RESEARCH UTILISATION

Research utilisation (RU) and the use of evidence in practice are often seen as the same; however, RU predates notions of EBP by some decades. In the UK, the Briggs Report (Department of Health, 1972) is often seen as the beginning of an interest in research utilisation in nursing (Smith, 1979; Hunt, 1981; Closs & Cheater, 1994; Mulhall, 1995; Tordoff, 1998). However, the extent to which this interest has successfully been translated into changes in practice is less clear. In the USA, there had been substantial efforts in the form of large well funded RU projects which were

focussed as much on increasing the research skills of nurses and assisting them to undertake research, as they were with RU (Omery & Williams, 1999). In the UK there was less clarity about the goal of RU, with discussions ranging around whether nursing research actually made any difference (Hunt, 1981) and whether research was even relevant to nursing (Mulhall, 1995). What most authors did agree on was that available nursing research was not being used (Hunt, 1981; MacGuire, 1990; Bircumshaw, 1990; Closs & Cheater, 1994; Pearcey, 1995). The reasons for this were outlined by Hunt (1981:192) in her seminal paper:

1. ‘Nurses do not know about research findings 2. Nurses do not understand research findings 3. Nurses do not believe research findings 4. Nurses do not know how to apply them

5. Nurses are not allowed to use research findings’.

Hunt did not conclude that there was a lack of research on which to base nursing practice, although this has been raised as a problem since (Mulhall, 1995). However, even this has not been without contention. Some authors have seen the problems not only as a lack of research, but also that the research base for nursing was poorly developed, not organised and not of sufficient quality to be applicable to practice (Mulhall, 1995). In contrast MacGuire (1995) believed that there was a plethora of research available to nurses and the difficulties arose from overload and lack of ability to assimilate the amount of information available.

In addition to improving the care for patients, there was a concern that research had not been part of the educational preparation of nurses and that this was a hindrance to RU (Smith, 1979). Nurses lacked the skills to undertake research and to understand it. It gradually became fully integrated into the pre-registration curriculum (by 1988 in Scotland). At the same time, nursing was trying to raise its profile as a profession and the possession of a unique knowledge base on which to base nursing care and to see it as separate from medicine, became entangled in the RU goal.

Types of RU

As thinking about the concept of RU has developed, there is a growing understanding that there are different types of RU. Closs and Cheater (1994) discussed the different ways in which research might influence practice, suggesting that it might be more than causing changes to practice, but that it might also influence the way that nurses think about or reflect on practice. Stetler (1994) in the further development of an RU model acknowledges that there are different types of RU, naming them; instrumental, conceptual and persuasive, also known as symbolic, RU (Estabrooks, 1999). These terms reflect the belief that research can influence individuals in different ways. In health care the focus has always been on instrumental use, that is, the direct use or impact on policy or practice. A specific piece of research could be identified as the basis for practice or policy. Conceptual use acknowledges the more diverse ways that research might influence an individual’s way of thinking about a practice problem or affecting their understanding of it. It is a means of affecting attitudes, rather than direct behaviour as in instrumental use but can also be considered as producing wider influences on knowledge and understanding, beliefs, practice behaviours and outcomes (Walter, et al., 2005). It is a more complex, less specific use of research, more difficult to trace or demonstrate (Nutley, et al., 2007). Symbolic or persuasive use describes the influence that research can bring through a third party, for example, practitioners using a piece of research to lobby for changes to service provision, within their own organisation (Stetler, 1994) or by using research to make a ‘good case’ for increased human or financial resources (Lacey, 1994).

Drawing on experience of studying cross sector research use Nutley, et al., (2004a) also note that RU can be viewed as a continuum, in which research raises practitioners awareness, through the development of knowledge and understanding, to influencing actual change in practice or policy (Nutley, et al., 2007). In an earlier paper, they suggest that in a review of the RU literature, three types of RU can be identified, depending on who the main focus of the RU is: those focussed on professionals, those types of RU that are organisation-wide and those that involve entire systemic re- orientations (Nutley,et al., 2002b).

In a study of the process of RU, Landry,et al.(2001a,b), once again identify the three main types of RU, instrumental, conceptual and symbolic, but they acknowledge that

the processes for getting research used in practice are complex and rarely depend on an individual knowing about a piece of research alone. Indeed, much of the work on RU over the recent years has begun to move away from the focus on the individual, to take account of the complexity of the process and the role of the employing organisation in this, for example, Estabrooks, et al., (2002); Estabrooks, (2003); Estabrooks & O’Leary, (2006).

There has been a growing awareness that efforts to improve the use of evidence and research in practice need to focus on the wider aspects of implementation, moving away from expecting nurses to know about and then use evidence in practice as the sole means of increasing evidence use. Studies such as that undertaken by the Foundation of Nursing Studies (2000; 2001), in recognising this, make recommendations which are designed to impact at all levels within the local and national NHS and at individual level. This move to consider wider organisational factors is demonstrated in the type of research that is now being undertaken to improve understanding of RU at this level, such as the study by Meijers,et al.(2006) and that outlined by Stetler,et al. (2007) which aim to improve understanding of the impact of contextual factors on RU.

Having considered the nature of evidence in its widest sense and introduced the concept of RU, the following section goes on to review the literature relating to EBPI and that is more directly related to the empirical concerns of this study. The section begins to focus the review on the complexities of the process and highlights the role of individual nurses in EBPI processes. It then goes on to consider the literature relating to the organisational aspects of EBPI and NMs within them. The section concludes by considering the difficulties in the process and presents the well- researched barriers to the process.