EMPIRICAL STUDIES
Swedish nurses’ perception of nursing research and its
implementation in clinical practice: a focus group study
Doris M. Bohman RN, RNT, PhD (Senior Lecturer), Terese Ericsson RN, MSc (PhD-student) and Gunilla Borglin
RN, MSc, PhD (Associate Professor)
School of Health Science, Blekinge Institute of Technology, SE-379 71 Blekinge, Sweden
Scand J Caring Sci; 2013; 27; 525–533
Swedish nurses’ perception of nursing research and its
implementation in clinical practice: a focus group study
Background: Nowadays, nursing research is seen as an
integral part of professional nursing although implement-
ing knowledge derived from nursing research into the
practice setting is still problematic. Current research, con-
ducted mainly with a descriptive quantitative design,
highlights the struggle experienced by Registered Nurses
(RNs) to use and implement research findings in clinical
practice. Therefore, the aim of this naturalistic inquiry was
to explore nurses’ perception of nursing research and its
implementation in a clinical context.
Method and sample: A qualitative approach was chosen, and
four focus group discussions were conducted. The groups
comprised a total of 16 RNs (three men and 13 women)
working in a secondary care setting. The transcribed texts
were analysed, inspired by Burnard’s description of con-
tent analysis.
Findings: The texts were interpreted as representing three
predominant themes: scholastic, individual and contextual
influences highlighted as influential components impact-
Introduction
Nursing research is seen as a unified part of professional
nursing, and results from nursing research can contribute
to the development and renewal of patient care (1) as well
as the development of nursing education and leadership in
clinical practice. However, studies conducted in the United
States and the Netherlands indicate that 30–40% of
patients do not receive care in line with the latest research
and that 20–25% of the care provided is inadequate and in
some cases even dangerous (2). Hence, Grol and Grimshaw
Correspondence to:
Doris M. Bohman, School of Health Science, Blekinge Institute of
Technology, Karlskrona, Sweden.
E-mail: doris.bohman@bth.se
 2012 The Authors
Scandinavian Journal of Caring Sciences  2012 Nordic College of Caring Science
doi: 10.1111/j.1471-6712.2012.01058.
ing on the RNs’ views on research and its implementation
as well as on their readiness to accept and support it.
However, the most influential aspect permeating our
themes was their educational background – the type of
qualification they held. In general, the RNs with a Bach-
elor of Science in Nursing viewed research and the
implementation of knowledge in practice more favourably
than those RNs with a diploma.
Conclusion: Our findings, although based on a small quali-
tative study, are congruent with others, indicating that
further research is warranted concerning the impact of
education on RNs’ views of nursing research and its imple-
mentation. Hence, it might well be that the RNs’ educational
point of departure needs to be stressed more than what so far
have been anticipated. In the meanwhile, it is possible that a
number of strategies could be tested to promote a more
favourable view in these issues and where the nursing
education has the possibility to influence this endeavour.
Keywords: clinical practice, evidence-based, focus group
interviews, implementation, nursing, qualitative methods.
Submitted 10 June 2012, Accepted 20 June 2012
(2) succinctly highlight the gap that exists between
research findings and their implementation in practice
whilst at the same time others (3, 4) emphasise that more
research is needed within the area. Subsequently, to
enable a change in clinical practice from mainly anecdotal
and experience-based nursing care to a safer knowledge
and an evidence-based practice, more work is acquired. An
increased awareness among Registered Nurses (RNs) of the
value of research as well as their professional responsibility
to implement sound research findings in clinical practice
are important (cf. 5, 6). This would appear particularly
imperative nowadays as nursing is acknowledged as an
increasingly complicated activity, and ‘nursing complexity’
is such that it can be seen as the quintessentially complex
intervention (7). Fittingly, Sandström and colleagues (8)
suggest that the process of implementing new knowledge
in clinical practice and what governs it still need to be a
high priority.
525
526 D. M. Bohman et al.
Currently, we do know that one of the most widely
researched aspects of evidence-based practice is research
utilisation, that is, implementation and the RNs’ general
attitude to and/or perception of it (9). Pravikoff and col-
leagues (6) identified a gap between theory-based knowl-
edge and nurses’ attitude to research in the clinical field in
terms of not understanding or valuing research and being
generally unprepared for practice built on evidence. Find-
ings underscore that attitude and beliefs could alone act as
true barriers to change. Forsman et al. (10) as well as Tagney
and Haines (11) have also shown that the use of research
evidence among RNs is quite low, a result also confirmed by
Kerrison et al. (12), who found that RNs felt that accessing
evidence-based information was extremely difficult. The
research focus within this area has expanded and gone from
originally targeting the individual RN and her/his charac-
teristics (see 6, 13, 14) to now also including factors such as
organisation, context and nursing leadership (e.g. 8, 15–18).
It would thus appear appropriate to focus research activities
on the intricate interplay that is likely to exist between the
individuals working in the healthcare context, the organi-
sation and its leaders. All of these components are now in
effect, believed to influence the implementation process
(14) and our potential to successfully implement knowledge
and promote change in a clinical setting.
To summarise, nursing research in Europe has during the
last two decades passed through an extensive process of
development although this is not yet truly reflected in the
RNs’ clinical practice. A plethora of nursing studies high-
lights the difficulties RNs could encounter in the quest to
implement knowledge-based care in clinical practice.
Hence, our knowledge about barriers that we now know
might make or break the implementation of research in
practice is well explored. A consensus is emerging that the
implementation of sound research findings is a complex
procedure and that numerous factors are likely to influence
the process. Available research indicates a need to alter the
research focus: from single barriers to what can and must be
done to facilitate a change in RNs’ behaviour, that is, beliefs
and attitude, and the successful implementation of research
findings in clinical practice. It could be important to note
that the literature review for this study indicated that the
majority of nursing studies in the field so far seem to have
used a survey approach. The above is applicable in any
European clinical nursing context. However, it is important
to acknowledge that nursing education throughout Europe
is not set up in a homogenous way. Educational research on
the topic is according to Ciliska (19: 40) ‘…in its infancy,
particularly with respect to nursing education’. For exam-
ple, in Sweden, the only route to the nursing profession has
for the last fifteen years been through a Bachelor’s degree in
Nursing Science (BSN). To facilitate a change in practice,
more detailed knowledge about the RNs’ personal view of
nursing research and its implementation in practice would
appear to be timely.
Scandinavian Journal of Caring Sciences  2012 Nordic College of Caring Science
Method
Informants and recruitment
A purposive sample consisting of 13 female RNs and three
male RNs (n = 16) was used with the aim of obtaining
different perceptions (1). The informants were working at
two thoracic units at a hospital in south-east Sweden.
These units were targeted as they had expressed an interest
in developing nursing and clinical praxis in collaboration
with the nearby higher educational institute (HEI). One of
the researchers (TE) attended staff meetings and informed
about the study and its aim both verbally and in writing. Of
the 28 informants initially approached, 12 declined, citing
lack of time as the reason for not participating. The mean
age was 36.3 years (range, 24–56) and their work experi-
ence in secondary care ranged from 8 months to 23 years.
Informants had either a Diploma or a Bachelor of Science
in Nursing (BSN) (Table 1).
Focus group interviews
Focus groups were the preferred method. It was antici-
pated that group processes would help the RNs to clarify
their perceptions about nursing research and its imple-
mentation in clinical practice in ways that would be less
easily accessible in a one-to-one interview (20–22). Four
focus groups were conducted during early spring 2011,
each consisting of four informants and lasting for an hour
each. Two were mixed gender whilst two consisted of fe-
males only. An interview guide consisting of an ‘ice-
breaker’, introductory questions, key questions and
wrapping-up questions was used (22). The interviews were
taped and transcribed by one of the researchers (TE).
Content analysis
The transcribed texts were analysed, inspired by content
analysis as described by Burnard (23). The method is an
inductive process of ‘four-step’ content analysis where the
investigator identifies, codes and categorises important
meanings and predominant themes from the text. In the first
step, the transcribed texts were read to obtain an overall
understanding, and the texts were then read in greater
depth, highlighting parts of the texts that were interpreted as
responding to the aim. In the second step, the highlighted
parts were condensed while still preserving the central
meaning. The third step involved the creation of codes
aimed at opening up to new reflections about the text. In the
fourth step, the codes were read, compared and contrasted
with the text again to ensure credibility (23, 24). In this final
stage, sub-themes consisting of several similar codes were
created, and these sub-themes were interpreted to represent
three predominating themes of importance to RNs’ percep-
tion of nursing research and its implementation (Table 2).
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 Swedish nurses’ perception of nursing research and its implementation in clinical practice 527

Table 1 Overview of the informants

Code Gender Age Education Position

A $ 48 Diploma and Specialist education Intensive Care RNa

B # 56 Diploma General RN
C # 50 Diploma and Specialist education Intensive Care RN
D $ 43 Diploma and Specialist education Intensive Care RN
E $ 50 Diploma General RN
F # 44 Diploma and Specialist education Intensive Care RN
G $ 45 Diploma and Specialist education Intensive Care RN
H $ 36 Bachelor of Science in Nursing and Specialist education Intensive Care RN
I $ 27 Bachelor of Science in Nursing and Specialist education Intensive Care RN
J $ 43 Bachelor of Science in Nursing General RN
K $ 23 Bachelor of Science in Nursing General RN
L $ 34 Bachelor of Science in Nursing General RN
M $ 22 Bachelor of Science in Nursing General RN
N $ 27 Bachelor of Science in Nursing General RN
O $ 24 Bachelor of Science in Nursing General RN
P $ 24 Bachelor of Science in Nursing General RN
a
Registered Nurse.

Table 2 Sub-themes and themes The concept. The sub-theme the concept reflected the RNs’
bewilderment concerning the theoretical concept of
Sub-themes Themes nursing research, viewed as nebulous and mixed up with
medical research. The RNs stated that nursing research
The concept Scholastic influences had no bearing on them, and they portrayed it as an
Knowledge and skills
isolated phenomenon belonging to RNs working in aca-
Frame of mind Individual influences demia, that is, nursing education. It was a sphere they
Old and new ways perceived as being complicated, far too theoretical and
Professional development superfluous. They emphasised that if knowledge origi-
Time and access Contextual influences nating from research was implemented this was done
Milieu unconsciously, and any integration between theoretical
Nursing care and experience-based knowledge occurred in a nonre-
flective manner. This view also showed that the RNs with
a diploma were of the firm opinion that experience-based
knowledge was the core in nursing care.
I would like to experience the usefulness of research in care
Ethical considerations more obviously. But we are not educated…, we have not been
This study was conducted in compliance with the estab- taught to think like that you feel that research is something
lished ethical guidelines of the Declaration of Helsinki. Even others are involved in. It depends on our background and an
though under the Swedish Ethical Review Act 2003:460 older education. (B)
(25) this study did not require ethical clearance, we applied
for and received ethical guidance from the ethical advisory Knowledge and skills. In the sub-theme knowledge and skills,
board in south-east Sweden (No. 95-2011). some of the RNs aired a view of themselves as restrained in
as much as they did not feel at home with nursing research
or basic research methods. This view also included their
Findings
lack of ability to identify and search for useful research,
which they perceived as frustrating. Being information
Scholastic influences
literate was viewed as an important skill that could support
The theme ‘scholastic influences’ and its sub-themes the them by providing a reason for or justifying a particular
concept and knowledge and skills (Table 3) mainly accounted nursing activity or simply by supporting them when they
for the RNs’ views about the theoretical concept of nursing needed to underpin a statement. This ability was therefore
research although the theme also included their views on perceived as a fundamental skill in the quest to implement
nursing research in relation to education. knowledge-based care.

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Scandinavian Journal of Caring Sciences  2012 Nordic College of Caring Science
528 D. M. Bohman et al.
I think it is too hard to find the latest research. You
shouldn’t need to go through all of that to find the latest; it
feels like a totally different world. (D)
RNs with a BSN discussed how initially during their
education, they had perceived nursing research as insig-
nificant but as time passed they had changed their minds.
The RNs felt that there were general differences in
knowledge about nursing research between the BSN and
diploma programmes. The latter had focused on clinical
rather than academic and theoretical skills. RNs with a
diploma, and who now had considerable working expe-
rience, emphasised that they would not search for or read
a scientific paper. They agreed that a great deal had
changed in nursing education – from focusing on a med-
ical perspective to focusing on caring science – and that
they might have ‘missed out big time’ on basic nursing
research methods. Some of the recently trained RNs (BSN)
stated that those with the ‘older’ education (diploma)
could not see the importance of nursing research. Diffi-
culty not knowing what research to trust and pinpointing
research of relevance to their practice setting was also
highlighted. On the whole, the RNs stated that knowledge
about basic nursing research methods was essential to
understand research findings and implement them.
Individual influences
The theme ‘individual influences’ consisted of the sub-
themes frame of mind, old and new ways and professional
development (Table 3). The RNs’ attitude to nursing research,
old and new practices and the impact of research on the
individual RN and her/his development were highlighted.
Frame of mind. In the sub-theme frame of mind, there was
an examination of the RNs’ perception of what imple-
mentation of research findings meant, that is, constantly
questioning prevailing practice. Here, the RNs discussed
the resistance, that is, negative attitudes among themselves
towards research and how this obstructed the under-
standing of nursing research and its implementation. Some
RNs stated that it was vital to remove the negative stamp
nursing research had in the practice setting, especially as a
means of involving more of their colleagues. The RNs be-
lieved that information, education, colleagues and front-
line nursing managers bestowed the power to alter nega-
tive attitudes and beliefs.
One doesn’t think that it is research we base nursing care on,
it is experience-based. But it becomes obvious if you have
research results showing the same. Then it feels better and it
becomes easier to promote if you have the combination. (A)
The RNs’ attitude towards nursing research and its imple-
mentation was considered to derive from personal interest
and individual involvement. Here, the RNs with long work
experience (diploma) expressed limited interest in
becoming involved in nursing research, and instead they
Scandinavian Journal of Caring Sciences  2012 Nordic College of Caring Science
prioritised medical research or seeking help from col-
leagues or others. On the other hand, the RNs with shorter
work experience (BSN) viewed nursing research as a
matter of course, especially when facing problems or tricky
situations in the practice setting. They also saw the
advantages of changing work practice in accordance with
research as it consolidated their professional role. The
general perception was that the attitudes and involvement
in nursing research could definitely be improved.
Old and new ways. In the sub-theme old and new ways, the
RNs discussed their views about the arrival of fresh ideas
into the practice setting. RNs with an ‘older’ education
(diploma) stated that it was necessary to take good care of
the ‘younger’ RNs (BSN) arriving with new thoughts, fresh
ideas and a different kind of insight into research.
Encounters between ‘old and new ways’ were perceived as
stimulating but also a threat as it could mean questioning
practice and initiating change. In contrast, some of the
‘younger’ RNs (BSN) spoke about the need to tread care-
fully, especially not to be too pushy regarding new ideas
despite the fact that they also felt that their ‘older’ colleagues
appreciated their suggestions in the long run. It was seen as
vital to be persistent and to not give way to peer pressure.
No, you do not dare to push it too far you need to just stay
put..... But in time you can influence it and express your
thoughts and opinions. (K)
The importance of continuously questioning why care was
supposed to be performed in a certain way came up among
the ‘younger’ RNs, who stated that remaining critical and
reflective was vital for the sake of the patients and their
care. They meant that much of the care was performed
routinely and was not explained properly to the patients,
who they maintained had an intrinsic right to be informed
as to actively participate in their own care.
Professional development. The sub-theme professional devel-
opment revealed the RNs’ perceptions about their progress
in relation to research. Some of the RNs stated that the art
of caring and nursing research were strongly intertwined.
The ‘younger’ RNs (BSN) discussed how their education,
including basic nursing research methods and with a
strong focus on caring science, had influenced them to
perceive research as fundamental. Hence, having sufficient
knowledge about research was now instrumental to their
individual progress and their professional role.
t can feel easier to motivate the patient if you know that there
is research to support you in your reasoning with the patient.
(L)
The knowledge that they were implementing sound
research findings made it easier for them to feel more
confident and to stand up for the ‘whys and hows’ in their
care. Some RNs were participating in a research project.
They discussed how being able to see the results and the
benefits emerging from research at first hand was a great
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 Table 3 Overview process of analysis

 2012 The Authors

Meaning unit Condensation Code Sub-theme Theme

‘I think nursing research means the study of how the RNs use their Hard to understand and to pinpoint the Difficulty defining the The Concept Scholastic Influences
knowledge in the care of the patient; the actual care, which is meaning of the concept of nursing research concept
documented and improved through research.... I think it is difficult
to pinpoint and I think it is merging with medicine’. (C)

‘I would like to learn how to search for research; I am not skilled in The RNs experience problems searching for Not having enough Knowledge and
searching in databases. I often get stuck finding the right papers’. (O) and using nursing research knowledge Skills

‘You stagnate (in relation to change) and you do as you have always Stagnated attitude towards change - no Thoughts about Frame of Mind Individual Influences
done, leaving no space to develop care’. (P) progress in care nursing research

‘The possibilities arrive when new RNs arrives’.(J) ‘Older’ RNs view newcomers as positive It is stimulating having Old and New Ways
‘When you work with a recently qualified RN there is always new colleagues
greater openness’. (H)
‘It is always interesting to see other things.... We are now using those Seeing the use of nursing research in the Growth and progress, Professional
electric blankets to investigate which of them are the best – that is profession both professionally Development
research too’. (C) and in care activities

Scandinavian Journal of Caring Sciences  2012 Nordic College of Caring Science

‘I think you hit the nail on the head when you said accessibility.... that is Access is important in order to search Access and time Time and Access Contextual Influences
what I miss... because I am not good at finding things in databases and for and use nursing research impact on use of
that is my dilemma... that is where I always get stuck and then I can’t nursing research
get any further’. (E)

‘There has been a lot of resistance from colleagues too, but it has The need and importance of support from The importance of Milieu
loosened up and become better’. (E) colleagues and others support

‘It is us who are going to point out the medical problems and pay RNs’ patients advocate. Use and importance in Nursing Care
attention. It is our business to listen to the patient and help them put The benefit of nursing research nursing care
forward their views’. (A)
‘Research should show if this is the best or worse way of doing it and
then it is a form of development for me and for patient care’. (K)
Swedish nurses’ perception of nursing research and its implementation in clinical practice
529
530 D. M. Bohman et al.
opportunity to develop further in their profession and at
the same time it led to a wish to learn more about research.
Contextual influences
The theme ‘contextual influences’ contained the sub-
themes time and access, milieu and nursing care (Table 3).
These represented environmental barriers and promoters
for taking on research and the relationship between
nursing care and research. There were also discussions
about the need for a more open climate among colleagues
regarding, for example, spending time in front of the
computer looking for nursing research. Colleagues did not
always view this type of activity favourably.
Time and access. In the sub-theme time and access, the RNs
expressed their views about a constant shortage of time,
which meant that catching up and acquiring information
about research had to be performed during their time off.
The general view was that each working shift was
extremely busy with no spare time to locate, discuss or
evaluate research. They shared a view that time should be
allocated in the rota for updating on guidelines and
research, as these were perceived to be vital to developing
their clinical practice. There were also discussions about
the need for a more open climate among colleagues
regarding, for example, spending time in front of the
computer looking for nursing research. Colleagues did not
always view this type of activity favourably.
There is very rarely any time to sit in front of the computer and
search for articles or anything like that. (N)
The RNs also talked about the difficulties accessing clinically
useful and relevant research and how this influenced the
implementation process. According to the RNs, these diffi-
culties could be eliminated by simple means, such as having
nursing journals and research reports available on the
wards. Another impeding factor was their awareness that
scientific nursing journals were in English and used com-
plicated language, that is, academic language, which added
to the difficulty accessing and understanding research.
Milieu. In the sub-theme milieu, the RNs discussed the
necessity of experiencing support within their working
context. Involvement and support from management and
front-line nurse managers were regarded as crucial for the
RNs to participate and to raise their level of involvement,
especially as the RNs stated that at present medical
research was the prioritised area within the organisation.
According to the RNs, taking charge and discussing nursing
research and nursing care issues are a management
responsibility. The ability of front-line nurse managers to
act and respond to issues that arise could have a positive
influence on the staff’s attitude and views towards
research. The RNs pointed out that feedback, encour-
agement and rewards from front-line nurse managers
Scandinavian Journal of Caring Sciences  2012 Nordic College of Caring Science
and from those higher up in the hierarchy, as well as
from colleagues, could be crucial elements in promoting
active involvement in the implementation of nursing
research.
There must be someone who educates the staff and who in a
way presents the latest findings – ‘‘This is out now and we
are going to develop it’’. (C)
Having a key mover pushing onwards and upwards in
issues concerning nursing research versus nursing care was
highlighted as another crucial component in the imple-
mentation process. The RNs stated that a key mover could
present the latest nursing research, lead discussions and
ensure in particular that medical research does not get the
upper hand on nursing research. Collegial support was also
viewed as important for implementing new routines as
bringing in new ideas for change without collegial support
was deemed impossible.
Nursing care. In the sub-theme nursing care, the RNs
views about the relationship between the patients, nurs-
ing care and nursing research were highlighted. The RNs
discussed the significance of acknowledging the possibil-
ities and the benefits of research and not simply focus on
the perceived disadvantages. Here, the RNs confessed that
research was important and necessary for the develop-
ment of patient care. There was a common agreement on
the importance of the patient as the focal point in nursing
care, regardless of what kind of changes the practice
setting went through. Some of the RNs discussed how
they referred to different research findings in conversa-
tions with the doctors and with the patients when it
involved nursing care activities. However, the general
view among RNs about how the development of nursing
care should proceed differed. Mainly, RNs with a BSN
stated that it would be best for patient care to work in
line with research, as it was perceived as an important
contributor to nursing care, whilst RNs with a diploma
regarded experienced-based nursing care as the preferred
option. In this discussion, it became obvious that the RNs
felt that they also bore a responsibility to make the
development of nursing care work.
You can lean towards research and it is simply the strength
of the profession. (N)
Some RNs stressed in particular that nursing research had
resulted in a more holistic view of the patient and high-
lighted the uniqueness in each caring situation. The dis-
cussions also revealed that it was more frequent nowadays
for patients to have questions about both care and treat-
ment, and the RNs felt that the patients expected them to
possess genuine knowledge about care and that they were
the first in line to answer any questions patients might
have. It was therefore important for the RNs to feel secure
in their professional role. Overall, the RNs reported that
research had led to better treatment options for patients
and raised the standard of nursing care. They viewed the
 2012 The Authors
 Swedish nurses’ perception of nursing research and its implementation in clinical practice
process of implementation as a demanding endeavour as it
required a constant state of preparedness for change.
Accommodating and implementing research thus
meant rapid changes, which could at times act in direct
contravention of prevailing practice, whilst at other times
research findings confirmed prevailing practice.
Research should show if this is the best or worse way of
doing it and then it is a form of development for me and for
patient care. (K)
Discussion
Our result reinforces emerging research that recognises that
the implementation of sound research findings in a practice
setting is a multifarious endeavour and a process influenced
by several components (8, 14, 26, 27). The findings from
this study can thus be understood in the light of three
predominant themes: scholastic, individual and contextual
influences, with their associated sub-themes (Table 2).
These were underscored as components impacting on the
RNs views about nursing research and its implementation,
as well as on their readiness to take on the process in a
practice setting. However, the most influential aspect that
permeates our themes, that is, the RNs’ perceptions, was
interpreted as a departure from their educational experi-
ence – their type of qualification. In general, the RNs with a
BSN viewed research and the implementation of know-
ledge in practice more favourably than RNs with a diploma,
thus indicating that the presence of more academically
trained nurses in the practice setting is a necessity if the gap
between research and practice is to be bridged.
The impact of the type of qualification became discern-
able through the obvious rift regarding academic skills and
hence attitudes to nursing research and its implementa-
tion. Here, the RNs with long working experience, but
with less academic training (diploma), were mindful of
their lack of knowledge and thus dismissed any form of
involvement in research (Table 3). We know from others
that educational preparation in terms of a good knowledge
base in research is a significant factor in developing a more
favourable attitude towards it (28–31). However, we also
know from systematic literature reviews (13, 32) that few
studies exist that focus on the RNs’ type of qualification
and its influence on research implementation and those
that do exist reveal contradictory findings. The evidence
base for the impact of the RNs’ type of qualification on
research implementation is thus still weak (19). We cannot
turn back time with regard to different educational
departure points, and instead, we might need to look for
new and different approaches to foster the uptake of
research into the practice setting (14, 33). Nevertheless, we
suggest that nursing education might need to assume
greater responsibility early on promoting preparedness for
change whilst also nurturing the uptake and implemen-
tation of research to enable evidence-based practice
 2012 The Authors
Scandinavian Journal of Caring Sciences  2012 Nordic College of Caring Science
531
settings. Ciliska (19) is in concordance and emphasise that
although many nursing undergraduate programmes
include courses in evidence-based practice, little have been
done concerning evaluating skills and behavioural change.
Highlighting the importance of faculty development in
terms of skills to incorporate evidence-based practice
concepts in clinical and classroom teaching.
It also appeared as if the RNs’ type of qualification
influenced not only their attitude to research and the
process of implementation but also how they took it on
board and their individual progress. It became evident that
the relationship between the more experienced RNs
(diploma) and those with less experience (BSN) could be
ambivalent. The latter emphasised nursing research as a
vital source for personal development and care, whilst the
more experienced RNs prioritised clinical experience and
medical research. This indicates that in this setting, the
relationship between clinical experience and research, that
is, evidence, may so far not be internalised. Our interpre-
tations can be said to be discerningly supported by a recent
study (34) focusing nursing students, in which the authors
found that when it concerned research and development,
the students seemed to fall ‘between the hospital practice
and concrete world of production’ and the university
‘theory world of education and research’ (34: 1). In Swe-
den, as in the rest of Europe’s healthcare settings, RNs
have different types of qualifications and, as mentioned
previously, it is not reasonable to expect them to have the
same educational level as their point of departure. How-
ever, one way to develop RNs with extended clinical skill
potential rather than academic skill potential, that is,
expert nurses (35), should be to support them and
encourage them to link their clinical expertise to research.
This approach might bridge the gap, bringing out the best
of different educational spheres while creating a team of
RNs who are more receptive to change.
Finally, our study highlighted that change seems to
thrive where ‘a context characterised by research is valued’
(8: 9). In this setting, it became clear that medical research
was not only prioritised by the experienced RNs (diploma)
but was also the research valued by the organisation at
large. This together with indicative signs of a lack of a
supportive organisational structure and a possible absence
of strong front-line nurse managers might be one expla-
nation for the negative attitude of RNs in this study. The
RNs’ reluctant approach to research and its implementa-
tion is perhaps not that surprising as this can be viewed as
a consequence of the possible existing contextual limita-
tions, that is, their reality. Despite this, the RNs felt that
they carried a huge responsibility to make the develop-
ment of nursing care work and that utilisation of research
was important to the patients. The possible negative
influence of organisation and leadership is supported by
studies emphasising that organisational and practice issues
and the leadership role are influential in implementing
532 D. M. Bohman et al.
evidence in practice (9, 36, 37). It is important to note that
the current study setting reflects the fact that despite
nearly two decades of an undergraduate nursing education
with full academic status (BSN), access to academically
trained front-line managers in the practice setting is still
limited (38). Furthermore, resources for in-service educa-
tion and skills development support are virtually nonex-
istent in comparison, for example, with the UK, where
further in-service education for RNs is a mandatory part of
postregistration education and practice (PREP) require-
ments (39). These are components that have been shown
to be of importance to RNs’ understanding of and imple-
mentation of knowledge (36). This once again highlights
how education, that is, different types of qualifications,
might have a hand in influencing the setting, research
implementation and the understanding of nursing
research. This leaves us with the question of how much
influence the diversity of different types of qualifications
has actually had on the ability of the nursing profession to
create evidence-based/knowledge-based practice.
Methodological consideration
Evaluating the trustworthiness could be performed within
the framework of its credibility (40). To accomplish this,
quotes are presented to enable a transparency of analysis.
To reduce this risk of subjectivity (41), the authors regularly
worked together throughout the content analysis (23, 24)
to strengthen the interpretations, not by achieving con-
sensus or arriving at identical formulations in interpreta-
tions but by supplementing and contesting each other’s
readings. Four focus groups were run and this was consid-
ered to be sufficient as we received guidance on the notion
of response saturation (42) as no new information emerged
after three focus groups. A limitation of the study may be
that the result is based on only 16 informants. Hence, the
result should therefore be interpreted with some caution.
Although the sampling was purposively conducted, it was
homogeneous with regard to gender (female) and work
context (two thoracic units). However, the sample can be
said to be representative of the nursing profession. This
together with the informants’ heterogeneous education
and work experience can be seen as an advantage.
Conclusion
Our findings, although based on a small qualitative study,
are congruent with others, indicating that further
research is warranted concerning the impact of education
for Nursing Practice, 9th edn.
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Acknowledgements and funding
We would like to thank Professor Ania Willman for her
valuable comments and Patrick O’Malley for his help with
language revision. This project was funded by the Blekinge
Institute of Research (BFR), Blekinge Hospital and the
School of Health Science, Blekinge Institute of Technology,
Karlskrona, Sweden. Gunilla Borglin has also received
support from the Strategic Associate Professors Programme
at Blekinge Institute of Technology, Karlskrona, Sweden.
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TE, DMB and GB conceived and designed the study. TE
collected the data and analysed it together with DMB and
GB. TE drafted the initial manuscript with the support
from GB and DMB who also revised it critically for
important intellectual content. All authors read and ap-
proved the final manuscript.
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None declared.
Ethical approval
Not applicable.
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