Wallin Lars, Boström Anne-Marie, Wikblad Karin, Ewald Uwe
Department of Women's and Children's Health and Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
J Adv Nurs. 2003 Mar;41(5):509-18. doi: 10.1046/j.1365-2648.2003.02574.x.
To examine the relationship between sustained work with quality improvement (QI) and factors related to research utilization in a group of nurses.
The study was designed as a comparative survey that included 220 nurses from various health care organizations in Sweden. These nurses had participated in uniformly designed 4-day basic training courses to manage a method for QI.
A validated questionnaire covering different aspects of research utilization was employed. The response rate was 70% (154 of 220). Nurses in managerial positions at the departmental level were excluded. Therefore, the final sample consisted of 119 respondents. Four years after the training courses, 39% were still involved in audit-related activities, while 61% reported that they had discontinued the QI work (missing = 1).
Most nurses (80-90%) had a positive attitude to research. Those who had continued the QI work over a 4-year period reported more activity in searching research literature compared with those who had discontinued the QI work (P = 0.005). The QI-sustainable nurses also reported more frequent participation in research-related activities, particularly in implementing specific research findings in practice (P = 0.001). Some contextual differences were reported: the QI-sustainable nurses were more likely to obtain support from their chief executive (P = 0.001), consultation from a skilled researcher (P = 0.005) and statistical support (P = 0.001). Within the broader health care organization, the existence of a research committee and a research and development strategy, as well as access to research assistant staff, had a tendency to be more common for nurses who had continued the QI work.
Sustainability in QI work was significantly related to supportive leadership, facilitative human resources, increased activity in seeking new research and enhanced implementation of research findings in clinical practice. It appears that these factors constitute a necessary prerequisite for professional development and the establishment of evidence-based practice.
探讨一组护士持续开展质量改进（QI）工作与研究应用相关因素之间的关系。
本研究设计为一项比较性调查，纳入了来自瑞典各医疗保健机构的220名护士。这些护士参加了统一设计的为期4天的基础培训课程，以掌握一种质量改进方法。
采用一份经过验证的涵盖研究应用不同方面的问卷。回复率为70%（220人中的154人）。部门级管理职位的护士被排除在外。因此，最终样本由119名受访者组成。培训课程结束四年后，39%的人仍参与与审核相关的活动，而61%的人报告称他们已停止质量改进工作（缺失 = 1）。
大多数护士（80 - 90%）对研究持积极态度。与已停止质量改进工作的护士相比，那些在4年期间持续开展质量改进工作的护士报告在搜索研究文献方面的活动更多（P = 0.005）。持续开展质量改进工作的护士还报告更频繁地参与与研究相关的活动，尤其是在实践中实施具体研究结果方面（P = 0.001）。报告了一些背景差异：持续开展质量改进工作的护士更有可能获得首席执行官的支持（P = 0.001）、熟练研究人员的咨询（P = 0.005）和统计支持（P = 0.001）。在更广泛的医疗保健机构中，研究委员会和研发战略的存在，以及获得研究辅助人员的支持，对于持续开展质量改进工作的护士来说往往更为常见。
质量改进工作的可持续性与支持性领导、促进性人力资源、增加寻求新研究的活动以及在临床实践中加强研究结果的实施显著相关。看来这些因素是专业发展和建立循证实践的必要前提条件。
