Utilization in Nursing Practices in Public Hospitals in Lahore , Pakistan

Aim: The aim of this study was to assess the barriers of research utilization among nurses of public hospitals Lahore, Pakistan. Methodology: Descriptive cross sectional study was used. This study was conducted among nurses of Mayo Hospital Lahore and Lady Aitchison Hospital Lahore. The data was collected through simple random sampling from 245 registered nurses from both hospitals. The questionnaire of barriers to research utilization developed by Funk et al. (1993) was used. Result: The current study results show that nurses didn’t utilize the research in practices. Non-supportive organization, colleagues, inadequate facilities, insufficient time, nurse feels she has no authority to change patient care procedure, research factor and nursing factor is the main barrier of research utilization. In the future nurses should come on a paradigm of research. Conclusion: This reveals that management should increase the focus on nurse’s knowledge and facilities about research utilization


Introduction
For providing quality care research utilization is very necessary.In different countries quality care is improved by the utilization of research findings into practices.Nursing research has been proved that research utilization in patient care improve the patient outcome (Kang., 2015) Now a day's its necessary for nurses bring up to date their knowledge and skills due to rapid enhancement in technology and medical knowledge.This is only possible when nurses utilize the current knowledge into their practices after approved by research.There are very few researches that have been conducted in Pakistan regarding barriers of research utilization in nursing practices.While many researches conducted in other medical professions regarding barriers of research utilization.There is a need to high light the barriers of nurses in the utilization of the research in nursing practices.
Nursing is an occupation that is to be considered as this occupation is best to know about how to provide an optimum level of good care to the patient, because patient is fully depended on nursing care.So that's why, this is only possible by getting evidence base knowledge through updating their knowledge which is guided the nurses to how fulfill their optimal task to quality improving.(Buhaid and Lau., 2014).
Several studies indicated that only few nurses Implement the research into their practices (Adejumo and Guobadia., 2013).Research itself again has been considered as much a vital strategy via as a discipline particularly in nursing, be able to generate knowledge then improve it in keeping its professional reputation.
Researchers are expected in stimulation of their study be carried out as nicely so utilized in order after enhance among the growth regarding patient care.Nursing research utilization is the system on synthesizing, disseminating or the use of research generated competencies to fulfill massive influence about the present nursing practice.(Nwozichi and Ojewole., 2014).
The purpose of the study is to assess, the hurdles behind research utilization in nursing practice.

Material and Methods
The study design was descriptive co relational study intended to fulfill the objective of the study.Two government hospitals were used to collect the data, Mayo Hospital Lahore and Lady Aitchison Hospital Lahore.Both

Research Article
were affiliated with the medical universities and considered as the tertiary care hospital.Many researchers conduct the study on barriers of research utilization.All indicated barriers that were quite different from each other.Questioner was used in this study barrier scale is utilized with demographic sheet.Funk et al. in 1991 designed this scale he categories this scale into four subtypes.(1).Characteristic of research (3items).(2).Characteristic of nurse (3 items).(3).Characteristic of communication (3 items) (4) Characteristic of organization (8items).The tool was the questionnaire designed by funk et al (1991).Likert scale choice, from 1,"Strongly Disagree", to 5, "Strongly Agree' (Mohsen et al., 2016) (Funk et al., 1991).Register nurses of both hospitals, of all shifts were participants (including night shift).Student nurses, midwifes and LHV, s, and register nurses those are not willing to participate in study were excluded.Simple random sample of 245 nurses.266from Mayo hospital Lahore and 45 from Lady Aitchison Hospital Lahore Ethical consideration conduct from Institution review board of University of Lahore, School of Allied Health Sciences and Department of Nursing.Official letter of co-operation was written to Mayo Hospital Lahore and Lady Aitchison Hospital Lahore from School of Nursing (UOL).This study was conducted during the time period from end of January 2017to May 2017.From both Hospitals administrations official approval was carried out for the purpose of the study and also tell about where the data will be collected.
Questioners were filled secretly.They completed the questioner at their own work place hardly in 15-20minutes.Before distribution of the questionnaires, introduce and tell the aim and objectives of the study.
By personal computer using SPSS (version 21.0) data collection were coded, entered, tabled and statistically analyzed.Data present statistical frequencies, mean, mode, median, standard deviation, and variables of the quantitative study.The relation between the variables assess by using correlation analysis.Statistical significance will be considered at p-value <0.05.

Results
Table 1 shows that two organizations were selected in which 12.7% (n=31) nurses from Lady Aitchison Hospital and 87.3% (n=214) nurses from Mayo Hospital Lahore.Participants age was 21.2 % (n= 52) respondents were between 20-25 years old, 54.7% (n=134) were between 26-30 years, 19.6% (n=48) were between 31-35 years old and 4.5% (n=11) were between 36-40 years of age.Most of the nurses were having <1 years of experience (n=39, 15.9 %), 1-5 year experience was (n=97, 39.6%), while 6-10 years experience were (n=84, 34.3%) and above 10 year were (n=25, 10.2%).Mostly nurses were diploma holder (n=113, 46.1%), specialized nurse were (n=81, 33.1%) and Post RN were (n=51, 20.8%) in the study.Most of the respondents were charge nurse (n=231, 94.3%) and head nurses were (n=14, 5.7%).Participants were 39.2% (n=96) married, Unmarried were 60.8% (n=149).This study was conducted to assess the barrier of research utilization among registered nurses in two government hospitals.Both hospitals for the first time used to identify the barriers of research utilization, and their related characteristics.The study results discussed in following section are composed of the barriers of research in Mayo Hospital Lahore and Lady Aitchison Hospital Lahore and their relationship with the nurse's demographic characteristics.
Regarding, barriers to research utilization results of the present study revealed that utilization of research findings are the complicated organizational procedure rather than the individual procedure as a prominent barrier, based on the mean score are related to the characteristics of organization.
Similarly to the study conducted in Egypt, China and Iran reported that setting barrier is the top barrier to research utilization (Belal et al.,2012) (Salemi et al.,2010) (Schoonover, 2009).Setting is also ranked the top barrier to research utilization in (Strickland et al., 2009) (Funk et al., 1991).Results shows that organization is the greatest barrier and this can increase the frustration in nurses with organization.Setting related barrier that come at the top rank; facilities are inadequate for implementation, nurse doesn't fell she has enough authority to change patient care procedure, other staff are not supportive for implementation, physicians not cooperate in implementation, Insufficient time on job to implement the research in practices.In other words, setting in current study has providing the low financial support which is directly affected on research utilization.
Setting related barriers to research utilization rank non supportive physician and other supportive staff.Similarly to the study conducted in Iran (Mohammad pour et al., 2014).
Unfortunately, tension has always existed between nurse and clinicians.
Regarding, the research characteristics nurses of Mayo Hospital and Lady Aitchison Hospital Lahore ranking that "research articles are not publish fast enough".This is due to lack of communication between practitioner nurse and nurse researcher due to discrimination between education, knowledge, skill and lack of interest in research utilization.Ezz study say that nurse who received only bachelor degree don't receive courses related the research except for those who are registered for post graduate studies (Ezz et al., 2011).
The last but not the least barrier based on the mean score is the "Nurse Characteristics".Similarly with the Ezz study in which the last barrier is the nurse barrier (Ezz et al., 2011).This credited may be due to the fact that about level of nursing practices asked significant questions in nursing profession.Nurses have difficulties in the description of their nursing profession after providing the list of daily performance for the evidences (Oelke et al., 2008).
The barrier marked in nurse barrier is the; Nurses sees little benefit for self.The results of current study similarly to the study conducted in China (Wang et al., 2013).This may be due to lack of questioning, nurse do not have the ability to identify the clinical problems and many uses the traditional knowledge and practices without questioning.In the future nurses must be prepared about the paradigm of evidence and practices, rather than traditional (Malik et al., 2017).
Study findings depicted that there are statistical significant differences between nurses demographic and sub scale of nursing research barriers (Table No.06).Qualification has significant relationship with sub scale of barriers of research except nurse factor.Age has no significant relationship with all barriers sub scale.Similarly with the study yava et al., showed that barriers of research utilization not influenced by age (Yava et al., 2009).

Table 1 :
Socio-demographic characteristics of respondents of public Hospitasl Lahore Pakistan.

Table 2
shows that nurses responded regarding the barriers of research utilization scale.The most prominent barriers were organization sub scale (mean=3.0934)and research sub scale (mean=3.0680).Setting related barriers were the inadequate facilities (49.8%),Nurse feels she has no enough authority to change the patient care procedure (49.8%),Other staff are not supportive (49.0%),Physicians are not

Table 2 :
Barriers of research utilization

Table 2 :
Barriers of research utilization

Table 3 :
Correlation between barriers subscale

Table 3
shows correlation between barriers scale, table shows that there was a statistical significant correlation (p<0.05) between nurse sub scale, organization subscale, and research sub scale and communication subscale.

Table 4
shows the correlation between barriers sub scale and demographic characteristics.Statistical analyzing between demographic and barrier sub scale revealed that stay in organization and qualification have significant relationship with organization sub scale, research sub scale and communication sub scale except nurse sub scale.Age has no significant relationship with all barriers sub scale.

Table 4 :
Correlation between barriers subscale and demographic characteristics Factors