nursing evidence based practice class - Needed on Saturday morning

Implementing Evidence-Based Practice in Taiwanese Nursing Homes Attitudes and Perceived Barriers and Facilitators

AbstrAct To date, there is a paucity of research

investigating nurses’ perceptions of evi-

dence-based practice (EBP) in nursing

homes, especially in non-Western coun-

tries. This descriptive, quantitative study

investigated attitudes toward and per-

ceived barriers and facilitators to research

utilization among 89 Taiwanese RNs. The

majority of nurses expressed positive at-

titudes toward research and EBP. The most

frequently cited barriers were related to

insufficient authority to change prac-

tice, difficulty understanding statistical

analyses, and a perceived isolation from

knowledgeable colleagues with whom

to discuss the research. EBP facilitators

included improved access to computers

and Internet facilities in the workplace,

more effective research training, and col-

laboration with academic nurses. These

findings are similar to those from research

conducted in Western countries and indi-

cate that further education and training

in research for nurses working in nursing

homes would be beneficial.

© 2

00 9

iS to

ck ph

ot o/

O le

h Av

er in

Hui Chen Chang, PhD, RN, MN, BA; Cherry Russell, PhD, BA; and Mairwen K. Jones, PhD, RN, BA (Hons.)

41Journal of GerontoloGical nursinG • Vol. 36, no. 1, 2010

During the past 2 decades, researchers and health care professionals, including nurses, have become increasingly aware of the importance of using evidence-based practice (EBP) in health care settings. Prior to this, nurses commonly complained of the irrelevancy of research to nurs- ing practice and generally regarded research in a negative light (Bas- sett, 1993; Burrows & McLeish, 1995; Funk, Champagne, Wiese, & Tornquist, 1991a). Although a gradual change toward more posi- tive attitudes about research has been recently reported (Glacken & Chaney, 2004; McCaughan, Thompson, Cullum, Sheldon, & Thompson, 2002; Olade, 2003), re- search is still not always rigorously

used in nursing practice, and this research-practice gap is considered a worldwide phenomenon (Mehr- dad, Salsali, & Kazemnejad, 2007; Nagy, Lumby, McKinley, & Mac- farlane, 2001; Olade, 2003). This is an especially important issue in the area of gerontological nurs- ing: As McConnell et al. (2009) recently noted, “Evidence-based practice holds tremendous poten- tial to optimize care outcomes for older adults, yet many nurses are ill prepared to identify, interpret, and apply the best evidence to their practice” (p. 27).

LiterAture review Unfortunately, research regard-

ing nurses’ attitudes and perceived

barriers to the adoption of EBP has been conducted predominantly in hospital settings in Western coun- tries, such as Australia (Bonner & Sando, 2008), England (Veeramah, 1995), Sweden (Kajermo, Nor- dström, Krusebrant, & Björvell, 1998), and the United States (Brett, 1987). Even in Western countries there is a lack of research examin- ing this topic in nursing homes (Boström, Kajermo, Nordström, & Wallin, 2009; Boström, Wallin, & Nordström, 2006). One study that did examine this issue was conduct- ed by Boström et al. (2006). They investigated staff perceptions of fac- tors related to EBP utilization in 11 facilities in Sweden providing care for older adults. The researchers found positive attitudes toward re-

search but a relatively low extent of research use in daily practice. This was particularly true for the nurses and nurse aides in the sample.

Studies examining why nurses have not widely adopted EBP have identified three main sets of barri- ers. These include the individual’s attributes, such as lack of research knowledge; the organizational con- text, including lack of accessibility to research findings, time, support from others, and authority; and the nature of research, including the gap between research and practice and the complexity of the presen- tation of research articles (Fink, Thompson, & Bonnes, 2005; Gla- cken & Chaney, 2004; Mehrdad et al., 2008).

Many studies have also shown that nurses lack knowledge and confidence to undertake research or apply research findings in practice (Gerrish & Clayton, 2004; Kuup- pelomäki & Tuomi, 2005; Oranta, Routasalo, & Hupli, 2002; Walsh, 1997). A study of 765 nurses work- ing in a U.K. hospital revealed that only 40.5% understood the term evidence-based practice and 68.9% had only a basic knowledge of the research process (McSherry, 1997). An Australian investigation of 400 hospital-based RNs found that lack of understanding of research was a major limitation to the RNs’ grasp of research knowledge (Retsas, 2000). Thus, there was a signifi- cant deficit in nurses’ knowledge of research and the research process, and this reflected an inadequacy in research training.

Organizational factors have also been implicated as a major obstacle for EBP implementa- tion. Researchers have consistently found that most of the significant barriers to EBP implementation were related to features of the or- ganization. These included a lack of accessibility to research articles among nurses (Boström et al., 2009; Kajermo et al., 1998), lack of time (McSherry, 1997; Nagy et al., 2001), lack of support from oth- ers in the workplace (Boström et al., 2009; Griffiths et al., 2001), and lack of authority from medical staff and managers (Funk, Tornquist, & Champagne, 1995; Kajermo et al., 1998). Given these findings, it is not surprising some researchers have as- serted that EBP should be considered an organizational issue rather than an individual response (Dunn, 1990).

As previously noted, most studies to date have been undertaken with nurses in hospital settings within Western countries. To ensure qual- ity of nursing care for older adults, research investigating the experience of and attitudes toward EBP of RNs who work in nursing homes is neces- sary. Further, an investigation of the

Researchers have consistently found that most of the significant

barriers to evidence-based practice implementation were related to features of the organization.

42 JOGNonline.com

difficulties geriatric nurses perceive in incorporating research into their daily care and the strategies they see as use- ful in facilitating the adoption of EBP into nursing homes will provide im- portant information about how best to close the research-practice gap.

study PurPose Given the lack of information

about EBP in nursing homes in non-Western countries, we select- ed Taiwan as the study site. This study extends the scope of previous work in two ways: by investigating a nonhospital setting and focusing on a non-Western society. To our knowledge, it is the first such study to do so. The specific research objec- tives were to:

l Determine the range of at- titudes toward EBP among nurses practicing in nursing home settings and the factors associated with these differing views.

l Describe nurses’ perceptions of barriers to EBP in these nursing home settings, as well as facilitators that may assist the development and use of EBP by nurses in nursing home settings.

Method A descriptive, quantitative study

was conducted with a convenience sample of 89 RNs from six nurs- ing homes. Participants completed a survey that collected self-report data on nurses’ involvement in research- related activities and EBP, along with attitudes toward and their perceived barriers to and facilitators of EBP implementation.

Sample Hsinchu, one of 16 districts in

Taiwan, has a total of 12 nursing homes registered with the Taiwan Department of Health. From these 12, 6 were randomly selected for in- clusion in the study using a lottery draw, which involved placing 12 numbered paper slips in a container and selecting one at a time until six numbers were drawn. Each slip cor-

responded to one of the 12 nursing home sites. The total study sample was composed of the 96 RNs who were employed across the six facili- ties. Eighty-nine of these RNs com- pleted the questionnaire.

Data Collection Because no previous single study

had addressed all of the aspects we wanted to examine, we developed a questionnaire that incorporated rel- evant items from other surveys. For example, the section “Barriers to Us- ing Research in Practice” included 29 items identical to those in the scale used by Funk et al. (1991b). This scale was used because it has high face and content validity, with Cronbach’s alpha coefficients reported between 0.65 and 0.80 (Funk et al., 1991b) and as high as 0.91 (Kajermo et al., 1998; Retsas, 2000). The other survey sec- tions contained items adapted from several sources, with permission from each of the authors (Clifford & Mur- ray, 2001; Hutchinson, & Johnston 2004; McSherry, 1997; Veeramah, 2004; Walsh, 1997). Minor modifications were made to the wording of some items to improve relevance to the tar- get audience and setting. All items (ex- cept sociodemographic characteristics) were in the form of statements, which

respondents were asked to rate on a Likert scale from 1 (strongly disagree) to 5 (strongly agree). Under the super- vision of the first author, these state- ments were translated into Mandarin by a professional translator. Because not all respondents were expected to be familiar with the term evidence- based practice, it was referred to in the survey as “the implementation of re- search evidence to nursing care.” The internal consistency of the sum vari- able was measured using a Cronbach’s alpha coefficient of 0.78.

Data Analysis The coded data were analyzed

using SPSS version 10.0. Descrip- tive statistics included frequencies, percentages, means, and standard deviations. Frequency and descrip- tive statistics were used to identify error entries and remaining am- biguously worded items that tend to yield missing data, as well as to analyze data on sociodemograph- ic details of the sample, attitudes toward EBP, and barriers to and facilitators of using research in practice. Inferential statistics were used to assess whether significant differences existed between de- pendent variables and sociodemo- graphic characteristics. The differ-

tAbLe 1

sociodeMogrAPhic chArActeristics of the sAMPLe (n = 89)

variable n (%) Mean (SD) Age (years) 31.83 (8.32)

Nursing experience (years) 9.00 (6.94)

Educational level

Nursing school 10 (11.2)

Graduate diploma 62 (69.7)

Bachelor’s degree 16 (18)

Master’s degree 1 (1.1)

Past employment position

RN 71 (79.8)

Nurse manager 12 (13.5)

Other 6 (6.7)

43Journal of GerontoloGical nursinG • Vol. 36, no. 1, 2010

ences in the background variables with nurses’ attitudes toward and associations of workplace with barriers to and facilitators of re- search utilization results were studied using chi-square analy- sis, nonparametric procedures (i.e., Kruskal-Wallis test, Mann- Whitney U test), t tests, one-way analysis of variance, Tukey’s hon- estly significant difference test, and Pearson correlations for com- paring mean values.

Ethical Issues Ethical approval for this study

was obtained from the boards of each participating nursing home and from the University’s Human Research Ethics Committee. All participants were given both writ- ten and verbal information about the purpose and nature of the study before being invited to sign the consent form. They were also in- formed that there was no obligation for them to participate, that they could withdraw at any time without penalty, and that information they provided would be treated strictly confidentially. The questionnaires

were returned to the first author in individual sealed envelopes. Identi- fication numbers were used on all completed questionnaires, which were stored and will be retained for 7 years in a locked filing cabinet in the first author’s university office.

resuLts Sociodemographic Characteristics

Table 1 presents the sociodemo- graphic characteristics of the 89 RNs. The mean age of these participants was 31.83 (age range = 22 to 53). On average, they had been in professional nursing for 9 years (range = less than 1 year to 30 years). Most participants (69.7%) held a graduate diploma in nursing, 18% held a bachelor’s de- gree, and 11.2% had graduated from nursing school. Only 1 participant held a master’s degree. All of the par- ticipants currently worked as RNs, although 12 had previously been em- ployed as nurse managers.

RNs’ Attitudes Toward EBP Table 2 shows the means and

standard deviations in rank or- der for the 11 statements assess- ing RNs’ attitudes toward EBP in

nursing homes. The results reveal that the RNs in this study reported generally positive attitudes toward research and EBP, with an overall mean of 3.74. The three statements that elicited the highest average rat- ings were: “Research is essential for the development of the nursing pro- fession” (mean = 4.19, SD = 0.56), “Gerontological nurses should do a compulsory course on research methodology” (mean = 4.01, SD = 0.75), and “Nursing research has a large part to play in improving aged care” (mean = 4.01, SD = 0.55). No significant differences were revealed between the RNs’ attitudes toward EBP and past employment position, educational level, age, and years of nursing experience.

Perceived Barriers to EBP The description of the RNs’ per-

ceptions of barriers to EBP in these nursing home settings was one of the research objectives of this study. Table 3 presents the means and standard deviations of the RNs’ perceived barriers to the use of re- search evidence. The most strongly endorsed perceived barrier was,

tAbLe 2

rNs’ Attitudes towArd evideNce-bAsed PrActice iN NursiNg hoMes

Attitude in rank order Mean (SD) 1. Research is essential for the development of the nursing profession. 4.19 (0.56)

2. Gerontological nurses should do a compulsory course on research methodology. 4.01 (0.75)

3. Nursing research has a large part to play in improving aged care. 4.01 (0.55)

4. Research is the way forward to change nursing practice. 3.99 (0.59)

5. One essential role of gerontological nurses is to carry out research. 3.98 (0.67)

6. Research helps me in my decision making. 3.92 (0.57)

7. Research is relevant to day-to-day work in nursing home settings. 3.82 (0.67)

8. Nursing homes should become an evidence-based practice setting. 3.75 (0.87)

9. I would change my practice based on research findings. 3.47 (0.72)

10. Nursing research is of interest to me. 3.42 (0.78)

11. Research-based practice is useful in a hospital setting, but not in a long-term care setting. 2.60 (0.96)

overall attitudes 3.74 (0.70)

Note. Scores are based on a scale of 1 (strongly disagree) to 5 (strongly agree).

44 JOGNonline.com

“The nurse does not feel he or she has enough authority to change pa- tient care procedures” (mean = 3.71, SD = 0.83), followed by “Statistical analyses are not understandable” (mean = 3.63, SD = 0.74). The next three most strongly endorsed barrier statements were: “The nurse is iso- lated from knowledgeable colleagues with whom to discuss the research” (mean = 3.58, SD = 0.88), “The nurse does not feel capable of evaluating the quality of the research” (mean = 3.56, SD = 0.81), and “There is insuf- ficient time on the job to implement new ideas” (mean = 3.54, SD = 0.80). The participants disagreed with the negative statements: “The nurse does not see the value of research for practice” (mean = 2.38, SD = 0.79), “The nurse feels the benefits of changing practice will be minimal” (mean = 2.51, SD = 0.85), and “The nurse is unwilling to change or try new ideas” (mean = 2.54, SD = 0.80). These results indicate that the RNs believe research is valuable, change is beneficial, and that the nurses were willing to try new ideas.

Although the “Barriers to Using Re- search in Practice” section of the ques- tionnaire included 29 items, the par- ticipants were invited to list additional statements (items 30 through 33) that were not included in the first 29 items. Only 3 of the 89 participants responded to this latter component of the study, and a total of six additional barriers were identified: lack of funding, lack of family support, residents’ lack of coop- eration and motivation, lack of access to research-relevant software, the nature of the environment, and teamwork.

Perceived Facilitators of EBP One of the research objectives

was to identify what the RNs per- ceived as potential facilitators in the development and use of EBP in the nursing home setting. Table 4 presents the means and standard deviations of the five items en- dorsed as the most significant and least significant facilitators to using research in practice.

The two highest perceived fa- cilitators were, “Provides enhanced ward-based computer and Internet

facilities” (mean = 4.14, SD = 0.53) and “Provides advanced education to increase research knowledge base”

tAbLe 3

Most sigNificANt ANd LeAst sigNificANt bArriers to usiNg evideNce-bAsed PrActice

barrier statement Mean (SD) The nurse does not feel he or she has enough authority to change patient care procedures.

3.71 (0.83)

Statistical analyses are not understandable. 3.63 (0.74)

The nurse is isolated from knowledgeable colleagues with whom to discuss the research.

3.58 (0.88)

The nurse does not feel capable of evaluating the quality of the research.

3.56 (0.81)

There is insufficient time on the job to implement new ideas. 3.54 (0.80)

The nurse is unaware of the research. 2.80 (1.03)

The nurse sees little benefit for self. 2.73 (0.93)

The nurse is unwilling to change or try new ideas. 2.54 (0.80)

The nurse feels the benefits of changing practice will be minimal.

2.51 (0.85)

The nurse does not see the value of research for practice. 2.38 (0.79)

Note. Scores are based on a scale of 1 (strongly disagree) to 5 (strongly agree).

tAbLe 4

Most sigNificANt ANd LeAst sigNificANt fAciLitAtors of usiNg evideNce-bAsed PrActice

facilitator statement Mean (SD) Provides enhanced ward-based computer and Internet facili- ties.

4.14 (0.53)

Provides advanced education to increase research knowledge base.

4.09 (0.60)

Improves the understandability of research reports. 4.08 (0.59)

Provides additional authority to instigate changes. 4.08 (0.59)

If clinical and academic nurses worked together to carry out research, it would be more relevant to patient care.

4.06 (0.63)

Improves availability and accessibility of research reports. 3.97 (0.61)

Provides opportunities for quarterly workshops on inter- pretation of statistics and methodology and implementing changes in nursing practice at the clinical level.

3.94 (0.66)

Provides opportunities to attend conferences. 3.94 (0.65)

Provides opportunities to attend research courses. 3.91 (0.62)

Increases the time available for reviewing and implementing research findings.

3.90 (0.57)

Note. Scores are based on a scale of 1 (strongly disagree) to 5 (strongly agree).

45Journal of GerontoloGical nursinG • Vol. 36, no. 1, 2010

(mean = 4.09, SD = 0.60). The least strongly endorsed facilitator was “Increases the time available for re- viewing and implementing research findings” (mean = 3.90, SD = 0.57). The means for all of these statements were within a very small range of 4.14 to 3.90, indicating that all of the statements were perceived by partic- ipants to be important facilitators.

discussioN Overall, the RNs demonstrated

a positive attitude toward research and EBP. This is in line with previous research findings (McCaughan et al., 2002; McSherry, 1997; Olade, 2003; Veeramah, 2004) and suggests that

the RNs recognize the importance of EBP and its potential value for their clinical practice. We also found that the RNs’ attitudes toward research did not differ in relationship to their past employment history, educational level, age, or years of nursing experi- ence. The only inconsistency with previous findings was that in Euro- pean studies, a higher level of educa- tion was associated with more posi- tive attitudes toward EBP (Kajermo et al., 2000; Olade, 2003; Veeramah, 2004). Similarly, a study conducted in Australia also found that senior-level nurses were more likely to have a positive attitude toward research, and that completion of university subjects on nursing research was significant in determining positive attitudes and knowledge of research (Bonner & Sando, 2008). One possible explana- tion may be that in the current study,

only 1 participant held a master’s de- gree, whereas a higher proportion of the European and Australian nursing participants had attained a master’s degree or higher levels of education. The small numbers in the current study have resulted in an inability to detect statistical differences, if they existed.

The RNs perceived a lack of au- thority to instigate change in the clinical setting as the most substantial barrier to research utilization. This concurs with other findings and may relate to the low status and autono- my of nurses across all of the coun- tries investigated (Fink et al., 2005; Schoonover, 2009). As Olade (2003)

argued, nurses’ general lack of power and authority might emanate from a tradition in which nurses did not question nursing practice but instead focused on tasks set for them by col- leagues in management positions or by medical staff.

Statistical analysis was rated as the second most significant perceived bar- rier in the current study. This item was ranked first in the United Kingdom (Walsh, 1997), fourth in Australia (Ret- sas, 2000), and tenth in Sweden (Kajer- mo et al., 1998). These rankings may be indicative of differences in nursing training in the various countries. Sta- tistical analysis is given only minimal attention in the nursing curricula of universities in Taiwan. Most students either do not understand statistics or show a fear of them (Kajermo et al., 2000). This may be because education in such skills is not a specific require-

ment for entering the nursing profes- sion in Taiwan.

The item “The nurse is isolated from knowledgeable colleagues with whom to discuss the research” was the third most significant perceived barrier to research utilization among these Tai- wanese RNs. This finding can be inter- preted in various ways. It may reflect a lack of RNs within organizations who have been trained in research meth- ods, or it may reflect the RNs’ need for knowledge and guidance when at- tempting to interpret research findings. To effect change and advance the status of nursing professionals, the employ- ment of highly qualified nurses with experience in research appears crucial. This will provide support to advance nurses’ skills and engender confidence with clinical capability in the work- place (Meah, Luker, & Cullum, 1996). The benefits of having access to nurse clinicians who can impart their clinical wisdom in combining evidence and practice specific to gerontological care is therefore extremely important (Bon- nel, 2009).

In line with previous findings (Griffiths et al., 2001; McSherry, 1997; Mehrdad et al., 2008), perceived lack of time was the fifth most commonly cited barrier to research utilization. Petten- gill, Gillies, and Clark (1994) suggested there is a need to investigate the concept of time in relation to personal factors such as motivation and aspiration. The need for such an investigation is further supported by Thompson et al. (2008), who suggested that lack of time as a barrier to research utilization is more multifaceted than depicted in the litera- ture and needs to include the notion of the mental time and energy required of nurses in their complex work environ- ments. Overall, the similarities between the findings of the current study and previous studies suggest that differenc- es between nursing in nursing homes and other settings should not be over- estimated.

Our findings suggest the need to im- plement interventions that promote the uptake of research evidence into prac- tice. The RNs in this study envisaged a

Our research suggests that nurses need to be supported so they can move from

using anecdotal evidence, past experience, and precedents to guide their clinical practice to evidence-based decision making.

46 JOGNonline.com

strong learning organization in which they would have greater opportunity and support for learning about EBP, ac- cess to further education and training to increase their research knowledge, and collaboration with clinical nurses who also have research-based knowledge to reduce the gap between research and practice. Previous studies have also demonstrated the effectiveness of a va- riety of interventions, such as increasing managerial support for frontline staff, providing access to advanced education programs to provide nurses with re- search skills, and increasing time avail- able to read and implement research (Kajermo et al., 1998; Parahoo, 2000; Thompson, Estabrooks, Scott-Findlay, Moore, & Wallin, 2007). A systematic review of these interventions by the NHS Centre for Reviews and Dis- semination (1999) concluded that single interventions are insufficient and that successful strategies to promote the up- take of EBP are likely to be multifac- eted, targeting various barriers.

iMPLicAtioNs for PrActice, educAtioN, ANd reseArch

The findings from this study have implications for practice, education, and research. Our research suggests that nurses need to be supported so they can move from using anecdotal evidence, past experience, and precedents to guide their clinical practice to evidence-based decision making. Managers can play an important role in promoting and sup- porting these changes by allowing more time to implement research findings and providing permission and support for nurses to change their nursing care practices.

Nurse educators need to consider the best ways of teaching epidemiol- ogy and statistics, developing skills in critical appraisal, and engendering fa- miliarity with the basic principles and concepts of research. This will help clinical nurses attain greater knowl- edge and understanding of research and its implementation. In addition, it will help nurses become confident in their ability to use appropriate research find- ings in practice and contribute to their

professional responsibility of providing high-quality care for nursing home res- idents. There is also a pressing need for inservice education to increase nurses’ knowledge and awareness of research and its utilization.

One of the limitations of this study is the small sample. Therefore, it would be prudent to repeat the study with a larger sample of nurses working in nursing homes, both in Western and non-Western countries. It is suggested that the questionnaire developed for this study be used in future research to facilitate comparative analyses. We also recommend that qualitative methods, such as individual interviews, focus groups, and direct observation, be used for a more comprehensive picture.

coNcLusioN Overall, our findings among Tai-

wanese RNs concur with those of previous studies that have investigated

barriers to and facilitators of research utilization in Western countries. De- spite cultural differences, a consistency exists among most studies in respect to the positive attitude of nurses toward research and EBP and the most com- mon barriers to EBP. It is clear that a considerable amount of work needs to be done in all countries, including Tai- wan, to overcome these barriers.

refereNces Bassett, C.C. (1993). Role of the nurse teacher as

researcher. British Journal of Nursing, 2, 911- 912, 917-918.

Bonnel, W. (2009). Sharing the evidence, adding our clinical wisdom. Journal of Gerontologi- cal Nursing, 35(5), 3-4.

Bonner, A., & Sando, J. (2008). Examining the knowledge, attitude and use of research by nurses. Journal of Nursing Management, 16, 334-343.

Boström, A.M., Kajermo, K.N., Nordström, G., & Wallin, L. (2009). Registered nurses’ use of research findings in the care of older people. Journal of Clinical Nursing, 18, 1430-1441.

keyPoiNts

EvidEncE-BasEd PracticE in taiwan Chang, H.-C., Russell, C., & Jones, M.K. (2010). Implementing Evidence-Based Practice in Taiwanese Nursing Homes: Attitudes and Perceived Barriers and Facilitators. Journal of Gerontological Nursing, 36(1), 41-48.

1 The most frequently cited perceived barriers to evidence-based practice (EBP) were related to insufficient authority to change practice, difficulty understanding statistical analyses, and a per- ceived isolation from knowledgeable colleagues with whom to discuss the research.

2 The most important facilitators of EBP included improved access to computers and Internet facilities in the workplace, advanced education to increase the research knowledge base, and under- standability of research reports.

3 Nurses working in nursing homes need to be supported so they can move from using anecdotal evidence, past experience, and precedents to guide their clinical practice to evidence-based deci- sion making.

4 Managers can play an important role in promoting and support-ing these changes by allowing more time to implement research findings and providing permission and support for nurses to change their nursing care practices.

47Journal of GerontoloGical nursinG • Vol. 36, no. 1, 2010

Boström, A.M., Wallin, L., & Nordström, G. (2006). Research use in the care of older people: A survey among healthcare staff. International Journal of Older People Nursing, 1, 131-140.

Brett, J.L. (1987). Use of nursing practice re- search findings. Nursing Research, 36, 344- 349.

Burrows, D.E., & McLeish, K. (1995). A model of research-based practice. Journal of Clinical Nursing, 4, 243-247.

Clifford, C., & Murray, S. (2001). Pre- and post-test evaluation of a project to facili- tate research development in practice in a hospital setting. Journal of Advanced Nursing, 36, 685-695.

Dunn, C. (1990). Setting standards—Improv- ing intensive care. Nursing Times, 86(12), 32-34.

Fink, R., Thompson, C.J., & Bonnes, D. (2005). Overcoming barriers and promot- ing the use of research in practice. Journal of Nursing Administration, 35, 121-129.

Funk, S.G., Champagne, M.T., Wiese, R.A., & Tornquist, E.M. (1991a). Barriers: The Barriers to Research Utilization Scale. Ap- plied Nursing Research, 4, 39-45.

Funk, S.G., Champagne, M.T., Wiese, R.A., & Tornquist, E.M. (1991b). Barriers to using research findings in practice: The clinician’s perspective. Applied Nursing Research, 4, 90-95.

Funk, S.G., Tornquist, E.M., & Champagne, M.T. (1995). Barriers and facilitators of research utilization: An integrative review. Nursing Clinics of North America, 30, 395- 407.

Gerrish, K., & Clayton, J. (2004). Promoting evidence-based practice: An organization- al approach. Journal of Nursing Manage- ment, 12, 114-123.

Glacken, M., & Chaney, D. (2004). Perceived barriers and facilitators to implementing research findings in the Irish practice set- ting. Journal of Clinical Nursing, 13, 731- 740.

Griffiths, J.M., Bryar, R.M., Closs, S.J., Cooke, J., Hostick, T., Kelly, S., et al. (2001). Bar- riers to research implementation by com- munity nurses. British Journal of Commu- nity Nursing, 6, 501-510.

Hutchinson, A.M., & Johnston, L. (2004). Bridging the divide: A survey of nurses’ opinions regarding barriers to, and facili- tators of, research utilization in the prac- tice setting. Journal of Clinical Nursing, 13, 304-315.

Kajermo, K.N., Nordström, G., Krusebrant, A., & Björvell, H. (1998). Barriers to and facilitators of research utilization, as per- ceived by a group of registered nurses in Sweden. Journal of Advanced Nursing, 27, 798-807.

Kajermo, K.N., Nordström, G., Krusebrant, A., & Björvell, H. (2000). Perceptions of research utilization: Comparisons between health care professionals, nursing students and a reference group of nurses clinicians. Journal of Advanced Nursing, 31, 99-109.

Kuuppelomäki, M., & Tuomi, J. (2005). Finn- ish nurses’ attitudes towards nursing re- search and related factors. International Journal of Nursing Studies, 42, 187-196.

McCaughan, D., Thompson, C., Cullum, N., Sheldon, T.A., & Thompson, D. (2002). Acute care nurses’ perceptions of barri- ers to using research information in clini- cal decision-making. Journal of Advanced Nursing, 39, 46-60.

McConnell, E.S., Lekan, D., Bunn, M., Egerton, E., Corazzini, K.N., Hendrix, C.D., et al. (2009). Teaching evidence- based nursing practice in geriatric care set- tings: The Geriatric Nursing Innovations through Education Institute. Journal of Gerontological Nursing, 35(4), 26-33.

McSherry, R. (1997). What do registered nurs- es and midwives feel and know about re- search? Journal of Advanced Nursing, 25, 985-998.

Meah, S., Luker, K.A., & Cullum, N.A. (1996). An exploration of midwives’ attitudes to research and perceived barriers to research utilisation. Midwifery, 12, 73-78.

Mehrdad, N., Salsali, M., & Kazemnejad, A. (2007). Nurses’ attitudes toward research utilization in clinical practice. Journal of Tehran Faculty of Nursing and Midwifery, 13(2), 41-52.

Mehrdad, N., Salsali, M., & Kazemnejad, A. (2008). The spectrum of barriers to and fa- cilitators of research utilization in Iranian nursing. Journal of Clinical Nursing, 17, 2194-2202.

Nagy, S., Lumby, J., McKinley, S., & Mac- farlane, C. (2001). Nurses’ beliefs about the conditions that hinder or support evi- dence-based nursing. International Jour- nal of Nursing Practice, 7, 314-321.

NHS Centre for Reviews and Dissemination. (1999, February). Effective health care: Getting evidence into practice. Retrieved from the University of York’s website: http://www.york.ac.uk/inst/crd/EHC/ ehc51.pdf

Olade, R.A. (2003). Attitudes and factors af- fecting research utilization. Nursing Fo- rum, 38(4), 5-15.

Oranta, O., Routasalo, P., & Hupli, M. (2002). Barriers to and facilitators of research uti- lization among Finnish registered nurses. Journal of Clinical Nursing, 11, 205-213.

Parahoo, K. (2000). Barriers to, and facilita- tors of, research utilization among nurses in Northern Ireland. Journal of Advanced Nursing, 31, 89-98.

Pettengill, M.M., Gillies, D.A., & Clark, C.C. (1994). Factors encouraging and discour- aging the use of nursing research findings. Image, 26, 143-147.

Retsas, A. (2000). Barriers to using research evidence in nursing practice. Journal of Advanced Nursing, 31, 599-606.

Schoonover, H. (2009). Barriers to research utilization among registered nurses prac- ticing in a community hospital. Journal for Nurses in Staff Development, 25, 199-212.

Thompson, D.S., Estabrooks, C.A., Scott- Findlay, S., Moore, K., & Wallin, L. (2007). Interventions aimed at increasing research use in nursing: A systematic review. Imple- mentation Science, 2, 15.

Thompson, D.S., O’Leary, K., Jensen, E., Scott-Findlay, S., O’Brien-Pallas, L., & Estabrooks, C.A. (2008). The relationship between busyness and research utilization: It is about time. Journal of Clinical Nurs- ing, 17, 539-548.

Veeramah, V. (1995). A study to identify the attitudes and needs of qualified staff con- cerning the use of research findings in clinical practice within mental health care settings. Journal of Advanced Nursing, 22, 855-861.

Veeramah, V. (2004). Utilization of research findings by graduate nurses and midwives. Journal of Advanced Nursing, 47, 183- 191.

Walsh, M. (1997). Perceptions of barriers to implementing research. Nursing Standard, 11(19), 34-37.

About the Authors Dr. Chang is Assistant Professor in

Nursing and Head of Department of Nursing, Faculty of Health Sciences, The University of Yuanpei, Hsinchu, Taiwan; Dr. Russell is Associate Professor, and Dr. Jones is Senior Lecturer in Psychology, Discipline of Behavioural and Social Sci- ences in Health, Faculty of Health Sci- ences, The University of Sydney, Sydney, Australia.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.

Address correspondence to Hui Chen Chang, PhD, RN, MN, BA, Assistant Professor in Nursing and Head of De- partment of Nursing, Faculty of Health Sciences, The University of Yuanpei, 306 Yuanpei, Hsinchu, Taiwan 300; e-mail: [email protected].

Received: July 14, 2009 Accepted: September 29, 2009 Posted: December 22, 2009 doi:10.3928/00989134-20091204-04

48 JOGNonline.com

Copyright of Journal of Gerontological Nursing is the property of SLACK Incorporated and its content may not

be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written

permission. However, users may print, download, or email articles for individual use.