Bridging the divide: a survey of nurses' opinions regarding barriers to, and facilitators of, research utilization in the practice setting

Background. Many researchers have explored the barriers to research uptake in order to overcome them and identify strategies to facilitate research utilization. However, the research–practice gap remains a persistent issue for the nursing profession.

Aims and objectives. The aim of this study was to gain an understanding of perceived influences on nurses' utilization of research, and explore what differences or commonalities exist between the findings of this research and those of studies that have been conducted in various countries during the past 10 years.

Design. Nurses were surveyed to elicit their opinions regarding barriers to, and facilitators of, research utilization. The instrument comprised a 29-item validated questionnaire, titled Barriers to Research Utilisation Scale (BARRIERS Scale), an eight-item scale of facilitators, provision for respondents to record additional barriers and/or facilitators and a series of demographic questions.

Method. The questionnaire was administered in 2001 to all nurses (n = 761) working at a major teaching hospital in Melbourne, Australia. A 45% response rate was achieved.

Results. Greatest barriers to research utilization reported included time constraints, lack of awareness of available research literature, insufficient authority to change practice, inadequate skills in critical appraisal and lack of support for implementation of research findings. Greatest facilitators to research utilization reported included availability of more time to review and implement research findings, availability of more relevant research and colleague support.

Conclusion. One of the most striking features of the findings of the present study is that perceptions of Australian nurses are remarkably consistent with reported perceptions of nurses in the US, UK and Northern Ireland during the past decade.

Relevance to clinical practice. If the use of research evidence in practice results in better outcomes for our patients, this behoves us, as a profession, to address issues surrounding support for implementation of research findings, authority to change practice, time constraints and ability to critically appraise research with conviction and a sense of urgency.

Barriers to effective management of depression in general practice

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice.

Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients.

Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p = 0.00), as did female GPs (p = 0.00). Male GPs (p = 0.00) and those in rural settings (p = 0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p = 0.00). Urban-based GPs (p = 0.04) and those with prior mental health training (p = 0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p = 0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p = 0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p = 0.01), although the results were not entirely consistent.

Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.

Rationale, restrictions and responses : online academic development to promote a community of practice

Casual academics play a major role in higher education in Australia today. In their roles as tutors, demonstrators and markers, casual academics need access to opportunities to develop as teachers. As such, Deakin University has developed an online academic development program designed to better equip new and inexperienced casual academics for their roles. This paper reports on the approach that has been taken to designing one module of an online academic development program for casual academics, considering the influence of information and communication technology (ICT) on this design, and discusses an analysis of the feedback on the module by the participants who completed it. A conclusion is drawn that aligning self paced online learning with induction into a community of practice via ICT presents particular challenges.

Development of an evidence-based scoring system (HF-IS) to assess the quality of heart failure programmes for patients postdischarge from hospital

Aim.  The aim of this study was to develop a potential scoring algorithm for interventions in a chronic heart failure management programme – the Heart Failure Intervention Score – to facilitate quality improvement and programme auditing.

Background.  The overall efficacy of chronic heart failure management programmes has been demonstrated in several meta-analyses. However, meta-analyses did not determine individual interventions in a programme that resulted in beneficial patient outcomes.

Design.  A prospective cross-sectional survey design.

Method.  All chronic heart failure management programmes in Australia (n = 62), identified by a national register, were surveyed to determine programme characteristics and interventions.

Results.  Of the 62 national chronic heart failure management programmes, 48 (77%) completed the survey and 27 individual interventions were identified. Variability in the use of the key interventions was common among the programmes. Each intervention was given an arbitrary weighted score according to the level of supportive evidence available and a total score calculated. Programmes were then categorised into low or high complexity based on several interventions implemented and their weighted score. A total score of ≥190 (median = 178, interquartile range 176–195) was used to divide programmes into two groups. Nine programmes were categorised into high Heart Failure Intervention Score group and majority of these were based in the acute hospital setting (78%). In the low Heart Failure Intervention Score group, there were 39 programmes of which there were a higher proportion of community-based programmes (38%) and programmes in small community hospitals (10%).

Conclusion.  The Heart Failure Intervention Score provides a potential evidence-based quality improvement tool through which a set of minimum standards can be developed. Implementation of the Heart Failure Intervention Score provides guidance to programme coordinators to enable monitoring of standards of heart failure programmes, which may potentially result in better patient outcomes.

Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan

Background: 

The emergence of the private entrepreneur in reform era China: re-birth of an earlier tradition, or a more recent product of development and change?

A private sector that now dominates economic activity has emerged in China since 1978, even though many of the essential institutions for market competition have been lacking or are under-developed. We find that there is no evidence that this upsurge of entrepreneurship is a re-birth of an earlier tradition. Instead, the dynamics of entrepreneurial emergence can be attributed to reforms and institutional changes that have occurred since 1949, both before and after the introduction of economic reforms in late 1978. We find that these institutional changes have been evolutionary, adapting to, as well as shaping, emerging forms of economic activity, including entrepreneurship. Our conclusion is that these dynamics of adaptation and evolution produce ‘rule ambiguities’ within the institutional framework that create opportunities for entrepreneurs as well as making these opportunities vulnerable to further institutional change.

Dispositional and maturational development through a competency based training intervention : getting to the heart of the matter

Presents a formative perspective on vocational learning that proposes that vocational competence is dependent upon dispositional development, which in turn results in moves towards maturation. Further, that dispositional and maturational outcomes occur as a result of a lifetime goal-setting intervention employed prior to training Reports qualitative and quantitative research with unemployed adults engaging in vocational education that resulted in four findings. Firstly, that while Training Packages describe assessable outcomes in competency-referenced terms, trainees describe learning outcomes in non-competency referenced terms. Secondly, that vocational trainees describe their learning in terms of dispositional outcomes, that is, in terms of values, interests and attitudes. Thirdly, that dispositions can be categorised in terms of maturational concepts. Fourthly, in support of incremental theory, that trainees made moves towards maturation as a result of a lifetime goal-setting intervention employed prior to training.

Organisation , development and change-Asia Pacific

This text focuses on the use of organisation development, which is a process that applies behavioural science knowledge and practices to help organisations achieve greater effectiveness. Other paradigms, including organisation tranformation, are also discussed in order to give a balanced perspective on the challenges of being an agent.

Empowering practitioners to critically examine their current practice

A Self-Assessment Manual (SAM) for early childhood practitioners has been developed around the previously reported framework (Raban, Waniganayake, Deans, Brown & Reynolds, 2003a), and this has been piloted in a number of early childhood settings. When engaging in self reflection using SAM, practitioners collaborate with mentors from the Early Childhood Consortium Victoria (ECCV) to consider their past, present and future professional experiences. This process empowers practitioners to critically examine their current practice and plan for their future professional development in a more systematic way. SAM is seen here to serve dual purposes: on the one hand, it is an evaluative instrument that can direct professional development of individual practitioners. On the other hand, it is a research tool aimed at identifying theoretical assumptions underpinning professional practice, and allows a longitudinal approach to mapping professional growth and development. Either way, it has the potential to enhance the quality of early childhood experiences for preschool children regardless of the settings in which they may find themselves. This paper presents a formative evaluation of this work and discusses its potential for professional development planning.

The attraction, retention/transition and nurturing process of sport development : some Australian evidence

The purpose of this study was to explore and map the sport development processes in Australia. A grounded theory approach identified sport development processes by examining 74 annual reports from 35 national sporting organizations (NSOs) over a period of 4 years, before and after the Sydney Olympic Games. The 3 frameworks presented in this article representing the attraction, retention/ transition, and nurturing process illustrate the generic processes and strategies described by NSOs. The results show that each sport development process requires human and financial input from various stakeholders. These stakeholders initiate or implement sport development strategies for each process and each process has different sport development outputs. These results contribute to the extant literature of sport development by demonstrating that sport development is more complex and encompassing than previously described. It is proposed that the generic frameworks derived from this study be subject to more specific testing using other sport systems, as context and case studies could lead to tailoring the frameworks to represent specific sport development processes and systems.

The origin of "Rare Earth" texture development in extruded Mg-based alloys and its effect on tensile ductility

The extrusion behaviour, texture and tensile ductility of five binary Mg-based alloys have been examined and compared to pure Mg. The five alloying additions examined were Al, Sn, Ca, La and Gd. When these alloys are compared at equivalent grain size, the La- and Gd-containing alloys show the best ductilities. This has been attributed to a weaker extrusion texture. These two alloying additions, La and Gd, were found to also produce a new texture peak with View the MathML source parallel to the extrusion direction. This “rare earth texture” component was found to be suppressed at high extrusion temperatures. It is proposed that the View the MathML source texture component arises from oriented nucleation at shear bands.