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Exploring the Perception of Nursing Research Held by Hospital Leaders

Noura AlMadani, Maryam Alkhalaf, Fatimah AlZawad*, Nouf Alharbi

Senior Nursing Specialist, Ministry of Health, Dammam, Saudi Arabia

Abstract: Nursing research can help address the healthcare needs of patients, enhancing their health and well-being as well as our nurses. So it is essential that nurses are encouraged to undertake nursing research to provide them with the opportunity to address the issues that could be seen in clinical practice. Moreover, the support of hospital leader in research has an important role in achieving research objectives, particularly with regard to identifying and documenting nursing sensitive outcomes. However, no formal studies had been carried out to explore the perception of healthcare leaders in nursing research across the kingdom. The aim of this study is to explore the level of support from hospital leaders towards conducting nursing research in Eastern province to be able to reach nursing department full potential in enhancing an organization's culture, and reshaping care delivery. A qualitative descriptive design is utilized. using purposive sampling for data collection. The data is obtained from an interview guided by the questions based on Kurger and Casey (2000) that include opening questions; introductory questions; transition questions; key questions; and ending questions. Interview was recorded, transcribed verbatim and analyzed with qualitative content analysis. This is conducted in three Ministry Hospital in Eastern Region with more than 300 bed capacity. Participated by the hospital directors, nursing directors and their deputy. The participants’ expressed perceptions were classified into three key themes: perception on nursing research, area of improvement, readiness in starting nursing research. Across the categories. The participant emphasized a on supporting nursing research. Despite of this many of the participant sought to provide awareness and education in conducting research for nurses to step in the right track. In the studies, among the issues expressed by the participants there is a positive attitude in supporting nursing research. However, nursing research is not taking into the priority of the healthcare organization. In this respect the result of the studies, indicate the need of improvement of nursing engagement in research through awareness and education to increase nurses’ participation.

Keywords: nursing research, leader’s perception, support, hospital, healthcare

Received June 04, 2019; Revised July 17, 2019; Accepted July 29, 2019

Citation: Noura AlMadani, Maryam Alkhalaf, Fatimah AlZawad, Nouf Alharbi, Exploring the Perception of Nursing Research Held by Hospital Leaders. American Journal of Nursing Research, 7 (5). 811-816. January 2019. doi:10.12691/ajnr-7-5-14

1. Introduction

The Saudi Arabian health care system is undergoing major transformation, and there are high expectations from authorities and stakeholders for an extraordinary level of care. The care aspect is emphasised by the Kingdom of Saudi Arabia Vision 2030, and the Ministry of Health (MOH) initiatives in the Strategic Objectives and Vision Realisation Programmes (Vision 2030), which focused on innovation and research. [1]

Nursing research is directly connected to the improvement of clinical practice and promotes evidence based practice [2]. However, the impact of nursing research on healthcare is not well recognised in the Saudi health system [3], and the growth of science in the nursing profession requires innovative nurses who can generate and test new knowledge in clinical practice [4]. Conducting and implementing nursing research are essential nursing skills that require support from the organisation itself [5].

This research study will focus on exploring the perception of nursing research of leaders.

1.1. Significance of the Study

The findings of this study will make a significant contribution to the nursing workforce. This is because research plays an important role in clinical practice today. The greater demand for nurses with a research background justifies the need for a more effective leadership approach. Nurses in management can take many approaches to engaging clinical nurses in research. Each organisation must perform its own assessment to identify areas for improvement. Nursing leadership can exploit these areas to structure a multifaceted approach to supporting clinical staff in the conduct and dissemination of nursing research [6]. Nursing management must provide research support through the development of infrastructure and setting strategies to assist time management and provide funding for researchers. In addition, nursing leadership should establish a solid foundation for research. It includes creating evidence based practice council, linking the goals of the organisation with research initiatives and financing projects [2]. This study will provide a baseline for shaping nursing research in Saudi Arabia. Understanding the authorities’ perception of nursing research and their role in support and enhancing the conduct of research.

1.2. Problem Statement

Nursing research is conducted worldwide to improve the quality of nursing care practices and promote evidence-based culture. However, the impact of nursing research in Saudi Arabia is not evident to healthcare providers. The amount of nursing research conduct is below the anticipated amount in some areas and these areas are addressed in this study. Many nursing graduates and registered nurses note that there are barriers and a lack of support and these reasons prevented them from engaging in research. This study explores these barriers to better understand the phenomenon.

1.3. Research Aim and Objectives

The aim of this study is to explore the level of support for nursing research in the Eastern Province from hospital leaders.

1.4. Objectives

To achieve this aim, this research study has the following objectives:

1. To determine the views of nursing administrators, hospital directors and the heads of nursing education departments regarding the influence of their support on nursing research development; and

2. To critically analyse the data and make recommendations that will encourage and support the future development of nursing research.

1.5. Research Question

This research study has been developed to explore the level of support offered to the conduct of nursing research by hospitals’ leaders in the Nursing research.

2. Literature Review

The current literature was reviewed to gain new insights and understanding on the perception of different leaders about the significance of implementing nursing research in clinical areas. This research will facilitate their role in supporting and encouraging nursing research in the Eastern Region. Hence, there are few literatures available on this topic based in Saudi Arabia.

It is suggested that, the current shortage of nurses is resulting in rejection or delay of new empirical research because of the concentration on existing problems in the system. Almalki, FitzGerald & Clark reported that Saudi Arabia suffers from a lack of nurses [7]. The nurse patient ratio in Saudi Arabia is 36:10,000, whereas in the UK it is 101:10,000 as per the [8]. The staff crisis prioritised the “Saudization” policy. Only one third of nurses in KSA are Saudi nationals, therefore the Saudization of professions will take a significant amount of time [9]. In the last decade, nursing research has mainly been conducted in an academic setting, but recently it has become popular in a clinical setting [5].

Despite this, Sarabia-Cobo et al. [10] cited that 30 to 40% of patients do not receive care that is consistent with available research. [4] reported that several studies completed worldwide, showed a lack of resources, support from leaders and research training were the major contributors to nurses not engaging in research. In addition, organisational culture, perceptions that only medical staff can conduct research, and a lack of hospital executive support were highlighted as barriers [5].

Barriers to conducting nursing research has been investigated internationally and nationally, but there is no evidence demonstrating how to overcome those barriers. Understanding the attitudes of leaders toward nursing research will positively influence the conduct of further nursing research. Furthermore, the majority of the studies investigating the barriers facing nursing research focus on the implementation of the evidence base (research result) in practice, rather than barriers hindering the actual conduct of research.

Chien, Bai, Wang & Lu assessed the levels of perceived barriers to research and the facilitation of research utilisation in practice for 743 register nurses [11]. They found that inadequate organisational support and limited knowledge and skills in research implementation and utilisation were the top ranked barriers, as perceived by nurses.

Hagan and Walden [12] conducted a survey of nurses, with 450 respondents, at a large paediatric hospital to examine barriers to nursing research and to develop the Barriers to Nurses’ Participation in Research Questionnaire (BNPRQ) in preparation for its use at other institutions. They reported the options available to nurses, such as online access to a clinical journal, and the existence of clinical support, such as a medical librarian, which can help nurses to engage with research and develop evidence based practice.

The American Nurses Association (ANA) claims that Registered Nurses (RNs) are expected to be able to conduct research and apply the findings to their practice. The American Nurses Credentialing Centre (ANCC) is pleased to present the next generation model for its esteemed Magnet Recognition Programme. This new model was design to provide a framework for nursing practice and research in the future, as well as serving as a road map for organisations seeking to achieve magnet recognition.

When there is strong leadership support, nurses are more equipped with the resources required to complete a research study. Leadership support through senior management who permitted and strongly encouraged nursing research team members to publicise a study, attend key leadership meetings, and receive supplies and release times for research-related work. [13]

The main motivation is that healthcare leaders have responsibility for practice development within government guidelines and the requirement of a hospital accreditation, such as Central Board Accreditation for Health Institutions (CBAHI) and Joint Commission International (JCI) and governmental policies that aim to ensure good quality care and patient safety.

3. Methodology

This study will explore the issue in an interpretative way and investigate using a descriptive approach and semi-structured interviews. This section establishes the techniques and methods of sampling, data collection, processing, analysis, and the area in which the study is carried out.

Qualitative descriptive design has been selected as the methodology, and it is used to critically analyse, describe and explore the phenomenon of the perception of leadership towards nursing research. Therefore, the use of qualitative descriptive research enables researchers to learn more about the topic from relevant leaders [13,14]. Moreover, the study was conducted to understand the experiences of leaders in terms of the participation of nursing staff in clinical research. Indeed, their interpretative views been taken into account in order to gain further insight into the phenomena [14]. Qualitative methods significantly increase the richness of the information derived and therefore has the capacity to significantly influence the nursing research pathway.

The study was conducted in public hospitals in the Eastern Province of the Kingdom of Saudi Arabia. Purposive sampling was used, as it is a vital source of data collection in qualitative methods, which allows researchers to gain further information from the key informant participants [14]. The participants were selected based on specific criteria, which included position and clinical experience with a leadership background.

Semi-structure interviews were conducted with nine senior leaders, including hospital directors, nursing directors and the head of nursing education from the MOH hospitals in the Eastern Region, who fulfilled the inclusion criteria, until the saturation of data was reached. In qualitative research, data saturation determines the sample size. This is achieved when there is no new information and any additional participants become redundant [14]. However, most researchers use semi-structured interviews as they allow the participants to express their experiences, and talk about their roles and interests in greater detail [15].

The interview question guidelines for this study were based on Kurger and Casey’s (2000) study and included opening questions; introductory questions; transition questions; key questions; and ending questions (Appendix 1).

Two trained investigators completed the interviews and it was audiotaped. Initially, 1-2 interviews were completed and transcribed in a pilot to ensure efficiency of transcription. The interviews were scheduled with the participants for 30-60 minutes during their working hours and at convenient times to prevent disruption of their normal routines.

4. Data Analysis

Interview data transcription was performed based on a qualitative data analysis. This is an appropriate technique given that the framework was used to guide the study methodology in terms of the semi-structured interview guide, where the researchers listen, writes notes, reads and re-reads transcripts. Two members of the research team conducted the interviews with the participants, after the participant signed the Informed Consent form. The participants’ responses were organised into themes as they emerged. The data was transcribed from the recordings in order to facilitate the categorisation and grouping of similar data. The actual process of data analysis involved clustering similar data, according to different themes [16].

Four stages of thematic analysis were used to describe the findings: decontextualisation, contextualisation, categorisation, and compilation.

5. Ethical Considerations

This study obtained official approval from the General Directorate of Medical Research at the MOH. The Research Ethics Committee is responsible for applying research ethics rules and regulations issued by the National Committee of Bio. & Med. Ethics, Reviewing Ethics of the Research (MOH, 2013).

6. Findings and Discussion

This section illustrates the findings and discussion of the research study. The data is presented in form of themes and subthemes, as illustrated in Table 1, where data could not be quantified and explained. The findings have been presented and organised in accordance with the study objectives.

Table 1. Themes and subthemes of the study

An explanation of each of the themes and subthemes is described below.

1. Perception towards nursing research

The general perception towards nursing research was discussed in details with each participant and it was covered in the following subthemes. Most participants agreed that the attitude and awareness of leaders of the beneficial impact of research in hospitals could have a major influence in supporting nursing research.

a. Attitudes of hospital leaders

The hospital directors who participated in the interview were supportive and enthusiastic about nursing research. They viewed nursing as a vital factor in improving healthcare services provided to patients. Most of the participants had a outlook on nursing research, where a majority of them noted that nursing staff was a key improvement area:

"We will not be able to improve quality of care, if we do not support and increase awareness of nursing research" (HD1).

In addition, training and education were identified by the participants as key factors that play an important role in supporting nursing research in clinical areas. According to Hagan & Walden (2017), providing research education to nurses, with online access to the libraries and research studies can improve research competencies among nurses.

Consequently, hospital leaders agree that an and training programme could improve research capabilities among nurses:

"A focus on special training will enhance the participation of nurses in research" (ND2).

With the current national transformation programme of the Saudi healthcare system, there is a momentum towards conducting national and international symposiums. Further, hospital organisations have started to introduce dedicated symposiums for its nurses to encourage them to take an active role in research activities. They aim to develop motivational strategies for those who actively participate in research and to give them privileges, such as scholarships or promotions, which motivates them and improves their interaction in nursing research too.

All of the participants agreed that the current transformation to the healthcare system could positively support the area of nursing research.

“Vision 2030 includes lots of changes that makes us more optimistic, look at things positively and we can feel that from now on” (HD3).

One of the participants was very optimistic about the future of nursing research and she stated that:

“You will see the difference within the upcoming couple of years. Because of the cluster transformation” (ND2).

“I will be glad to start real implementation of evidence based practices and Nursing Research in this hospital” (ND2).

“I see a good future with leadership support and qualified staff” (ND2).

Most of the participants therefore agreed that there will be an improved focus on nursing research in the near future due to the positive evolution taking place in hospitals in Saudi Arabia.

b. Awareness of the importance of nursing research

On this theme, all of the participants commented on their awareness of nursing research, its importance and the requirement for improvement in this area. For example, one of the participants commented:

“Some nurses do not take an active part in research due to personal reasons, some nurses do not want to, it is awareness, and they believe this has nothing to do with the improvement of their work” (HD3.)

It is a common belief amongst the nursing staff that research is scientific and unrelated to the their daily work. Nursing staff, including Head Nurses and Clinical Instructors, need to be educated on how to write proposals, documentation and report writing, as per the comments made by participants:

“We want to increase the awareness among the experienced staff, like Head Nurses and Clinical Instructors, from the beginning, since the performance of Nursing Staff needs improvement with respect to documentation, report writing skills and other weaknesses that may affect patient safety” (NE1).

“This is what we really need; to raise the awareness of research. Then people will start to conduct research, but let them know what research is first!” (NE3).

Nursing leaders agreed on this view of the increasing demand for awareness of clinical nursing research.

“Lack of knowledge is the top challenge, which needs a plan” (ND1).

“We need more research awareness, which is lacking currently” (NE2).

The information that was obtained from this part of the research focused on increasing the awareness of nursing research in the clinical domain and how it will be beneficial to the cluster strategy plan.

2. Level of support

The need for support from the authorities was a common area that was highlighted for improvement by different participants in this theme.

a. High Authority Support

Some of the participants commented that nursing research is not given enough attention in the Eastern Province, while others stressed the importance other factors of support, such as administrative, financial, and moral:

“Research has been dragged to the bottom end of the action list” (NE3).

“There is huge defect in research at Eastern Region (MOH hospitals) and research is not given attention” (HD3).

Some participants mentioned that support from higher authorities is providing enough staff, allowing nurses to be more relaxed and have more time to focus on other tasks, such as conducting research in addition to patient care. Participants agreed that more support is needed from the decision makers to meet the future needs of the Saudi healthcare system in order to transform it. One of the participants stated:

“There is no clear instruction. There is no emotional support. There is no appreciation that you are trying. In the end there is no guidance or clear instruction you will do what you think is right, but there is no one to tell you if this is correct or not” (NE3).

The general perception of the participants was that more leadership support for nursing research is required for the ongoing transformation of the Saudi healthcare system.

b. Education & Training Support

The participants agree that education and training support is a key factor to developing the research capability of nurses. The participants noted that educational courses on evidence based practices and nursing research are key focus areas that need to be established in hospitals. The participants stated that:

“Many nurses didn’t have the basic knowledge and skill to conduct research, for example, writing proposals” (ND2).

“Staff need to be educated about research to improve research productivity” (ND1).

“A lot of nurses didn’t know what is research, so people need to be more educated about research” (ND3).

It is clear from the above quotations that there is a lack of a basic knowledge of nursing research and more emphasis on research training is required. Further, the participants suggested the following:

Ÿ “A research centre to learn and understand how to conduct research” (NE2).

Ÿ “Arrange a workshop for one or two weeks for all of us to learn and participate in nursing research, so we can educate others about it” (NE3).

Indeed, a research education programme should include competencies, including skill, knowledge and attitude, which focus on methodology, the data collection process, analysis and discussion. These topics could be covered on workshops or seminars. This could assist in supporting the development of the research capabilities of nurses in clinical areas.

c. Financial Support

The availability of financial support is vital to the success of nursing research in hospitals. The participants suggested that financial support would encourage both nurses, who are already involved in the research process, and those who are not to conduct clinical research. One participant noted as follows:

"Funding is important and more financial support is needed to sustain/assist research" (HD2)

Funding and the availability of electronic libraries are important aspects of nursing research.

3. Readiness to start nursing research

Most of the participants agreed that introducing research in nursing is important, as it allows nurses to conduct research at their convenience. Moreover, it allows self-direction and it also provides them with the ability to support the knowledge that they have with evidence.

Despite these benefits, the area of research has a greater drop-out rate than other fields. This could be due to barriers such as time and the infrastructure available.

a. Time

Time constraints are considered to be a barrier due to nursing shortages and work overload. The availability of time is key aspect to providing nurses with the opportunity to participate and engage in nursing research, and this was noted by the participants.

The nursing staff are also overloaded with daily work, which makes it difficult for them to make time for new initiatives, such as conducting nursing research. Their work load should be reduced in order to allow them to focus on nursing research, and many participants made comments to this effect as follows:

“Give the time or priority to leave and concentrate on research activities” (HD2).

"Minimise their job tasks" (ND2).

"Leave them to focus on research even if we have a staff shortage” (HD2).

"There is no right time, it depends on us. Once we feel confident, we will move to a nursing research course. We are focusing on competency right now, which will be followed by a nursing research phase around 2020, as per our strategic plan” (NE1).

Further, staff shortages was seen by the participants as a barrier to increasing research productivity, as nurses are occupied with providing care to high number of patients. Reducing this workload would create time for nurses to actively participate in research studies.

b. Infrastructure

Infrastructure is one of the main facilitators required to launch nursing research in hospitals. Some hospitals are already in the process of planning the establishment of a research centre. Others do not have the facilities available to operate nursing research, however they stated that they are willing to support any activities relating to research. Indeed, resources like computers, libraries and databases are lacking is some of the hospitals and these could enhance nursing research activities. Some of the participants commented on this:

"The hospital infrastructure is being changed and they are willing to open a research centre soon, as its function is to regulate and filtrate research production. Building a research centre will facilitate and enhance research production, both medical or nursing research. This can be through bringing in outside speakers and attending certain courses" (HD1).

“Staff shortage is a barrier to increasing research productivity, as nurses are occupied with providing care to a high number of patients” (HD3).

"Several challenges to nursing research are created by a lack of resources, such as not having enough computers, tools, library, databases, and literature review for the nurses to start conducting nursing research. Adding to that, motivation is another challenge; how to motivate nurses to participate in research when they are already overwhelmed with staffing shortages. Nursing education is not different in this aspect and they believe in initiating a research centre" (ND2).

In addition to motivational support, facilities and infrastructure are key factors that are required to enhance the development of, and engagement in, nursing research.

7. Limitations

One of the limitations highlighted in this study is geographical location. There are only three large hospitals in the Eastern Province, which may not be reflective of the views of the leadership teams in the Kingdom of Saudi Arabia in general. Therefore, the findings cannot be extended to wider populations with the same degree of certainty that quantitative analyses can. Ambiguities are recognised in the analysis [17], for example, “zero” (HD2) can be inferred with many different meanings. However, in qualitative research, the main goal for the researcher is to collect in-depth information about the phenomena, not to generalise the result as quantitative [18].

8. Conclusion

This study has demonstrated that the attitudes of hospital leaders and nursing administrators are positive and that importance is placed on research for better patient services and outcomes. However, it was stated that nursing research is not one of the highest priorities in the improvement plan. Further studies are required to evaluate the actual input and plans of leaders to improve the engagement of nurses in research. This study highlights the areas for improvement, such as a requirement for further support and the provision of educational courses to nursing staff, in order to increase their participation in nursing research.

Acknowledgments

The researcher expresses their sincere gratitude and thanks to all of those who assisted in this study.

References

Appendices

Appendix 1

Table

[1]   | Kingdom of Saudi Arabia 2030. http://vision2030.gov.sa/en.
[2]   | Sellars B, M. A. (2013). Transforming care through leadership and research alignment. evidence based practice.
[3]   | Fairman, J. (2008). Context and Contingency in the History of Post World War II Nursing Scholarship in the United States. Journal of Nursing Scholarship 40(1): 4-11.
[4]   | Uys, L. R., et al. (2013). Descriptive survey of the contextual support for nursing research in 15 countries. Curationis 36(1): E1-8.
[5]   | Kelly, K. P., Turner, A., Speroni, K. G., McLaughlin, M. K., & Guzzetta, C. E. (2013). National survey of hospital nursing research, part 2: Facilitators and hindrances. Journal of Nursing Administration, 43(1), 18-23.
[6]   | Scala E., Price C. and Day J. (2016). An Integrative Review of Engaging Clinical Nurses in Nursing Research. The Johns Hopkins Hospital, Baltimore, MD, USA. Journal of Nursing Scholarship, 48:4, 423-430. 423.
[7]   | Almalki, M., FitzGerald, G., Clark, M. (2011). The nursing profession in Saudi Arabia: An overview. Int Nurs, 58. 304-11.
[8]   | World health statistics 2010. WHO Library Cataloguing-in-Publication Data. World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
[9]   | AlYami, M., S., Watson, R. (2014). An overview of nursing in Saudi Arabia. Journal of Health Specialist, 2(1). 10-12.
[10]   | Sarabia-Cobo, C. M., Sarabia-Cobo, A. B., Pérez, V., Hermosilla, C., Nuñez, M. J., & de Lorena, P. (2015). Barriers in implementing research among registered nurses working in the care of the elderly: A multicenter study in Spain. Applied Nursing Research, 28(4), 352-355.
[11]   | Chien, W.-T., Bai, Q., Wong, W.-K., Wang, H., & Lu, X. (2013). Nurses’ perceived barriers to and facilitators of research utilization in mainland china: a cross-sectional survey. The Open Nursing Journal, 7, 96-106.
[12]   | Hagan J & Walden M (2017). Development and Evaluation of the Barriers to Nurses’ Participation in Research Questionnaire at a Large Academic Pediatric Hospital. Volume: 26 issue: 2, page(s): 157-175.
[13]   | Burns, N. and Grove, S.K. (2011). Understanding nursing research: Building an evidence-based practice. 5th ed. Atlanta, GA: Elsevier
[14]   | Pilot D. & Beck C (2017). Essentials of Nursing Research: Appraising Evidence for Nursing Practice. Lippincott Williams and Wilkins; Ninth edition.
[15]   | Hesse-Biber, S. N., & Leavy, P. (2010). The practice of qualitative research (2nd ed.). London: Sage.
[16]   | Streubert, H. J., & Carpenter, D. R. (1999). Qualitative research in nursing: advancing the humanistic imperative (2nd ed.) Philadelphia: Lippincott.
[17]   | Atieno, O. P. (2009). An analysis of the strength and limitation of qualitative and quantitive research aradigms, 13, 13-18.
[18]   | Malterud, K. (2001). Qualitative research: standards, challenges , and guidelines, 358(panel 2), 483-488.
[19]   | American Nurses Credintialing Center (2014). Magnet manual update. https://www.nursingworld.org/organizational-programs/magnet/magnet-manual-updates/
[20]   | Central Board Accreditation of Health Institutions (2014). Hospitals accreditation guide. Retrieved on 12/07/2014 from http://www.moh.gov.sa/depts/Pharmacy/Documents
[21]   | JCI (2014). Our mission. Retrieved on 12/07/2014 from http://www.jointcommissioninternational.org
[22]   | Tingen, M. S., Burnett, A. H., Murchison, R. B., & Zhu, H. (2009). The Importance of Nursing Research. The Journal of Nursing Education, 48(3), 167-170.