Research Utilization: A Cross‐Sectional Survey of the Barriers and Facilitators Among Clinical Nurses in Ghana

ABSTRACT

Background and Aims

The involvement of clinical nurses in the utilization of nursing research in practice has been reported to be minimal. Globally, several studies have reported a host of challenges that hinder the efforts of nurses to use research in practice. However, other facilitators to nursing research exist. This study sought to assess the barriers and facilitators to the utilization of nursing research among Ghanaian nurses in practice.

Methods

A cross‐sectional survey was conducted among clinical nurses working at a tertiary health facility in northern Ghana. A total of 330 participants were systematically recruited to ensure equal opportunity for each nurse to partake. Data were collected using the standardized tool; Barriers and Facilitators to Nursing Research. Data processing was carried out using Microsoft Excel. Data were checked, cleaned, and analyzed using Statistical Package for Social Sciences, SPSS version 24.

Results

More than 70% of participants believed they lacked the authority to change practice whilst another 60% believed statistical analyses are not understandable. Other key barriers identified included perceived lack of authority to change practice by nurses, inadequate time, uncooperative physicians, and inapplicable research findings. Other commonly identified facilitators were further education, support from administration, and formation of research clubs and committees at the health facility.

Conclusion

To enhance the participation of clinical nurses in the utilization of nursing research in practice, several barriers identified need to be addressed, including stakeholder support and opportunities for clinical nurses for further education to improve their research skills. Collaboration between clinical nurses and nurses in academia is paramount.

1. Introduction

The International Council of Nurses mandates that, nurses provide care according to the best available evidence. Evidence‐based care, which is mostly derived from scientific studies is defined as “systematic approach to problem‐solving for health care providers which is characterized by using the best research evidence that is currently available, clinical expertise, and patient values for clinical decision‐making to provide consistent and best possible care to patients.” Research utilization refers to analyzing and utilizing research‐produced knowledge to improve patient care [1]. Despite numerous benefits of evidenced base care, a host of challenges hinder the efforts of clinical nurses towards nursing research utilization. Ranking in order of priority, 84% of nurses from a study in England indicated a lack of time as their major challenge to utilize research in practice, whereas 64.8% indicated a lack of confidence. Challenges to research implementation in the UK include incomprehensible research findings, attitudes and resistance from senior colleagues and doctors toward implementation of findings, unrealistic research findings, inability to understand the significance of research. Difficulties in implementing research findings, time constraints, and difficulty in critiquing studies and searching relevant literature were some other challenges [1, 2, 3].

Key barriers identified among Spanish nurses include lack of Spanish nursing journals in which to publish the research results, insufficient funding in nursing care research, and the lack of connection between the healthcare institutions and the universities [4].

A survey of 1368 nurses from Northern Ireland, Parahoo [5] reported a number of challenges that impede clinical nurses from utilizing research findings. Ranked in order of magnitude, some barriers reported include lack of authority to change practice among nurses, complex statistical analysis, inadequate time to implement findings, ward management not supporting research implementation, research findings not generalizable to their practice settings, and doctors not cooperating with implementation.

Barriers to research utilization among clinical nurses in the US have been discussed at length. Cline et al. (2017) reported several barriers to the use of nursing research. Predominant among them were overwhelming research results and challenges discerning their relevance. Major barriers to research utilization in the US includes lack of organizational support and knowledge deficit among clinical nurses [6].

There is a dearth of nursing studies on barriers to nurses' participation in research activities in Ghana [1]. However, a few studies conducted reported some challenges. Only a study conducted among three hospitals in the Kumasi metropolis [7] categorized the challenges into settings, nurses' demographic and qualities of the nurses. Challenges imposed on clinical nurses with regard to practice settings include a lack of funding for nursing research, inadequate support from hospital authorities, and lack of a research committee in the health facilities, as well as insufficient time to participate in research activities. Regarding the qualities of the nurse as a barrier, less than half of nurses agreed that nurses' perception about their role in research was a barrier, whilst a handful said level of knowledge on research activities was a challenge. With regard to nurses' demographics, only the level of education was statistically significant as a challenge to nursing research.

In Ghana, nurses identified their impediments to research utilization and EBP to include lack of opportunities to participate in workshops, lack of facilities such as libraries and internet facilities at the hospitals, lack of policies supporting the nurses in research and EBP, and heavy workload due to insufficient nursing staff [8].

Whilst most academic institutions make it a mandatory requirement for nurse educators to conduct nursing research in order to be promoted, there is no corresponding compulsion on their clinical counterparts to apply research knowledge in clinical practice. This results in most clinical nurses making less efforts to search for and apply best available evidence in clinical practice.

In Ghana, a study conducted on the barriers towards nurses' participation and utilization of research reported unpleasant results. Only 25.3% had used research findings to change their practice. According to the study, most nurses perceive research as not part of a nurse's role whilst others considered research to be of minimal benefits [7]. This definitely does not augur well for the development of nursing research among clinical nurses and their professional development. The study concluded by recommending that health facilities motivate nurses who apply research findings to their clinical practice.

This study therefore seeks to explore the barriers that impede the efforts of clinical nurses to utilize or apply nursing research in their practice, as well as the facilitators to research utilization among clinical nurses in Ghana.

2. Methods

2.1. Study Design and Settings

A cross‐sectional survey, which allows for data to be collected at a specific point in time and permits generalization, was conducted among nurses at Tamale Teaching Hospital in Northern Ghana.

2.2. Study Participants and Settings

The study settings, a tertiary referral teaching facility, Tamale Teaching Hospital. The hospital which is located in the northern part of Ghana was established in 1974 and later upgraded to a teaching hospital in 2005 by the Ministry of Health, Ghana Health Service (GHS), in partnership with the Northern Regional Coordinating Council. It is the third largest tertiary health facility in Ghana, and serves the five regions of the north, sections of Volta and Ahafo regions and neighboring countries, including Burkina Faso and Ivory Coast [9]. The over 800‐bed capacity hospital provides services in Accident and Emergency, Trauma and Orthopedics, Child Health, Pathology, Ear, Nose and Throat (ENT), Endoscopy, Neurosurgery and General Surgery, Anesthesia and Intensive Care Unit (ICU), Psychiatry, Dentistry, Eye Unit, and ambulance service [10]. Additionally, the facility also serves as a training center for medical personnel, including physicians, nurses, pharmacists, medical laboratory personnel, among others.

Participants of the study include nurses with at least 1 year of experience at the facility. Newly recruited nurses and nurses undergoing their mandatory national service were excluded. A sampling frame comprising 1800 nurses at the facility was obtained. Participants were systematically selected by picking every fourth name on the list. Nurses who declined to participate or could not be contacted, such as those on leave were replaced by the succeeding name on the list. This resulted in a total of 330 participants.

2.3. Sample Size Determination and Selection

The formula used to determine the appropriate sample size for the study is Yamane (1967) [11]. Which states;

$$\begin{array}{l}n=\underset{\_}{N}\\ 1+N\left(e\right)²\end{array}$$

where n is the sample size, N is the population size, approximately 1800 nurses, and e is the level of precision of 0.05.

therefore n = 1800

1 + 1800(0.05)²

n = 327.

However, a total of 330 participants were recruited to enhance a representation of the population and provide more accurate results.

A sampling frame comprising 1800 nurses in the facility was obtained. To get the desired sample size, participants were systematically selected by picking every fifth name on the list. Nurses who declined to participate or could not be contacted, such as those on leave, were replaced by the succeeding name on the list. This resulted in a total number of 330 participants.

2.4. Ethical Considerations

To conduct the study, the proposal was submitted to the Research and Development Unit of the Tamale Teaching Hospital, the study center. A written permission with the serial number TTH/003/22 was granted after the proposal was reviewed by the research and ethics committee of the facility (clearance). A time period of 6 months was given for data collection, after which the researchers will have to apply for extension if required. Nurses who were systematically chosen as participants were contacted and a password encrypted link to the study tool shared with them. To gain access to the tool, participants were first asked if they consented to participating in the study. Those who answered yes could proceed to answer the questionnaire, whilst those who did not consent declined. Personal data such as name and place of birth were not captured. Data collected was placed under password locked device known only to the authors. Data were protected according to the Data Protection Act 483 of Ghana.

2.5. Study Instrument

The instrument used in this study was adapted from the standardized barrier scale developed by Funk et al. and an 8‐item facilitators scale developed by Hutchinson and Johnston (Funk et al. 1991; Hutchinson et al. 2004). The barrier and facilitators scale has demonstrated acceptable validity and reliability and has been used in various geographical settings, including the UK, United States, China, Hong Kong, and Spain [4, 5, 12, 13]. The facilitators scale was adopted without any modification, whereas the barrier scale was adapted.

The adapted barrier scale consisted of 20 items instead of the original 28‐item scale (Funk et al. 199a). Similar items were eliminated to prevent participant fatigue and hence preventing low response rate. The adapted scale further focused on key constructs and adapting to local context. Avoiding redundancy, items removed from the original scale include “the nurse does not feel capable of evaluating the quality of research,” “the nurse is unwilling to change or try new ideas,” “there is insufficient time on the job to implement new findings,” “other staff are not supportive of implementation,” “the research is not relevant to the nurses' practice,” “the research is not reported clearly and readably,” “literature reports conflicting results,” and “the conclusions drawn from the research are not justified.” Questions such as “other staff are not supportive of implementation,” which has been removed from the adapted tool shares similarities with “administration will not allow implementation” and “physicians will not cooperate with implementation,” which have been included in the adapted tool.

The adapted tool however retained its valid psychometric properties as all subscales scored acceptable Cronbach's alphas. The settings subscale had a Cronbach's alpha of 0.77, presentation subscale had a Cronbach's alpha of 0.74, the nurse subscale had 0.74, and the research subscale had a Cronbach's alpha of 0.80, as displayed in Table 1 in Supplementary File. Additionally, the adapted tool was also given face validity by a panel of nurse researchers at the University for Development Studies, Department of Nursing, Ghana.

3. Data Collection and Analysis

Participants of the study were approached and a detailed explanation of the study given. As data collection was online, WhatsApp contacts were taken and a link to the questionnaire was shared for participants to answer. Reminders were sent weekly to participants who could not respond and those who did not respond after a period of 5 weeks were replaced. Data were checked, cleaned, and coded using Excel, and analyzed using SPSS version 24. Data analysis was performed using both descriptive and inferential statistics. Descriptive statistics were used to describe the demographic characteristic of respondents and items in the study scales. Frequencies, mean score, standard deviations, and percentages were used to analyze and report the data, whilst inferential statistics such as Chi‐square were performed to assess the relationships and influential factors. Higher mean scores indicate the most common barriers and facilitators whereas lower mean score reports the least barriers and facilitators. All statistical analyses were performed at 0.05% confidence interval.

4. Findings

4.1. Demographic Characteristics of Respondents

Based on the findings presented in Table 2 (see Supplementary File), the demographic data of respondents are presented. A total of 330 respondents were surveyed with age range between 20 and 40 years and mean age 28.03 years. From the findings, 115 (35%) had Bachelor of Science degrees and majority of the respondents representing 52% were basic nurses with diploma certificates and 2% with graduate education. Majority of the participants, 236 (72%), had worked for 1–3 years whilst 16% had 7 years and above of work experience. Of the respondents, majority representing, 206 (62%) were males. The respondents were sampled from various categories of health workers with general nurses constituting 71%, enrolled nurses with a certificate in nursing made up 10%, midwives were 8% whilst nurses with a specialty in nursing made up 10%.2.

4.2. Perceived Barriers to Research Utilization

The study examined the perceived barriers to research utilization among nurses sampled at the study setting. Based on the responses, the findings are illustrated below.

4.3. Barriers Related to Nurses' Workplace

From the findings presented in Table 3 (see Supplementary File), 163 (49.4%) of participants agreed the nurse does not feel she/he has enough authority to change patient care procedures with research findings in the hospital whilst, 81 (24.5%) disagreed with the statement as a perceived barrier affecting nurses used of research in the hospital. It was also found that, most of the respondents, 141 (42.7%) disagreed that, administration would not allow implementation of research findings in the hospitals whilst few of the respondents, 48 (14.5%) strongly disagreed.

4.4. Barriers Related Presentation of Research Findings

From the findings presented in Table 4, 150 (45.5%) of participants agreed, statistical analyses are not understandable and this affected nurses' participation in research whilst few of the respondents, 20 (6.1%) strongly disagreed. It was found that, a little over half of the respondents 191 (57.9%) agreed with the statement that implications for practice are not made clear and this affected nurses' utilization of research whilst few of the respondents representing 79 (23.9%) disagreed with the statement as perceived barriers affecting nurses' participation in research.

4.5. Nurses Perceived Barriers

From the findings presented in Table 5, it was found that, most of the respondents representing 116 (35.2%) disagreed with the statement that, nurses were unaware of research and 40 (12.1%) respondents strongly agreed with the statement and this affected nurses' research utilization. The study also found that, 39 (11.8%) respondents strongly disagreed with the statement that nurses saw little benefit for self and few of the respondents 55 (16.7%) strongly disagreed with the statement. The study also found that, 71 (21.5%) respondents strongly disagreed with the statement that, the nurse does not see the value of research for practice and 86 (26.1%) respondents agreed.

4.6. Barriers Related to Research Findings

From the findings presented in Table 6, it was found that, 191 (57.9%) agreed with the statement, research has not been replicated in the hospital for nurses to participate and few respondents 33 (10.0%) disagreed with the statement. The study also found that, most of the respondents, 151 (45.8%) agreed with the statement that, nurse is uncertain whether to believe the results of the research and 34 (10.3%) respondents strongly agreed with the statement. It was also reported that, few of the respondents, 13 (3.9%) strongly disagreed with the statement that research reports/articles are not published fast enough for nurses whilst 79 (23.9%) respondents strongly agreed.

4.7. Facilitators to Nursing Research

The study examined the facilitators to nursing research in the study setting. Facilitators were categorized as education and training, research improvement and support, and motivation.

When it comes to education and training as research facilitators, it was found that, majority of the respondents, 176 (53.3%) strongly agreed with the statement that nurses engaged in research to advance education to increase their knowledge base whilst a few of the respondents representing 25 (7.6%) disagreed with the statement.

It was reported that, majority of the respondents, 205 (62.1%) strongly agreed with the statement, one way to facilitate research utilization in nursing is to improve the availability and accessibility of research reports whilst 23 (7.0%) respondents disagreed. The study also found that, about 164 (49.7%) respondents indicated that, they strongly agreed with the statement that, employing nurses with research skills to serve as role models for others whilst 15 (4.5%) respondents strongly disagreed.

Regarding support and motivation as facilitators for research, it was found that, half of the respondents strongly agreed with the statement that, one way to facilitate research utilization among nurses was to provide nurses support network/mechanisms whilst 40 (12.1%) respondents disagreed. The study also found that, 123 (37.3%) respondents agreed with the statement that one way to facilitate research work was to form research clubs to increase research interest among nurses whilst 27 (8.2%) respondents disagreed. This information is displayed in Table 7.

4.8. Association Between Facilitators to Nursing Research and Demographic Factors

Table 8 shows that, there was an association between respondents age and identifications of facilitators for nursing research (χ ² = 6.21, p = 0.013). Age corresponds to work experience therefore nurses with more years of experience in the field are more likely to identify facilitators to research. Also, type of educational qualification was found to be associated with respondents' identifications of facilitators for nursing research (χ ² = 16.22 p < 0.001). General Nurses were more likely to identify opportunities for nursing research compared to enrolled nurses. There was however, no association between the various categories of respondents and identifications of facilitators for nursing research (χ ² = 1.82, p = 0.178).

5. Discussion

5.1. Demographic Characteristics of Participants

Majority of the participants were within the ages of 20–40 years. This illustrates the youthful nature of Ghana's population. In terms of academic qualification of the participants, majority of the participants were undergraduates with either a diploma or a Bachelor of Science degree. Just over 2% of participants had a master's degree. This could be attributed to the fact that most nurses consider it as a disincentive to pursue a master's program as a result of exorbitant fees for graduate studies in Ghana and lack of promotion after completion. The few nurses who venture into graduate education often transition from the ward into academia. This trend has negatively affected the number of clinical nurses in Ghana with research expertise. The participants of the study comprised of various categories of nurses, ranging from enrolled to general nurses, midwives and nurses with specialties such as pediatrics, emergency, neurosurgery, and intensive care.

5.2. Barriers to Utilization

The participants of the study identified various barriers to effective research utilization for clinical nurses in Ghana. Barriers related to clinical practice settings were identified first. Majority of the participants believed that they do not have enough authority to implement research findings that are likely to change patient care procedures and that physicians will not cooperate with the implementation. These challenges were identified as major barriers to research utilization in Northern Ireland, where participants cited resistance from physicians as a key obstacle to research utilization [5, 14]. This is particularly true in Ghana considering the policy and administrative control of health facilities by physicians.

On the issue of whether hospital authorities will allow implementation of nursing research findings that might change practice, participants were evenly divided. Almost half of the participants believed management of the facility will not endorse changes in nursing practice that results from nursing research. In an earlier study conducted in Ghana, most nurses believed administrators of health facilities are most likely not to support the implementation of nursing research findings to change practice [7]. This finding can be attributed to the fact that, healthcare in Ghana is managed in a top‐down approach, where managers must sanction every policy and practice before it is implemented.

Regarding the generalizability of research findings, majority of the participants believed most research results are not generalizable to their practice setting. This may be due to the fact that most nursing researches that informs change in nursing practice is conducted outside the continent of Africa, mostly in Europe and America. Systemic factors in Ghana, including limited integration of research into clinical decision‐making limits the abilities of nurse researchers to conduct studies that can influence practice and for clinical nurses to utilize. This finding aligns with an earlier study in Ghana where nurses believed most nursing studies are not generalizable to their practice settings [7].

Studies the world over have reported nurses indicating inadequate time to read and implement research findings in nursing practice [5, 13, 14, 15, 16]. Unlike most studies, a little over half of the participants of this study did not perceive time constraint as a barrier. This could probably be attributed to the fact that most clinical nurses in Ghana have limited experience in nursing research and therefore do not realize how time‐consuming research can be. In other studies, however, time was not reported as a major barrier [14].

The most rated and identified barriers with regard to the settings of practice in order of highest to lowest were, the nurse does not feel he/she has the authority to change practice, the nurse feels results are not generalizable to own setting, the facilities are inadequate for implementation, and physicians will not cooperate with implementation.

The next barrier to nursing research utilization was regarding the presentation of nursing research findings. More than half of the participants believed that statistical analyses used in nursing research are not understandable. This could be attributed to the fact that, majority of clinical nurses in Ghana, and particularly this study, are undergraduates with either a diploma or bachelor's degree. These categories of nurses find it difficult to understand research results that are analyzed with inferential statistics, such as regression, Chi‐square, and ANOVA. This finding is consistent with other studies which report that, nurses with higher levels of education, such as Master's and PhD, are more likely to use nursing research because of their understanding and ability to interpret findings [17].

The next set of barriers was the nurse's own perceived barriers to research utilization. The first barrier discussed was whether the nurse is aware of research findings that may change practice. Almost half of the participants believed that, most nurses are not aware of research findings that may change current nursing practices. This may be due to the lack research facilities and inadequate knowledge of nurses regarding nursing research. Ignorance about the availability of nursing research findings was reported as a major barrier to research utilization among clinical nurses [7].

Other commonly identified barriers according to the participants of this study were the nurse perceiving the benefits of changing practice to be minimal and the absence of a documented need for such change. Most nurses believe that a documented need must exist before changes to current practice can be made. Others believe newly proposed changes might be of little benefit compared to current nursing practices. This finding agrees with similar findings in Ghana, where participants believed that most changes proposed by nursing studies might be of minimal benefit [7]. Lack of a documented need to change practice and benefits of change being minimal were cited as moderate barriers to research utilization and participation among nurses in Hong Kong [13].

The final set of barriers was related to research utilization. More than half of the participants believed that research findings not being replicated by other studies makes it difficult for them to implement their findings. This finding corresponds with that from China where research findings not being replicated was among the top 10 cited barriers by clinical nurses [12]. For research findings to inform and change practices, the study should be replicated in other settings and similar results produced. This was endorsed by more than half of pediatric nurses [15].

5.3. Facilitators to Research Participation and Utilization

Facilitators to nursing research were categorized into three subscales: education and training, research and support, and motivation. Under education and training, advanced education to increase research‐based knowledge and organizing regular workshops on nursing research for nurses were overwhelmingly endorsed by over 80% of participants as facilitators to their research usage. Statistical analysis of the data shows that respondents with higher educational qualifications such as those with a master's degree are more likely to identify facilitators for nursing research. This finding corresponds with several other studies. In a systematic review on individual determinants on research utilization by nurses, several studies reported a significant relationship between increasing education and research utilization [18]. The ability of clinical nurses to search and retrieve relevant research articles is related to the levels of study and most nurses with undergraduate degrees find it challenging to search for relevant articles [19]. In a systematic review, statistically significant relationships were found between attending research workshops and conferences and research utilization [18].

Improving the availability and accessibility of nursing research reports or articles among clinical nurses was seen as a facilitator by majority of respondents. Providing facilities for research, such as libraries, internet facilities, and access to subscribed databases and journals, will boost access to research articles among nurses and facilitate their utilization of nursing research [12].

Improving the ability to comprehend research reports and conducting more clinically relevant studies were reported as facilitators to research utilization among participants of this study which were supported by previous studies [5]. The call by participants of this study for nurses to conduct more clinically relevant research is in the right direction.

Employing more nurses with relevant research knowledge to serve as role models and increasing the time for nursing research are other facilitators endorsed by participants of this study. In a study conducted among Nigerian nurses to improve nursing research participation, the nurses recommended a collaboration between clinical and nurses in academia who have adequate research knowledge and experience to serve as role models [20].

The final subscale on facilitators was on support and motivation for nurses who utilize nursing research in practice. Enhancing managerial support for nursing research was overwhelmingly endorsed by majority of the participants. For nursing research to thrive in the clinical settings, nurse managers and managers of various health facilities need to support and encourage nurses who utilize nursing research in practice [12].

6. Conclusion and Recommendation

The study uncovers several factors that impede the efforts of clinical nurses to utilize nursing research in practice. Barriers were identified in the settings of nursing practice, the manner in which research results are presented, the nurse's own perception and the usability of the research. Highly rated barriers were perceived lack of authorities by nurses to change practice, results not generalizable to their practice settings, and inadequate facilities to conduct and implement research findings. Other barriers were statistical analysis difficult to understand, a perceived little benefit for nurses and a lack of documented need to change practice. However, several other facilitators were identified, which, if implemented will increase the utilization of nursing research among Ghanaian clinical nurses. Some highly endorsed facilitators include advanced education to increase research knowledge among nurses, employing nurses with research skills and experience to serve as role models, conducting more clinically relevant studies, providing managerial support for nurses, and providing motivation for nurses who use nursing research in practice.

6.1. Implications

The results of this study present several key implications for nursing research, practice, and education. In nursing research, the study has revealed the need for more reader‐friendly research articles with less jargon to enable the ordinary nurses comprehend research findings. The study further calls for more collaboration between nurse researchers and clinicians in order to conduct clinically related studies that can influence practice. In nursing education, the study highlights the need for the Nursing and Midwifery Council of Ghana to develop a more research‐oriented curriculum at the undergraduate level to equip undergraduate nurses with the required knowledge in nursing research. This can be achieved by emphasizing evidence‐based practice and incentivizing research involvement. Further, professional development opportunities, including further training and research workshops should be made available for clinical nurses to enhance their understanding of nursing research. In nursing practice, the study presents the need for interprofessional collaboration to enable the implementation of research findings in practice.

6.2. Limitations

Despite the robust methodological approach adopted in the study, some limitations associated with the study might include the use of a single tertiary facility as opposed to multiple settings. The low number of participants with postgraduate education may influence research utilization. Caution should therefore be observed when generalizing findings of this study to other settings, unless with similar demographics and other features. Furthermore, the modification of the tool and single site sampling may have slight impact in findings although the adapted tool retained its psychometric properties.

Author Contributions

Bayor Surazu: conceptualization, methodology, data curation, writing – original draft. Alhassan Salifu Sharif: data analysis, review of final draft, software and validation. Mikare Danang Maurice: literature review, methodology, and visualisation.

Funding

The authors received no specific funding for this work.

Disclosure

The lead author Bayor Surazu affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Table 1: Adapted Barriers Scale showing reliable psychometric properties. Table 2: Biographic data of participants. Table 3: Settings that affect research utilization and participation among nurses. Table 4: Presentation of research that affects nurse's utilization and participation. Table 5: Nurse perceived barriers affecting research participation. Table 6: Research utilization and participation. Table 7: Facilitators to research utilization. Table 8: Association between facilitators to nursing research and demographic factors.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.