The role of nurse leaders in supporting the use of nursing research in acute care

1. The role of nurse leaders in supporting the use of nursing research in acute care By: Dan Fraser, Heidi Fraser & Kelda Hagell

2. Definitions: • Nurse leader (NL) • Nursing Research (NR) • Evidence-based practice (EBP) • Knowledge translation (KT)

3. Outline: • Introduction • Literature Review • Research Question • Theoretical Frame • Research Tradition • Methods • Ethics • Rigour • KT • References

4. Introduction • The aim of this study is to understand how nurse leaders (NL) support the use of research into nursing practice in the acute care setting.

5. Significance of the study: • Improve client outcomes • Competency of the RN • Many nurses are not supporting research in their practice • Numerous barriers to supporting research evidence in acute care

6. Initial Search Strategies:

7. Literature review process Works reviewed:

8. Literature Review • Key concepts: • Knowledge to action gap • Many frameworks, models and methods • Multiple barriers & supports • Power imbalance

9. Gaps in the literature: • Power imbalance as a barrier • No discussion of why organisational barriers exist • Limited research on the organisational infrastructure needed to support acute care nursing leaders in EBP • Deficit regarding the role of the nursing leader in promoting EBP

10. Methods used in the literature: • focused ethnographic approach • semi-structured interviews • nonexperimental quantitative designs decriptive, cross-sectional study and descriptive survey design • systemic literature reviews • qualitative descriptive methodological approach and telephone interviews

11. Purpose statement: • The purpose of this institutional ethnographic (IE) study is to understand the NL’s role in supporting research evidence into nursing practice in acute care. At this stage in the research the NL’s role in supporting research to practice will generally be defined as knowledge transfer (KT).

12. Theoretical Frame • Transformative framework (TF) • - use to reflect power and social relations within society (Creswell, 2013) • - attempt to provide a voice to marginalized groups affected by oppression, domination, suppression, alienation, and hegemony (Creswell,, 2013) • - TF’s stress that knowledge should be used to enhance social justice, further human right and respect cultural norms (Mertens, 2010).

13. Why TF? • Nurses are an oppressed group within health care settings (Roberts, Demarco, & Griffin, 2009). • Nurse leaders have been forced to promote the agenda of power in health care settings as opposed to their own nursing agenda (Roberts, Demarco, & Griffin, 2009). This power imbalance limits nurses ability to advocate for KT. • Exposing this power imbalance will enable NL’s to promote social justice within the workplace, and enable them to provide EBP

14. How TF? • Identify NLs’ as an oppressed group with healthcare settings and attempt to give them a voice • collaboration between researcher and participant in designing questions, collecting data, analyzing data, shaping final reports will empower NLs’ and level the power balance between researcher and participant (Karnieli-Miller, Strier, & Pessach, 2009).

15. Research Methodology = Institutional Ethnography - Institutional ethnography (IE) as described by Dorothy Smith (2005) in the book “Institutional Ethnography: A sociology for the people:.

16. Institutional Ethnography (IE) • Assumptions: • NL’s are a cultural group • NL’s everyday actions are determined by the influence of social forces they are not full aware • Inquiry using IE can expose the influence of social forces • Focus • Not on providing rich account of NL’s experiences but showing how ruling relations influence NL’s actions

17. Methods: Types of data used in IE • Entry level data – describe how individuals act and their experiences (Campbell & Gregor, 2002). • Level two data – fills in missing information that explains the experiences of the individuals (Campbell & Gregor, 2002).

18. Methods: Data Types and collection methods • NL’s – participant observation and semi-structured interviews • Texts- multiple kinds of charting documents, workload measurement grids, professional journals, educational textbooks, doctor’s orders, hospital administrative policy, staff memos, health care policy

19. Sample strategy and recruitment • Convenience strategy • Recruitment form acute care setting in large metro hospital • Initial sample size 20

20. Data analysis in IE • Analysis in IE doesn’t receive much attention (Walby, 2012). • Analysis methods need refinement (Walby, 2012). • Presentation of analysis frequently weak (Campbell and Gregor, 2002) • Literature we’ve encountered using IE did not have separate analysis section and did not give details about analysis

21. Goal of our analysis To show how NL’s conduct with respect to KT is affected by ruling ideas and practices

22. How we did our analysis… • Listening method described by Walby (2012) • 4 levels of analysis – • - 1st show how one’s views influence production of transcript • - 2nd how participant narrates their sense of self • -3rd multiple voices affecting reflecting the broader sense of self • 4th how cultural discourses and structural forces shape participants capacity for action

23. Why the listening guide? • Consistent with IE in that (Walby, 2012): • both promote critical appreciate of power • narrative as a way of assessing the voice of the interviewee • understanding of self as socially produced and enmeshed in relations with others

24. References • Bellman, L., Webster, J., & Jeanes, A. (2010). Knowledge transfer and the integration of research, policy and practice for patient benefit. Journal of Nursing Research, 16(3), 254-270. doi: 10.1177/1744987110385271 • Boyatzis, R., E. (1998). Transforming Qualitative Information. Sage Publications Inc: Thousand Oaks, California, USA. • Campbell, M., & Gregor, Frances. (2002). A Primer in doing institutional ethnography. Garamond Press: aurora, Ontario. 2. Canadian Institute of Health Research. (2012). More about knowledge translation at CIHR. Retrieved October 13th, 2012 from http://www.cihr-irsc.gc.ca/e/39033.html 3. Canadian Nurses Association. (2012). Competencies. Ottawa, Ontario. Retrieved October 13th, 2012 from http://www.cna-aiic.ca/en/becoming-an-rn/rn-exam/competencies/ 4. Canadian Nurses Association. (2009). Position Statement: nursing leadership. Ottawa, Ontario, Canada Retrieved October 12th, 2012 from http://www2.cna-aiic.ca/CNA/documents/pdf/publications/PS110_Leadership_2009_e.pdf 5. Creswell. J., W. (2013). Qualitative Inquiry & research design: Choosing among five approaches (3rd Edition). Sage Publications: California, USA. 6. Estrada, N. (2009). Exploring perceptions of a learning organization by RNs and relationship to EBP beliefs and implementation in the acute care setting. Worldviews on Evidence-Based Nursing, 6(4), 200-209. doi: 10.1111/j.1741-6787.2009.00161.x

25. References 7. Graham, I.D., Logan, J., Harrison, M.B., Straus, S.E., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: time for a map? The Journal of Continuing Education in the Health Professions, 26(1), 13-24. Retrieved from http://www.amchp.org/programsandtopics/data-assessment/Documents/Knowledge%20Translation%20Training%202011/Graham_Logan%20et%20al_2006_Lost.pdf 8. Houlston, C. (2012). The role of a research nurse in translating evidence into practice. Nursing Management, 19(1), 25-28. Retrieved from http://web.ebscohost.com.libproxy.stfx.ca/ehost/pdfviewer/pdfviewer?vid=4&hid=24&sid=87f44e3d-9348-4fa0-846a-ff433672dbd0%40sessionmgr10 9. Kajermo, K.N., Unden, M., Gardule, A., Eriksson, L.E., Orton, M.L., Arnetz, B.B., & Nordstrom, G. (2008). Predictors of nurses’ perceptions of barriers to research utilization. Journal of Nursing Management, 16, 305-314. doi: 10.1111/j.1365-2834.2007.00770.x 10. Karnieli-Miller, O., Strier, R., & Pessach. L. (2009). Power relations in qualitative research. Qualitative Health Research, 19, (2), 279-289.

26. References • 11. LoBiondo-Wood, G., Haber, J., Cameron, C., and Singh, M.D. (2009). Nursing research in Canada, methods and critical appraisal for evidence- based practice, 2nd Canadian Ed. Toronto: Elsevier • 12. McGibbons, E., Peter, E., & Gallop, R. (2010). An institutional ethnographer of nurses’ stress. Qualitative Health Research, 20(10) 1353- 1378. • 13. Mertens, D., M. (2010). Transformative mixed methods research. QualatativeInquiry, 16, (6), 469-474. • 14. Roberts, S., J., Demarco, R., & Griffin, M. (2009). The effect of oppressed group behaviours on the culture of the nursing workplace: a review of the evidence and interventions for change. Journal of Nursing Management, 17, 288-293. • 15. Smith, Dorothy, E. (2005). Institutional Ethnography: A Sociology for People. AltaMira Press: Maryland, USA. • 16. Walby, Kevin. (2012). Institutional ethnography and date analysis: making sense of date dialogues. International Journal of Social Research Methodology, 1-14.

27. References 10. Profetto-McGrath, J., Negrin, K.A., Hugo, K., & Smith, K.B. (2010). Clinical nurse specialists’ approaches in selecting and using evidence to improve practice. Worldviews on Evidence-Based Nursing, 7(1), 36-50. doi: 10.1111/j.1741-6787.2009.00164.x 11. Rogers, J.L. (2009). Transferring research into practice: an integrative review. Clinical Nurse Specialist, 23(4), 192-199. doi: 10.1097/NUR.0b013e3181a8ca63 12. Sandstrom, B., Borglin, G., Nilsson, R., & Willman, A. (2011). Promoting the implementation of evidence-based practice: a literature review focusing on the role of nursing leadership. Worldviews on Evidence-Based Nursing, 8(4), 212-223. doi: 10.1111/j.1741-6787.2011.00216.x 13. White-William, C. (2011). Evidence-based practice and research: the challenge for transplant nursing. Progress in Transplantation, 21(4), 299-305. Retrieved from http://natco.metapress.com/content/w856605361j271lg/fulltext.pdf

28. References