Nursing Research Roundtable.doc by shensengvf


									Nursing Research Roundtable Notes
November 3, 2005

Readiness for U.S. Nurses for Evidence-Based Practice
Am J Nurs 2005 Sep; 105(9): 40 – 51
D.S. Pravikoff, A.B. Tanner, S.T. Pierce

Roundtable Facilitator
Jeanne St. Pierre

Margie Pyron, Cherlynn Bennett, Linda Hamilton, Susan Paige, Joe Wheatley, Emma Gayle
Collins, Kathy Cheslik, Chanel Flake, Sherry Simmonds, Debra Siela, Janey McKinley, Kris
Larson, Leslie Cowan, Doreen Johnson, Gwendolyn Rook, Kari Hargreaves, Lorna Springston

The Nursing Research Roundtable has evolved from the Nursing Journal Club. The purpose of
the Roundtable is to promote evidence-based practice (EBP), to discuss the content and the
quality of the research presented in a pre-selected article, and to facilitate discussion on how to
bring new knowledge (from the literature) to the bedside for the purposes of improving the
delivery, and quality of patient care at Ball Memorial Hospital.

Journal Article
The article “Readiness for U.S. Nurses for Evidence-Based Practice” was summarized for
participants (article summary attached at end of this note). From the article it was determined
that only 46% of respondents were familiar with the term evidence-based practice, and the
number one barrier to research was nurses do not believe it has value to nursing practice.

Participants found the article was weak in its discussion of the research limitations. However,
overall, it was agreed that the results of the survey were reliable.

Discussion on the Comparison of Survey Respondents and Survey Results to BMH Nursing
Participants agreed that the nurses participating in the survey, which assessed the readiness for
evidence-based practice of RNs in various work settings, were representative of nurses at Ball
Memorial Hospital (BMH), with the exceptions that BMH employs more BSNs, and BMH is not
as ethnically diverse as the respondents to the survey.

Participants also agreed that the barriers to the literature at BMH – older nurses lacking
computer, literature search, and research training were similar to barriers listed in the article. It
was pointed out that pre-1990 nursing education did not emphasize research, nursing literature,
or statistical methods, and that nurses trained before 1990 are not comfortable with obtaining
information from the literature, or engaging in research. Generational differences in their
approach to technology and research/literature management was also discussed.
Another barrier cited by participants was the number of working computers available in BMH
nursing care areas. It was noted that there are several computers available, but they may not be

The March 2004 in-house survey on research was discussed and compared to the survey in the
article. There were 138 BMH nursing respondents; 50% responded that they were aware that
research was integrated into their unit’s processes; 75% responded that they were interested in
learning more about EBP.

From the in-house survey the barriers to research and the literature at BMH were determined to
be -- lack of knowledge on how to obtain the literature; lack of time; inability to understand a
research article (usually refers to statistical outcome).

Participants also discussed the willingness of BMH nurses to deliver research at the bedside,
their recognition of “research experts”, and the value of the Library’s engagement and support in
this process. It was noted that BMH nurses are looking at nursing research, as well as the
research from other disciplines.

Bringing EBP to BMH Nurses
It was suggested that clinical nurse specialists promote EBP by engaging in modeling behaviors,
analyzing the research/literature and assisting with the delivery of research to the bedside.

The importance of communication and dissemination of EBP was discussed. It was agreed that
how the research results are communicated is as important as the what and why of research.

It was recommended that local performance improvement (PI) measures be shared with nursing
as an introduction to EBP even though PI places less emphasis on statistical evidence. BMH
nurses might then be more receptive to a shift to EBP if they could see that nursing was invested
in the process through clinical queries, and research, and that the Administration supports
nursing research and EBP.

Participants also agreed that there is a new awareness of nursing research and EBP, and the
numbers of nurses, who look at the literature for evidence, is growing.

Participants agreed that the next steps to bringing EBP to BMH nurses is basic education for all
nursing staff in the units, to train nursing management, and to address the problems of working
computers with IS.

The Next Nursing Research Roundtable
To be announced.

Respectfully submitted,

Lorna Springston, MIS
Director, Library and Information Services
Readiness of U.S. Nurses for Evidence-based Practice.
Am J Nurs. 2005 Sep;105(9):40-51
D.S. Pravikoff, A.B. Tanner, S.T. Pierce

Article Summary

Most nurses deliver nursing care according to what they’ve learned in nursing school, and the skills they acquired
early-on in their careers (the average age of today’s nurse is older than 40, and their education and training was
attained 15 to 20 or more years ago). Most recognize the need for information in their practice, and their most
frequent source of information cited was a peer or colleague.

Today, there is a demand for nurses to practice professionally, based on up-to-date information available from
online resources, government agencies, payers, accrediting bodies (JCAHO, American Nurses Credentialing
Center), and patients, but nurses lack the access, skills, and time to obtain the information. Without the knowledge
and the tools to access the information their participation in evidence-based practice – use of the best evidence
available from nursing, medical, and healthcare literature combined with clinical expertise to provide the best
possible care for patients - is not possible.

For this study 3,000 RNs from across the U.S. were randomly selected to participate in a survey examining nurses’
perceptions of their access to the literature, and whether they have the skills to effectively search literature resources.

The survey identified institutional level and individual level barriers to the literature to support evidence-based
practice, and they were as follows --

Primary institutional barriers (other than time) were identified by the survey respondents as
Other institutional goals with a higher priority
Difficulty in recruiting and retaining staff
Organizational budget for acquiring information resources
Organizational budget for training in resource use
Organizational perception that nurses are not eager or prepared to incorporate or pursue evidence-based practice
Organizational perception that evidence-based practice or research use is not realistically achievable

Primary individual barriers (other than time) were identified by the survey respondents as
Lack of value for research in practice (this was the most frequently selected barrier)
Difficulty accessing research materials
Lack of computer skills
Difficulty understanding research articles
Lack of access to a computer
Lack of library access
Lack of search skills
Lack of knowledge about research
Lack of skills to critique or synthesize the literature (or both)

In conclusion nurses are not ready for evidence-based practice because of gaps in their information literacy,
computer skills, limited access to information resources, and their attitudes toward research. These barriers are
reinforced by nurses’ perception of organizational priorities.

To top