|Year : 2021 | Volume
| Issue : 3 | Page : 163-169
Assessment of nurses’ involvement in health research and policy development at a Federal Teaching Hospital in South East Nigeria
Ifeoma Ndubuisi1, Ijeoma L Okoronkwo2, Chisom Mbadugha1, Ijeoma Maduakolam1, Chijioke Nwodoh1
1 Department of Nursing Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria
2 Department of Nursing Sciences; Department of Health Administration and Management, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria
|Date of Submission||01-Jun-2020|
|Date of Decision||24-Aug-2020|
|Date of Acceptance||12-Feb-2021|
|Date of Web Publication||20-Apr-2021|
Department of Nursing Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka-Onitsha Road, Nsukka, Enugu State.
Source of Support: None, Conflict of Interest: None
Background: Nurses account for a significant proportion of the health-care workforce in most countries; however, they are marginally represented in policy decision-making. Aim: To assess nurses’ involvement in health research and policy making at a Federal Teaching Hospital in Nigeria. Materials and Methods: A cross-sectional design was adopted by using 305 nurses. Data collection was done by means of a validated questionnaire. Data were analyzed descriptively by using frequencies, percentages, means, and standard deviations. Results: The findings revealed that 71.1% of the respondents had been involved in research activity; however, only 16.6% had participated in a research study after school. The result also revealed that only 23.6% of the respondents had been involved in health policy decision-making in the hospital. Educational qualification did not have any influence on their involvement with research and policy development. The major barriers identified were lack of knowledge and relevant skills (89.8%), lack of organizational support (84.5%), and professional dichotomy (67.2%). The respondents strongly agreed that organizational support (94.4%), having interest in politics (89.8%), mentoring in research (84.6%), higher education in nursing (84.2%), funding of research (80%), and belonging to professional organizations (80%) will enhance their involvement in research and health policy decision-making. Conclusion: Nurses have not been adequately involved in research and policy development. Findings revealed organizational and individual factors as barriers to nurses’ involvement in the research and policy-making process. These findings, therefore, suggest strengthening nurses for effective participation in health policy and building support for research activities in nursing.
Keywords: Health research, nurses’ involvement, policy formulation
|How to cite this article:|
Ndubuisi I, Okoronkwo IL, Mbadugha C, Maduakolam I, Nwodoh C. Assessment of nurses’ involvement in health research and policy development at a Federal Teaching Hospital in South East Nigeria. Int J Med Health Dev 2021;26:163-9
|How to cite this URL:|
Ndubuisi I, Okoronkwo IL, Mbadugha C, Maduakolam I, Nwodoh C. Assessment of nurses’ involvement in health research and policy development at a Federal Teaching Hospital in South East Nigeria. Int J Med Health Dev [serial online] 2021 [cited 2021 May 11];26:163-9. Available from: https://www.ijmhdev.com/text.asp?2021/26/3/163/313949
| Introduction|| |
Nurses form the largest group of health workers as well as serve as the “backbone” of the health-care system in Africa., 1n 2012, there were 249,566 nurses and midwives in Nigeria compared with 65,759 medical doctors in the country, a ratio of approximately four nurses to one medical doctor. However, despite their numerical strength, professional autonomy, and educational advancement, they have not made an appreciable impact in initiating health research and policy formulation as compared with other health professionals.
The World Health Organization has also acknowledged that up to 90% of the health workforce comprises nurses who make substantial contributions to health-care delivery in diverse settings but despite their contributions they are seldom involved in policy development. They affirmed that although nurses from western countries such as the United Kingdom and the United States have made significant progress in influencing health policy development, they still face significant challenges. Even when nurses are part of the government system, they still have limited ability to influence health policy due to the negative image and status accorded to the nursing profession and the dominance of the medical profession in policy development.
In our contemporary society, nurses can no longer rely on their initial training, knowledge, and skills to meet the challenges of health care, advanced technology, and increased consumer awareness. The Institute of Medicine (IOM) has emphasized the need to combine best research evidence and clinical experience with patients’ values in their report on “Crossing the Quality Chasm: A New Health System for the 21st Century.” This release followed the inability of the health system to provide the high-quality care needed and that is expected from the populace. Similarly, the IOM suggested the need for the largest members of the health-care system to take lead in bringing about the much needed change in the health system.
In a study in East Africa, findings revealed that although the majority of the nurses are aware of policy issues, only a few are involved in the policy development process and this is mainly during the adoption, implementation, and evaluation stages. In Nigeria, a study that evaluated nurses’ leadership in research and policy formulation in Southern Nigeria found a marginal leadership in policy formulation and research. The hindering factors were mainly individual and institutional factors. The author concluded that nurses’ effective leadership in policy formulation and research has not yet been actualized.
With the global debates around health policy reforms, there have been increasing calls for nurses to be actively involved in the national policy process and several authors have emphasized the need for nurses to utilize research as credible evidence to inform policy decisions., Evidence-based nursing practice relies on available research evidence to enable the individual patient and organization attain high-quality and cost-effective care., The potential of nurses to make major contributions regarding the quality and effectiveness of health services has been recognized. and, as such, they must be involved at all levels of the health system in health-care policy reforms. Further, governments must develop legal frameworks to ensure nursing representation in policy making, research generation, and health-care planning.
Nurses, by virtue of their number, knowledge, and wealth of experience, are well positioned to play a leading role in improving the health of Nigerians. They form an integral part of the system because they are at the forefront of patient care and have prolonged engagement with patients and families., Their involvement in research and health policy will bring nursing values to the policy arena, which is needed to influence the decisions that affect them. However, evidence shows that nurses have not been involved in health research and policy making to any reasonable extent. It has also been affirmed that although research is considered a very important part of nursing practice, professional practices are often still guided by traditional methods and rituals, and nurses do not generally utilize research findings in providing care.
Studies in Nigeria,, and from other countries have identified many barriers that prevent nurses from undertaking research activity and engaging in policy development; these include lack of adequate staff and excessive workload, lack of experienced nurse researchers, cost, lack of organizational support, unavailability of Internet services, lack of nursing research mentors, and poor leadership. The IOM has provided nurses with new opportunities to deliver care and to play an integral role in leading change; their ability to succeed depends on their transferring from the patient’s bedside to the boardroom where health policies are made., Similarly, the WHO has raised concern over the minimal representation of nurses and midwives at national, regional, and international health policy fora.
From anecdotal reports and observations made by the researchers in many hospitals in the study setting, despite the obvious contributions that nurses make in the health system, policy decisions are often taken without nurses’ consideration or involvement. With this renewed call on nurses by the IOM and WHO, it has become necessary to ascertain the extent of their involvement in research and policy development for evidence-based practice. This article presents the result of nurses’ involvement in health research and policy development, and the factors that hinder or facilitate their involvement in a tertiary institution in South East Nigeria.
| Materials and Methods|| |
This was a cross-sectional descriptive survey among the nursing staff of Federal Teaching Hospital Abakaliki (FETHA), Ebonyi state, South East Nigeria.
The population of the study comprised all the nurses working at FETHA. The total population according to the hospital’s statistical records was 1010 nurses of all ranks or cadres at the time of study.
A sample of 305 nurses working in FETHA I and II was determined by using power analysis. This was determined by using the formula
where is standard normal distribution at 95%, which corresponds to the confidence interval 1.96; P indicates 50% (the prevalent rate is not known); d is an allowable error that is taken as 0.05% or 5%; population = 1010; and sample size = 278. A 10% attrition/ nonresponse was added to the sample size of 278 nurses and calculated to get 305 nurses.
In selecting the sample size, the respondents were stratified according to their ranks and a proportionate allocation was done to obtain the quota allocated to each rank by using the formula:
where Ns is the sample size of the selected population strata, Nt is the total population in each quota, and n is the sample size for the study.
In selecting the sample size, the respondents were stratified according to their ranks and a proportionate allocation was done to obtain the quota allocated to each rank, for example, NO 11 (74), NO 1 (70), SNO (40) etc.
The instrument used in collecting data from the respondents was a validated questionnaire made up of three sections: Section A included questions related to sociodemographic characteristics of the respondents; section B was focused on nurses’ involvement in health research and policy making; and section C comprised questions on factors that hinder or facilitate nurses’ involvement in health research and policy making.
Ethical clearance was sought and obtained from the Research and Ethical Committee of FETHA. Written informed consent was also obtained from each respondent before questionnaire administration, and participation was clearly communicated to be voluntary.
Descriptive statistical methods such as simple percentages, frequency, means, and standard deviation were used. Questions on nurses’ involvement in research and policy making were scored by using frequencies and percentages, whereas questions on factors that facilitated or hindered the involvement of nurses were scored by using a 4-point Likert scale, which was graded from 4 to 1: strongly agree, 4; agree, 3; disagree, 2; and strongly disagree, 1, giving a criterion mean score of 2.5. To determine the decision rule for the 4-point scale questions, items with a mean value of 2.50 and above were accepted as negative or hindrances [Table 4] whereas a mean value below 2.5 was considered as not a factor. In [Table 5], a mean value of 2.5 and above was considered a facilitator. The Statistical Package for Social Science (SPSS) version 20 was used for all analyses.
| Results|| |
A total of 305 nurses were studied. The mean age of the respondents was 31.1 (6.75%) years and they were mostly females (230, 75.4%). Less than half (140, 45.9%) of the respondents had nursing diploma certificates only, 64 (20.9%) had a BSc, and 35 (11.5%) had an MSc. The majority (148, 48.5%) had professional experience of between 11 and 20 years, as presented in [Table 1].
The majority (217, 71.1%,) of the respondents have been involved in research writing whereas 88 (28.9%,) have not. Of the 217 nurses who have been involved in research writing, only 36 (16.6%) have participated in research studies since after their nursing education. Among those involved, 8 (22.2%) agreed that they received financial support whereas 28 (77.8%) did not receive any support, as presented in [Table 2].
[Table 3] shows that only a few (72, 23.6%) nurses have been involved in health policy decision-making whereas 233 (76.4%) have never been involved. On the frequency of involvement, 46 (15.1%) respondents have been involved once whereas 26 (8.5%) nurses have been involved more than once. On the nature of involvement, 15 (20.8%) respondents indicated that they were involved in making budget proposals of their units, 32 (44.4%) represented their units or department in staff recruitment, and 25 (34.7%) advocated for patients’ rights.
As seen in [Table 4], the majority of our study respondents strongly agreed that lack of relevant knowledge and skills with a mean score of 3.83 ± 0.89; inadequate organizational support with a mean score of 3.67 ± 0.75; and professional dichotomy with a mean score of 3.50 ± 0.71 were hindrances to being involved in research activities and health policy decision-making. However, the majority (84%) of the respondents disagreed that time factor was a hindrance with a mean score of 1.29 ± 0.41.
|Table 4: Factors that Hinder Nurses’ Involvement in Research and Policy Making (n = 305)|
Click here to view
[Table 5] shows that all the respondents were positive in their responses that organization support with a mean value of 3.93 ± 6.69, having interest in politics with a mean value of 3.85 ± 6.59, mentoring in research with a mean value of 3.78 ± 2.09, higher education in nursing with a mean value of 3.77 ± 2.09, funding of research with a mean value of 3.72 ± 6.69, and belonging to a professional organization with a mean value of 3.70 ± 1.23 will enhance their involvement in policy making and research.
|Table 5: Factors that facilitate Nurse’s involvement in policy making and research (n = 305)|
Click here to view
| Discussion|| |
Nurses comprise the majority of the global health-care workforce, working closely with patients and their families in a variety of settings. Thus, their experiences and insights may help guide improvements in the quality of health service delivery and inform the strengthening of health systems. Findings from this study revealed that most (71.1%) of the nurses were involved in research writing but a few (28.9%) had participated in research studies after school. This result is not surprising, as research is one of the partial fulfillments in one’s graduation. However, it was disturbing to note that only a third had participated in research studies in their workplaces. Limited nurses’ involvement in this study could be attributed to nonacquisition of research skills after school education and an unfavorable attitude toward research. The significance of nurses leading health-care reforms through collaborative research has been stressed. Quality nursing care relies on current research evidence and 20% to 25% care rendered is potentially harmful if it is not based on research. Further, the study revealed that only a few (22.2%) nurses indicated that they received financial support for the research. Inadequate funding of the health-care system is a general challenge that influences funding of resources, which could have enhanced research and evidence-based nursing practice.
Findings from this study revealed minimal (23.6%) involvement of nurses in policy decision-making. Their health policy participation revolved around representing nurses’ issues at selected policy tables, such as budgets, and staff recruitment. This finding is very disheartening when you consider that the majority of the respondents should have been more proactive, especially in respect to their numerical strength, educational qualifications, and long years of professional experience, as seen in the demographic characteristics. This finding suggests that when decisions on important health policy issues are taken in their absence, they only serve as implementers. This may adversely affect their services and the overall health outcome of their patients. This agrees with Benton, who submitted that nurses are marginally involved in health policy and are implementers of decisions imposed on them by other health-care professionals. It appears that the nursing profession has really been slow to recognize and utilize its power to support and impact health-care policy development or emphasize the need for nurses to participate in public policy formulation and political activities., This is an essential requirement if nurses are to meet their responsibilities in providing optimal health for their communities and the nation.
This study highlighted hindrances to research and policy involvement by the respondents, which include lack of relevant knowledge and skills in research and policy making, inadequate organizational support, and professional dichotomy. These factors are mainly individual and institutional barriers. Respondents indicated that nurses had inadequate knowledge and skills required to contribute to research and policy processes. This finding agrees with similar studies that lack of financial and organizational support as well as knowledge deficiency are the most important barriers to nurses’ involvement in research and policy making., The authors also noted that nurses, by virtue of their numbers, could generate enough power to successfully reform the health-care system but are not willing to step out of their comfort zone into the complex policy arena. This deficiency in nurses’ knowledge may be attributed to failure of the nursing profession to incorporate policy issues and policy processes into nurses’ training curricula, thus maintaining the status quo for nurses’ role in decision-making. The inadequate knowledge and skills in research will affect the generation and utilization of research evidence to influence policy decisions. Given the need to strengthen nursing leadership to influence policies, the International Council of Nurses has developed programs to train nurse leaders in ways that influence policies. Such training may help strengthen nurses’ competency in engaging in health-care decision-making.
The low participation of nurses in health policy decision-making was revealed in this study. This is similar to the findings in a study in Kenya, which revealed limited participation of nurses. Nurses’ limited participation in policy processes has also been attributed to gender differences in the health-care system. This may probably be due to the fact that nursing is viewed as a woman’s occupation involving caring for others whereas men are typically seen in positions of power and decision-making. Such an approach denies nurses the opportunity for direct involvement in policy decisions. Studies have also confirmed that organizational support in terms of funding the health-care system is a general challenge that influences the funding of research that could enhance research and evidence-based nursing practice. Sometimes, where funding is made available, undue restrictions are attached, which reduces nurses’ chances of accessing research funding, especially in low- and middle-income countries.
The other barrier as indicated by the respondents was professional dichotomy. Nurses are perceived as being isolated from other professionals, concerning themselves only with professional issues and not broader issues affecting the health-care system. The health-care system is made up of different professionals; therefore, the recognition of each professional’s contribution toward achieving a common goal should involve equal representation of every group in decision-making. Given the top–down nature of policy-making processes in the health sector, the findings speak to the importance of finding ways to give nurses some voice in decision-making at all levels. Failure to engage all professionals in strategic decisions and actions in a balanced way leads to circumstances where those who have the greatest power usually have the greatest say, implying that rules and regulations would be created by others for nurses.,
It was surprising that the time factor was not seen as a hindrance in this study, bearing in mind the reported shortage of nurses in the workplace. This finding is in contrast with similar studies where time was a major hindrance. Other studies,, have emphasized that the biggest barrier to research productivity in nursing practice is the lack of time; they suggest the need for organizational change toward increasing time availability for nurses, as a way forward in achieving their goal.
With respect to factors that will enhance nurses’ involvement in research and policy making, the respondents were in agreement that organization support, having interest in politics, mentorship in nursing, higher education in nursing, funding of research, and belonging to professional organizations will improve nurses’ involvement in policy and research. These findings agree with the study of Shariff and Potgieter, who recognized the potential of nurses to make major contributions regarding the quality and effectiveness of health services if they had effectively utilized the factors cited earlier. The existence of good organizational culture that supports nursing research and policy making will improve nurses’ participation in these activities.
Health policy is synonymous with politics and in the health sectors only those who know how to play the game influence policies. Nurses need political skills to engage management and the government to address policy gaps that affect nurses’ work. They need political skills to dialogue with politicians and other leaders in the health-care sector.
Higher education in nursing is needed to take the profession to greater heights and to collaborate with other health team members as partners in the system. Currently, there are relatively few PhD nurses and university-based training is relatively new; thus, there are a limited number of nurses in the system who can provide mentoring and supervision to young researchers.
Active participation in professional and other organizations equips nurses with the much needed political skills, exposure, cohesion, unity, and network needed for effective policy involvement. All these facilitators will improve nurses’ involvement in research and policy.
| Conclusion|| |
Nurses have not been adequately involved in research and policy development. Findings revealed organizational and individual factors as barriers to nurses’ involvement in research and the policy-making process. These barriers should be addressed for nurses to take their rightful place as leaders in the transformation of the current health-care system, which will ultimately enhance the quality of care and patient health outcomes.
Limitation of the study
The study was carried out in one teaching hospital in South East Nigeria and, therefore, cannot be used for generalization. In addition, there was no correlational statistics done due to limited responses.
Financial support and sponsorship
Conflicts of interest
The authors declare that they do not have any competing interests in the publication of this article.
| References|| |
Institute of Medicine (IOM) of the National Academies. Future of Nursing: Leading change, advancing health. A report of the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. Washington, DC: The National Academies Press; 2000.
Alliance for Health Policy and Systems Research. Strengthening health systems: The role and promise of policy and systems research. Geneva: Global Forum for Health Research; 2004.
National Health Policy 2016: Promoting the health of Nigerians to accelerate socio-economic development. Retrieved from https://naca.gov.ng/wp-content/uploads/2019/10/National-Health-Policy-Final-copy.pdf. [Last accessed 2019 Feb 5].
Asuquo EF, Etowa J, John M, Ndiok A, Akpan Sampson P, Edet O Assessing nurses capacity for health research and policy engagement in Nigeria. J Appl Med Sci 2013;2:35-51.
Shariff N, Potgieter E Extent of east-african nurse leaders’ participation in health policy development. Nurs Res Pract 2012;2012:504697.
Edwards N, Webber J, Mill J, Kahwa E, Roelofs S Building capacity for nurse-led research. Int Nurs Rev 2009;56:88-94.
Juma PA, Edwards N, Spitzer D Kenyan Nurses ‘Involvement in National policy Development Process. Hindawai Publishing Corporation. Nursing Res Pract 2014;15:236-573.
Clancy CM, Glied SA, Lurie N From research to health policy impact. Health Serv Res 2012;47:337-43.
Grol R, Grimshaw J From best evidence to best practice: Effective implementation of change in patients’ care. Lancet 2003;362:1225-30.
Edwards NC Leveraging nursing research to transform healthcare systems. Nurs Inq 2008;15:81-2.
Abood S Influencing health care in the legislative arena. Online J Issues Nurs 2007;12:3.
Munjanja O, Kibuka S, Dovlo D The Nursing Workforce in Sub-Saharan Africa. Geneva: International Council of Nurses; 2005.
Tan M, Akgün Sahin Z, Kardas Özdemir F Barriers of research utilization from the perspective of nurses in eastern Turkey. Nurs Outlook 2012;60:44-50.
Mitchell K, Baillie L, Phillips N Increasing nurse and midwife engagement in research activity. Nurs Stand 2015;29:37-42.
Fajemilehin BR Evidence-based practice, networking and quality care. Nigeria J Nurs2009;1:10-25.
World Health Organization. The Strategic Directions on Strengthening Nursing and Midwifery Services 2011–2015: http://www.who.int/hrh/nursing_midwifery/en/. [Last accessed 2019 Jan 21].
Rogers SE The extent of nursing research utilization in general medical and surgical wards. J Adv Nurs 2000;32:182-93.
Benton D Advocating globally to shape policy and strengthen nursing’s influence. Online J Issues Nurs 2012;17:5.
International Council of Nurses (ICN), Participation of Nurses in Health Services Decision Making and Policy Development, 2000, htttp://www.icn.ch/images/stories/documents/publications/position statements/D04. [Last accessed 2019 Sep 20].
Retsas A Barriers to using research evidence in nursing practice. J Adv Nurs 2000;31:599-606.
Rispel L Enhancing Nurses Participation in Health Policy; Health policy and Systems Research. Johannesburg, South Africa: University of the Watersrand; 2013; 91:748-56.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]