NR505-Nurses Use Of Research Information in Clinical Decision Making/; COMPLETE SOLUTION

Nurses’ Use Of Research Information In Clinical Decision Making: A Descriptive and Analytical Study Final Report. Carl Thompson Dorothy McCaughan Nicky Cullum Trevor Sheldon David Thompson Anne Mulhall ...

Nurses’ Use Of Research Information In Clinical Decision Making: A Descriptive and Analytical Study Final Report. Carl Thompson Dorothy McCaughan Nicky Cullum Trevor Sheldon David Thompson Anne Mulhall Report Presented To The NHS R&D Programme In Evaluating Methods To Promote The Implementation Of R&D. Executive Summary. Study Background and Rationale Policy and professional developments over the last 15 years have placed increasing pressure on nurses to be more accountable for their actions. At the same time, research into nurse decision making and research information use by nurses has also increased. The advent of National Service Frameworks, The Commission for Health Improvement (CHI) and the National Institute for Clinical Excellence (NICE), mean that evidence based approaches to nursing practice have become firmly established in research, professional and policy agendas. The starting point for evidence based approaches to healthcare are the decisions made by professionals delivering services. Little, if any, work has been conducted examining the types of decisions made by nurses. Knowing the nature of these decisions, what reduces the likelihood of nurses using research information when making them, how they access research knowledge in practice, and how useful they think research knowledge might be in informing their clinical decisions, will help policy makers, educators, service developers, researchers and, most importantly, clinicians estimate the potential of nurses to contribute to an evidence based health service. This study uses qualitative interviews, observation and a form of statistical modelling (Q methodology) to explore and describe data from over 120 nurses working in acute care settings in three case sites (Hospitals) in the UK. The study focuses on the following research questions: • To what extent does nursing care involve making clinical decisions which require research evidence? • What are the perceptions of nurses regarding the barriers and obstacles to access and use of research based information? • How do clinical nurses access research-based information? • What are the perceptions of nurses regarding the need for research based evidence to support clinical decision making? The study took place in medical, surgical and coronary care units in three NHS Trusts in the North of England (See Table E1). The Decisions Made By Nurses Nurses made clinical decisions in six key areas: • intervention/effectiveness: choosing between intervention X and intervention Y. • targeting: a subcategory of intervention/effectiveness decisions outlined above. These decisions were of the form, ‘choosing which patient will most benefit from this intervention’ • timing: again, a subcategory of intervention/effectiveness decisions. These commonly take the form of choosing the best time to deploy particular interventions. • communication: these decisions focused on choices relating to ways of delivering and receiving information to and from patients, families or colleagues. Sometimes these decisions were specifically related to the communication of risks and benefits of different interventions or prognostic categories. • service organisation, delivery and management: decisions concerning the configuration or processes of service delivery. • experiential, understanding or hermeneutic: these relate to the interpretation of cues in the process of care. The choices involved might include deciding on the ways in which a patient may be experiencing a particular situation. Barriers to Using Research Based Information in Clinical Decisions Four primary perspectives on what stops nurses using research based information in practice emerged: • problems in interpreting and working with research products which are seen as too complex, ‘academic’ and overly statistical. Nurses defining this perspective want to use research but feel limited in their ability to do so by their lack of research appreciation skills and confidence. • despite being confident with research-based information, and the perceived ability to be able to engage with such material if they so wished, nurses defining this perspective perceive a lack of organisational support (in the form of restricted local access to information and unsupportive colleagues) as a significant block. The more experience nurses had in a clinical domain the less likely they were to be aligned with this perspective. • many nurses adopted the stance that research products and researchers lack clinical credibility and that they fail to offer the desired level of clinical direction. It would appear that nurses educated to graduate level are more likely to want to see clinically credible and more prescriptive research products in the workplace. • some nurses lacked the skills and (to a lesser degree) the motivation to use research themselves. Consequently, these individuals liked research messages passed to them by a third party and sought to foster others’ involvement in research based practice rather than direct involvement themselves. The old style SRN- trained nurse was seen to be the most strongly associated with this perspective. Graduate level (in any subject) nurses were less likely to be aligned with the perspective. These results suggest that there may be a significant skills (with respect to interpreting and using research material) disparity between the SRN-trained nurses and graduate nurses. Accessing Research Based Information in Practice Of 4000 clinical information documents and text based resources audited on the wards only around 42% had any form of traceable heritage. The average age of resources was 5 years and only around a third of all resources made any kind of explicit reference to research. We found three primary perspectives on accessibility: • humanistic: in which human sources were easily the most accessible • local information for local need: in which locally developed technologies began to be seen as accessible • moving towards technologies: in which new technologies such as on-line databases began to be seen as accessible Whilst there were areas of delineation between these perspectives the main characteristic across all perspectives was the accessibility of human sources. Specifically, the sources who combine a clinical research remit with clinical workload (CNSs and link nurses) and immediate colleagues. As well as homogeneity in what counted as accessible, there was also remarkable commonality regarding some sources relative inaccessibility. Specifically, all the perspectives saw the nurse-managerial structure (in the form of the Director of Nursing and their team) as not easily accessed. Two of the perspectives stressed the perceived inaccessibility of the Trust medical or nursing librarian in relation to their role in helping resolve clinical uncertainty. The overall picture was one characterised by an insider-outsider distinction with regard to accessibility: if the source was locally relevant, required little ‘translation’, clinically credible and reflected the experiences of practitioners it was judged as accessible. Those resources which were perceived as most accessible were those which were linked directly to ward-life: the specialist nursing function, the link nurse who helped operationalise the CNSs knowledge, technologies which were local and focussed on the clinical area (information files or guidelines and protocols). Unfortunately, the documentary evidence suggests that despite the important role of clinical nurse specialists and other members of the healthcare team as producers of research based information sources, the basis for much of what is produced remains difficult to ascertain.