Nurses unable to engage in research practices essential for positive patient outcomes

A recent study published in the September issue of the American Journal of Nursing (AJN), found that many U.S. registered nurses are not ready to engage in evidence-based practice (EBP), the "gold standard" approach to clinical problem solving, due to gaps in computer literacy knowledge and skills, limited access to quality information resources and attitudes toward research. This lack in usage could adversely affect patient outcomes.

Evidence-based practice (EBP) is a systematic research process that uses the best evidence currently available for clinical decision making in order to provide the most consistent and best possible care for patients.

"Most nurses practice nursing based on what they learned in nursing school. Given that the average age of today's nurse is over 40, nursing school was many years ago," said Diane Pravikoff, PhD, RN, managing editor of the Online Journal of Clinical Innovations and director of research and professional liaison at Cinahl Information Systems in Glendale, CA and author of the study. "This presents the profession with a serious dilemma. The community and patients demand a professional practice based on the most recent up-to-date information and, there are healthcare providers who may not be prepared to meet these demands because they don't know how to find information or don't have the tools to obtain it."

While nurses acknowledge that they frequently need information for practice, they feel more confident in asking colleagues, peers and searching the Internet than in using more credible bibliographic databases such as PubMed or CINAHL to find specific information. Personal and organizational barriers to research utilization and implementation of EBP include:

• Lack of time and access. Only 18% of nurses had access to the CINAHL database and 40% to MEDLINE, yet 98% to the Internet and World Wide Web.
• Technological search skills in electronic environment. Eighty-three percent of respondents consider themselves at least somewhat successful when searching the Internet or World Wide Web, yet only 19% and 36% respectively are confident in their abilities to search CINAHL or MEDLINE.
• Attitudes toward research. Many of the respondents did not understand the value of research in practice stating that the importance of research and its contribution to patient care is not being made in education or practice. Many respondents also lack understanding of electronic databases and many have difficulty understanding research articles. Many RNs believe that they are not adequately prepared to appraise research and interpret its usefulness for clinical decision-making.

The Study

The study was based on a descriptive exploratory survey to examine U.S. RNs' perceptions of information resources available to them and their skills in using these resources. The results were based on a geographically stratified random sample of 1,097 U.S. RNs. Of those, 987 were RNs in administration, education or clinical practice roles. Seven hundred and sixty worked in clinical settings.

"These barriers must be addressed if the largest group of healthcare providers in the nation is to embrace a culture of evidence-based practice," said Diana Mason, PhD, RN, editor-in-chief, American Journal of Nursing. "Integrating EBP into nursing requires a multifaceted approach that involves students, educators, clinicians and administrators working collectively to facilitate a change."

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