Abstract
Research Utilization (RU) plays a vital role in preparing future registered nurses. As clinical professionals, they are expected to remain current with research, interpret findings effectively, and apply evidence-based solutions to enhance problem-solving and decision-making in practice. Many baccalaureate nursing programs include RU as a core curricular outcome, reflecting its importance in modern nursing education.
This study aimed to explore final-year nursing students’ perceptions of research utilization. A sequential mixed-methods approach was used, although this paper focuses exclusively on the qualitative component. Employing a qualitative descriptive design, the study recruited a purposive sample of 20 final-year undergraduate students from four-year basic, honors, and accelerated BScN programs. Participants were invited via email.
Thematic analysis was guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework, which emphasizes three key elements: evidence, context, and facilitation. Analysis revealed several themes influencing students’ engagement with research, including educational preparedness, clinical experience and expertise, limited time, the theory– practice gap, clinical evaluation standards, faculty support, and faculty competence in research.
Most students reported that they rarely applied research findings in clinical settings. The predominant barrier was a lack of knowledge and confidence in using research. These findings highlight the need for greater institutional and pedagogical support to help nursing students integrate research into their practice effectively.
Keywords: Nursing, Students, Nursing Research, Research Utilization, Evidence-Based Practice
Use of Research by Undergraduate Nursing Students
Amina Rashid, Carol Smith, and Heather Thompson University of Westbridge, Westbridge, Canada
Research utilization (RU) is a fundamental component in preparing future registered nurses, who are increasingly expected to engage with current research, apply evidence in clinical decision-making, and solve healthcare problems independently. Many baccalaureate nursing programs identify RU as a key curricular outcome. This study aimed to explore the perceptions of final-year undergraduate nursing students regarding the use of research in their clinical practice. Using a sequential mixed methods design, this paper reports only on the qualitative findings. A qualitative descriptive approach was employed, guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework, which encompasses three core elements: evidence, context, and facilitation. A purposive sample of 20 final-year nursing students—drawn from four-year basic, honors, and accelerated BScN programs—was recruited via email to participate in the study. The analysis revealed several themes perceived by students as either facilitating or hindering RU. These included educational preparedness, clinical experience and expertise, time constraints, the theory-practice gap, evaluation criteria in clinical placements, and the level of faculty support and competence in research. A predominant finding was that most students did not apply research findings in clinical settings, primarily due to a lack of understanding of how to use research effectively. These findings underscore the need for nursing education programs to strengthen student competencies in RU and foster a supportive academic and clinical environment that encourages evidence-based practice. Enhanced faculty engagement, curriculum alignment, and targeted skill-building in research literacy may bridge the existing gap and better prepare nursing graduates for contemporary clinical challenges.
Keywords: Nursing Education, Undergraduate Students, Research Utilization, Evidence-Based Practice, Clinical Readiness, PARIHS Framework
Translating research findings into practical healthcare applications is vital for improving health outcomes worldwide (Athanasakis, 2013; Madon et al., 2007; Mutisya et al., 2015; Sanders & Haines, 2006; Wang et al., 2013). Globally, there is growing emphasis on evidence-based nursing practice, which integrates the best available research into clinical decision-making (Kajermo et al., 2010; Melnyk et al., 2014; Squires et al., 2011a; Squires et al., 2011b; Thompson et al., 2007). As a result, developing the ability to critically evaluate and apply research has become a key goal in nursing education.
While the terms “evidence-based practice” (EBP) and “research utilization” (RU) are often used interchangeably, they are not synonymous (Estabrooks et al., 2008). EBP refers to the integration of a broad range of evidence sources—such as empirical research, clinical expertise, pathophysiological understanding, patient values, expert opinions, and quality improvement data—to guide best practice (Estabrooks et al., 2008). In contrast, RU is more narrowly focused, referring specifically to the application of scientific research findings to improve clinical care. For the purposes of this discussion, RU will refer solely to the use of research-derived evidence.
Translating research findings into clinical practice plays a crucial role in improving health outcomes on a global scale (Athanasakis, 2013; Madon et al., 2007; Mutisya et al., 2015; Sanders & Haines, 2006; Wang et al., 2013). Internationally, there is growing momentum behind evidence- based or research-informed nursing practice (Kajermo et al., 2010; Melnyk et al., 2014; Squires et al., 2011a; Squires et al., 2011b; Thompson et al., 2007). Accordingly, developing the ability to critically evaluate and apply research evidence has become a key objective in modern nursing education.
Although the term “evidence-based practice” (EBP) has become common within the nursing profession, it is often mistakenly equated with “research utilization” (RU). However, these concepts are not synonymous (Estabrooks et al., 2008). EBP refers to the integration of a broad range of evidence sources—including research findings, pathophysiological understanding, clinical expertise, patient preferences, quality improvement data, and expert consensus—to guide best practices in care delivery (Estabrooks et al., 2008). In contrast, RU specifically focuses on the application of scientific research findings to improve clinical practice. In the context of RU, the term “research” refers primarily to empirical and scientific studies.
Literature Review
A prevailing and persistent philosophy in contemporary nursing and healthcare is that healthcare professionals should utilize research evidence when making decisions concerning client care (Athanasakis, 2013; Chien, Bai, Wong, Wang, & Lu, 2013; Kajermo et al., 2010; Squires et al., 2011a; Squires et al., 2011b; Thompson et al., 2007). Nurses are expected to incorporate research into their practice and are encouraged to embrace this philosophy by applying various strategies (Squires et al., 2011a; Squires et al., 2011b), including the expansion of electronic databases, a stronger emphasis on research within nursing education, and the critical appraisal of published studies to properly assess their relevance for nursing practice. Additionally, practitioners are subject to standards, clinical guidelines, and audit mechanisms within the quality assurance framework, all of which aim to integrate and apply research findings. Implementing relevant research into clinical care—and assessing the effectiveness of these changes—helps bridge the gap between research and practice (Wangensteen, 2010). For instance, research shows that adopting evidence-based clinical guidelines can enhance nursing interventions, improve patient outcomes, and raise the quality of care (Athanasakis, 2013; Chien, Bai, Wong, Wang, & Lu, 2013; Kajermo et al., 2010; Profetto-McGrath, 2005; Seymour, Kinn, & Sutherland, 2003; Squires et al., 2011a; Thompson et al., 2007; Wallin, 2009).
Despite this, researchers in the field of research utilization (RU) continue to raise concerns about whether nurses consistently use the most reliable scientific (i.e., research-based) evidence in clinical decision-making (Estabrooks, Kenny, Adewale, Cummings, & Mallidou, 2007; Alp- Yılmaz & Tel, 2010; Wangensteen, Johansson, Bjorkstrom, & Nordstrom, 2011; Forsman, Wallin, Gustavsson, & Rudman, 2012a). In a widely-referenced study drawing from data in the United States and the Netherlands, Grol and Grimshaw (2003) found that between 30% and 40% of
patients did not receive care aligned with current scientific knowledge, and that up to 25% of patients received unnecessary or harmful care. The World Health Organization (2004) also emphasized, “Stronger emphasis should be placed on translating knowledge and research into action to improve public health by bridging the gap of what is known and what is actually done” (p. V).
The extent of nurses’ use of research in clinical practice has been widely examined using diverse nursing populations across varying settings and measurement tools (Kajermo et al., 2010). A systematic review by Squires et al. (2011b) exploring the degree of research use among nurses concluded that most studies reported moderate-to-high levels of RU. Nevertheless, several investigations have highlighted low research utilization among nursing students and newly qualified nurses (Forsman, Rudman, Gustavsson, Ehrenberg, & Wallin, 2010; Forsman et al., 2012a; Wangensteen et al., 2011). These findings raise significant concerns about how well undergraduate nursing education prepares students to apply research in practice. Although educational reforms have elevated nursing to a university-level discipline and prioritized RU in curricula (Spitzer & Perrenoud, 2006a, 2006b; Forsman et al., 2012a; Florin, Ehrenberg, Wallin, & Gustavsson, 2012), challenges remain—especially in terms of bridging theory with practice and supporting students in accessing, interpreting, and analyzing research (Hofler, 2008; Hegarty, Walsh, Condon, & Sweeney, 2009; Florin et al., 2012).
Numerous studies have identified barriers that prevent registered nurses from utilizing research in their clinical environments. These studies reveal a broad range of individual, organizational, and contextual factors that influence healthcare providers’ ability to use research effectively (Forsman et al., 2012a, 2012b; Halabi & Hamdan-Mansour, 2010; Wangensteen et al., 2011). However, both individual and organizational elements have not been comprehensively explored (Meijers, Janssen,
Cummings, Wallin, Estabrooks, & Halfens, 2006; Squires et al., 2011a). Little research has been conducted on how or whether undergraduate nursing students integrate research into their clinical practice, despite the strong emphasis placed on research within academic nursing programs. A study by Florin et al. (2012) examined students’ experiences of educational support for RU across 26 universities in Sweden and discovered significant variation depending on the institution. Notably, students rated the support received during classroom instruction higher than that received during clinical placements. This study also highlighted the ongoing disconnect between theoretical knowledge and its practical application.
As far as current knowledge extends, there remains limited research into nursing students’ perceptions of using research in clinical settings. Since students are expected to deliver evidence- based care, it follows that they must be equipped with the knowledge and competencies necessary for research integration in clinical contexts. Yet, previous research showing limited RU among qualified nurses casts doubt on how well undergraduate programs are preparing their students to apply research in practice.
Theoretical Framework
Understanding Research Utilization Through the Lens of the PARIHS Framework
Research utilization (RU) in healthcare is a multidimensional and complex phenomenon that requires consideration from various conceptual, organizational, and practical perspectives. Scholars and practitioners alike have recognized that the mere generation of research evidence is insufficient for effective integration into clinical practice. Rather, successful RU depends on the dynamic interplay of evidence, the context within which it is implemented, and the processes that
facilitate its application. In light of this complexity, several conceptual frameworks have been proposed in the literature to guide the analysis and application of RU strategies (Mitchell, Fisher, Hastings, Silverman, & Wallen, 2010; Sudaswad, 2007).
Among these frameworks, the Promoting Action on Research Implementation in Health Services (PARIHS) framework has gained significant prominence for its comprehensive and practical approach to understanding and facilitating research implementation in healthcare settings. First introduced by Kitson, Harvey, and McCormack in 1998, the PARIHS framework has been continually refined over the years to incorporate emerging insights from implementation science and empirical research (Kitson et al., 1998; Rycroft-Malone, 2004; Harvey et al., 2002; Kitson et al., 2008; Kitson, 2009).
At its core, the PARIHS framework posits that the successful implementation of research into practice is a function of the relationship between three key elements: evidence, context, and facilitation. These components are interdependent and must align synergistically to achieve effective research utilization. The framework is typically depicted in a triangular format, with each corner representing one of the core elements and the interactions among them highlighted to indicate the importance of balance and alignment (McCormack et al., 2002; Rycroft-Malone, 2004).
The first component, evidence, refers not only to empirical research findings but also to a broader spectrum of knowledge that informs healthcare decisions. This includes clinical experience, patient preferences, and local data, as well as research-based knowledge. The PARIHS framework emphasizes that for evidence to be considered robust and applicable, it must be credible, relevant, and meaningful to those who will use it in practice (Rycroft-Malone et al., 2002). This
conceptualization challenges traditional hierarchies of evidence and acknowledges the value of experiential and contextual knowledge in shaping clinical decision-making.
The second component, context, pertains to the environment or setting in which the evidence is to be implemented. Context encompasses factors such as leadership, culture, evaluation mechanisms, organizational readiness, and infrastructure. According to the PARIHS framework, a supportive context is characterized by transformational leadership, a culture conducive to learning and innovation, and effective feedback and evaluation systems. Context is not static; it is dynamic and shaped by ongoing interactions among individuals, teams, and organizational systems (Rycroft- Malone, 2004).
The third and final component, facilitation, refers to the mechanisms through which the implementation process is supported and enabled. Facilitation involves individuals or teams who act as change agents or implementation leaders, helping others understand and apply evidence within their specific contexts. Facilitators play a crucial role in assessing barriers, building capacity, offering support, and maintaining momentum throughout the implementation process. The skills, attributes, and strategies employed by facilitators can significantly influence the success of RU efforts (Harvey et al., 2002; Rycroft-Malone et al., 2004).
The integration and interaction of these three elements—evidence, context, and facilitation—form the theoretical foundation of the PARIHS framework. As Helfrich et al. (2010) emphasize, successful research implementation is not the result of any single component in isolation but rather the product of the interrelationships and balance among these elements. For example, even the most robust and well-documented evidence may fail to achieve impact if it is introduced into an unsupportive context or lacks effective facilitation. Conversely, strong facilitation and a receptive
context may compensate to some extent for less compelling evidence by fostering engagement and dialogue among stakeholders.
The utility of the PARIHS framework has been demonstrated across a range of healthcare settings and populations. Numerous studies have applied the framework to examine and guide RU in acute care, pediatric and neonatal care, psychiatric services, and rural hospitals (Cummings et al., 2007; Estabrooks et al., 2007; Jansson et al., 2010; Wright et al., 2006). In the Canadian context, researchers have employed the PARIHS framework to evaluate the role of organizational context and leadership in nursing practice environments, revealing significant associations between contextual factors and research utilization outcomes (Cummings, Hutchinson, Scott, Norton, & Estabrooks, 2010).
These empirical applications have not only validated the PARIHS framework’s relevance but have also contributed to its refinement and evolution. Subsequent iterations of the framework have integrated additional dimensions such as organizational learning, patient involvement, and system- level influences, making it more responsive to the realities of contemporary healthcare practice (Kitson et al., 2008; Kitson, 2009). Moreover, the flexibility of the PARIHS framework allows it to be adapted to different levels of implementation, from individual practice changes to large-scale organizational interventions.
In summary, the PARIHS framework offers a comprehensive and theoretically grounded model for understanding and promoting research utilization in healthcare. By conceptualizing implementation as a function of evidence, context, and facilitation, the framework provides a practical guide for researchers, practitioners, and policymakers seeking to bridge the gap between knowledge generation and clinical application. Its ongoing refinement and widespread application across diverse settings underscore its value as a dynamic and adaptable tool in implementation
science. As the demands on healthcare systems continue to evolve, frameworks like PARIHS will remain essential for ensuring that evidence-based innovations are translated effectively into improved patient outcomes and sustainable practice change.
Figure 1: PARIHS Framework (Kitson, Harvey & McCormack, 1998; Rycroft-Malone, 2004).
Evidence
The implementation of research into clinical practice is a cornerstone of evidence-based healthcare. However, the process is complex and influenced by a range of factors. The Promoting Action on Research Implementation in Health Services (PARIHS) framework, originally
developed by Kitson et al. (1998), serves as a valuable guide for understanding and facilitating the integration of research evidence into healthcare settings. This framework posits that successful implementation of evidence into practice is a function of the relationship among three core elements: evidence, context, and facilitation. This paper focuses on two of those elements— evidence and context—and how they contribute to meaningful and sustainable change in healthcare practice.
Evidence: Definition, Credibility, and Applicability
Evidence within the PARIHS framework is not limited to formal research findings but includes a combination of sources: scientific research, clinical experience, patient preferences, and local information. According to Rycroft-Malone et al. (2004), research evidence becomes credible and usable knowledge when it is drawn from diverse sources, rigorously tested, and widely accepted by the relevant professional community. In other words, it is not just the existence of evidence that matters, but its quality, reliability, and relevance to the specific healthcare setting.
A key consideration is that for evidence to be useful in clinical practice, it must not only be robust but also transferable and adaptable to the local context. For example, a clinical guideline developed in a tertiary hospital in one region may not directly translate to a rural primary care setting without adaptation. Rycroft-Malone et al. (2004) emphasize that evidence should make sense to practitioners and be aligned with the realities of their practice environment. The process of contextualizing evidence ensures that research findings are not implemented in isolation but are interpreted through the lens of local culture, resources, and patient needs.
Furthermore, the type of evidence—whether qualitative or quantitative—must be well-conceived and methodologically sound. According to Stetler et al. (2011), high-quality evidence includes
research that is reproducible, generalizable, and generated through rigorous methodologies. Achieving consensus among stakeholders about the validity of evidence also increases the likelihood of successful adoption and integration into practice.
Clinical and patient experience also form an important part of what the PARIHS framework defines as evidence. Clinicians bring experiential knowledge acquired through years of practice, while patients offer insights into their lived experiences and preferences. A synthesis of formal research with these experiential dimensions ensures a more holistic approach to evidence-based practice.
Context: The Environment for Change
Context refers to the setting in which the proposed changes or research findings are to be implemented. According to Kitson et al. (1998) and McCormack et al. (2002), context encompasses a broad array of environmental, organizational, and cultural factors. These include the healthcare organization’s structure, its leadership styles, its receptiveness to change, and the systems in place for evaluation and feedback.
Within the PARIHS framework, context is delineated into three primary components: culture, leadership, and evaluation.
- Culture: The cultural environment of an organization plays a pivotal role in either enabling or hindering the uptake of evidence-based A learning culture—one that promotes open communication, collaboration, and continuous professional development—is more conducive to the successful implementation of research. Organizations that value reflective practice and encourage innovation are more likely to foster environments where evidence- based change can occur. Stetler et al. (2011) argue that such environments are characterized
by decentralized decision-making, clarity of professional roles, and the recognition and valuing of staff contributions.
- Leadership: Effective leadership is another cornerstone of a strong implementation
Transformational leaders, who are visionary, supportive, and capable of inspiring staff, can significantly influence the successful adoption of evidence into practice. Leadership that prioritizes research literacy and champions evidence-based decision-making helps cultivate an atmosphere of trust and motivation. Strong leadership also ensures the alignment of organizational goals with evidence-based practices.
- Evaluation: For any implementation strategy to be successful, ongoing evaluation mechanisms must be in place. These systems should measure the effectiveness of new practices and provide feedback loops that inform future Clinical evaluative criteria should be clear, achievable, and tailored to the specific objectives of the implementation. Evaluation fosters accountability and allows organizations to make informed adjustments to their strategies over time.
Interplay of Evidence and Context
The PARIHS framework suggests that successful implementation is more likely when both evidence and context are “high”—that is, when the evidence is robust and the context is conducive to change. For example, even the most compelling evidence may fail to be implemented if the context is characterized by rigid hierarchies, poor leadership, or resistance to innovation. Conversely, a supportive and well-prepared context may enable the successful adoption of even moderately strong evidence, particularly if it is combined with practitioner and patient input.
Educational preparedness is a critical enabling factor that intersects both evidence and context. Healthcare professionals must have the skills to critically appraise research and apply it appropriately within their settings. Clinical expertise, honed through experience, complements formal evidence by enabling nuanced decision-making in complex patient scenarios.
Barriers such as lack of time, the theory-practice gap, and limited access to research resources also impact the implementation process. These contextual challenges must be addressed through systemic changes, such as workload management, ongoing education, and integrated support structures.
Facilitation as the Bridging Element
Although this paper primarily focuses on evidence and context, it is important to acknowledge facilitation as the mechanism that binds the two together. Facilitators—often in the form of educators, clinical champions, or change agents—play a crucial role in enabling implementation by supporting individuals, addressing barriers, and aligning the elements of evidence and context. According to Kitson et al. (1998), effective facilitation requires a combination of interpersonal skills, organizational understanding, and technical knowledge.
Facilitators must also be competent in research methodology and skilled in communication to translate complex evidence into actionable steps for healthcare professionals. They provide the momentum and scaffolding necessary to initiate and sustain change, particularly in environments that may initially be resistant.
Conclusion
In summary, the successful implementation of research evidence into healthcare practice is contingent upon a dynamic interaction between the nature of the evidence and the context in which
it is applied. High-quality, contextually relevant evidence, supported by a strong organizational culture, effective leadership, and robust evaluation systems, creates fertile ground for change. The PARIHS framework offers a valuable lens for understanding these interactions and designing implementation strategies that are both effective and sustainable. As healthcare continues to evolve, frameworks like PARIHS will remain essential tools for bridging the gap between research and practice.
Context
The PARIHS Framework: Context and Facilitation in Implementing Research into Practice
The successful implementation of research evidence into healthcare practice is a complex and multifaceted challenge that depends on various interacting factors. The Promoting Action on Research Implementation in Health Services (PARIHS) framework, initially developed by Kitson et al. (1998), provides a comprehensive model to understand these factors by focusing on three core elements: evidence, context, and facilitation. This framework has gained recognition in the healthcare sector for guiding the translation of research into practice and improving the quality of patient care. Among these elements, context and facilitation play pivotal roles in determining the success of implementation efforts. This paper elaborates on these two dimensions within the PARIHS framework, emphasizing their definitions, components, and significance in fostering evidence-based practice.
Context in the PARIHS Framework
In the PARIHS framework, the term context refers to the environment or setting in which healthcare services are delivered or where evidence is integrated into routine practice (McCormack et al., 2002). This environment encompasses organizational, cultural, social, and structural factors
that collectively influence how research evidence is accepted, adapted, and sustained in practice. Context is not merely a backdrop but an active and dynamic domain that shapes implementation processes.
The contextual factors that promote successful evidence incorporation can be grouped broadly into three themes: culture, leadership, and evaluation (Stetler et al., 2011). Each of these dimensions contributes uniquely to creating an environment conducive to change and improvement.
Culture within context refers to the shared values, beliefs, norms, and behaviors that characterize an organization. Learning organizations that nurture a culture of openness, continuous improvement, and collaboration tend to be more receptive to change. Such cultures emphasize individuals’ growth, team processes, leadership support, and systemic alignment. They create fertile ground for innovation and adaptation by encouraging staff to engage with new knowledge and translate it into practice.
Leadership is a critical contextual factor that can either facilitate or hinder implementation. Transformational leaders who provide clear vision, empower staff, and foster supportive relationships enhance the capacity of the organization to embrace new evidence. Effective leadership clarifies roles and responsibilities, decentralizes decision-making, and values staff contributions. This leadership style promotes trust, motivation, and ownership, which are essential for embedding change.
Evaluation involves mechanisms for monitoring, feedback, and reflection on practice and outcomes. Organizations that systematically assess the implementation process, patient outcomes, and staff experiences can identify barriers and facilitators in real time. Evaluation helps create
accountability and continuous learning, ensuring that the integration of evidence is responsive and sustainable.
Stetler et al. (2011) emphasize that a strong context characterized by clarity of roles, decentralized decision-making, valuing of staff, and transformational leadership significantly increases the likelihood of successful evidence implementation. Conversely, weak contexts—marked by unclear responsibilities, rigid hierarchies, and undervaluing of staff—tend to resist change and undermine implementation efforts.
The dynamic and interconnected nature of these cultural, leadership, and evaluative factors means that context is more than the sum of its parts. It is a system that requires ongoing assessment and adaptation to optimize conditions for research use (RU) and evidence-based practice.
Facilitation in the PARIHS Framework
Alongside context, facilitation is a central element of the PARIHS framework. Facilitation refers to the process and role of providing help and support to individuals and teams to enable them to understand, adopt, and sustain evidence-informed changes in their practice (Harvey et al., 2002). It is both a function and a role that involves interactive problem-solving, reflective learning, and supportive relationships.
Stetler et al. (2006) define facilitation as “a deliberate and valued process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship” (p. 6). This definition highlights facilitation as an intentional, relational, and context-sensitive activity aimed at overcoming barriers and enhancing capabilities.
Facilitation can be understood through three key components: purpose, role, and the skills and attributes of the facilitator (McCormack et al., 2002; Rycroft-Malone et al., 2002; Rycroft-Malone, 2004).
- Purpose: Facilitation exists on a continuum between task-oriented and holistic-oriented purposes. At one end, it focuses on achieving specific, tangible goals, such as completing a project or implementing a guideline. At the other end, it aims to enable individuals and teams to engage in critical reflection, change attitudes, and transform ways of working more broadly. Both purposes are important but require different approaches and
- Role: The facilitator’s role can range from doing tasks for others, such as managing project logistics or providing technical expertise, to enabling others by fostering reflection, empowerment, and learning. On the task-oriented side, facilitators might employ skills in project management, marketing, or technical problem-solving. On the holistic side, they use coaching, counseling, and critical thinking techniques to help teams navigate complexity and change.
- Skills and Attributes: Effective facilitators possess a combination of interpersonal, analytical, and organizational skills. They demonstrate empathy, communication, flexibility, and resilience. They must be able to build trust, negotiate conflicts, and adapt their style to the needs of the group and These skills underpin the ability to sustain engagement and overcome resistance.
Recent scholarship expands the notion of facilitation beyond an individual role to a collective and processual activity that involves multiple stakeholders (Dogherty, Harrison, & Graham, 2010).
Facilitation is increasingly recognized as a key method to encourage research utilization in clinical practice, especially in nursing, where it supports practitioners in bridging the gap between evidence and care delivery (Dogherty, Harrison, Baker, & Graham, 2012). Nevertheless, there remains a growing need for rigorous evaluation of facilitation outcomes, particularly how facilitative actions translate into practice improvements (Dogherty et al., 2010).
Interconnectedness of Context and Facilitation
The PARIHS framework proposes that the success of implementing an intervention is a function of the interplay between evidence, context, and facilitation. Context and facilitation are deeply interconnected. A strong context creates a supportive environment where facilitation can be more effective, while skilled facilitation can strengthen weak contextual elements by fostering leadership, culture change, and evaluation practices.
The framework also suggests that these elements can be assessed on a continuum from weak to strong, where a strong context and effective facilitation significantly enhance the likelihood of successful implementation (Rycroft-Malone, 2008). The variability in these elements explains why similar interventions may yield different outcomes in different settings (Helfrich et al., 2010).
Application of the PARIHS Framework in Research
In empirical studies, the PARIHS framework guides the exploration of barriers and facilitators to research utilization (RU) and implementation. For instance, in the study by Meherali, Paul, and Profetto-McGrath, the framework informed the development of interview questions aimed at capturing participants’ perceptions of the critical elements influencing RU in their practice environments. Using the PARIHS domains helped ensure comprehensive data collection by focusing attention on context and facilitation factors alongside evidence characteristics.
The analysis of qualitative data through the lens of the framework allowed identification of common attributes acting as barriers or facilitators. This structured approach to data collection and analysis strengthens the validity of findings and enhances the practical relevance of implementation strategies derived from research.
Role of the Researchers
Salima Meherali (SM), the first author of this study, is currently a PhD candidate whose doctoral research focuses on understanding the relationship between research utilization and critical thinking dispositions among undergraduate nursing students. Her dissertation employs a sequential mixed methods design to comprehensively investigate these constructs. This methodological approach involves two distinct but connected phases: an initial quantitative phase followed by a qualitative phase. The purpose of this design is to first gather broad numerical data and then deepen the understanding of the findings through detailed qualitative exploration.
The initial quantitative phase involved the collection of numeric data from undergraduate nursing students using several well-established instruments. These included the California Critical Thinking Disposition Inventory (CCTDI), which measures individuals’ inclination toward critical thinking; the most current version of the Research Utilization (RU) Survey, designed to assess how frequently and effectively nursing students apply research findings in clinical or academic contexts; and a background/demographic questionnaire, which collected essential participant information such as age, year of study, and previous research exposure. The quantitative results from this phase have been published previously (Meherali, Profetto-McGrath, & Paul, 2015), providing a statistical foundation for the subsequent qualitative inquiry.
The qualitative phase of the study was designed to explore in greater depth the statistical trends and relationships revealed by the quantitative analysis. The aim was to gain a richer, more nuanced understanding of how undergraduate nursing students perceive and experience research utilization in their academic and clinical practices. Given the complexity and subjective nature of research utilization, a qualitative descriptive design was chosen for this phase. This approach enables researchers to provide a comprehensive summary of participants’ experiences and perspectives in everyday language, thus facilitating an authentic and accessible understanding of the phenomenon under investigation.
The second and third authors, Drs. Pauline Paul and Joanne Profetto-McGrath, are esteemed professors within the Faculty of Nursing where this research was conducted. Both scholars bring extensive expertise in qualitative research methodologies and provided mentorship and guidance to SM throughout the entire doctoral research process. Their supervision was instrumental in shaping the study design, refining the research questions, and ensuring methodological rigor, particularly during the qualitative phase. The collaborative supervision process also included supporting the first author in the practical aspects of data collection and analysis.
A critical aspect of qualitative research is the role of the researcher as the primary instrument for data collection and interpretation. As Pezalla, Pettigrew, and Miller-Day (2012) discuss, the unique attributes of the qualitative researcher—including their experiences, perspectives, and interactions with participants—can significantly influence the data gathering and analysis process. In this study, SM conducted all focus groups and individual interviews. She is well trained in qualitative research techniques and proficient in various data collection strategies, including semi-structured interviews and focus group facilitation. This training enabled her to elicit detailed and meaningful
responses from participants while maintaining the flexibility needed to explore emerging themes and insights.
Before initiating the qualitative phase, the study obtained ethics approval from the relevant institutional review board, ensuring adherence to ethical standards for research involving human participants. Additionally, administrative approval was secured from the Faculty of Nursing to recruit undergraduate nursing students for participation. These approvals underscored the importance of protecting participant rights and promoting ethical conduct throughout the study.
Participation in the qualitative phase was entirely voluntary, and no incentives were offered. This approach was intended to minimize any undue influence on students’ willingness to share their honest views and experiences regarding research utilization. Potential participants were fully informed about the study’s background, purpose, and procedures. They were assured that their confidentiality would be maintained, and that their involvement would not affect their academic standing or relationship with the faculty. Prior to each interview or focus group session, students provided informed consent by signing consent forms, signifying their understanding and voluntary agreement to participate.
Data collection in the qualitative phase involved conducting semi-structured individual interviews and focus groups with undergraduate nursing students. These formats allowed participants to express their thoughts in their own words and engage in reflective discussions about the challenges, facilitators, and personal meanings of research utilization in their education and practice. The interviews were guided by an interview schedule developed based on the quantitative findings, ensuring that the qualitative inquiry was focused yet open-ended enough to capture unexpected themes.
Data from these interviews and focus groups were transcribed verbatim and subjected to qualitative descriptive analysis. This analytic approach involved systematically organizing the data to identify common patterns, themes, and categories that illustrated how nursing students understand and apply research findings. The analysis process was iterative, with the first author repeatedly reviewing transcripts to ensure a thorough and trustworthy interpretation of the data. The involvement of the supervising professors in reviewing the analysis also contributed to confirmability and credibility of the findings.
Overall, this sequential mixed methods study offers a comprehensive examination of research utilization and critical thinking dispositions among undergraduate nursing students. The quantitative data provides a broad overview of the prevalence and characteristics of these constructs, while the qualitative findings offer an in-depth perspective on students’ lived experiences and the contextual factors influencing research use. By integrating these methods, the study contributes valuable insights for educators, curriculum designers, and nursing practitioners seeking to enhance evidence-based practice education and critical thinking development.
In conclusion, the qualitative findings reported in this paper focus specifically on the theme of research utilization as experienced and perceived by undergraduate nursing students. These findings complement the quantitative results previously published and underscore the importance of understanding the complexities involved in translating research knowledge into practical application within nursing education. The expertise and collaborative mentorship of the research team ensured that the study adhered to rigorous methodological standards and ethical principles, ultimately contributing to the scholarly discourse on nursing education and research utilization.
Methods
A qualitative descriptive design (Sandelowski, 2000, 2010) was employed to explore the study questions. Sandelowski (2000) describes qualitative descriptive studies as grounded in the “general tenets of naturalistic inquiry” (p. 337). However, unlike other qualitative approaches such as phenomenology or ethnography, this design is less constrained by predetermined theoretical or philosophical frameworks (p. 337). At the start of this research, guided by the principles of naturalistic inquiry (Lincoln & Guba, 1985; Loiselle, Profetto-McGrath, Polit, & Beck, 2010), we acknowledged that students’ behaviors and attitudes toward using research in learning are likely influenced by a variety of factors. Therefore, we aimed to capture their experiences through rich, detailed subjective accounts.
Sample
A purposive sample of 20 final-year undergraduate nursing students was selected from three different BScN programs: the four-year basic program, the honors program, and the after-degree program. Students enrolled in the four-year basic program typically enter with a high school diploma or some postsecondary education. Their curriculum integrates concepts from nursing, physical sciences, medical sciences, social sciences, and humanities, with clinical practice conducted in a variety of settings. The honors program consists of high-achieving students from the basic program who receive additional training focused on advanced scholarship and research to deepen their undergraduate experience. Meanwhile, the after-degree program admits students who have already completed a university degree in a non-nursing field, often including research courses from their prior studies; this program is designed to be completed within 23 months.
The purposive sampling method was chosen because it allows researchers to select participants who are considered ‘information rich’ (Patton, 1990, p. 169) and capable of providing detailed insights into the phenomenon under study (Creswell, 2013). Eligible students in their final year who consented to participate and were willing to reflect thoughtfully on their educational and clinical experiences were invited to engage in extended discussions with the researchers.
Data Collection
This study employed semi-structured focus groups and individual interviews to gather data from a total of 20 participants. Individual interviews were arranged for those unable to attend focus groups due to scheduling conflicts with clinical rotations. Specifically, three focus group sessions were held, each consisting of 5 to 7 participants, along with three individual interviews. A semi- structured interview guide, developed based on the PARIHS framework, was used to pose open- ended questions aimed at exploring participants’ perceptions of research utilization (RU) (see Appendix A: Interview Guide). Additionally, a biographical questionnaire was administered to collect demographic and background information. Focus groups lasted between 60 and 75 minutes, whereas individual interviews ranged from 45 to 60 minutes. With participants’ consent, all sessions were audio-recorded. Immediately following each interview or focus group, field notes were taken to document participants’ nonverbal cues and emotional responses. A reflective journal was also maintained throughout the data collection phase to capture the overall process. To ensure accuracy, transcriptions were shared with five participants (one from each focus group and two from the individual interviews) for member checking.
Ethical Considerations
Ethical approval was granted by the Ethics Review Board of the participating university, along with administrative clearance from the nursing faculty to access the student population.
Participation was entirely voluntary, and students were informed of their right to withdraw at any point during the study. Confidentiality was maintained through the use of coded identifiers instead of names. Written informed consent was obtained from all participants. Participants were also informed that the study findings might be disseminated through publications and presentations.
Data Analysis
Data collection and analysis occurred simultaneously. The lead researcher transcribed all audio recordings verbatim soon after the sessions. Following Thorne’s (2008) guidance, the researcher initially immersed herself in the data by repeatedly listening to the recordings to gain a deep understanding, rather than jumping directly into coding. Subsequently, transcripts were read multiple times to capture the overall essence of the phenomenon. A coding scheme was then developed and applied to identify categories, themes, and patterns. Categories sharing similar meanings were grouped to form overarching themes. These themes were reviewed collaboratively with two supervisors to ensure they accurately represented the data. Although themes and sub- themes were inductively derived, the PARIHS framework provided a conceptual lens to categorize participant-identified barriers and facilitators to RU in their practice settings. NVivo 10 software was utilized to support the data analysis process.
Measures to Ensure Trustworthiness
To establish trustworthiness, the study employed Lincoln and Guba’s (1985) criteria of credibility, dependability, confirmability, and transferability. Credibility was ensured through prolonged engagement, with the first author deeply involved in transcription, repeated reading, and inductive analysis, maintaining transparency throughout. Data saturation was achieved by continuing interviews until no new information emerged. Dependability was addressed by providing a
thorough and detailed description of the research methodology to enable study replication and highlight unique aspects (Krefting, 1991). Confirmability was strengthened by maintaining an audit trail, including verbatim transcripts, category documentation, and field notes, thereby supporting the neutrality of the findings. Finally, the transferability of the results is supported by providing rich demographic information about participants, detailed descriptions of the RU context, and reflective journal excerpts, enabling readers to assess applicability to other pre- licensure nursing programs
Findings
A total of 20 baccalaureate nursing students participated in this study, comprising five students from the four-year basic program, two from the honors program, and thirteen in their final year of the after-degree program. The majority of participants were female (n = 17, representing 85%), with ages ranging between 22 and 30 years. All students had successfully completed a mandatory nursing research course. While 30% of the participants reported involvement in research activities, most (66.6%) indicated their role was limited to being research subjects. Only two students reported active participation as research assistants in actual projects (see Table 1). The findings of this study have been organized according to the three core elements of the PARIHS framework: evidence, context, and facilitation.
Evidence
Participants agreed that nursing students in general tend to view evidence as equivalent to research. However, they also acknowledged that there is a difference between evidence and research. In their view, evidence is more than research findings and data: it can include patient feedback, and
clinical observations and experiences. The major themes identified in this category were: level of educational preparedness to understand the evidence, clinical experience, and expertise to use research evidence.
Level of educational preparedness
Research Utilization Among Baccalaureate Nursing Students: Insights from a Study Applying the PARIHS Framework
This study explored the perspectives and experiences of 20 baccalaureate nursing students regarding research utilization (RU) in nursing education and clinical practice. The participants
comprised students from different academic streams within the nursing program, specifically the four-year basic program (n = 5), the honors program (n = 2), and the final year of the after-degree program (n = 13). The majority were female students (85%, n = 17), with ages ranging between 22 and 30 years. All participants had completed a mandatory nursing research course, which laid the foundation for understanding research concepts and methodologies essential for evidence- based nursing practice.
Participant Involvement in Research
An important aspect of this study was to ascertain the extent to which these nursing students had engaged with research activities beyond the classroom setting. Approximately 30% of students indicated some involvement in research projects. However, when probed further, most of these students (66.6%) revealed that their participation was limited to serving as research subjects, rather than active contributors to the research process. Only two participants reported direct engagement in research projects as research assistants, providing them with hands-on experience in research implementation. This discrepancy highlights a common challenge in nursing education where exposure to research is often passive, limiting students’ understanding and application of research principles in practice.
The PARIHS Framework as an Analytical Lens
The study’s findings were organized using the Promoting Action on Research Implementation in Health Services (PARIHS) framework, which identifies three core elements essential for successful research utilization: evidence, context, and facilitation. This framework provided a structured approach to analyzing students’ attitudes and experiences concerning research and its application in clinical settings.
- Evidence: This component relates to the students’ ability to recognize, understand, and critically appraise research findings.
- Context: This reflects the environment, including educational and clinical settings, that supports or hinders research uptake.
- Facilitation: This focuses on the support mechanisms, such as mentorship and educational strategies, that promote research engagement and translation into practice.
Evidence: Students’ Perceptions of Research Quality and Complexity
The majority of participants expressed a common perception that research utilization is a complex process, often not sufficiently covered in nursing curricula. One participant in a focus group stated candidly, “Research utilization for a student is that most students don’t understand how complex this is, because it’s just really not taught.” This statement underscores a gap in nursing education where the intricacies of translating research into clinical practice may be oversimplified or overlooked, leaving students ill-prepared to apply research findings confidently.
Contrasting this view, students enrolled in the honors program demonstrated a higher level of research literacy and confidence. For example, an honors student interviewed individually remarked, “I am very fortunate … to have had a lot of experience in research, and as a result, I am able to discern what is quality research, what is research that should be incorporated into clinical practice.” Another honors program participant noted, “I’m in the honors program, so research is a part of who we are and what we do… it’s the amount of exposure to research that is much more important. I see how research makes change and it makes people’s lives better.”
These contrasting perspectives highlight the impact of research immersion on students’ attitudes towards research. Honors students, by virtue of increased exposure and active participation,
develop critical thinking skills and an appreciation for the practical value of research. This suggests that curricular differences and opportunities for engagement profoundly influence students’ ability to evaluate and utilize evidence-based research.
Context: The Educational and Clinical Environment
The study revealed that the context in which students learn and practice significantly affects their research utilization. Most participants agreed that research education is a fundamental component of nursing training and vital for delivering high-quality, research-based care. The clinical environment, however, may not always provide sufficient support or encouragement for applying research findings. Many students observed a disconnect between theoretical knowledge and clinical realities, with some citing limited opportunities to observe or practice evidence-based interventions during clinical placements.
This contextual gap can hinder students’ confidence and willingness to use research in their decision-making processes. Therefore, fostering an environment that integrates research within everyday nursing practice is crucial for bridging theory and practice. Supportive clinical settings that encourage inquiry, discussion of evidence, and mentorship by experienced nurses can facilitate this integration.
Facilitation: The Role of Research Education and Support
Effective facilitation emerged as a key factor influencing research utilization among nursing students. All focus group participants emphasized that education about research utilization is one of the basic and essential principles for providing research-based care. They expressed a collective belief that quality research education, which extends beyond didactic teaching to include practical
exposure and facilitation, empowers students to incorporate research evidence into their clinical practice.
The role of faculty, mentors, and clinical supervisors in facilitating research utilization was highlighted as vital. Providing guidance, modeling research-informed practice, and encouraging critical appraisal skills help students to transition from passive consumers of research to active users. The honors students’ testimonies reinforce the value of immersive educational experiences and active facilitation in shaping positive attitudes towards research.
Implications for Nursing Education and Practice
The findings from this study have important implications for nursing education and clinical practice. To enhance research utilization among nursing students, educators must consider strategies that increase meaningful exposure to research processes, including opportunities to participate as research assistants or co-investigators. Curricular reforms might integrate research projects, critical appraisal exercises, and evidence-based practice workshops throughout all levels of nursing programs.
Moreover, creating supportive clinical environments where research utilization is modeled and encouraged can bridge the gap between education and practice. Clinical preceptors and supervisors should be equipped to mentor students in evidence-based decision-making and facilitate their engagement with current research.
Research utilization (RU) in clinical practice is a critical component of evidence-based nursing. Despite its importance, various factors influence how effectively nursing students engage with research during clinical placements. This paper explores several contextual and systemic barriers that hinder RU among nursing students, including cultural dynamics within healthcare
environments, time constraints, the persistent theory-practice gap, and inadequacies in clinical evaluation systems.
Cultural Context and Organizational Influence
The organizational culture and structure of healthcare institutions significantly shape the extent to which nursing students engage in research utilization. One of the prevailing themes identified is the perception of authority as a pre-requisite for employing research in clinical decision-making. Students often felt that hierarchical dynamics within hospital units discouraged innovation or questioning of routine practices, particularly in units where traditional roles were rigidly enforced.
Participant 5 from Focus Group 3 illustrated this point succinctly, stating, “Hospitals have an impact on research use. There are units where you find lots of encouragement and there are units where you just keep quiet, don’t get in their way and do not question what they are doing.” This quote underscores a culture where silence and conformity are often prioritized over inquisitiveness and evidence-based discussion, ultimately deterring students from integrating research into their care strategies.
Group dynamics also emerged as a pivotal factor. In units characterized by strong interdisciplinary collaboration and open lines of communication, students felt more supported and encouraged to utilize research findings. Participant 3 from Focus Group 1 noted that collaborative healthcare teams fostered a more inclusive environment where discussions about research and its application were common. These settings not only promoted the exchange of evidence-based ideas but also nurtured students’ confidence in articulating and defending research-informed clinical decisions.
Peer discussions played a significant role in enhancing students’ understanding and application of research. When students were able to consult with peers or senior staff, they were more capable of
reflecting on research evidence critically, linking it with their theoretical knowledge, and assessing its relevance to specific patient cases. Such collaborative dialogues supported the development of professional judgement and reinforced the importance of evidence-based practice.
Time Constraints as a Barrier
Time limitations were universally acknowledged as a major obstacle to engaging with research during clinical placements. Students consistently reported a lack of dedicated time to access or read research materials while on shift. While the availability of research articles within clinical settings was sometimes sufficient, the actual opportunity to engage with this material was almost non-existent during working hours due to the intensity of clinical responsibilities.
The exhaustion from physically and mentally demanding shifts further reduced the likelihood of students engaging with academic literature outside of clinical hours. One participant admitted, “If I am tired, I don’t bother to read up or think of work anymore. I go home and I just want to go to bed” (Participant 1, Focus Group 3). This sentiment was echoed by many students, who emphasized that despite their interest in research, fatigue and workload made it nearly impossible to sustain academic engagement.
To address this issue, participants advocated for the inclusion of protected time within their clinical schedules to access, review, and discuss research articles. Integrating such time into pre- and post- clinical conferences was suggested as a feasible strategy to promote evidence-based practice without adding to students’ already heavy workloads.
Theory-Practice Gap
One of the longstanding issues in nursing education—the gap between theory and practice—was also identified as a critical barrier to RU. Participants described a disconnect between what they
were taught in academic settings and what they observed in clinical environments. They noted that much of the knowledge gained through coursework was medical-centered and heavily theoretical, often failing to align with real-world clinical procedures and expectations.
Participant 3 from Focus Group 1 remarked, “Our academic education gives medical-centered theoretical knowledge from texts that are sometimes not applicable in practice. I just feel like we do not actually apply all that we learn in theory classes.” This disjunction left students feeling frustrated and disempowered, questioning the relevance of their academic learning.
A key contributor to this gap was the lack of communication and collaboration between nurse educators, clinical nurse specialists, and nurse researchers. Students believed that stronger professional relationships among these roles would facilitate a more seamless integration of academic knowledge into clinical routines. As Participant 7 from Focus Group 1 explained, “In nursing education, the most recent up-to-date research findings are available to students. However, when they enter the clinical setting, sometimes the updated research information is not used by practicing nurses. It is for this reason that it is difficult for us to use updated evidence in the clinical setting.”
Improved collaboration and communication between academic and clinical nursing staff could help bridge this divide, making it easier for students to translate their theoretical learning into practical, evidence-based interventions.
Clinical Evaluation and Its Role in Research Utilization
Another important factor influencing students’ engagement with research was the clinical evaluation process. Although clinical performance assessments were theoretically aligned with the entry-to-practice competencies of registered nurses—covering professional responsibility, ethical
practice, knowledge-based practice, public service, and self-regulation—students reported that RU was largely ignored during evaluation.
Participant 4 from Focus Group 2 noted, “Research utilization is included in the nursing evaluation checklist. However, clinical educators are not including it in their evaluation. I am assessed only in my patient notes (routine work), rather than in my research-based care plans for the patients I developed.” This lack of emphasis on RU during performance assessments contributed to students perceiving it as a low-priority skill. Participants expressed that if RU were more explicitly integrated into evaluation criteria, they would be more motivated to engage with research literature. The absence of such accountability mechanisms sent a conflicting message about the value of evidence-based practice. As Participant 6 from Focus Group 1 succinctly put it: “If the clinical evaluation doesn’t include research, the message is that it doesn’t matter whether or not students use it.”
Conclusion
The integration of research into clinical practice is a vital aspect of modern nursing, ensuring that patient care is informed by the latest evidence. As such, nursing students are expected to develop strong research utilization (RU) skills throughout their academic and clinical training. RU refers to the process of using research findings to inform and improve clinical decision-making and patient outcomes. While nursing theory courses provide a foundation in research knowledge, it is equally important that nursing students learn how to apply this knowledge in practical settings. This study adds to the body of knowledge by exploring nursing students’ perceptions of RU and identifying the factors that influence its implementation during clinical practice.
The findings of this study provide valuable insight into the various barriers and facilitators that affect students’ ability to utilize research effectively. Many of the factors influencing RU were found to be modifiable, suggesting that interventions can be designed to address these issues and improve students’ engagement with research. For example, a lack of confidence in interpreting research findings, limited time during clinical placements, and insufficient mentorship were all cited as barriers. On the other hand, supportive clinical environments, access to academic resources, and guidance from research-informed educators were seen as important enablers of RU. Understanding these dynamics is crucial for educators and policymakers seeking to close the gap between research and practice in nursing education.
In addition to identifying modifiable factors, the study also sheds light on the reasons behind low levels of RU among nursing students. These include a lack of emphasis on research in some areas of the curriculum, limited opportunities for hands-on experience in applying research during clinical placements, and the perception that research is not always relevant to everyday nursing practice. By recognizing these challenges, nursing programs can take targeted action to ensure that students view research as a valuable and integral part of their professional responsibilities.
The transition from student to registered nurse is a critical period in professional development, and equipping students with research-based knowledge and skills is essential for this process. Nurses who are confident in using research are more likely to deliver evidence-based care, contribute to quality improvement initiatives, and advocate for best practices within their teams. Therefore, a proactive approach to fostering RU skills during nursing education can have a long-lasting impact on the quality of care provided in healthcare settings.
To enhance RU among nursing students, curriculum reform should focus on embedding research content throughout the program, rather than confining it to isolated research modules. Clinical
mentors and educators should also be trained to model and promote research-informed practice. Early and frequent exposure to real-life applications of research can help demystify the process and demonstrate its practical relevance. Ultimately, by cultivating a research-minded culture within both academic and clinical environments, nursing education can better prepare students for their future roles as competent, evidence-based practitioners.
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