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Nurses’ KAP related to research conduct and utilization: EBNP “are we ready
yet.

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DOI: 10.14419/ijans.v7i1.11814

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 International Journal of Advanced Nursing Studies, 7 (1) (2018) 72-76

International Journal of Advanced Nursing Studies

Website: www.sciencepubco.com/index.php/IJANS
doi: 10.14419/ijans.v7i1.11814
Technical paper

Nurses’ KAP related to research conduct and utilization: EBNP

“are we ready yet.
Dr. Amel Abouelfettoh 1, 2 *,Dr. Elham Al Ateeq 3
1 College of Nursing, King Saud bin Abdul-Aziz University for Health Sciences, KSA
2 Faculty of Nursing, Cairo University, Egypt
3 Imam Abdurrahman Bin Faisal University, College of Nursing, KSA

*Corresponding author E-mail: abouelfettoha@ngha.med.sa

Abstract

Background: Nurses make a positive difference every day and continue to shape the future of healthcare through planning, implementa-
tion and dissemination of quality research studies. The practice of evidence-based nursing is determined by the nurse’s clinical experi-
ence as well as clinically relevant research knowledge, willingness to apply research to practice, and the skills to do so. No previous stud-
ies had been conducted to assess the conduct and utilization of nursing research and EBP in the Eastern province of Saudi Arabia.
Objective: Assess current nurses’ research knowledge, attitude, and practice related to research conduct and utilization and to determine
individual, organizational and contextual factors that predicts nurses’ ability to conduct and utilize research findings into practice.
Methods: Descriptive correlational cross-sectional design utilized to study a convenient sample of 719 nurses working at different health
care sectors in the Eastern Region of KSA. [33] Items Research KAP Survey measured nurses’ KAP related to research© (KAP), a. three
level Likert Scale (ranging from one to 3). Score less than 1.66 is “low, 1.67 to 2.33 is “moderate” and 2.34 to 3.0 is “high”.
Results: A response rate of 89.9% was obtained. Nurses were mostly females, aged between 30 to 40 years. Nurses’ knowledge and
attitude levels were moderate (1.78, 1.88 respectively), however the practice was low (1.31). Individual factors explained 77.4% (R2
= .774, F (5)=458, p<.001), contextual factors explained 8% (R2 = .089, F(4)=15.2, p<.001), and organizational factors explained 77.4%
of the nurses ability to practice evidence based (R2 = .774, F(5)=458, p<.001).
Conclusion: The study findings provide feedback to strengthen nursing research competencies at the regional level and to the Develop-
ment of nursing research-related policies, guidelines, and educational programs for evidence based nursing practice.

Keywords: Evidence- Based; Nursing Practice; Saudi Arabia.

plained in previous research studies by individual, organizational,

1. Introduction and recently contextual factors (Squires, et al., 2011). Traditional-
ly, the factors examined in nursing had been explained to be de-
Evidence Based Nursing Practice (EBNP) becomes the new clini- terminants of research use that are characterized as individual or
cal standard in the nursing profession. The practice of evidence- personal factors, such as; age, attitude toward research use (Chien,
based nursing is determined by the nurse’s clinical experience as et al., 2013), clinical setting factors and prior research knowledge
well as clinically relevant research knowledge, willingness to (Eizenberg, 2011; Sanjari, et al., 2015) as well as the employment
apply research to practice, and the skills to do so. Based on re- status and years of experience in the nursing profession (Wallin, et
search findings, health care agencies and professional organiza- al., 2012). Pryse, McDaniel, and Schafer (2014) explained that
tions are establishing new practice guidelines that maintain high organizational factors also have an influence on the nurses’ re-
quality safe patient care (Deegan, 2013; Asuquo et al., 2013). search conduct and utilization Those factors include: complexity
Therefore, nurses should be able to effectively integrate the results and size of the health care facility, presence of a research champi-
of published research into nursing practice, as well as to expand on, traditionalism, access to, and amount of resources, as well as
the knowledge base by conducting research as a regular part of organizational support and professional autonomy (Abad-Corpa et
clinical practice. The Institute of Medicine (IOM) aiming that by al., 2013).
2020, ninety percent of all health care decisions made evidence More attention is given to contextual factors in promoting research
based (IOM, 2013), previous research have reported that the use of use in healthcare settings. Contextual factors are factors related to
research evidence is often not reflected in the delivery of nursing the setting in which proposed change is being implemented and it
care despite the benefits of adopting research-based practices, and comprised of three dimensions: culture (beliefs and values), lead-
the increased availability of research to health professionals ership (clear roles, teamwork, and effective organizational struc-
(Wangensteen et al., 2011). As a result, patients often do not re- ture, and staff involvement in decision making. Research findings
ceive optimal or effective nursing care. have shown that organizational structures, roles and policies, fa-
Fineout-Overholt and associates (2010) indicated that efforts to vorable organizational climate towards research use, material sup-
change clinical practice can be hindered by various factors includ- port to attend conferences, time to read research, educational ac-
ing individual and organizational barriers. Additionally, variation tivities had significant association with research use among nurses
of research conduct and utilization among nurses has been ex- (Aarons, et al.,, 2015; Melnyk, et al., 2010; Stokke, et al., 2014).
Copyright © 2018 Dr. Amel Abouelfettoh,Dr. Elham Al Ateeq. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
International Journal of Advanced Nursing Studies 73

For nurses to conduct and use research in clinical practice, it is two private hospitals. Table1 shows distribution of the subjects'
very crucial to systematically account for the factors that influence demographics. Nurses were mostly females, working at different
their use and conduct of research within the organizational setting. units, aged between 30 to 40 years, Filipino, with more than 5
To formulate appropriate strategies to account for those factors years of professional experience but less than five years working
and to foster the development of research in daily nursing practice in their current hospital.
at a regional level, the current study aims: to assess current nurses’
research knowledge, attitude, and practice related to research con- Table 1: Distribution of Participants ' Demographic Characteristics
duct and utilization, and to determine the individual, contextual Characteristics Categories Frequency* Percentage
and organizational factors that predict nurses’ research knowledge, Under 30 253 35.3%
attitude, and practice related to research conduct and utilization. Age group 30 – 40 318 44.7%
More than 40 144 20%
Female 632 87.9%
Gender
2. Materials and methods Male 87 12.1%
Saudi 223 30.9%
Filipino 268 37.2%
The study was approved by the Research Scientific Committee at Nationality
Indian 122 17.0%
King Abdullah International Medical Research Center; MNGHA Other 107 14.9%
and IRB approval was obtained. Data was collected during the Diploma 395 54.9%
period from January 2016 to May 2017. Descriptive cross- Level of Education Baccalaureate 308 42.8%
sectional correlational design was used for the purpose of the Postgraduates 16 2.3%
study. Based on a sample size calculation using previous research <3 years 133 19.1%
study (Eller, et al., 2003), a convenient sample of 700 nurses from 3-5 years 200 28.7%
Years of Experience 6-9 years 123 17.6%
different health care sectors (semi-governmental, Governmental
10 years and
and private) in the eastern province of KSA were approached by a 237 34.1%
up
research coordinator to participate in the study. Nurses’ research <3 years 268 37.2%
knowledge, attitude, and practice were measured by Nurses’ Re- 3-5 years 203 28.2%
Years working in the
search KAP Survey© (KAP). The 33 item survey includes three 6-9 Years 114 15.9%
hospital
separate but related scales that measures knowledge, attitude, and 10 years and
112 15.6%
ability to performer activities related to research conduct and utili- up
zation (Burke, et al., 1999; Van-Mullem et al., 1999). The devel- Medical-
298 49.3%
Surgical
opment of the survey items was based on the research utilization Specialty/Unit
Maternal Child 179 29.6%
process steps described in the Iowa Model for Evidence-Based Critical Care 128 21.2%
Practice (Titler, et al., 1994). The survey describe the research 12 hours shift 111 16.7
activities that are categorized under five factors: 1) identifying Hours / shift 8 hours shift 388 58.5
clinical problem, 2) establishing current best practice, 3) imple- Others 164 24.7
menting research into practice, 4) administering research imple- *Note: The total number of respondents in the study was 719. However,
mentation, and 5) conducting and communicating research. Each the ‘total’ categories do vary since some respondents left some of the de-
item describes a research activity, for each activity listed on the mographic questions blank.
survey the participants will indicate their level of knowledge, will-
ingness to engage (attitude), and ability to perform (practice) the About half of the participants (49.1%) had research course in their
specific activity by rating their responses from 1 to 3, with 1 indi- formal nursing education but without a component foundations of
cates “low”, 2 indicates “moderate, and 3 indicates “high”. Sum- EBP, most of them (69.5 %) never attended research meetings or
mary score for each subscale was calculated by totaling responses workshops during their professional life, and did not participate in
for each item and divided by 33 (the total number of survey any research studies (68.8%), only 33% of those participated in
items). Scores from 1.0 to 1.66 considered “low, scores from 1.67 research were the principal or co- investigators, however most of
to 2.33 considered “moderate” and scores from 2.34 to 3.0 consid- them (60.8%) were only participated in data collection (Table 2).
ered “high”. The content, and construct validity, and reliability of
the survey subscales have been established in previous research Table 2: Participants’ Research Experience
Research Experience Responses No. Percent
(Burke, et al., 1999). Demographic data sheet was developed for
Research course during nursing edu- No 336 50.9
the purpose of the study and it includes questions related to indi- cation Yes 324 49.1
vidual factors; age, education, years of experience, previous re- Attend research meetings Or work- No 459 69.5
search activities, organizational support factors; research work- shops? Yes 201 30.5
shops, research activities, participation in research activities, and Is mandatory to attend research work- No 449 68.1
contextual factors; availability of research center, library and ac- shop Yes 210 31.9
cess to data base, an open ended question was asked about how Previously participated No 454 68.8
subjects perceive their work environment as challenging and/or In any research study? Yes 206 31.2
PI 30 14.5
facilitating their involvement in research activities and use of re-
Co-I 41 19.9
search findings in clinical practice. Data was entered into the Sta- If yes, what was your role? Data collection 125 60.8
tistical Package for Social Sciences (SPSS) version18.0. Descrip- Committee
tive analysis was performed to describe sample characteristics and 10 4.8
member
study variables. Regression analysis was used to explain the con- Never 89 13.5
How often do you
tribution of the individual, contextual and organizational to the Read a research article?
Sometimes 532 80.6
nurses' ability to implement evidence based practice after dummy Always 39 5.9
coding of the categorical variables.

3. Results
In the two biggest cities in the Eastern Region of Saudi Arabia,
out of 800 approached nurses, 719 participated, giving a response
rate of 89.9%, out of which 51.3 % from Al Ahsa and 48.7% from
Al Damam city, 153 participants from two NGHA hospitals, 532
participants from four MOH hospitals and 34 participants from
74 International Journal of Advanced Nursing Studies

Table 3: Organizational /Contextual Factors moderate (1.78, 1.88 respectively), however the practice level was
Response Number Percent low (1.31). In terms of subscales scores, the participants’
Is there a library No/I do not Know 11/30 1.7/4.6 knowledge of identifying clinical problems (factor 1) was the
In the hospital? Yes 613 93.7 highest among the nurses in knowledge, attitude as well as prac-
Never 241 36.9
If yes, how often tice the other four factors were low. * Scores from 1.0 to 1.66
Sometimes 399 61.0
Do you use it?
Always 14 2.1 considered “low, scores from 1.67 to 2.33 considered “moderate”
Do you access to internet No/ I do not Know 353 54.1 and scores from 2.34 to 3.0 considered “high.
and data base Yes 299 45.9 Correlation and multiple regression analyses were conducted to
Never 89 13.5 examine the relationship between the nurses EBP score and vari-
Do you read research arti-
Sometimes 532 80 ous potential predictors (individual, contextual and organization-
cles
Always 39 6.9 al). Table 5 summarizes the descriptive statistics and regression
No/ I do not Know 447 71.7 analysis results for nurses’ individual factors (Knowledge, Atti-
Research Center
Yes 176 28.3
tude, Age, Level of education, and years of experience). The re-
sults of the regression indicated the individual factors /predictors
Most of the hospitals have a library (93.7%), but very few of the explained 77.4% of the nurses ability to practice evidence based
participants use it (2.1%). Have no research center or access to (R2 = .774, F (5) =458, p<.001). It was found that EB knowledge
research data base (71.7, 54.1) respectively. Most of the partici- significantly predicted the nurses ability to practice EB (β = .58,
pants perceive their work environment as encouraging for conduct p< .001), as did the nurses' attitude (β = -.35, p< .001), however,
and use of research findings to change current nursing practice. nurses age, education or years of experience did not.
Table 4 shows that Nurses’ knowledge and attitude levels were

Table4: KAP Survey Descriptive Statistics (N = 719)

Knowledge Score* Attitude Score* Practice Score* Total KAP Score*
Mean SD Mean SD Mean SD M SD
Total Scale 1.79 0.67 1.88 0.67 1.31 0.68 1.66 0.67
Identifying clinical Problems 2.04 0.73 2.38 0.69 2.01 0.71 1.66 0.71
Establishing current best practice 1.66 0.63 1.76 0.64 1.02 0.64 1.48 0.636
Implementing Research into practice 1.37 0.69 1.96 0.67 1.11 0.72 1.48 0.69
Administering research Implementation 1.61 0.65 1.88 0.68 1.12 0.68 1.54 0.67
Conducting and communicating Research 1.61 0.65 1.88 0.68 1.30 0.69 1.58 0.67
Total Scale M ± SD 1.68 0.67 1.95 0.67 1.31 0.68 1.64 0.67

Table5: Summary Statistics, Correlations and Results from the Regression Analysis
Variable Descriptive Correlation Multiple regression
Mean ± SD with practice score b β*
Practice Score 1.82 0.51
Knowledge Score 1.80 0.48% 0.58 0.61 0.585***
Attitude Score 1.87 0 .48% 0.79 0.37 0.353***
Education
324 45.1% 0.10 0.03 0.036
(BSN and higher)
Experience > 5 years 360 50.1% 0.11 0.12 0.11**
* P < .05 ** p < .01 ***p<.001.

Table 6: Summary Statistics from Regression Analysis for Contextual Factors

Variable Descriptive Correlation coefficient Multiple regression weights
Practice Score Mean, SD 1.82 0.51 b β*
Long Shifts (12 hours) 111 15.4% -0.17 -0.258 -0.17***
Research course during nursing education 381 53% 0.07 0.05 0.05
Attend research meetings or workshops? 459 63.8 0.21 0.16 0.15
Is mandatory to attend
270 37.6 0.09 0.01 0.009
research workshop/course
Previously participated in any research study? 206 28.7 0.30 0.26 0.24***
* P < .05 ** p < .01 ***p<.001.

Table 7: Summary Statistics from Regression Analysis for Organizational Factors

Variable Descriptive Correlation coefficient Multiple regression weights
Practice Score Mean, SD 1.82 0.51 b β*
Is there a library in the hospital? N,% 613 85.3% 0.25 0.29 0.19*
Access to internet and data base N, % 299 41.6% 0.38 0.31 22*
Research Center N, % 176 24.5% 0.04 0.05 0.05
* P < .05 ** p < .01 ***p<.001.

Results of the regression analysis indicated that contextual factors

/predictors explained only 8% of the nurses ability to practice 4. Discussion
evidence based (R2 = .089, F(4)=15.2, p<.001), long shift (12
hours) previous participation in a research project were signifi-
cantly related to the nurses ability to perform EBP (β = .-.17, p< No previous studies had been conducted to assess the conduct and
.001, β = .24, p< .001) respectively. utilization of nursing research and EBP in the Eastern province of
The results of the regression indicated that organizational factors Saudi Arabia. In order to design interventions that increase re-
explained only 4% of the nurses ability to practice evidence based search use in nursing, it is necessary to address what influences
(R2 = .040, F (2.4) = 9.4, p<.001), presence of a library with ac- research use. The results of the current study provide a baseline
cess to database was significantly related to the nurses ability to for developing a strategic plan aiming to improve evidence based
perform EBP (β = .26, p< .001). nursing practice and will guide the nursing research agenda in the
Eastern Province of Saudi Arabia.
International Journal of Advanced Nursing Studies 75

The results showed that the nurses' attitude scored the highest related policies, guidelines, and educational programs for evidence
compared to the knowledge and practices scores, moreover, nurs- based nursing practice.
es' attitude toward EBP explained about 30% of the nurses' ability
to perform EBP skills. The importance of a good understanding of 5. Recommendations for future research
the attitude, awareness of health professionals about implementa-
tion of evidence-based practice was emphasized (Maaskant, et al.,
2013). Positive attitudes toward EPB will definitely lead to better 1) Development of standard measures of research use.
understanding and implementation of new research evidences into 2) Strong well-designed studies to assess nurses' use of re-
practice. Additionally, nurses' attitude is positively correlated with search and its impact on patient outcomes.
their ability to implement new research evidences into practice 3) Identify strategies to increase the research knowledge and
which was scored low in the current study (Adejumo & Guobadia, skills of nurses.
2013). Nurses’ lack of knowledge about EBP needs to be ad- 4) Compare the evidence-based practice and research utiliza-
dressed. Participants' knowledge level was ranging from low to tion of nurses with other health care professional groups.
moderate and it explains about 60% of the nurses EBP skills. Par-
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