nursing research

 
Imagine you have taken a nursing research class, and answer this question.
Read the attached article on research utilization by nurses. Please provide an overall summary of what you personally took away from this article. Please comment on the findings. Read the discussion of the findings and identify your thoughts about nurses utilization of research on the units. What do you foresee that you will do. Has this course influenced you regarding reading and utilizing research findings – if so, in what ways? Has your opinion about nursing research and evidence based practice changed in any way since taking this course?
INTEGRATIVE LITERATURE REVIEWS AND META-ANALYSES
Individual determinants of research utilization: a systematic review
Carole A. Estabrooks PhD RN
Associate Professor, Faculty of Nursing, University of Alberta, Edmonton; Canadian Institutes of Health (CIHR) Health
Scholar; Alberta Heritage Foundation for Medical Research (AHFMR) Population Health Investigator; and Adjunct Scientist,
Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
Judith A. Floyd PhD RN
Professor, College of Nursing, Wayne State University, Detroit, Michigan, USA
Shannon Scott-Findlay PhD(c) RN MN
Doctoral Candidate, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
Katherine A. O’Leary BA BScN
Undergraduate Student, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
and Matthew Gushta BA
Graduate Student, Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
Submitted for publication 9 April 2002
Accepted for publication 31 March 2003
Correspondence:
Carole A. Estabrooks,
Faculty of Nursing,
5-112 Clinical Sciences Building,
University of Alberta,
Edmonton,
Alberta,
Canada T6G 2G3.
E-mail: [email protected]
ESTABROOKS C.A., FLOYD J.A. , SCOTT-FINDLAY S. , O’LEARY K.A., S., A. &
GUSHTA M. (2003) Journal of Advanced Nursing, 43(5), 506–520
Individual determinants of research utilization: a systematic review
Context. In order to design interventions that increase research use in nursing, it is
necessary to have an understanding of what influences research use.
Objective. To report findings on a systematic review of studies that examine individual
characteristics of nurses and how they influence the utilization of research.
Search strategy. Asurvey of published articles in English that examine the influence of
individual factors on the research utilization behaviour of nurses, without restriction
of the study design, from selected computerized databases and hand searches.
Inclusion criteria. Articles had to measure one or more individual determinants of
research utilization, measure the dependent variable (research utilization), and
evaluate the relationship between the dependent and independent variables. The
studies also had to indicate the direction of the relationship between the independent
and dependent variables, report a P-value and the statistic used, and indicate the
magnitude of the relationship.
Results. Six categories of potential individual determinants were identified: beliefs
and attitudes, involvement in research activities, information seeking, professional
characteristics, education and other socio-economic factors. Research design, sampling,
measurement, and statistical analysis were examined to evaluate methodological
quality. Methodological problems surfaced in all of the studies and, apart from attitude
to research, there was little to suggest that any potential individual determinant
influences research use.
Conclusion. Important conceptual and measurement issues with regard to research
utilization could be better addressed if research in the area were undertaken
longitudinally by multi-disciplinary teams of researchers.
506
2003 Blackwell Publishing Ltd
Keywords: research utilization, knowledge utilization, individual determinants,
systematic review, evidence-based nursing, evidence-based practice, nurse characteristics
As the first reports of studies in nursing (Ketefian 1975,
Kirchoff 1982), research utilization has persisted as a field of
interest in the profession. Over the course of the past
30 years, some 85 studies directly examining research
utilization have appeared in the literature. Additionally,
many hundreds of smaller evaluation projects, conceptual
and opinion pieces, editorials, and commentaries have been
generated. Without fail, authors encourage or admonish
clinicians to use research. Commonly, scholars working in
the field have described models of research utilization
(Horsley et al. 1978, Crane 1985, Logan & Graham 1988,
Goode & Bulechek 1992, Stetler 1994, Kitson et al. 1998).
There is, however, a general consensus that the theory–
practice problem which is a widening gap between research
and practice, persists. Given current drives to ensure evidence-
based practice, this gap (real or perceived) is even more
problematic for a nursing profession trying to respond
simultaneously to parallel agendas of professionalization
and public good.
An understanding of what influences research utilization is
necessary in order to design interventions to increase research
use. Towards that end, a systematic review was conducted to
examine the strength of the evidence supporting claims that
one or another individual factor increases research use. This
article reports on the findings of the systematic review, and
makes recommendations for further study in the field of
research utilization.
Review process
Search strategy
We began by searching selected computerized bibliographical
databases, and the detailed search strategy is outlined
in Box 1. In addition, Applied Nursing Research, Journal
of Clinical Nursing and Clinical Nursing Research (1993–
2000) were hand-searched because we thought these
journals targeting clinicians might contain relevant studies
that were not indexed in the usual way; however, these
searches yielded no further studies. Dissertations and ‘grey
literature’ (such as conference proceedings) were not
included in the search strategy, although the Dissertation
Abstracts database was searched, and relevant dissertations
were followed up to determine if the authors had published
their results. Our experience to date with systematic
reviews has been that exhaustive searching for grey
Box 1 Search strategy
The following bibliographical databases were searched: Medline
(1995 to February 2001), HSTAR (1996 to January 2000),
CINAHL (1982 to February 2001), ERIC (May 1998 to February
2001), PsychInfo (May 1998 to February 2001), ABI Inform
(1998 to May 2001), Dissertation abstracts (1998 to May 2001).
As not all databases use the same controlled vocabulary, different
search terms were used as applicable. These terms were as follows:
CINAHL
Diffusion of innovation (subject heading)
Research utilization (textwords) OR
Research transfer (textwords)
Nursing research (subject heading)
CINAHL (1998–2001)
Diffusion of innovation (subject heading)
Research utilization (textword) OR
Research, nursing (subject heading, exploded)
AND
Transfer, practice or practise (textwords)
Research AND transfer (subject heading and textword)
Limited to research as publication type
Medline & HSTAR
Evidence-based medicine (MeSH)
Research transfer (textword)
Diffusion of innovation (MeSH-exploded) OR
Professional practice (MesH-exploded)
Research utilization (textword)
Education, medical continuing (MeSH)
AND
Physicians (MeSH-exploded)
Allied health personnel (MeSH-exploded)
Nurses (MeSH-exploded) OR
Learning (MeSH-exploded)
Research (MeSH-exploded)
Motivation (MeSH-exploded)
Knowledge, attitudes, practice (MeSH)
Medline updates (1998–2001)
Diffusion of innovation (MeSH-exploded)
Research utilization (textword)
Nursing methodology research (MeSH)
Nursing research (MeSH-exploded) OR
Evidence-based medicine (MeSH)
Research transfer (textword)
Research AND Physician’s practice patterns (MeSH)
In addition to electronic searches, manual searches were performed
on the print version of CINAHL from its beginning
through to 1982, and on the journals Applied Nursing Research
and Clinical Nursing Research from 1998 through to the issue
current at the time of this writing
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2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(5), 506–520 507
literature results in a very low yield, but incurs significant
material and human costs.
Inclusion criteria
We reviewed published articles, in English only, that examined
the influence of individual factors on the research
utilization behaviour of nurses, without restriction of the
study design. We reviewed English-only articles because
preliminary searches did not uncover any non-English papers.
As none of the authors is conversant enough in a second
language to critique a research paper, and based on initial
searching, it was reasonable to examine English-only papers.
The search strategy generated over 1000 research titles and
abstracts of articles. Three members of the team assessed the
titles and abstracts (when available) of these articles, using
preliminary inclusion criteria. More detailed review of the
articles thus identified resulted in 104 reports being included
in a full inclusion/exclusion screening, which was completed
by team members working in pairs. The lead authors made all
final inclusion decisions. The results of this process are
illustrated in Box 2. All 104 articles were successfully
retrieved.
Screening of the 104 retrieved articles was guided by three
inclusion criteria: measurement of the independent variable,
measurement of the dependent variable, and an appropriate
study design. Failure to meet any of the three criteria resulted
in the study failing to pass to the next stage of screening,
where studies were subjected to two procedures. The first
required that the study measure one or more potential
individual determinants of research utilization (see Box 3 for
examples of these determinants) and measure the dependent
variable of research utilization. Whether an omnibus or
instrumental measure, research utilization must have been an
outcome measured for the study to be included. Second, the
study design had to have evaluated the influence of the
independent variable(s) on the dependent variable, and this
relationship had to be reported. The initial and final screening
tools are shown in Boxes 4 and 5, respectively.
Each study was reviewed independently by the authors.
Those published prior to 1998 were each reviewed by the
first and second authors, while the others were each
reviewed by two authors (either authors three and four or
authors three and five), with a sub-sample of these being
reviewed by the first and third authors to ensure consistency.
Consensus was used to reach final decisions on
inclusion and exclusion. When discrepancies in judgement
were encountered, the article in question was re-reviewed
and discussed.
Screening and data extraction
Four team members completed the final inclusion screening
process and resolved disagreements by consensus. The final
inclusion criteria comprised four categories: (1) an indication
of direction of the relationship between the independent and
dependent variables; (2) the presence of a P-value; (3) a
report of the statistics used; and (4) an indication of the
magnitude of the relationship. No articles met all four
criteria, and so the decision was made that study reports must
satisfy the first condition only (a report of the direction of the
relationship) to stay in the dataset.
Twenty-two articles remained in the dataset and proceeded
to data extraction. These 22 articles represent 20 individual
studies; two authors (C.A. Estabrooks and K. Parahoo) each
have two papers reporting one study. Data extraction was
Box 3 Individual determinants
• Age
• Sex
• Family income
• Number of professional memberships
• Research beliefs
• Research attitudes
• Years employed as a registered nurse
• Current role
• Area of specialty
• Years of specialty experience
• Full- or part-time status
• Type of education
• Years since basic education
• Completion of research/statistics classes
• Hours of continuing education
• Hours spent reading professional journals
• Involvement in research activities
• Attendance at conferences
• Job satisfaction
• Perceived support for research
• Perceived availability of research
Online database yield
1063
Articles requested and screened for
inclusion/exclusion
104
Studies meeting inclusion
criteria 20
(representing 22 articles)
Studies excluded
82
Box 2 Search and retrieval process
C.A. Estabrooks et al.
508
2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(5), 506–520
completed by all team members. Each study was independently
evaluated by at least two members, and disagreements
were resolved by consensus. Data on setting, design, sampling
scope and size, subjects, individual determinant, theoretical
framework, approaches to measuring research utilization,
and analysis design and approaches were extracted. The final
set of included studies and their characteristics is included in
Table 1.
Methodological evaluation
The 20 studies were evaluated for methodological quality; in
other words, a validity assessment. Tools to guide this
process were developed by the lead authors based on
published criteria and their research experience. The tools
assessed four features of each study: research design, sampling,
measurement and statistical analysis. Two team members
independently evaluated each study and the group met to
discuss discrepancies. The principal investigators independently
rated a subset of the same studies, and discrepancies
were again resolved by consensus. One team member carried
out a final assessment to ensure consistency.
Results
Summary of quality of studies
Published research projects were evaluated on 13 criteria for
a total of 14 possible points. Twelve items were scored
dichotomously (‘met’ ¼ 1, or ‘not met’ ¼ 0). One criterion,
whether use of research results was measured by self-report
only or by independent observation, was considered more
important; thus, it was scored as no points for ‘self-report
only’ and two points for ‘objective measures used’.
A greater weight was assigned to this criterion because
self-report measures represent a potentially serious threat to
construct validity. The 13 items were designed to evaluate
those design, sampling, measurement, and analysis features
that protect study conclusions from threats to statistical
conclusion validity and external validity in correlational
studies. Studies with scores of less than half the possible
points, i.e. between 0 and 6, were considered weak studies.
Those with scores of 7–9 were considered to have moderate
strength, and those with scores of 10 or more were
considered strong (Table 2).
Box 5 Screening tool, part B
Systematic review of individual determinants of research utilization
in nursing relevance (inclusion/exclusion criteria) tool
Final screen
Instructions for completion
1. Circle Y or N for each criterion
2. Record inclusion decision: Must satisfy #1 to stay in dataset
3. Record discrepancies
Inclusion/exclusion criteria:
1. Is there an indication of direction? Y N
Text only: ____ yes ____ no
Comments:
2. Is there a P-value? Y N
3. Is there a statistic identified? Y N
Which one(s)? ______________________________
4. Is there any indication of magnitude? Y N
Comment: ______________________________
___ Discrepancy in inclusion decision: Y N
Reason for discrepancy
___ Oversight
___ Other (explain)
Final decision: include in study Y N
Comments:
Box 4 Screening tool, part A
Systematic review of individual determinants of research utilization
in nursing relevance (inclusion/exclusion) tool
Instructions for completion
1. Circle Y or N for each criterion
2. Record inclusion decision: article must satisfy both criteria
3. Record if additional references are to be retrieved
Inclusion/exclusion criteria
1. Does the study measure one or more individual
determinants of research utilization? (be specific)
Y N
List: _________________ ________________
_________________ ________________
2. Does the study measure research utilization? Y N
How is it measured?
___ Omnibus
Specify (e.g. NPQ,
NPQ-E, etc.)
___ Instrumental ________________
___ Other (specify) ________________
________________
Excluded studies
___ Instrumental development/testing — Other (specify)
___ Extent of utilization
___ Intervention/strategy testing ________________
___ Organizational factors
___ Innovation attributes ________________
___ Knowledge sources
___ Discrepancy in inclusion decision
Reason for discrepancy
___ Oversight
___ Other (explain): ___________________________
Final decision: include in study Y N
Comments:
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2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(5), 506–520 509
Table 1 Characteristics of included studies
Author(s) and year Journal Subjects Framework Measurement Scoring Reliability Validity
Barta (1995) Journal of Professional
Nursing
Pediatric
nurse educators
Rogers’ Theory
of Diffusion
Modification
of NPQ
Used total score for
diffusion
Overall a ¼ 0Æ74 Content
Bostrom
& Suter (1993)
Journal of Nursing
Staff Development
Registered nurses Not specified RIS Used single item on RIS a ¼ 0Æ88 for RIS;
no information on
single item
Not addressed
Brett (1989) Nursing Research Registered nurses Rogers’ Theory
of Diffusion
NPQ Used total score for
diffusion
a ¼ 0Æ69–0Æ95
for 14 practices
Content
Butler (1995) Canadian Journal
of Nursing Research
Registered nurses Not specified Used a single
question
Dichotomous outcome Not reported Not addressed
Champion
& Leach (1989)
Journal of Advanced
Nursing
Staff nurses
in community
hospitals
Not specified RUQ Used total for 10-item
scale
Overall a ¼ 0Æ92 Content
Coyle
& Sokop (1990)
Nursing Research Staff nurses in
medium-sized
hospitals
Rogers’ Theory
of Diffusion implied
NPQ Used total score
for diffusion
Test–retest r ¼ 0Æ83
Overall a ¼ 0Æ95
Content
Davies (1999) Nursing Times Practice nurses Not specified Other multi-item
scale
Measured summarized
RU on a 23-point scale
Not reported Not reported
Estabrooks (1999a) Research in Nursing
and Health
Estabrooks (1999b) Western Journal
of Nursing Research
Staff nurses Not specified Single-item assessment
of overall RU in the
past year
Extent of use scored
according to an 8-point
frequency scale
Not reported Content
Kirchoff (1982) Nursing Research Critical care nurses Rogers’ Theory
of Diffusion
Self-report of two
practices
Separate scores for
awareness, persuasion,
and use
Pretested but no a’s
reported for factor
analysis
Content
Lacey (1994) Journal of Advanced
Nursing
General nurses
at F/G Grade
Not specified RUQ Used total score for
10-item scale
No new information
reported
No new
information
reported
Lia-Hoagberg
et al. (1999)
Public Health
Nursing
Public health nurses
and directors of public
health agencies
Rogers’ Theory
of Diffusion
Self-reported
incorporation
of guidelines
into practice
Measured extent of use
on a 4-point scale
Not reported Not reported
C.A. Estabrooks et al.
510
2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(5), 506–520
Table 1 (Continued)
Author(s) and year Journal Subjects Framework Measurement Scoring Reliability Validity
Logsdon
et al. (1998)
Kentucky Nurse Registered nurses Not specified Self-reported
research utilization
Dichotomous outcome
(use of research to change
practice at least once a year)
Not reported Not reported
Michel
& Sneed (1995)
Journal of Professional
Nursing
STTI Chapter
nurses
Rogers’ Theory
of Diffusion
Modification of NPQ Used total score for diffusion Overall a ¼ 0Æ85;
sub-scale range
was 0Æ73–0Æ84
No new
information
reported
Parahoo (1998) International Journal
of Nursing Studies
Hospital nurses Not specified 11-item self-report
of attitudes towards
research
Scored on a 4-point
agreement scale
Not reported Content
Parahoo (1999) Journal of Advanced
Nursing
Rodgers (2000) Nurse Education
Today
Medical/surgical
nurses
Not specified Modification of NPQ Measured average RU score
on 14 items, 4-point scale
Overall a ¼ 0Æ631 Content
Rutledge
et al. (1996)
Oncology Nursing
Forum
Oncology
staff nurses
Rogers’ Theory
of Diffusion
Modification of NPQ Used total score for diffusion Overall a ¼ 0Æ75 No new
information
reported
Tsai (2000) International Journal
of Nursing Studies
Staff nurses
and nurse
managers
Not specified Self-reported
research utilization
in the last 3 years
Dichotomous outcome
(‘yes’ or ‘no’)
Not reported Content
Varcoe
& Hilton (1995)
Canadian Journal
of Nursing Research
Staff nurses
in medicalsurgical
and critical
care nursing
Crane’s
conceptualization
Major modification
of NPQ
Measured amount of use
of 10 practices on 4-point
scales
Overall a ¼ 0Æ87 Content
Winter (1990) Journal of Continuing
Education in Nursing
Staff nurses Rogers’ Theory
of Diffusion
Self-reported use of
one research-based
innovation
Dichotomous outcome Not reported Not reported
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2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(5), 506–520 511
For the 20 studies evaluated, validity scores ranged from 5
to 10. Four were evaluated as weak, two as strong, leaving
the remaining 14 (represented by 16 articles) in the moderate
strength category. Because both strong studies received
a score of 10, while the 4-weak studies had scores of 5 and
6, respectively – meaning not clear, it was concluded that
even the weakest studies in this domain had enough merit to
be included, while even the strongest studies had threats to
validity.
All 20 projects shared two major weaknesses, one regarding
measurement and another regarding analysis. Measurement
of nurses’ use of research was always by self-report
only, and all research reports failed to address explicitly the
possibility that outliers unduly influenced results. Other
weaknesses that emerged during the validity review were
that: (a) only 25% of the studies addressed inter-correlations
among predictors; (b) only 35% had response rates that met
the minimum recommended criterion of 60% (Polit &
Hungler 1999, p. 348); and (c) the self-reported use of
research was measured by scales with acceptable levels of
reliability (scales with reported internal consistency coefficients
‡ 0.70) only 50% of the time.
Strengths in this set of studies included the fact that all
20 projects were prospective, and 75% of them drew their
subjects from more than one site. Of the four studies using a
single site, three may have had results influenced by a threat
to anonymity, especially for subjects in leadership positions,
who are easily identifiable from their unique sets of
background characteristics. Other sampling strengths were
that: (a) all except the two weakest studies were judged to
have adequate sample sizes, and (b) 65% of the projects
reported use of random sampling methods. Finally, there was
almost no evidence of restriction of range in the measurement
of key variables in these 20 projects.
Retaining all studies regardless of their assessed methodological
strength (low, medium or high) in the final dataset is a
less conservative approach. When we compared the effects of
individual determinants on research utilization between studies
with a medium or high quality rating and those with a low
rating (Table 2), we did not see a differential effect between
the two groups. This supported the idea that studies varied
along a continuum of quality rather than falling into three
distinct categories regarding trustworthiness of the findings.
Predictors of research utilization
Data on predictors (individual determinants) of research use
were extracted in six categories: beliefs and attitudes,
Table 2 Summary of validity scores
Author (year) Journal Validity score
Strong
Brett (1989) Nursing Research 10
Michel & Sneed (1995) Journal of Professional Nursing 10
Moderate
Estabrooks (1999a) Research in Nursing & Health 9
Estabrooks (1999b) Western Journal of Nursing Research 9
Rutledge et al. (1996) Oncology Nursing Forum 9
Varcoe & Hilton (1995) Canadian Journal of Nursing Research 9
Rodgers (2000) Nurse Education Today 9
Barta (1995) Journal of Professional Nursing 8
Bostrom & Suter (1993) Journal of Nursing Staff Development 8
Butler (1995) Canadian Journal of Nursing Research 8
Coyle & Sokop (1990) Nursing Research 8
Kirchoff (1982) Nursing Research 8
Davies (1999) Nursing Times 7
Hatcher & Tranmer (1997) Canadian Journal of Nursing Administration 7
Parahoo (1998) International Journal of Nursing Studies 7
Parahoo (1999) Journal of Advanced Nursing 7
Tsai (2000) International Journal of Nursing Studies 7
Winter (1990) Journal of Cont Education in Nursing 7
Weak
Champion & Leach (1989) Journal of Advanced Nursing 6
Logsdon et al. (1998) Kentucky Nurse 6
Lacey (1994) Journal of Advanced Nursing 5
Lia-Hoagberg et al. (1999) Public Health Nursing 5
C.A. Estabrooks et al.
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2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(5), 506–520
Table 3 Summary of findings
Individual determinant Source Finding Comment
Beliefs & attitudes
Research beliefs Bostrom & Suter (1993) NS
Perceived support for research Butler (1995) NS
Attitude towards research Bostrom & Suter (1993) NS Significant for general
Champion & Leach (1989) þ but not specific use
Coyle & Sokop (1990) þ
Estabrooks (1999a, 1999b) þ
Lacey (1994)
Varcoe & Hilton (1995)
Perceived availability of research findings Champion & Leach (1989) þ
Hatcher & Tranmer (1997) þ
Perceived support for specific RU Champion & Leach (1989) þ
Perception of research policy Michel & Sneed (1995) þ
Expectation of self to use research Varcoe & Hilton (1995) þ Significant for general
but not specific use
Expressed interest in research Varcoe & Hilton (1995) þ Significant for general
but not specific use
Self-perceived preparedness for health promotion Davies (1999) S No statistic given
Problem solving ability Estabrooks (1999a, 1999b) NS
Cosmopoliteness Estabrooks (1999a, 1999b) NS
Autonomy Estabrooks (1999a, 1999b) NS
Dogmatism Estabrooks (1999a, 1999b) NS
Activism Estabrooks (1999a, 1999b) NS
Belief suspension Estabrooks (1999a, 1999b) þ
Theoretical orientation Estabrooks (1999a, 1999b) NS
Trust Estabrooks (1999a, 1999b) NS
Involvement in research activities
Current collaboration on research Bostrom & Suter (1993) þ
Current data collection for others Bostrom & Suter (1993) þ
Butler (1995) þ
Current data collection for own work Bostrom & Suter (1993) NS
Current presentation of research findings Bostrom & Suter (1993) NS
Current applying for funding Bostrom & Suter (1993) NS
Current research proposal writing Bostrom & Suter (1993) NS
Current service on research committee Bostrom & Suter (1993) NS
Past collaboration on research Bostrom & Suter (1993) NS
Past data collection for others Bostrom & Suter (1993) NS
Past data collection for own work Bostrom & Suter (1993) NS
Past presentation of research findings Bostrom & Suter (1993) NS
Past service on research committee Bostrom & Suter (1993) NS
Participation in research as subject Hatcher & Tranmer (1997) NS
Past use of research Butler (1995) þ
Extent of job related research activities Rutledge et al. (1996) þ
Participation in research study Brett (1989) NS
Educational preparation for participation in research Logsdon et al. (1998) þ
Research participation Tsai (2000) þ
Research experience Varcoe & Hilton (1995) þ
Information seeking
Nursing texts as a top information source Bostrom & Suter (1993) NS
Barta (1995) NS
Nursing journals as a top information source Bostrom & Suter (1993) þ
Winter (1990) NS
Barta (1995) 
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2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(5), 506–520 513
Table 3 (Continued)
Individual determinant Source Finding Comment
Educational activities as a top information source Barta (1995) NS
Reads professional journals Tsai (2000) þ
Hours spent reading professional journals Brett (1989) þ
Kirchoff (1982)* NS
Kirchoff (1982) NS
Coyle & Sokop (1990) NS
Michel & Sneed (1995) NS
Number of journals read Kirchoff (1982)* NS Significant only
Kirchoff (1982) NS if read regularly
Rodgers (2000) þ
Rutledge et al. (1996) þ
Subscription to professional journals Tsai (2000) þ
Reads AJN Kirchoff (1982) þ
Kirchoff (1982)* NS
Reads Heart & Lung Coyle & Sokop (1990) þ
Kirchoff (1982)* NS
Kirchoff (1982) 
Michel & Sneed (1995) þ
Reads Nursing Research Brett (1989) þ
Coyle & Sokop (1990) NS
Michel & Sneed (1995) NS
Reads RN Brett (1989) þ
Educational offerings as top source Bostrom & Suter (1993) NS
Attendance at conferences Coyle & Sokop (1990) þ
Michel & Sneed (1995) þ
Winter (1990) þ
Butler (1995) NS
Rutledge et al. (1996) þ
Number of continuing education sessions Kirchoff (1982) NS
In-services attended Estabrooks (1999a, 1999b) þ
Hours of continuing education Brett (1989) NS
Coyle & Sokop (1990) NS
Number of study days attended Rodgers (2000) þ
Time spent studying (on duty) Rodgers (2000) NS
Time spent studying (off duty) Rodgers (2000) þ
Peers as source of research Winter (1990) NS
Nursing school as research source Winter (1990) þ
Education
Education Lacey (1994) þ
Type of degree Bostrom & Suter (1993) NS
Brett (1989) NS
Butler (1995) þ BSN vs. diploma
Champion & Leach (1989) NS
Coyle & Sokop (1990) NS
Davies (1999) S No statistic given
Estabrooks (1999a, 1999b) NS
Logsdon et al. (1998) þ
Michel & Sneed (1995) þ BSN vs. MS
Parahoo (1998, 1999) þ Project 2000 vs. pre-Project 2000
Rodgers (2000) þ Highest qualification
Tsai (2000) þ
Varcoe & Hilton (1995) NS
Winter (1990) NS BSN vs. diploma
C.A. Estabrooks et al.
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2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(5), 506–520
Table 3 (Continued)
Individual determinant Source Finding Comment
Possessing a degree Parahoo (1998) þ
Highest degree Rutledge et al. (1996) 
Working towards a degree Bostrom & Suter (1993) NS
Brett (1989) NS
Coyle & Sokop (1990) NS
Well prepared in education process Logsdon et al. (1998) þ
Number of degrees Brett (1989) NS
Courses attended Estabrooks (1999a, 1999b) NS
Attendance at a study day Davies (1999) S
Completion of research class(es) Brett (1989) NS
Coyle & Sokop (1990) NS
Rodgers (2000) þ
Tsai (2000) þ
Completion of a statistics course Tsai (2000) þ
Butler (1995) NS
Attended advanced degree program Tsai (2000) þ
Years since basic education Kirchoff (1982)* þ
Kirchoff (1982) NS
Brett (1989) NS
Years since last degree Estabrooks (1999a, 1999b) NS
Kirchoff (1982)* þ
Kirchoff (1982) NS
Taught a topic based on nursing research Rodgers (2000) þ
Having Project 2000 training Parahoo (1999) NS
Professional characteristics
Full- or part-time status Butler (1995) NS
Years employed as an RN Bostrom & Suter (1993) NS
Butler (1995) NS
Champion & Leach (1989) NS
Coyle & Sokop (1990) NS
Davies (1999) S No statistic given
Estabrooks (1999a, 1999b) NS
Kirchoff (1982)* þ
Kirchoff (1982) NS
Lia-Hoagberg et al. (1999) þ No statistic given
Michel & Sneed (1995) NS
Rodgers (2000) NS
Tsai (2000) þ
Winter (1990) NS
Years in post Davies (1999) S
Current role Butler (1995) þ Those in leadership or advanced
roles report more use
Hatcher & Tranmer (1997) þ Those in leadership of advanced
roles report more use
Tsai (2000) þ Nurse managers reported
more use than staff nurses
Clinical specialty Bostrom & Suter (1993) NS
Estabrooks (1999a, 1999b) NS
Michel & Sneed (1995) NS
Tsai (2000) þ
Winter (1990) NS
Years of specialty experience Kirchoff (1982)* NS
Kirchoff (1982) NS
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2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(5), 506–520 515
involvement in research activities, information seeking,
education, professional characteristics and other socioeconomic
factors. These are reported here for all 20 studies.
It should also be noted that we did not predetermine the six
general categories of individual determinants that are illustrated.
After reviewing and extracting data, we decided that
the individual determinants relevant to our objectives could
be grouped in these six categories, and that to do so would
facilitate comparison and discussion. A summary of their
effects on the outcome of interest (research utilization) is
presented in Table 3.
Beliefs and attitudes
Ten studies assessed one or more individual determinants in
this category (see Table 3). The most frequently assessed
determinant was attitude towards research. This was
assessed in six studies, and a statistically significant effect
was found in five of these. This was the most frequently
replicated result in all categories, and the only one with a
consistent pattern of positive effect. Other belief and attitudinal
determinants were, for the most part, present in only
one study; therefore, their results cannot be considered with
any confidence.
Involvement in research activities
Eight studies assessed one or more determinants in this category,
and again each determinant was present in only one
study. Through simply counting, eight potential determinants
were found which were reported to have a significant and
positive effect and 12 were non-significant. No trends could
be detected.
Information seeking
In this category, 12 studies reported findings. As the shaded
area in Table 3 shows, several nurse investigators have been
interested in the influence of reading patterns on research use.
The results are equivocal, however, with about half reporting
a significant and positive effect and half a non-significant
effect. In the remainder, information seeking behaviours
studied were unique to each study.
Table 3 (Continued)
Individual determinant Source Finding Comment
Years experience on a specific unit Kirchoff (1982)* þ
Kirchoff (1982) NS
Specialty organization membership Kirchoff (1982) NS
ANA membership Kirchoff (1982) þ
Number of professional memberships Coyle & Sokop (1990) NS
Oncology nursing society status Rutledge et al. (1996) 
Oncology certification Rutledge et al. (1996) þ P ¼ 0.137
Job satisfaction Coyle & Sokop (1990) þ
Estabrooks (1999a, 1999b) NS
Affiliation Estabrooks (1999a, 1999b) NS
Dependant care hours Estabrooks (1999a, 1999b) NS
Hours/week worked Estabrooks (1999a, 1999b) NS
Shift usually worked Estabrooks (1999a, 1999b) NS
Shift satisfaction Estabrooks (1999a, 1999b) NS
Other socio-economic factors
Age Butler (1995) NS
Champion & Leach (1989) NS
Estabrooks (1999a, 1999b) NS
Lacey (1994) 
Rodgers (2000) NS
Winter (1990) NS
Married or partnered Bostrom & Suter (1993) NS
Estabrooks (1999a, 1999b) NS
Family income Estabrooks (1999a, 1999b) NS
Winter (1990) NS
Health/lifestyle activity Estabrooks (1999a, 1999b) NS
Gender Estabrooks (1999a, 1999b) NS
*Restricting ice water measure.
Rectal temperature measurement.
C.A. Estabrooks et al.
516
2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(5), 506–520
Education
Education was the most commonly studied presumed determinant,
with 18 of the 20 studies including some kind of
education variable. Where the same variable was measured,
findings were about evenly split as either significant and
positive or non-significant (for example, type of degree,
completion of research classes, years since basic education,
years since last degree). The remaining variants on education
appear only once; therefore, no trends can be suggested.
Professional characteristics
Professional characteristics were the second most commonly
studied set of individual determinants, with 14 studies
reporting one or more findings in this category. While some
18 different characteristics were reported (see Table 3), only
years employed as a Registered Nurse (n ¼ 13), clinical specialty
(n ¼ 5), and current role (n ¼ 3) were reported by more
than one investigator. Only current role was found to correlate
consistently with research use, with nurses in managerial
and leadership positions reporting higher research use.
Other socio-economic factors
Of the eight studies reporting findings in this category, none
reported a positive effect on research use. Age was the most
commonly reported determinant. Others included marital
status, income, gender and lifestyle activities.
Discussion
This review focused on the individual determinants that have
been studied with regard to their influence on nurses’ use of
research. The results suggest that the effects of factors
presumed to be determinants are equivocal. The extent to
which beliefs and attitudes, involvement in research activities,
information-seeking, education, professional characteristics,
and other socio-economical factors influence research use
remains largely unknown, although there is support for a link
between beliefs and attitudes and research utilization. This
set of potential determinants is likely to be highly intercorrelated,
but the study designs used typically did not allow
for careful analysis of inter-correlations among variables.
We, therefore, remain uncertain about individual determinants
of research utilization, including whether attitude is the
precursor of other determinants or whether other potential
determinants, such as role, determine attitude.
The most useful outcome of this review was the clear
picture presented of the state of the science in terms of theory
development, measurement, research design, and analysis
despite over 30 years of research in this area in nursing. It is
unmistakable that the development of this research domain
remains in its infancy, and requires new approaches to
knowledge generation if it is to provide a sophisticated
understanding of research utilization in nursing.
Recommendations
A series of recommendations were developed based on the
review. Their implementation is needed to ensure the
productive study of research utilization and to advance
knowledge in this area.
Design and analysis
While the need to conduct descriptive studies will remain,
these should be precursors to well-controlled intervention
studies that enable researchers to evaluate the effectiveness of
interventions to increase research use. Further descriptive
work should be preparatory to that end. The use of stratified
random sampling whenever possible, or quota sampling
when non-probability sampling is necessary, would improve
the ability to generate more precise knowledge about the
individual determinants that cannot be varied, such as age,
sex, and education. We also recommend that power estimates
be carried out when designing the study in order to assure an
adequate sample size to detect meaningful effect sizes. There
is no need for more studies that report only bivariate relationships,
given the clear evidence of inter-correlations
among factors that may influence research utilization.
Theoretical framing
Many of the studies, we reviewed did not identify any theoretical
framework for the study. Of those that did, all but
one used Rogers’ innovation diffusion framework (Rogers
1995). We believe that, unless the purpose of a study is
clearly to develop theory, it is essential to use a framing
theory. One reason the research community has not made
more progress in nursing has been the failure to treat this field
as a theoretically rich area and to develop and test relevant
theory. In additional, we believe that nurses have relied far
too exclusively on Rogers’ work. There are many theoretical
positions in the field of research and knowledge utilization
(Rich 1979, Lomas 1993, Oh 1997, Rich 1997, Landry et al.
2001) from which investigators could draw. Numerous nurse
scholars have developed research utilization models which
ought to form some basis for rigorous theory testing (Goode
& Bulechek 1992, Stetler 1994, Kitson et al. 1998, Logan
et al. 1999).
Predictors of research use
This review has focused on individual determinants of
research use, largely because they have consumed most of
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2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(5), 506–520 517
researchers’ energy in this field. If nurse researchers are to
continue to focus on this category of determinant, it is
essential that they agree on some general inclusion list of
relevant variables and common approaches to measuring
them. It is evident that many of the individual determinants
are not modifiable (for example, age, gender, years of work);
therefore, the focus ought to be on those that can be realistically
changed. Studies should not focus exclusively on
individual determinants; rather they should focus on a wider
range of influencing factors, including research specific
(attributes of the innovation) factors and organizational
factors (Funk et al. 1991, Rogers 1995, Nilsson Kajermo et al.
1998, Swap et al. 2001).
Outcome
Significant measurement difficulties plague investigators in
the field of research utilization (Pelz & Horsley 1981, Weiss
1981, Dunn 1983, Rich 1997). Such measurement issues are
predictably preceded by conceptual difficulties. Investigators
rarely provide clear theoretical or operational definitions of
research utilization. Equally uncommon are explicit discussions
of how it is measured, why particular measures are
chosen, or how a particular measure was developed or performs
in the population of interest. Often, an explicit measure
of research use is not used; rather the assumption is
made that using a particular technique (for example, a temperature
taking technique) is representative of research utilization.
Where there are a few reasonably well-developed
measures of research utilization or some aspect of it [such as
Brett’s Nursing Practice Questionnaire (NPQ)], the measures
are most often measures of instrumental research utilization
(as distinct from conceptual and symbolic research utilization)
and are rarely used repeatedly, making comparisons
difficult. Existing measures of research utilization rely
exclusively on self-report and often ask respondents to recall
behaviour over excessively long periods of time (1, 5 years).
As far as could be determined, no existing measures have
been systematically developed and tested over time in different
populations. Some evidence exists to suggest that Knott
and Wildavsky’s (1980) measure has been used somewhat
more widely (Landry et al. 2001) in a series of studies
examining knowledge utilization in various populations. In
additional, there are significant conceptual issues that influence
the development of sound measurement strategies. For
example, should research utilization be conceptualized as a
product or process? Each implies unique approaches to
measurement. Should nursing vigorously pursue an omnibus
measure of research utilization, or separate measures of
instrumental, conceptual and symbolic research use (Weiss
1979, Stetler 1994, Estabrooks 1999a, 1999b), or a combination
of the two approaches? Are these categories of
research utilization valid?
A second important issue related to outcomes is the
persistent use of research utilization as the dependent
variable, rather than as an independent variable predicting
a patient or system outcome of relevance. While it is
understandable that the focus of those in the field has been
on research utilization as a dependent variable, ultimately
the use of research is only of interest if it positively
influences patient and system outcomes. While intuitively
this makes sense, very little empirical work to support this
claim exists.
Interdisciplinary and programmatic research
Teams of nurse investigators conducted the studies in this
review. No single discipline, including nursing, can undertake
serious and sustained study in this field without interdisciplinary
collaboration. The knowledge utilization field is large
and complex, and composed of collections of literature and
research in many areas, such as political science, sociology,
policy studies, organizational studies, anthropology, psychology,
medicine, epidemiology, and nursing. It is characterized
by a lack of easily accessible theory and tools. While
many of these fields contain rich avenues of inquiry, none are
sufficient by themselves and the requirements for blending
knowledge from the various fields are strenuous. Donaldson
(1992) used the term ‘discipline of knowledge utilization’ in a
nursing paper referring to work conducted outside of nursing
in the 1970s and 1980s; however, the discipline has been
slow to emerge, and does not currently exist as a recognized
academic discipline. Attempts made by nursing to develop the
field as an interdisciplinary one will advance knowledge not
only in nursing, but also across the entire knowledge utilization
field.
When reviewing the 20 studies in the final dataset (Table 1)
and the larger collection of research utilization literature in
nursing, it is evident that research in this field has been carried
out largely as a ‘one-off’ undertaking. That is, rarely do we
see investigators focusing a programme of research over
several years on the central problems in the field. Unless this is
done, it will be impossible to develop the individual acumen
or cross-disciplinary relationships required to advance the
science of knowledge utilization. Unless nurse investigators
take up this challenge, studies that repeat previous studies and
contribute little will continue to be generated.
Conclusions
The manner in which individual factors may interact with
each other to influence research utilization in nursing remains
C.A. Estabrooks et al.
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2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 43(5), 506–520
completely unknown. The research evidence supporting a
significant influence of any one category of individual
determinant is at best equivocal. At worst, it is counterproductive,
in that it gives the erroneous impression that the
research in the field provides dependable information with
which to design interventions. In order to move the state of
the science forward, a radical change in approach is advocated.
We propose that to develop further the research utilization
field in ways that will be useful to nursing, we must focus our
limited resources on programmatic research linked with
interdisciplinary scholarship. In so doing, important conceptual
and measurement issues will be addressed, a more
comprehensive understanding of the multi-level factors that
influence the use of research in practice will be developed,
and work on the influence of research use on relevant patient
and system outcomes can begin. Further, investigators who
have interesting first studies that could be the beginning of
research programmes should be recognized and supported by
being linked with established programmes of research and
interdisciplinary networks. This is a challenge to the few
nurse investigators currently working systematically in this
field.
Acknowledgements
This work was supported by Canadian Institutes of Health
(CIHR) and Alberta Heritage Foundation for Medical
Research (AHFMR) career awards to Dr. Estabrooks, CIHR
and AHFMR doctoral fellowships to Ms. Scott-Findlay, and
AHFMR support for Ms. O’Leary and Mr. Gushta. We
thank Connie Winther and James Kropfreiter for their
substantial library science and editing assistance, respectively.
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