This paper addresses two dimensions of evidence-based nursing practice. The first section analyzes a 2004 journal article by Chaney and Glacken examining perceived barriers and facilitators to implementing research findings in Irish nursing practice, reviewing its background, literature review, methodology, data analysis, and conclusions. The second section presents an annotated bibliography of ten peer-reviewed sources on collaborative nursing interventions in mental health therapeutic care, identifies common themes across those sources, summarizes the evidence base, and proposes a specific collaborative nursing intervention strategy drawn from experiential and evidence-based knowledge across nursing, medicine, and related disciplines.
The following analysis is based on: Chaney, D. & Glacken, M. (2004). Perceived barriers and facilitators to implementing research findings in the Irish practice setting. Journal of Clinical Nursing, 13, 731–740.
The researchers drew on information from previous studies — such as Treacy & Hyde (2003) — to establish background for the research. The background indicates that nurses increasingly recognize the role of research in daily practice; however, evidence shows a lack of actual application of research results in practice. The researchers identify the background of the study as the absence of empirical investigations into the barriers to implementing research findings in nursing practice.
The researchers conducted a review of the literature to support the topic and to find evidence of the barriers to applying research in nursing. The findings from this review indicate an increased awareness among nurses of the importance of research findings. Barriers identified in the literature include nurses' negative perceptions of research (Camiah, 1997; Baessler et al., 1994), communication and organizational barriers (Kajermo et al., 1998), and negative nurse attitudes. The review of literature was used to construct the background of the research in terms of the accessibility of research findings to nurses, nurse attitudes toward research utilization, and barriers to that utilization.
The researchers describe the method used to collect data that would support the research objectives. The methodology section first identifies the aims of the research, then describes the method as "a cross-sectional survey" of registered nurses enrolled in a nursing-focused academic course, selected through a non-probability sampling method. Data from the sample population were collected using a 29-item, 5-point Likert scale questionnaire known as the Barriers Scale.
The survey produced numerical data, which were analyzed using SPSS version 10.0 on a personal computer and presented as both inferential and descriptive statistics. Data were presented under headings including "response rate," "access to research findings," "biographical profile of respondents," "barriers to research utilization," and "factors of research utilization." Results were displayed in graphs, percentages, and tables using ANOVA statistics, measures of central tendency, and measures of dispersion.
The researchers summarized their research findings in relation to the literature reviewed. The conclusion identifies the key barriers to the utilization of research findings in nursing practice and makes recommendations for addressing those barriers.
The evidence supports the conclusion that research findings are not being applied in nursing practice. The main barriers identified include: limited access to research material due to insufficient time at work to review research, lack of confidence in using sources such as the internet, and lack of authority stemming from nurses' subordinate position within the healthcare system. The five areas of the research collectively lead to data identifying common barriers to the use of research findings in practice from the perspective of registered nurses. The research also finds evidence of factors that can facilitate the utilization of research findings. Furthermore, the evidence identifies the need for future studies to examine why nurses cannot access research reports and the need to carry out research among clinicians.
Several ethical issues may have arisen during the survey process. These ethical concerns emerged from conducting human research, which requires researchers to protect the rights of respondents in accordance with the International Council of Nurses (1996). This body identifies that human respondents in research have the right not to be harmed, the right to self-determination, the right to full disclosure, and the right to confidentiality and privacy. Additionally, the researchers were bound by the ethical principle of obtaining consent or approval from respondents, from respondents' affiliated institutions such as colleges, and from authors of the research instruments used in data collection.
The type of research used in this study is the quantitative research method, which employs empirical approaches and produces data with discrete values. The method is considered quantitative because it uses structured questions with responses on a 5-point Likert scale that generate discrete or numerical data. Quantitative survey research, as used here, is suitable for providing factual evidence and descriptive information needed to meet the study's objectives (De Vaus, 2002). This type of hard evidence was necessary given the gap in the research field — specifically, the lack of empirical evidence regarding barriers and facilitators to the utilization of research findings in nursing practice. The method was also appropriate because it produced rich data about real nurses, real nursing situations, and the actual behavior of nurses regarding the use of research findings.
Other forms of research that could have provided the required empirical evidence include ethnographic studies, which would have required a longer study period as researchers analyze the behavior of a focus group. Interview-based research surveys could also have elicited empirical evidence by capturing the views and opinions of nurses on the use of research findings in nursing practice.
Nursing interventions in therapeutic care for patients encompass dependent and interdependent interventions. Dependent interventions are specific nursing responsibilities that require particular technical nursing knowledge, such as drug classification, medication administration, normal dosage, physiological action, and side effects. Interdependent, or collaborative, nursing interventions are actions performed jointly with other members of the healthcare system. In therapy, collaborative interventions draw on knowledge and skills from other disciplines — such as psychology and physical therapy — and require collaboration with the patient, family and friends, the community, and other healthcare providers. The following section presents a research review of collaborative nursing intervention as a form of therapeutic nursing care for mental health patients.
Davies, M.A., McBride, L., & Sajatovic, M. (2008). The collaborative care practice model in the long-term care of individuals with bipolar disorder: A case study. Journal of Psychiatric and Mental Health Nursing, 15, 649–653.
The researchers carried out a case study analysis to demonstrate the need for applying collaborative practice in the long-term care of patients with bipolar disorder receiving outpatient treatment. The paper emphasizes the co-management of the illness and the successful outcomes of a supportive environment achieved through joint patient–provider partnership in treatment and decision-making. The case study demonstrates the success of the collaborative intervention model and recommends it for psychiatric nurses.
Browne, G., & Quinn, C. (2009). Sexuality of people living with a mental illness: A collaborative challenge for mental health nurses. International Journal of Mental Health Nursing, 18, 195–203.
The research seeks to establish the need for a nurse–consumer relationship in creating a collaborative environment required to provide support and foster positive therapeutic outcomes for patients with sexual health issues. Collaborative approaches are identified as therapeutic intervention measures that mental health nurses can employ to assist patients with sexual mental health concerns in their recovery.
Buck, K.D., & Lysaker, P.H. (2010). Clinical supervision for the treatment of adults with severe mental illness: Pertinent issues when assisting graduate nursing students. Perspectives in Psychiatric Care, 46(3), 234–244.
The article discusses the importance of student nurses acquiring skills in therapeutic collaboration for the treatment of severe mental illnesses. Establishing meaningful therapeutic relationships between the psychiatric clinical nurse, the patient, other clinical health providers, and the patient's family is identified as necessary for assisting mental health patients in their recovery.
Allison, R., Flowerdew, K., & Elsmlie, A. (2012). Promoting a discussion about adherence to psychiatric medication. Mental Health Practice, 16(3), 18–22.
The research finds that patients are adversely affected by psychiatric medication, thereby calling for good practice through encouraging collaborative therapy. This entails open discussions on prescription and treatment with the patient, healthcare providers, and family in order to reduce the effects of psychotropic drugs. Collaborative interventions in the therapeutic treatment of mental health are identified as effective clinical management approaches for nurses.
Berk, M., Berk, L., & Castle, D. (2004). A collaborative approach to the treatment alliance in bipolar disorder. Bipolar Disorders, 6(6), 504–518. doi:10.1111/j.1399-5618.2004.00154.x
Collaborative approaches encompassing treatment alliances in therapeutic interventions for mental illnesses such as bipolar disorder are identified as effective in clinical practice. Collaborative approaches allow for the modification of risk factors associated with non-adherence to treatment. Collaborative intervention involves treatment alliances among therapists, therapy nurses, pharmacologists, patients, family members, and related disciplines such as psychology.
Rossen, E.K., Bartlett, R., & Herrick, C.A. (2008). Interdisciplinary collaboration: The need to revisit. Issues in Mental Health Nursing, 29(4), 387–396. doi:10.1080/01612840801904449
The nature of the healthcare system and the prevalence of chronic and acute mental illnesses call for a multi-system interventional approach. This means that primary healthcare providers and nurses must collaborate with professionals from different healthcare disciplines to address the diverse needs of psychiatric and mental health patients.
Keady, J., Woods, B., Hahn, S., & Hill, J. (2004). Community mental health nursing and early intervention in dementia: Developing practice through a single case history. Journal of Clinical Nursing, 1357–67. doi:10.1111/j.1365-2702.2004.01045.x
The researchers use a case study of a dementia patient in primary care intervention to highlight the need for a diversity of early intervention approaches in dementia care involving a community health nurse and a psychiatric social worker. This diversity of intervention entailed collaboration with the patient's family and proved successful in the case study.
Forrest, S.S., & Masters, H.H. (2004). Evaluating the impact of training in psychosocial interventions: A stakeholder approach to evaluation — part I. Journal of Psychiatric & Mental Health Nursing, 11(2), 194–201. doi:10.1111/j.1365-2850.2003.00708.x
The research indicates that intervention approaches for mental health nurses treating and supporting patients with mental health problems require a stakeholder approach. This approach is applied in the evaluation of patients and in creating collaboration between service carers and mental health educators to achieve success in the intervention methods used in mental health treatment.
Dobscha, S.K., Corson, K., Perrin, N.A., Hanson, G.C., Leibowitz, R.Q., Doak, M.N., & Gerrity, M.S. (2009). Collaborative care for chronic pain in primary care. JAMA: Journal of the American Medical Association, 301(12), 1242–1252.
The researchers demonstrate that collaborative interventions are increasingly becoming an important concern in healthcare management. This research used a controlled trial of patients with musculoskeletal pain receiving collaborative care in a primary healthcare setting. The results indicate that collaborative interventions produced positive changes in patients' ability to manage pain and depression and improved general medical outcomes.
Gray, R., White, J., Schulz, M., & Abderhalden, C. (2010). Enhancing medication adherence in people with schizophrenia: An international programme of research. International Journal of Mental Health Nursing, 19(1), 36–44. doi:10.1111/j.1447-0349.2009.00649.x
Collaborative intervention for patients with schizophrenia is identified as a successful therapeutic approach to mental health management. This approach calls for cooperation between patients and healthcare professionals in creating shared decision-making to help both parties share goals, assist in medication management, and improve clinical outcomes.
"Common themes across collaborative care research sources"
"Evidence-based collaborative nursing strategy for mental health"
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