Running head: UTILIZATION OF NURSING RESEARCH

The Utilization of Nursing Research in Extended Care Facilities

By

Ellenor Chance

Coppin State University

A Non-Thesis Paper Submitted to the Faculty of the School of Graduate Studies of

Coppin State University in Partial Fulfillment of the Requirements for the
Degree of Master of Science in Nursing

Approvals
Advisor: _____________________________________

Date:______________

Chairperson:__________________________________

Date:______________

Area Dean:___________________________________

Date:______________

Dean, Graduate Studies: ________________________

Date:_____________

Format used: Publication Manual of the American Psychological Association, 6th edition

UTILIZATION OF NURSING RESEARCH

ACKNOWLEDGEMENTS
I would like to express my appreciation and gratitude to Dr. Tilghman and Dr. Hinds
whose expertise, leadership, and patience guided the completion of this non-thesis paper. In
addition, I would also like to thank the rest on the graduate nursing faculty.
In conclusion, I would like to thank my mother, Charlene Johnson and Father, Willie
Chance whose support helped me throughout this process.

UTILIZATION OF NURSING RESEARCH

Abstract
The title of this clinical project is The Utilization of Nursing Research in Extended Care
Facilities. The purpose of the project is to investigate the utilization of nursing research by
registered nurses practicing in extended care facilities because extended care services are
reportedly suboptimal. Individuals are living longer with chronic diseases and comorbidities that
may have them require extended care services. These trends suggest, that there is a need for
extended care nurses to be active in the utilization of research and evidence based care, to ensure
that quality care is delivered to this growing population. The clinical project question was, Are
registered nurses utilizing nursing research in extended care facilities? The clinical project
question was expanded upon by using Rogers Diffusion of Innovation theory as the conceptual
framework. Diffusion of Innovation theory describes the manner in which innovations become
adopted within social networks. After reviewing literature on the topic, a power point
presentation was put together, and the findings were presented to a group of nurses working in an
extended care facility in Baltimore City. After the presentation, participants completed an
evaluation form and a survey which assessed each nurses current research practices. The
presentation was conducted with adherence to Coppin State University School of Graduate
Studies standards. Research was not conducted; therefore, there was no need to seek approval
from Coppin State Universitys Institutional Review Board. Participation in the presentations
was voluntary. Full disclosure and confidentiality was provided throughout the presentation.

UTILIZATION OF NURSING RESEARCH

TABLE of CONTENTS
Chapter 1-The Problem
Introduction.6
Significance of the Clinical Project.8
Statement of the Problem.9
Purpose 9
Research/Clinical Project Questions9
Assumptions.9
Theoretical Definitions.9
Operational Definitions...10
Summary..10
Chapter Two-Literature Review
Introduction.12
Utilization of Nursing Research Globally.......................................................13
Utilization on Nursing Research in Hospital Settings.....15
Utilization of Nursing Research in Extended Care Facilities......15
National Agencies16
Conceptual Framework.17
Summary...19

UTILIZATION OF NURSING RESEARCH

Chapter Three-Methodology
The Design of the Clinical Project .20
The Clinical Project Limitations 20
The Clinical Project Setting....20
The Sample for the Clinical Project............21
Procedures for the Clinical Project .....21
Protection of Human Subjects.21
Clinical Project Tools/Instrument....21
Clinical Project Analysis.22
Summary..22
Appendices...25
Appendix 1...26
Appendix 2...................................................................................................27
Appendix 3...28
Appendix 4.......30
References ...31

UTILIZATION OF NURSING RESEARCH

Chapter One- The Problem

Introduction
Nursing has evolved over the years into a professional practice through the use of nursing
research and evidence based practice (Alligood & Tomey, 2010). However, Solomons and Spross
(2010) report that nurses are not utilizing research based practices at the bedside, instead they
obtain information from each other. Bostrom, Kajermo, Nordstrom, and Wallin (2008) suggests
that for nurses to understand evidence based care; there is a need to understand dissemination
and implementation of research findings and factors that impact research use.
Flynn, Liang, Dickson, and Aiken (2010) found that supportive nursing environments are
associated with increased patient outcomes. These types of nursing environments focus on
activities aimed at developing professional nursing practice through education and research. In
reviewing the literature on research utilization, it is evident that researchers looked more often
than not at nurses working in acute care settings, when assessing research utilization in clinical
practice. It was difficult to locate articles on research utilization in extended care facilities.
Bostrom et al., (2008) found that evidence of research utilization in nursing home settings is
scarce and that it is inappropriate to extrapolate hospitals findings into nursing home settings
because the context of care is different.
Professional development through the use of nursing research in nursing homes settings
is a phenomenon that has gained global attention. An international task force was convened in
2010 by the International Association of Gerontology and Geriatrics in partnership with the
World Health Organization, to address gaps in clinical practice in nursing homes, and give
recommendations for improvement (Tolson, 2011). The recommendations focused on enhancing

UTILIZATION OF NURSING RESEARCH

the reputation of nursing home practice through strengthening leadership, clinical practice,
quality care, education, and research (Tolson, 2010).
Increasing health care cost and numbers of individuals living longer with chronic
diseases calls for health care professionals to be equipped and competent to provide care. The
Center for Disease Control and Prevention (2007) projects that over the next 25 years the number
of persons age 65 and older is expected to double. The cost for providing care to the elder adult
is 3-5 times higher than younger adult care (CDC, 2007). In 2005, Medicare spent $336 million
dollars towards older adult care (CDC, 2007). These trends suggest that many of these
individuals will at some point face admission into an extended care facility, thus admission rates
and cost of extended care is expected to rise(National Nursing Home Survey, 2004). Therefore,
there is a need to assess research utilization in extended care facilities because care is suboptimal
and research utilization is associated with increased patient outcomes and improved quality of
care (Bostrom et al., 2008).
Extended care facilities have become an integral part of the health care system. Shorter
hospital stay leads to admission of sicker residents into extended care facilities. Katz, Karuza,
Intrator, and Mor (2009) reports that this trend has increased functional dependence, co morbid
conditions, and the use of highly technical interventions in both short term and long term
residents. Only 1.6% of nursing home residents require no assistance with activities of daily
living (ADLs), such as bathing, eating, dressing, toileting, and transferring. In fact, more than
half of all nursing home residents require assistance or are totally dependent with all ADLs
(NNHS, 2004). Although most nursing home residents are dependent on nursing staff for care,
the quality of care being delivered in nursing homes is suboptimal (Katz et al., 2009).

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Significance of the Clinical Project
Assessing the utilization of nursing research in extended care facilities is significant
because evidence based care increases quality of care and improves patient outcomes. As it
stands, extended care facilities nursing care is suboptimal and information on research
utilization in this setting is scarce (Bostrom et al., 2008 & Katz et al., 2009). The National
Nursing Home Survey identified areas in which quality of care was deficient in extended care.
Deficient areas included admission into ED departments while in the care of a nursing facility,
pressure ulcers, falls, poly pharmacy, and poor pain management (NNHS, 2004). The use of
nursing research may offset deficits in these areas and improve patient outcomes.
Assessing the utilization of nursing research in extended care facilities is significant for
nurses because negative extended care facility images decreases the reputation of extended care
facilities, staff morale, and recruitment and retention rates (Tolson, 2010). In addition,
information on this subset of nurses utilization of research in clinical practice is lacking.
Therefore, information gained from this clinical project may add to the body of knowledge.
The clinical project is significant for the United States because applying research and
evidence based care may potentially improve patient outcomes, avoid excessive health care
spending, and decrease costs. Each year the U.S. spends billions of dollars in Medicaid costs to
help cover the expenses of extended care facility care (CDC, 2007). The amount spent is
projected to double by year 2030(CDC, 2007)
Statement of the Problem
Suboptimal nursing care places nursing home residents at risk for detrimental events and
decreases quality of care, while the utilization of nursing research and evidence based care is

UTILIZATION OF NURSING RESEARCH

associated with improved patient outcomes. The extended care nurses utilization of research in
clinical practice is scarce (Bostrom et al., 2008)
The Purpose of the Clinical Project
The purpose of this clinical project is to bring awareness to the need to assess the utilization of
nursing research in extended care facilities since current literature is scarce. This may help to
decreases incidences of deficiencies as identified by the National Nursing Home Survey. In
addition, assessing the utilization of nursing research in this setting is important to ensure that
health professionals are making attempts to achieve Healthy People 2020s goal of improving the
health, function, and quality of life in the elderly population (Healthy People, 2020).
Clinical Project Question
Are registered nurses utilizing nursing research in extended care facilities?
Assumptions
The basic assumption is that nurses working in extended care facilities are not using
research because nursing home care is reportedly suboptimal.
Theoretical Definitions
The following are theoretical definitions for this study:
Registered Nurse- A registered nurse holds a valid state nursing license. This person uses the
nursing process in the care of clients. Responsibilities include providing education on health
promotion and counseling. In addition, nurses administer medications, interprets patient
information, uses critical thinking, coordinates care in collaboration with other health care
professionals, directs and supervise personnel, and participates in research activities (American
Nurses Association, 2012).
Utilization: to make use of or turn into practical use (Merriam-Webster, 2012).

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Research- The use of systematic, controlled, empirical, and critical investigations in an attempt
to discover or confirm facts that relate to a specific phenomenon (Alligood and Tomey, 2010)
Extended care facilities- a facility that offers sub-acute care to patients requiring inpatient care
but who do not require continuous hospital services. These facilities admit patients who require
convalescent or restorative services, rehabilitative services, and patients with terminal disease
requiring maximal nursing care (Department of Health and Mental Hygiene, 2007).
Operational Definitions
The following are operational definitions for this study:
Registered Nurse- A nurse who holds a valid license in the state of Maryland with no actions
against the license. The nurse must be working either full time or part time in an extended care
facility.
Utilization- The practical application of research findings in clinical practice. The use research
materials (articles and/ or journals) in clinical practice areas.
Research- Any nursing research based practices used by the RN in the clinical practice area.
This includes reading of research journal or articles.
Extended Care Facility- An inpatient nursing facility (nursing home) that provides extended care
to patients after discharge from an acute care hospital setting.
Summary
Nursing research and evidence based practice is associated with improved patient
outcomes. Nurses, however, are not utilizing research in clinical practice areas. Most studies on
the utilization of nursing research assessed nurses practicing in hospital settings. Little is known
about extended care nurses research utilization. This is crucial because individuals are living
longer with chronic illnesses that increase the likeliness of being admitted into an extended care

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facility. In addition, the cost of providing care to the elderly population is 3-5 times higher than
with younger adults. Despite these trends, Flyn et al., (2010) found that nursing home care is
suboptimal.

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Chapter Two Literature Review

Introduction
The utilization of nursing research and perceived barriers to care are two interrelated
topics that have been looked at in depth in research practice. The utilization of nursing research
is often affected by the Registered Nurses perceived barriers such as inability to understand
research and lack of time to apply research findings into clinical practice areas (Brown, Ecoff,
Kim, Wickline, Rose, et al., 2010). In addition, organizational barriers, such as a lack of
supportive environments and management teams that foster research utilization, greatly impact
the dissemination of research and its use in practice (Brown, et al., 2010). This review of
literature aims to look at the utilization of nursing research and perceived barriers to research
utilization across the health care continuum, and will generate insight into the utilization of
nursing research in extended care facilities. This literature review will flow from broad to
specific and examine nursing utilization globally and end with nursing research utilization in
extended care facilities. In an attempt to understand the global view of the utilization of nursing
research and perceived barriers to research, findings of studies from Hong Kong, Nigeria,
Sweden, Iran, and Turkey were analyzed. In Sweden, it was found that the barriers to research
utilization increased with competence and experience (Andersson, Jylli, Kajermo, and Klang,
2007). Hong Kong nurses appreciated the value of research but felt they lacked organizational
support to implement research into daily practice (Chau, Lopez, & Thompson, 2008). Turkish
nurses found research to be important but did not participate in research activities (Uysal, Temel,
Ardahan, & Ozkahraman, 2010). Research utilization was low in Nigeria because nurses did not
understand statistical analysis and language used in research reports (Ofi, Sowunmi, Edet, &
Anarado, 2008). Iranian nurses felt they lacked time to read research and implement findings into

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daily practice (Mehrdad, Salsali, & Kazemnejad, 2007). These items were selected for review
because demographics of the nurses in each country are substantially different, thus providing a
good mix of nurses to represent a global view of nursing research utilization. Also, this review
will look at utilization of nursing research and perceived barriers to research regarding nurses
working in acute care hospitals within the United States. This topic was selected for review
because many studies conducted on the utilization of nursing research are more often than not
conducted with nurses working in acute care hospital settings; therefore, information on this
subset of nurses is robust and deserves review. Mcloskey (2008) found that many nurses
working in acute care settings are not utilizing nursing research in clinical practice. In addition,
the paper will review information on the utilization of nursing research and perceived barriers to
utilization in extended care facilities. Information gained will support or refute the claim that
there is a knowledge gap within this subset of nurses utilization of nursing research. The
literature review will conclude with a description of the environments nurses working in
extended care facilities endure, the cost of extended care facilities, and the nations goal of
improving the quality of care delivered to the elderly population, as outlined by national agencies
such as the Center for Disease Control and Prevention (CDC) and Healthy People 2020.
Utilization of Nursing Research Globally
Increasing problems in the international healthcare systems, such as limited financial
resources, rising health care costs, and shortage of health care professionals, specifically nurses,
are being improved upon as per the utilization of research findings which are deemed globally
important (Baernholdt & Lang, 2007). However, studies have shown that internationally nursing
research findings are not implemented because of barriers to research utilization (Uysal, Temel,
Ardahan, & Ozkahraman, 2010; Mehrdad, Salsali, & Kazemnejad, 2008; Chau, Lopez, &

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Thompson, 2008; Ofi, Sowounmi, Edet, & Anardo, 2007; and Anderson, Jylli, Kajermo, &
Klang, 2007). These barriers include lack of interest in research, insufficient time to apply
research findings to clinical practice, lack of authority to change practices, inability to
understand research findings, and unsupportive organizational climates (Uysal et al., 2010;
Salsali et al., 2008; Chau et al., 2008; and Ofi et al., 2007). In Turkey. Uysal et al (2010) found
that 72.2% of nurses stated they did not read any research journal and only a quarter of these
nurses were professionally interested in nursing research. Chau et al (2008) found that nurses in
Hong Kong understood the value of research and of implementing appropriate research findings.
However, they felt they lacked the authority to facilitate change (Chau et al, 2008). In Iran, the
prominent factor influencing research utilization was the lack of adequate facilities for nurses to
practice and use research evidence (Salsi et al., 2008). In Nigeria, the most pertinent barrier to
research utilization was an inability to understand research reports and statistical analysis (Ofi et
al., 2007). A study conducted on a group of Swedish nurses found that the nurses perceived
barriers to research were not due to organizational discord but were due to nurses perceived
professional self (Anderson et al., 2007). The study concluded that the nurses professional self
was independent of educational level and work experience and that barriers to research
utilization increased with the nurses competence and experience level (Anderson et al., 2007).
While each country shared a different barrier to research utilization, most shared the common
theme of organizational change and leadership involvement in addressing the identified barriers
to research utilization (Uysal, Temel, Ardahan, & Ozkahraman, 2010; Mehrdad, Salsali, &
Kazemnejad, 2008; Chau, Lopez, & Thompson, 2008; Ofi, Sowounmi, Edet, & Anardo, 2007;
and Anderson, Jylli, Kajermo,& Klang, 2007).

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Utilization of Nursing Research in Hospital Settings

In the United States, many accrediting agencies, such as The Joint Commission on
Accreditation, recognize that research utilization and evidence based practices are necessities in
improving healthcare quality (Brown, Ecoff, Wickline, & Glazer, 2008). However, studies show
that many nurses working in acute care settings are not utilizing nursing research in clinical
practice (Mcloskey, 2008; Brown et al., 2008; and Brown et al., 2010). There is no concrete
answer as to why nurses fail to utilize research in clinical practice areas. McCloskey (2008)
found that differences exist between the nurses perceptions of research based upon education
level and position within the health care organization. Many of the advanced degree nurses and
those in management positions in this study were more apt to model care based upon research
findings (McCloskey, 2008). Although many studies connect research utilization to actual or
perceived barriers using the BARRIERS scale, Brown, Kim, Ecoff, Wickline, Rose, et al.(2010)
found that the BARRIERS scale has minimal influence over the implementation of evidence
based practice for most hospital nurses. They concluded that it is unclear whether reducing
research barriers will increase research utilization among staff nurses (Brown et al., 2009). In
addition, they recommend more research to assess the relationship between barriers to research
utilization and the implementation of evidence based practice (Brown et al., 2010).
Utilization of Nursing Research in Extended Care Facilities
Extended care facilities admission rates are increasing with one in two women and one
in four men over the age of 65 being admitted into extended care facilities (Mathews, 2012).
Despite these trends, the quality of care in nursing homes is inconsistent and suboptimal (Katz et
al., 2009). Bostrom, Nilsson, Kajermo, Nordstrom,and Wallin (2008) state that nurses working
in the care of older people have relatively little use for research, despite positive attitudes

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towards nursing research similar to nurses working in acute hospital settings. In addition, they
suggest that a supportive organizational structure will increase the utilization of nursing research
in the care of the elderly (Bostrom et al., 2008). Flynn et al (2010) found that supportive nursing
practice environments have initiatives aimed at maintaining and supporting professional nursing
practice through education and research. In their study, Flynn et al (2010) found that supportive
nursing practice environments had a positive effect on quality outcomes in extended care
facilities; these facilities received fewer deficiency citations, and pressure ulcer acquisition rates
were decreased. While some believe that nursing practice will improve the quality of care
delivered in extended care facilities (Flynn et al., 2010; Bostrom et al., 2008), Katz et al (2010)
propose that the consistent presence of a physician specialist in extended care facilities may
increase the quality of care. They additionally postulate that a consistent physician presence in
nursing homes positively influences extended care facility residents hospitalization rates,
functional status, and satisfaction.
National Agencies
According to the NNHS (2004), there are almost 1.5 million nursing home residents in
16, 100 facilities within the U.S, and this number is projected to double by 2050. The average
length of stay for nursing home residents is 835 days with a median stay of 463 days (NNHS,
2004). Nursing home expenditures currently exceed $120 billion dollars per year, and this figure
is projected to double by the year 2015(Katz et al., 2009). On average, a nursing home resident
will be charged a fee of$ 4,000-12,000 dollars monthly for nursing home services (Mathews,
2012). Even though extended care admission rates are high, staffing levels remain low with 7
registered nurses per 100 beds, 11 licensed practical nurses per 100 beds, and 35 nursing
assistants per 100 beds (NNHS, 2004).

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The CDC (2007) projects that over the next 25 years the number of adults age 65 and
older is expected to double. These individuals will account for approximately 20% of the United
States population (CDC, 2007). This is due to improved medical care and preventive health
services. The cost for providing care to older adults is 3-5 times higher than providing care to
those who are younger than 65 (CDC, 2007). The overall cost in Medicare spending for
providing care to older adults was $336 billion dollars in 2005 compared to a mere $37 billion
dollars spent in 1980 (CDC, 2007). Increasing health care costs and an increasing number of
individuals living longer with a chronic disease calls for health care professionals to be equipped
and competent when providing care to this vulnerable population.
Improving health care services to the elderly population through providing evidence
based care and practices meets Healthy people 2020s goal of improving access to quality
comprehensive health care (Healthy People, 2020). It is known that evidence based care
improves patient outcomes and increases quality of care; for these reasons the utilization of
nursing research must be attempted. In addition, access to safe and reliable long term and
palliative care services are emerging issues for the U.S because the numbers of individuals
requiring these services are projected to increase (Healthy People, 2020).
Theory/ Conceptual Framework
Rogers Diffusion of innovation theory will be used to guide this research. Rogers theory
looks at the process through which new innovations become adopted within social networks.
This theory was selected to guide this research because according to Roger (2003), diffusion
research has a pragmatic appeal in getting research results utilized (pp. 104105). Murray
(2009) suggests that innovation diffusion is general and may be applied to all fields of research.
In turn, Rogers theory is frequently used to assess the utilization of nursing research in different

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practice areas because of this consistency; Thusly it is appropriate to use this theory to assess the
utilization of research in extended care facilities.
Rogers diffusion of innovation theory is a five step process that assesses diffusion,
innovation, communication channels, time, and social systems in research utilization (Bostrom et
al., 2008). Diffusion is defined as the process in which an innovation is communicated through
certain channels over time (Bostrom et al., 2008). The innovation is defined as an idea that is
perceived as new by persons (Bostrom et al., 2008). The communication channels, either internal
or external, are the ways the messages are spread between individuals (Bostrom et al., 2008).
Time represents the process that the individual uses to adopt or reject the new information
(Bostrom et al., 2008). The social system represents the group or members involved in the new
idea, who share a common goal, although typically the function of each member may vary
(Bostrom et al., 2008). Based upon this process, an individual may adopt, implement, or
institutionalize the new idea (Murray, 2009). Adoption occurs when individuals seek or acquire
the new idea; implantation occurs when the new idea is tested or practiced, and
institutionalization occurs when the idea is fully supported and practiced daily (Murray, 2009).
Rogers Diffusion of Innovation theory has implications for assessing the utilization of
nursing research in extended care facilities. Four elements of Rogers theory will be expanded
and related to key elements discussed in this study. A diffusion model will be used to assess the
extent registered nurses working in extended care facilities are utilizing evidence based practices
and nursing research. In this study, the nurses utilization of research will represent the diffusion
aspect of Rogers model. It is proposed that if nursing professionals are utilizing research, then
this process would have occurred. The types of research being used in the extended care facilities
will represent the new idea or innovation. The study will assess nurses use of communication

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channels such as journal articles, internet, television, and word of mouth in research
dissemination. In doing so, insights will be gained as to whether or not extended care nurses are
accessing and disseminating nursing research findings. Time will be used to assess how long it
takes nurses to adopt or reject the innovation. Lastly, there will be an examination of extended
care facility policies and organizational structures in an attempt to locate evidence of research
utilization. This will represent the social system element in Rogers theory because organization
characteristics and social networks of a facility render it more or less likely to adopt a new
innovation (Murray, 2009).
Summary
Ensuring access to safe and reliable long term and palliative care services are emerging
issues for the United States and surrounding countries; therefore, emphasis is placed on the
utilization of nursing research to increase patient outcomes. After reviewing the literature on
research utilization, it is clear that little is known about extended care nurses research practices.
Extended care facilities are expected to have an increase in admission rates due to individuals
living longer with chronic diseases and co morbidities (CDC, 2007). For these reasons,
assessment of extended care nurses utilization of nursing research using Rogers Diffusion
theory is imperative.

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Chapter Three-Methodology
Introduction
Bostrom et al., (2008) reports that for nurses to understand evidence based care; there is a
need to understand dissemination and implementation of research findings and factors that
impact research use. Most studies on research utilization investigates registered nurses working
in hospitals settings. It is inappropriate to infer upon a hospitals findings, in relation to extended
care settings because the context of care is different (Bostrom et al., 2008). A literature review
was performed on the topic and findings were presented to a group of nursing home nurses. This
chapter will review the design of the clinical project, limitations, setting, sample, procedures,
protection of human subjects, and instruments used. In addition, this chapter will discuss
participants feedback.
Design of the Clinical Project
A quantitative descriptive design was employed to explore and describe the utilization of
nursing research in extended care facilities. A descriptive research design will generate additional
information on the utilization of nursing research in extended care facilities because little
information exists on this subset of nurses research utilization. Thusly, this research design will
help to answer the question, what is the utilization of nursing research by registered nurses caring
for elderly patients in extended care facilities? Subjects would be selected using a convenience
sample of registered nurses employed in an extended care facilities in Baltimore, Maryland.
The clinical project was presented power point presentation. Several different clip art
caricatures were used to emphasize points. Also, graphs and pie charts were used to present
statistical data. A short descriptive survey was administered at the end of the presentation to
assess the research utilization of each participant. Key points of the presentation were presented

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in the form of a newsletter that participants were allowed to keep as a reference. In addition,
participants were asked to complete an evaluation form at the end of the presentation for
feedback and future use.
Sample
A sample of Registered Nurses would be obtained from at least three inner city extended
care facilities using convenience sampling techniques. Inclusion criteria for participation in the
study would be as follow: subjects must hold a valid RN license for the state of Maryland with
no prior actions taken against the license, must be able to speak English and give consent, and
work either full time or part time in an extended care facility or nursing home setting. A
description of participants for the study would be a target of at least 30 English speaking RNs,
who work either full time or part time in extended care facilities. Age, gender, and education
level of subjects will vary because there are no restrictions on these variables. Licensed Practical
Nurses (LPNs) were excluded from this study because research utilization is not within their
scope of practice and the researcher aims to assess the utilization of research by Registered
nurses.
The sample for the clinical project was selected using convenience sampling. The sample
included 10 registered nurses whose educational background ranged from associates degree to
Masters prepared. Nurse duties ranged from bedside care to nurse manager. In addition, one
nurse practitioner, a dietician, and two physical therapists attended the presentation.
The Clinical Project Limitations
This sampling technique is a weak approach to sampling because it provides little
opportunity to control for biases (Burns & Grove, 2009). To increase validity and decrease
limitations, future projects could incorporate a larger sample of registered nurses working in

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extended care facilities. In addition, setting restrictions on extraneous variables such as age and
educational level may decrease the opportunity for biases. The clinical project presentation was
limited to registered nurses working at the extended care facility during the day of the
presentation, who were willing to participate in the presentation. This mix of nurses may not
adequately represent nurses practicing in extended care facilities on a larger scale. Therefore,
feedback from the presentation is not likely to yield generalizable findings.
The Clinical Project Setting
The setting for this clinical project was an extended care facility in Baltimore, Maryland.
The project was presented in the main conference room at the extended care facility. A projector
were used to display the power point presentation. The lights in the conference room were
dimmed during the presentation for better view of the projector. The temperature in the room
was comfortable for everyone in attendance. Participants were seated at a round table, with
comfortable chairs. All participants were provided lunch, they also received educational
handouts, and mementos.
Procedures for the Clinical Project
The participants for the project were selected at an extended care facility in Baltimore
city. An email was sent initially to the facilitys nurse educator explaining the clinical projects
objectives and seeking approval. Approval for the presentation was given via email. After
approval was given, participants received a flyer about the presentation content, setting, and
time.
Protection of Human Subjects
The clinical presentation placed human subjects at very minimal physical risk; however,
steps were taken to maintain the protection of human rights such as, right to self-determination,

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right to privacy, and right to confidentiality. All aspects of the presentation were explained to the
participants. They were allowed to voluntarily participate in the study. Participants privacy was
maintained. No unnecessary personal information was obtained or used without prior participant
authorization.
Clinical Project Tools/Instrument
A research assessment survey was used to assess each individuals current research
practices, this tool was created by the presenter for presentation purposes only. However, to
conduct this study and gather information on research utilization, The Research Utilization
Questionnaire (RUQ) is the recommended tool. This instrument was developed in 1986 and
updated in 1989 by Champion & Leach (Mcloskey, 2008). The RUQ consists of 46 items,
however, only 10 questions would be used for this proposed study. The items will be taken from
the research use subscale, which focuses on the degree to which nurses incorporate research into
their daily practice. Items on the subscale are rated on a 5 point Likert scale that ranges from 1
(strongly disagree) to 5 (strongly agree). The RUQ has an internal consistency range of 0.84 to
0.94 and a Cronbach alpha of .93 (McCloskey, 2008). The instrument was validated by a panel of
experts for content validity and found to be appropriate for assessing research utilization
(McCloskey, 2008).
Clinical Project Analysis
After the clinical project presentation, an evaluation form was presented for participants
to complete. The evaluation form consists of 11 questions describing the effectiveness of the
presentation on a scale of strongly agree to strongly disagree. All reviewers strongly agreed that
the presentation was effective, specifically the presentation style and the use of visual aids.
However, one reviewer did suggested using a larger font on the power point presentation.

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Descriptive information was included on the evaluation forms, which included information such
as age or reviewer, educational level, and years as a nurse. The clinical assessment survey
consisted of 5 questions assessing each nurses current research practices. It was found that 40 %
of nurses were comfortable with research, 40% had previously participated in research, 20%
were aware of research currently being conducted in their facility, 40 % felt that their facility
encouraged research, and all of the nurses felt that there is a need to assess the utilization of
nursing research in extended care facilities.
Summary
In this chapter, methods and procedures to present the clinical project were used in
accordance with standards and guidelines set by Coppin State Universitys School of Graduate
Studies. The clinical project was presented to a group of nurses working in an extended care
facility in Baltimore City. The sample consisted of at least 10 registered nurses with varying
degrees of education, level of experience, and age. Based upon findings of the research
assessment survey, all of the participants felt that the utilization of nursing research in extended
care facilities is a topic that is important and needs further review. The evaluation tool proved
that the reviewers strongly agreed that the presentation content, organization, presentation style,
and use of visual aids were all used effectively.

UTILIZATION OF NURSING RESEARCH

APPENDECIES

Appendix 1

25

BARRIERS TO RESEARCH UTLIZATION

UTILIZATION OF NURSING RESEARCH
Newsletter

Lack of interest, lack of time, lack ability to

change practices, inability to understand 26
research findings, and unsupportive
organizational climates
EXTENDED CARE FACILITIES

THE UTILIZATION OF NURSNG RESEARCH IN

EXTENDED CARE FACILITIES
NURSING RESEARCH
Scientific process that validates and existing
knowledge and generates new knowledge that
directly and indirectly influences the delivery of
evidence based nursing care.
EVIDENCE BASED PRACTICE
Use of the best research evidence to support clinical
decision making and improve health outcomes of
patients.

The quality of care in many U.S nursing homes

remains less than optimal. Most notably the
presence of pressure ulcers (important indicator
of the QUALITY of nursing home care) have
increased and now 11% of all nursing home
residents have pressure ulcers, of these 76% are
stage 2 or higher.
Many nursing homes receive deficiency
citations during federally mandated nursing
home inspections and continue to cycle in and
out of deficiency states.
NNHS identified 6 areas of improvement this
included ED admission rate, falls, poly
pharmacy, pressure ulcer acquisition, and pain
management.

UTILIZATION OF NURSING RESEARCH

27

IMPLICATIONS
Individuals are sicker and living longer with chronic
diseases and may at some point require extended care
services. The delivery of suboptimal nursing care in
RESEARCH QUESTION
Are registered nurses utilizing nursing research in
extended care facilities?

these facilities decreases quality of care, patient

outcomes, and leads to excessive health care spending.
For these reasons, it is imperative that registered nurses

INTERVENTIONS
An international task force was convened to address
the gaps in clinical practice in nursing home settings.

working in extended care be active in the development

and utilization of research in the elderly population. The
utilization of nursing research in extended care facilities

Recommendations focused on enhancing the

reputation of nursing homes through strengthening
leadership, clinical practice, and quality of care,
education and REASEARCH.

may decrease incidences of deficiency citations and

improve patient outcomes.

INTERACT clinical tool that being used in NH to

decrease hospital admission rates.
Ellenor Chance RN, BSN

UTILIZATION OF NURSING RESEARCH

28

Appendix 2
Research Assessment Tool
Created by Ellenor Chance RN, BSN
Using the key, please answer the following questions regarding the utlization of nursing research.
KEY
1.Yes

2. No

3. Somewhat

4. Not Sure

1. Are you comfortable are you with research?

2. Have you participated in any research projects at work?
3. Are you aware of any research thats currently being conducted in your facility?
4. Do you feel that your facility encourages research?
5. Do you see a need to assess the utlization of nursing research in exteded care facilities?

Appendix 3
THE UTILIZATION OF NURSING RESEARCH IN EXTENDED CARE FACILITIES
Evaluation form created by Ellenor Chance RN, BSN

UTILIZATION OF NURSING RESEARCH

Please Complete:
Title of position:
Years of experience:
Educational Level (Please Circle): Diploma in Nursing, ASN, BSN, MSN, DNP,

Please rate the following items on a scale from by circling the appropriate number:
Strongly Disagree (1), Disagree (2), Slightly Agree (3), Agree (4), Strongly Agree (5)

Content and Organization

The introduction section was effective
The Objectives were clearly stated
The presentation was appropriate for the audience
Presentation Style
Presenter was professional
Presently was knowledgeable about the subject material
Pace of the presentation was appropriate
Eye contact maintained
Visual Aids
Slides were easy to read
Slides were relevant and communicated content effectively
Presenter provided handouts
Suggestions/ Comments for future presentations?

Appendix 4
Power Point Presentation

29

UTILIZATION OF NURSING RESEARCH

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