Registered nurses' self-rated research utilization in relation to their work climate: Using cluster analysis to search for patterns.

AIM: To describe and study the association between registered nurses' self-rated research utilization and their perception of their work climate. BACKGROUND: Research utilization is an important part of evidence-based nursing, and registered nurses value a work climate that supports the possibility to work evidence-based. METHOD: This cross-sectional study was conducted using the Creative Climate Questionnaire together with three questions measuring instrumental, conceptual and persuasive research utilization. The analysis was done using variable- and pattern-oriented approaches. RESULTS: An association was found between research utilization and experience of dynamism/liveliness. Women reported higher use of conceptual research utilization. Regarding work climate, younger registered nurses and registered nurses with less work experience gave higher scores for playfulness/humour and conflicts. The results showed an association between having a Bachelor's or Master's degree and higher instrumental research utilization. DISCUSSION: Research utilization was higher in registered nurses with higher academic education. Low users of research tended to experience a lack of dynamism and liveliness, which indicates the importance of improving the work climate by creating a climate that allows opinions and initiate discussions. CONCLUSION: The findings support the importance of creating a work climate that encourages reflection and discussion among registered nurses, and to promote academic education for nurses plus an optimal work-place staffing-mix. SUMMARY STATEMENT: What is already known about this topic? Research utilization is an important part of evidence-based nursing. Registered nurses value a work climate that supports the possibility to work evidence-based. Little is known about the association between how nurses use research in clinical work and how they perceive their work climate. What this paper adds? Low research users tended to experience low dynamism and liveliness in their work climate, showing the importance of improving the work climate in health care organizations to support clinical nurses' ability to express opinions and initiate discussions. The association between work climate and the use of research among nurses needs further investigation. Our findings support previous research showing that a higher academic level is associated with increased research among registered nurses working clinically, and therefore benefits patient outcomes. The implications of this paper: The association between low research utilization and experience of low dynamism and liveliness indicates the importance of improving the work climate by creating an atmosphere where nurses can express their opinions and initiate discussions. There is a need to support clinical registered nurses to maintain their research utilization throughout their working career. The health care sector and the individual workplace should support registered nurses in furthering their academic level.

Development and evaluation of the measurement properties of a generic questionnaire measuring patient perceptions of person-centred care.

BACKGROUND: Implementation of person-centred care (PCC) is a challenging undertaking. Thus, a call has been issued for a robust and generic instrument to measure and enable evaluation of PCC across settings and patient groups. This study aimed to develop a generic questionnaire measuring patients' perceptions of PCC. Further aims were to evaluate its content and measurement properties using a mixed-methods approach entailing Rasch and qualitative content analyses. METHODS: The study was conducted in three iterative phases. Phase one included six key informants to gain a broad view of the concept. Phase two entailed a Delphi study involving two rounds with eight experts who generated ratings on relevance, readability, comprehensiveness and suggestions for revision. Data were analysed using the Item Content Validity Index in conjunction with qualitative comments to improve the questionnaire. Phase three was performed using a mixed-methods design. Quantitative data were collected from patients (n = 553) responding to the questionnaire who were recruited from six in- and outpatient care units in a health care region in Sweden. Data was analysed using the Rasch measurement model. Qualitative data were based on the respondents' free-text comments, cognitive interviews (n = 10) and field notes, and then analysed with deductive content analysis. RESULTS: A questionnaire was developed and operationalised based on the information given by key informants in phase one and then validated for its content by experts in phase two. In phase three Rasch analyses revealed problems with targeting, thresholds and two misfitting items. These problems were corroborated by data from the qualitative analyses, which also revealed some issues of wording and interpretation of items. When thresholds were resolved and two items removed, the questionnaire met the assumptions of the Rasch model. CONCLUSIONS: Experts gave the questionnaire content high ratings and it met measurement requirements assumed by the Rasch model after revisions. Those problems on targeting that remain need to be addressed in future studies. Meanwhile, we regard the questionnaire as of sufficient quality to be useful in benchmarking PCC.

Clusters of competence: Relationship between self-reported professional competence and achievement on a national examination among graduating nursing students.

AIMS: To identify clusters based on graduating nursing students' self-reported professional competence and their achievement on a national examination. Furthermore, to describe and compare the identified clusters regarding sample characteristics, students' perceptions of overall quality of the nursing programme, and students' general self-efficacy (GSE). DESIGN: A cross-sectional study combining survey data and results from a national examination. METHODS: Data were collected at two universities and one university college in Sweden in January 2017, including 179 students in the final term of the nursing programme. The study was based on the Nurse Professional Competence Scale, the GSE scale, and results from the National Clinical Final Examination. A two-step cluster analysis was used to identify competence profiles, followed by comparative analyses between clusters. RESULTS: Three clusters were identified illustrating students' different competence profiles. Students in Clusters 1 and 2 passed the examination, but differed in their self-assessments of competence, rating themselves under and above the overall median value, respectively. Students in Cluster 3 failed the examination but rated themselves at the overall median level or higher. CONCLUSION: The study illustrates how nursing students' self-assessed competence might differ from competency assessed by examination, which is challenging for nursing education. Self-evaluation is a key learning outcome and is, in the long run, essential to patient safety. IMPACT: The study has identified clusters of students where some overestimate and others underestimate their competence. Students who assessed their competence low but passed the exam assessed their GSE lower than other students. The findings illuminate the need for student-centred strategies in nursing education, including elements of self-assessment in relation to examination to make the students more aware of their clinical competence.

Nursing management matters for registered nurses with a PhD working in clinical practice.

AIM: To investigate what registered nurses (RNs) with a PhD working in clinical practice experience in terms of their role, function and work context. BACKGROUND: Previous studies have shown that RNs with a graduate degree contribute to better and safer care for patients. However, little is known about what further academic schooling of RNs, at PhD level, means for clinical practice. METHOD: Qualitative design, with semi-structured interviews and inductive content analysis. RESULTS: The main areas of responsibilities for RNs with a PhD working in clinical practice were related to practice development and implementation of research results. In their work, they experienced barriers to the full use of their competence; the expectations and prerequisites of the organisation were not clearly defined, and they often lacked a mandate to create conditions for quality improvement of nursing care. CONCLUSIONS: RNs with a PhD can contribute to evidence-based practice (EBP), clinical training, as well as the development of clinical research. Their roles and responsibilities need to be clarified, and for this, they need support from managers. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers have the opportunity to partner with RNs with a PhD to support the EBP process and help structure nursing practice in more efficient ways.

Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care-A process evaluation of an implementation intervention in the orthopaedic context.

RATIONALE, AIMS, AND OBJECTIVES: The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery. METHODS: A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed. RESULTS: Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit. CONCLUSION: To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.

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

AIM: The aim was to explore first line nurse managers' experiences of opportunities and obstacles to support evidence-based nursing. DESIGN: A qualitative study with a phenomenographical approach. METHOD: Data were collected through focus group interviews with 15 first line nurse managers' in four settings. RESULTS: The results are presented in four categories of description headed: Manage the everyday work vs. evidence-based nursing; Uncertainties about evidence-based nursing and nursing research; Time as a reality, as an approach; and Shaping awareness-towards an active approach to evidence-based nursing. The overarching category of description has been formulated as follows: The internal relation-how active leadership influences evidence-based nursing. The outcome space is presented as: The individual path-how to make vision and reality become a working entity around evidence-based nursing.

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

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

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

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

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

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

The concept of research utilization as understood by Swedish nurses: demarcations of instrumental, conceptual, and persuasive research utilization.

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

Nurses' research utilization two years after graduation--a national survey of associated individual, organizational, and educational factors.

BACKGROUND: Nurses' research utilization (RU) as part of evidence-based practice is strongly emphasized in today's nursing education and clinical practice. The primary aim of RU is to provide high-quality nursing care to patients. Data on newly graduated nurses' RU are scarce, but a predominance of low use has been reported in recent studies. Factors associated with nurses' RU have previously been identified among individual and organizational/contextual factors, but there is a lack of knowledge about how these factors, including educational ones, interact with each other and with RU, particularly in nurses during the first years after graduation. The purpose of this study was therefore to identify factors that predict the probability for low RU among registered nurses two years after graduation. METHODS: Data were collected as part of the LANE study (Longitudinal Analysis of Nursing Education), a Swedish national survey of nursing students and registered nurses. Data on nurses' instrumental, conceptual, and persuasive RU were collected two years after graduation (2007, n = 845), together with data on work contextual factors. Data on individual and educational factors were collected in the first year (2002) and last term of education (2004). Guided by an analytic schedule, bivariate analyses, followed by logistic regression modeling, were applied. RESULTS: Of the variables associated with RU in the bivariate analyses, six were found to be significantly related to low RU in the final logistic regression model: work in the psychiatric setting, role ambiguity, sufficient staffing, low work challenge, being male, and low student activity. CONCLUSIONS: A number of factors associated with nurses' low extent of RU two years postgraduation were found, most of them potentially modifiable. These findings illustrate the multitude of factors related to low RU extent and take their interrelationships into account. This knowledge might serve as useful input in planning future studies aiming to improve nurses', specifically newly graduated nurses', RU.

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

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

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

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

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

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