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
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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- "It has also been recommended that nurses who provide direct patient care work as change agents to promote improved patient outcomes such as decreased length of stay and reduced morbidity and mortality (Milner et al. 2005; Thompson et al. 2006; Profetto-McGrath et al. 2007). Among the authors who examined nurses as knowledge brokers, the identified functions or specific competencies of a broker were fostering linkage and exchange between researchers and clinicians (Milner et al. 2005), facilitating innovation or change within organizations (Thompson et al. 2006), managing multiple sources and types of knowledge (Gerrish et al. 2011), creating and sustaining a milieu that is supportive of evidence use (Sandström et al. 2011) and the provision of infrastructure support and resources to facilitate EIDM (Gerrish et al. 2012). In their study of APNs acting as knowledge brokers, Gerrish et al. (2011) identified knowledge broker roles such as generating evidence through clinical audits and evaluations; becoming a repository for evidence by accumulating multiple sources of information ; synthesizing evidence and clinical expertise so that it could be better utilized for practice decisions; translating evidence, which involved interpreting and applying the evidence for multiple audiences; and disseminating evidence often through personal contact with other nurses. "
ABSTRACT: Registered nurses with graduate preparation are in a unique position to act as knowledge brokers owing to their extensive clinical experience and ability to be seen as a credible and respected resource by their peers. Nurse knowledge brokers can bridge the gap between research producers and those that need evidence for decision-making and support capacity development for evidence-informed decision-making (EIDM). Knowledge broker competencies include graduate-level education with exposure to research methods; experience with the EIDM process; and established networking skills to bring researchers, decision-makers, stakeholders and policymakers together. For the knowledge broker to be successful, the nurse leader can cultivate an organizational culture supportive of evidence use with advocacy for mandates that require evidence for decisions, structures in place for each stage of the EIDM process, and physical resources such as library services for evidence retrieval. Copyright © 2015 Longwoods Publishing.
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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) , 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) , 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]. "
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.
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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., 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]. "
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.
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