Description of studies
Figure 1 summarizes article selection for this review. The database and hand searches yielded 42,770 titles and abstracts. Of these 42,770 articles, 501 were identified as being potentially relevant after a title and abstract review. A total of 456 articles were excluded for not meeting our inclusion criteria, leaving 45 articles for inclusion in this review, and 31 (69%) of these articles are additions to the previous review). The 45 articles represent 41 original studies; four studies have two reports each: McCleary and Brown [29, 30]; Estabrooks [31, 32]; McCloskey [33, 34]; and Parahoo [35, 36]. A list of all (n = 45) included articles can be found in Additional File 4. The original review [17] included 22 articles. This review update excluded eight of these articles, leaving 14 of the original articles in the update. The eight articles were excluded for one of three reasons: they did not include a measure of research utilization as we defined it for this review update (n = 5) [37–41], they did not report on individual characteristics (n = 2, these two articles represented a second report of a study that did not report individual characteristics - the first report of each study, which did report on individual characteristics, were included) [2, 42], or did not provide a quantitative (statistical) test of the association between the individual characteristic(s) and research utilization (n = 1) [43].
A variety of self-report instruments, multi-item and single item, were used to measure research utilization in the 45 included articles. Multi-item instruments used included: the Nurses Practice Questionnaire (n = 8) [12, 14, 44–49]; the Research Utilization Questionnaire (n = 11) [33, 34, 50–58]; the Edmonton Research Orientation Survey (n = 3) [29, 30, 59]; and three research utilization indexes, each used in a single study [60–62]. Single-item instruments used included: Estabrooks Kinds of Research Utilization Items (n = 9) [31, 32, 63–69]; Parahoo's Item (n = 2) [35, 36]; Past, Present, and Future Use Items (n = 3) [70–72]; and other single items, each used in a single study (n = 6) [73–78]. The majority of articles examined research utilization by nurses in the United States (n = 18, 40%) followed by Canada (n = 14, 31%), Europe (n = 8, 18%), Australia (n = 2, 4.5%), China (n = 2, 4.5%), and Africa (n = 1, 2%). The most commonly reported setting was hospitals (n = 28, 62%) followed by a mixture of settings, e.g., sampling from a provincial or state nursing roster (n = 13, 29%), nursing homes (n = 2, 4.5%), an educational setting (n = 1, 2%), and a flight team setting (n = 1, 2%). With respect to year of publication, the vast majority of articles were published since 1995 (n = 40, 89%). Further details on the characteristics of the included articles can be found in Additional File 4.
Methodological quality of included studies
Methodological quality of the articles included in this review is reported in Additional Files 2 and 3. All articles used an observational design: the majority (n = 43, 96%) used a cross-sectional design while two articles (4%) used a quasi-experimental design. Of the 45 included articles, one (2%) was rated as strong, 13 (29%) as moderate-strong, 18 (40%) as moderate-weak, and 13 (29%) as weak. Discrepancies in quality assessment related mainly to sample representativeness, treatment of missing data, and appropriateness of the statistical test(s) used.
The outcome: individual characteristics and research utilization
Data on individual characteristics were extracted into the original six categories from the previous review [17]: beliefs and attitudes, involvement in research activities, information seeking, education, professional characteristics, socio-demographic and socio-economic factors (relabeled from other socio-economic factors), and one additional category, and critical thinking. Relationships between these characteristics and research utilization in general, and kinds of research utilization, are summarized next with additional details presented in Tables 1 and 2 respectively.
Research utilization in general
A total of 39 (87%) articles examined relationships between individual characteristics and nurses' research utilization in general (Table 1).
Beliefs and attitudes
Fourteen articles assessed one or more individual characteristic in the beliefs and attitudes category. Of these 14 articles, six were rated as weak methodologically, five were rated as moderate-weak, and three were rated as moderate-strong (Additional Files 2 and 3). Sample sizes varied from a low of 20 participants [54] to a high of 1,117 participants [62] (Additional File 4). The most frequently assessed characteristic in this category was attitude towards research, assessed in eight articles. The majority of these eight articles were rated as weak (n = 3) or moderate-weak (n = 4) methodologically while one article received a quality rating of moderate-strong (Additional Files 2 and 3). In all eight articles, attitude towards research was measured using multi-item summated scales. A 21-item scale developed by Champion and Leach [50] with items tapping nurses' feelings about incorporating research into practice was used in four of the eight articles [50, 52, 56, 57]. Similar multi-item measures, with six [31, 61], 12 [54] and 15 items [72] were used in the remaining four studies. A positive association with research utilization, at statistically significant levels, was found in all eight articles. The magnitude of effect, on average, was high moderate, with correlation coefficients ranging from 0.41 to 0.82. Other belief and attitudinal characteristics were assessed in less than four articles and therefore their results cannot be considered with any confidence.
Involvement in research activities
Thirteen articles assessed one or more individual characteristic related to nurses' involvement in research activities. Of these articles, three were rated as weak methodologically, eight were rated as moderate-weak, and two were rated as moderate-strong (Additional Files 2 and 3). Sample sizes also varied from a low of 82 participants [55] to a high of 1,100 participants [49] (Additional File 4). Examples of activities assessed that were reflective of involvement in research activities included: participation in a research study [44, 55], participation in quality improvement initiatives [58], participation in quality management [29], and data collection for others conducting research [71]. Additional examples can be found in Table 1. A total of 13 individual characteristics were identified in this category overall. However, each characteristic was assessed in less than four articles, precluding us from drawing conclusions on the relationships between individual characteristics typical of involvement in research activities and nurses' use of research findings in practice.
Information-seeking
A total of 15 articles reported individual characteristics consistent with information-seeking behavior. Two articles were rated as weak methodologically, five articles as moderate-weak, and the remaining eight articles as moderate-strong (Additional Files 2 and 3). Sample sizes varied largely from a low of 92 participants [57] to a high of 5,948 participants [69] (Additional File 4). Several articles examined the relationships between different reading practices and research utilization. For example, reading professional journals [46]; hours spent reading professional journals [44, 47, 48]; the number of journals read [12, 49, 72]; and reading specific journals such as Heart and Lung[47, 48], Nursing Research[44, 48], and RN[44], were studied. Different combinations of these six reading characteristics were tested a total of 12 times (some articles assessed more than one of the reading practices simultaneously). Findings from these investigations were equivocal with seven articles (58%) reporting statistically significant findings and five articles (42%) not finding statistically significant findings. Thus, no conclusion can be drawn as to the effect of reading practices on nurses' use of research in practice.
The second most commonly studied information-seeking characteristic was attendance at conferences and/or attendance at in-services, examined in five articles [31, 47–49, 71]. Four of these articles [31, 47–49], all rated moderate-strong with respect to methodological quality, found positive relationships, at statistically significant levels, between conference and/or in-service attendance and research utilization. The overall magnitude of this effect, however, is not computable since each article used a different test of statistical association. The remainder of individual characteristics falling within the category of information seeking were only investigated in one or two articles, precluding us from considering their findings (Table 1).
Education
A total of 28 articles reported individual characteristics within the domain of education, making it the most commonly studied category of characteristics in this review. Of the 28 articles, 10 were rated as weak methodologically, nine were rated as moderate-weak, and nine were rated as moderate-strong (Additional Files 2 and 3). Sample sizes varied from a low of 20 participants [54] to a high of 5,948 participants [69] (Additional File 4).
Twenty-five of the articles in this category examined one of three characteristics related to formal nursing education: increasing levels of education (i.e., diploma, bachelor degree, masters degree, PhD degree, but without post hoc analyses to determine between which levels noted differences lied), type of degree: bachelor versus diploma, and type of degree: graduate degree (masters or PhD) versus lower (bachelor and/or diploma). Increasing levels of education was assessed in seven articles [12, 44, 47, 49, 54, 55, 77]. Findings from these investigations were equivocal with only four (57%) of these articles [12, 49, 54, 77] finding positive relationships, at statistically significant levels, between higher levels of education and research utilization. A total of 11 articles [14, 29, 31, 46, 57, 61, 62, 69, 71, 73, 76] examined the relationship between research utilization and type of degree: bachelor versus diploma. Eight of these articles [14, 31, 46, 57, 61, 62, 73, 76] did not find a significant association between bachelor degree versus diploma and research utilization, leading to the conclusion that type of degree: bachelor versus diploma is not an important characteristic to nurses' use of research. An additional seven articles (six studies) [29, 33, 34, 48, 50, 59, 60] examined the relationship between research utilization and type of degree: graduate degree (masters or PhD) versus lower (bachelor and/or diploma). The majority of these articles (n = 5, 71%) found a statistically significant relationship between graduate degree versus bachelor degree/diploma and research utilization [29, 33, 34, 48, 50, 59]. Overall, findings from all 25 articles examining characteristics related to formal nursing education levels indicate that a positive effect exists for level of education, when a nurse holds a graduate degree compared to a bachelor degree/diploma but not when a nurse holds a bachelor degree compared to a diploma.
Another educational characteristic assessed in greater than four articles was completion of research classes [12, 30, 44, 47, 55]. Findings showed that this characteristic however was not significantly related to research utilization. Two articles [12, 30], rated as weak and moderate-strong methodologically respectively, found a positive relationship, at statistically significant levels, while three articles (60%) [44, 47, 55], one rated as weak methodologically and two rated as moderate-strong, did not find evidence of a statistically significant relationship.
The remaining individual characteristics related to education (e.g., well prepared in education process, working towards a degree, number of degrees, see Table 1) were assessed in less than four articles and therefore, were not considered.
Professional characteristics
The second most commonly studied category of individual characteristics, assessed in 27 of the 39 included articles, was professional characteristics. Of these articles, 12 were rated as weak methodologically, eight as moderate-weak, and eight as moderate-strong (Additional Files 2 and 3). Sample sizes varied from a low of 20 participants [54] to a high of 5,948 participants [69] (Additional File 4).The most commonly reported characteristics in this category were: experience (i.e., years employed as a nurse) (n = 12 articles), current role (e.g., leadership compared to staff nurse) (n = 10 articles), clinical specialty (e.g., critical care compared to medical/surgical (n = 9 articles) and job satisfaction (n = 5 articles) (Table 1). Of these characteristics, consistent statistically significant relationships with research utilization were found for current role, specialty, and job satisfaction. Experience was not related to research utilization.
Ten articles (nine studies) examined the impact of current role on research utilization. Six (60%) of these articles (three rated as weak methodologically, two as moderate-weak, and one as moderate- strong, see Additional Files 2 and 3) found that nurses practicing in advanced practice or leadership roles had significantly higher research utilization scores compared to staff nurses [33, 34, 52, 59, 69, 71]. However, nurses in such advanced practice and leadership roles generally have higher levels of education, which may have confounded this finding. Nine articles examined the impact of clinical specialty on research utilization. Six (67%) of these articles (two rated as weak, as moderate-weak, and as moderate-strong respectively, see Additional File 2) found a significant relationship between specialty and research utilization; nurses who worked on specialty wards (e.g., critical care, diabetes care) reported higher frequencies of research utilization in comparison to nurses who worked in more generalized units (e.g., medical or surgical floors) [14, 36, 53, 55, 60, 62]. Five articles examined the impact of job satisfaction on research utilization. Three (60%) of these articles (one rated as moderate-weak methodologically and two as moderate-strong, see Additional File 2) found a statistically significant relationship between job satisfaction and research utilization [47, 62, 69]. Experience, assessed in 12 articles, was not related to research utilization at statistically significant levels in the majority (n = 10 of 12, 83%) of these articles (Table 1).
Socio-demographic and socio-economic factors
Of the ten articles reporting other socio-demographic and socio-economic nurse characteristics (four rated as weak methodologically, three as moderate-weak, and three as moderate-strong, see Additional File 2), none reported a significant association with research utilization. Further, with the exception of age, which was assessed in nine studies, the characteristics were assessed in less than four studies, precluding the drawing of conclusions.
Kinds of research utilization
While the majority of articles identified in this review update assessed associations between individual characteristics and nurses' use of research in general, there is also a beginning trend in the literature to examine kinds of research utilization. A total of six articles (one rated as weak methodologically, two as moderate-weak, two as moderate-strong, and one as strong, see Additional File 2) were identified that explicitly examined the relationship between individual characteristics and nurses' use of one or more kinds of research utilization. The following section presents an overview of the findings from these six articles. More details on these findings can be found in Table 2.
The only individual characteristic assessed in a sufficient number of articles (i.e., in four or more articles) was a nurse's attitude towards research. All four articles reported a positive relationship, at statistically significant levels, between a nurse's attitude towards research and at least one kind of research utilization [32, 63, 66, 67]. Only instrumental and overall kinds of research utilization were assessed in four articles. A positive relationship was found in three articles (75%) for both of these kinds of research utilization: instrumental [32, 63, 67] and overall [32, 66, 67]. All remaining characteristics were assessed in less than four articles, precluding conclusions.
One individual characteristic, critical thinking dispositions, was assessed in two articles examining kinds of research utilization. Critical thinking dispositions refers to a "set of attitudes that define a personal disposition to prize and to use critical thinking in one's personal, professional, and civic affairs" [79]. Both articles assessed critical thinking dispositions using the California Critical Thinking Disposition Inventory that measures seven dispositional components: truth-seeking, open-mindedness, analyticity, systematicity, self-confidence, inquisitiveness, and maturity [79]. Both identified studies found a positive relationship, at statistically significant levels, between nurses' ability to think critically (as measured by an average of all seven dispositions) and each of the four kinds of research utilization [64, 65]. The magnitude of this effect was small to moderate with correlation coefficients ranging from 0.15 to 0.35, depending on the kind of research utilization (Table 2).