Nurses’ Use Of Research Information In Clinical Decision Making: A Descriptive and Analytical Study
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Module
Nr 505
Institution
Chamberlain College Of Nursing
Nurses’ Use Of Research Information In Clinical Decision Making: A Descriptive and Analytical Study
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, re...
● ethical decision making ○ when making choices about ethical issues based on the standards of right vs wrong ○ it requires a systematic framework for addressing the complex and often controversial m
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Nr 505
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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).
1
, 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)
2
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