Nurses and Use of Research Information in Clinical Practice: a Case Study of the University Teaching Hospital in Zambia.

Author:Monde, Mercy Wamunyima
Position:Case study
 
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Introduction

Decision making in health care has changed dramatically, with nurses expected to make choices based on the best available evidence and continually reviewing them as new evidence comes to light (Pearson et al., 2007). It is a global challenge for nurses to scrutinise their practices and provide healthcare informed by current scientific knowledge (World Health Organisation, 2004). The capacity to provide evidence-based practice is one of the core competencies all healthcare professionals should possess in order to meet the needs of the 21st century healthcare system. In this regard, researchers have stated that clinical decision making is an integral part of nurses work and vital to health outcomes for patients. They argue that Clinical Decision Making, if based on reliable decision making criteria arising out of evidence can constitute a legally defensible position for the nurse in the event of a malpractice accusation (Deegan, 2013). Moreover, nurses' ability to recognise changes in the patient's physical condition is crucial as they have meaningful interactions with patients, frequently and for longer periods than any other health professional; and are therefore, likely to be the first link in the causal chain between the detection of complications and the commencement of corrective interventions (Gregory, 2011; Levett-Jones et al., 2010).

Zambia likewise, recognises health as one of the priority sectors that contribute to the well-being of the nation and, therefore, remains committed to providing quality health services to all its citizens. Zambia has a high burden of disease, which is mainly characterised by high prevalence and impact of communicable diseases, particularly, Malaria, Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), Sexually Transmitted Infections (STIs), and Tuberculosis (TB), and high maternal, neonatal and child morbidities and mortalities (Zambia. Ministry of Health, 2012). The country is also faced with a rapidly rising burden of noncommunicable diseases, including mental health, diabetes, cardio-vesicular diseases, hypertension, chronic respiratory disease, blindness and eye refractive defects, oral health problems and violence. In addition, health information systems are one of the major challenges the country is faced with and this includes access and usage of information by nurses (Zambia. Ministry of Health, 2012).

Due to the high disease burden, nurses in Zambia have a huge role to play in order to help in reducing the load. There is need therefore, for nurses to use research information in clinical practice and to effectively use strategies for extracting relevant information from many publications that are available. The quality of information that nurses demand and how effectively they evaluate and use it for clinical decision making may influence patient outcomes and ultimately, the part nurses play in the delivery of health care. Nursing practice is information intensive; the rapid growth of information means that nurses cannot rely on information acquired as students and must therefore constantly update their practice (Royle and Blythe, 1998). It is for this reason that nurses need to familiarise themselves with high quality research to help them make justifiable decisions in clinical practice and justifies a study such as this one.

Nurses need evidence based information (EBI) for effective patient care and better patient outcomes because in the majority of cases, nurses constitute the majority of hospital clinical employees and are the most frequently consulted resource in the health care system. Nurses are also responsible for not only implementing physicians and surgeons clinical orders or prescriptions but also for maintaining constant surveillance over their patient's health. Moreover, nurses care for the sick and provide them assistance with physical and psychological needs, until they achieve stability, regain their previous state of wellness or achieve new levels of functioning. Furthermore, nurses also gather and transmit or communicate information from patients to patients' families and to other health care providers. In addition, hospital nurses are responsible for coordinating all care activities for patients care. Information, is therefore a very critical tool for nurses and how they acquire and use that information determines their performance (Corcoran-Perry and Graves, 1990). In general, nursing includes the promotion of health, prevention of illness, and the care of the ill, disabled and dying people. Advocacy for patients and their significant others, promotion of a safe environment inside and outside health care facilities, research, participation in shaping health policy, inpatient and health systems management, and education are also key nursing roles (International Council of Nurses, 2007). In such a situation, the nurses' role therefore, includes many work responsibilities and decisions for patient care. Unfamiliar tasks could present themselves and the nurse will need to seek information to complete the task.

Nurses are charged with the care and management of human lives, and therefore, there is no margin for mistakes or errors. An information question is considered serious because it can affect health outcomes. The use of research information by nurses in practice can facilitate innovation that may lead to better client health outcomes, validate existing nursing knowledge, procedures or interventions and challenge nurses to critically examine traditional practices, procedures and also question those that are not substantiated by research or other evidence. Research utilisation also enhances professional self-concept, ensures provision of safe and effective care and enhances nurses' self-confidence. To the health care agency, it helps in provision of cost effective care, high quality care and professional satisfaction and motivated nursing staff. Furthermore, research utilisation adds value on the nursing profession itself by enhancing nursing autonomy, strengthening professional status, positive professional image and broadens the field of nursing scientific knowledge base (Gills and Jackson, 2009).

The General Nursing Council of Zambia (GNC) which is a statutory body responsible for regulating nursing and midwifery education, training and practice in Zambia acknowledges the importance of Evidence Based Information (EBI) and has decided to introduce Continuing Professional Development (CPD) for nurses and midwives in Zambia with a view to ensuring that they have the necessary competencies to provide quality health care to clients and communities. Continuing professional development of health professionals (particularly nurses) is a key element of the quality and efficiency of a health care system. The CPD process ensures that nurses and midwives update their knowledge and skills to use in clinical practice (General Nursing Council, 2014). This can only be attained through lifelong learning and; without access to timely and relevant research information this goal may be difficult to attain.

Study Context

The University Teaching Hospital (UTH) formerly known as Lusaka hospital is the biggest public tertiary hospital in Zambia. UTH is in the capital city of Lusaka, approximately 4km east of the city centre. It was built in 1910; and in the colonial period was only meant for sick Africans who were only cared for by male orderlies as the hospital had no doctors and nurses. With the decision to move the capital city of Zambia from Livingstone to a much more central Lusaka, plans for a...

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