the complex problem of factors influencing research-based practice.Study of nurses’ value for, interest in, and expectations to use research should bereplicated with other samples. The impact of these characteristics needs further study to136identify why such high value, interest, and expectations do not result in research-basedpractice. The results of this study suggest that further exploration of organizational factorswould be valuable and might help to explain differences between nurses’ individualcharacteristics and levels of research-based practice. Further study of the impact oforganizational climate, support and expectations is required. These variables should bemeasured from the nurses’ and employers’ perspectives simultaneously and measurements ofcongruence between organizational and staff nurse perspectives should be obtained. Inaddition, similar studies should be completed in a variety of contexts, including otherprovinces, states or countries.This study supports the conclusion of earlier work that educational level does notinfluence research use. This surprising and interesting conclusion warrants investigation todetermine why the additional research experience and education about research did not resultin increased research use in practice. Further study to compare specific approaches to researcheducation are needed. The impact of courses focusing on research utilization and models ofintegrated research education should be evaluated.The strong support for research activities that are directly related to practice implies thatnursing research should continue to strive toward addressing research questions which arerelevant to practice and which answer specific practice problems.Some discrepancy between nurses’ expectations of themselves, organizationalexpectations and the use of research has been shown. However, further study is required tounderstand this complex relationship. The responses showed variation in the congruencebetween the expectations of the nurse and key individuals in the organization. However, the137survey approach prevented follow-up with the nurses to understand the influence of differentlevels of congruence. The survey approach also prevented identification of factors influencingthe use of research utilization from the perspective of the nurse. Further study usingqualitative approaches would allow a deeper understanding of the complex problem ofpromoting research-based practice.********This study focused on the relationship between organizational expectations and supportfor the use of research in nursing practice. While expectations were not shown to directlyaffect research utilization, organizational infrastructure and climate were found to beinfluential. The conceptual framework directed the study to consider the problem of research-based practice within an organizational context, but only examined that context in a limitedfashion. Lomas (1993) suggests that the use of research findings must consider thepractitioner as embedded in “a powerful network of influences” that include influences of theeconomic environment, the media and other professionals (p. 10). Further study of research-based practice should consider nursing practice within a broader context and should examinethe control of nursing practice within that broader context. Specifically, the influence of theeconomic context of practice and the influence of physicians should be examined. Finally,the question of who controls nursing practice should be addressed. Nurses are only able toimplement the findings of nursing research to the extent that they have control over theirpractice. Ultimately, nursing care of clients can only be improved through application ofknowledge generated and refined through research.138ReferencesAkinsanya, J.A. (1994). Making research useful to the practising nurse. 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(1988a). Theoretical approaches to the study of roles. In M.E. Hardy & M.E.Conway, Role Theory: Perspectives for professionals, (2nd ed., pp. 63-72). Norwalk,Conn.: Appleton & Lange.Coyle, L.A., & Sokop, A.G. (1990). Innovation adoption behaviour among nurses. NursingResearch, 39(3), 176-180.Crane, 3. (1985a). Using research in practice: Research utilization-theoretical perspectives.Western Journal of Nursing Research, 1(2), 261-7.Crane, J. (1985b). Using research in practice: Research utilization-nursing models. WesternJournal of Nursing Research, 2(4), 494-497.Crane, J. (1989). Factors associated with the use of research-based knowledge in nursing.Unpublished doctoral dissertation, University of Michigan.Cronenwett, L.R. (1987). Research utilization in a practice setting. Journal of NursingAdministration, 17(7/8), 9-10.Davis, B., & Simms, C.L. (1992). Are we providing safe care? Canadian Nurse, 89(1), 45-5.Davies, B., & Eng, B. (1991). Final report: Survey of nursing resarch programs in children’shospitals. Vancouver, B.C.: B.C. Children’s Hospital.Funk, S.G., Tornquist, E.M. & Champagne, M.T. (1989). A model for improving thedissemination of nursing research, Western Journal of Nursing Research, 11(3), 361-367.Funk, S.G., Champagne, M.T., Wiese, R.A. and Tornquist, E.M. (1991a). Barriers: Thebarriers to research utilization scale. Applied Nursing Research, 4(2), 39-45.140Funk, S.G., Champagne, M.T., Wiese, R.A. and Tornquist, E.M.(1991b). Barriers to using research findings in practice: The clinician’s perspective.Applied Nursing Research, 4(2), 90-5.Goode, C. 3., Lovett, M.K., Hayes, J.E. & Butcher, L.A. (1987). Use of research basedknowledge in clinical practice. Journal of Nursing Administration, 17(12), 11-18.Gordon, S., & Stokes, S.E. (1989). Improving response rate to mailed questionnaires. NursingResearch, 38(6), 375-6.Grinspun, D., MacMillan, K., Nichol, H., & Shields-Poe, D. (1992). Using research findingsin the hospital. The Canadian Nurse. 89(1), 46-48.Hardy, M.E., & Hardy, W.L. (1988). Role stress and role strain. In M.E. Hardy & M.E.Conway, Role theory: Perspectives for professionals. 2nd Ed., pp. 29-62). Norwak, conn,:Appleton & Lange.Havelock, R. (1969). Planning for innovation through dissemination and utilization ofknowledge, University of Michigan, Ann Arbor, MI: Institute for Social Research.Havelock, R. (1973). The change agent’s guide to innovation in education. Englewood Cliffs,N.J.: Educational Technology Publications.Horsley, 3., & Crane, J. (1986). Factors associated with innovation in nursing practice. FCH,9(1), 1-11.Horsley, J., Crane 3., & Bingle, J. (1978). Research utilization as an organizational process.Journal of Nursing Administration, 8, 4-6.Hunt, J. (1981). Indicators for nursing practice: The use of research findings. Journal ofAdvanced Nursing, 6, 189-194.Hunt, M. (1987). The process of translating research findings into nursing practice. Journal ofAdvanced Nursing, 12, 101-110.Kazanjian, A., Pulcins, I., & Kerluke, K. (1992). A human resources decision support model:Nurse deployment patterns in one Canadian system. Hospital and Health ServicesAdministration, 37(3), 303-3 19.Ketefian, S. (1975). Application of selected nursing research findings into nursing practice: Apilot study. Nursing Research, 24(2), 89-92.King, D., Bernard, K., & Hoehn, R. (1981). Disseminating the results of nursing research.Nursing Outlook, 29, 164-199.Kirchoff, K.T. (1982). A diffusion survey of coronary precautions. Nursing Research, 31(4),196-201.141Kirchoff, K.T. (1991). Who is responsible for research utilization? Heart & Lung, 20(3),308-9.Lewin, K. (1952). Field theory in social science: Selected Theoretical Papers. London:Tavistock.Linde, B.J. (1989). The effectiveness of three interventions to increase research utilizationamong practising nurses. Unpublished doctoral dissertation, University of Michigan.Lomas, J. (1993). Teaching old (and not so old) docs new tricks: Effective ways to implementresearch findings. Centre for Health Economics and Policy Analysis Paper 93-4. Hamilton:Mc Master University.Loomis, M.E. (1985). Knowledge utilization and research utilization in nursing. Image: TheJournal of Nursing Scholarship, 17(2), 35-39.MacGuire, J.M. (1990). Putting nursing research findings into practice: Research utilization asan aspect of the management of change. Journal of Advanced Nursing, 15, 614-21.Mercer, R.T. (1984). Nursing research: The bridge to excellence in practice. Image: TheJournal of Nursing Scholarship, 16(2), 47-51.Miller, J.R., & Messenger, S.R. (1978). Obstacles to applying nursing research findings.American Journal of Nursing, 4., 632-4.Munro, B.H., & Page, E.B. (1993). Statistical methods for health care research, (2nd ed.).Philidelphia: Lippincott.Polit, D.F., & Hunger, B.P. (1991). Nursing research principles and methods, (4th ed.).Philideiphia: J.B. Lippincott.Reinhard, S.C. (1988). Managing and Initiating Change. In E.J. Sullivan & P.J. Decker,Effective Management in Nursing, 93-119, (2nd Ed.). Menlo Park: Addison Wesley.Rogers, E.M. (1983). Diffusion of innovations. New York: Free Press.Romano, CA. (1990). Diffusion of technology innovation. Advances in Nursing Science.13(2), 11-21.Spence, D.G. (1994). The curriculum revolution: can educational reform take place without arevolution in practice? Journal of Advanced Nursing, 19, 187-193.Statistics Canada (1991). Registered nurses management data 1991. Canadian Centre forHealth Information.Stetler, C.B. (1985). Research utilization: defining the concept. Image: The Journal of NursingScholarship, 17(2), 40-44.142Stevens, J. (1990). Intermediate statistics: A modern approach. Hillside, N.J.: LawrenceErlbaum.Thurston, N., Tenove, S., & Church, J. (1987). Nursing research in Canadian teachinghospitals. Final report. Calgary, Alta.: Foothills Provincial General Hospital.Welch, L.B. (1990). Planned change in nursing: The theory. In E.C. Hien & M.J. Nicholson(Eds.) Contemporary leadership behaviour: Selected readings (pp. 299-3 10). Boston: LittleBrown.Wood, N.F., & Catanzaro, M. (1988). Nursing research: Theory and practice. St. Louis:Mosby.Winter, J.C. (1990). Brief: Relationship between sources of knowledge and use of researchfmdings. Journal of Continuing Education in Nursing, 21(3), 138-140.143Appendix A:R.N.A.B.C. Electoral District StructureRNABC ELECTORAL DISTRICT STRUCTUpjFIDB144A - Mainland-Coastal DistrictChapters: North Shore, Sunshine Coast,Richmond/DeltaB - Vancouver Metropolitan DistrictChapters: Vancouver MetropolitanC - North Vancouver Island, Powell River & GulfIslands DistrictChapters: Campbell River, Comox Valley, Duncan,Gulf Islands, Long Beach, Mt. Arrowamith, Nanaimo,North Island, Port Alberni, Powell RiverD - Greater Victoria DistrictChapters: Greater VictoriaE - Fraser Valley DistrictChapters: Central Fraser Valley, Fraser-Cheam, MapleRidge-Pitt Meadows, Mission, New Westminster, SouthFraserF - Northeast DistrictChapters: Bella Cooler Valley, Central Cariboo,Chinook, Fort Nelson, Misinchinka, Nechako Valley,North Cariboo, North Peace, Prince George, SouthCariboo, South Peace, Stuart lakeG - Northwest DistrictChapters: Houston, Kitrnano, Omineca, Prince Rupert,Queen Charlotte Islands, Rocher, Smithers, TerraceII- Kootenays DistrictChapters: Castlegar, Cranbrook, Creston, Fernie,Golden & District, Invermere & District, Kimberley &District, Nelson, TrailI - Thompson-Columbia DistrictChapters: Kamloops, Nicola Valley, North Thompson,Reveistoke & District, Salmon Arm, Lillooet AreaJ - Okanagan DistrictChapters: Kelowna, Penticton, Spallumchecn, SouthOkanagan, Summerland, Vernon145Appendix BResearch Utilization in Nursing Practice QuestionnaireResearchUseinNursingPracticeColleenM.Varcoe,MSNStudentUniversityofBritishColumbiaSchoolofNursingPhone:469-8400August,1993ResearchUseinNursingPractice2.PerceivedRoleinResearchThissurveyasksquezionsaboutthevalueofusingresearchinnursingpractice,pportforusingresearchanduseofresearchfindingsinpractice.Pleaseanswereachquestionascompletelyaspossible.Yourresponsesareimportanttounderstandingthefactorsthatinfluencetheuseofresearchinnursingpractice.1.PerceivedvalueofresearchinnursingOnascaleof1-4,indicatetheresponsethatreflectsyourownvaluesandtheresponsethatreflectsyourunderstandingofthephilosophy,missionstatement,goalsorobjectivesofyournursingdepartment/division.Pleaseputtheappropriatenumberintheboxesontheright.1.Researchbasedknowledgeassiststhenursetoimprovetheeffectivenessofnursing.1=stronglydisagree2=disagree3=agree4=stronglyagree2.Researchenhancestheprofession’saccountabilitytothepublic.3.Researchfindingsprovide“thefacts”neededtovalidateclinicalpracticedecisions.4.Theresearchprocessisessentialforcreatinginnovative,scientificnursinginterventions.5.Researchenhancesnursing’seffectivenessinrespondingtonewdevelopmentsaffectinghealth.6.Researchfindingsenablenursestousescarcehealthcareresourcesmoreefficiently.Onascaleof1-4,pleaseindicatetheresponsethatbestreflectstheresearchactivitiesyouexpectofyourselfandthoseactivitiesthatareexpectedofyoubyothers.Pleaseputtheappropriatenumberintheboxesunderthecorrectcolumnsontheright.Ifthereisnoclinicalinstructororclinicalnursespecialist,pleaseput“N/A”(notapplicable)intheappropriatebox.1=stronglydisagree2disagree3=agree4=stronglyagreeOWNNuRsINGVALUESDEPT.VALUESExpectationsof:SelfHeadClinicalC,N.S.NursingNurseInstruct.Director1.criticallyquestioneffectivenessofdailynursingpractice.2.promoteaclimatethatsupportsmycolleague’sresearchendeavours.3,beinvolvedincollectingdatafornursingresearchstudies.4.beinvolvedincollectingdatafornon-nursingresearchstudies.5.conductresearchstudies.6.applyresearchfindingstoclinicalpractice.-3.Perceivedresearchclimateinyourorganization.Pleaseindicatethatwhichbestdescribestheclimateofinquiryinyourorganization.—1=stronglydisagreedisagree)3’=agreeInmyorganization:4stronglyagree1.nursesareencouragedtoquestiontheirnursingprctices.2.nursesareencouragedtoconductresearchstudiestodevelopmoreeffectivemethodsofpractice.3.nursesareencouragedtoutilizeresearchfindingstodevelopmoreeffectivemethodsofpractice.4.therearestrategies(eg.committees,plans,people)specifictosupportresearch-relatedactivities.5.otherstaffnurscsarcInterestedinrcscarchrelatedactivities.6.physicianssupportnursingresearch.7.otherdisciplinesareinterestedinresearchcollaboration.8.nursingprofessorsareavailabletoactasresearchadvisors,consultantsorcollaborators.9.nursingprofessorsconductresearchstudies.10,studentsconductresearchstudies.11.nurseswhoparticipateintheresearchprocessreceiverecognitionfortheirinvolvement.4.YourinterestinresearchForeachstatement,pleaseindicatetheresponsethatbestdescribesyourinterestinNURSINGresearch-relatedactivities.1=stronglydisagree2=disagree3=agree4=stronglyagreeIaminterestedin:1.findinganswerstospecificnursingproblems.2.readingresearchstudies.3.discussingresearchstudies.4.participatinginresearchprojectsofothers.5.knowingtheresultsofresearchprojectsconductedinmyorganization.6.knowingtheresultsofresearchprojectsconductedinmyareaofpractice.7.usingtheresultsofresearchtochangepractice.8.determiningwhatdifferencesresearch-basednursingpracticemakes.9.conductingresearchaspartofaworkassignment.10.conductingresearchevenifitisnotpartofaworkassignment.5.YourresearchexperienceForeachstatement,pleaseindicatewhetherornotyouhavedoneanyofthefollowing:Pleasecheckoneonly(I’)YESNO1.takenacourseinresearchmethods.2.takenacourseinstatistics,3.completedquestionnairesforaresearchproject.4.conductedinterviewsforaresearchproject.EEJEEl5.collectedspecimensforaresearchproject.EEJ6.beenaprincipalinvestigatorofaresearchproject.7.beenaco-investigatorofaresearchproject.EJ8.beenaresearchassistant.EEl[El9.assistedwiththewritingofagrantproposal.EEl[El10.writtenagrantproposal.D11.receivedfundsfrommyorganizationtoconductresearch.5.Yourresearchexperience(continued)Foreachstatement,pleaseindicatewhetherornotyouhavedoneanyofthefollowing:Pleasecheckoneonly(I’)YESNO12.receivedfundsfromothersourcestoconductresearch.13.attendedconferenceswhereresearchstudieswerepresented.14.attendedconferenceswhereresearchfindingswereincludedinpresentations.15.publishedresearchresults.D16.presentedresearchresults.17.changednursingpracticebasedonresearchfindings.18.evaluatedtheresultsofthechangedpractice.6.YouruseofresearchPleaseindicatetheextenttowhichyoudoeachofthefollowing:1=notatall2=sometimes3=frequently4=always1.Iamfamiliarwithcurrentresearchrelevanttomyareaofnursing.2.Icanidentifytheresearchbasisformycommondailypractices.Pleaseindicatetheextenttowhichyoudoeachofthefollowing:3.I criticallyquestiondailypracticesforeffectiveness.I=no,never2=yes,sometimes4.Iuseresearcharticlestosupportmyquestioningof3=yes,alwaysN/A=notavailabledailypractices.inmyareaofpractice5.Icanidentifyhospitalpolicies/proceduresthatarebasedoncurrentresearch.2,Priortoremovalofacatheterwhichhasbeeninapatientforat6.Icanidentifyhospitalpoliciesorproceduresthatleast 36hours,thecatheterisintermittentlyclampedandarenotbasedoncurrentresearch,released.Bladdertoneisbelievedtobeincreased,resultinginanearlierreturntonormalmicturitionpatterns.7.Iimplementnursingcareonthebasisofcurrentresearchfindings.Doyouusethismethodwhencaringforpatientswho8.Icommunicateconcernsabouttheeffectivenessofhavehadabladdercatheterforatleast36hours?practicestocolleagues.3.Sensoryinformationaboutwhatistobefelt,seen,heard,tasted9.Ichangepracticebasedonresearch.Iand/orsmelledduringadiagnosticprocedurehasresultedinIpatientsexperiencinglessdistressduringtheprocedure.10,Ievaluatetheresultsofchangedpractice.Doyouprovidesensoryinformationtopatients7.Youruseofspecificresearchfindingswhenpreparingthemfordiagnosticprocedures?.Pleaseindicater!ieextenttowhichyoudoeachofthefollowing:4.Sensoryinformationaboutwhatistobefelt,seen,heard,tastedand/orsmelledinrelationtoasurgicalprocedurehasbeen1=no,neverassociatedwithimprovedpatientoutcomespostoperatively.2=yes,sometimes3=yes,alwaysDoyouprovidesensoryinformationtopatientsN/A=notavaiIaI)Ic•whenpreparingthemforsurgkalprocedures?inmyareaofpractice1.Internalrotationofthefemurduringinjectionintothedorso-5.Preoperativetraininginrelaxationtechniquesreducespaindistressandincreasescomfortinpost-operativepatients.glutealsite,ineithertheproneorside-lyingposition,resultsinreduceddiscomfortfromtheinjection.DoyouteachyourpreoperativepatientsrelaxationDoyouusethismethodwhengivinganinjectionintotechniques?cI’thedorsoglutealsite?6.Testingtheurineofpatientsforglycosuriaandacetonecanbedone8.OrganizationalOverviewwithequalaccuracyoneitherthefirstorsecondvoidedspecimens.PleaseindicatewhetherornotyourorganizationhasthefollowingDoyouroutinelyusethefirstvoidedspecimensupportsfornursestobeinvolvedinresearchrelatedactivities.forsugarandacetonetesting?Pleasecheckoneonly(V)(Yes,No,Don’tKnow)7.Aformallyplannedandstructuredpreoperativepatienteduca-YESNODKtionprogramprecedingelectivesurgeryresultsinimprovedMyorganizationhas:patientoutcomes.1.ahospitalmissionstatementwithprioritiesDoyouprovideaformallyplannedandstructuredforresearchpreoperativeeducationprogramforyourelectivesurgerypatients?2.anestablishedresearchpolicy/protocolDD8.Accuratemonitoringoforaltemperaturescanbeachievedon3.aresearchreviewcommittee.patientsreceivingoxygentherapybyusinganelectronicthermometerplacedinthesublingualpocket.4.ifyes,istherenursingrepresentationonthecommittee?Doyouusetheoralmethodtoelectronicallymonitor-thetemperatureofapatientreceivingoxygentherapy?L_.I5.anethicsreviewcommittee.9.Whilepassiverangeofmotionactivitiesdonotseemtoberelatedto6,ifyes,istherenursingrepresentationincreasedintracranialpressure,otheractivitiesare,suchaschangingonthecommittee?thepatient’spositionbyrotatingtheheadorturningthepatient.7.acombinedresearchandethicsreviewcommittee.Doyouusethisknowledgewhenyouprovidecare8.ifyes,istherenursingrepresentationtoyourpatients?onthecommittee?9.experiencedresearcherswhocanactas10.Theprocessofmutualgoalsetting(wherepatientandnurseconsultants.collaborativelycefineasetofpatientgoals)leadstomoreeffectivegoalachievementandincreasespatientandstaffsatis-10.secretarialservices(e.g.,forsubmittingfaction,proposals,transcribingaudiotapes).Doyouusemutualgoalsettinginyourinteractions11.librarysearchservices.withpatients?12.computerfacilitiesfordataprocessing.26.nurseresearchassistants/associatesworking.onnursingresearchstudiesaspartofthenursingdepartment13.dataanaly;isconsultants,27.nurseresearchassistants/associatesworking14,fundingibudgetforpilot,feasibilityorfacilitationstudiesDonnon-nursingresearchstudiesaspartofthenursingdepartment15.releasetimefornurseinvolvementinresearchrelatedactivities.9.HospitalDataOurNursingDepartmenthas:Thefollowingprovidesinformationaboutthehospitalinwhichyouareemployed:16.anursingphilosophywhichexplicitlyreferstoresearchandnursingD1.Inwhatsizeofhospitalareyouemployed?17.adefinitionofnursingresearchwhich<249bedsguidesthedevelopmentofournursingresearchprogram18.aseparatenursingresearchdepartment,250-499bedsdivisionorcouncil19.anursingresearchcommitteeaspartof>500bedstheorganizationalstructure20.aninformalnursingresearchcommitteeor2.Whattypeofunitdoyouworkonmostofthetime?interestgroupMedical21, jobdescriptionsfornurseadministratorsthatincluderesearchresponsibilitiesSurgical22. jobdescriptionsformiddlemanagementDthatincluderesearchresponsibilities23. jobdescriptionsforclinicalinstructorsMedical/SurgicalDthatincluderesearchresponsibilitiesDDD24. jobdescriptionsforclinicalnursespecialistsCriticalCarethatincluderesearchresponsibilitiesOther(pleasespecify).25. jobdescriptionsforstaffnurseswhichinc1udef___________________researchresponsibilities_____________________10.PersonalDataThefollowingprovidesinformationaboutyourself1.Whatisyourageinyears?2.Whatisyourgender?MaleFemale3.Whatisyoureducationalpreparation?CheckyearsifearnedsincegraduationR.N.DiplomaBaccalaureatedegree(Nursing)Baccalaureatedegree(Other)Master’sdegree(Nursing)Master’sdegree(other)4.Howmuchdoyouwork?Checkoneonly,please.FulltimeParttimeThankyouforyour participationinthissurvey.Yourtimeandinterestaregreatlyappreciated.ColleenVarcoeUi154Appendix C:Letter to ParticipantsSchool of NursingT. 206-2211 Wesbrook MallVancouver, B.C. Canada V6T 2B5Fax: (604) 822-7466I am a student in the Master’s in Nursing program at the University of British Columbia. I am writing to invite you toparticipate in a study investigating how nursing practice changes. In particular, this study will explore how nursingknowledge is used among nurses and how organizations can facilitate the use of research in practice. Because of thecurrent emphasis on research in nursing and research-based practice, this study should provide valuable informationregarding how an organization can facilitate practice change. The title of my project is “The Relationship of Support andExpectation for Research Utilization to Research Use in Practice”.Your name was selected from the list of nurses registered with the Registered Nurses Association of B.C. In order topreserve your anonymity, I paid the R.N.A.B.C. to select a random sample of nurses for this study, label and mail thispackage to you on my behalf. No person, nursing unit or institution will be identifiable in the results of the survey. Inaddition, all responses will be completely confidential, to be used only for the purposes of this study. I have enclosed astamped, self-addressed envelope for your convenience in returning the questionnaire. Instructions for completing theform are included on the questionnaire.I have also asked R.N.A.B.C. to generate and keep an extra set of mailing labels for all nurses selected for this study fora follow up letter.The results from this survey will be used as part of my thesis. If you are interested, when the results are complete I willsend you a summary of the results. For that reason, I have enclosed a separate form for you to indicate that you wouldlike a summary of results. This form can be mailed separately or will be separated from the survey when it is received.Since your name was selected as part of a scientific sampling technique, in order for my results to be valid, it is importantthat all participants complete and return the questionnaire. Could you please take some time today, or at your earliestconvenience, to complete the questionnaire and return it? The questionnaire should take about 15 minutes to complete.Your participation in this research is entirely voluntary and your response will be greatly appreciated. You have the rightnot to participate. Return of the questionnaire will indicate your consent to participate in the study. Please do not hesitateto contact me if you have any questions regarding this research. Questions can also be directed to the chair of my thesiscommittee, Dr. Ann Hilton at 822-7498.Thankyou for your participation!CoBeen Varcoe R.N., M.Ed.469-8400THE UNIVERSITY OF BRITISH COLUMBIADear Registered Nurse155Sincerely156Appendix D:Optional Form to Receive Summary of Results157Optional: Please complete only if you would like to receive a summary ofresults when available *This sheet will be separated from the questionnaire when it is received, oryou may mail it separately or fax it to 469—7178.Name_________________________________________________Address_ _ _ _Postal Code__________158Appendix E:Correlations Between Educational Level and Hospital Size and Study VariablesTable48CorrelationMatrixforStudyVariablesAGE=Nurses’ageYEARS=YearssincegraduationEXSELF=Nurses’ownexpectationstouseresearchINTEREST=Nurses’interestinresearchEXPER.=Nurses’researchexperienceOWNVALUE=Nurses’ownvalueforresearchEXP.EXP.GENERALHEADNURSEDIRECTORUSECLIMATE=OrganizationalClimateINFRA.=OrganizationalInfrastructuresNDEPT.VALUE=NursingdepartmentvalueforresearchEXP.HEADNURSE=HeadnurseexpectationsofstaffnurseEXP.DIRECTOR=NursingdirectorexpectationsofstaffnurseGENERALUSE=GeneraluseofresearchEDUCHOSPSIZEEXSELFINTERESTEXPER.OWNCLIMATEINFRA.NDEPT.VALUEVALUEEDUC1.00HOSPSIZE0.011.00EXSELF0.07-0.081.00INTEREST0.09-0.050.601.00EXPER.0.44”-0.010.29**0.31***1.00OWN0.17*-0.030.52***0.46***0.141.00VALUECLIMATE-0.11-0.440.20*0.090.060.161.00INFRA.0.120.140.110.27***0.050.63***1.000.39***NDEP.-0.080.020.060.05-0.120.23**0.49***0.29***1.00VALUEEXP.HEAD-0.090.100.42***0.11-0.070.010.49***0.30***0.47***1.00NURSEEXP.-0.020.26*40.26***0.04-0.150.020.56’’0.35***0.56***0.67***1.00DIRECTORGENERAL0,03-0.060.51”0.50*0.37***0.41***0.18*0.24***0.050.160.131.00USEUSEOF-0.020.16*0.25’0.23**0.15*0.130.33***0.31***0.140.060.24*0.38***FINDINGS*p<0.05**p<0.l**p’<O.OOl90between responders and non-responders led to a final sample that was more representative ofbaccalaureate nurses, nurses who work part time and nurses working in medical-surgical areasthan of the population of staff nurses working in B.C. acute care hospitals. The sample wassimilar in gender and age to the underlying population.Individual FactorsThe individual factors include personal and professional characteristics and individualchange factors. In addition to the demographic characteristics, the professional characteristics ofresearch experience and the individual change factors of the nurses’ own value for research,interest in using research, and expectations of self for using research in practice were considered.The individual nurse’s assessment of available resources was also considered, but will bediscussed under organizational change factors.Research Experience. Although the research-related experience of baccalaureate nurses wassignificantly greater than that of diploma nurses, the experience of the overall sample was low.As noted earlier, most of the difference between educational levels could be accounted for by thefact that most of the baccalaureate nurses had taken research and statistics courses (89%),whereas diploma nurses had not (14% and 17%, respectively). Most of the nurses had five orfewer research experiences. It was discouraging to note that the most frequently reported researchexperience was completing questionnaires, meaning that the nurses had more experience withbeing the subjects of research than with learning about, participating in or implementing researchfindings. However, it is possible that the experience of completing questionnaires was frequentlyreported because the nurses included participating in the current study as an experience.These fmdings are similar to those of Alcock et al. (1990) who surveyed nurses in Ontario.They found the same rank order among the experiences but found lower levels for allexperiences. The lower levels of experience may be explained because Alcock et al. used a91sample comprised of 26% baccalaureate nurses.These findings are also very similar to the findings of Clarke and Joachim (1993) in theirsurvey of B.C. schools of nursing. A key individuals with research responsibility in each schoolgave his or her opinion of faculty in relation to research. Using a tool derived from theinstrument which was the basis of the current study, Clarke and Joachim found that the mostfrequently reported research experiences of faculty were completing questionnaires, followed bycourses in research or statistics and attending conferences. Very few schools reported that facultyhad other research experiences such as being a principal investigator, being a research assistant,writing proposals or obtaining funding for research.The findings of the current study are, however, quite different from those of Clarke (1992)who used the same items to survey key hospital personnel regarding nurses’ research relatedexperience. Only “a few” nurses were perceived to have each of the research experiences, withthe exceptions of completing questionnaires and changing practice based on research, which wereestimated to have been experienced by more than a few, but still less than a quarter of nurses.The differences between the low levels of staff nurse research experience perceived by keyhospital personnel in Clarke’s study and the higher levels reported by the staff nurses in thecurrent study may be partially due to differences between responders and non-respondents. It maybe that the respondents to this survey were different from non-responders in their level ofresearch experience. However, even if none of the non-respondents had any research experience,more than one quarter of the diploma nurses surveyed would have had experience completingquestionnaires and attending conferences. Therefore, the differences in experience betweenClarke’s study and the current study must also be partially explained as a difference between thekey hospital personnels’ perception of staff nurses and the staff nurses’ perception of themselves.92Staff Nurses’ Value For Research. While the baccalaureate nurses had a significantly highervalue for research than the diploma nurses, value for both groups was high, with the means being20.7 and 19.7 on scores with a possible range of 6-24. Alcock et al. (1990) found a similar rankorder of support for statements, with value for solving patient care problems receiving 92%support and cost-effectiveness receiving 73%, compared to 98% and 77% in the current study.However, they found a slightly lower level of support for all value statements, most notably 70%support for public accountability compared to 89% in the current study. As in the current studythey also found that baccalaureate nurses had significantly higher value for research. Thedifferences between the studies are not remarkable and may be due to slight provincial variations,elapsed time between studies, increased media attention to public accountability, different samplecomposition or chance.The support for value statements in the current survey is very similar to the findings ofClarke’s (1992) study. Clarke surveyed nurses responsible for research in hospitals and found thatthe value statements related to enhancing nursing decisions, effectiveness, and interventions andpublic accountability received agreement from over 90% of those surveyed. In the current survey,these same statements received 92-98% agreement. The statement regarding enabling nurses touse resources efficiently was also the least supported statement, although it received 86%agreement from those responsible for research in Clarke’s study compared to 77% agreementfrom staff nurses in the current study.These findings are also very similar to the findings regarding faculty value for research asreported by Clarke and Joachim (1993). They found that the strongest agreement (mean=3.9;range=1-4) was with the statement that research improves the effectiveness of nursing and theleast supported statement (mean=3.6) was that “research-based knowledge assists nurses to usescarce resources more efficiently”. The findings are also similar to those of Bostrom, Malnight,93MacDougall, and Hargis (1989), who found that the most supported statement was that researchfindings that are advantageous to patient care can be implemented.In the current survey, the statement “research findings enable nurses to use scarce resourcesmore efficiently” was frequently commented upon. One nurse wrote “nursing does not havecontrol of health care practices” and others circled the word “scarce” and/or put question marksbeside the statement. This indicates that the statement itself was problematic and open to differentinterpretations. Responses to this statement, intended to measure the nurse’s value for research,were confounded by questions of whether or not resources were actually scarce and to whatextent nursing had control over resource utilization.The nurses in this sample valued research, with baccalaureate nurses having greater valuefor research than diploma nurses. The findings are comparable to the value for research expressedby staff nurses in other surveys and by key personnel in hospitals and schools of nursing in B.C.Interest in Research. All the nurses’ interest in research was high, with no significantdifference between baccalaureate and diploma nurses. The nurses were most interested in usingresearch in practice, in solving specific problems, and in their own areas of practice. The resultswere also encouraging because the nurses had a reasonably high interest in reading anddiscussing research and in participating in research. They were least interested in conductingresearch themselves, which seems reasonable given their level of educational preparation andexperience with research.The results are very similar to the findings of Alcock et al. (1990). The percentages ofsupport reported by Alcock were within 10 percentage points of the current study on all intereststatements, with the exception of interest in reading research studies and conducting research aspart of work (see Table 44). Alcock reported that 71% were interested in reading compared to83% in the current study, and that 85% were interested in conducting research compared to 73%94in the current study. Alcock et al. found a significant difference between educational levels,which was not found in the current study. Again, the differences may be due to provincialdifferences, different economic conditions, and differences in the sample composition.Table 44Comparison of Staff Nurse Research Interests from the Perspective of Staff Nurses and KeyHospital PersonnelInterest in: Percent Agreement (Agree Percent Interested+ Strongly Agree) by Staff estimated by KeyNurses HospitalPersonnelCurrent Study Alcock et Clarke (1991)al. (1990)using results to change practice 97% 88% 25%-50%finding answers to specific problems 96% 94% 25%-50%knowing results (own area/ own organization) 96%,91% * 96% 25%-50%determining differences research-based practice makes 89% 25%reading/discussing research studies 83%176%* 71% <25%participating in research projects of others 82% 84% 25%conducting research as part of work 73% <25%conducting research not as part of work 57% 45% few*two separate items were used in the current survey; one item in Clarke (1992)The results are also remarkably similar to the reported interests of faculty (Clarke &Joachim, 1993). Clarke and Joachim found that key individuals in nine schools of nursingreported that three quarters or more of their faculty were interested in using research results tochange practice, but only four schools reported that the same number of their faculty wereinterested in conducting research, even when it was part of their work assignment. It appears thatthe staff nurses in this sample are more interested in using research, and almost as interested inconducting research, as nursing faculty in B.C., as perceived by the heads of their schools.95However, the interest level among faculty might be considerably higher if the faculty themselvesself-reported rather than the report being from the perspective of a single individual within theirschool.In Clarke’s (1992) survey, respondents from hospitals used the same scale to estimate theproportion of staff nurses who held various research-related interests. The research interest resultsare compared in Table 44. It is evident that this sample of staff nurses reported a higher levelof interest than key hospital personnel perceived staff nurses to have. Hospital personnel mayunderestimate the research interest of staff nurses or the staff nurses may have responded in amore socially desirable direction than their true interests indicate, or both. Again, differencesbetween the research interests of respondents and non-respondents are not known.Interest in research among nurses in this sample was encouragingly high and similar toearlier estimates. It is especially remarkable that although the diploma nurses had less researchexperience and lower value for research, their interest was as high as the interest of baccalaureatenurses. The staff nurses compare favourably with available estimates of the research interests offaculty and compare reasonably with hospital respondents’ perceptions of staff nurse interest.Expectations for Using Research. Overall, the nurses in this sample had high expectationsof themselves to use research regardless of their educational level or the size of hospital theyworked in. Again it is interesting that diploma nurses had as high expectations of themselves asthe baccalaureate nurses. Clearly expectations directly related to practice were more stronglysupported than the conduct of research. This was congruent with the expressed interest statementsin which direct practice statements were most strongly supported. However, it is remarkable thatover half of the nurses expected themselves to actually conduct research. This finding seemedsurprisingly high.It is of particular interest that while 93% of nurses expected themselves to use research96findings to change practice, only 80% agreed that they use research articles to support practicechange. These findings are congruent with the conclusion based on a research review thatresearch publications have a limited effect on physicians’s use of research (Lomas, 1993).The expectations to use research reported by nurses in this study are again very similar tothose of Alcock et al. (1990). They found similar high levels of expectation and strongest supportfor practice-related expectations. However, unlike the current study, they found differencesbetween education levels.Despite little research experience, the nurses’ value for research, interest in using researchand expectations of self for using research were high in this sample regardless of educationallevel and hospital size. Ancillary findings illustrate that these individual factors are also inter-correlated, which seems reasonable. Although it might be argued that these responses weresocially desirable, the range and standard deviation suggest wide variability in individual scoresand the lower responses to specific items and to items regarding the actual use of researchsuggest that social desirability was not a significant concern in this study.Organizational FactorsThe organizational factors included the infrastructures to support research and theorganizational change factors of organizational research climate, nursing department value ofresearch and key individuals’ expectations of staff nurses to use research. One of the anticipatedlimitations of this study was the fact that the organizational change factors would be reportedonly from the perspective of staff nurses. Fortunately, the survey by Clarke (1992) used the sameitems and scaling to obtain the opinions of key nursing personnel in health care organizations andprovides an excellent comparison to the opinions of the staff nurses regarding the organizationalchange factors.97Infrastructures. The organizational infrastructures such as research related policies,committees, personnel, and resources, varied significantly by hospital size, with the number ofsupports increasing by an average of 2.6 between small and medium hospitals and by an averageof 3.9 between medium and large hospitals. There was a statistically significant correlation(r=O.40) between hospital size and the presence of research-related infrastructures. This seemsreasonable as hospital resources are likely to increase with size.It was disappointing that the most commonly identified supports (library services, ethicsconmiittees, and mission statements) are general supports that are not specific to researchactivities. Overall, 33.4% of the responses were “Don’t Know”, indicating that the staff nurses’awareness of infrastructures was low. Over 26% of the nurses did not know whether there wasa separate nursing research department, division, or council in their organization or whether theirown job descriptions contained research responsibilities.Although the difference was not significant, baccalaureate nurses tended to report a highernumber of organizational infrastructures. This tendency may be related to an increased awarenessof the infrastructures due to greater research experience or might be related to a different attitudetoward research by baccalaureate nurses as indicated by their higher value for research. Anotherpossibility is that the baccalaureate nurses might be attracted to hospitals that have more research-related infrastructures regardless of hospital size.The number of infrastructures did not correlate with any of the personal or professionalcharacteristics or change factors, except for a low correlation with research experience. Thissupports the earlier suggestion that increased experience with research made the nurses moreaware of what organizational supports were available. This correlation also highlights one of themajor methodological limitations of the study: all variables are measured from the perspectiveof the staff nurse. In this case, the organizational infrastructures reported are only those that are98known to the staff nurse. However, this limitation is also a strength because the infrastructuresthat are unknown to the staff nurse are unlikely to impact practice.Nursing Department Value of Research. The value for research that the staff nurses reportedas being held by the nursing department was reasonably high (mean=19.5; range=8-24), but notas high as the nurses’ own value for research (mean=20.3; range=12-24). The nursing departmentvalue for research was significantly different by hospital size, with the scores increasing fromsmall to medium hospitals and from medium to large hospitals. This contrasts with the nurses’own value for research in which there were no differences between hospital sizes. Again, thesignificant difference between hospital sizes is reasonable given that resources for research andassociations with universities are likely to increase with hospital size, and the difference iscongruent with the differences in infrastructures found between hospitals of different sizes.The high levels of support for the nursing department’s value for research in enhancingnursing’s effectiveness, accountability, decision-making, interventions and responsiveness weresimilar in emphasis to the findings of regarding the value statements of those responsible forresearch in hospitals (Clarke, 1992). The statement regarding enabling nurses to use resourcesefficiently was also the statement least supported by respondents to Clarke’s survey, although itreceived 86% agreement (see Table 45).The degree of agreement with value statements tended to be lower when reported by thestaff nurse than when reported by hospital personnel, but otherwise the similarity is remarkable.This suggests that both the staff nurses and the key hospital nursing personnel have a high valuefor research. The nurses seemed to think that their nursing departments have a fairly high valuefor research and the perception of this value increases with hospital size.99Table 45Comparison of the Value of Nursing Research from Three PerspectivesStatement About Mean Score (% agreement)Value of ResearchNurses’ Own Nursing Department Value Value Reported by Key NursingValue Reported by Staff Nurse Personnel (Clarke, 1992)improve effectiveness 3.57 (98%) 3.32 (92%) 3.55 (95%)enhance 3.47 (95%) 3.31 (92%) 3.49 (93%)accountabilityvalidate practice 3.43 (93%) 3.29 (90%) 3.55 (96%)decisionscreate innovative, 3.32 (89%) 3.21 (87%) 3.51 (94%)scientific interventionsrespond to 3.40 (93%) 3.24 (90%) not surveyeddevelopmentsuse resources 3.04 (77%) 3.05 (76%) 3.25 (86%)efficientlyExpectations of Staff Nurses Perceived to be Held by Key Individuals. The staff nurses inthis sample believed that expectations held by their head nurses and nursing directors weresimilar. As agreement with all expectation statements would have resulted in a score of 18, themean of 17.8 for head nurses and 17.7 for nursing directors suggests that there was bothagreement and disagreement with the statements. The nurses’ own expectations were significantlyhigher than those perceived to be held by the head nurses and directors. Inspection of the scoresfor instructors (mean=19.3) and clinical nurse specialists (mean=18.8) indicate that the scoreswere also higher than perceived expectations by head nurses and directors, and may have beenhigher than the nurses’ expectations, but the small number of respondents precluded analysis.There were no differences in the reported expectations by the educational level of the nursesreporting. However, there was a difference between the perceived expectations of head nursesfrom hospitals of different sizes and an interaction effect between hospitals and level of100education. The apparent relationship between the perceived level of expectation and hospital sizewas not simple. From baccalaureate nurses, head nurse expectations for small hospitals receivedthe lowest scores, followed by medium, then large hospitals. However, from diploma nurses,large hospitals received the lowest scores and medium hospitals received the highest scores. Thisindicates that the staff nurses’ perception of head nurse expectations in hospitals of different sizesvary by educational level. For baccalaureate nurses, the perceived expectations increase withhospital size; for diploma nurses, the perceived expectations are highest in medium sizedhospitals, lower in small hospitals and lowest in large hospitals. The pattern for baccalaureatenurses follows the pattern of other organizational factors. The pattern for diploma nurses is moredifficult to explain. It may be that larger hospitals have more baccalaureate nurses resulting ina greater perceived or actual contrast between nurses from different educational levels.For the nurses’ reported expectations of nursing directors, there was also a significantdifference between hospitals of different sizes. Although no interaction effect was detected, thepattern of reported expectation of the nursing directors was similar for baccalaureate nurses asexpectation scores increased with hospital size. For diploma nurses, nursing director expectationscores were again highest for medium-sized hospitals. However, this was followed by largehospitals and then small hospitals. Because the interaction effect was not statistically significant,it can only be concluded that nursing director expectations are reported higher as hospital sizeincreases by both diploma and baccalaureate nurses. The increase in perceived expectations seemsreasonable and is congruent with the increase in research infrastructures and climate by hospitalsize.Although the expectations were reported by the staff nurses, the pattern of response issimilar to the expectations reported by key nursing personnel (Clarke, 1992). Because the samescale was used, the reported expectations from the current study can be compared with the101expectations reported by Clarke (see Table 46).The rank order of research expectations is different and the mean scores of the staff nurses’perceptions of the expectations of key individuals are lower than the expectations as reported toClarke by key individuals. However, there is a greater similarity between the staff nurses’perceptions of themselves and the expectations reported by Clarke than between the other setsof expectations. Inspection of these scores suggests that the staff nurses’ perceptions of nursingdirectors expectations are lower than, but similar to those reported by hospital personnel. It alsosuggests that the expectations of nursing personnel are more similar to the nurses’ ownexpectations than the nurses think.Table 46Comparison of Expectations from Current Study and from Clarke (1992)Expectation Mean Item Score (Rank)StatementOwn Head Nurse Nursing Director ExpectationsExpectations Expectations Expectations Reported by KeyReported by Staff Reported by Staff Hospital PersonnelNurse Nurse (Clarke, 1992)apply findings to 3.40 (1) 3.21 (1) 3.10 (2) 3.29 (2)practicecritically question 3.39 (2) 3.19 (2) 3.04 (4) 3.35 (1)practicepromote research 3.28 (3) 3.13 (3) 3.14 (1) 3.20 (3)climatecollect data for 3.18 (4) 3.10 (4) 3.05 (3) not surveyednursing researchcollect data for non- 2.69 (5) 2.63 (5) 2.62 (6) not surveyednursing researchconduct research 2.58 (6) 2.63 (6) 2.72 (5) 2.38 (4)The staff nurses perceive the expectations of the head nurses and nursing directors to belower than their own expectations. This finding is corroborated by Clarke’s report of expectationswhich are also lower than the staff nurses’ own expectations. Expectation scores vary with102hospital size, and educational level appears to affect perception of expectations, especially withregard to head nurse expectations. The perceived head nurse and nursing director expectationswere correlated with the nurses’ own expectations, but not with any other individual characteristicor change factor. Both perceived head nurse and nursing director expectations correlated with allof the organizational variables.Research Climate. The low opinion of research climate and significant difference betweenhospital sizes are consistent with the low estimates of infrastructure and the lower levels of otherorganizational factors reported by nurses from smaller hospitals. Crane (1989) measuredorganizational climate and organizational resources and reported the mean scores for nurses usingtwo different dissemination methods. However, she did not report the range of scores and did notcompare hospital sizes.The climate statements in the current study were ranked in a similar manner as the samestatements in Clarke’s (1992) survey of B.C. hospitals. In the current study, 74% of nurses agreedthat they are encouraged to question their nursing practices and three other statements receivedover 50% agreement. However, the seven remaining statements received less than 50%agreement. The climate scores tended to be higher and there was a higher percentage ofagreement with all statements when reported by key personnel in Clarke’s study than whenreported by staff nurses in the current study or in the study by Alcock et al. (1990).A comparison of staff nurses opinions of climate in the current study and the study byAlcock et al. with Clarke’s findings is summarized in Table 47. This comparison indicates thatClarke’s nursing department leaders tended to have higher estimates of the climate with regardto staff nurses (encouragement to question, use findings, conduct research and recognition) thanthe staff nurses themselves. Conversely, the staff nurses seem to give higher estimates of theavailable supports (support strategies, interest from other staff nurses and students) than do the103personnel responsible for those supports. It seems that nurses in these samples tended to be morecritical of areas with which they were most familiar.Table 47Comparison of Response to Research Climate Statements by Staff Nurses and Key NursingDepartment PersonnelResearch Climate Statement Staff Nurse Mean Staff Nurse OrganizationalScore (Percent Percent Personnel Mean ScoreAgreement) Agreement (Percent Agreement)_________________(Alcock, 1990) Clarke, 1992Nurses are encouraged to question 2.90 (74%) 41% 3.51 (97%)nursing practicesNurses are encouraged to use 2.70 (62%) 48% 3.21 (85%)research findingsThere are strategies to support 2.57 (58%) * 2.21 (36%)research activitiesOther staff nurses are interested 2.54 (57%) * 2.28 (34%)in researchOther disciplines are interested in 2.31 (46%) 69% 2.52 (53%)research collaborationNurses who participate in 2.32 (43%) 38% 2.63 (56%)research receive recognitionNurses are encouraged to conduct 2.32 (42%) * 2.72 (60%)research studiesStudents conduct research studies 2.27 (42%) * 2.12 (32%)Professors conduct research 2.16 (35%) * 2.06 (27%)studiesPhysicians support nursing 2.15 (35%) 38% 2.19 (30%)researchProfessors are available to 2.03 (29%) 41% 2.03 (25%)consult, advise, collaborate*Statements not comparableThe responses were very similar in both B.C. studies regarding support from nursingprofessors and physicians. However, the responses regarding nursing professors are likely to berelated to the fact that most of the hospitals (especially small hospitals) were not likely to have104nursing professors associated with them. The similarity in the mean scores of the two statementsabout nursing professors, in both the current study and the study by Clarke, suggests that nursingprofessors who are seen to conduct research are also seen to be available for consultation. Thisconclusion is different from that of Clarke (1992) who concluded that professors who conductresearch are not necessarily seen by those responsible for research in hospitals as available forconsultation.The research climate scale was somewhat problematic as it contained items that overlappedwith items covered under infrastructures (e.g. strategies for support, professors to consult).Furthermore, items such as the two regarding nursing professors automatically gave a larger scoreto larger hospitals which were more likely to be associated with nursing schools.In summary, staff nurses’ reported the research climate to be low, with the scores beinglowest in small hospitals. The climate scores tended to be lower than, but similar to, scoresobtained from hospital personnel regarding staff nurses and from personnel in schools of nursingregarding faculty.The fact that all of the organizational factors increased with hospital size supports theassumption that research resources, supports and expectations increase as hospital size increases.The fact that all of the organizational factors were inter-correlated suggests that the staff nurse’sview of nursing within the organization is cohesive. It may also reflect real cohesiveness andinterrelationships with regard to research within nursing organizations. The relationships betweenthese factors also support the conceptual framework, as anticipated relationships were supported.Research Utilization OutcomesResearch utilization outcomes included the nurses’ opinions of their own general use ofresearch and their ratings of their frequency of using specific research based practices. Previousstudies have used specific practices as measures of research use.105General Use of Research. As rating all statements as “sometimes” would result in a scoreof 20, the mean of 22.7 for this sample suggests that the nurses thought they used research tosome extent. One of the limitations of this study is the fact that it is difficult to interpret what“sometimes” meant to the nurses and impossible to know to what extent nurses were biasedtoward giving a socially favourable response. The distribution of the scores illustrates that thescores of most nurses were clustered around this mean and that, as only 8% had scores higherthan 30, few nurses responded “always” to any of the statements. There was no reporteddifference between respondents from different educational levels or different sizes of hospital,but there was considerable variation in the responses to different items.The fact that statements regarding the actual implementation and evaluation of practicebased on research were less well supported than statements regarding questioning practice andcommunication of concerns suggests that assessment of research-based practice is done morethan implementation of research-based practice. It was discouraging to note that the least wellsupported statement was about the use of research articles to support questioning of practice. Oneof the limitations of this study (as with any survey) was that the nurses’ perceived basis forquestioning practice was not identified.The statements regarding the identification of hospital policies were also problematic. It wasimpossible to know if the nurses could or could not identify policies based on research becausethe policies themselves were or were not based on research, or because the nurse did not knowthe research support well enough to evaluate the basis of the policies. These statements thereforemay reflect the nurses’ knowledge or the status of policies.The response to the use of research in general appears to be more favourable than theresponse to the use of specific findings. This may be partially due to the fact that, as Lomas(1993) points out, research-based practice is not the “black and white” implementation of findings106but rather decisions in grey areas. Lomas criticized research on medical decision-making forfocusing on the use of clear and unambiguous findings. Similarly, research on the use of findingsin nursing practice has focused on unambiguous findings and therefore may not have accuratelyportrayed research-based nursing practice. Measuring general use of research may captureconviction about application in general, or cognitive application of research, rather than specificbehavioral change. Alternatively, the statements about use of research in general ask the nurseto make broad generalizations about practice and might be expected to be more positive. Thismeasure may simply be another measure of the nurses’ attitudes toward research rather than anactual estimate of practice behaviour.The general use of research seemed to be similar regardless of the nurses’ educational levelor hospital size. The nurses reported using research to some extent and tended to focus onquestions and concerns about practice rather than on the actual use of research to improvepractice. General use of research correlated with the use of specific findings and with all of theindividual factors but none of the organizational characteristics.Use of Specific Research Findings. Of the ten specific findings that were used as a measureof the use of research in practice, nine were used at least sometimes by over half the nurses. Thefindings were used at least sometimes by 49% - 96% (average of 77%) of nurses. This level ofuse is comparable to the findings of Brett (1987) who found that 31% - 93% (average of 61%)of nurses used the 14 findings she studied, and Coyle and Sokop (1990) who found that 26%-93% (average of 54%) used the same 14 findings. It is important to note that the ten findingsused in this study were the same as those used by Brett and by Coyle and Sokop.One explanation for the higher percentage of use in the current study is that the numberof years between studies may have allowed the findings to become more well known. In addition,four of the practices were eliminated, which may have resulted in findings which are more well107known or more appropriate to current practice. Another explanation is the fact that neither Brettnor Coyle and Sokop identified whether or not practices were applicable to the nurses’ practice.When Coyle and Sokop excluded nurses who were not aware of findings, they found that 71-100% used the innovations under study. Similarly, Winter (1990) found that 56.5% of nurses whoknew about relaxation therapy research used the findings in practice. Although the nurses in thecurrent study were not asked if they were aware of the specific findings, the opportunity toindicate that the fmdings were not applicable may have partially served the same purpose.Interpreting the practical significance of the level of use of specific findings is difficult,partially because of the limitations of the study. The survey approach did not permit identificationof the reasons for non-use of findings. There was no possibility of finding out whether nurses didnot use a particular finding because of a lack of knowledge or lack of persuasion on the part ofthe nurse, or for some other reason. Other possible reasons for non-use of findings include 1) thefindings might not be applicable to a specific patient, 2) organizational policy may preclude use,3) norm or job descriptions may preclude use, or 4) more recent innovations may have made theinnovation out-dated. Given these possibilities, it may be that an average use of 77% could beconsidered high. Although other studies have measured use in a similar manner, none of theauthors have attempted to establish what an ideal level of use might be.The percentage of nurses who found that the specific research findings were not applicablewas interesting. Urine testing was rated ttNot Applicable” by 36%, and comments that bloodglucose monitoring had replaced urine testing were frequently added to the survey. Althoughsome nurses may not nurse preoperative patients, it is difficult to explain why three items relatedto preoperative preparation (relaxation, teaching, and giving sensory information) were rated “NotApplicable” at different rates (20%, 38% and 19%, respectively). It was also difficult tounderstand why 5% of nurses considered mutual goal setting and giving sensory information108before diagnostic procedures “Not Applicable”. The survey approach limited obtainingexplanations for these findings.This measure of specific research utilization was similar to the general use of research interms of there being no differences between nurses of different educational levels or in hospitalsof different sizes. The two measures of research utilization were correlated, although weakly. Itseems that the nurses’ individual characteristics and change factors influenced their general useof research which may have moderated the organizational influences on the use of specificfindings.Comparison of Findings by Nurses’ Educational LevelEducation was a major professional characteristic on which all other research utilizationpredictor and outcome variables were compared. Nurses with baccalaureate degrees hadsignificantly more research related experience and had significantly higher scores on their valuefor research. Most of the difference in research experience was due to the large number ofbaccalaureate nurses who had taken statistics and research methods courses. It may be that thegreater research experience of baccalaureate nurses provided opportunities for those nurses todevelop more value for research. The difference in value for research may also account for thehigher response rate from baccalaureate nurses regarding the use of research. However, therewere no significant differences between the groups on the other individual change factors ofresearch interest or expectations to use research.Bostrom, Malnight, MacDougall and Hargis (1989) report similarities and differencesbetween baccalaureate and diploma nurses in terms of interest and attitudes toward research andpreparedness for conducting research. However, because their group sizes were greatly unequal(only 13% baccalaureate degrees) and no statistical analysis of the findings was reported, theirfindings cannot be compared with the current sample.109Alcock et al. (1990) found that baccalaureate nurses reported higher research experience andvaluing of research. However, these authors additionally found that baccalaureate nurses hadhigher interest in research and higher research expectations, not confirmed in the current study.Again, Alcock et al. used greatly unequal group sizes: 74% diploma nurses and 26%baccalaureate nurses and had a different sample composition in terms of variety in place ofemployment and part and full time employment.The two groups in the current survey also reported similar views of their organizations, asthere were no differences by educational level in nursing department value for research,organizational climate, or organizational expectations to use research. Although the baccalaureategroup tended to report higher organizational infrastructures, the difference was not significant.There were also no differences between educational level in the reported general use ofresearch or use of specific findings. Champion and Leach (1989) measured nurses’ self reportedgeneral use of research and also did not find education to be significant predictor. These concurwith Brett (1987), Crane (1989), Coyle and Sokop (1990), Ketefian (1975) and Winter (1990).Overall there was little difference between baccalaureate and diploma nurses in this study inresearch utilization predictor or outcomes variables. The only differences noted betweeneducational levels were in research experience, which may be a direct consequence of educationalexperiences, and value for research, which may be related to greater research experience. Thisstudy supports earlier findings that educational level is not a significant predictor of researchutilization.Comparison of Findings by Hospital SizeIt was anticipated that the organizational characteristic of hospital size would influence otherorganizational characteristics and change factors. Differences between hospital sizes were foundfor all of the organizational change factors and the organizational infrastructures. The perceived110nursing department value of research, the research climate, infrastructures and expectations bykey individuals for staff nurses to use research were all significantly different by hospital size.All of these variables increased as hospital size increased from small, to medium, to large. Therewere, however, no differences in any of the personal or professional characteristics, or individualchange factors between nurses working in hospitals of different sizes. There were no differencesin the value for research, interest in research, research experience or expectations of self. Therewere also no differences in general use of research or use of specific findings between nursesfrom hospitals of different sizes. This suggests that while increased organizational resources resultin more support and higher expectations for research, the research-related attitudes, values andbehaviours of nurses practising in those hospitals are not significantly affected.Previous studies have presented conflicting results regarding the influence of hospital sizeon the use of research. Kirchoff (1982) found a difference in hospital sizes related to the use ofcoronary precautions, whereas Brett (1987, 1989) did not find a difference between hospital sizeand the use of 14 specific findings. Kirchoff also found a difference in the use of the specificfinding and the hospital type (state, private) and location (urban, rural), whereas Brett did not.These studies classified hospital sizes differently, with Kirchoff having six categories and Bretthaving three. The categories used by Brett were used in this current study, but the type andlocation of hospitals were not considered. It may be that differences would have been found inthe current study if finer categories were used. There may have been differences amongrespondents within the small hospital category in the current study, as responses indicated thatthese nurses were from hospitals as small as 14 beds and as large as 250 beds. As infrastructuresand climate increases with hospital size, it could be anticipated that even greater variation wouldbe seen if smaller categories were used.None of the personal or professional characteristics or research utilization outcomes were111significantly different by hospital size; all of the organizational factors were significantly differentby hospital size.Relationships Between Individual and Organizational Factors and Research UtilizationThe factors within the three components of individual factors, organizational factors andresearch utilization outcomes were seen as interrelated. The relationships between thesecomponents are discussed in this final section.Individual Factors. The individual factors assessed the demographics as well as thepersonnel and professional factors that served as study variables. While the demographic variablesdid not correlate with any of the study variables, all individual factors were interrelated andcorrelated with the general use of research. The nurses’ own expectations also correlated withreported head nurse expectations, and research experience correlated with reported infrastructures.The age of the nurses did not correlate with any of the study variables except with the yearssince graduation. To date, only Winter (1990) has reported on the relationship of age to researchutilization. She did not find any significant differences related to age.It was also noted that the years since graduation did not correlate with any of the studyvariables. Thirteen of the diploma nurses and eight of the baccalaureate nurses did not report theiryears since graduation. As these nurses were in a wide variety of age categories and reportedtheir ages, the omission of this information did not seem to be related to age. Previous studiesthat considered years since graduation have produced conflicting results. Kirchoff (1982) founda significant relationship between years since graduation and the use of coronary precautionswhereas Ketefian (1975) found no difference in the use of correct temperature technique andBrett (1987) found no difference in the use of 14 specific findings by years since graduation. Itis also relevant to note that previous studies (Champion & Leach, 1989; Coyle & Sokop, 1990;Winter, 1990) have not found significant differences in research utilization in relation to years112of nursing experience.The lack of significant relationships between age and years since graduation and researchutilization outcomes questions the influence of both education and experience. One possibleexplanation for the lack of a relationship is that because the majority of nurses in the samplegraduated within the past 10 years, variation in the time since graduation and thus, variation inthe quality and content of education, may not have been sufficient to show differences in researchutilization variables. However, it seems that the range in years should have been sufficient todemonstrate a difference if experience as an important time-related predictor of researchutilization. Another explanation is that education has a lasting effect or little effect on researchutilization, either of which would result in little difference in research use over time. This studyadds to growing evidence that age and years since graduation are not predictors of research use.In the current study, research experience had a low correlation with the nurses’ expectationsof themselves to use research, interest in research, and general use of research findings, but didnot correlate significantly with any of the other study variables. As noted earlier, although theyhad higher research experience, the baccalaureate nurses did not have higher expectations orinterest in research or higher reported use of research. Baccalaureate nurses had higher valuescores, but value and research experience did not correlate for the sample or for the subgroupsby educational level.Alcock et al. (1990) found significant low correlations between research experience andresearch interest (r=0.41). However, in contrast to the current study, Alcock et al. did not finda correlation between experience and expectations, but did find a low correlation with researchvalue (r=0.36). Other studies (Crane, 1989; Champion & Leach, 1989) have considered researchexperience only in relation to the use of specific fmdings, and have found no significantrelationships. In the current study, there was no significant correlation between research113experience and the use of specific findings. Crane (1989) found a significant relationship betweenhaving specific research responsibilities at work and the use of specific findings. However, in thecurrent study, few nurses had any experience with research beyond courses or attendingconferences, so this comparison could not be made. The findings of this study suggest thatresearch experience is related to increased expectations to use research, interest in research andreported general use of research but, in agreement with earlier studies, is not related to the useof specific findings.The nurses’ value for research had a moderate correlation with expectations to use research;a low but significant correlation with interest in research; a low correlation with general use ofresearch findings; but no relationship with the use of specific findings. Alcock et al. (1990) foundthat value for research correlated with experience (r=0. .45), research interest (r=0.54) andexpectations (r=0.36). Champion and Leach (1989) also found a significant correlation (R=O.65)between attitudes toward research and self-reported general use of research and found thatattitude accounted for 42% of the variance in general research use.Interest in research was moderately correlated with expectations to use research and showeda low correlation with value for research and research experience. All of these correlations werealso found by Alcock et al. (1990). The nurses’ own expectations were moderately correlatedwith value for and interest in research and showed a low correlation with experience. Thestrongest correlations with research utilization outcomes were those between the nurses’ interestand expectations and general use. Again these findings are congruent with those of Championand Leach (1989) regarding the relationship of attitude and general use of research. This studyadds to evidence that attitude is positively related to the use of research.The personal and professional characteristics of education and age did not seem related toother research-related characteristics or to research utilization outcomes. However, the nurses’114research experience appeared to be related to individual change factors and general use ofresearch. The individual change factors of interest, value and expectations were inter-correlatedand correlated with research experience. These four factors are related to general use of researchfindings, but not to the use of specific findings.Organizational FactorsThe nurses’ assessment of the expectations of head nurses and nursing directors correlatedwith their own expectations, but none of the other organizational factors correlated withindividual factors. None of the organizational factors correlated with general use of research, buttwo of the organizational factors, infrastructure and research climate, correlated with the use ofspecific research findings.The correlations between expectations suggests that the nurses have cohesive views of theirpractice and to some extent think that their practice is congruent with the expectations of others.Neither their assessment of nursing director expectations nor head nurse expectations correlateddirectly with research utilization outcomes suggesting that the perceived expectations of keyindividuals may not have a direct effect on practice. Champion and Leach (1989) also found nocorrelation between the nurses’ reported use of research and their opinions of others until theydid correlations with specific administrators. However, because they studied a single communityhospital, their results pertain to specific key individuals rather than key roles. The current surveydetected a difference between organizational expectations and nurses’ expectations of themselves,but did not clarify the complex relationship between expectations and research utilizationoutcomes. It did, however, add to understanding and show the complexity of the situation.Infrastructures were related to other organizational characteristics and change factors andseemed to be related to research utilization outcomes, especially the use of specific findings. Thenumber of infrastructures were correlated with all of the organizational variables and with the use115of specific research findings. The correlation between infrastructures and the general use ofresearch was too low to be considered (r=0.24). However, correlations by hospital size revealedthat the correlation became stronger as hospital size increased from small (r=0.09; p=O.49), tomedium (r=0.36; p=O.OO), to large (r=0.42; p=O.OO). This suggests that research-relatedinfrastructures may affect the use of specific practices more strongly than they affect the nurses’opinions of their general use of research.Brett (1989) found conflicting relationships when examining specific infrastructures. Shefound that in small hospitals, mechanisms to support nurses doing research and exposure topublications was positively correlated with the use of findings. However, she found that in largehospitals these same infrastructures and those intended to promote attendance at conferences andpresentations, performing research duties in work and inducements to learn were negativelycorrelated with the use of specific findings. It is also relevant to note that Brett (1987) and Coyleand Sokop (1990) all indicated that perception of hospital policy was related to the use ofspecific findings. It is therefore not surprising that the nurses’ perceptions of organizationalinfrastructures were related to the use of specific findings.Similarly, the research climate correlated with all of the organizational characteristics andchange factors and with the use of specific research findings, but did not correlate with generaluse of research. The research climate had a fairly high correlation with infrastructure (r=0.63) andseveral of the items seemed to overlap with infrastructure, suggesting that the research climateand infrastructures are closely related and may be defining the same construct.The low correlation of infrastructures and climate and the absence of a correlation betweenthe other organizational factors and research utilization outcomes does not mean that theorganizational context is not influential. The nurses who responded to the survey added revealingcomments. One nurse stated, “Our hospital is very rigid and backwards in regards to116administration. The new head nurse is trying hard to develop (a research climate), but it’s likebanging your head against a brick wall”. Another nurse made the comment, “Don’t make wavesattitude” referring to research climate. Another nurse wrote, “If my hospital involved moreresearch it would improve nursing and patient care 100%”.Several nurses commented on the difficulty of using research-based practice within thecurrent practice setting. For example, a nurse wrote, “As an RN who works on a ward I find itdifficult to answer these questions. Being short staffed, we don’t have time for research in ourwork day”. Others suggested that the context of practice was broader than the context addressedby the study. For example, one nurse commented that “people in this town won’t accept it(referring to changing nursing practice based on research)”, and several other respondents madecomments on the lack of nursing control over resources and decisions.There was a wide range and considerable variability in the research climate andinfrastructure scores, suggesting a wide range of opinion and a wide range of organizationalsupport for research. The nurses’ individual characteristics may mediate the influence of theorganization on research practice, thus obscuring the relationship.Research Utilization OutcomesThe two measures of research use were correlated. General use of research correlated withall of the personal and professional characteristics and change factors but none of theorganizational characteristics. The use of specific findings was correlated with two of theorganizational variables (organizational infrastructure and research climate), but did not correlateto any of the personal or professional variables. Although research climate and infrastructuresvaried by hospital size and correlated with the use of specific findings, the use of specificfindings did not vary by hospital size. It seems that both individual and organizationalcharacteristics are related to the use of research, but that individual factors influence how nurses117perceive their general use of research, whereas organizational factors influence the use of specificpractices. The relationship between the nurses’ individual factors and general use suggests thatthe nurses’ values, attitudes and expectations are congruent with their perceived behaviour. Inother words, the nurses see themselves generally practising as they expect themselves to and incongruence with their values and interests. The relationship between the organizational factorsand the use of specific findings suggests that the organizational infrastructure and climate is moreinfluential in the use of specific findings than individual factors are. This finding is congruentwith the findings that the perception of hospital policy influences the use of specific findings(Brett, 1987; Coyle & Sokop, 1990). Previous lack of attention to organizational variables mayexplain the inconclusive findings regarding the predictors of use of specific findings. Finally, thefact that the use of specific findings did not vary with hospital size but correlated with researchclimate and infrastructures which did vary by hospital size, suggests that the individual factorsmay mediate the influence of the organizational factors on the use of specific findings.Theoretical and Methodological ConsiderationsThese research results support the components and relationships proposed in the conceptualframework. The findings support Crane’s (1989) conclusion that individual factors are not directlyrelated to the use of specific findings. Rather, organizational factors have a direct influence onthe use of specific findings and individual factors mediate the influence of organizational factors.However, the findings also suggest a relationship between individual factors and general researchuse, which was not proposed in the model by Crane. Previous studies, including Crane’s, haveexamined the use of specific findings, but not the general use of research.The results of this study confirm, complement, and extend previous research fmdings. Thelevel of research use is similar to that of previous studies. The influence of individual factorssuch as education, attitude and experience were similar to previous studies. The findings118regarding the influence of organizational factors supports the work of Crane (1989), Clarke(1992) and Clarke and Joachim (1993) in clarifying the understanding of the importance oforganizational value, climate and infrastructure. The findings regarding the influence ofexpectations extends understanding of the influence of both individual and organizational factors.This study has inherent limitations common to survey research. Specifically the differencesbetween respondents and non-respondents was not known and the organizational expectations andsupports were reported from the perspective of the staff nurse. However, the impact of theselimitations is lessened by the stratified random sample, reasonable sample size and theopportunity to compare the findings with those of Alcock et al. (1990), Clarke (1992) and Clarkeand Joachim (1993) obtained using a similar instrument and comparable geographical areas.Additional limitations were related to hospital size categories, the measurement of researchuse and problems with individual items on the survey. The categories of hospital sizes werebroad, possibly limiting the detection of differences in research use between sizes. This problemmay have been especially important regarding the small hospital category. The measurement ofresearch utilization was also problematic. First, research use was measured from the perspectiveof the nurse. Second, the general use of research may have only been another measure of attitude.Third, measurement of the use of specific findings was limited to practices which have varyingapplicability and there was no means of clarifying the meaning of responses or the reasons fornon-use. Finally, the survey had some items that were clearly difficult to interpret and there wasno way to clarify responses.SummaryIn this study, the sample consisted of 183 staff nurses working in medical-surgical andcritical care areas of hospitals of different sizes in British Columbia. The stratified samplingresulted in a sample which consisted of 45% diploma educated nurses and 54% baccalaureate119educated nurses. The representation from educational levels and hospital sizes yielded subgroupsthat were sufficiently similar in size to permit the use of analysis of variance. The sample wassimilar to the population of nurses in B.C. in terms of gender and age, but was purposefullystratified to over represent baccalaureate educated nurses and nurses working in medical-surgicalor critical care settings.While the response rate (42%) was adequate for a mail survey, the response rate differed byeducational level and it was not known how the non-respondents differed from respondents.Overall, the nurses in the sample had very positive attitudes toward research and had highexpectations of themselves. There was little difference between educational preparation, with onlyresearch experience and value for research showing significant differences. Individual factors andresearch utilization outcomes did not vary with hospital size; however, the nurses’ opinions oftheir organizations varied considerably with organizational size and with organizational support,and expectations for research utilization generally increasing with hospital size. The nursesreported moderate general use of research and of use of specific findings at levels that arecomparable to or better than previous findings. Education does not seem to significantly influenceresearch utilization. Individual factors seem to influence general use of research whereasorganizational factors influence the use of specific findings. Organizational size influences theresearch-related organizational characteristics but does not influence the use of specific researchfindings.The relationships between the individual factors, organizational factors and researchutilization outcomes had a definite pattern. All of the organizational factors varied with hospitalsize, whereas none of the individual factors did. None of the organizational factors varied withthe nurses’ educational levels whereas the individual factors of value for research and researchexperience were higher for baccalaureate nurses. All of the individual factors were inter-related120and all of the organizational factors were inter-related, however, there was little correlationbetween individual and organizational factors. The only correlations between individual andorganizational factors were the correlation between respondents’ reports of head nurseexpectations and their own expectations to use research and the correlation between the nurses’research experience and perception of organizational infrastructures. In terms of researchutilization outcomes, the general use of findings was related to individual factors and the use ofspecific findings was related to organizational factors. All of the individual factors were relatedto general use of research and there were no differences between nurses of different educationallevels or hospital sizes. Only two organizational characteristics (research climate andinfrastructure) and none of the individual characteristics correlated with the use of specificfindings.This study supports the conceptual framework proposed by Crane (1989) and suggests meritin adding the concept of general use of research. The results confirm previous findings regardinglevels of research use and the influence of individual factors such as education, attitude, andexperience. The findings about the influence of organizational factors increases understanding ofthe importance of organizations communicating value, setting climate and providing infrastructuresupport for research, and offers new understanding regarding the influence of nurses’ expectationsin this regard.The major limitations of this study include the unknown differences between respondentsand non-respondents and the fact that organizational factors were reported from the perspectiveof the staff nurse. However, the stratified random sample, reasonable sample size and theopportunity to compare the findings with similar studies strengthened the validity andgeneralizability of the study.In this chapter, the survey results have been presented, analyzed and discussed. In the next121chapter, the study will be summarized and the implications for nursing practice, education andresearch that arise from this study’s conclusions will be presented.122CHAPTER FWESummary, Conclusions, and ImplicationsThis study was designed to describe the levels of organizational expectations andsupport for research use, levels of nurses’ expectations of themselves to use research, andlevels of research use by staff nurses. The study was further designed to investigate therelationships between nurses’ use of research and their expectations of themselves, how theyperceived their employers’ expectations and organizational support for research utilization.The study compared the levels and relationships between these research predictor andoutcome variables for groups of randomly selected diploma and baccalaureate prepared nursesworking in hospitals of different sizes. In this final chapter, the study is summarized and theconclusions are presented. The implications for nursing practice, education and research arealso presented.Summary of the Research ProjectA review of the literature revealed that previous studies had focused on the influence ofthe characteristics of individual nurses on the use of specific research-based practices (Brett,1987; Coyle & Sokop, 1990; Ketefian, 1975; Kirchoff, 1980; Linde, 1989, Winter, 1990) andon the factors influencing dissemination, communication and use of findings (Champion &Leach, 1989; Crane, 1989; Funk, Champagne, Wiese & Tornquist, 1991b). Mostinvestigations of the influence of organizational factors on the use of research were limitedto secondary consideration within studies that focused on the characteristics of individualnurses (Brett, 1986; Champion & Leach, 1989; Coyle & Sokop, 1990; Crane, 1989; Funket a!., 1991 b; Kirchoff, 1982; Linde, 1989). The organizational characteristics of hospital size123(Brett, 1987; Kirchoff, 1980) and research support mechanisms (Brett, 1989; Crane, 1989)were studied, but results were inconclusive. Other studies (Champion & Leach, 1989; Coyle& Sokop, 1990; Funk et al., 1991b; Linde, 1989) each considered different organizationalcharacteristics, and thus their findings were not confirmed. The only organizationalcharacteristic which was consistently shown to influence the use of research in practice wasthe perception of unit policy (Brett, 1986; Coyle & Sokop, 1990; Kirchoff, 1982). Theseresearchers found a relationship between the perception that a policy existed regarding aspecific practice and the use of that practice, regardless of whether there was an actual policyin existence.More recently, organizational infrastructures and expectations for research have beendescribed from the perspective of key individuals responsible for research activities in healthcare organizations and schools of nursing (Clarke, 1992; Clarke & Joachim, 1993) and fromthe perspective of staff nurses (Alcock et a!., 1990). However, no research has been reportedregarding the influence of organizational support or expectations on research-based practice.The purpose of this study was to investigate the organizational support and expectations forresearch and their influence on the use of research findings in nursing practice from theperspective of the staff nurse.Crane’s (1989) conceptual framework guided this study to focus on the influence of theorganizational context, organizational change factors, individual characteristics, and individualchange factors on research utilization outcomes. The contextual variables considered werehospital size and research-related infrastructures. The organizational change factors includedthe nursing department’s value for research, the expectations for research-based practice124perceived to be held by key nursing personnel, and the organization’s research climate. Theindividual characteristics included demographics and the nurses’ education and researchexperience. Finally, individual change factors included the nurses’ own value for research,interest in research and expectations to use research in practice. This researcher viewed thesevariables as predictors of research utilization outcomes. The research outcomes consideredwere the nurses’ views of their general use of research and their use of ten specific findingsidentified in earlier studies (Brett, 1987; Coyle & Sokop, 1990).This descriptive correlational survey was conducted using a stratified random sample ofstaff nurses working in British Columbia. The sample was stratified by educational level(diploma and baccalaureate) and by district to obtain responses from nurses working inhospitals of different sizes. Four hundred and fifty (450) nurses were surveyed by mail. Allparticipants completed the Research Use in Nursing Practice instrument modified from Clarke(1991). Consent to participate was assumed by the nurses returning the completed survey.Descriptive and parametric statistics were used to analyze the data.Responses were obtained from 183 staff nurses (42%) who worked in medical-surgicaland critical care areas of hospitals of different sizes in British Columbia. The stratifiedsampling resulted in 45% diploma educated nurses and 54% baccalaureate educated nurses.The sampling strategy also resulted in representation from hospitals of different sizes whichwere categorized as small (<250 beds), medium (250-499 beds) and large (>500 beds). Therepresentation from educational levels and hospital sizes yielded subgroups that weresufficiently similar in size to permit comparisons between groups and the use of analysis ofvariance.125The sample was similar to the population of nurses in B.C. in terms of gender, but waspurposefully stratified to over-represent baccalaureate nurses and to limit the study to nursesworking in medical-surgical or critical care settings. The sample was also more representativeof nurses working part-time than of the population of staff nurses working in B.C. acute carehospitals. The sample was younger than the overall population of nurses in B.C., but waslikely similar in age to nurses currently employed, especially those employed in acute carehospitals. While the response rate (42%) was adequate for a mail survey, the responsediffered by educational level. It was not known how the non-respondents differed fromrespondents. This posed the greatest limitation for the study.The nurses in the sample had very positive attitudes toward research and had highexpectations of themselves to use research in practice. The nurses had high value for research(mean=20.3; SD=2.99; possible range=6-24), high but varied interest levels (mean=30.7,SD=5.9; possible range=lO-40) and high expectations of themselves to use research(mean=18.2; SD=3.6; possible range=6-24). There were no differences between educationalgroups with regard to interest and expectations, but the baccalaureate nurses held asignificantly higher value for research. There was also a difference in research-relatedexperience, with the baccalaureate nurses having significantly more experience than diplomanurses. Overall, the nurses had little research experience (mean of 5.8 experiences per nurse;SD=3.3) and most of the difference was due to courses taken by baccalaureate nurses.Despite little research experience, the nurses’ values for research, interests in researchand expectations of self for using research were high in this sample regardless of educationallevel and hospital size. Although Alcock et al. (1990) found greater differences between126educational levels, the findings regarding in individual factors in the current study wereotherwise remarkably similar to previous research (Clarke, 1992; Clarke & Joachim, 1993;MacDougall & Hargis, 1989).The nurses reported moderate levels of general use of research (mean 22.7; SD=4.91;possible range 10-40) and of use of specific findings (average of 77% use at least“sometimes”) that were comparable to or better than previous findings (eg. Brett, 1987; Coyle& Sokop, 1990; Winter, 1992) but difficult to evaluate in terms of adequacy. As withprevious studies (Brett, 1987; Crane, 1989; Coyle & Sokop, 1990; Ketefian, 1975; Miller andMessenger; 1978; Winter, 1990) there were no differences in research utilization outcomesbetween educational levels and no differences were found between nurses from hospitals ofdifferent sizes.General use of research was correlated with all of the nurses’ individual characteristicsand change factors (r—0.37-0.51) but was not correlated with any of the organizationalcharacteristics or change factors. In contrast, the use of specific findings had significant lowpositive correlations with the organizational change factor of research climate (r=0.33) andthe number of research-related infrastructures (0.31), but was not correlated with any of theindividual characteristics or change factors. There was a low significant correlation betweenthe general use of research and use of specific findings (r=0.38). These findings wereinterpreted as indicating that general use did not measure the same behaviour as the use ofspecific findings. Nurses’ opinions regarding their general use of research may be useful, ormay simply be another estimate of attitude toward research rather than an estimate ofresearch-related behaviour.127The nurses’ opinions of their organizations varied considerably with organizational size,with the support and expectations for research utilization generally increasing with hospitalsize. The value for research that the staff nurses believed was held by the nursing departmentwas reasonably high (mean=19.5; SD=3.3; possible range 6-24), but not as high as the nurses’own value for research on the same scale (mean=20.3). The value for research wassignificantly different by hospital size, with value scores increasing from small to mediumhospitals and from medium to large hospitals. This contrasted with the nurses’ own value forresearch where there were no differences between hospital sizes.The staff nurses reported that the head nurse and director expectations to use researchwere fairly high (mean=17.7 and 17.8), but not as high as the nurses’ own expectations (mean18.2). The perceptions of nursing director expectations reported by the staff nurses werelower than, but similar in distribution and order of importance, to those reported by keyindividuals in hospital settings (Clarke, 1992). The nurses’ own expectations correlated withtheir perceived head nurses’ expectations, but not with the directors’ expectations. Thereported organizational expectations were lowest in small hospitals and highest in largehospitals, with the perception of expectations held by head nurses being influenced by thenurses’ educational level.The research climate was generally reported as low (mean=25.9, SD=6.8, possiblerange=1 1-44) and the number of infrastructures reported was low (mean=7.2 infrastructuresper organization). Opinions of the research climate were consistent with the findings of otherstudies by Alcock et a. (1990), Clarke (1992) and Clarke and Joachim (1992). The researchclimate and infrastructures were lowest in small hospitals and highest in large hospitals.128Organizational climate and infrastructures seemed to be the strongest factors influencingthe use of specific findings. This finding is congruent with earlier findings (Brett, 1986;Coyle & Sokop, 1990; Kirchoff, 1982) that perceptions of unit policy were influential onpractice. As with the other organizational factors, the climate and infrastructure werecorrelated with all of the organizational characteristics (r=0.49-0.56 and r=O.29-0.56,respectively). In addition, both the climate and infrastructures were inter-correlated (r=0.63)and correlated with the research utilization outcome of use of specific findings (r=0.33 and0.31, respectively). However, although these organizational factors varied by hospital size andcorrelated with the use of specific findings, the use of specific findings did not vary byhospital size. Whereas Crane thought that organizational factors overwhelmed individualfactors, the findings of the current study were interpreted as suggesting that nurses’ individualcharacteristics mediate the influence of organizational factors.The relationships between organizational and individual factors and research utilizationoutcomes were as predicted by Crane’s (1989) conceptual framework. The individual changefactors were inter-related (r=0.46-0.60) and correlated with the general use of research asreported by the nurses (r=0.4 1-0.51). The organizational change factors were also inter-related(r=O.47-0.67) and climate correlated with the use of specific findings. The organizationalfactors were not related to individual factors, except for the correlation between the nurses’own expectations to use research and the perceived head nurses’ expectations, and thecorrelation between research experience and reported organizational infrastructures. The useof specific findings was only related to organizational factors, whereas the second measureof research utilization (general use of research) was only related to individual factors. The129two measures of research utilization outcomes were also correlated. These findings wereinterpreted as providing support for Cranes’ conceptual framework.The major factors limiting the study were methodological concerns with the surveyinstrument, the fact that organizational factors were measured from the perspective of thestaff nurse and the low response rate. The internal validity of the study was limited by thefact that the organizational characteristics and change factors were reported from theperspective of the staff nurse. However, this can be viewed as a strength in that perceptionsof organizational supports and expectations are likely to be more influential on research-related behaviour than the presence of supports or expectations as perceived by others.Furthermore, comparison with the work of Clarke (1992) reveals that the perceptions of thestaff nurses were reasonably similar to those of key individuals in hospitals.The generalizability of this study is limited by the potential differences betweenrespondents and non-respondents. The non-respondents may have been significantly differentthan respondents in attitudes and expectations toward research and in levels of research use.However, the random selection, reasonable sample size and similarity of the sample to thepopulation of staff nurses makes it reasonable to generalize the patterns of relationshipsobserved in the study. The random selection makes it reasonable to generalize to staff nursesworking in medical surgical or critical care areas of hospitals in B.C. Given the similarity ofhealth care systems in Canada, it is also reasonable to generalize to other provinces. Becausethe sample was stratified, it is also reasonable to generalize to both baccalaureate and diplomaeducated nurses. Therefore, in the following section, conclusions which arise from this studyare presented.130ConclusionsBased on the limitations, the following conclusions seem reasonable. The first set ofconclusions that can be reached from this study pertain to the individual nurses’characteristics: their value for, interest in, experience with and expectations for using research.Nurses’ interests in research and expectations of themselves to know and use researchfindings seem to be similar regardless of educational level or hospital size. Nurses areespecially interested in knowing research results relevant to their area of practice, findinganswers to specific nursing problems and using research results to change practice. Nursesexpect themselves to use research, especially to critically question practice and to applyfindings to practice. Nurses who have baccalaureate education seem to hold higher value forresearch and have more research experience than nurses with diploma education.A second set of conclusions can be reached regarding the influence of individual factorson the use of research in practice. Nurses’ values for, interests in, experiences with andexpectations to use research seem to influence nurses’ perceived general use of research.These characteristics do not seem to directly influence the use of specific findings, but maymediate the influence of the organization on the use of specific findings. Educational leveldoes not appear to make a significant difference to the levels of general use of research orthe use of specific findings.This study also permits conclusions regarding nurses’ perceptions of organizationalchange factors. Nurses perceive the organizational climate and support for research to be low,especially in small hospitals. However, nurses perceive the organizational expectations for theuse of research to be fairly high but this varies with hospital size and lower than nurses’131expectations of themselves.Conclusions regarding the impact of the organizational context and change factors arenot easily drawn. While organizational size does not seem to influence nurses’ individualcharacteristics or use of research, organizational supports and expectations are higher in largerhospitals. Organizational climate and support do not appear to be related to general use ofresearch, but are related to the use of specific findings. These organizational variables werethe only factors which correlated with the use of specific findings. The results suggest thatorganizational climate and support are the strongest factors influencing the use of specificfindings.Conclusions regarding research utilization outcomes are also difficult to reach. Nurses’opinions of their general use of research appear to be related to the values, interests,experiences and expectations they hold regarding research. Nurses’ use of specific findingsare related to the presence of positive organizational factors. Neither general use nor use ofspecific findings were as high as would be ideal for a profession which aspires to beresearch-based. The findings suggest implications for the promotion of research-based nursingpractice.Implications for Nursing Theory, Practice and EducationThis study builds upon earlier research which has shown that nursing practice is notpredominantly research-based. However, this study reveals that both diploma educated andbaccalaureate educated nurses value, are interested in, and expect themselves to use researchin practice. This study also illustrates that the organizational context in which nurses practiceis influential. Theory, practice and education could be enhanced by the understandings offered132by this study.First, theory about research-based practice should be based on a more complexunderstanding of research, practice, and organizations. Nurses from education, research, andpractice need to understand that the factors influencing research-based practice are not limitedto the characteristics of the individual nurse. This study has demonstrated that organizationalinfluences need to be considered and modified to enhance research-based practice. Therefore,research-based practice must be thought of as a complex, multi-factorial situation that isinfluenced by the organizational practice setting as well as by the individual practitioner. Theconceptual framework used in this study could be used as a basis for understanding practiceand for educating nurses as well as for guiding future research. In addition to considering thegeneration, communication and evaluation of research findings, theories of research utilizationneed to focus on the implementation of research findings in practice.Second, nurses need to be educated to enhance the use of research in practice. The factthat education has not been shown to have a significant impact on research-based practiceshould not be interpreted as meaning that research-related education is not valuable. It maybe that the amount of research education that nurses receive is insufficient to have an impactor that the methods of teaching and/or the focus of research education have not beeneffective. It could also be that research utilization is not or has not been taught (H. Clarke,personal communication, April 6, 1994). It may also be that organizational factors limit theimpact of the individual nurse and his or her education. However, the findings that nurses areespecially interested in research activities that are directly related to their practice and specificpractice areas suggest that an integrated approach to teaching research (in addition to or rather133than the separate course approach) would likely be beneficial. These findings also supportrecent emphasis on research utilization in baccalaureate education. The findings furthersuggest that nursing education at both diploma and baccalaureate levels should build practice-related research activities into curriculum. For example, the research related to basic nursinginterventions should be introduced to beginning level students. The findings also suggest thatmore emphasis on research utilization in graduate programs is warranted. In introductorynursing courses and throughout their education, nurses should be required to evaluate thefindings from research to guide their practice. As noted by Akinsanya (1994), research shouldbe brought to the centre of basic nursing education.Third, practice environments need to promote research-based practice. As argued bySpence (1994), changes in education are unlikely to have an impact unless there are changesin practice organizations. The findings of this study illustrate that nurses are interested inresearch activities that are directly related to their practice. This suggests that expectationsfor research-based practice could be built formally into clinical practice requirements throughjob descriptions and performance appraisal systems, and that research activities directlyrelated to practice would be expectations that are acceptable to staff nurses. Additionalsupports, such as in-service education or consultative services, in the environment could targetenhancing research-based practice.The low perceptions of climate and support for research could be enhanced, especiallyin smaller hospitals. Although different supports for research in different sizes of hospitalswould be reasonable, hospital administrators could evaluate what their expectations are andhow their expectations will be supported. If a hospital is committed to research-based nursing134practice, the extent of that commitment should be reflected in the communication of thoseexpectations and the support available.The variation and discrepancies between organizational expectations and nurses’expectations for research use suggest that organizations could make expectations explicit andcommunicate expectations clearly. The frequency with which the nurses did not know whatresearch supports were available suggests that organizations could focus on communicatingthe available supports to staff nurses.Implications for Further ResearchThe findings of this study suggest implications regarding instrumentation, conceptualframeworks and methods to be used in further studies of research utilization. The findingsalso suggest further research that needs to be done.In terms of instrumentation, the results suggest that measuring general use of researchprovides different information than that obtained by measuring the use of specific findings.Although general use of research may only be another measure of the nurse’s attitude towardresearch, this suggests that the measurement of research-based nursing practice should not belimited to the implementation of specific findings. The scale measuring general use ofresearch should be further developed and refined.The high percentage of nurses who found the specific research findings “not applicable”to their practice indicates that methods of measuring research utilization must be more currentand specific to the nurses area of practice. Research findings in more specific areas ofpractice should be reviewed to identify research that is ready for implementation. This wouldprovide a better measurement of research utilization outcomes. The current study used135specific findings that were considered to be clearly appropriate for implementation as ameasure of research use. Further work also needs to be done to measure the use of researchwhere findings are not clear or are ambiguous. Research needs to explore how nurses can anddo incorporate research findings in making decisions about nursing practice. Finally, studiesto date have focused on reported use of research, but have not explored the relationshipbetween these reports and actual behaviour. Methods of measuring the actual implementationof research findings in practice must be sought. Triangulation through multiple data collectionmethods, such as observation and interviews, would be useful.Crane’s conceptual model guided the study in a useful and productive manner. Theresults support the framework and suggest that further work using it would be valuable. Themodel could now be tested using techniques such as LISREL. The data obtained in this studymay be useful for such testing.The survey approach used in this study prevented follow-up with the nurses to clarify andunderstand responses to questions and to explore the organizational context in which thenurses practice. For example, the influence of different levels of congruence between nurses’expectations and their perceptions of employer expectations or between their ownexpectations and their use of research could not be explored. The survey approach alsoprevented identification of factors influencing the use of research utilization from theperspective of the nurse. Further study using qualitative approaches would allow a deeperunderstanding of the complex problem of factors influencing research-based practice.Study of nurses’ value for, interest in, and expectations to use research should bereplicated with other samples. The impact of these characteristics needs further study to136identify why such high value, interest, and expectations do not result in research-basedpractice. The results of this study suggest that further exploration of organizational factorswould be valuable and might help to explain differences between nurses’ individualcharacteristics and levels of research-based practice. Further study of the impact oforganizational climate, support and expectations is required. These variables should bemeasured from the nurses’ and employers’ perspectives simultaneously and measurements ofcongruence between organizational and staff nurse perspectives should be obtained. Inaddition, similar studies should be completed in a variety of contexts, including otherprovinces, states or countries.This study supports the conclusion of earlier work that educational level does notinfluence research use. This surprising and interesting conclusion warrants investigation todetermine why the additional research experience and education about research did not resultin increased research use in practice. Further study to compare specific approaches to researcheducation are needed. The impact of courses focusing on research utilization and models ofintegrated research education should be evaluated.The strong support for research activities that are directly related to practice implies thatnursing research should continue to strive toward addressing research questions which arerelevant to practice and which answer specific practice problems.Some discrepancy between nurses’ expectations of themselves, organizationalexpectations and the use of research has been shown. However, further study is required tounderstand this complex relationship. The responses showed variation in the congruencebetween the expectations of the nurse and key individuals in the organization. However, the137survey approach prevented follow-up with the nurses to understand the influence of differentlevels of congruence. The survey approach also prevented identification of factors influencingthe use of research utilization from the perspective of the nurse. Further study usingqualitative approaches would allow a deeper understanding of the complex problem ofpromoting research-based practice.********This study focused on the relationship between organizational expectations and supportfor the use of research in nursing practice. While expectations were not shown to directlyaffect research utilization, organizational infrastructure and climate were found to beinfluential. The conceptual framework directed the study to consider the problem of research-based practice within an organizational context, but only examined that context in a limitedfashion. Lomas (1993) suggests that the use of research findings must consider thepractitioner as embedded in “a powerful network of influences” that include influences of theeconomic environment, the media and other professionals (p. 10). Further study of research-based practice should consider nursing practice within a broader context and should examinethe control of nursing practice within that broader context. Specifically, the influence of theeconomic context of practice and the influence of physicians should be examined. Finally,the question of who controls nursing practice should be addressed. Nurses are only able toimplement the findings of nursing research to the extent that they have control over theirpractice. Ultimately, nursing care of clients can only be improved through application ofknowledge generated and refined through research.138ReferencesAkinsanya, J.A. (1994). Making research useful to the practising nurse. 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The process of translating research findings into nursing practice. Journal ofAdvanced Nursing, 12, 101-110.Kazanjian, A., Pulcins, I., & Kerluke, K. (1992). A human resources decision support model:Nurse deployment patterns in one Canadian system. Hospital and Health ServicesAdministration, 37(3), 303-3 19.Ketefian, S. (1975). Application of selected nursing research findings into nursing practice: Apilot study. Nursing Research, 24(2), 89-92.King, D., Bernard, K., & Hoehn, R. (1981). Disseminating the results of nursing research.Nursing Outlook, 29, 164-199.Kirchoff, K.T. (1982). A diffusion survey of coronary precautions. Nursing Research, 31(4),196-201.141Kirchoff, K.T. (1991). Who is responsible for research utilization? Heart & Lung, 20(3),308-9.Lewin, K. (1952). Field theory in social science: Selected Theoretical Papers. London:Tavistock.Linde, B.J. (1989). The effectiveness of three interventions to increase research utilizationamong practising nurses. Unpublished doctoral dissertation, University of Michigan.Lomas, J. (1993). Teaching old (and not so old) docs new tricks: Effective ways to implementresearch findings. Centre for Health Economics and Policy Analysis Paper 93-4. Hamilton:Mc Master University.Loomis, M.E. (1985). Knowledge utilization and research utilization in nursing. Image: TheJournal of Nursing Scholarship, 17(2), 35-39.MacGuire, J.M. (1990). Putting nursing research findings into practice: Research utilization asan aspect of the management of change. Journal of Advanced Nursing, 15, 614-21.Mercer, R.T. (1984). Nursing research: The bridge to excellence in practice. Image: TheJournal of Nursing Scholarship, 16(2), 47-51.Miller, J.R., & Messenger, S.R. (1978). Obstacles to applying nursing research findings.American Journal of Nursing, 4., 632-4.Munro, B.H., & Page, E.B. (1993). Statistical methods for health care research, (2nd ed.).Philidelphia: Lippincott.Polit, D.F., & Hunger, B.P. (1991). Nursing research principles and methods, (4th ed.).Philideiphia: J.B. Lippincott.Reinhard, S.C. (1988). Managing and Initiating Change. In E.J. Sullivan & P.J. Decker,Effective Management in Nursing, 93-119, (2nd Ed.). Menlo Park: Addison Wesley.Rogers, E.M. (1983). Diffusion of innovations. New York: Free Press.Romano, CA. (1990). Diffusion of technology innovation. Advances in Nursing Science.13(2), 11-21.Spence, D.G. (1994). The curriculum revolution: can educational reform take place without arevolution in practice? Journal of Advanced Nursing, 19, 187-193.Statistics Canada (1991). Registered nurses management data 1991. Canadian Centre forHealth Information.Stetler, C.B. (1985). Research utilization: defining the concept. Image: The Journal of NursingScholarship, 17(2), 40-44.142Stevens, J. (1990). Intermediate statistics: A modern approach. Hillside, N.J.: LawrenceErlbaum.Thurston, N., Tenove, S., & Church, J. (1987). Nursing research in Canadian teachinghospitals. Final report. Calgary, Alta.: Foothills Provincial General Hospital.Welch, L.B. (1990). Planned change in nursing: The theory. In E.C. Hien & M.J. Nicholson(Eds.) Contemporary leadership behaviour: Selected readings (pp. 299-3 10). Boston: LittleBrown.Wood, N.F., & Catanzaro, M. (1988). Nursing research: Theory and practice. St. Louis:Mosby.Winter, J.C. (1990). Brief: Relationship between sources of knowledge and use of researchfmdings. Journal of Continuing Education in Nursing, 21(3), 138-140.143Appendix A:R.N.A.B.C. Electoral District StructureRNABC ELECTORAL DISTRICT STRUCTUpjFIDB144A - Mainland-Coastal DistrictChapters: North Shore, Sunshine Coast,Richmond/DeltaB - Vancouver Metropolitan DistrictChapters: Vancouver MetropolitanC - North Vancouver Island, Powell River & GulfIslands DistrictChapters: Campbell River, Comox Valley, Duncan,Gulf Islands, Long Beach, Mt. Arrowamith, Nanaimo,North Island, Port Alberni, Powell RiverD - Greater Victoria DistrictChapters: Greater VictoriaE - Fraser Valley DistrictChapters: Central Fraser Valley, Fraser-Cheam, MapleRidge-Pitt Meadows, Mission, New Westminster, SouthFraserF - Northeast DistrictChapters: Bella Cooler Valley, Central Cariboo,Chinook, Fort Nelson, Misinchinka, Nechako Valley,North Cariboo, North Peace, Prince George, SouthCariboo, South Peace, Stuart lakeG - Northwest DistrictChapters: Houston, Kitrnano, Omineca, Prince Rupert,Queen Charlotte Islands, Rocher, Smithers, TerraceII- Kootenays DistrictChapters: Castlegar, Cranbrook, Creston, Fernie,Golden & District, Invermere & District, Kimberley &District, Nelson, TrailI - Thompson-Columbia DistrictChapters: Kamloops, Nicola Valley, North Thompson,Reveistoke & District, Salmon Arm, Lillooet AreaJ - Okanagan DistrictChapters: Kelowna, Penticton, Spallumchecn, SouthOkanagan, Summerland, Vernon145Appendix BResearch Utilization in Nursing Practice QuestionnaireResearchUseinNursingPracticeColleenM.Varcoe,MSNStudentUniversityofBritishColumbiaSchoolofNursingPhone:469-8400August,1993ResearchUseinNursingPractice2.PerceivedRoleinResearchThissurveyasksquezionsaboutthevalueofusingresearchinnursingpractice,pportforusingresearchanduseofresearchfindingsinpractice.Pleaseanswereachquestionascompletelyaspossible.Yourresponsesareimportanttounderstandingthefactorsthatinfluencetheuseofresearchinnursingpractice.1.PerceivedvalueofresearchinnursingOnascaleof1-4,indicatetheresponsethatreflectsyourownvaluesandtheresponsethatreflectsyourunderstandingofthephilosophy,missionstatement,goalsorobjectivesofyournursingdepartment/division.Pleaseputtheappropriatenumberintheboxesontheright.1.Researchbasedknowledgeassiststhenursetoimprovetheeffectivenessofnursing.1=stronglydisagree2=disagree3=agree4=stronglyagree2.Researchenhancestheprofession’saccountabilitytothepublic.3.Researchfindingsprovide“thefacts”neededtovalidateclinicalpracticedecisions.4.Theresearchprocessisessentialforcreatinginnovative,scientificnursinginterventions.5.Researchenhancesnursing’seffectivenessinrespondingtonewdevelopmentsaffectinghealth.6.Researchfindingsenablenursestousescarcehealthcareresourcesmoreefficiently.Onascaleof1-4,pleaseindicatetheresponsethatbestreflectstheresearchactivitiesyouexpectofyourselfandthoseactivitiesthatareexpectedofyoubyothers.Pleaseputtheappropriatenumberintheboxesunderthecorrectcolumnsontheright.Ifthereisnoclinicalinstructororclinicalnursespecialist,pleaseput“N/A”(notapplicable)intheappropriatebox.1=stronglydisagree2disagree3=agree4=stronglyagreeOWNNuRsINGVALUESDEPT.VALUESExpectationsof:SelfHeadClinicalC,N.S.NursingNurseInstruct.Director1.criticallyquestioneffectivenessofdailynursingpractice.2.promoteaclimatethatsupportsmycolleague’sresearchendeavours.3,beinvolvedincollectingdatafornursingresearchstudies.4.beinvolvedincollectingdatafornon-nursingresearchstudies.5.conductresearchstudies.6.applyresearchfindingstoclinicalpractice.-3.Perceivedresearchclimateinyourorganization.Pleaseindicatethatwhichbestdescribestheclimateofinquiryinyourorganization.—1=stronglydisagreedisagree)3’=agreeInmyorganization:4stronglyagree1.nursesareencouragedtoquestiontheirnursingprctices.2.nursesareencouragedtoconductresearchstudiestodevelopmoreeffectivemethodsofpractice.3.nursesareencouragedtoutilizeresearchfindingstodevelopmoreeffectivemethodsofpractice.4.therearestrategies(eg.committees,plans,people)specifictosupportresearch-relatedactivities.5.otherstaffnurscsarcInterestedinrcscarchrelatedactivities.6.physicianssupportnursingresearch.7.otherdisciplinesareinterestedinresearchcollaboration.8.nursingprofessorsareavailabletoactasresearchadvisors,consultantsorcollaborators.9.nursingprofessorsconductresearchstudies.10,studentsconductresearchstudies.11.nurseswhoparticipateintheresearchprocessreceiverecognitionfortheirinvolvement.4.YourinterestinresearchForeachstatement,pleaseindicatetheresponsethatbestdescribesyourinterestinNURSINGresearch-relatedactivities.1=stronglydisagree2=disagree3=agree4=stronglyagreeIaminterestedin:1.findinganswerstospecificnursingproblems.2.readingresearchstudies.3.discussingresearchstudies.4.participatinginresearchprojectsofothers.5.knowingtheresultsofresearchprojectsconductedinmyorganization.6.knowingtheresultsofresearchprojectsconductedinmyareaofpractice.7.usingtheresultsofresearchtochangepractice.8.determiningwhatdifferencesresearch-basednursingpracticemakes.9.conductingresearchaspartofaworkassignment.10.conductingresearchevenifitisnotpartofaworkassignment.5.YourresearchexperienceForeachstatement,pleaseindicatewhetherornotyouhavedoneanyofthefollowing:Pleasecheckoneonly(I’)YESNO1.takenacourseinresearchmethods.2.takenacourseinstatistics,3.completedquestionnairesforaresearchproject.4.conductedinterviewsforaresearchproject.EEJEEl5.collectedspecimensforaresearchproject.EEJ6.beenaprincipalinvestigatorofaresearchproject.7.beenaco-investigatorofaresearchproject.EJ8.beenaresearchassistant.EEl[El9.assistedwiththewritingofagrantproposal.EEl[El10.writtenagrantproposal.D11.receivedfundsfrommyorganizationtoconductresearch.5.Yourresearchexperience(continued)Foreachstatement,pleaseindicatewhetherornotyouhavedoneanyofthefollowing:Pleasecheckoneonly(I’)YESNO12.receivedfundsfromothersourcestoconductresearch.13.attendedconferenceswhereresearchstudieswerepresented.14.attendedconferenceswhereresearchfindingswereincludedinpresentations.15.publishedresearchresults.D16.presentedresearchresults.17.changednursingpracticebasedonresearchfindings.18.evaluatedtheresultsofthechangedpractice.6.YouruseofresearchPleaseindicatetheextenttowhichyoudoeachofthefollowing:1=notatall2=sometimes3=frequently4=always1.Iamfamiliarwithcurrentresearchrelevanttomyareaofnursing.2.Icanidentifytheresearchbasisformycommondailypractices.Pleaseindicatetheextenttowhichyoudoeachofthefollowing:3.I criticallyquestiondailypracticesforeffectiveness.I=no,never2=yes,sometimes4.Iuseresearcharticlestosupportmyquestioningof3=yes,alwaysN/A=notavailabledailypractices.inmyareaofpractice5.Icanidentifyhospitalpolicies/proceduresthatarebasedoncurrentresearch.2,Priortoremovalofacatheterwhichhasbeeninapatientforat6.Icanidentifyhospitalpoliciesorproceduresthatleast 36hours,thecatheterisintermittentlyclampedandarenotbasedoncurrentresearch,released.Bladdertoneisbelievedtobeincreased,resultinginanearlierreturntonormalmicturitionpatterns.7.Iimplementnursingcareonthebasisofcurrentresearchfindings.Doyouusethismethodwhencaringforpatientswho8.Icommunicateconcernsabouttheeffectivenessofhavehadabladdercatheterforatleast36hours?practicestocolleagues.3.Sensoryinformationaboutwhatistobefelt,seen,heard,tasted9.Ichangepracticebasedonresearch.Iand/orsmelledduringadiagnosticprocedurehasresultedinIpatientsexperiencinglessdistressduringtheprocedure.10,Ievaluatetheresultsofchangedpractice.Doyouprovidesensoryinformationtopatients7.Youruseofspecificresearchfindingswhenpreparingthemfordiagnosticprocedures?.Pleaseindicater!ieextenttowhichyoudoeachofthefollowing:4.Sensoryinformationaboutwhatistobefelt,seen,heard,tastedand/orsmelledinrelationtoasurgicalprocedurehasbeen1=no,neverassociatedwithimprovedpatientoutcomespostoperatively.2=yes,sometimes3=yes,alwaysDoyouprovidesensoryinformationtopatientsN/A=notavaiIaI)Ic•whenpreparingthemforsurgkalprocedures?inmyareaofpractice1.Internalrotationofthefemurduringinjectionintothedorso-5.Preoperativetraininginrelaxationtechniquesreducespaindistressandincreasescomfortinpost-operativepatients.glutealsite,ineithertheproneorside-lyingposition,resultsinreduceddiscomfortfromtheinjection.DoyouteachyourpreoperativepatientsrelaxationDoyouusethismethodwhengivinganinjectionintotechniques?cI’thedorsoglutealsite?6.Testingtheurineofpatientsforglycosuriaandacetonecanbedone8.OrganizationalOverviewwithequalaccuracyoneitherthefirstorsecondvoidedspecimens.PleaseindicatewhetherornotyourorganizationhasthefollowingDoyouroutinelyusethefirstvoidedspecimensupportsfornursestobeinvolvedinresearchrelatedactivities.forsugarandacetonetesting?Pleasecheckoneonly(V)(Yes,No,Don’tKnow)7.Aformallyplannedandstructuredpreoperativepatienteduca-YESNODKtionprogramprecedingelectivesurgeryresultsinimprovedMyorganizationhas:patientoutcomes.1.ahospitalmissionstatementwithprioritiesDoyouprovideaformallyplannedandstructuredforresearchpreoperativeeducationprogramforyourelectivesurgerypatients?2.anestablishedresearchpolicy/protocolDD8.Accuratemonitoringoforaltemperaturescanbeachievedon3.aresearchreviewcommittee.patientsreceivingoxygentherapybyusinganelectronicthermometerplacedinthesublingualpocket.4.ifyes,istherenursingrepresentationonthecommittee?Doyouusetheoralmethodtoelectronicallymonitor-thetemperatureofapatientreceivingoxygentherapy?L_.I5.anethicsreviewcommittee.9.Whilepassiverangeofmotionactivitiesdonotseemtoberelatedto6,ifyes,istherenursingrepresentationincreasedintracranialpressure,otheractivitiesare,suchaschangingonthecommittee?thepatient’spositionbyrotatingtheheadorturningthepatient.7.acombinedresearchandethicsreviewcommittee.Doyouusethisknowledgewhenyouprovidecare8.ifyes,istherenursingrepresentationtoyourpatients?onthecommittee?9.experiencedresearcherswhocanactas10.Theprocessofmutualgoalsetting(wherepatientandnurseconsultants.collaborativelycefineasetofpatientgoals)leadstomoreeffectivegoalachievementandincreasespatientandstaffsatis-10.secretarialservices(e.g.,forsubmittingfaction,proposals,transcribingaudiotapes).Doyouusemutualgoalsettinginyourinteractions11.librarysearchservices.withpatients?12.computerfacilitiesfordataprocessing.26.nurseresearchassistants/associatesworking.onnursingresearchstudiesaspartofthenursingdepartment13.dataanaly;isconsultants,27.nurseresearchassistants/associatesworking14,fundingibudgetforpilot,feasibilityorfacilitationstudiesDonnon-nursingresearchstudiesaspartofthenursingdepartment15.releasetimefornurseinvolvementinresearchrelatedactivities.9.HospitalDataOurNursingDepartmenthas:Thefollowingprovidesinformationaboutthehospitalinwhichyouareemployed:16.anursingphilosophywhichexplicitlyreferstoresearchandnursingD1.Inwhatsizeofhospitalareyouemployed?17.adefinitionofnursingresearchwhich<249bedsguidesthedevelopmentofournursingresearchprogram18.aseparatenursingresearchdepartment,250-499bedsdivisionorcouncil19.anursingresearchcommitteeaspartof>500bedstheorganizationalstructure20.aninformalnursingresearchcommitteeor2.Whattypeofunitdoyouworkonmostofthetime?interestgroupMedical21, jobdescriptionsfornurseadministratorsthatincluderesearchresponsibilitiesSurgical22. jobdescriptionsformiddlemanagementDthatincluderesearchresponsibilities23. jobdescriptionsforclinicalinstructorsMedical/SurgicalDthatincluderesearchresponsibilitiesDDD24. jobdescriptionsforclinicalnursespecialistsCriticalCarethatincluderesearchresponsibilitiesOther(pleasespecify).25. jobdescriptionsforstaffnurseswhichinc1udef___________________researchresponsibilities_____________________10.PersonalDataThefollowingprovidesinformationaboutyourself1.Whatisyourageinyears?2.Whatisyourgender?MaleFemale3.Whatisyoureducationalpreparation?CheckyearsifearnedsincegraduationR.N.DiplomaBaccalaureatedegree(Nursing)Baccalaureatedegree(Other)Master’sdegree(Nursing)Master’sdegree(other)4.Howmuchdoyouwork?Checkoneonly,please.FulltimeParttimeThankyouforyour participationinthissurvey.Yourtimeandinterestaregreatlyappreciated.ColleenVarcoeUi154Appendix C:Letter to ParticipantsSchool of NursingT. 206-2211 Wesbrook MallVancouver, B.C. Canada V6T 2B5Fax: (604) 822-7466I am a student in the Master’s in Nursing program at the University of British Columbia. I am writing to invite you toparticipate in a study investigating how nursing practice changes. In particular, this study will explore how nursingknowledge is used among nurses and how organizations can facilitate the use of research in practice. Because of thecurrent emphasis on research in nursing and research-based practice, this study should provide valuable informationregarding how an organization can facilitate practice change. The title of my project is “The Relationship of Support andExpectation for Research Utilization to Research Use in Practice”.Your name was selected from the list of nurses registered with the Registered Nurses Association of B.C. In order topreserve your anonymity, I paid the R.N.A.B.C. to select a random sample of nurses for this study, label and mail thispackage to you on my behalf. No person, nursing unit or institution will be identifiable in the results of the survey. Inaddition, all responses will be completely confidential, to be used only for the purposes of this study. I have enclosed astamped, self-addressed envelope for your convenience in returning the questionnaire. Instructions for completing theform are included on the questionnaire.I have also asked R.N.A.B.C. to generate and keep an extra set of mailing labels for all nurses selected for this study fora follow up letter.The results from this survey will be used as part of my thesis. If you are interested, when the results are complete I willsend you a summary of the results. For that reason, I have enclosed a separate form for you to indicate that you wouldlike a summary of results. This form can be mailed separately or will be separated from the survey when it is received.Since your name was selected as part of a scientific sampling technique, in order for my results to be valid, it is importantthat all participants complete and return the questionnaire. Could you please take some time today, or at your earliestconvenience, to complete the questionnaire and return it? The questionnaire should take about 15 minutes to complete.Your participation in this research is entirely voluntary and your response will be greatly appreciated. You have the rightnot to participate. Return of the questionnaire will indicate your consent to participate in the study. Please do not hesitateto contact me if you have any questions regarding this research. Questions can also be directed to the chair of my thesiscommittee, Dr. Ann Hilton at 822-7498.Thankyou for your participation!CoBeen Varcoe R.N., M.Ed.469-8400THE UNIVERSITY OF BRITISH COLUMBIADear Registered Nurse155Sincerely156Appendix D:Optional Form to Receive Summary of Results157Optional: Please complete only if you would like to receive a summary ofresults when available *This sheet will be separated from the questionnaire when it is received, oryou may mail it separately or fax it to 469—7178.Name_________________________________________________Address_ _ _ _Postal Code__________158Appendix E:Correlations Between Educational Level and Hospital Size and Study VariablesTable48CorrelationMatrixforStudyVariablesAGE=Nurses’ageYEARS=YearssincegraduationEXSELF=Nurses’ownexpectationstouseresearchINTEREST=Nurses’interestinresearchEXPER.=Nurses’researchexperienceOWNVALUE=Nurses’ownvalueforresearchEXP.EXP.GENERALHEADNURSEDIRECTORUSECLIMATE=OrganizationalClimateINFRA.=OrganizationalInfrastructuresNDEPT.VALUE=NursingdepartmentvalueforresearchEXP.HEADNURSE=HeadnurseexpectationsofstaffnurseEXP.DIRECTOR=NursingdirectorexpectationsofstaffnurseGENERALUSE=GeneraluseofresearchEDUCHOSPSIZEEXSELFINTERESTEXPER.OWNCLIMATEINFRA.NDEPT.VALUEVALUEEDUC1.00HOSPSIZE0.011.00EXSELF0.07-0.081.00INTEREST0.09-0.050.601.00EXPER.0.44”-0.010.29**0.31***1.00OWN0.17*-0.030.52***0.46***0.141.00VALUECLIMATE-0.11-0.440.20*0.090.060.161.00INFRA.0.120.140.110.27***0.050.63***1.000.39***NDEP.-0.080.020.060.05-0.120.23**0.49***0.29***1.00VALUEEXP.HEAD-0.090.100.42***0.11-0.070.010.49***0.30***0.47***1.00NURSEEXP.-0.020.26*40.26***0.04-0.150.020.56’’0.35***0.56***0.67***1.00DIRECTORGENERAL0,03-0.060.51”0.50*0.37***0.41***0.18*0.24***0.050.160.131.00USEUSEOF-0.020.16*0.25’0.23**0.15*0.130.33***0.31***0.140.060.24*0.38***FINDINGS*p<0.05**p<0.l**p’<O.OOl

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