Barriers to Research Use in Practice: Persistence of the Research-Practice Gap
In a previous post, I talked about the research-practice gap, also known as the evidence-practice gap. This phenomenon is not a figment of our past but is still a problem struggled with today (Agbedia, Okoronkwo, Onokayeigho, & Agbo, 2014; Curtis, Fry, Shaban, & Considine, 2016; Middlebrooks, Carter-Templeton, & Mund, 2016).
Of course, research takes time! From planning to funding to the conduct of the study (i.e., sample recruitment to data analysis) can take years, depending on the research design. The writing of the manuscript and submission to a journal — rewrites and resubmissions – another, possibly, significant period of time.
Then the study then needs to be found, read, critiqued, and translated into practice. An oft-quoted “fact” in EBP is that it takes 17 years for an innovation to be implemented into practice from the time of publication of the original research to use at the bedside (Morris, Wooding, & Grant, 2011). That’s quite a time lag!
The research-practice gap effectively stalls the translation of evidence into practice (EBP). If nurses are not aware of research findings or can’t find or critique relevant studies, they won’t use research and other valid evidence in practice. Many nurse researchers have focused on identifying barriers to research use. While some of these barriers have been overcome, many still exist. In this post, I’ll talk about some common reasons for why the research-practice gap still exists in healthcare and nursing.
Common Reasons for the Research-Practice Gap
Knowledge of the research process and skills related to EBP are core competencies for nurses caring for today’s complex patients (IOM, 2010). Many articles and editorials have been written in an attempt to explain the disparity between the publication of research findings and their utilization (i.e., the research-practice gap). Nurse leaders have studied barriers to the use of research and evidence in practice for a very long time (Thompson, 1997). Much of this “barriers” research was published in the 1980s and 1990s. (I’m not going to cite all of these authors, but if you are interested in these seminal and classic works, email me [cathy@nursingeducationexpert.com] and I’ll send you a list!)
My research interests have mainly focused on individual and organizational factors related to research utilization and evidence-based practice. Barriers to research use have been identified in three main categories: professional, organizational, and personal. All of these factors affect the rate and ease with which nurses use research and evidence in professional, clinical, and teaching practice.
Barrier to EBP
There are many barriers to using evidence in practice. Photo by Cristina Gottardi on Unsplash
Professional Factors as Barriers to EBP
Professional factors are those barriers that are a result of professional influences. The following are a couple of examples of professional factors that can hinder the translation of evidence into practice.
Complex Communication
There are many different terms that mean the same thing or something similar in nursing. Research language is complex and can be confusing the nurses who are responsible for identifying problems and finding solutions. For example, a study by Graham et al. (Graham et al. cited in Curtis et al., 2016) found 29 terms used in the U.S., Canada, the U.K., Europe, and Australia that all referred to knowledge translation including, research utilisation (utilization), research dissemination, research diffusion, knowledge uptake, and knowledge-to-action. I didn’t have access to this study but if it’s not noted, implementation science is another similar term.
“The complexity of the research language and the tendency for nurse researchers to publish in research journals not routinely read by the bedside nurse also may have hindered implementation of the findings in practice” (Thompson, 1997, p. 50).
Additionally, in the past, nurse researchers didn’t routinely publish in clinical journals or translate their work into practical language or action steps that could be understood by the bedside nurse. For tenure purposes, publication of research in highly-regarded research journals is looked at more favorably than publication in clinical journals. The discussion of methodology, the need to interpret statistics related to quantitative research findings, and the perceived lack of practical implications, caused many a bedside clinician (myself included before I went back to school!), to shy away from reading the scientific literature.
“Research is seen as too complicated, too scholarly, excessively statistical, ambiguous, and having limited or no relevance to practice” (Gale & Schaffer, 2009, p. 91).
This is one area that has changed for the better as more original research studies are being published in clinical journals. Many journals have added a Research to Practice column and help translate the evidence by walking clinicians through the fine points of evidence and research studies. Additionally, many nursing journals now require researchers to include an “implications for clinical practice-” or “clinical pearls-” type of section in their manuscripts to help facilitate the translation of research into practice.
Publication Time Lag
The delay between the generation of knowledge (i.e., from design to the completion of a research study) and the diffusion of those research findings through written and oral means has been another significant barrier to the timely application of research in the clinical setting and continues to be a major factor impeding research utilization and EBP.
There is a lot of variability in publication time due to a number of factors including whether the manuscript is being submitted to a peer-reviewed journal or not, the amount of revising that may be required, and the time for copyediting and getting the manuscript to print (Cofactor, 2012).
This barrier has also been mitigated somewhat because the availability of the Internet allows for immediate access to information. “Googling” search terms for your practice is likely to identify recently published research and/or clinical practice guidelines. The increase in online publishing by many journals has decreased the time to publication through the publishing of online preprints and fast-tracking of manuscript acceptance.
Barriers to Research Use
Barriers can hinder research use in practice. Photo by Agnieszka Boeske on Unsplash
Personal and organizational barriers may also preclude nurses from seeking out and applying relevant research in their practice settings (Bradshaw, 2010; Curtis et al., 2016; Middlebrooks et al., 2016; Wells et al., 2007; Thompson, 1997). Here are a few examples for each.
Organizational Factors as Barriers to EBP
Organizational Culture
Organizational culture, in terms of EBP, refers to the organization’s environment for learning and inquiry. Does the culture encourage or discourage questioning the status quo? Are there resources (financial, material, personnel) to support a culture of inquiry? Is EBP an expectation of practice? Are nurses considered an important part of the team? etc.
“Research culture [in an organization] has a significant effect on the individual nurse’s desire and
ability to use research in clinical practice” (Thompson, 2001, p. 476).
Staff Nurse Empowerment: No Time or Authority
Time is the number one factor identified for both organizational and personal influences of research use. No time to read, to search the literature, to design or conduct a study, to change practice, or to go to school are some of the laments.
Unless you work in a Magnet-recognized hospital, staff nurses don’t feel that they have the time or the power to change practice (Fink, Thompson, & Bonnes, 2005), even if they had the skills to initiate, develop, and implement change proposals.
Lack of Human Resources to Facilitate EBP
Staff nurses are busy! As I noted, the lack of research skills and the lack of time are major barriers to the implementation of best practices. Advanced practice nurses (APNs) are educated with core knowledge and skill competencies in evidence-based practice, quality improvement, and systems thinking to facilitate positive patient, nurse, and organizational outcomes. APNs can, and should, mentor the clinical staff to implement EBP.
The lack of mentorship by EBP experts has been cited as a barrier to research utilization for years (Bradshaw, 2010; Fink et al., 2005; Gale & Schaffer, 2009; Middlebrooks et al., 2016; Wells et al., 2007). Clinical nurse specialists (CNSs) are educated to be translators of research into practice. CNS and should be used to mentor staff nurses to identify and solve clinical problems using EBP knowledge and skills.
CNSs are perfect for the role of EBP mentor. To promote positive patient outcomes organizations need to hire CNSs to support the clinical staff! Yup, I’m biased because I’m a CNS and I directed the highly-ranked CNS track at my university. I also have consulted on the role of the CNS in the hospital and I KNOW how powerful the role can be!
Now, even though the masters-prepared clinical nurse leader (CNL) is not recognized as an advanced practice role, it is a unit-based nurse specialist role and can be a resource to the staff. The CNL role is growing and is considered a complement to the CNS role. The CNL can guide staff nurses to implement best practices on the unit.
Personal or Individual Factors as Barriers to EBP
Education: Knowledge and Skill Deficits
Evidence-based practice is the way of the healthcare world. But many nurses didn’t learn about evidence-based practice in school; and depending on their program, they may not have learned about the research process, either. Even if you did learn about the research or evidence-based practice process, like almost anything, you have to practice these skills or you will forget how to use them and why they are important!
EBP knowledge and skills include the ability to: access and search databases, retrieve research studies and other evidence, critically appraise the evidence, and interpret the results (quantitative or qualitative). Once the preliminary steps are finished, then you have to decide if the results are ready for implementation into practice and if they can be used in your particular patient population. That’s a lot to know and be able to do – and I haven’t even talked about the knowledge of how to change the culture or instigate the process (i.e., deal with the bureaucracy) of making changes in practice!
For most staff nurses, knowledge, and skill deficits are major barriers to implementing EBP. The consequence is that when staff nurses recognize a problem, they don’t have the confidence or the resources to move forward with the EBP process to solve their problem.
No Time to Search, Critique, Implement, Evaluate
Barriers to research use include Time.
Lack of Time is a common barrier to research use. Photo by Niklas Rhöse on Unsplash
I’ve said this throughout, but Time is an issue when it comes to EBP. The number one barrier that is reported is nurses’ complaints that there is “no time” to do anything “extra” – at work or at home (Bradshaw, 2010; Curtis et al., 2016; Fink et al., 2005; Gale & Schaffer, 2009; Middlebrooks et al., 2016; Thompson, 1997; Wells et al., 2007). EBP is seen as a burden, a “necessary evil” (Thompson, 2001, p. 479), not a benefit.
Nursing Attitudes Towards Research
We know that attitudes influence behavior. The attitudes and beliefs of clinical nurses have been studied as a barrier to research and evidence-based practice (Thompson, 1997, 2001). The perception that research has no relevance to practice is translated into negative attitudes and the non-use of research findings. My own research also showed this relationship (Thompson, 1997, 2001).
For some nurses, research didn’t have much value to the clinical setting; it was only a class to take in nursing school (if you went to university), but no relevance to real life or clinical practice. Depending on when you went to school, evidence-based practice may not have been emphasized or expected.
However, we know that research and EBP are core competencies for 21st-century nurses (IOM, 2010), so nurse educators have to innovate when it comes to teaching these competencies that are so important for practice! We know that positive research attitudes facilitate research- and evidence-based practice.
Solutions to Narrow the Gap
There are nurses who continue to study the research-practice gap phenomenon in the U.S. and abroad (e.g., Agbedia, Okoronkwo, Onokayeigho, & Agbo, 2014; Curtis et al., 2016; Middlebrooks, Carter-Templeton, & Mund, 2016). Their efforts will help to build the science and to offer research-based recommendations to narrow the research-practice gap.
As a result of pointed efforts to promote evidence-based practice, many of the issues that may have contributed to slow dissemination and implementation of research and evidence findings may not be barriers today. I’ll take those up at a later time.
How to Cite this Blogpost in APA*: Thompson, C. J. (2018, April 17). Barriers to translating research into practice [Blog post]. Retrieved from https://nursingeducationexpert.com/barriers-translating-research *Citation should have hanging indent
References
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Bradshaw, W. G. (2010). Importance of nursing leadership in advancing evidence-based nursing practice. Neonatal Network, 29(2), 117-122. doi:10.1891/0730-0832.29.2.117
Cofactor. (2012, June 13). Acceptance to publication time [Blog post]. Retrieved from http://cofactorscience.com/blog/acceptance-to-publication-time
Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2016). Translating research findings to clinical nursing practice. Journal of Clinical Nursing, 26(5-6), 862-872. doi:10.1111/jocn.13586
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Institute of Medicine [IOM]. (2010). The future of nursing: Focus on education [Report brief]. Washington, DC: National Academies Press. Retrieved from http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Nursing%20Education%202010%20Brief.pdf
Middlebrooks, Jr., R., Carter-Templeton, H., & Mund, A. R. (2016). Effect of evidence-based practice programs on individual barriers of workforce nurses: An integrative review. Journal of Continuing Education in Nursing, 47(9), 398. doi:10.3928/00220124-20160817-06
Morris, Z. S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: Understanding time lags in translational research. London, England: SAGE Publications. doi:10.1258/jrsm.2011.110180
Thompson, C. J. (1997). Extent and factors influencing research utilization among critical care nurses. Unpublished Doctoral Dissertation. Texas Woman’s University. Houston, Texas. (University Microfilms No. 9818572)
Thompson, C. J. (2001). The meaning of research utilization: A preliminary typology. Critical Care Nursing Clinics, 13(4), 475-486.
Wells, N., Free, M., & Adams, R. (2007). Nursing research internship: Enhancing evidence-based practice among staff nurses. JONA: The Journal of Nursing Administration, 37(3), 135-143. doi:10.1097/01.NNA.0000262732.14123.a2
