32 © 2007, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses Volume 11 Issue 1
in infl uencing the ability of nurses to apply
research evidence to their practices.
To begin, let’s focus on using a research
implementation framework. One of the more
popular research implementation frameworks
used in nursing is the Promoting Action on
Research Implementation in Health Services
(PARIHS) framework, which was developed by
Kitson and colleagues in the United King-
dom (Kitson, Harvey, & McCormack, 1998;
Rycroft-Malone, 2004; Rycroft-Malone et al.,
2002). Their framework, created from collective
experience gained from research, quality im-
provement and practice development projects,
suggests that successful use or implementation
of research into clinical practice is a function of
three elements: evidence, context and facilita-
tion. These three elements, each with their own
Putting Evidence Into PracticeDoes the Workplace Really Matter?
Shannon Scott-Findlay, RN, PhDErna Snelgrove-Clarke, RN, PhD(c)Mandi Newton, RN, PhD
sSince the inception of the “Evidence & Out-
comes” column, we’ve tackled a host of issues
related to putting research into practice, rang-
ing from the frank questions of “Is there a place
for research in my clinical practice?” and “What
are the benefi ts to research-based practice?” to
the dilemmas of using evidence that doesn’t
“fi t” with clinical expertise, and the challenges
of using clinical practice guidelines. In this
article, we discuss the role of the workplace
February | March 2007 Nursing for Women’s Health 33
subelements, are thought to have a synergistic
relationship, with each positioned on a high-to-
low continuum. According to the framework,
for implementation of research to be success-
ful, there must be clarity about the nature of
the evidence (“high” evidence), the quality of
the practice environment (“high” context) and
how evidence is “assisted” into practice (“high”
facilitation). The assumption underpinning
the framework is that if each subelement is
deemed to be high, then implementation is
more likely to be successful. For example,
under the element “evidence,” there are three
components—research, clinical experience and
patient preferences. Evidence is deemed to be
high if knowledge from randomized controlled
trials, systematic reviews and evidence-based
guidelines are used and if there are high levels
of consensus and partnerships between patients
and health care professionals in determining
treatment plans.
Keeping this framework in mind, the issues
discussed in previous “Evidence & Outcomes”
columns have focused exclusively on the state
of the evidence, whether that be the benefi ts
of putting research into practice, how to use
clinical practice guidelines (a form of evidence)
and the implementation of research evidence
when clinical experience, practical wisdom
and research evidence are incongruent. In this
article, we’ll shift focus and begin to untangle
some of the challenges of a second element of
the framework: Context.
The Workplace As ContextTraditionally, the onus to integrate research
fi ndings into everyday practice has been placed
on individual practitioners. This is consistent
with the era of personal and professional re-
sponsibility. This onus contributes to an inad-
equate understanding of the infl uence organiza-
tional context has on practitioners’ research use
behaviors. In addition, lack of understanding
regarding the infl uence of context in research
use is one of the greatest barriers to using
research in clinical practice. Specifi cally, the
context in which nurses work shapes a broad
host of patient and organizational outcomes,
including nursing retention, sick time and qual-
ity of care. Therefore, it stands to reason that
nurses’ ability to read and use research in their
practice is shaped by their work environment.
The appeal of the PARIHS framework is that
it emphasizes that to put research into clinical
practice, we need to look at more than simply
identifying high-quality research.
Research utilization scholars have con-
sistently identifi ed the organizational envi-
ronment, or context, as an important factor
infl uencing research use and health care
professionals’ behaviors (Brett, 1987, 1989;
Crane, 1989; Stetler, 2003). However, they
haven’t examined the infl uence of context in
great detail. This is likely due to the complexity
of organizational context. Context is the overall
environment or setting in which practice takes
place (Kitson et al., 1998; McCormack et al.,
2002). Organizational context is a broad term
for the practice environment. It has three
subelements that contribute to an organiza-
tion’s complex nature: culture, leadership and
evaluation (Kitson et al.; McCormack et al.,
2002) (see Box 1). In the PARIHS framework, a
high context would be characterized as valuing
Box 1.
Elements That Constitute a Practice Environment (Context)
Culture is expressed in terms of accepted patterns of physical, cognitive, affective and social behaviors of the individuals who work in the organization.
Leadership refers to leaders’ approaches to managing conflict and relationships, building teams, implementing solutions and responding to everyday work situations to achieve one or more particular goals.
Evaluation is both part of the research process that generates evidence on which to base practice and is part of the feedback process that demonstrates whether or not changes in practice are appropriate.
Shannon Scott-Findlay,
RN, PhD, is a postdoctoral
fellow in the Department
of Pediatrics, Faculty of
Medicine and Dentistry at
the University of Alberta,
Edmonton, Canada.
Erna Snelgrove-Clarke,
RN, PhD(c), is an assistant
professor in the Faculty
of Nursing, Dalhousie
University in Halifax,
Canada.
Mandi Newton, RN, PhD,
is a postdoctoral fellow in
the Faculty of Nursing at
the University of Alberta in
Edmonton, Canada.
DOI: 10.1111/j.1751-486X.2007.00115.x
34 Nursing for Women’s Health Volume 11 Issue 1
continuing education and patient-centered
care, as well as having clear leadership, effec-
tive teamwork and measures to evaluate work
processes and other aspects of the environment.
To illustrate, culture is expressed in terms of
accepted patterns of physical, cognitive, affec-
tive and social behaviors of the individuals who
work in the organization. Leadership occurs
within the organization’s context and refers to
leaders’ approaches to managing confl ict and
relationships, building teams, implementing
solutions and responding to everyday work
situations to achieve one or more particular
goals (Cummings, Mallidou, & Scott-Find-
lay, 2005). Finally, evaluation is both part of
the research process that generates evidence
on which to base practice and is part of the
feedback process that demonstrates whether or
not changes in practice are appropriate. In the
PARIHS framework, evaluation is acknowl-
edged to include multiple methods and sources
of feedback. Therefore, considering the element
of context in this framework, research uptake is
more likely to occur when there is a high con-
text—that is, when there are receptive cultures,
strong leadership and appropriate evaluative
systems.
Infl uences of the WorkplaceOther conceptual work demonstrates how the
culture of a nursing work environment, in par-
ticular, can affect how research is or is not used
by nurses in their day-to-day work. Scott-Find-
lay and Golden-Biddle (2005) argue that there
are at least three different ways in which culture
infl uences the research-use behaviors of prac-
titioners (see Box 2). First, the organizational
approach to work infl uences how practitioners
do or don’t use research in their practice. In
much of nurses’ work, the researchers found a
strong organizational preference for “doing”
and looking busy—that is, doing tasks is valued
over developing relationships with patients and
refl ecting on one’s practice; looking busy is val-
ued over sitting and a fast pace is valued over a
slower pace. Using research in clinical practice,
Successful use or
implementation of
research into clinical
practice is a function
of three elements:
evidence, context
and facilitation.
Box 2.
Three Ways the Workplace Can Infl uence Research Use
1. The organizational approach to work influences how practitioners do or don’t use research in their practice. For example, in a culture where “doing” tasks and appearing “busy” are valued, nurses may be less likely to take the time to read research and consider how to apply it to their practices.
2. The organization’s culture influences what types of knowledge are perceived as important or rel-evant, and which health care professionals (e.g., doctors, nurses) think it’s acceptable to use research for guiding practice decisions. For exam-ple, in a culture where discussing research find-ings on rounds is considered acceptable, nurses may be more likely to want to apply research to their practice.
3. The structuring and organization of nurses’ work shapes how they use or do not use research. For example, in a culture where interaction and col-laboration with colleagues is limited or is not fos-tered, nurses may be less likely to read research and apply it to their practice.
February | March 2007 Nursing for Women’s Health 35
however, requires opportunities and time for
nurses to refl ect on their clinical practices and
to keep abreast of research relevant for their
practices.
Second, the researchers found that cul-
ture infl uences what types of knowledge are
perceived as important or relevant, and which
health care professionals (e.g., doctors, nurses)
think it’s acceptable to use research for guiding
practice decisions. Refl ect on your own practice
environment for a moment. For instance, what
type of knowledge (e.g., research, experiential)
is valued in patient rounds? Is research knowl-
edge even considered in this space?
Finally, the researchers found that the struc-
turing and organization of nurses’ work shapes
how they use or do not use research. Again, if
nurses’ work is oriented toward “doing” tasks,
less time and space will be allocated for forums
for interacting and collaborating with col-
leagues on using research in practice.
The Role of LeadersSo, does the workplace matter in the pursuit of
research-based practice? We think it does and
we’re convinced that most nurses would agree
that their work setting shapes the decisions they
make at work (e.g., the infl uence of institu-
tional priorities and values) and how they’re
able to carry out their work (e.g., through the
accessibility of resources). There are organi-
zational or institutional reasons why nurses
do or don’t use research in their practices. We
feel that leadership, as part of organizational
context, has an important role in creating
organizational contexts that are conducive to
research-based practice. As Cummings et al.
(2005) suggest, “Research use does not happen
in a vacuum without resources, without being
sanctioned within the organizational culture,
without being convenient when multiple priori-
ties face the practitioner, and without having
some perceived benefi t” (p.7). Leaders can be
critical in developing workplace environments
where research use is expected, where resources
are allocated to facilitate research use and where
time and space are set aside for nurses to have
the opportunity to participate in activities to
use research. While much responsibility for
making research-based practice a reality in
today’s health care institutions remains at the
bureaucratic level (management-level decision
makers), leaders at the hospital unit level where
nurses work have a signifi cant role. The work-
place does matter! NWH
In the next “Evidence & Outcomes” column, we’ll
focus on strategies nursing leaders can use to cre-
ate work environments that foster research use.
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Cummings, G., Mallidou, A., & Scott-Findlay, S. (2004). Does the workplace infl uence nurses’ use of research? Journal of Wound, Ostomy and Continence Nursing, 31(3), 106–107.
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Lack of under-
standing regarding
the influence of
context in research
use is one of the
greatest barriers to
using research in
clinical practice.