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RESEARCH UTILIZATION IN NURSING CLASS 6 Judith Anne Shaw, Ph.D., R.N. October 21, 2009.
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Transcript of RESEARCH UTILIZATION IN NURSING CLASS 6 Judith Anne Shaw, Ph.D., R.N. October 21, 2009.
![Page 1: RESEARCH UTILIZATION IN NURSING CLASS 6 Judith Anne Shaw, Ph.D., R.N. October 21, 2009.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649eaa5503460f94bb007e/html5/thumbnails/1.jpg)
RESEARCH UTILIZATION IN NURSING
CLASS 6
Judith Anne Shaw, Ph.D., R.N.
October 21, 2009
![Page 2: RESEARCH UTILIZATION IN NURSING CLASS 6 Judith Anne Shaw, Ph.D., R.N. October 21, 2009.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649eaa5503460f94bb007e/html5/thumbnails/2.jpg)
OVERVIEW OF CLASS #6
• Nursing Research Utilization
• Barriers to Research Utilization
• Change, a Positive Strategy for Research Utilization
• Iowa Model for Research-Based Practice
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DEFINE
RESEARCH UTILIZATION
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Consider
• Utilization: to make use of, to use
• Research utilization: to make use of research in clinical practice
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Research Utilization
– the systematic process by which research-based knowledge becomes incorporated (or used) into practice.
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PURPOSE
• RESEARCH UTILIZATION
• Application of available knowledge to improve client outcomes.
• Validation of existing nursing procedures and interventions
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Evidence-Based Practice
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Research Utilization
Important
all levels of nursing
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Research Utilization Nurses in the clinical setting
• Promotes critical thinking
• Enhances professional self-concept
• Ensures safe and reflective practice
• Practice based on current, scientific, sound knowledge
• Enrich nurse’s self-confidence
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Researcher
• Validates researcher’s efforts
• Provides motivation for scholars to continue to discover new knowledge
• Reinforces professional accountability
• Helps uncover new clinical problems for investigation
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Health Care Agency
• Cost effective nursing care
• High-quality care
• Improved client outcomes
• Retention and recruitment tool
• Professionally satisfied and stimulated nursing staff
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Profession of Nursing
• Enhances practice autonomy
• Positive professional image
• Strengthen professional status
• Expands nursing’s scientific knowledge base
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What does history tell us about research utilization?
• A gap or time lag in the use of new knowledge in the clinical setting.
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Time Lag Between Idea & Utilization
• can be 10-15 years
(Bostrom & Wise, 1994)
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Narrowing the Research-Practice Gap Through Research Utilization
Step # 1. select a relevant problem area
• Problem-focused triggers
• Knowledge-focused triggers
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Problem Focused Triggers for Problem Identification
• Evident to nurses in the practice setting
¤ Clinical problems
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Knowledge-Focused Triggers for Problem Identification
• Knowledge obtained from:
¤ Journal clubs
¤ Attending a professional/academic
conference
¤ Reading a scientific paper
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Narrowing the Research-Practice Gap Through Research Utilization
Step #2. Review the literature
¤ Sufficient quantity
¤ Sufficient quality
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Narrowing the Research-Practice Gap Through Research Utilization
• Step # 3. Determine …are findings appropriate to apply in the practice setting?
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Criteria for Research Utilization
• Utility to nursing
• Applicability to practice
• Replication
• Scientific merit
• Client safety
• Feasibility
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Narrowing the Research-Practice Gap Through Research Utilization
Step # 4. Written plan to communicate the research-based intervention or protocol
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Narrowing the Research-Practice Gap Through Research Utilization
Step # 5. Implementation of the planned innovation
¤ involve all staff¤ change process
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Narrowing the Research-Practice Gap Through Research Utilization
Step # 6. Evaluation of innovation
¤ what went right?¤ what went wrong?¤ what changes are required?
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Narrowing the Research-Practice Gap Through Research Utilization
Step # 7. Dissemination of findings
¤ publishing results of theresearch utilization
¤ did it make a difference?
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Problems: using research findings
Barriers to knowledge “use” in nursing
Nurse Characteristics
Setting Characteristics
Research Characteristics
Innovation Characteristics
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Barriers to Knowledge Use
• Study findings:– do not solve pressing clinical problems– often can not be used in practice– lack replication– communicated primarily to other researchers– not expressed in easily understood terms by
practitioners
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Nurse Characteristics
Knowledge
Attitudes
Beliefs
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Nurse Characteristics
Knowledge
Two Kinds of Knowledge
1. specific research studies related to practice setting
2. ability to critique reported research
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Nurse Characteristics
Attitudes
Need positive attitude towards research
utilization
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Nurse Characteristics
Beliefs
Correct or erroneous beliefs about research
¤ Change often begins with the articulation of negative beliefs
٠lack of time
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Setting Characteristics
Five characteristics that must be present:
1. Openness to new ideas
2. Interpersonal and information linkages for open communication
3. Freedom from organizational constraints
4. Supportive leadership
5. Trust … to risk possible failure
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Research Characteristics
Clearly communicated
Comprehensive
Investigation of pertinent problems
Staff nurses part of the research team
Replication of research studies
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Innovation Characteristics
• Perceived improvement
• Compatibility with present practice
• Complexity
• Trialability
• Observability
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How to work together and use Nursing Research Findings
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Bridging The Research - Practice Gap
1. Commitment
2. Knowledge of the practice setting structure
3. Planned strategy of change/clinical setting
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Pay-Off Narrowing the Research-Practice Gap
1. Improved client care
2. Developing the artistry of practice
3. Professional status of nurses
4. Status of nursing within the scientific, academic, and health service community
5. Societal relevance of professional practice
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Current Conceptions of Research Utilization
A continuum in terms of the specificity or
diffuseness of the use of knowledge
conceptual instrumental
mid-ground
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Research Utilization
Instrumental Utilization:
- base specific actions on research
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Instrumental Utilization
• discrete
• clearly identifiable attempts
to base some specific action on the
results of research findings
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Conceptual Utilization
Influences nurses’ thinking about an issue.
Conceptual Instrumental
Mid-Ground
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Conceptual Utilization
Situations in which users (nurses) are influenced in their thinking about an issue based on their knowledge of one or more studies but do not put the knowledge to any specific documented use.
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Mid Ground Utilization
• Knowledge creep
• Decision accretion
Conceptual Instrumental
Mid-Ground
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Mid-Ground Utilization
Partial impact of research findings on nursing activities
-these nursing actions are based to some extent on research findings but other
factors are considered.
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Middle Ground Research Utilization
Knowledge Creep:
-an evolving percolation of research ideas and findings
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Middle Ground Research Utilization
Decision Accretion:
-momentum for a decision builds over time based on accumulated information gained through such actions as reading, discussions, and meetings
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Research Utilization
Appropriate Goal for Nurses
- all points along the continuum
Conceptual Mid Ground Instrumental
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Knowledge Gap in Nursing Production & Utilization
• A gap does exist in nursing , as well as other disciplines
• Some gap is inevitable given the imperfection of scientific research as a means of knowing
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Possible Inflated GapNursing Knowledge
Production & Utilization
1. Technical changes
2. Risk/benefit analysis
3. Non-captured utilization
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Technical Changes
Utilization studies do not always consider
changes that make the knowledge irrelevant.
(may take 2 yr. to publish findings)
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Risk/Benefit Analysis
- the risks for problems if the results are implemented and prove to be incorrect
(nursing is more conservative versus medicine)
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Non-Captured Utilization
Focus of utilization studies is most often on instrumental utilization; probably mid -ground utilization of the continuum not captured.
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What can... YOU & OTHER NURSES DO?
• Student nurses & practicing nurses
– think, conceptually “use” research findings
– regularly read research journals
– read critical reviews of research– attend professional conferences
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What can... YOU & OTHER NURSES DO?
• Researchers– conduct “quality” research– replicate– collaborate– disseminate aggressively & broadly (publish)– communicate clearly
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What can... YOU & OTHER NURSES DO?
• Scholars & educators– incorporate research findings into the curriculum
– note absence of relevant research, when appropriate
– encourage research utilization
– prepare integrative research reviews with class content
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What can... YOU & OTHER NURSES DO?
• Administration– foster a climate of intellectual curiosity– offer emotional or “moral” support for
utilization– reward efforts for utilization
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Planned Change
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Change Agent
… one who works
to bring about
a change
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The Process of Change
Driving Restraining
Forces Forces
Target System
(Adapted from Lewin, K. (1951). Force Field Model)
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Driving & Restraining ForcesBegin the change process by…
Analyzing the entire system involved to identify the forces for and against change
driving forces: push the system toward
change
restraining forces: pull the system away
from change
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Forces
driving forces: push the system toward
change
restraining forces: pull the system away
from change
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ProblemConcern: When the existing restraining
forces are the same or stronger
than the driving forces
Resolution: Use participative change
strategies to reduce the restraining
forces and increase the driving
forces for change to occur.
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Assessing Opposing Forces
Need a thorough knowledge about:
- the target system
- the environment
- the characteristics of the change
- the potential responses to change
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PEOPLE RESIST CHANGE SOURCES
TECHNICAL
PSYCHOLOGICAL NEEDS
THREATS TO POSITION & POWER
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Change Process
Three Phases:
1. Unfreezing
2. Change
3. Refreezing
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THE CHANGE PROCESS
Unfreezing Change Refreezing
Comfort Discomfort New Comfort Zone Zone Zone
(diagnostic) (moving) (consolidation & evaluation of
innovation)
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Unfreezing Phase
Takes deliberate actions to “stir things up”
1. Creates disconfirmation (feelings of discomfort or dissatisfaction)
2. Introduces guilt & anxiety (demonstrate unmet goal or value)
3. Provides psychological safety (sufficient security to minimize risk)
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Unfreezing Phase
At completion of the unfreezing phase:
people feel “off-balance”
people have hyper-energy
people require direction for productive action
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Changing Phase
Implementation phase of change:
(the target system is unfrozen
& moving towards change)
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Changing Phase
The change agent:
- introduces new information
- encourages the new behavior
- continues the supportive climate
- provides opportunities for ventilation
- provides feedback & clarification of goals
- presents self as trustworthy
- overcomes resistance
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ESSENTIAL
KEEPING EVERYONE INFORMED
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Refreezing Phase
To stabilize & integrate the change so that it becomes a regular part of target system
Beginning of the phase: situation still fluid
- the target system could still take another course than the planned change
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Change Agent’s Action in the Refreezing Phase
The change agent:
-continues to act as an energizer
-continues to guide new behavior
-increases delegation of responsibilities for change behavior
-maintain visibility and credibility of change
-increases others’ responsibility and decreases leader-manager’s responsibility
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CHANGE
• CONSIDER-
WHETHER YOU THINK YOU HAVE A CHOICE FOR CHANGE OR THINK YOU DON’T HAVE A CHOICE FOR CHANGE, YOU’RE RIGHT
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Iowa Model
for
Research-Based Practice
(Gillis & Jackson, 2002; Farrington, Lang, Cullen, & Stewart; Titler et al., 2001)
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Iowa Model for Research-Based Practice
Set of steps
used as a guide
to identify
practice questions
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Iowa Model for Research-Based Practice
Step #1:
Determine type triggerto improve practicethrough research
(-that will initiate the need for change)
Problem-Focused Knowledge-Focused
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Iowa Model for Research-Based Practice
Problem-focused triggers
1. Risk management data
2. Process improvement data
3. Internal/External benchmarking data
4. Financial data
5. Identification of clinical problem
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Iowa Model for Research-Based Practice
Knowledge-focused triggers
1. New research or other literature2. National agencies or organizational
standards and guidelines3. Philosophies of care4. Observation from institutional standards
committees
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Iowa Model for Research-Based Practice
Step #2:
Identification of relevant literature
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Iowa Model for Research-Based Practice
Step#3:
Critique and Evaluate Research
for use in Practice
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Iowa Model for Research-Based Practice
Step #4:
Determine if there is
Sufficient Research Base?
Sufficient Not Sufficient
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Iowa Model for Research-Based Practice
Step # 5:
If
Sufficient Research Base
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Iowa Model for Research-Based Practice
Step #5, Sufficient Research Base: PILOT THE CHANGE IN PRATICE
• Select outcome to be achieved• Design Nursing/Multidisciplinary Practice
Interventions• Implement Practice Changes on a PILOT
UNIT• Evaluate process and Outcomes• Modify Intervention as Needed
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Iowa Model for Research-Based Practice
Step #5, Insufficient Research Base:
• Conduct Research
• Base practice on other types of evidence
– Case Reports
– Expert opinions
– Scientific principles
– Theory
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Iowa Model for Research-Based Practice
Step #6: Ask-
Is the Change
Appropriate for Adoption
in Practice?
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Iowa Model for Research-Based Practice
Step #7:
If answer is NO
Continue to evaluate quality of care
and
new knowledge
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Iowa Model for Research-Based Practice
Step #7:
If answer is YES
Institute the change
in practice
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Iowa Model for Research-Based Practice
Step #8
Monitor Outcomes
Patient Environment Staff Fiscal
& (Cost)
Family
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Iowa Model for Research-Based Practice
Step #9:
Disseminate results
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Sharing knowledge…and putting knowledge into practice