Disseminating Research Evidence To Breast Care Nurses: The Case Of Exercise For Breast Cancer Patients

Background: Historically, nursing has struggled to introduce researchbased interventions into routine clinical practice. Reasons for this difficulty range from poor communication between clinically and academically based nurses to limitations within organisations that obstruct the implementation of new ideas. Aims: To identify the barriers to research utilisation and the preferred methods of research dissemination amongst breast care nurses (BCNs), to develop a dissemination intervention for BCNs and to evaluate a dissemination intervention for BCNs. Method: The study was conducted in three stages. In Stage 1, a national survey was conducted using the Barriers to Research Utilisation Scale (Funk et al. 1991), questions about dissemination preferences and a demographic questionnaire. In Stage 2, the Conceptual Framework for Selecting a Targeted Experimental Dissemination Method based on social interactionalist theory was developed. In Stage 3, a pre-test/post-test randomised controlled design was used to evaluate the dissemination method developed in Stage 2; the unit of randomisation and analysis were hospital clusters of BCNs. Sample: 263 BCNs from 13 regions within the U.K. comprised the sample in Stage 1. In Stage 3, the sample consisted of 92 BCNs from 62 hospitals in the north of England. Analysis: In Stage 1 analysis was undertaken using descriptive and nonparametric statistics. In Stage 3, analysis consisted of descriptive statistics 19 and clustered regression techniques with estimation of robust standard errors: clustered logistic regression for knowledge items, clustered linear regression for knowledge scores, ologit for attitude and reported practice items and clustered multiple regression for paired and multiple variable analyses. Findings: The results from the Barriers Scale revealed ‘statistical analyses not understandable’, ‘insufficient time on the job to implement new ideas’, ‘facilities inadequate for implementation’, ‘research not reported clearly and readably’ and ‘no time to read research’ as the greatest barriers to research utilisation. Free text responses revealed additional problems with communication and conditions within provider organisations and identified facilitators for research utilisation and dissemination. These data led to the selection and production of a targeted information booklet, entitled Exercise and Breast Cancer: A Booklet for Breast Care Nurses, specifically designed to be accessible, time efficient, understandable and relevant to the target audience. In evaluation, the booklet was shown to overcome the perceived barriers of the sample associated with accessing and understanding research. A statistically significant increase in knowledge and changes of reported practice and attitudes were found. Robust variables affecting knowledge acquisition were identified as the promotion of health, promotion of exercise and understanding of how exercise can reduce cancer-related fatigue. Implications: This study has demonstrated that printed materials can be used as an effective dissemination method provided that they are developed in line with the needs, values and context of a target audience. The 20 Conceptual Framework can be followed to develop similar booklets on different topics and could provide a purposeful contribution to the promotion of evidence-based practice for all nurses