Despite three decades of empirical investigation into research utilization and a renewed emphasis on evidence-based medicine and evidence-based practice in the past decade, understanding of factors influencing research uptake in nursing remains limited. There is, however, increased awareness that organizational influences are important.
To develop and test a theoretical model of organizational influences that predict research utilization by nurses and to assess the influence of varying degrees of context, based on the Promoting Action on Research Implementation in Health Services (PARIHS) framework, on research utilization and other variables.
The study sample was drawn from a census of registered nurses working in acute care hospitals in Alberta, Canada, accessed through their professional licensing body (n = 6,526 nurses; 52.8% response rate). Three variables that measured PARIHS dimensions of context (culture, leadership, and evaluation) were used to sort cases into one of four mutually exclusive data sets that reflected less positive to more positive context. Then, a theoretical model of hospital- and unit-level influences on research utilization was developed and tested, using structural equation modeling, and 300 cases were randomly selected from each of the four data sets.
Model test results were as follows-low context: χ 2 = 124.5, df = 80, p <. 001; partially low: χ 2 = 144.2, p <. 001, df = 80; partially high: χ 2 = 157.3, df = 80, p <. 001; and partially low: χ 2 = 146.0, df = 80, p <. 001. Hospital characteristics that positively influenced research utilization by nurses were staff development, opportunity for nurse-to-nurse collaboration, and staffing and support services. Increased emotional exhaustion led to less reported research utilization and higher rates of patient and nurse adverse events. Nurses working in contexts with more positive culture, leadership, and evaluation also reported significantly more research utilization, staff development, and lower rates of patient and staff adverse events than did nurses working in less positive contexts (i.e., those that lacked positive culture, leadership, or evaluation).
The findings highlight the combined importance of culture, leadership, and evaluation to increase research utilization and improve patient safety. The findings may serve to strengthen the PARIHS framework and to suggest that, although it is not fully developed, the framework is an appropriate guide to implement research into practice.
Greta G. Cummings, PhD, RN, is Assistant Professor and Health Investigator & Principal Investigator, CLEAR Outcomes Research Program (Connecting Leadership Education & Research); and Carole A. Estabrooks, PhD, RN, is Professor and Canada Research Chair in Knowledge Translation, Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta, Edmonton, Canada.
William K. Midodzi, MSc, PhD(c), is Doctoral Candidate, Department of Public Health Sciences, and Statistician, Knowledge Utilization Studies Program; and Leslie Hayduk, PhD, is Professor, Department of Sociology, University of Alberta, Edmonton, Canada. University of Alberta, Edmonton, Alberta, Canada.
Lars Wallin, PhD, RN, is Researcher, Clinical Research Utilization, Karolinska University Hospital, Stockholm, Sweden.
Accepted for publication April 26, 2007.
Thank you to Dr. J. Ivan (Jack) Williams for thoughtful comments on an earlier version of this manuscript. Thank you to Drs. Ann Tourangeau, Marianne McLennan, and Anastasia Mallidou for helpful feedback on earlier versions of this work.
Supported by a New Investigator Award, Canadian Institutes of Health Research (CIHR) Population Health Investigator award, and Alberta Heritage Foundation for Medical Research (AHFMR) to Dr. Greta Cummings; Canada Research Chair award to Dr. Carole A. Estabrooks; a postdoctoral fellowship from the CIHR and AHFMR to Dr. Lars Wallin; and operating funds from CIHR for the research program "Knowledge Utilization and Policy Implementation: A Five Year Program of Research" (2002-2007) Grant 53107.
Corresponding author: Carole A. Estabrooks, PhD, RN, Faculty of Nursing, 3rd Floor, Clinical Science Building, University of Alberta, Edmonton, Edmonton, Alberta, Canada T6G 2G3 (e-mail: firstname.lastname@example.org).