Copyright is owned by the Author of the thesis.  Permission is given for 
a copy to be downloaded by an individual for the purpose of research and 
private study only.  The thesis may not be reproduced elsewhere without 
the permission of the Author. 
 



BARRIERS TO AND FACILITATORS OF RESEARCH USE 

IN CLINICAL PRACTICE FOR A SAMPLE OF 

NEW ZEALAND REGISTERED NURSES 

A thesis presented in partial fulfilment of the requirements for the degree of 

Master of Arts in Nursing at Massey University, Palmerston North 

Petra Stolz-Schwarz 

December 2001 



ii 

Abstract 

The professionalisation of nursing has created much debate about 

nursing research and research utilisation in clinical nursing practice. Clarke 

(1999) has commented that research on research utilisation is a whole new 

field worthy of further exploration. An early study in the field identified a 

considerable lack of integration and application of research findings in 

clinical practice (Ketefian, 1975). 

Research utilisation is a complex process with many varied 

influencing factors. Funk, Champagne, Wiese and Tornquist (1991a) 

developed a research tool , the BARRIER scale, to assess barriers to and 

facilitators for the use of research that covers factors within four major sub 

scales, i.e. factors on the level of the individual nurse, of the organisation, 

the research, and the way of communicating research results. This tool is 

based on Rogers' (1995) framework of the diffusion of innovation. The 

present study is a replication study using the BARRIER scale to assess 

barriers to and facilitators of research use in clinical practice in a New 

Zealand sample of registered nurses and midwifes. 

The data for the study was collected from 164 registered nurses and 

midwifes working in the Inpatient wards of a tertiary teaching hospital. Data 

analysis was performed with the Statistical Software Package for Social 

Sciences (SPSS), including descriptive statistics, item ranking, group 

comparisons and factor analysis. Two open ended questions on additional 

barriers and facilitators were analysed for their thematic content and in 

relation to tha BARRIER sub scales. 

Findings are discussed in relation ~o the theoretical framevt_.ork and 

against the literature. Overall, this sample perceived the organisational and 

research items as the biggest barriers to registered nurses' use of 

research. Time was the most often stated barrier to and facilitator of 

researci1 use. The item ranking of this sample is compared with 

international results. The research tool is evaluated for its psychometric 

value and scope of development. Finally, the general limitations of the 

study are outlined and implications for future research are discussed. 



iii 

Acknowledgements 

I would like to acknowledge and thank the following people and 

institutions for their advice, guidance and financial support in the 

preparation of this thesis: 

• Dr. Anthony Paul O'Brien, Research Supervisor, School of Health 

Sciences, Massey University. 

• Susan Forbes, Research Officer, and the Staff Research Committee 

members, Whitireia Community Polytech, Porirua. 

• Graduate Research Fund, School of Health Sciences, Massey 

University, Palmerston North. 

• Nurses and Midwifes Study Assistance Fund, Capital and Coast 

Health, Wellington. 

I would like to express my gratitude to all the registered nurses and 

midwifes who participated in the study. Their time to fill out and return the 

questionnaires is greatly appreciated. 

The work on this thesis over the last two years could not have been 

upheld without much support from my family and friends. Special thanks for 

their patience, encouragement and understanding expressed through 

uplifting overseas phone calls, warm meals, computer trouble shooting and 

their love to: Adrian, Brischit, Claire, Claud, Graeme, Janis, Jill, Marni, 

Peter, Sony, Susie and Teresa. 

Thanks Walt. 



Table of Content 

Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii 
Acknowledgements ................. . ......... . .............. . .. iii 
List of Tables and Figure ..................... . ............. . .... 3 
Glossary of Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 
Chapter 1 : Introduction and Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 
1. 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 
1. 2. Background . .. . ....... . .. ....... ... ....... .... . .. ... . ...... . . 6 
1. 3. Aim and Significance of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 

1. 3. 1. Research Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 
1. 3. 2. Specific Aims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 

1. 4. Overview of the Thesis Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 
Chapter 2: Literature Review .... .. ... . ......... . . .. ..... . ...... 10 
2. 1. Theoretical Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 

2. 1. 1. Rogers' Diffusion of Innovation Model . . . . . . . . . . . . . . . . . 11 
2. 1. 2. Summary ....... .... . .. . . ... .. .. . ..... .. .... ... ..... 16 

2. 2. Nursing Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 
2. 3. Research Utilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 

2. 3. 1. Conceptual Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 
2. 3. 2. Models of Research Utilisation . ................ . ...... 21 
2. 3. 3. The Influence of Research Paradigms . . . . . . . . . . . . . . . . 23 
2. 3. 4. Research Utilisation in Evidence-Based 

Nursing .... . ... .. ............. ....... .. ............ 25 
2. 4. Individual, Organisational and Research related Issues ........ 27 

2. 4. 1. The Individual Nurse and Research 
Utilisation ................ ................... ........ 27 

2. 4. 2. Organisational Impact and Responsibilities . .. ........ . 30 
2. 4. 3. Characteristics of the Research . . . . . . . . . . . . . . . . . . . . . . 32 

2. 5. Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 
Chapter 3: Methodology and Procedures ............. .... . . ... 35 
3. 1. Study Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 
3. 2. Participant Selection and Data Collection . . . . . . . . . . . . . . . . . . . . . 36 

3. 2. 1. Selection Criteria and Sampling ....... ..... ... ........ 36 
3. 2. 2. Data Collection Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 

3. 3. Research Instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 
3. 3. 1. Demographic Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 
3. 3. 2. The BARRIERs Scale Questionnaire . . . . . . . . . . . . . . . . . . 39 

3. 4. Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 
3. 4. 1. Quantitative Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 
3. 4. 2. Standardised Qualitative Data .... ....... . . ........... 41 

3. 5. Ethical Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 
3. 5. 1. Informed Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 
3. 5. 2. Anonymity and Confidentiality .............. . .......... 42 
3. 5. 3. Cultural Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 

3. 6. Summary . . .......... . ... . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 



Chapter 4: Results .... . . .... . . ..... .. .... ... . ........ . . .. ... .. .. 44 
4. 1. Response Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 
4. 2. Demographic Data ....... . . . . ............. . ..... . ... .. . . . .. .. 45 

4. 2. 1. Characteristics of the Sample . . . . . . . . . . . . . . . . . . . . . . . . 45 
4. 2. 2. Work Area and Designation . . . . . . . . . . . . . . . . . . . . . . . . . . 46 
4. 2. 3. Education and Qualifications ............... . . .. ....... 48 
4. 2. 4. Reading Frequency ........ . .... . ... . .. . .. . .......... 50 

4. 3. The BARRIER's Scale . ... . . ...... . ........................... 50 
4. 3. 1. Instrument Reliability .............................. . . 50 
4. 3. 2. Item and Sub Scale Scores . ............... . ......... . 51 
4. 3. 2. Item Rankings ....... . . . .... .... .. ........... . ..... .. 52 

4. 4. Additional Barriers . .. .. . .. ... . .... . .. . ... . .... . ..... . .. ...... 55 
4. 5. Facilitators of Research Utilisation .. . . . .. .... .. .............. . . 57 
4. 6. Inferential Statistics ........................................... 60 

4. 6. 1. Non Parametric Results . .... . . ...... .. ... . . . . . . .... . . 60 
4. 6. 2. Independent Sample T-Tests .. . ... ... ..... ... .. .. . ... 60 
4. 6. 3. One Way Analysis of Variance .. . . ... . .. .. .... ........ 61 
4. 6. 4. Correlation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 

4. 7. Factor Analysis ...... ....... . . .. ...... .. . ...... ... ...... ..... 63 
4. 7. 1. Four Factor Solution ..................... . . . . . .. ..... 64 
4. 7. 2. The Three Factor Solution ........ . . . ... . .......... .. . 67 

4. 8. Summary . ...... ... .... . . .... ....... ... .. ......... .. .. . .. . . .. 69 
Chapter 5: Discussion ................. . ...... . ....... .. . .. . ... . 71 
5. 1. Barriers to and Facilitators of Research Use in Clinical 

Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 
5. 1. 1. Individual Barriers and Facilitators .... . .. .. ....... . .. . 72 
5. 1. 2. Organisational Barriers and Facilitators . .. . ........ .. . 75 
5. 1. 3. Research Barriers and Facilitators . ...... . . .. .. ..... . . 78 

5. 2. Differences between Sub Samples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 
5. 3. Comparison with International Studies . . . . . . . . . . . . . . . . . . . . . . . . . 82 
5. 4. The Research Instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 
5. 5. Limitations of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 
5. 6. Future Direction: Recommendation for Practice . . . . . . . . . . . . . . . . . 87 
5. 7. Further Research ..... . ......... ... . . .... .. . .. . .. ...... .. . ... 89 
5. 8. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 
Appendices 1 - 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 



List of Tables and Figure 

Table 1: Age grouping of sample 

Table 2: Grouping of sample according to their years of 
registration 

Table 3: Work areas of respondents 

Table 4: Designation 

Table 5: Hours worked per fortnight 

Table 6: Type of initial qualification 

Table 7: Cross tabulation of research module availability and 
qualification type 

Table 8: Post registration qualifications 

Table 9: Frequency of reading professional research 
publications 

Table 10: Cronbach's alpha coefficient across studies 

Table 11: Means( SD) for the four sub scales 

Table 12: Means(SD) of all BARRIER's scale items 

Table 13: Comparison of ranking of BARRIER's scale items 

Table 14: Additional barriers to research utilisation in clinical 
practice 

Table 15: Statements on library services/journal access and 
availability 

Table 16: Overview on facilitators of research utilisation in 
clinical practice 

Table 17: Mann-Whitney-U statistics for gender comparison 

Table 18: Kruskall Wallis statistics for designation 
comparison 

Table 19: t-test statistics 'research participation' 

Table 20: t-test statistics 'availability of research module in 
basic education' 

Table 21: ANOVA for basic qualification type 

Table 22: Pearson's product correlation 

Table 23: Four factor solution 

Table 24: Three factor solution 

Figure 1: Scree plot 

3 

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AND 

AT&R 

BM 

BN 

CCU 

CNS 

DHB 

EBM 

EBN 

EN 

ENB 

FTE 

ICU 

NNU 

RM 

RN 

RPN 

4 

Glossary of Abbreviations 

Advanced Nursing Diploma 

Assessment, Treatment and Rehabilitation Unit 

Bachelor of Midwifery 

Bachelor of Nursing 

Cardiac Care Unit 

Clinical Nurse Specialist 

District Health Board 

Evidence Based Medicine 

Evidence Based Nursing 

Enrolled Nurse 

English National Board (UK accreditation body for further 
nursing education) 

Full Time Equivalent 

Intensive Care Unit 

Neonatal Unit 

Registered Midwife 

Registered Nurse 

Registered Psychiatric Nurse 



5 

Chapter 1: 

Introduction and Overview 

1. 1. Introduction 

The professionalisation of nursing has created much debate about 

research and research utilisation in clinical nursing practice. Fawcett 

(1980) has stated that nursing professionalism depends on research and 

the implementation of research findings into clinical practice. Furthermore, 

it has been argued that research has to be part of every nurse's daily 

thinking and activity in order to make the desired impact in clinical practice 

(Evans, 1980). The recent move toward evidence-based practice, which 

seem to support the call for a research based nursing profession, could 

also contribute to increased authority and autonomy for nurses 

(Benell, 1999). However, there is substantial debate as to what should 

constitute nursing research (Ford-Gilboe, Champbell & Berman, 1995; 

Greenwood, 1984; Hicks & Hennessy, 1997). A similar debate is held 

around a definition for evidence based nursing practice (Closs & Cheater, 

1999) and what is needed for an evidence base for nursing (Kitson, 1999). 

It is not surprising that research utilisation, essential to nursing practice, is 

an issue of considerable concern within today's nursing. 

Champagne, Tornquist and Funk (1997) see three main benefits of 

research use: (1) to increase in the understanding of the patient's situation, 

(2) more accurate assessment and (3) more effective nursing intervention. 

Similarly, Crane (1995) contends that research utilisation is not an ultimate 

goal in itself, but a means to an end in the delivery of high quality, 

cost-effective care in order to achieve desirable patient outcomes. 

However, research utilisation is a complex endeavour with multiple 

influencing factors. In fact, Clarke (1999) comments that 'research on 

research utilisation' is a whole new research field worthy of further 

exploration in nursing. 



6 

An early study in the field of research utilisation identified the lack of 

integration and application of research findings in clinical practice 

(Ketefian, 1975). More recently, inquiries into the underlying factors that 

shed light on the dynamics of the deficits in research utilisation and give 

support to the development of research utilisation strategies were 

advanced (Champion & Leach, 1989; Funk, Champagne, Wiese & 

Tornquist, 1991 a, 1991 b; Horsley, Crane & Bingle, 1978; Hunt, 1987; 

Jones, 2000; Michel & Sneed, 1995; Wilson-Barnett, Corner & De Carle, 

1990). 

These international concerns and efforts to analyse and address 

research and research utilisation within the nursing profession have also 

been influential on the development of nursing research in New Zealand. 

However, being a country with its unique context and historical 

development, some effort has to be made towards inquiry that takes into 

account characteristics specific to New Zealand, and which highlights the 

differences that might exist. 

1. 2. Background 

New Zealand nursing is faced with similar issues regarding research 

and it's utilisation practice as is the case internationally. In the century 

since the first nurse has been registered in New Zealand, nursing has 

evolved here as a distinct professional discipline. Engaging initially in 

research through involvement in medical research from the 1930s, nurses 

developed their own research interests. This development has been 

supported and expanded by the shift that took place in nursing education 

that saw the move from hospital based training to academic education in 

the tertiary sector (Wood, 2001 ). 

Although the current preparation of nurses and midwives at tertiary 

institutions includes education in research, the nursing/midwifery work 

force is still dominated by professionals without adequate research 

education in their pre registration preparation. The Nursing Council of New 

Zealand (2000a) reports that only 7% of 31, 739 professionals applying for 



7 

their annual practicing certificate completed a degree programme and 27% 

a diploma programme to gain initial registration. Less then a fifth, i.e. 18.2 

% of nurses with a current annual practicing certificate hold a Bachelors 

degree. However, the Nursing Council reports a more then fivefold 

increase in the number of post registration Bachelor degree qualifications 

for the period between 1995 - 1999. Although the content of the 

educational preparation of the nursing workforce is crucial to nursing 

research and research utilisation in clinical practice, it is only part of the 

influences exerted on the overall picture. 

It is of importance to acknowledge the impact that socio -cultural , 

political and/or economic aspects, specific to New Zealand, have on 

nursing research and research utilisation. New Zealand society is based on 

an understanding of biculturalism, aiming at honouring the principles 

embedded in the Treaty of Waitangi, i.e. partnership, protection, 

participation and equity. Implications of these principles should be 

considered in the conduct and dissemination of research in nursing, and 

the implementation of the findings. 

Geographical isolation, legislation and governmental policies put 

more constraints on nursing research activity. Availability of some health 

care resources, appliances or medications, can be limited for example by 

the decisions made by PHARMAC etc. Furthermore, access to various 

study populations or intellectual resources, i.e. experts in specialty fields of 

nursing research, are confined by the low population numbers. 

In summary, it can be said that there is a need to further study 

relevant factors underlying successful research utilisation in clinical 

nursing practice. Building on existing frameworks, taking into account the 

differences of the setting, an assessment of the essential barriers and 

facilitators that a group of nurses in New Zealand experience can shed 

some light on the state of research utilisation in clinical practice in this 

country. 



8 

1. 3. Aim and Significance of the Study 

This study is a replication of a research study carried out by Funk et 

al. (1991 a). The purpose was to assess the barriers to and facilitators of 

research use in clinical practice in a sample of New Zealand nurses. The 

factors assessed for their impact on research use are modelled by Rogers' 

(1995) theoretical framework on the diffusion of innovation and comprise 

attributes in the domains of the individual nurse, the organisational setting, 

the research itself and of communication. 

1. 3. 1. Research Question 

The main research question for this study was: 

• What are the most frequent barriers to and facilitators of research use 

in clinical practice stated by a sample of New Zealand nurses and 

midwives as measured by the BARRIER's scale? 

1. 3. 2. Specific Aims 

The specific aims of the project were: 

• To assess the barriers to and facilitators of the use of research in 

clinical practice in a sample of New Zealand nurses and midwives. 

• To discuss the findings of the New Zealand sample in comparison with 

international studies using the same research instrument. 

• To evaluate the BARRIER's scale questionnaire psychometric 

characteristics with a culturally different population. 

A search on electronic database, including [CINAHL] and [Medline] 

for the years up to 2000 did not yield any published study that reported on 

the assessment of barriers of and/or facilitators to research utilization 

within clinical nursing practice in New Zealand. Therefore, this study has a 

significant contribution to make to advance knowledge on factors pertinent 

to research utilisation in nursing practice within this country. Furthermore, 

the replication of a study in a different setting, and the reuse and further 

refinement of a previously developed research instrument is a valuable 



9 

contribution to facilitate research utilisation (Crane, 1995; Funk, Tornquist 

& Champagne, 1989a; 1989b ). 

1. 4. Overview of the Thesis Structure 

Chapter One begins with an introduction and the relevant 

background to the study and outlines the aim and significance of the study 

and the structure of the thesis report. 

Chapter Two reviews the literature relevant to nursing research 

utilisation within the broader theoretical framework of the diffusion of 

innovation model (Roger, 1995) and particularly in the context of nursing in 

New Zealand. Research utilisation will be addressed historically. 

Furthermore, research utilisation models are presented. Issues impacting 

on research utilisation, namely the use of diverse methodological 

approaches in nursing research and debates within the evidence based 

practice movement will be discussed. 

Chapter Three outlines the methodological approach used in the 

research study and comprises considerations made in regards to the 

sampling strategy, the data collection process, and the statistical analysis 

techniques employed. The ethical issues that were considered in the 

development of the study are also discussed. 

Chapter Four presents the findings of the study generated by 

analysis of the collated data of the 164 returned questionnaires. The 

sample's demographic characteristics and results of the questionnaire are 

reported in terms of their descriptive values, relevant relationships within 

the data and in comparison with data from overseas studies that have 

previously used the research instrument. Psychometric testing of the 

instrument and the result of two factor analyses are also presented. 

Chapter Five provides a critical discussion of the results in Chapter 

Four, set critically in the context of the literature reviewed in Chapter Two. 

Suggestions for further research, and the implications and 

recommendations for practice a_re put forward on the basis of this 

discussion. 



10 

Chapter 2: 

Literature Review 

Research and research utilisation are integral and necessary 

aspects of professional nursing practice, as highlighted in Chapter One. 

After a presentation of the theoretical framework of the study, an overview 

of the development and scope of nursing research will be given. The 

conceptual structure of research utilisation will then be critically analysed 

and put into context, taking account of the influence exerted by the use of 

differing research paradigms and the relationship to the evidence-based 

practice movement. Various models of research utilisation are compared. 

In the remaining review of the literature pertinent to this study, 

aspects generally relevant to the process of research utilisation will be 

critically discussed. The discussion is organised within the theoretical 

framework of Rogers' (1995) diffusion of innovation model. The specific 

function, responsibilities and problem areas that arise out of the 

characteristics of key elements in the process, i.e. the individual as 

adopter, the organisation and the research as innovation, will be outlined. 

Special consideration will be given to the situation of the New Zealand 

nursing context. 

2. 1. Theoretical Framework 

Inquiry into research utilisation in nursing practice can be 

approached based on several theoretical models (Crane, 1985). Research 

utilisation is a process in need of incorporating methods and principles of 

Change management theory (Kitson, 1999; Swansburg, 1995). This 

process has to build on a definition of research utilisation as a conceptual 

entity. The main structure of Rogers' (1995) model is outlined to form the 

framework for the following review of the literature. 



11 

The overview is structured around the model's four key elements, 

i.e. the individual as adopter, the organisation as social context, the 

research as innovation and the necessary communication channels 

through which the key elements are related to each other. 

2. 1. 1. Rogers' Diffusion of Innovation Model 

In the development of the questionnaire used in this study, Funk et 

al.(1991 a) derived four factors that closely resemble the framework of the 

'diffusion of innovation' model described by Rogers (1995). Diffusion 

research has its origin in the early decades of this century. Rogers, a social 

scientist, developed the model in the early sixties and explored and revised 

it continuously into the nineties. Throughout these three decades the model 

had been widely researched and applied in several disciplines, amongst 

them medicine, and more recently the field of nursing. The basic 

assumption of the model is that: 

diffusion is a process by which an innovation is 

communicated through certain channels over time among the 

members of a social system. (Rogers, 1995, p.5) 

The conceptual structure of the process model has four key 

elements interacting and influencing each other throughout the diffusion 

process that is made up of five phases. 

These key elements are: 

The adopter: Adopters are the people that take on, or oppose the 

take-on of the innovation. In the present study's context the adopters 

are the nurses and midwives in the wards. 

Adopters can be grouped according to their place within the social 

network and the speed with which they take up the application of 

innovations within five distinct categories. The five categories are 

innovators, which includes nurse researchers, early adopters, early 

and late majority, and laggards (Rogers, 1995). These categories of 



12 

adopters can be further viewed in terms of some specific 

characteristics regarding their innovativeness. Rogers (1995) 

describes these characteristics in three main broad domains: 

socio-economic, personality and communication behaviour. 

Rogers (1995) argues that early adopters seem to have more formal 

education and a higher social status. They display, on a personal 

level, a higher ability to deal with abstraction, cope better with 

uncertainty and risk, and have generally a more favourable attitude 

toward change. Research evidence has shown that innovators and 

early adopters have a central place within a particular social system, 

with an extensive formal and informal contact network. This includes 

their more active search for information about innovation and more 

exposure to mass media communication channels. Contact to 

change agents are higher and so is the degree of their opinion 

leadership within their social system (Rogers, 1995). 

In nursing it has been documented that advanced practice nurses 

and/or clinical nurse specialists that occupy a role in which there is 

an expectation of early adoption of research results, can play a 

crucial part in their role as change agents (Crane, 1995; Dooks, 

2001; Elcock, 1996; Mackintosh & Bowles, 1997). Therefore, it can 

be suggested that the characteristics of the adopter sub groups can 

be used to advantage in the planning of the form and content of the 

diffusion of innovations for a desirable change of clinical nursing 

practice. 

The innovation: Research results requiring adaptation or change of 

existing nursing practice are the innovation in this study context. 

Innovations have five characteristics that are pertinent to the 

diffusion process. These characteristics are 'relative advantage', 

'compatibility', 'complexity', 'trialability' and 'observability' (Rogers, 

1995, pp. 208). 

The relative advantage of an innovation is the perceived superiority 

over the status quo. Adoption of an innovation has to be linked with 



13 

some benefit, be it of an economic, social, or of some other nature. 

For example, specific adopter sub groups could have an affinity for 

specific benefits, i.e. some adopters might be keen on new 

interventions that save time and money. Whereas another sub group 

might be more attracted by some form of individual gain. Rogers 

(1995) claims that 'preventative innovations' are far more difficult to 

diffuse because of the generally longer time lapse between their 

adoption and the desired beneficial consequences, or the non 

observability of the consequences, respectively. This fact could be 

of relevance to nursing service delivery that aims at health 

promotion and to nursing practice that is concerned with 

preventative interventions. 

Compatibility, i.e. the fit between the research finding and the 

values, previous experiences in, and needs of the practice setting 

the research finding is targeted at, also has to be given 

consideration. Estabrooks (1998) has argued that the gap between 

theory and practice is often overshadowed by the unpredictability of 

the need for reinvention. Reinvention is an important factor to 

consider when the research findings are to be translated for, or 

moved from the study setting to the clinical practice setting. 

The cognitive or technical newness of research findings, i.e. their 

complexity compared to the existing practice does influence their 

acceptability. The easier a new idea or procedure is understood and 

applied, the faster it will diffuse through the system (Roger, 1995). 

The possibility of trialing and experimenting with the practical 

implication of a research study's finding, in a limited fashion, is 

another important feature of the innovation. Especially for the early 

adopter group, this trial period decreases the level of uncertainty 

that every change contains. 

Observability is the term used by Rogers (1995) to describe the 

essential characteristic of the innovation to make itself visible to 



14 

others. The less a change is visible the more difficult it is to 

convince a potential adopter to take the innovation on. 

The social system: An organisational structure, that is evident in an 

institution like the one of the hospital in this study, presents a social 

system with its own culture, defining norms and values. These 

contextual aspects of the system can potentially facilitate or hinder 

the diffusion of research into the practice of the individual working 

within the organisation. 

Furthermore, the organisation has an influence over the type of 

adoption decision that is made. Rogers (1995) describes three types 

of decision: (1) optional innovation-decision, where the choice lays 

with the individual; (2) collective innovation-decision, where an 

agreement on adoption is reached among the members of a system, 

and (3) authority innovation-decision, where few individuals with 

power make the decision. 

The change management practices employed by the organisation 

can have considerable impact on the success of introducing new 

research based practices. Implementation of an innovation, rather 

than adoption, has been specified as a distinct aspect of concern 

within organisations. A two phase model for the innovation process 

in an organisation is described by Zaltman, Duncan and Holbek 

(1973). After the initial perception of a need for innovation and the fit 

of an innovation with the problem at hand, a second stage of 

implementation should occur. Within the second phase, the 

innovation is modified and reinvented to match the organisation, the 

innovation is then clarified for the members of the organisation and 

routinised, i.e. fully incorporated into the organisational activities. 

The communication channels: Within the model of diffusion of 

innovations, communication is seen as a crucial process via which 

an innovation is spread amongst the members of the social system. 

This process differentiates between the source of an innovation 



15 

(research result) and the channel (face to face contact, presentation, 

book or journal publication etc.) by which it is transmitted to the 

targeted receiver. The channels have been differentiated as being 

either of an interpersonal or more collective nature, i.e. face-to-face 

contact versus mass media; and being sourced from the local or 

from outside the local social system (Rogers, 1995, p.194). 

Depending on the stage of the diffusion process and the adopter 

category, different channels have greater importance for effective 

communication. 

A factor that has been described as discriminating in interpersonal 

communication is the degree of homophily between the parties. 

Homophily describes the level of equity in terms of personal and 

social characteristics, i.e. age, education, social class, professional 

status etc. (Lazarsfeld & Merton, 1964; in Rogers, 1995). At the 

other end of this equity continuum is heterophily, a high degree of 

difference in the aforementioned characteristics. Interpersonal 

communication that occurs between homophilous parties increases 

the speed by which diffusion of innovations occurs, however this 

'horizontal' pattern of diffusion could present a barrier to the flow of 

the innovation throughout a more complex and larger social 

organisational system (Rogers, 1995). 

The process underlying the model of diffusion of innovation is one of 

change management, with a structure that facilitates the implementation of 

change in a planned fashion. 

Rogers devised five phases in the ensuing process (Swansburg, 

1995). These phases are: 

Phase 1 : Awareness 

Phase 2: Interest 

Phase 3: Evaluation 

Phase 4: Trial 

Phase 5: Adoption 



16 

In all of these phases the four key elements discussed previously 

have unique influences on the process through their given characteristics. 

The application of this theoretical framework has been summed up 

by Swansburg (1995) commenting: 

Rogers' theory depends on five factors for success. These 

factors are as follows: 

1 . The change must have the relative advantage of being 

better then existing methods. 

2. It must be compatible with existing values. 

3. Complexity: more complex ideas persist even though 

simple ones get implemented more easily. 

4. Divisibility: change is introduced on a small scale. 

5. Communicability: the easier the change is to describe, the 

more likely is it to spread. (p. 251) 

2. 1. 2. Summary 

The theoretical framework used for this study is drawn from the 

diffusion of innovation model by Rogers (1995). The four key elements, i.e. 

adopter, organisation, innovation and communication channels have been 

described in terms of some of their specific characteristics pertinent to the 

diffusion process. The process itself has been outlined into the five phases 

of awareness, interest, evaluation, trial and adoption. The key elements' 

characteristics and the features of the individual phases of the process 

have implications regarding the research utilisation process in clinical 

nursing practice within a hospital setting. 

Following a general positioning of research and research utilisation 

in nursing that takes into account influencing factors and relationships, the 

literature is now reviewed critically, based on the theoretical framework and 

its implications for research utilisation in clinical practice. 



17 

2. 2. Nursing Research 

Nursing research is a relatively new scientific endeavour compared 

to other disciplines. Over the last century nursing has embraced research 

to develop and strengthen its position as a profession. It has been 

recognised that there is a need for a unique knowledge base to achieve 

professional identity within the health care context (Polit, 1997). 

A fundamental event in the history of nursing research occurred in 

1952 with the publication of the premier issue of 'Nursing Research' in the 

United States. The first journal dedicated entirely to nursing research 

(Sarnecky, 1993; Stevenson, 1987). Since then, the numbers of nursing 

journals that publish research articles have increased markedly and include 

a variety of research publications that are dedicated to sub specialities 

within nursing. 

The early nursing research agendas were concerned with the study 

of nursing education. About thirty years ago, with an increasing number of 

nurse scholars with academic credentials pursuing theoretical inquiries into 

nursing practice, the need for clinical nursing research became more 

apparent (Polit, 1997). In the last two decades however, driven heavily by 

economic factors, nursing research has been often guided by priority 

research areas, set by government policy aimed at reducing increasing 

health care delivery costs. Furthermore, the need for pivotal research into 

clinical practice, combined with the efforts to contain health care cost, led 

to the attempts to establish research priority lists internationally (e.g. Bond 

& Bond, 1982; Cooney et al., 1995; Daly, Chang & Bell, 1996; 

Lewandowski & Kositsky, 1983; ). However, the impact that the 

establishment of such priority lists have had, in terms of effective 

subsequent research output, has yet to be adequately evaluated. 

The history of nursing research in New Zealand parallels the above 

developments, albeit in a somewhat delayed time frame. In New Zealand, 

nursing entered the academic world in the seventies after a review of 

nursing education, commisioned by the then Department of Health 

(Carpenter, 1971 ). Diploma and Bachelor degree nursing programs were 



18 

then established at tertiary institutions and the transition from diploma to 

degree education has been completed in the mid nineties. The first 

doctoral degree was awarded in 1988 (Sigsby & Bullock, 1996). 

Chick (1987) noted in her article about nursing research in New 

Zealand that: 

The form and place of nursing in any society is shaped by 

interaction of it's historical origins with political and economic 

pressures arising in the contemporary sociocultural context. 

(p.317) 

In New Zealand history, research seems not to have played an 

important role in nursing and is arguably still not 'fully incorporated into 

nursing identity' (Chick, 1987, p. 319). Outlining the issue further, Chick 

states how the move from hospital based nursing training to tertiary 

education - with the opportunity to pursue post graduate degrees and 

nursing doctorates within New Zealand - has promoted a broader 

acceptance of nursing research. However, Chick (1987) was disappointed 

about the slow development of position of research within clinical practice 

that were forecasted at her time. 

Bachelor degree programs and post graduate nursing education 

programs at the tertiary level do include education about nursing research. 

In a recent survey of all nurses, midwifes and enrolled nurses that applied 

for their annual practising certificate to the New Zealand Nursing Council, it 

was reported that 18% of registered nurses hold a Bachelor's degree, 0. 7% 

a Master's degree and 0.1 % (n=16) hold a Doctorate (Nursing Council, 

2000a). These figures are from a 31,801 strong sample, representing a 

70% response rate. Thus, the part of the nursing work force that can be 

expected to have some knowledge of research and its processes is still 

small. This poses a concern for undertakings in nursing research 

utilisation. The small number of academically prepared nurses is reflected 

also in the paucity of nationally published nursing research. The journal 

'Nursing Praxis in New Zealand', inaugurated in 1985, has remained the 

only peer reviewed journal dedicated to the publication of research articles. 



19 

The history of nursing research itself has a fundamental influence on 

any discussion about research utilisation. Other influencing factors that are 

crucial to a better understanding of research utilisation will be discussed 

after the following conceptual definition. 

2. 3. Research Utilisation 

There are several considerations to make to gain a comprehensive 

understanding of research utilisation in clinical nursing practice. So far, a 

theoretical framework underlying the process of research utilisation and its 

emergence as essential activity, developing out of the historical 

developments in nursing research, has been explored. Following this 

exploration, some conceptual and contextual factors pertinent to research 

utilisation are reviewed. 

2. 3. 1. Conceptual Definition 

The term research utilisation has not been unequivocally defined in 

the literature (Estabrooks, 1998). The view on what constitutes research 

utilisation spans from the use of findings in clinical practice to the task of 

carrying out an actual research project. Closs and Cheater (1994) state 

that 'research utilisation means rather more than simply the practical 

implementation of research findings' (p. 762). The complexity of the term, 

and the lack of common understanding for research utilisation contributes 

to the uncertainty of practising nurses regarding what is expected from 

them and what skills they need to fulfil these expectations. There is a 

difference between the critical review of a research report to evaluate the 

appropriateness of the findings for one's practice and the competencies 

needed for the planning and conducting of a research project. 

Stetler (1994) divides the term research utilisation into the three 

functional levels of instrumental, conceptual and symbolic utilisation. The 

instrumental use is a direct use of results in practice, whereas the 



20 

conceptual use is defined as being of an indirect form, i.e. influencing one's 

thought or attitudes without influencing obvious changes in practice. 

Symbolic utilisation is seen as being of a persuasive nature where 

research results are used to influence other people. Depending on the 

context of the individual nurses, it is understood that they might need 

assistance from others to achieve all levels of integration, i.e. policy and 

procedure writing or change of equipment (Stetler, 1994 ). 

Specific actions, skills and knowledge requirements that are 

necessary for the involvement in research and research utilisation at 

different levels of professional expertise have been earlier described by 

Stetler (1983). Stetler sees a 'basic responsibility of all nurses to 

understand the importance of research to nursing and support the effort of 

others' (p. 18). The involvement of nurses has been described in four 

categories. Firstly, the facilitation of research that is conducted by others. 

Secondly, the routine use of the research process in practice to solve 

problems. The involvement in the third category is the utilisation of 

research findings, and fourthly the conduct of research. Stetler (1983) 

acknowledges that, despite the ' ... single most important activities of a 

nurse ... to remain current in order to provide up-to-date, scientifically based 

practice' (p. 19), organisational support must be evident in these 

categories, mainly for research utilisation and the conduct of research. 

Estabrooks (1999) reports on empirical support for a conceptual 

structure model of research utilisation. Through a complex process of 

structural equation modelling, she tested two different theoretical models of 

the concept. The first, a simplex, longitudinal model hypothesised research 

utilisation to be influenced in a temporal order. However, this model could 

not be sustained from her results. A second, common cause model tested 

by Estabrooks, suggested that the three factors of direct, indirect and 

persuasive research utilisation existed and were influencing the overall 

measure of research utilisation. The underlying concept of research 

utilisation, in tum, influenced nurses responses to indicators measuring the 

concept 'research utilisation' over time. This model demonstrated 

convergence with the data obtained from 600 nurses. 



21 

Although the conceptual make up of research utilisation is not as yet 

unequivocally defined, efforts have been made to define and develop 

models that guide the process of research utilisation in clinical nursing 

practice. 

2. 3. 2. Models of Research Utilisation 

Several individuals and groups of nurse researchers in the United 

States have developed models for research utilisation over the last three 

decades. White (1995), in her comments about three of the most prominent 

models of research utilisation, suggests that they show more similarities 

than differences. This might be because of their common intent to bridge 

the research practice gap. Whereas the Conduct and Utilization of 

Research in Nursing (CURN) model, and the Iowa model of Research in 

Practice were focusing on the organisational level of the utilisation process, 

the Stetler model addressed the process from the more individualised 

perspective of the clinician. 

The CURN project, seeing research utilisation as an organisational 

process, has been described by Horsley et al. (1978). Six distinct phases 

have to be followed in this research utilisation model that 'complement 

quality assurance programs' (p. 6). The initial two-fold step is the 

identification of nursing practice problems that need a solution, and the 

provision of resources to access valid research information. This research 

based knowledge is then, in the second phase, assessed regarding its 

validity and feasibility within the organisation. In the third phase, a nursing 

practice intervention is designed which meets the need arising from the 

clinical problem. After a trial and evaluation of the innovation in a pilot area 

in the fourth phase, a decision is made to adopt, adapt or reject the 

innovation within the organisation. If the adoption decision is made, the 

sixth and final step becomes the development of the necessary structures 

and support to disseminate and implement the innovation within the whole 

organisation. 



22 

The Stetler model of research utilisation has been termed 'the 

practitioner model of research utilisation' (White, 1995, p. 414). Designed 

more than two decades ago and subsequently refined, the process 

framework is aimed at giving guidance to individual nurses in their 

utilisation practice (Stetler, 1994). The model is divided in six phases 

similar to the CURN model: 'preparation', 'validation', 'comparative 

evaluation', 'decision making', 'translation/application', and final 

'evaluation'. A systemic perspective of research utilisation for the individual 

is added, and is made up of the concepts 'environmental input', 'internal 

throughputs' and 'user output' . This systematic perspective, linking the 

process model to other influencing factors, accounts for the complexity of 

research utilisation. 

More individual approaches to establish a successful strategic 

model of research utilisation within a particular organisation or health care 

agency can be seen in the two following examples. Dufault and Sullivan 

(2000) report on a collaborative research utilisation (CRU) approach to 

evaluate the effects of pain management standards on patient outcomes. 

The CRU model is based on the linkage of academic researchers and 

students, taking advantage of the relationship between knowledge 

developers and users. The model was based on a six step approach which 

the authors described as: brainstorming problems, round table discussions, 

development, testing, adoption and implementation. Barnsteiner, Ford and 

Howe (1995) describe the model of research utilisation that directs clinical 

practice at the Metropolitan Children's Hospital of Philadelphia. Based on 

their institution's mission statement, that includes an emphasis on 'high 

standards of paediatric nursing care based on the development and 

incorporation of research' (p. 447), a practice committee structure with six 

sub committees has been designed. This structure ensures that the 

involvement of all staff is incorporated at different levels to ensure research 

dissemination and implementation. 



23 

2. 3. 3. The Influence of Research Paradigms 

The multitude of research paradigms employed in nursing seems to 

be of concern to research development itself, and especially for the 

facilitation of research utilisation. The discussions around quantitative and 

qualitative research approaches, and the opposing paradigms they 

supposedly represent, seem to impact negatively on research utilisation 

(Bonell, 1999). The discourse on a qualitative versus a quantitative 

research approach in nursing is deeply rooted within the question about 

what nursing is, and therefore, what type of knowledge nursing should be 

based on. 

Nurses' professional knowledge does not solely consist of 

empirico-scientific knowledge derived through traditional methods. Carper 

(1978) proposed four types of knowledge sources - empiric, personal, 

ethics and aesthetics. Traditional empirical methods of scientific enquiry 

use a quantitative positivist research approach. This approach aims to test 

theory by a deductive process in which hypotheses are falsified or 

supported. To achieve high levels of reliability and validity, the study 

environment is controlled for by the research design and units of enquiry 

are operationalised. On the other hand, qualitative methods aim at the 

production of meaning to understand the subjective context in the 

individual situation. This is pursued in an inductive fashion. The researcher 

collects and analyses the data in the language of the participants in the 

research setting she has immersed herself in. From the facts obtained this 

way, it is attempted to generate theory or clarity of previously undefined 

concepts (Duffy, 1985; Polit, 1997). 

To be able to carry out all the tasks and manage all the situations in 

the complexity that nurses encounter in their daily work, knowledge of 

various kinds is needed to underpin required skills and competencies, be 

they of a more technical, or 'hands off' nature. Depending on the issue at 

hand, the methodology employed in nursing research has to be chosen in 

accordance with the phenomena to be studied. To illustrate, one could for 

example look at the issue of pain management in nursing. Various aspects 



24 

of pain and pain assessment, management and education relevant to 

nursing practice have been studied using a variety of research approaches 

from the quantitative (e.g. Bennett, 2001; Czurylo, Gattuso, Epsom, Ryan & 

Stark, 1999) and qualitative (e.g. Gibson & Kenrick, 1998; Madjar, 1981 ; 

1991) field, or a combination of both approaches (e.g. Seers & Friedli , 

1996). 

Another voice that has received increasing support within the 

quantitative versus qualitative debate is the call to create an entirely new 

view on nursing research. Not the means by which the data is collected 

and analysed but the relevance the research has to directly influence 

nurses' practice in the clinical setting is of interest. Greenwood (1984) 

commented that a majority of nursing research was fruitless if it neglected 

the fact that nursing is 'a social phenomena and a practice discipline' 

(p. 77). This author raised the need to structure nursing inquiry as action 

research to bridge the gap between theory and practice, and to make 

research and its findings relevant to nurses in clinical practice. 

The use of action research in nursing has since been further 

discussed (Hart, 1996; Holter & Schwartz-Barcott, 1993; Nolan & Grant, 

1993; Rolfe, 1996). These authors emphasise the benefit of action 

research regarding research utilisation. The cyclic nature of the research 

process aims at direct change for improvement of practice. The process 

starts out with a joint problem definition/needs assessment and 

incorporates reflective practice and immediate application of generated 

new knowledge in the specific natural context. The lack of a systematic 

identification of core characteristics and general definitions of action 

research, however, need some further development to support its superior 

place within nursing research (Hart, 1996). 

To narrow, or even close the gap between theory-research-practice 

and to consequently enhance research utilisation, requires that nursing 

sees beyond the discourse of qualitative versus quantitative methodology. 

Corner (1991) and Rolfe (1994) support this stand, one by a research 

example using triangulation of methodology, and the other in an attempt to 



25 

define a new model on research classification. Although paradigms 

influence researchers' priorities, the ultimate goal is to improve the health 

and well being of people using the findings of research. Ford-Gilboe et al. 

(1995) conclude, therefore, that: 

Nursing could be on the forefront of developing 

methodologies that combine numbers and stories in novel 

and exciting ways to maximise understanding and the impact 

of the knowledge that is created, regardless of the paradigm 

perspective used. (p. 25) 

However, there are problems imposed on research utilisation 

arising from the debate on what nursing research is, ought to be, and how 

it is to be best approached. If some research approaches, and the 

knowledge they produce, are seen to be more valid and/or more useful 

than others, then what relevance has this regarding the application of that 

knowledge in clinical practice? This issue is further explicated in the newer 

debate around evidence-based practice and a possible answer to the 

above question might be found. 

2. 3. 4. Research Utilisation in Evidence-Based Nursing 

With the development of the evidence based medicine (EBM) 

movement, a hierarchical frame of reference has been set regarding the 

value of various evidence sources. Embracing that value system within 

evidence based nursing (EBN), the Joanna Briggs Institute for Evidence 

Based Nursing and Midwifery publishes in their practice guideline sheets a 

four level evidence hierarchy ladder (Joanna Briggs Institute, 2001 ). At the 

top of the scale are (I) systematic reviews of all relevant randomised 

control trials (RCT), followed by (II) a single RCT, the third level is 

subdivided in (111.1) well designed non randomised control trials, (111.2) 

preferably multicenter cohort or case control studies and (111.3) multiple time 

series, with or without intervention, respectively 'dramatic results in 

uncontrolled experiments'. At the bottom level (IV) are listed descriptive 

studies together with expert opinions. 



26 

Nursing, although in need of using adequate scientific knowledge as 

a basis for its practice, will have to be careful not to neglect the rich source 

of knowledge and usable insight that is gained from the qualitative study of 

phenomena pertinent to nursing. Recently, Kearney (2001) put forward a 

framework to evaluate levels and applications of qualitative research 

evidence. She describes five categories of qualitative findings that vary in 

their levels of complexity and discovery. Further, Kearney (2001) proposes 

four modes of clinical application of qualitative evidence, i.e. 'insight or 

empathy', 'assessment of status or progress', 'anticipatory guidance' and 

'coaching'. 

Estabrooks (1998) also cautions the thoughtless application of a 

conceptual frame for evidence from another discipline. Support for a 

conceptualisation of nursing knowledge that is broader than just scientific 

is given by Estabrooks (1998), based on a study with 600 randomly 

selected nurses from the Alberta Association of Registered Nurses in 

Canada. The nurses based their practice mostly on knowledge gained from 

'information learned about each patient as an individual', 'personal 

experience of nursing patients over time' and 'information learned at 

school'. The most common source of research knowledge for this sample 

was 'nursing journals' (52%). However, further analysis of the data 

revealed that the primary nursing journals read, were not research journals. 

In the same vein, Stetler et al. (1998) report on their project to define 

evidence for nursing practice within their organisation. A medical initiative 

to create practice guidelines in their organisation, using levels of evidence 

similar to the one described above, made them realise that: 

Neither this language nor routine reliance on large scale 

randomised control trials or meta-analyses was a fit for the 

division of nursing. (p. 47) 

In summary, the integration of all knowledge, despite its source, into 

comprehensive evidence that ultimately will be used to improve clinical 

practice, is a task still to be accomplished (Estabrooks, 1998). 



27 

2. 4. Individual, Organisational and Research related Issues 

Inquiries into aspects of importance to research conduct and 

research utilisation have received a considerable amount of attention since 

Ketefian (1975) reported on the poor state of application of research 

findings in clinical practice. Fundamental considerations to be made in the 

discussion on research utilisation in clinical nursing practice have been 

outlined in the previous sections. There are more factors facilitating and 

hindering nursing research in general, and research utilisation in particular, 

that have been studied from various view points. These factors are many 

and varied, and their interplay is complex. To facilitate the discussion 

around some of the pertinent factors, the remaining literature reviewed is 

subdivided into three thematic domains focusing on the individual nurse, 

the organisation, and the research itself as a process and product. 

2. 4. 1. The Individual Nurse and Research Utilisation 

Factors that influence nurses' engagement in research utilisation 

have been studied widely. It is apparent, given the complexity of research 

utilisation, that multiple issues are of concern, namely the individual 

nurse's educational preparation, their attitudes and beliefs about research 

and research utilisation, and their perception of the hindering and 

facilitating factors for research use in their daily practice. Moreover, as has 

been explicated within the previously described theoretical framework, the 

individual nurse's characteristics, including their specific role within the 

organisation, might have an impact on research utilisation behaviour. 

The development of nursing education from vocational, hospital 

based training to degree education in the tertiary sector has also had its 

bearing on nurses' knowledge and skills pertaining to research utilisation. 

Harrison, Lowery and Bailey ( 1991) examined the changes that occurred in 

a sample of nursing students' (n=54) knowledge about and attitudes toward 

research after a undergraduate research course which focused on 

research utilisation teaching. Although the knowledge scores were 

significantly higher at the end of the course than at the beginning, the 



28 

scores declined markedly again on the third measurement, which was 

taken at the end of the nursing program. The authors raised the question 

about students' knowledge retention, especially in terms of their ability to 

adequately criticise and utilise research finding in their practise after 

graduation. However, the finding that students had more positive attitudes 

toward research at the end of the nursing program, compared with their test 

scores before the research course, was encouraging. 

Similarly, Pond and Bradshaw (1996) report on an positive increase 

in the scores on their measurements of attitude toward research, collected 

before and after an educational intervention. This intervention aimed at 

presenting research knowledge and skills in a 'meaningful and realistic 

context' (p. 182) to their student sample (N=107). Bostrom, Mal night, 

MacDougall and Hargis (1989) report on the interesting differences 

between attitudes of nurses with a degree and nurses with diploma 

training. Degree nurses were more confident about their skills and 

knowledge to conduct research, implying that this might impact on their 

beliefs about research being as important as 'bedside' nursing. 

Nurses' attitudes toward research have been widely identified as 

one of the most prevalent factors that impact on research utilisation (Funk, 

Tornquist, & Champagne, 1995; Lacey, 1994; Pettengill, Gillies, & 

Chambers Clark, 1994 ). Attitudes are also a prominent factor in 

determining the involvement of nurses in clinical research activities 

(Rizzuto, Bostrom, Suter, & Chenitz, 1994). As one important component of 

the 'internal throughputs', positive attitudes can facilitate research 

utilization (Stetler, 1994). Furthermore, Champion and Leach (1989) report 

in their study a significant positive relationship between research utilization 

and attitudes toward research. 

As mentioned earlier there is a dearth of nursing research in New 

Zealand. Consequently, studies on educational outcome such as change in 

behaviours or attitudes, e.g. after research courses, are missing. 

Horsburgh (1989) commented after a field work study investigating 

graduate nurses' adjustment to their initial employment, that the general 



29 

hope of nurses from the comprehensive tertiary based program to act as 

change agents once they are in practice, has not been fulfilled. A decade 

later, Walker (1998) conducting an explorative study in this field, held focus 

groups with five newly practising nurses in their first year after graduation. 

The aim of the focus groups was to identify if the outcome criteria of the 

degree programme had been met. Walker's sample, although not 

representative, believed that their knowledge about research would be 

linked to further academic study. A result which is rather disappointing, 

arguing that the research content within the bachelor degree program 

should enable graduates to understand and critically review research 

reports for their appropriateness in their clinical practice. In addition, the 

sample stated that it was difficult to challenge practice behaviour that does 

not reflect current best practice evidence. Walker (1998) further suggests 

that this issue has to be addressed in the educational setting to prepare 

prospective nurses for the challenge of implementing research findings to 

achieve best practice. 

Some benefits of evaluating outcome behaviours and implementing 

change of curriculum for the nursing research component in academic 

nursing programs has been reported by Miller (1996). Students initial 

requirement in their research course to develop a research proposal 

seemed to have negatively impinged on students' ability to focus on the 

learning centred around research critique. Based on the agreement that 

dissemination and utilisation of research was the prime outcome expected 

to be demonstrated by the graduates, the content and structure of research 

education at their institution had been changed. These changes included 

teaching about the research process within practice setting situations, 

inclusion of vignettes and the abandonment of the research proposal in 

favour of a research utilisation group project. 

The needs of individual nurses, educated before the degree era, 

that mostly had not had any specific preparation in research and research 

utilisation, have to be given consideration. Barriball, While and Norman 

(1992) conclude from their literature review on continuing professional 

education for nurses that: 



Many current continuing professional education events fail to 

deliver anticipated improvements in reflective practice, 

research awareness and creative and critical thinking needed 

to improve patient care. (p. 1138) 

30 

Furthermore, they comment on the paucity of assessment relating to 

the perception and needs of nurses regarding their continuing education. 

Apart from the negative impact this lack of needs assessment can have 

attaining the goal of increased research utilisation capability, the general 

cost-effectiveness and efficiency of continuing education is questionable 

(Barriball, While, & Norman, 1992). Similarly, Leino-Kilpi, Solante and 

Katajisto (2001) conclude that getting nurses to make use of the results of 

nursing research is one of 'the main challenges for continuing education in 

the future' (p. 187). 

The review of literature regarding the influencing factors for 

research utilisation on the individual nurses' side shows several points 

worthy of attention. Personal characteristics of each nurse, i.e. awareness, 

attitudes and beliefs regarding research and research utilisation in clinical 

practice are of importance. However, with the discussion on the nurses' 

need for adequate educational preparation and support, it becomes 

progressively clear that the wider organisational context - be it an 

educational facility or a health care agency - has a considerable bearing on 

the success of implementation of research into clinical practice. 

2. 4. 2. Organisational Impact and Responsibilities 

Health care organisations have to respond to the demand of high 

quality service delivery, including nursing care, within often tight budgets. It 

seems obvious, therefore, that investment in and support of a structure that 

aims at developing efficient and effective clinical nursing practice would be 

beneficial to all health care organisations. An organisation, such as a 

hospital, has, through administrative and managerial structures, 

considerable impact on the activities (such as research utilisation) that take 

place within it. This organisational power to influence research utilisation, 



31 

however, entails the responsibility to ensure that the commitment and 

resources to support those desired activities are visible and available. 

Nursing leadership has a prime role to play in the building of 

organisational capacity and in the support of an environment where 

research and research utilisation can flourish. Successful principles and 

methods to facilitate the process of research utilisation in an organisation 

have been described by the following authors. Horsley, Crane and Bingle 

(1978), outline the process of the previously described CURN project 

emphasise the need to provide visible and enduring support mechanisms 

to demonstrate organisational commitment to research utilisation. This 

support should be in the form of research committees, policies and 

procedures, and could further include the provision of resources in the form 

of personnel, time and available funds. 

Hefferin, Horsley and Ventura (1982) examined the particular role of 

the nurse administrator in the promotion of research-based nursing 

practice. They report general agreement among their small sample (n=46) 

that nursing directors, supervisors and head nurses were the most likely 

people to promote the use of innovative practice. The majority of nurse 

administrators in their sample (88 - 97%) believed that securing the 

necessary resources and permission to implement innovations were the 

responsibilities of administrators. 

Other authors describe similar organisational responsibilities in the 

description of research utilisation projects within their health care agency 

(Rutlege, & Donaldson, 1995; Stetler et al., 1998; Van Mullen et al., 1999). 

Change management, as an underlying theoretical feature of research 

utilisation and evidence-based practice promotion in an organisation, 

clearly has to be initiated and guided by the administrators of 

organisations. Organisations are encouraged to: 

Develop a culture, capacity, and infrastructure for 

institutionalisation of research findings and other objective, 

systematically-obtained information to enhance the practice 



of their clinicians, managers, educators and other staff. 

(Stetler et al. , 1998, p. 52) 

32 

In summary it can be said that if research utilisation is to become 

part of everyday nursing care delivery, several issues have to be 

addressed at the organisational level. Administrators and other key people 

in the organisation have to show commitment to the process and support 

their staff in the process. This should include resources, including time, 

greater funding and adequate support facilities. Apart from efforts at the 

individual adopters and organisational level to enhance research utilisation 

in nursing, the way research is conducted, including it's dissemination, has 

to be taken into account for it's influence on the research utilisation 

process. 

2. 4. 3. Characteristics of the Research 

Because results of research are the innovations to be applied in 

research utilisation, it is important to consider several features of research. 

These features are mainly related to the structural make up of the 

research. Another pertinent issue is the reporting of the research and its 

results. The diffusion of research findings from their discovery by 

researchers to the point of application or use in clinical practice is a 

process that has to be adequately looked at. 

One problematic area, arising because of divergent views on 

research stemming from different, i.e. qualitative or quantitative, 

methodological backgrounds has been discussed in a previous section. 

The need for a broad approach to knowledge generation for nursing 

practice has been outlined. However, regardless of the methods and 

methodology employed, research that ultimately aims at the use of findings 

in practice has to display certain criteria. Stetler (1994) outlined a set of 

assessment criteria before research can be utilised in practice. These 

criteria include the importance of validation regarding a study's 

methodological rigour or soundness. Furthermore, evidence from one study 

should have been substantiated by means of replication studies and/or 



33 

descriptions of similar studies or additional non research information. 

Research findings should also be clearly placed within a given context so 

that evaluation for the fit to other settings can be critically analysed, based 

on any similarities and differences. Finally, the level of effectiveness of 

'current practice' has to be understood so that the expected innovation 

outcomes can be measured against it. This set of research assessment 

criteria clearly has implications for the appreciation of the value of research 

regarding its utilisation potential in clinical practice. 

Much in clinical practice research is still conducted in a 'stand alone' 

way, leading to a lack in substantiation of evidence. This fact can be seen 

to emanate partly from the short history of nursing research (Mulhall, 

1995). One solution to this problem supported by several authors is the 

fostering of replication studies, especially in the area of research projects 

by novice researchers, for example nursing students at masterate level 

(Crane, 1995; Funk et al. , 1989a; 1989b). 

The failure of research reports to be understood widely and to 

present the implications for practice clearly, including the expected 

outcomes, has been noted (Funk et al., 1989a; 1989b; Lacey, 1994; 

Rodgers; 1994). Caution to pressurise researchers into jumping to 

premature conclusions about the applications of their work (Downs, 1996) 

should not deter from the fact that research itself and its findings should be 

disseminated widely and in a form that is understandable by a wide range 

of practising nurses for easy utilisation. Dissemination of research findings 

should be an integral part in the planning of any research project, and can 

take various forms, i.e. publication in professional journals and 

monographs, presentations at conferences or information packs for 

practitioners (Akinsanya, 1994; Cronenwett, 1995; Funk, 1989a; 1989b; 

Stetler, 1994). 

King, Barnard and Hoehn (1981) acknowledged two decades ago 

the importance of adequate communication for dissemination of research 

findings. They investigated several communication modes and influencing 

components to devise a model . within the Nursing Child Assessment 



34 

Satellite Training (NCAST) project. They argue that the overriding concern 

is careful planning that allows flexibility. Researchers, in their view, have a 

considerable responsibility in systematically planning the dissemination of 

their findings from the very beginning of their project. 

2. 5. Summary 

The review of the literature presented gives evidence to the 

complexity of research utilisation in nursing. The multiple interacting 

aspects, impacting on research utilisation as an essential part of daily 

clinical nursing practice, have to be acknowledged and critically analysed 

in their individual context. Constraints arising, and the possibility of 

facilitating activities at different levels, have to be assessed and explored 

to develop strategies for successful research utilisation, at the individual 

practitioner and the organisational level. 

Due consideration of facilitation of research utilisation in the 

planning and presentation of research projects could additionally be of 

benefit. Nursing researchers can contribute to the achievement of that goal 

by investigating issues relevant to practising nurses, either in a 

participatory manner, or at least in a way that portrays the value and 

applicability of the research outcomes clearly. Wide dissemination of 

understandable implication for practice will support practitioners to use the 

findings in their clinical nursing practice. 

The following chapter presents the methodological and procedural 

strategies employed for the survey of a sample of registered nurses in a 

New Zealand context. Furthermore, the research tool used to assess 

barriers to research utilisation in clinical practice that have been 

highlighted in the literature review will be described. 



35 

Chapter 3: 

Methodology and Procedures 

This descriptive questionnaire survey followed a non-experimental 

design by replicating the study of Funk et al. (1991 a). The information in 

this chapter describes the study setting, the selection of participants and 

the data collection procedure. The research instrument used and the 

statistical data analysis employed will also be presented. Furthermore, the 

ethical considerations made for the study will be outlined and the 

limitations of the research project are described. 

3. 1. Study Setting 

The research was conducted in a 435 - bed hospital in the North 

Island of New Zealand. The hospital is part of a District Health Board 

(DHB) and serves an urban and suburban population of approximately 

250,000 people. The district health board employs around 1 '470 

nursing/midwifery staff across its services, which cover inpatient and 

outpatient facilities for acute and long term care requirements. 

As a tertiary institution the hospital where the research was 

conducted collaborates in partnership with several universities and a 

regional polytechnic for the education of nurses at undergraduate and post 

graduate level. Within the hospital, nursing staff are provided with 

opportunities for post registration education by several speciality areas that 

conduct educational courses of various lengths. For example, a six month 

certificate in acute care, or a year long emergency and trauma care course, 

at masterate level in conjunction with a local university. 



3. 2. Participant Selection and Data Collection 

3. 2. 1. Selection Criteria and Sampling 

36 

The population accessed for the study were all of the registered 

nursing/midwifery staff working on the Inpatient wards in the above 

described hospital setting. 

The selection criteria for the participants entailed: 

• Permanent full or part time employment by the hospital ; 

• Registered nurses and/or midwives, i.e. Registered Nurses (RN), 

Registered Midwives (RM), Registered General Obstetric Nurses (RGON), 

Registered Psychiatric Nurses (RPN) and/or Registered Comprehensive 

Nurses (RCpN) of any designation; and 

• Working in one of the Inpatient wards. 

Returned questionnaires were excluded for analysis if the respondent: 

• Was not a permanent staff member of any Inpatient ward; or 

• If the participant was not registered as a nurse or midwife, i.e. 

enrolled nurse or nurse aid. 

The decision on sampling strategies, including the sample size, was 

weighed up on several factors. Firstly, the statistical power in the analysis 

and the required precision of results were important factors, and the 

availability of participants, time and cost, were also taken into account 

(Schofield & Jamieson, 1999). The non random style of participant 

selection for this study was chosen, because facilitation of a randomised 

strategy could not be supported by the payroll manager of the institution. 

This was due to concern about participants' privacy. Thus, the decision to 

increase the sample size for this study was taken to overcome some of the 

limitations imposed by the absence of randomisation. 

Access to the desired population of registered nurses in the hospital 

was by the charge nurses/team leaders of all the Inpatient wards. They 

were asked to mediate the distribution of questionnaire packs. Having the 

support from charge nurses/team leaders was critical as they played a 



37 

'gate keeper' role in the sampling strategy chosen (Schofield & Jamieson, 

1999). 

Before data collection began, charge nurses and team leaders of all 

Inpatient wards of the hospital were contacted by e-mail explaining the 

study and its aims and procedures. They were also requested to distribute 

the questionnaire to the number of registered nurses on their duty roster. 

Charge nurses/team leaders who did not respond to the initial e-mail were 

followed up personally by the researcher to ask for their assistance. 

Reasons for non response to the above request were change of person 

holding the position, or being on leave when the request had been sent. 

Another reason was time restraints caused by other work commitments. 

The final sample population was 471 nurses, working in nineteen 

wards in different specialities of nursing. The specialities were: acute 

medical, surgical, paediatrics, adult rehabilitation and therapy (AT&R), 

coronary care unit (CCU), intensive care unit (ICU), neonatal unit (NNU) 

and gynaecology/obstetrics. 

3. 2. 2. Data Collection Procedure 

The questionnaire packs comprising an information letter (Appendix 

1 ), the research instrument (Appendix 2) and a postage paid return 

envelope were distributed to the Inpatient wards on the 31 October and 1 

November 2000, respectively. A reminder notice (Appendix 3) was placed 

in the staff rooms of all wards two weeks after the initial distribution of the 

questionnaire packs. A sticker that expressed thanks to all who had 

returned a questionnaire, was attached to this notice. The final date for 

returns of completed questionnaires was the 30 November 2000. This time 

frame of four weeks ensured that all recipients of a questionnaire had had 

enough time to consider participation, taking into account a busy working 

environment that incorporates rostered and rotating shifts. 

The questionnaires were returned in free post envelopes to the 

research supervisor's university office where they were collected by the 

researcher. The researcher proeeeded then to collate and code the 



38 

returned questionnaires. The data was entered using the SPSS (Version 

9.0) software package to create the final data set for analysis, which will be 

discussed after the presentation of the research instrument below. 

3. 3. Research Instrument 

3. 3. 1. Demographic Data 

A demographic data sheet (Appendix 2) was created by the 

researcher and reviewed by three academics, including the research 

supervisor, with nursing and research experience and context relevant 

cultural knowledge for its appropriateness in a New Zealand setting. 

The demographic attributes measured were age, gender, initial 

nursing qualification, post registration education, research module 

availability in undergraduate and in the post basic education program, 

other qualifications and/or relevant skills, year of registration, work setting, 

designation and the amount of hours worked in two weeks. Furthermore, 

participants were asked to indicate if they had ever participated in a 

research project and how frequently they read nursing journals that 

published research articles. The reading frequency of research articles was 

assessed by means of five categories: at least once a week, at least once a 

month, at least once in three months, less then once in three months and 

never at all. 

Peer review with nurse educators highlighted the need for further 

clarification on wording of some demographic items in the education 

section of the questionnaire. Such changes included former registration of 

hospital trained psychiatric nurse (RPN), baccalaureate graduates in 

midwifery (BM); and to differentiate more clearly between first nursing 

registration qualification and post registration qualifications. 



39 

3. 3. 2. The BARRIERs Scale Questionnaire 

The BARRIERs Scale questionnaire was developed by Funk et al. 

(1991 a). It has been used in a number of studies in different geographical 

settings and with various groups of health care workers (Funk et al. 1991 a, 

1991 b, 1995, Funk et al., 1995; Dunn, Crichton, Roe, Seers, & Williams, 

1997; Nilsson Kajermo, Nordstrom, Krusenbrant, & Bjorvell, 1998, 2000; 

Retsas & Nolan, 1999; Retsas, 2000). The questionnaire consists of four 

sub scales that assessed barriers to and facilitators of research utilisation, 

totalling 28 items. 

These sub scales assess: 

a) Characteristics of the individual nurse as an 'adopter' of research 

findings; 

b) Characteristics of the organisation; 

c) Characteristics of research findings which, in this context, are seen as 

the innovation; and 

d) Characteristics of the communication of research findings, i.e. Issues 

around availability and presentation of research findings. 

The sub scales above were identified through factor analysis by 

Funk et al (1991a), and are also key concepts of Rogers' (1995) model of 

the diffusion of innovations. A four point Likert type scale was provided for 

each statement to indicate the degree to which any questionnaire item was 

perceived to be a barrier to research use. The Likert scale was labelled: 1. 

'Not at all'; 2. 'Little'; 3. 'Moderate'; 4. 'Great'. Two final open ended 

questions asked participants to state any additional barriers to, or 

facilitators of research use that respondents encountered in their everyday 

professional practice. 



40 

3. 4. Data Analysis 

3. 4. 1. Quantitative Data 

The Statistical Package for Social Science (SPSS) version 9.0. was 

used for data analysis. The data was summarised with computed 

descriptive statistics which included frequencies, means, standard 

deviations (SD) and contingency tables. Skewness of variables' distribution 

was assessed. This first step in the exploratory data analysis ensured a 

thorough base, which enabled the researcher to conduct inferential 

statistics and to employ the appropriate tests (Unsworth, 1999). The items 

of the BARRIER's scale were ranked with regards to the cumulative 

percentage of sores of 3 (moderate barrier) and 4 (great barrier), 

respectively. 

Non parametric inferential statistics, i.e. Mann- Whitney U test and 

Kruskall - Wallis, were chosen for testing differences between pair or 

groups of variables that were not normally distributed. These test statistics 

are adequate if any rigorous assumption about the sample distribution 

cannot be made (Polit, 1997; Story, 1999). Parametric tests in the form of 

independent sample T-tests and ANOVA were performed in instances 

where the distribution of variables could be assumed to be normal or close 

to normal as measured by the skewness index (SPSS Version 9.0 

Integrated Results Coach). Spearman's rank order correlation was 

computed to test for strength and direction of relationships between 

variables and sub scales. Statistical significance was set at the p < .05 

level. 

Factor analysis was performed using principal component analysis 

with Varimax rotation. Factor retention was decided upon the results of 

initial eigenvalues, percentage of explained variance and scree plotting 

(Child, 1990; Kim & Mueller, 1978a, 1978b; Kline, 1994; Polit, 1996). 

Loading was set to have occurred if an item had a measure of =/> .40 on a 

factor. This loading level has been used by Funk et al. (1991 a) in their 

initial study. 



41 

3. 4. 2. Standardised Qualitative Data 

Responses regarding the type of post registration qualifications 

were grouped according to their content focus and tabulated to produce 

frequency measures. 

Responses to the two questions regarding additional barriers to, or 

facilitators of research use were collated verbatim in a master document. 

Questionnaire code numbers were retained with individual excerpts to 

facilitate tracking if necessary, and will be included in the presentation of 

the results. This data was then used for a thematic content analysis 

(Babbie, 1992). The responses were compared with the items of the 

BARRIER scale. Statements that indicated new barriers to, or facilitators of 

research use, were classed according to their thematic fit into the four sub 

scales. This analysis of the data was validated through a review of the 

process by the research supervisor. 

3. 5. Ethical Issues 

Ethics approval for this study was granted by the Massey 

University's Human Ethics Committee (MUHEC) in Palmerston North (on 

the 10 October 2000) and the Wellington Regional Ethics Committee prior 

to commencement of data collection on the 31 October and 1 November 

2000. General approval was also provided by the Staff Research 

Committee of Whitireia Community Polytechnic, Porirua. The research 

project conformed to the 'Code of Ethical Conduct for Research and 

Teaching involving Human Subjects' (Massey University) and the New 

Zealand Health Research Council Guidelines on Ethics in Health Care 

Research. Special ethical appreciation in the preparation of this study was 

given to issues of informed consent, anonymity, confidentiality and cultural 

concerns. 



42 

3. 5. 1. Informed Consent 

The questionnaire packages distributed to the clinical areas 

contained an information letter (Appendix 1) that outlined the purpose and 

procedures of the study, including contact details of the principal 

researcher and supervisor for any additional queries. Further, the rights of 

all participants and the benefits and risks of participating in the study were 

explicitly stated. In the information letter and the questionnaire it was stated 

that return of the questionnaire implied the respondent's consent to use the 

data for this study and the eventual publication of the results. 

3. 5. 2. Anonymity and Confidentiality 

Anonymity was assured to each participant and enforced with the 

provision of a pre addressed free post envelope for the return of the 

questionnaires. Name identification was not required and the information 

letter asked participants not to put their names on the questionnaire. Data 

from all questionnaires was collated and reported in aggregated form only. 

Furthermore, to safeguard confidentiality, the researcher undertook 

responsibility to destroy the raw data when it is no longer required to 

validate any aspects of the study. Until then all data will be kept safely for 

up to five years, accessible only by the principal researcher or the research 

supervisor. 

3. 5. 3. Cultural Concerns 

Due to the bicultural concerns that all New Zealand research is 

inclusive of cultural factors, this research was carried out in a way that 

acknowledged the fundamental bicultural principles of the Treaty of 

Waitangi. However, the project did not specifically impact on Maori people. 

The study population was viewed as representing the 'nursing culture' of 

the hospital site and information regarding ethnicity was not assessed. 



43 

The Wellington Regional Ethics Committee review board advised 

that more consideration would be given to the impact culture has on 

practice. The chairperson suggested that the questionnaire items would be 

reviewed with advice from the staff research co-ordinator of Whitireia 

Community Polytechnic, where the principal researcher was working at the 

time of the design stage of the study. Out of this review, it was decided to 

include a prompt in the two open questions at the end of the questionnaire. 

The inclusion of a prompt specifically mentioning 'cultural matters' was to 

enable participants to discuss any barriers and facilitators of a cultural 

context in comfort. Based upon these important amendments, the 

Wellington Regional Ethics Committee granted approval for the study on 

the 26 October 2000. 

3. 6. Summary 

This chapter detailed the methodological processes employed for 

the questionnaire survey research into barriers to and facilitators of 

research use in clinical practice in a sample of New Zealand nurses. The 

study setting has been described and the participant selection outlined. 

Data collection and analysis procedures have been presented and the 

ethical issues considered for this study described. 

The findings of this study will be presented in the next chapter, 

summarising the demographic characteristics of the sample, comparing the 

ranking order of items with overseas study that used the BARRIER's scale 

questionnaire and reviewing relevant statistical relationships of the sample 

sub groups and the ranking order. 



44 

Chapter 4: 

Results 

The results from the analysis of the questionnaire investigating the 

barriers to and facilitators of research use in New Zealand clinical nursing 

practice are presented in this chapter. Firstly, an overview of the 

demographic characteristics is given, including personal attributes of the 

sample, nurses' work area and designation, and their educational 

background. Following the presentation of the psychometric evaluation of 

the instrument, the item ranking will be compared with other overseas 

studies' results. Qualitative data from the two open ended questions will be 

presented using verbatim excerpts. Finally, the factor analysis results will 

be described. Discussion of these results in the context of the literature, 

theoretical framework and importance to research use in this particular 

setting will be discussed in the ensuing chapter. 

4. 1. Response Rate 

From the 471 questionnaires distributed to the acute care wards of 

the study site, 167 were returned within the one month time frame 

established in the information letter to the participants. Three 

questionnaires could not be included in the analysis because two did not 

satisfy an inclusion criteria set out in the previous chapter, i.e. one was 

filled out by a staff member identifying herself as working for the casual 

pool and another by an enrolled nurse. The third questionnaire was 

returned with the BARRIER's scale left blank. 

A response rate of 34.8% was achieved. The data set analysed for 

this study was generated by collated responses from 164 returned 

questionnaires. 



45 

4. 2. Demographic Data 

4. 2. 1. Characteristics of the Sample 

The majority of respondents (93.3%) were female with a mean age 

of 34 (SD 9.25) years. Table 1. gives an overview on the age grouping of 

the sample. The percentage of male respondents (6. 1 % ) is representative 

of the average male distribution within the nursing profession in New 

Zealand, which is 5.8% of all nurses (The Nursing Council, 2000b). 

However, the sample was clearly younger than the national average which 

was 42.6 years in 2000. Furthermore, the number of nurses in this study 

under the age of 45 years was almost 20% higher than the national 

average of 61.2%. 

Table 1: Age Grouping of Sample (n=164) 

Agegroup Frequency Percent Cumulative 
Percent 

20-29 61 37.2 38.6 
30-39 54 32.9 72.8 
40-49 30 18.3 91.8 
50-59 11 6.7 98.7 
>/=60 2 1.2 100.0 
Total 158 96.3 

Missing 9 6 3.7 
Total 164 100.0 

The mean time since registration was 10.7 (SD 9.36) years ranging 

from one to 38 years respectively. A third (33.5%) of respondents had been 

registered for 4 years or less. Table 2. provides a summary of the 

distribution of the sample in terms of the years elapsed since their initial 

nursing/midwifery registration. 



46 

Table 2: Grouping of Sample according to their Years after Registration 

Cumulative 
FreQuencv Percent Percent 

1-4 Years 55 33.5 33.7 
5-9 Years 37 22.6 56.4 
10-14 Years 23 14.0 70.6 
15-19 Years 16 9.8 80.4 
20 and more 32 19.5 100.0 
Total 163 99.4 

Missing 9 1 .6 
Total 164 100.0 

4. 2. 2. Work Area and Designation 

Participants had eight options to indicate their work area: (1) 

medical, (2) surgical, (3) gynacology/obstetrics, (4) CCU, (5) ICU, (6) 

paediatrics, (7) AT&R and (8) 'other' with a space provided for the 

participants to specify the area. 

A sample from each clinical area was received. However, the 

response rate for the differing areas ranged between the low 20 to 60 

percentile of the questionnaires distributed to each individual area. Four 

out of the nine areas had a response rate of 50% or above. 

Table 3. gives an overview of the respondents' work area. The 

option of 'other' was chosen by 19 nurses from the NNU and eight nurses 

from the oncology/haematology ward. The groups of nurses from the NNU 

and oncology/haematology ward were considered separately in the 

analysis. Two nurses each used the 'other' option to indicate that they were 

working in the area of neurology/neurosurgery or renal nursing, 

respectively. Because of the work content comprising many varied invasive 

treatments, e.g. neurosurgery or renal transplantation, the small number of 

nurses from the above areas was pooled with the respondents from other 

surgical areas. 

From the sample (n=164), staff nurses made up the biggest group 

totalling 143 of all respondents (Table 4). The remaining questionnaires 



47 

were returned by charge nurses/teamleaders/co-ordinators and by 

educators, or clinical nurse specialists. 

Table 3 : Work Areas of Respondents 

Area Frequency Percent 
Medical 25 15.2 
Surgical 26 15.9 
Gynaecoloov/Obstetrics 10 6 .1 
CCU 15 9.1 
ICU 34 20.7 
Paediatrics 15 9.1 
AT&R 5 3.0 
Neurology/Neurosurgery 2 1.2 
NNU 19 11 .6 
Oncology 8 4.9 
Renal 2 1.2 
Missing 3 1.8 
Total 164 100.0 

Table 4 : Designation 

Designation Frequency Percent 
Missing 1 .6 
Staff Nurse, Staff Midwife 143 87.2 
CN/Teamleader/Co-ord 11 6.7 
Educator/CNS 9 5.5 
Total 164 100.0 

One hundred and twenty five participants indicated that they worked 

72 or more hours a fortnight which equates to a .9 or more full time 

equivalent employment (FTE) (Table 5.). Only 6% of the respondents 

worked equal to, or less than .5 FTE. 

Table 5 : Hours worked per fortnight 

Hours Frequency Percent 
16.00 3 1.8 
20.00 1 .6 
36.00 2 1.2 
40.00 4 2.4 
44.00 1 .6 
48.00 14 8.5 
56.00 3 1.8 
64.00 11 6.7 
72.00 30 18.3 
76.00 1 .6 
78.00 1 .6 
80.00 91 55.5 
90.00 2 1.2 
Total 164 100.0 



48 

4. 2. 3. Education and Qualifications 

In line with the years since registration, 61 (37.2%) participants were 

educated in a baccalaureate degree programme. The remaining 

respondents indicated that they had comprehensive credentials attained 

from a tertiary institution, or that they were hospital trained (Table 6.). 

Table 6: Type of Initial Qualification 

Qualification Type Frequency Percent Cumulative 
Percent 

Hospital Training 45 27.4 27.6 
Comprehensive Diploma 57 34.8 62.6 
Degree Program 61 37.2 100.0 
Total 163 99.4 
Missing 1 .6 
Total 164 100.0 

The sample was nearly even in size regarding the exposure to a 

research module in their basic education/training with 49.4% affirming that 

research education had occurred in their initial professional preparation 

(Table 7.). Furthermore, with a third having had other post registration 

professional education, the majority of nurses had received some research 

education during their educational experience, prior to, or after registration. 

Table 7: Cross tabulation of Research Module Availability and Qualification 

~ 

Qualification Type Research Module in Basic Total 
Education 

Yes No 
Hospital Trained 2 42 44 
Comprehensive Diploma 22 33 55 
Degree Program 55 5 60 

79 80 159 
Missing 5 
Total 164 

A research module is usually part of a degree programme at 

baccalaureate and/or masterate level. It is also often included in speciality 

courses. Ninety four (57%) respondents indicated to have participated in a 

research project previously. 



49 

Table 8 : Post Registration Qualifications 

Qualification Qualifications n/59* 
Group 
Speciality PGCertlCU,ICU Speciality Course/Certificate,ENB Critical 13 
Qualifications Care,DipCritCare, AdvCritCare Cert.,ENB100 

NICU Speciality Course, Neonatal Course, ENB NICU 9 

RM 7 
Paediatric Speciality Course, Sick Children Course, 6 
Registered Sick Children Nurse 
Cardiac/Cardiothoracic Speciality Course 5 

PGCert (Mental Health), Cert. Psychiatric Nursing Skills, 4 
Psychiatry Course, Cert. Psychiatric Care 
Dip.Occupational Health & Safety 2 
Cert. AT&R Elderly, Cert. Gerontology Nursing 2 
OT Nursing 2 
Flight Nursing Course 1 

PGCert. Emergency & Trauma 1 

ENB Speciality Spinal Injury 1 

ENB Speciality Neuroscience 1 

PAP Smear & Mamma Check 1 

Diploma in Maori Health 1 

Renal Certificate 1 
Dip. Tropical Nursing 1 
Counselling in Nursing 1 

Plastic Surgery & Bums Course 1 

Academic AND, BN/MA Papers, DipSocSci (Midwifery) , PGDipNurs 9 
Programs 
Non Nursing Computer Diploma; Diploma in Agronomy, Diploma in 8 

Administration , B.Sc. (Hons), BA (Sociology/Criminology) 
& (Psychology), Patholoav Assistant 

Teaching Teaching Course, CAT, Cert. Clinical Te