Using Roger's model of the diffusion of innovations to test research utilization of cancer-related fatigue evidence by oncology nurses.

摘要

This manuscript style dissertation, which is entitled Using Roger's Model of the Diffusion of Innovations to test Research Utilization of Cancer-related Evidence by Oncology Nurses, presents three interconnected manuscripts. Manuscript I discusses the systematic review of the literature related to barriers to research utilization that have been demonstrated in the nursing literature. Manuscript II presents the psychometric analysis of the Cancer-related Knowledge and Use Instrument that was specifically developed to measure whether nurses have obtained knowledge regarding CRF symptom management innovations that has been published in the literature and use it in their practice. Manuscript III presents the methods, specific aims, hypotheses, and findings of the study. The purpose of this investigation is to describe factors associated with research utilization among nurses specializing in oncology and to describe the diffusion of evidence-based innovations related to cancer-related fatigue (CRF) symptom management among these nurses. The study had two primary aims: (1) Describe barriers and facilitators of research utilization among nurses specializing in oncology; and (2) Describe the diffusion of evidence-based innovations for CRF symptom management. Roger's Theory of Innovation Diffusion (1995) provided the theoretical framework for the evaluation of barriers. The Oncology Nursing Society "Putting Evidence into Practice" guidelines (Mitchell, Beck, Hood, Moore & Tanner, 2007) and the NCCN Cancer-related fatigue and anemia: Treatment guidelines for patients, Version III (2005) provided the foundation for the development of the CRF Knowledge and Use instrument. Participants for this study were selected from a random sample of the ONS membership. The study achieved a 14% response rate (N=608). Data analysis was conducted with SPSS version 16.0 of the eight research questions that were developed for the study. Findings revealed that: (1) the top three barriers based on ranking of mean scores were, there is insufficient time on the job to implement new ideas (mean 3.10, SD=1.00), the research has not been replicated (M=3.08), SD=1.46), the nurse does not have time to read research (M=3.05, SD=0.96) and the research has methodological inadequacies (means 3.05, 1.56); (2) top ranked sources used to update participants' clinical practices included the Clinical Journal of Oncology Nursing (66%), other information sources (66%), and the ONS website (63%). The least utilized information source was the Cochrane Database (9%); (3) the relationship between CRF knowledge and use scores with organizations that provided a research facilitator or those nurses who reported having a research mentor found no significance; (4) there were not significant relationship between demographic or professional characteristics on knowledge or use of CRF innovations; (5) 13% of participants viewed the impact of regulatory bodies on the use of current research findings positively, while 46% viewed the effect as negative and 40% perceived no effect. The study found a significant relationship between knowledge and those participants who viewed the impact of regulatory bodies negatively; (6) 59% of participants had the knowledge of CRF symptom management innovations that were disseminated in ONS PEP and NCCN guidelines. Of that group, 76% used those innovations in their clinical practice. 45% of all study participants knew and used those innovations in practice; (7) the Oncology Nursing Forum and the NCCN guidelines significantly predicted the knowledge score of participants R2 = .034, F= 1.728, ONF beta .097 p = .034, NCCN beta .132, p = .002 These values when all info sources ran, I can get better values when I regress each info source individually on knowledge or use?) and the NCCN guidelines significantly predicted the score for use of innovations to manage CRF symptoms R2 = .059, F = 3.121, beta .163, p = .001, same thing as above here; (8) there was no relationship between knowledge or use scores and the four subscales of the Barriers Scale that measure constructs of Roger's model of the diffusion of innovations.