Barriers to research awareness among nurses in Italy

The achievement and spread of evidence-based practice, of which research use is a key factor, is challenging and requires more than desire and enthusiasm (Rickbeil & Simones 2012). Using research in nursing practice requires research awareness. Research awareness has been determined as having not only having a good understanding about the principles of research; but the confidence and authority to use research (McSherry et al. 2006). While little is known empirically about Italian nurses’ confidence and authority with regard to research, anecdotally both are low (Bressan et al. 2016). In keeping with international trends (Timmins et al. 2012, Gerrish and Clayton 2004) nurses’ research awareness in Italy is anecdotally affected by a lack of resources, confidence, knowledge, and the lack of a strategic leadership (Sasso et al. 2013). In some Italian health care settings, there are also reports of a culture that is not attuned to the use of research use, and in some cases there is limited managerial support. Additionally it has been acknowledged internationally that competing demands in an under-resourced health care environment place nurses in a position whereby they prioritise care and thus miss out some aspects that could be deemed of lesser priority (Kalisch et al. 2009). A recent Italian study found that up to 41% of care that nurses were expected to perform was missed (Sasso et al., 2016aa,b).Within this context it has been found that nurses [understandably] prioritise the most urgent nursing tasks (usually tangible clinical tasks) at the expense of less tangible aspects of nursing (such as communication, developing relationships and patient education) (Sasso et al., 2016a,b, Aiken et al. 2012, Sermeus et al. 2011). However of greater concern is that the percentage of this ‘missed care’ is higher in Italy compared with other countries most likely due to a much lower staff/patient ratio than many European counterparts (Sasso et al., 2016a,b). While research awareness is not specifically measured within these studies it is very likely that is given a low priority due to the aforementioned constraints. There are also few national or local financial incentives for research and clear leadership within the discipline is lacking (Bagnasco et al. 2014). While there has been an impetus at national level towards setting up a national nursing research strategy this has never translated into a reality (Sansoni 2001). At the same time key nursing figures in Italian universities are actively working towards building research capacity (Bagnasco et al. 2014). As a result while published research in nursing was notably weak in the past, and mostly led by non-nurses, this situation is improving with an increasing number of robust nurse-led research and publications, with direct relevance to clinical nursing practice (Marucci et al. 2013). A further compounding factor in the use of research is limited access to libraries and Information Technology (IT) resources and the language barrier (Bressan et al. 2016, Sasso et al. 2013). As English is considered to the language of the health sciences this creates difficulty for Italian nurses who struggle with English comprehension (da Silva et al. 2009). At the same time publications in Italian do not always highlight the practical implications of the findings and/or the recommendations often have a limited evidence base (Fazzini 2012). Dissemination of Italian nursing research results in English peer reviewed is therefore essential to create a robust body of literature (Marucci et al., 2015, Sansoni et al. 2006). This would facilitate the exchange of knowledge and information with international colleagues, encourage debate and facilitate cultural exchange and dissemination (Marucci et al. 2013). One additional barrier to research in nursing is that some local regional research ethics committees are notoriously bureaucratic and frequently refuse or return applications made by nurse researchers on the grounds that they are not considered to be pertinent for the ethics committee. The need for qualitative research is not fully understood, for example, nor is it perceived as warranting ethical approval (Gallagher et al. 2014). While this does not necessarily hinder research on patients or nurses, Italian nurses as a result have difficulty getting their research published in prominent peer reviewed international journals without the necessary ethical approval. This issue affects not only professional confidence and international development but also the circulation and development of national research. For research-based practice to become a reality it needs to proceed through four distinct phases: research; communication of the research; reading and understanding the research; and research utilization (Jacobson 2000), and we have highlighted above that there are issues with nursing research in Italy across all of these phases. The process of utilization requires a thoughtful systematic process that is adopted both by an organisation and the individual. However, nurses working in an organisation may not have sufficient authority to bring about the necessary changes required to implement research based practice and require the support of their organization, managers, and university faculty staff (Staffileno & Carlson 2010). Indeed constraints within organisations, such as lack of managerial support and time constraints have predominated as reasons for non-utilisation of research (McSherry et al. 2006, Gerrish and Clayton 2004). Research based practice is a time consuming activity. There are many approaches cited in the literature that can facilitate use and implementation of research in practice (Fazzini 2012). We believe that it may be important for the Italian healthcare system to select a common approach and standardized modality for evaluating research interventions that may be used to inform evidence based practice. This would simplify the process for nurses and other healthcare staff and lead to the ability to immediately compare results obtained. Experience within research teams would also be useful for Italian nurses to improve their research awareness. Protected time and formal mentorship for Italian nurses as part of healthcare research teams could help them develop interprofessional research skills and lead to important benefits in their understanding through participation in research (Hager et al. 2016). The extent of research awareness among nurses Italy is uncertain, as there has been little exploration of this topic. It is widely acknowledged that developing a research culture in nursing requires attainment of PhDs by substantive numbers of nurses, financial support and strong national and local leadership (Begley et al. 2014). However there are low numbers of nurses in Italy with PhDs, even within the universities. While research is certainly taught at undergraduate level the extent to which this translates into use and understanding of research in healthcare practice is unclear. The funds and investments for nursing research in Italy are scarce, and this is mainly due to the persistence of a culture that gives little emphasis to the importance of nursing research. This slows down the development of nursing research that could have major impact on health care. Unlike other countries, such as the USA and some countries of northern Europe, resources for nursing research are limited in Italy. In the aforementioned areas there are enviable national nursing organisations and health policy systems that each year fund nursing research projects to improve patient outcomes and health care. none of which are features of the current Italian healthcare system (Hinshow & Grady 2011). Financial and other support for nursing research in Italy is crucial, in addition to the support of Faculty and the employment of tenured Professors at both a university and clinical level. Support and encouragement is also needed from international colleagues within nurse education settings, particularly those with the skill set and influence required to support the required changes ahead. Networking at international conferences is essential to learn ideas and gain support, and colleagues need to be aware of the disparity that exists internationally (Hackmann 2000) and offer support where appropriate. Certainly, within one Italian university, the University of Genoa, these steps are already in place (Watson 2015) with promising initial results. While some of the aforementioned restrictions are frustrating, the impetus and motivation of nurses in Italy is driving momentum. Ethical approval was not required for this paper. There was no funding obtained for this paper.

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