Henrietta Forsman

Research use in clinical practice – extent and patterns among nurses one and three years postgraduation

AIMnThis paper is a report of a study of nurses research use in clinical practice one and three years postgraduation in Sweden.nnnBACKGROUNDnInternationally, learning to critically appraise and use research is an educational objective within nursing training, with the aim of promoting research use in nursing practice. The extent to which these skills is acquired and used among relatively newly graduated nurses is largely unexplored, however.nnnMETHODn. A descriptive study was conducted in 2006 using a national longitudinal survey of two nursing cohorts one (n = 1,365) and three (n = 933) years postgraduation. The self-reported extent of instrumental, conceptual and persuasive research use was measured. Data were analysed using both variable- and pattern-oriented approaches based on cluster analysis.nnnRESULTSnResearch use was reported to occur in about half or fewer of the working shifts. In both samples, seven clusters of nurses with different research use profiles were identified. Clusters representing overall low and very low users in all three types of research use were predominant both at one (45.6%) and three (51.6%) years postgraduation, whereas clusters of nurses reporting overall high research use were uncommon. The proportion of very low users was larger 3 years after graduation than 1 year after graduation.nnnCONCLUSIONSnThe low extent of reported research use, raises the question of whether scientific perspectives included in nursing education are translated into clinical application. The pattern-oriented approach illustrates the complexity of research use and identification of typical research use profiles in specific contexts may have potential to guide interventions aimed at supporting evidence-based practice.

Use of research by nurses during their first two years after graduating

AIMnThis paper reports on a study of research use among nurses two years after graduation, as well as changes over time in research use in relation to changes in working conditions.nnnBACKGROUNDnThe demand for evidence-based practice is widely expressed, and newly graduated nurses should possess the skills to provide high-quality care based on the best knowledge available. The way in which nurses use research during the first few years after graduating is, however, largely unknown.nnnMETHODnAs part of a national longitudinal survey, nurses reported their extent of instrumental, conceptual and persuasive research use in 2006 (n = 1365) and 2007 (n = 1256). Data were analysed cross-sectionally and prospectively, using variable- and pattern-oriented methods.nnnRESULTSnInstrumental research was reported most frequently, on about half of the working shifts. Seven profiles of research use were found, showing structural stability over time when compared with results from year 1. Most typically, nurses maintained the same profile over time; moreover, low users tended to become even lower users. Two years after graduation, 54.9% reported overall low use. Changes in working conditions did not explain the decrease in research use.nnnCONCLUSIONnThe results support previous claims of a gap between research and clinical practice. The predominance of overall low users is alarming and requires further research, including investigation of individual and organizational factors, to study their impact on nurses research use.

Nursing students’ intentions to use research as a predictor of use one year post graduation: A prospective study

BACKGROUNDnGraduating nursing students are expected to have acquired the necessary skills to provide research-based care to patients. However, recent studies have shown that new graduate nurses report their extent of research use as relatively low. Because behavior intention is a well-known predictor of subsequent behavior, this gives reasons to further investigate graduating nursing students intentions to use research in clinical practice after undergraduate study.nnnOBJECTIVESnTo investigate graduating nursing students intentions to use research in clinical practice and, furthermore, to investigate whether intention in itself and as a mediating variable can predict subsequent research use behavior in clinical practice one year post graduation.nnnDESIGNnA follow-up study was performed of graduating nursing students in their final semester of undergraduate study (2006) and at one year post graduation (2008). Data were collected within the larger national survey LANE (Longitudinal Analysis of Nursing Education).nnnPARTICIPANTSnA sample of 1319 respondents was prospectively followed.nnnMETHODSnGraduating nursing students intentions to use research instrumentally were studied as a predictor of their subsequent instrumental research use one year post graduation. A statistical full mediation model was tested to evaluate the effects of intention and factors from undergraduate study on subsequent research use in daily care.nnnRESULTSnThirty-four percent of the nursing students intended to use research on more than half or almost every working shift in their future clinical practice. Intention showed a direct effect on research use behavior. In addition, significant indirect effects on research use were shown for capability beliefs (regarding practicing the principles of evidence-based practice) and perceived support for research use (from campus and clinical education), where intention acted as a mediating factor for those effects.nnnCONCLUSIONSnStudents rated a modest level of intention to use research evidence. Intentions close to graduation acted as an essential predictor of subsequent research use behavior, both through a direct effect and as a mediating variable. These findings give support for designing future interventions aiming at influencing students intention to use research to improve subsequent behavior. Focusing on strengthening students capability beliefs and providing support for research use appear as promising target activities.

Nurses’ research utilization two years after graduation—a national survey of associated individual, organizational, and educational factors

BackgroundNurses’ research utilization (RU) as part of evidence-based practice is strongly emphasized in today’s nursing education and clinical practice. The primary aim of RU is to provide high-quality nursing care to patients. Data on newly graduated nurses’ RU are scarce, but a predominance of low use has been reported in recent studies. Factors associated with nurses’ RU have previously been identified among individual and organizational/contextual factors, but there is a lack of knowledge about how these factors, including educational ones, interact with each other and with RU, particularly in nurses during the first years after graduation. The purpose of this study was therefore to identify factors that predict the probability for low RU among registered nurses two years after graduation.MethodsData were collected as part of the LANE study (Longitudinal Analysis of Nursing Education), a Swedish national survey of nursing students and registered nurses. Data on nurses’ instrumental, conceptual, and persuasive RU were collected two years after graduation (2007, nu2009=u2009845), together with data on work contextual factors. Data on individual and educational factors were collected in the first year (2002) and last term of education (2004). Guided by an analytic schedule, bivariate analyses, followed by logistic regression modeling, were applied.ResultsOf the variables associated with RU in the bivariate analyses, six were found to be significantly related to low RU in the final logistic regression model: work in the psychiatric setting, role ambiguity, sufficient staffing, low work challenge, being male, and low student activity.ConclusionsA number of factors associated with nurses’ low extent of RU two years postgraduation were found, most of them potentially modifiable. These findings illustrate the multitude of factors related to low RU extent and take their interrelationships into account. This knowledge might serve as useful input in planning future studies aiming to improve nurses’, specifically newly graduated nurses’, RU.

Patient-reported outcomes and visual acuity after 12 months of anti-VEGF-treatment for sight-threatening diabetic macular edema in a real world setting

AIMSnTo examine objective visual acuity measured with ETDRS, retinal thickness (OCT), patient reported outcome and describe levels of glycated hemoglobin and its association with the effects on visual acuity in patients treated with anti-VEGF for visual impairment due to diabetic macular edema (DME) during 12months in a real world setting.nnnMETHODSnIn this cross-sectional study, 58 patients (29 females and 29 males; mean age, 68years) with type 1 and type 2 diabetes diagnosed with DME were included. Medical data and two questionnaires were collected; an eye-specific (NEI VFQ-25) and a generic health-related quality of life questionnaire (SF-36) were used.nnnRESULTSnThe total patient group had significantly improved visual acuity and reduced retinal thickness at 4months and remains at 12months follow up. Thirty patients had significantly improved visual acuity, and 27 patients had no improved visual acuity at 12months. The patients with improved visual acuity had significantly improved scores for NEI VFQ-25 subscales including general health, general vision, near activities, distance activities, and composite score, but no significant changes in scores were found in the group without improvements in visual acuity.nnnCONCLUSIONSnOur study revealed that anti-VEGF treatment improved visual acuity and central retinal thickness as well as patient-reported outcome in real world 12months after treatment start.

Visual functioning and health-related quality of life in diabetic patients about to undergo anti-vascular endothelial growth factor treatment for sight-threatening macular edema

PURPOSEnTo examine patient-reported outcome (PRO) in a selected group of Swedish patients about to receive anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME).nnnMATERIAL AND METHODSnIn this cross-sectional study, 59 patients with diabetes mellitus, who regularly visited the outpatient eye-clinics, were included. Sociodemographic and clinical data were collected and the patients completed PRO measures before starting anti-VEGF treatment. PRO measures assessed eye-specific outcomes (NEI-VFQ-25) and generic health-related quality of life (SF-36).nnnRESULTSnThe participants consisted of 30 men and 29 women (mean age, 68.5years); 54 (92%) patients had type 2 diabetes; 5 (9%) patients had moderate or severe visual impairment; 28 (47%) were classified as having mild visual impairment. Some of the patients reported overall problems in their daily lives, such as with social relationships, as well as problems with impaired sight as a result of reduced distance vision.nnnCONCLUSIONSnFurther studies are needed to investigate PRO factors related to low perceived general health in this patient population. It is important to increase our understanding of such underlying mechanisms to promote improvements in the quality of patient care.

The Concept of Research Utilization as Understood by Swedish Nurses: Demarcations of Instrumental, Conceptual, and Persuasive Research Utilization

BACKGROUND AND AIMSnThe literature implies research utilization (RU) to be a multifaceted and complex phenomenon, difficult to trace in clinical practice. A deeper understanding of the concept of RU in a nursing context is needed, in particular, for the development of instruments for measuring nurses RU, which could facilitate the evaluation of interventions to support the implementation of evidence-based practice. In this paper, we explored nurses demarcation of instrumental RU (IRU), conceptual RU (CRU), and persuasive RU (PRU) using an item pool proposed to measure IRU, CRU, and PRU.nnnMETHODSnThe item pool (12 items) was presented to two samples: one of practicing registered nurses (nxa0= 890) in Sweden 4 years after graduating and one of recognized content experts (nxa0= 7). Correlation analyses and content validity index (CVI) calculations were used together with qualitative content analysis, in a mixed methods design.nnnFINDINGSnAccording to the item and factor analyses, CRU and PRU could not be distinguished, whereas IRU could. Analyses also revealed problems in linking the CRU items to the external criteria. The CVIs, however, showed excellent or good results for the IRU, CRU, and PRU items as well as at the scale level. The qualitative data indicated that IRU was the least problematic for the experts to categorize, whereas CRU and PRU were harder to demarcate.nnnCONCLUSIONSnOur findings illustrate a difficulty in explicitly demarcating between CRU and PRU in clinical nursing. We suggest this overlap is related to conceptual incoherence, indicating a need for further studies. The findings constitute new knowledge about the RU concepts in a clinical nursing context, and highlight differences in how the concepts can be understood by RNs in clinical practice and experts within the field. We suggest that the findings are useful for defining RU in nursing and further development of measures of RU.

Urinary incontinence and its management in patients aged 65 and older in orthopaedic care – what nursing and rehabilitation staff know and do

AIMS AND OBJECTIVESnTo describe what nursing and rehabilitation staff know and do with regard to urinary incontinence and risk of urinary incontinence in patients 65xa0years or older undergoing hip surgery.nnnBACKGROUNDnUrinary incontinence is a common but often neglected issue for older people. Despite the existence of evidence-based guidelines on how to assess, manage and prevent urinary incontinence, there are indications that these guidelines are not applied in hospital care.nnnDESIGNnA qualitative study with descriptive design was conducted in two orthopaedic units.nnnMETHODSnForty-six interviews and 36 observations of care were conducted from January-October 2014 and analysed with qualitative content analysis.nnnRESULTSnEnrolled nurses performed most of the care related to bladder function, with focus on urinary catheterisation and preventing urinary tract infection and urinary retention. Registered nurses role in urinary matters mainly comprised documentation, while the rehabilitation staff focused on making it possible for the patient to be independent in toileting. The nursing staff considered urinary incontinence a common condition for older people and that it was convenient for the patients to have an indwelling catheter or incontinence pad/pant, although they acknowledged some of the risks associated with these procedures.nnnCONCLUSIONSnUrinary incontinence is not a priority in orthopaedic care, and urinary incontinence guidelines are not applied. Further, attitudes and actions are mainly characterised by a lack of urinary incontinence knowledge and the nursing and rehabilitation staff do not take a team approach to preventing and managing urinary incontinence.nnnRELEVANCE TO CLINICAL PRACTICEnAn increased focus on knowledge on urinary incontinence and evidence-based guidelines is needed. To secure evidence-based practice, the team of nursing and rehabilitation staff and managers must be aligned and work actively together, also including the patient in the team.

First line nurse managers’ experiences of opportunities and obstacles to support evidence-based nursing

The aim was to explore first line nurse managers’ experiences of opportunities and obstacles to support evidence‐based nursing.

Patients’ experiences before starting anti-VEGF treatment for sight-threatening diabetic macular oedema: A qualitative interview study

The diabetic complication macular oedema (DME) is a growing problem worldwide because of the increasing number of patients suffering from diabetes mellitus (DM). DME is treated with injections of anti-vascular endothelial growth factor (anti-VEGF) in the eye. This real-world study aimed to describe patients’ experiences before they received their first injection in the eye. Twenty-one men and women aged 49 to 86 years were interviewed. The interviews were analysed using qualitative content analysis. Two categories and an overall theme ‘to be at a crossroads and a crucial phase in life with an uncertain outcome’ were found. The participants expressed thoughts and concerns at different levels, practical concerns about the treatment procedure, and other existential thoughts regarding hope for improved visual acuity or fear of deterioration. Cooperation between eye clinics and diabetes clinics should be strengthened to clarify who is responsible for providing the information and support required by patients.