Abstract
Introduction
Research and evidence are important components of professional nursing practice, and inform the core curriculum of nursing education.
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It is paramount that nurses acquire the necessary knowledge, skills and attitudes towards research before they can utilise it effectively. Research utilisation (RU), in simple terms, is the use of research evidence to make an impact on or change in the existing nursing practice.
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RU among newly graduated registered nurses has been reportedly to be low in previous population-based longitudinal studies, whereby only about 50% (
Individual, organisational and environmental factors play an important role in developing and promoting RU among nurses. 5 Individual factors such as having a mentor and effective time management is vital while organisational factors in terms of availability of administrative support and formal RU program also helped in the promotion of evidence-based practice (EBP). 5 In addition, an information-friendly environment that links the clinical nurse to a variety of information brokers, the healthcare literature and other evidence-based resources helps in promoting RU in the busy clinical environment. The literature was consistent in the identification of key factors that inhibited nurses’ involvement in research and EBP, namely, lack of time, lack of support and lack of research knowledge. 6
In 2015, an exploratory study on Registered Nurses’ continuing educational needs in research was conducted in Singapore to find out on the most preferred mode of education. The study concluded that most nurses preferred skill-based workshop followed by immersion program whereas online learning and self-learning (reading journals or books) were the least preferred mode of education respectively. Among the different mode of educational deliveries, immersion program was found to be statistically significant among the younger nurses between 19 and 35 years old (
From 2013 to 2015, nine workshops were conducted by Singapore General Hospital (SGH) nursing research unit in which 224 nurses were trained on EBP. Although the feedback on the workshop was good and that the nurses have gained knowledge, however the translation of knowledge to practice was poor. None of the participants who attended the workshops were engaged in any evidence-based projects or research work post training. The most common reason for not participating in research work was due to lack of time as they are working full-time as clinical nurses in the ward.
In view of the above, a research immersion program for nurses was launched in June 2016. Building a strong research foundation is important for the future of nursing profession. This article describes the efforts of a large teaching hospital in Singapore in promoting and building research competence among clinical nurses. An immersion program such as the one described in this article provides a strategy to promote a culture of EBP.
Immersion as a pedagogy in learning and practice
According to Oxford dictionary, immersion is a ‘
Immersion programs have also been used in a research setting to increase collaboration between nursing and international research collaborators. For example, the Minority Health International Research Training (MHIRT) program found that students learn better about the conduct of research and adopt a culturally expanded view after immersion abroad, which was evident in their research report. 8
Similar to an immersion program, research internship also offers an in-depth and experiential learning experience. In North America, an undergraduate nursing research internship program was developed to provide a hands-on experience working as part of a research team and found that in addition to gaining research knowledge and skills, participants described positive attitude towards research and a better understanding of EBP. 9 Similar to the findings above, another research internship program paired undergraduate nurses with an experienced research mentor and found that research internship enhanced intern’s critical thinking skills and professional networking. 10 Nevertheless both of these research internship programs were initiated in an academic setting thus the student’s nurse motivation to learn may be different compared to nurses in the clinical care setting.
Research immersion program in SGH
The aim of this program was to develop novice nurses’ ability to implement and evaluate evidence-based project that aimed to improve treatment outcomes of patients in SGH. Nurses who are interested were invited to apply for the program. Applications were endorsed by their clinical supervisors as well as their assistant directors of nursing. All applications were reviewed and applicants were invited for an interview by nurse leaders and also nurse researchers. The purpose of the interview was to ascertain the applicants’ research topic of interest and their expectation of the program. Their research topics should reflect their current clinical experience or aimed to address gaps in the literature.
Successful applicants were given protected time of one day in a week for a period of 24 weeks to work on their research topic. The 24 weeks of immersion period was decided by the senior management and is deemed to be sufficient for a small scale research project. In addition, a one-on-one mentorship was provided by a Doctor of Philosophy (PhD)/Doctorate Nurse Practitioner (DNP) prepared nurses or experienced nurse researchers throughout the program. Mentors were matched to mentee according to their clinical and research expertise.
As the nurses’ research topics were already determined during the application review period, the first three weeks was mainly used to recapitulate on the research process, writing the research proposal and going through the ethical review process. After ethic approval was obtained, about 8 to 12 weeks were allocated for data collection and the remaining weeks were reserved for data analysis and writing of report.
Experience of the inaugural batch of research immersion nurses
Four nurses were selected and enrolled in the program. Their clinical work years of experience ranged from three to six years. The immersion nurses investigated a wide range of research topics (Table 1).
Research topics of the inaugural batch of research immersion program nurses.
The immersion nurses meet with their assigned mentor on a regular basis for guidance and to answer any doubts or questions regarding the research process. At the end of the program, the nurses were given the opportunity to discuss concerns and offer suggestions for improvement. Nurses frequently speak about feeling anxious prior to beginning the program, but reported that with the availability of their mentor, the reality was not as stressful as they pictured it. Such feedback has helped the research unit to understand the concern of these nurses and helped to inform refinements of the program for the next batch of immersion nurses.
Overall, the nurses were positive about the research immersion program and viewed it as beneficial to their professional development. The 24 weeks of immersion and mentorship has allowed them to develop, implement and analyse their research project with little difficulty. All four nurses had submitted their abstract to a local scientific conference to disseminate their findings. A detailed summary of their research outcomes is listed in Table 2. Some of the qualitative comments on the immersion program were: I like this program because we are given an advantage of using one day of the week to complete the project. Also, for having a mentor to guide us through the project. My mentor was supportive and guided me through the project. This program has definitely given me the best opportunity of implementing {carrying out} an actual research under the guidance of mentor and other team members. This program enables me to have protected time to conduct the research, allowing me to have more (uninterrupted) time to work on the research.
Summary of the outcomes of the research projects.
Conclusion
The immersion program involved the provision of protected time from clinical duties and mentoring. It offered nurses the opportunity to be hands-on with the research process and at the same time fosters collaboration and socialisation among research administrators, research nurses and clinical nursing staffs. Future direction is to continue building research competence among clinical nurses and developing our first generation of nurse scientist.