Jordanian National Study of Nurses’ Barriers to Participating in Research

Background: The nurses are the healthcare providers and researchers in critical institutions that provided health care for all people, and society needs to invest in them. The purpose of this study was to survey nurses regarding barriers to participate in research studies. Methods: A cross-sectional descriptive study. A total of 447 nurses agreed to participate in the study. Barriers were measured using Barriers of Research Utilization Scale (BRU). Results: More than half (53.3%) of the sample perceived the barriers to be high, whereas 8.9% perceived it as low. Barriers related to the organization scored the highest (P<0.01) compared to the other domains (nurse, innovation and communication).Regression analysis model showed that age, working experience, and nationality were associated with barriers to participate in research. Conclusion: More than half of the nurses in Jordan perceived the barriers of participation in research to be high. The barriers associated with the organization had more inuence. A comprehensive approach should be developed to boost participation in research by signicantly improving managerial support since it may be the most productive facilitator.


Background
All professions and specialties require scienti c research. The researchers used the gained knowledge to improve the state of science in all elds 1 and to bene t both the researchers and society. The nurses are the healthcare providers and researchers in critical institutions that provided health care for all people, and society needs to invest in them. [2][3][4] The decision maker and institutions need to know the barriers that are preventing nurses to participate in the research. Many studies reported that the main barriers to participation in research are regarding the organization. This includes inappropriate support from professionals, culture and climate of the work. 3,5 Other factors include the nurse characteristics related to poor knowledge and skill, negative attitude toward nurses, poor awareness of the importance of evidence based practice. 3,6 In Jordan, there is a demand to increase the quality of healthcare and to reduce its cost. This is especially essential because of the limited resources, coupled with an increasing number of very learned patients who demand high standards from their systems of health care. Besides, the health care system in Jordan is experiencing cost and quality challenges that nursing research can address. 2,4,6 Several studies were conducted in other countries to examine the barriers of participation in research among nurses 7 and how such barriers are in uenced by demographic variables, 3,8 Identi cation of the barriers and factors associated with them may help decision maker and institutions to engage more nurses in the research to enhance the visibility of nurses in developing evidence based health care. Therefore, the Purpose of this study was to survey nurses regarding barriers of participating in research.

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Method Research design, sample, and setting A descriptive cross-sectional correlation design was used to ful ll the goals of this study. A survey questionnaire was distributed electronically to a convenience sample of 1000 nurses working at any private and governmental hospital in Jordan. Inclusion criteria include holding at least a bachelor degree and having a current job in a hospital. A total of 448 nurses agreed to participate in the study (response rate is about 45%).

Procedure
The IRB Committee of the XXXX approved the study. Convenience number of nurses who met the requirements for inclusion in the research was invited to participate. The investigators approached each eligible nurse to give them a summary of the study and then asked them if they would like to take part in the study. If they wished to participate, their informed consent was obtained at this time. After a brief summary of the research had been given, the electronic questionnaire was sent to the agreed nurses. Out of a total of 1000 surveys that were distributed, 448 were lled electronically.
The electronic survey consisting of two parts as listed in the instrument section sent to nurses who meet the inclusion criteria at all wards in private and governmental hospitals. The electronic surveys sent by the head of each ward to allow a high response rate of those respondents. The two parts of the survey used in the study are: First part asked questions about age, gender, marital status, income, years of experience, nursing rank, nationality, living arrangement, working area. Also, asked two questions about previous publication and participating in research.
The second part is the Perception of Barrier of Research Utilization (BRU), this scale is developed by Funk et al . 9 This scale includes 28 items. Each item is rated from 1 ('to no extent') to 4 ('to a great extent') re ecting the degree to which the item is perceived as a barrier. Four subscale utilized in this scale that includes (1) characteristics of the nurse such as the nurse's own awareness (8 items); (2) characteristics of the organization (8 items); (3) characteristics of the innovation (6 items) and (4) characteristics of the communication with organization (6 items). The scores of this scale range between 28 and 112. Score from 28 to 56 consider low, 57 to 74 consider moderate, and 75 to 112 consider high. This scale has veri ed for validity and reliability among nurses. 7,9 Cronbach's α-values was .86. 3

Ethical Consideration
This study approved by Jordan University of Science and Technology's IRB. Participants who meet the criteria received an electronic form about barriers of perception of barriers to participate in the research. This information states that researchers will use the information to help nurses and people in the community. The researcher will maintain the privacy of the nurses' information; the researcher will not use any information in presentations or publications in a way that could identify the participant. The Principal investigator, the O ce for Human Research Protections and agents will have appropriate regulatory oversight.

Statistical Analysis
Data were analyzed using SPSS statistical software version 21. A multiple regression model was used to examine the association of demographics with total barrier score. A P value < 0.05 was considered signi cant.

Descriptive analysis
Demographic characteristics of the study are shown in Table 1. Average age of participants was 32.04 (SD = 8.2) years, females represented 51.2%. The majority of the study participants were Jordanian, married, and living in a city. They worked in both governmental and private institutions with years of work experience ranging from one to over 10 years. Most of the study participants (81.1%) were practicing nurses. Yet, only 35.6% had previous research experience, and 11.6% had research publications.

Perception of Barriers to Participation in research
Perception of barriers to participation in research was measured using BRU scale. According to the scale, 53.3% of the sample perceived the barriers to be high, whereas 8.9% perceived it as low. See Fig. 1. In addition, more than one-third (37.8%) perceived the barriers as moderate. When the items of the BRU were divided according to the four domains of the scale, barriers related to the organization domain scored the highest compared to the other domains (nurse, innovation and communication, P < 0.01). See Fig. 2. According to the individual items of the scale (Table 2), the highest mean scores were for the followings: "The nurse does not feel she/he has enough authority to change patient care procedures" (3.13) and "The facilities are inadequate for implementation" (3.07). On the other hand, the lowest mean scores were for the following items: "The research is not relevant to the nurse's practice" (2.34), "The conclusions drawn from the research are not justi ed" (2.42), and "The literature reports con icting results" (2.46). Table 2 shows the responses to each attitude element in the perception of barriers to participation in the research scale questionnaire.

Multiple regression analysis
Multiple regressions were used to predict nurses' perceptions of barriers to participation in research according to demographic variables (age, gender, education level, work experience, and job role). Table 3 summarizes the outcomes of the multiple logistic regression tests. All of the listed factors are not associated with the perception of perception of Barrier of Research Utilization orders (p value > 0.05) except age, working experience, and nationality.

Discussion
This is the rst national study in private and governmental hospital has been undertaken in Jordan to examine the perceptions that nurses have about barriers of participating in research. The current research, which was conducted in private and public hospital in Jordan, used a quantitative model to assess barriers of participating in nursing research. The study showed that the perception of barriers in participating in research in Jordanian nurse is high. This result is in agreement with other previous study. For example, Buhaid found that perception of participating in research for nurses in Bahrain is high and related to many issues of organization and authority. 10 Our study found that the rst barrier of participating in research according to nurse perception was the failure of nurses to consider themselves capable of changing the procedure of caring for patients. This outcome concurs with various studies of Buhaid in Bahrain. 10 Thayumanavan& Paul in Bangolare 11 and Nwozichi & Ojewole1 in Nigeria 12 who reported the same results regards authority and organization issues. Many medical institutions have an environment that shows medical dominance, nurses work in clinical surroundings where doctors impose most clinical decisions on them. This usually leads to a negative impact on the self-con dence of nurses and reduces the authority and power of nurses, including their possibility of fully working in the nursing eld within the con nes of their career. 13,14 Nurses require o cial authority that will enable them to create the best working atmosphere, including utilizing research, not only for their advantage but also for the patients' bene ts by offering high standards for patients. 15,16 Although these studies use different sample types (nation, level of education, and different position in nursing), the outcomes indicate that many nurses assume that they do not have the power to make a difference in their workplace. 8,11 Our study found that the second barrier of participating in research was "inadequate research implementation facilities". This was in agreement with previous research as major barriers of participating in research that include Chien et al, 17 Chen et al, 18 and Rutledge & Skelton 16 which re ects the role of the institution in promoting participation in research. Thus, organizations of health care must make sure that resources are given to handle greater levels of participation in research. The outcome may be due to nancial resource limitations that bar the application of the research ndings in the work environment. 19,20 Nurses may require logistic assistance and motivation for the adoption of research to promote access to participation in research resources. The absence of facilities may be because Jordan is among the developing nations with limit resources that may in uence the application of research outcomes. 3 Thus, organizational and support from management is one method that can assist nurses in applying research in their job.
The multiple regression analysis carried out in the study to comprehend the effect of the demographic attributes of nurses on their views regarding barriers to utilization scale in the research indicated that there was no substantial connection between these attributes and the perception of nurses towards the obstacles to involvement in research. 18, 21 22 Nevertheless, this outcome is different from an initial study, which showed that none of the individual and career attributes-that is, age, sex, experience in nursing, education research, and involvement-had signi cance. 3,5 Research on barriers to participation in research has indicated that nurses perceive organizational factors as barriers more than their attributes. 5,23 Studies showed a positive association between the duration of experience and the recognized barriers. 18; 24 According to this study, experience had a negative correlation with barriers to participation in research.
This may be because nurses with more experience years often have higher administrative power in hospitals, which probably allow them to execute research outcomes in a clinical environment that could ultimately reduce their view towards participation in research barriers. More experience years allow nurses the perception of having the professional power to alter practice.
From the outcome of our research, it appears that nurses with younger ages show more positive attitudes toward research may be because younger ages require before and after graduation received an education and knowledge still update about information acquisition, methods of research, knowledge in statistics, evidence based practice, and applying research outcomes in practice. 25 Additionally, it is essential that methods of research and statistics have a clear presentation in published issues. 26,27 It would especially bene t those articles of research that propose new results to incorporate participation in research regarding translating the research into work. 24,25,28 The present results contradict other studies that found no association between demographic data and perception of barriers to participate in research. 5,18 Establishing research and education unit in hospitals may be useful in which nursing research is investigated for its clinical environment use; such research and education unit could additionally offer consultation to nurses and help concerning methods of research and statistics. There is a high recommendation that nurse management is very proactive in applying research outcomes into practice and supports the topic more.

Relevance to Clinical Practice
There must be an explicit adoption of participation in research policy in all clinical environments and other clinical institutions. Recognizing the perceived barriers to the use of research would promote applying up to date and authentic research outcomes that may increase the standard of care patients receive, with little con ict in roles and more self-esteem among certi ed nurses. Besides, evidence based practice could reduce the cost of health care, the stay-length of patients, and possible complications in health.

Conclusions
There has not been a wide implementation of research use in Jordan due to several barriers. The barriers associated with the organization had more in uence, with organizational issues related to authority and facility situation, limited time, limited administrative assistance, and lack of power being leading recognized barriers. A comprehensive approach should be developed to boost participation in research by signi cantly improving managerial support since it may be the most productive facilitator, considering the uniqueness of the culture in Jordan and the health care system in Jordan. Speci c emphasis should give more focus to research-oriented continuing programs of learning, especially the newly selected nursing cadre. Multidimensional factors hinder participation in research. Their optimization should an obligation shared among the nursing managers, tutors, clinicians, and researchers.

Abbreviations PRU = Participation in Research Scale
Declarations Ethics approval and consent to participate: This research got an Approval from Jordan University of Science and Technology IRB(#20202343).
Consent form was signed from all the participants.

Consent to publish:
We gave the right to BMC NURSING to publish Availability of data and materials: data will be sent upon request Competing interests: no con ict of interest for any author in this paper Funding Section: This project was carried out as part of "The Research Ethics Education Program in Jordan" and has been supported by NIH grant number (1R25TW010026-01). The funder support data collection and fees for publication.
All authors have read and approved the manuscript", and ensure that this is the case.   Figure 1 Perception of barriers to participation in research according to BRU scale. Values were expressed as percentages. The total number of sample was 448.