Clinical nurse educators as agents for change: Increasing research utilization

University of Alberta, Faculty of Nursing, 3rd floor, Clinical Sciences Building, Edmonton, Alberta, Canada T6G 2G3.
International Journal of Nursing Studies (Impact Factor: 2.9). 12/2005; 42(8):899-914. DOI: 10.1016/j.ijnurstu.2004.11.006
Source: PubMed


The purpose of this study was to examine the determinants of research utilization among clinical nurse educators. The primary goal for clinical nurse educators is the facilitation of professional development of practicing nurses. Responsibilities include promoting best practice by mentoring others, acting as an information source, and assisting in the development of policies and procedures based on available research evidence. Using Rogers' (Diffusion of Innovations, 4th edn., The Free Press, New York) diffusion of innovations theory as a theoretical foundation, we conducted a secondary analysis to test a predictive model of research utilization using linear regression. Results show that educators report significantly higher research use than staff nurses and managers. Predictors of research utilization include attitude toward research, awareness of information based on research, and involvement in research activities. Localite communication predicted conceptual research use and mass media predicted symbolic use, lending support to the idea that overall, instrumental, conceptual, and symbolic research utilization are conceptually different from one another. Our findings show that the research utilization behaviors of clinical nurse educators position them to facilitate evidence-based nursing practice in organizations. We discuss the theoretical, conceptual, and nursing role implications of our findings for nursing practice, education, and research. Suggestions for future research includes studying actual use of research findings of clinical nurse educators and designing intervention studies that assesses the effectiveness of clinical nurse educators as facilitators of research utilization in organizations.

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    • "Other features of changes agents identified in the literature but considered to be less important than those of responsibility, accountability, respect and role-modeling, include the age of the change agent (e.g., younger nurses have been associated with being able to influence higher levels of research use) [28], accessibility of the change agent (knowledge is more likely to be used when the change agent is perceived to be accessible, organized, expert and credible) [52], culturally compatible (perceived connection with the target group) [35,53], reflective [33,50,54], and having a positive attitude [28,33,46,48,54,55]. "
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    ABSTRACT: Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why? The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use. 24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents' function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches. This is the first realist review of change agency. Though effectiveness evidence is weak, change agent roles are evolving, as is the literature, which requires more detailed description of interventions, outcomes measures, the context, intensity, and levels at which interventions are implemented in order to understand how change agent interventions effect evidence-informed health care.
    Implementation Science 09/2013; 8(1):107. DOI:10.1186/1748-5908-8-107 · 4.12 Impact Factor
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    • "A surprising result was that the use of research-based evidence as a source in practice increased with the age of the nurse and with number of years of nursing practice. This contrasts with the findings of Milner et al.[26], who found that increasing age indicated a lower score in the use of research-based evidence. The reason why age and number of years of practice were associated with various responses could be that experienced nurses have basic knowledge-based experience that provides confidence in how to carry out routine tasks and manage unforeseen events [27,28]. "
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    ABSTRACT: Health authorities in several countries have decided that the health care services should be evidence-based. Recent research indicates that evidence-based practice may be more successfully implemented if the interventions overcome identified barriers. The present study aimed to examine factors influencing the implementation of evidence-based practice among nurses in a large Norwegian university hospital. Cross-sectional data was collected from 407 nurses during the period November 8 to December 3, 2010, using the Norwegian version of Developing Evidence-based Practice questionnaire (DEBP). The DEBP included data on various sources of information used for support in practice, on potential barriers for evidence-based practice, and on self-reported skills on managing research-based evidence. The DEBP was translated into Norwegian in accordance with standardized guidelines for translation and cultural adaptation. Nurses largely used experienced-based knowledge collected from their own observations, colleagues and other collaborators for support in practice. Evidence from research was seldom used. The greatest barriers were lack of time and lack of skills to find and manage research evidence. The nurse’s age, the number of years of nursing practice, and the number of years since obtaining the last health professional degree influenced the use of sources of knowledge and self-reported barriers. Self-reported skills in finding, reviewing and using different sources of evidence were positively associated with the use of research evidence and inversely related to barriers in use of research evidence. Skills in evidence-based practice seem to reduce barriers to using research evidence and to increase use of research evidence in clinical practice.
    BMC Health Services Research 10/2012; 12(1):367. DOI:10.1186/1472-6963-12-367 · 1.71 Impact Factor
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    • "With increased delegation of clinical support responsibilities away from nurse managers (Advisory Committee on Health Human Resources 2002), clinical leaders are also important in influencing nurses' use of research in clinical care (Thompson et al. 2001; Redfern & Christian 2003; Milner et al. 2005). Clinical leaders such as clinical nurse specialists, nurse educators, advance practice nurses, and practice developers are ideally positioned to influence research use through their roles in mentoring, providing information, and assisting in the development of policies and procedures to support professional practice (Milner et al. 2005). Although much has been written about the importance of leadership, how to develop nursing leaders to bring about change in improved processes of care and patient outcomes is less understood (Kent & McCormack 2010). "
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    ABSTRACT: The importance of leadership to influence nurses’ use of clinical guidelines has been well documented. However, little is known about how to develop and evaluate leadership interventions for guideline use. The purpose of this study was to pilot a leadership intervention designed to influence nurses’ use of guideline recommendations when caring for patients with diabetic foot ulcers in home care nursing. This paper reports on the feasibility of implementing the study protocol, the trial findings related to nursing process outcomes, and leadership behaviors. A mixed methods pilot study was conducted with a post-only cluster randomized controlled trial and descriptive qualitative interviews. Four units were randomized to control or experimental groups. Clinical and management leadership teams participated in a 12-week leadership intervention (workshop, teleconferences). Participants received summarized chart audit data, identified goals for change, and created a team leadership action. Criteria to assess feasibility of the protocol included: design, intervention, measures, and data collection procedures. For the trial, chart audits compared differences in nursing process outcomes. Primary outcome: 8-item nursing assessments score. Secondary outcome: 5-item score of nursing care based on goals for change identified by intervention participants. Qualitative interviews described leadership behaviors that influenced guideline use. Conducting this pilot showed some aspects of the study protocol were feasible, while others require further development. Trial findings observed no significant difference in the primary outcome. A significant increase was observed in the 5-item score chosen by intervention participants (p = 0.02). In the experimental group more relations-oriented leadership behaviors, audit and feedback and reminders were described as leadership strategies. Findings suggest that a leadership intervention has the potential to influence nurses’ use of guideline recommendations, but further work is required to refine the intervention and outcome measures. A taxonomy of leadership behaviors is proposed to inform future research.
    Worldviews on Evidence-Based Nursing 05/2012; 10(1). DOI:10.1111/j.1741-6787.2012.00254.x · 2.38 Impact Factor
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