Authors
- Hines, Sonia RN, BN, Cert IV TAE, Grad Dip Ed (Adult & Tertiary), MAppSci (Research)
- Ramsbotham, Joanne RN, EM, BN, Grad Cert (Adult Ed), MNursing (Child Health), PhD
- Coyer, Fiona RN, Dip (Nursing), Post Grad Cert Ed (Adults), MSc (Nursing), PhD
Abstract
Review question/objective: The objective of this review is to identify the effectiveness of research literacy interventions on the research literacy of registered nurses.
More specifically, the objectives are to identify: The effectiveness of workplace, tertiary-level educational or other interventions designed to improve or increase post-registration nurses' research literacy, defined as their understanding of research literature and ability to critically interact with research literature, with the aim of promoting the use of research evidence in practice.
Background: Evidence-based practice means "integrating individual clinical expertise with the best available external clinical evidence from systematic research."1(p.71)Standard 3.1 of the Australian national competencies for registered nurses states that the professional registered nurse should practice "within an evidence-based framework" and be able to identify the relevance of research to improving health outcomes.2Of the 13 evidence-based practice competencies for practicing registered nurses, identified in the USA, at least three cannot be achieved at all without the ability to accurately read and understand research.3Melnyk et al.3list the ability to critically appraise both primary and synthesized evidence, and to evaluate and synthesize new evidence as critical competencies for nurses, none of which are achievable without the ability to read and understand research. Internationally, a considerable body of research exists examining why nurses do not use evidence in practice, and consistently the research finds that lack of knowledge about research, or discomfort with understanding research terminology are chief reasons why integrating evidence into practice is not done.4-9If nurses are unable to utilize research literacy skills to determine what the 'best available clinical evidence' is, then logically they will be unable to fully participate in evidence-based practice activities.10
Discussions of evidence-based practice (EBP) frequently state that it is important for nurses for to be "research literate" without exploring how this might be achieved or proposing conceptually what research literacy might look like.11,12Some authors such as Moule and Goodman have proposed a framework of skills the research literate nurse should possess, such as critical thought capacity, analytical skills, searching skills, research critique skills, the ability to read and critically appraise research, and awareness of ethical issues.13Moule and Goodman's skills framework appears to fit well into the "environment" of evidence-based practice1,14and yet still a gap exists between this ideal and the reality of nursing practice. This gap is well-illustrated by the numerous studies into nurses' research implementation and/or translational activities that list nurses' discomfort with research and research terminology as a significant barrier to successful evidence implementation or translation.4,5,7,8,11
A small number of studies investigating nurses' research literacy have been conducted, although few of those deal with the needs of post-registration nurses. Research education is commonly included in undergraduate nursing degree programs, but this does not seem to translate into a strong understanding of research following graduation, or an ability to use it in practice.15Jakubec and Astle describe their policy and guideline critical appraisal program as "successful" in improving second and third-year undergraduates' research literacy and ability to critically appraise evidence; however they did not publish any baseline data.16Participants in Hardwick and Jordan's study of graduate nurses reported they "felt" more research literate after undertaking a post-registration degree, but were unable to provide concrete examples of how this translated to their work or evidence translation activities and research literacy was not defined by these authors.17Research education courses have been found by some authors to be effective for improving nurses' use of and involvement in research18-20however the reported outcomes of those studies have not included any measures of nurses' research literacy.
Despite research literacy's importance for nurses21many nurses report feeling unable to effectively read and understand research, which in turn results in lower research utilization in practice.6Nurses themselves identify poor experiences with trying to understand and use research as factors that contribute to a reluctance to utilize research.22This reluctance often leads nurses to preference other sources of information, such as colleagues, instead.22Meaningful engagement with evidence-based practice requires that nurses have the skills to do more than simply ask colleagues when they have a practice problem.
Different educational strategies have been tested for use in teaching nurses about research. Hamilton reports positive results in teaching advance practice nurses about research by guiding them through a process of "conceptualizing" a research proposal.23Similarly, Jack and colleagues24report positive results in their trial of an EBP course designed to give nurses skills in understanding and utilizing research evidence by the guided development of a proposal for evidence-based practice change. Student-centred problem-based learning has been used to teach an advanced practice nurse curriculum based on evidence-based practice principles with some success; however, it is unclear how much research content was included in the course.25Formal university courses in reading and understanding research have also been trialed in the United Kingdom, with positive responses being reported, albeit without quantitative evidence of improvement.18
No single accepted definition of research literacy for the health sciences has been found to exist, despite extensive searching. For the purposes of this review we propose that research literacy should be defined as "understanding research language and its application to practice" which has been found in use in the complementary therapies literature.26(p.76)This definition encompasses the reading and understanding implicit in the term "literacy"27and the specific functional application required when examining research literacy in particular.
Comparatively few nurses will conduct research during their careers, but the ability to read, understand and utilize research is needed by all nurses.10No current systematic review of this topic has been identified after searching across all major health science databases and Google Scholar. The current research reports conflicting results on the effectiveness of interventions to improve nurses' research literacy and/or knowledge, which points to the importance of conducting a systematic review of this evidence.
Article Content
Inclusion criteria
Types of participants
This review will consider studies that include post-registration registered nurses working or studying in any healthcare or educational setting. Studies including enrolled nurses, assistant nurses, licensed vocational nurses, other equivalent non-registered nurse occupations, or other healthcare workers will be excluded unless the reported data clearly separates the results for registered nurses from other participants. Studies of undergraduate or pre-registration nurses will be excluded.
Types of intervention
This review will consider studies that evaluate the effectiveness of workplace educational programs or interventions conducted in a healthcare organization or tertiary-level educational facility that aim to improve or increase participants' research literacy. These may be short courses, workshops, education for a formal qualification such as graduate diploma or certificate, or other activities with the stated purpose of improving nurses' research literacy. The interventions of interest may be in comparison to different interventions or to usual educational practice, whether historical or concurrent, or there may be a comparison to no intervention at all.
Types of outcomes
This review will consider studies that include the following primary outcome measures: research knowledge or research understanding which may be measured through tests or evaluations, use of research evidence in practice which may be measured through self-report or observational assessments, ability to critically appraise research which may be measured through testing activities such as carrying out the critical appraisal of a systematic review or research paper. Secondary outcomes include EBP self-efficacy, preferably as measured by a validated scale such as the Self-Efficacy in Evidence-Based Practice Scale (SE-EBP)28or the Evidence-Based Practice Self-Efficacy Scale (EBPSE)29.
Types of studies
This review will consider experimental study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, and before and after studies for inclusion.
Search strategy
The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Studies published in English will be considered for inclusion in this review, due to lack of available resources for translations. To maximize the amount of potential inclusions, studies published at any time will be considered for inclusion in this review.
The databases to be searched include: CINAHL, Medline, Cochrane CENTRAL, Web of Science, Embase, ERIC, PsycInfo, Scopus, and Mednar.
The search for unpublished studies includes OpenSIGLE, New York Academy of Medicine Library Gray Literature Report, Conference Proceedings Citation Index- Science (CPCI-S) and Conference Proceedings Citation Index Social Science & Humanities (CPCI-SSH) (via Web of Science), Conference Papers Index, Index of Conference Proceedings, and Dissertation Abstracts International.
Initial keywords to be used will be: "research litera*", "research education", "research knowledge", "evidence-based practice education", education, course, workshop, nurs*, "evidence-based practice", "evidence-based healthcare", "evidence-based nursing", EBP, quantitative, research.
Assessment of methodological quality
Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.
Data collection
Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods, and outcomes of significance to the review question and specific objectives.
Data synthesis
Quantitative data, where possible, will be pooled in statistical meta-analysis using the Cochrane Collaboration's Review Manager 5.2 software. Effect sizes expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed statistically using the standard Chi-square and also explored using subgroup analyses based on the different study designs included in this review. Additionally, the I2statistic will be calculated to further inform estimations of heterogeneity. Where statistical pooling is not possible the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate. If sufficient data is available, subgroup analysis will be conducted to assess whether there are differences in effectiveness between interventions delivered in workplace and tertiary or other formal education settings and to assess differences between interventions delivered to participants with different educational backgrounds.
Conflicts of interest
The reviewers declare no conflicts of interest.
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Appendix I: Appraisal instruments
MAStARI appraisal instrument est message[Context Link]
Appendix II: Data extraction instruments
MAStARI data extraction instrument[Context Link]
Keywords: nursing; nurse education; research education; research literacy