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| Peta Drury RN, MNsg, MRCNA, Clinical Coordinator Neurosurgical 1 Medical Unit St Vincent's Hospital |
A group of practicing registered nurses completing a Master of Nursing program was encouraged to discuss evidence-based nursing care. The group identified constraints that impinge upon the successful initiation conduct and application of research to the clinical setting. When comparing the groups' concerns to literature dating back to the early seventies it appears that the nursing profession has made little progress in the area of evidence-based practice.
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It is not a new idea that nurses need to engage in research and integrate research findings into practice. In spite of the seemingly common acceptance of this principle, the actual merger of research and practice has yet to become widespread (Carol et al., 1997). The gap that exists between research and practice has been termed the research-practice gap (Bostrom et al., 1993). Bostrom et al. (1993) contend that although many different reasons are put forward for the research-practice gap, there is agreement that ways should be found to strengthen the role of research in nursing and to overcome the factors inhibiting this role.
Whilst undertaking a Master of Nursing program, the subject content required that I facilitate a group discussion focusing on the research-practice gap. The group consisted of twenty (20) fellow Master of Nursing program students, all practicing clinicians from a range of clinical backgrounds including neurological, psychiatric, paediatric orthopaedic and community-based nursing. In preparation for this session an extensive literature review was conducted, with the earliest material dating back to the early seventies. Following a review of the literature I chose to initiate discussion from the following two questions:
The following is a comparative analysis of the groups' concerns and their strategies compared to what has been portrayed in the literature.
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The first three concerns raised by the group are not new. A study conducted by Voda et al., dating back to 1971 highlighted that the research-practice gap was the result of
These constraints have repeatedly been discussed in current literature. Akinsanya (1993) deduced that the majority of research disseminated in journals is not read by the practicing clinician. Smith (1986) & Miller et al. (1997) surmised that nursing's poor research performance is due to insufficient time for nurses to participate in research activities.
The fourth constraint identified by the group and probably the most disconcerting, is that practicing clinicians do not understand the importance of research. Although most nursing research reports contain at least one finding that could be implemented in hospital wards and community nursing (Aldnsanya, 1993) the group highlighted many examples of nursing care that continue to be driven according to the procedure book rather than through research. Cruickshank (1996), Walsh & Ford (1986: 2) also agree that 'nursing tends to be in-situation driven rather than research driven and actions have become rituals.' One participant stated "applying research findings in nursing practice is perhaps the greatest challenge facing the nursing profession."
The final constraint identified by the group, and Akinsanya (1993: 174) agrees that, 'at the heart of the debate about the usefulness of research to the practicing nurse is a fundamental lack of concern with the education of nurses in the process of research during initial training.' One participant described research as a "minute and difficult component" of undergraduate nursing programs. Millar (1993) also agrees that there has been no consensus by the nursing profession about the place of research and development in nurse education.
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The group surmised it is definitely a challenge to put research into practice as changing ward practice is generally resisted by the clinical nurse. Considerable evidence exists to show that change is disruptive and resisted by most people (Schon, 1971; Marris, 1978; Wright, 1989). Up to date there has been little discussion of the importance of nurse leaders when implementing research into the clinical setting (Wilson-Barnett et al., 1990; MacGuire, 1990). Freda (1989) contends a leader is at the forefront of change and must guide others in that change. The group deduced there are many difficult roles that their leaders had not mastered including:
The group deduced that todays times demand a leader who is comfortable with influencing directing and initiating change.
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The group suggested a further strategy is the development of research teams. These teams would include members with the education required to carry out and evaluate research, but importantly, act as teachers to future researchers. The team would also consist of registered nurses directly involved with patient care and leaders who support research and have the ability to initiate change. Team researching, the group agreed, would have the potential to:
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Through education the value of research can be promotedHowever, as the group identified there is a lack of concern with the education of nurses in the process of research during initial training. Akinsanya (1993) pointed out that graduate nurses are themselves more likely to wish to pursue research, since, by the nature of their own education, the pursuit of knowledge through research is firmly embedded in their attitudes after graduation. For the practicing nurse to appreciate and recognise the usefulness of research they have to become research-aware and research-minded. Therefore research should form a core of undergraduate and postgraduate education (Akinsanya, 1993). A study conducted by MacGuire (1990) reported that the preparation of nurse teachers was fundamentally deficient in the elements of research. Bond pointed out that there is no guarantee that nurse teachers completing a course today will have been exposed to methods of incorporating research into their teaching The group concluded further developing research skills amongst nurses will improve research skills amongst future nurse educators.
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The overall implication of the research-practice gap has been the inability to change nursing practice to incorporate nursing-research findings (Wilson-Barnett et al., 1990). Nursing as a profession is obliged to promote change in order to enhance high standards of patient care (Smith, 1986). However at the same time the profession must utilise research to validate and prove that those changes are beneficial (Jaarsma & Dassen, 1993). Akinsanya (1993: 174) deduced 'it is the fostering of a critical and questioning approach made possible by research that improves our quality of nursing care.' The clinical nurse is a critical component of nursing research who is capable of identifying the constraints contributing to the research-practice gap, and identifying strategies to ensure evidence-based nursing care.
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