The improvement in research orientation among clinical nurses in Qatar: a cross-sectional study
Intended for healthcare professionals
Evidence and practice    

The improvement in research orientation among clinical nurses in Qatar: a cross-sectional study

Albara Alomari Director of nursing research, Hamad Medical Corporation, Doha, Qatar
Kalpana Singh Senior epidemiologist, Hamad Medical Corporation, Doha, Qatar
Nesiya Hassan Research nurse scientist, Hamad Medical Corporation, Doha, Qatar
Kamaruddeen Mannethodi Research nurse, Hamad Medical Corporation, Doha, Qatar
Jibin Kunjavara Research nurse, Hamad Medical Corporation, Doha, Qatar
George Vellaramcheril Joy Research nurse scientist, Hamad Medical Corporation, Doha, Qatar
Badriya Al Lenjawi Executive director of nursing research, Hamad Medical Corporation, Doha, Qatar

Why you should read this article:
  • To understand why there is less nursing research in the Middle East than in other countries

  • To explore an innovative approach to overcome the lack of research knowledge

  • To appreciate how increasing research capacity can benefit nurses and evidence-based practice

Background The main barrier to engaging nurses in research is the lack of research knowledge and skills.

Aim To explore the influence of research workshops on the research orientation of nurses in a large referral hospital in Qatar.

Discussion This article describes a cross-sectional study involving 564 nurses working in 14 health facilities who attended research workshops in Qatar. The authors collected data using the Edmonton Research Orientation Survey (EROS) as well as questions considering support and barriers to research. Descriptive statistics were used to summarise and determine the sample characteristics and distribution of participants. The participants who attended the workshop were found to have a higher orientation towards the EROS sub-scales of evidence-based practice, valuing of research, involvement in research, being at the leading edge of the profession and support for research, compared to those who did not attend the workshop. There was no statistical difference between the groups in the research barrier sub-scale.

Conclusion Despite significant improvements in their responses to the EROS research orientation sub-scales after attending the workshop, the nurses still reported many barriers to being actively engaged in research.

Implications for practice Healthcare organisations should assist with integrating evidence-based practice into healthcare. There is a need for research education for clinical nurses to bring evidence into clinical practice to improve the quality of patient outcomes. Increasing the research capacity of nurses will lead to their emancipation in addressing the flaws in clinical practice and motivate them to use evidence in patient care.

Nurse Researcher. doi: 10.7748/nr.2022.e1863

Peer review

This article has been subject to external double-blind peer review and has been checked for plagiarism using automated software

Correspondence

aalomari5@hamad.qa

Conflict of interest

None declared

Alomari A, Singh K, Hassan N et al (2022) The improvement in research orientation among clinical nurses in Qatar: a cross-sectional study. Nurse Researcher. doi: 10.7748/nr.2022.e1863

Published online: 13 December 2022

Introduction

Improving health care requires providing care based on solid scientific evidence and constant innovation in healthcare practices. Healthcare institutions have acknowledged research as the gold standard for providing safe and effective care. Participation in clinical research is associated with improved organisational healthcare performance (Boaz et al 2015), including increased organisational efficiency, improved patient and staff satisfaction, and decreased mortality rates (Harding et al 2016). However, despite the growing availability of research findings and consensus on the significance of their benefits to the nursing profession, their application in nursing practice remains slow and arbitrary. This gap between research and practice is a global phenomenon that results in patients receiving suboptimal care (Al-Lenjawi et al 2022).

Barriers to evidence-based practice (EBP) in healthcare organisations are complex issues (Lizarondo et al 2019). These barriers may include: a lack of incentives for research and advanced education, inadequate information resources, inadequate human and material resources, and research knowledge that is inadequate for EBP (Shayan et al 2019). Brown et al (2010) explored clinical nurses’ perceptions of research and found participants lacked knowledge about searching for and evaluating research reports. Similarly, Malik et al (2015) concluded that insufficient skills and knowledge in searching for and retrieving research studies prevented nurses from using EBP.

Educational workshops are a commonly recommended strategy for bridging the gap between research and practice and improving research orientation among nurses (Scala et al 2020). Research orientation is defined as the nurse’s attitudes towards and use of research. It is the degree of importance that nurses attach to research compared to other activities such as teaching, administrative duties or engaging with practice (Edgar and Geare 2013). Research orientation is also frequently defined, not only quantitatively through the number of studies or publications, but also in terms of conducting ‘good’ research that improves patient care and staff’s well-being (Messner 2015). It can be improved by providing nurses with the necessary knowledge and skills to conduct high-quality research (Farokhzadian et al 2015).

McCleary and Brown (2002) found that three factors influence research utilisation: individual nurses’ characteristics, such as education; organisational characteristics, such as research climate; and environmental characteristics, such as population density. This article reports on a study focused on nurses’ attitudes toward research utilisation.

Key points

  • Research education is essential to build basic principles of nursing research and develop a positive research orientation

  • Health organisations should provide nurses with educational support to improve their research orientation

  • Barriers to research among nurses are still complex. Healthcare organisations should address the barriers to engaging nurses in research including lack of time and mentorship

Background

The development of the nursing profession in Middle Eastern countries is relatively new, compared to Europe and North America (Boswell and Cannon 2017). Nursing research in Arab countries began early in Jordan, where the first nursing research paper was published in 1951 (Khalaf 2013). In countries including Qatar, the evolution of nursing research has been recent – true scientific research did not begin until the 2000s (Nashwan et al 2017). Furthermore, only a small percentage of nursing research was funded in Qatar and nurses received little national grant funding. However, there has been a recent national call to sponsor undergraduate and graduate programmes to increase the number of postgraduate nurses in Qatar. In line with this national vision of promoting nursing research, the country’s largest healthcare organisation launched the Nursing and Midwifery Research Department (NMRD) to conduct leading-edge research related to Qatar’s health needs. NMRD aims to provide an academic and clinical health research support system to increase nurses and midwives’ engagement in clinical research.

NMRD started a series of educational research workshops to improve nurses’ knowledge and information about research. The ‘Introduction to Research’ workshop is a one-day, face-to-face refresher course related to practices and ethics in nursing research that also provides a brief introduction to research designs. The workshop is considered a first step in promoting research and research culture among the nursing staff. It also serves as a prerequisite course for nurses interested in pursuing nursing research activities. All nurses can attend the workshop. More than 500 nurses attended the workshop over five months between July 2021 and early January 2022.

This study seeks to explore the influence of this workshop on the research orientation of nurses in a large referral hospital in Qatar.

Design

This study is based on critical social science (CSS). The aim of CSS is to empower people and create a transformative awareness, which will serve as a catalyst for action (Fay 1987). Enlightenment, empowerment and emancipation are the means by which CSS achieves its practical purpose (Fay 1987). Societies acquire enlightenment by raising their consciousness and enhancing their awareness of current circumstances (Fay 1987). Education, such as workshops, contributes to raising awareness. Individuals’ enhanced understanding of their current circumstances, such as the significance of research and participation in research activities, will encourage them to act for change (Corbett et al 2007).

Increasing nurses’ awareness of research will make them feel more confident to maximise their participation. In this context, empowerment refers to nurses’ ability to influence their research culture (Glasson et al 2008). The objective of empowerment is emancipation, which enables individuals to act in more satisfying ways (Casey et al 2018). Therefore, CSS could explain the effect of educational workshops on nurses’ attitudes toward research orientation and participation.

Method

A descriptive, cross-sectional research survey design was used. The study was conducted at the largest health organisation in Qatar. This organisation includes 14 health facilities, covering all the medical needs of Qatari residents and citizens. The organisation employs more than 10,000 nursing staff working in different facilities.

Participants

The study’s target population was registered nurses working for the organisation in Qatar. Participants in the study needed to be registered nurses with licences from the Qatar Council for Healthcare Practitioners and working in the health organisation; they also needed to have had at least one annual performance appraisal.

The recruited participants were divided into two groups: the nurses who attended the research workshop and the nurses who did not. Assuming the mean difference between the groups was 0.8, we would require 952 subjects (476 per group) to achieve 80% power and a 5% level of significance. After accounting for a 10% non-response rate, the final sample size required was 1,050 (525 in each group).

Data collection tool

A structured questionnaire was used to collect data in the study. The first part of the questionnaire asked for the respondent’s demographic data. The second part was the Edmonton Research Orientation Survey (EROS) (Peachey et al 2018), which is designed to measure research utilisation and attitudes toward research (McCleary and Brown 2002). EROS has been used with allied health professions to study the influence of educational interventions on the research orientation of nurses (Peachey et al 2018), as well as rehabilitation therapists, occupational therapists, physiotherapists and speech and language therapists/pathologists (Pain et al 2004).

EROS is a valid and reliable self-reporting instrument composed of 38 items in four constructs:

  • 1. ‘Valuing research’: this contains eight items that pertain to positive attitudes toward research.

  • 2. ‘Research involvement’: this contains seven items that measure participation in conducting research.

  • 3. ‘Being at the leading edge’: this contains six items that reflect valuing innovation.

  • 4. ‘Evidence-based practice’: this explores the use of research in practice.

EROS uses a Likert scale to identify a positive orientation towards research, which in turn is associated with increased utilisation of research in clinical practice. The total score and sub-scale scores are calculated by adding the responses to each item and dividing them by the number of items (McCleary and Brown 2002) – they are the mean responses to EROS items and sub-scale items respectively (McCleary and Brown 2002). Higher scores indicate stronger research orientation, with more positive attitudes toward research and participation in research.

The final part of the questionnaire included five items to assess the support for and barriers to applied research.

Data collection procedures

The participants were emailed a link to the questionnaire along with the information sheet. A reminder message was sent every two weeks to increase the response rate. The survey was open for three months (January-March 2022). The data were collected online using a Microsoft form then transferred to Microsoft Excel.

Completion of the survey was considered to imply consent. No identifiable information was obtained and participants were informed that their participation was voluntary.

Results

The proposed sample size was 1,050. However, only 53.7% (n=564) responses to the survey were received: 297 from nurses who had not attended the workshop and 267 from nurses who had. Based on the mean score difference between both groups, the power calculation is 84%, which is justifiable.

Analysis

Descriptive statistics were used to summarise and determine the sample characteristics and distribution of participants’ data. The normally distributed data and results were reported with a mean and standard deviation. A question was included in the questionnaire to split the group for data analysis. The coding –1 as disagree, 0 for neutral and 1 for agree was used to calculate the proportion of every element.

The knowledge, attitude and barriers scores were calculated as the sum of all the questions for different domains. Categorical data were summarised using frequencies and proportions. Associations between two or more quantitative data variables were assessed using the X 2 test or Fisher Exact test as appropriate. All P-values shown were two-tailed and P-values less than 0.05 were considered statistically significant.

Participants’ characteristics

The mean age of participants was 39.0 (SD 7.3). Table 1 provides a breakdown of the other demographic characteristics of the respondents.

Table 1.

Participant characteristics

Characteristicn%
GenderMale15026.6
Female41473.4
PositionRegistered nurse41473.4
Charge nurse549.6
Head nurse346.0
Other6211.0
Clinical nursing experienceLess than two years142.5
Two to five years9717.2
More than five years45380.3
Education levelBachelor’s degree41874.1
Diploma407.1
Master’s degree10017.7
PhD40.7
Specialist20.4
Attended a workshopNo29752.7
Yes26747.3
Knowledge related to researchExcellent346.0
Fair22039.0
Good24944.1
Poor6110.8

Research orientation

Table 2 shows the mean scores for the EROS sub-scales.

Table 2.

Association between the EROS questionnaire components and the group

nr.2022.e1863_0002_tb1.jpg

Evidence-based practice

Overall, the highest scored sub-scale for all participants was EBP at 24.3 (SD 3.2). The 10 items for the EBP sub-scale include research literature, critical appraisal, evaluating the validity of the material, and awareness of information types and sources. The mean EBP score was significantly (P=0.001) higher for those who attended the research workshop (24.7, SD 3.1) compared to those who did not (23.9, SD 3.3).

Valuing research

This sub-scale includes eight items related to cost-effectiveness, research training and activities. The overall mean score was 21.7 (SD 2.3). The mean score was significantly higher (P=<0.001) for those who attended the workshop (22.2, SD 2.0) compared to those who did not (21.2, SD 2.4).

Research involvement

This has seven items, which are related to the professional field, satisfaction related to research, ability to conduct the research and presentation of the research. The overall mean score was 16.1 (SD 3.3). The mean score of those who attended the workshop was 17.0 (SD 3.1), which is significantly higher (P=<0.001) than that of those who did not attend (15.4, SD 3.3).

Being at the leading edge

This is measured by six things: attending conferences, ideas related to clinical practice, new information, the creation of new guidelines and new ways to work based on research. The overall mean score was 15.9 (SD 2.1). The mean score was significantly higher for those who attended the workshop compared to those who did not attend the research workshop (P=<0.001).

Support for research

This sub-scale contains two items: involvement and conduct. The overall mean score was 5.1 (SD 1.0). The mean score was significantly higher (P=<0.001) for those who attended the workshop (4.9, SD 1.0) compared to those who did not (5.3, 0.9).

Barriers to research

Components of this sub-scale include factors related to lack of time, skills and mentorship. The overall mean score was 6.0 (SD 1.8). There was no statistically significant difference between the two groups.

Discussion

Lack of research knowledge is one of the main barriers to engaging nurses in research. The high scores in terms of overall research orientation indicate a positive response to research orientation. The study shows that the education workshop significantly increased nurses’ research orientation in implementing EBP, valuing research, involvement in research, support for research and being at the leading edge of the profession. There is no statistical difference in the barriers to the research sub-scale between nurses who attended the workshop and those who did not attend.

EBP and valuing research were the highest-scoring sub-scales for both groups of participants. This could have been influenced by the nurses’ prior coursework and professional expectations – in Peachey et al’s (2018) pre- and post-test study of nurses who participated in research education sessions, the ‘being at the leading edge’ sub-scale scored higher than ‘research involvement’ and ‘evidence-based practice’.

‘Support for research’ and ‘barriers to research’ received the lowest scores in this study. This contrasts with previous research that found occupational therapists in South Africa, paediatric occupational therapists in Australia and nurses in Australia scored ‘research involvement’ lowest (Henderson et al 2006, Brown et al 2010, Pitout 2013). The increased scores were indicative of their anticipated involvement in research and use of EBP in their intended careers. This could be an outcome of the workshop.

It is promising that nurses reported being willing and motivated to be involved in research. This is consistent with Brown et al’s (2011) pre-intervention/post-intervention study, which assessed changes in 111 nurses’ attitudes and their perceptions about research; this showed that a research workshop was an effective strategy to empower nurses to engage in more research activities. More recently, Black et al (2019) evaluated the effects on nurses of a research training programme and concluded it enhanced nurses’ appreciation for research and their interest in advanced education, as well as the meaningful dissemination of findings to improve patient care. When nurses feel that they are empowered, they are more likely to use research in their clinical practice (Donahue et al 2008).

The nurses who attended the workshop reported in the EBP and ‘valuing research’ sub-scales a higher level of motivation than the non-attending group for incorporating clinical practice based on research findings. This could be because the research knowledge the nurses gained from the workshop was linked to improved self-confidence and the ability to improve their own practice through research (Alomari et al 2020a). The educational workshop raised the nurses’ awareness of their own practice issues and prompted them to think critically about resolving everyday concerns (Balakrishnan and Claiborne 2017). Black et al (2015) found that healthcare organisations seeking to empower clinicians and advance EBP should offer their clinicians research training opportunities.

It is evident in the result of the ‘leading edge’ sub-scale that nurses were more interested in leading research studies after attending the research workshop. As Alomari et al (2020b) also found, the workshop helped the nurses to be competent and use critical thinking to answer clinical questions based on EBP. Consistent with Chen et al (2022), which found that a research training programme for clinical nurses could be used to improve nursing research competence and critical thinking, the findings of this study suggest that a research training programme for clinical nurses could be used to enhance nurses’ research competence. Increasing nurses’ knowledge will lead them to find ways of taking action and enable them to challenge and reframe their current working conditions to conduct research (Van Lieshout 2013).

The participants in this study identified barriers to research and EBP implementation, despite the workshop. These obstacles include a lack of time and resources, and a perceived role in changing practice (Cailor et al 2017). This result is consistent with Loke et al (2014), which found that lack of research knowledge, time and resources from an employing organisation is a barrier to nurses’ engaging in research. To effect positive change, these impediments should be removed (Shirey 2013). The promotion of nursing research culture requires continuous support from organisations (Laschinger et al 2014).

The influence of organisational support was explained by Kanter’s theory of structural empowerment (Kanter 1979). This theory states that access to education, training and educational resources may empower employees and alter their beliefs and attitudes concerning engagement in research (Christie et al 2012).

Limitations

This study used a convenience sampling method to recruit participants and is limited in its generalisability. Furthermore, it was not intended to compare participants’ knowledge and attitudes before the course and afterwards to determine whether the changes were a result of its influence.

Research output, which includes the publication of research articles and oral presentations of research, is a measure of participation in research. However, no information regarding research outputs, such as publications, was collected for this study.

Self-reporting questionnaires may contain social desirability bias, which is the tendency for participants to present a more favourable image of themselves (Van de Mortel 2008). The participants may believe the information they report, or they may feign their answers to abide by socially acceptable norms or avoid criticism. Socially desirable responses are most likely to occur in socially sensitive questions (Van de Mortel 2008).

Conclusion

Research education is essential for those who lack research knowledge, to build basic principles of research and develop a positive research orientation. Furthermore, nurses should have the opportunity to receive continuing education about applying research evidence to clinical practice to achieve higher professional standards.

The findings from this study strongly recommend the need for research education for clinical nurses to bring evidence to clinical practice to improve the quality of patient outcomes. However, the nurses who attended the workshops still reported many barriers to being actively engaged in research. These barriers should be addressed at the organisational level.

Healthcare organisations should promote research to address the nursing workforce’s research interests and explore their attitude toward research and the use of research findings. Finding new innovative ways to engage nurses and reduce the barriers to their engagement in research will add value to nursing professional practice and promote evidence-based practice.

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