Scottish Institute of Reflexology

C.A.M.

STUDY 1

Research-based practice: myth or reality? A review of the barriers affecting research utilisation in practice

Nathalie Pallen and Fiona Timmins

A research-practice gap still exists despite the promotion and strategies for research-based practice by governments and nursing organisations. Hunt (1981 Journal of Advanced
Nursing 12:101–110) and Walsh and Ford (1989 Nursing rituals: research and rational action.
Butterworth-Heinemann) report a wealth of anecdotal evidence to support the failure of nurses to use research in practice. A body of evidence confirms that the number of identified barriers to research utilisation is great. Drawing on the work of Rogers (1983 Diffusion of innovations. The Free Press, New York) or the Barriers Scale (Funk et al. 1991a
Applied Nursing Research 4(1):39–45), many authors (Dunn et al. 1997 Emergency Nurse
5(2):24–27; Walsh 1997a 1997b Nursing Standard 11(19):34–37; 1997c Nursing Standard
11(29):34–39; Kajermo et al. 1998 Journal of Advanced Nursing 27(4):798–807; 2000 Journal of Advanced Nursing 31(1):99–109; Parahoo 2000 Journal of Advanced Nursing 31(1):89–98) have structured the barriers into sub-groups: the characteristics of the organisation, of the adopter, of the communication and of the research. Several studies reveal that the actual ‘setting’ poses the greatest barrier to the utilisation of research. Walsh (1997b) describes this as a paradox, in other words: practice is perceived as the biggest obstacle to change in practice. A systematic approach to research utilisation is outlined aimed at targeting these specific identified barriers, and third level institutes and practice settings are urged to consider strategic and focused approaches to the development of research plans.
© 2002 Elsevier Science Ltd. All rights reserved.

Nathalie Pallen, RGN Dip Nursing, Staff Nurse, St James Hospital, Dublin, Ireland.

Fiona Timmins, RGN BNS RNT, FFNRSCI NFESC MSc, Lecturer, School of Nursing
& Midwifery, Trinity Centre for Health Sciences, Trinity College Dublin, Du

STUDY 2

Barriers to evidence based practice in primary care: a review of the literature

Hugh McKenna, Sue Ashton, Sinead Keeney*
School of Nursing, 12J05b, University of Ulster, Shore Road, Newtownabbey, Co.Antrim. BT37 OQB, UK

Abstract

People with health problems deserve a service that is based on best available evidence and is possible within obtainable resources. No credible health professional could deny that sound evidence should be an integral part of clinical decision making. The demand for up to date information to inform care and treatment highlights the crucial role of research and development in the modern health service. However, within primary care, practitioners have not always been able to underpin their actions with robust research findings. In addition, the research activities within primary care are limited to a small number of ‘enthusiasts’. This paper aims to analyse the literature surrounding this area, highlighting the significance of United Kingdom (UK) government reports on primary care, primary care research activities and the pursuit of evidence based practice in primary care. It shows that primary care research has been the ‘poor relation’ in terms of research funding and this has resulted is a dearth of high quality research results to underpin practice.

International Journal of Nursing Studies 41 (2004) 369–378

STUDY 3

An exploration of the factors that influence the implementation of evidence into practice

RYCROFT-MALONE J, HARVEY G, SEERS K, KITSON A, McCORMACK B &
TITCHEN A (2004) Journal of Clinical Nursing 13, 913–924

Background

The challenges of implementing evidence-based practice are complex and varied. Against this background a framework has been developed to represent the multiple factors that may influence the implementation of evidence into practice.

It is proposed that successful implementation is dependent upon the nature of the evidence being used, the quality of context, and, the type of facilitation required to enable the change process. This study sets out to scrutinize the elements of the framework through empirical enquiry.

Aims and objectives

The aim of the study was to address the following questions:
• What factors do practitioners identify as the most important in enabling implementation of evidence into practice?
• What are the factors practitioners identify that mediate the implementation of evidence into practice?
• Do the concepts of evidence, context and facilitation constitute the key elements of a framework for getting evidence into practice?

Design and methods

The study was conducted in two phases. Phase 1: Exploratory focus groups (n ¼ 2) were conducted to inform the development of an interview guide. This was used with individual key informants in case study sites.

Phase 2:

Two sites with on-going or recent implementation projects were studied. Within sites semi-structured interviews were conducted (n ¼ 17).

Results

A number of key issues in relation to the implementation of evidence into practice emerged including: the nature and role of evidence, relevance and fit with organizational and practice issues, multi-professional relationships and collaboration, role of the project lead and resources.

Conclusions

Relevance to clinical practice

Key elements that require attention in implementing evidence into practice are presented and may provide a useful checklist for future implementatio

The results are discussed with reference to the wider literature and in relation to the on-going development of the framework. Crucially the growing body of evidence reveals that a focus on individual approaches to implementing evidence based practice, such as skilling-up practitioners to appraise research evidence, will be ineffective by themselves.