Lo T K T, Hoben Matthias, Norton Peter G, Teare Gary F, Estabrooks Carole A
Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada.
Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.
BMJ Open. 2018 Jul 13;8(7):e020074. doi: 10.1136/bmjopen-2017-020074.
This study explored the effect of clinical educators as facilitators of research use and how it may be modified by organisational context in the settings.
Cross-sectional observational study.
A representative sample of 91 residential long-term care (LTC) facilities across Western Canada.
We used surveys to collect data from the frontline care aides and information about the organisational context of the care units.
We assessed research use (the outcome) with the Conceptual Research Utilization (CRU) scale. Explanatory variables in the multiple regression analysis were facilitation, organisational context and the interaction terms. Facilitation was measured by the frequency of contacts between care aides and clinical educator or person who brings new ideas about resident care. Three core organisational context variables were measured using the Alberta Context Tool.
We included data of 3873 care aides from 294 care units in the LTC facilities. We found significant associations between CRU and facilitation, leadership, culture and evaluation. Interactions of facilitation x leadership and facilitation x culture were negative. The coefficient of the facilitation x evaluation term in the regression model was positive (0.019, 95% CI 0.012 to 0.026), suggesting synergistic effects between facilitation and a well-developed process to evaluate care quality using relevant data.
Findings indicate clinical educators are effective facilitators of research use among the care aides, but the effect is modified by organisational context. For greatest impact, managers can direct efforts of the clinical educators to care units where leadership and culture ratings are lowest, but a proficient feedback and evaluation process is in place. This understanding enables managers to deploy clinical educators (a scarce resource in LTC settings) most efficiently.
本研究探讨临床教育工作者作为研究应用促进者的作用，以及在不同环境中其如何受到组织背景的影响。
横断面观察性研究。
加拿大西部91家长期护理（LTC）机构的代表性样本。
我们通过调查收集一线护理助手的数据以及护理单元的组织背景信息。
我们使用概念性研究应用（CRU）量表评估研究应用情况（结果）。多元回归分析中的解释变量包括促进作用、组织背景及交互项。促进作用通过护理助手与临床教育工作者或带来有关居民护理新想法的人员之间的接触频率来衡量。使用艾伯塔省背景工具测量三个核心组织背景变量。
我们纳入了来自LTC机构294个护理单元的3873名护理助手的数据。我们发现CRU与促进作用、领导力、文化和评估之间存在显著关联。促进作用与领导力以及促进作用与文化的交互作用为负。回归模型中促进作用与评估项的系数为正（0.019，95%CI 0.012至0.026），表明促进作用与利用相关数据评估护理质量的完善流程之间存在协同效应。
研究结果表明临床教育工作者是护理助手中研究应用的有效促进者，但这种效果会受到组织背景的影响。为了产生最大影响，管理人员可以将临床教育工作者的工作重点放在领导力和文化评级最低但具备完善反馈和评估流程的护理单元。这种认识使管理人员能够最有效地部署临床教育工作者（LTC环境中的稀缺资源）。
