Discuss the distinction between research utilization and evidence-based practice. What do you see as your role in applying research to practice? How will you recognize the need for further research related to a patient-care scenario and how will you know when any given research is ready for utilization? What are some barriers to RU and EBP you may encounter and strategies for overcoming those barriers? (10 possible points)
Research utilization (RU) and evidence-based practice (EBP) may be presented as the same thing in some sources, but they are not. One way to think of the difference between RU and EBP is to consider RU as a technical process and EBP as a paradigm of the clinical environment. RU refers to the process of applying the results of studies to problems in real-world circumstances. The definition of "problem" here can be quite flexible, and RU has been described as existing in a continuum from narrow approaches such as changing protocols to broad approaches such as changing staff attitudes to problems-solving (Polit & Beck, 2006). EBP refers to a way of conducting oneself or one's staff in a setting of continuous patient care such as a hospital or public health venue. It means making patient care decisions in light of the best possible empirical knowledge, and it is essentially a way of defining the relationship between health care and the social and natural sciences.
One way to conceive of the difference between RU and EBP is to consider what types of questions are asked under these two approaches. Strictly speaking, RU might not be a type of questioning, but could be something that could be used in the process of answering questions. However, RU could also represent an approach to questions that starts from the science: "Here is some research. What does it mean for us?" EBP represents an approach to questions that starts from clinical problem-solving: "Here is a problem. What research exists for us?"
Between the two approaches of RU and EBP, nurses do not actually have to choose. Besides titled positions (such as CNS) dedicated to performance review, the role of a nurse applying research to practice is mutlifaceted and can be conceptualized by looking at the two types of questions above. The EBP question starts from a clinical situation, so it implies that the nurse is in a practice situation already. The RU question starts from research, which would be found in perusing journals or databases, so it implies that the nurse is engaged with the research outside the clinical situation. EBP is a theoretical approach to patient care, but RU is part of the professional aspect of nursing--continuing self-education and keeping up with the latest knowledge in the profession by reading journals. The role of the nurse who subscribes to EBP is to define problems during practice and approach the literature in off hours to define solutions to those problems. The role of the nurse as professional is to read broadly and maintain education related to the latest science.
In order to succeed with either EBP or RU, the nurse must be familiar with the specific jargon and methodologies used in research studies. For nurses engaged in EBP, it is necessary to know when the research that has been found is adequate to solve the clinical problems and when further research is needed. For nurses engaged in RU, it is necessary to know when specific studies are appropriate for being brought to the practice setting. Together, these are the skills necessary to evaluate evidence. Questions must be asked: Was the sample representative? Was the questionnaire valid and reliable? Did the interviewer adequately control for her own preconceptions? Were the results significant enough (p) to be meaningful?
One would hope that the hard work of reading the methodology closely would be done by journal editors and peer reviewers, but that is not always the case as some research might not be adequate to change practice but might be publishable for its value in suggesting new directions for research. To make things easier for those using research, systematic strategies have been devised such as Cochrane-based evidence hierarchies and multiple practical models (e.g., Stetler and Ottawa). These provide guidance to the reader on the quality of studies and the method for decision-making about studies. In the end, however, the nurse is left to contend in her own local health-care setting with her education and wits.
And wits the nurse may need aplenty if she is to overcome some of the barriers to RU and EBP. Polit and Beck (2006), describe a number of these in the eighteenth chapter of their text. The barriers described there run the gamut from individuals to organizations and inertia to intention. Examples include a lack of education for research skills on the part of nurses, lack of financial incentives on the part of hospitals, and the perceived threat of those whose practice must change in the face of evidence. But one possible barrier is not addressed in this chapter. Does the profession of nursing, by its nature, appeal to people who are resistant to research review?
In talking with ICU and PCU nurses at a local hospital, themes emerged of impatience with and disinterest in research, as well as social marginalization of nurses who were interested in such "intellectual" pursuits. Comments were made such as "I'm a hands-on learner" and "I wanted to be a nurse so I would be doing something." EBP has definite advantages for patients and RU is a clearly important component of patient care, but the skills and psychology of administering bedside care and pursuing research represent a type of task-switching that other professions are not asked to do.
This barrier is a difficult one to overcome since it relates not only to nurses' conceptions of the profession of nursing but also to their own identities. It is a shame to say that the most consistently successful and implementable idea would probably be a transactional solution related to nurses' job responsibilities. Providing more personal time or breaks in exchange for participation in journal clubs or study participation would force nurses to describe their responsibilities differently. A more deeply successful idea would be a transformational solution. Unfortunately, this is less implementable since transformational leadership so often requires inspiration itself.
References
Polit, D.F., & Beck, C.T. (2006). Essentials of nursing research: Methods, appraisal, and utilization (6th ed.). New York: Lippincott Williams & Wilkins.
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