Introduction

Current trends of nursing practice require higher level of expression that it became a necessity to not just practice but to practice with the “evidentiary” basis, hence, the application of EBP or Evidence-based Practice in the nursing profession. Experts defined EBP as the “synthesis and application of scientific information derived from systematic research findings such as clinical trials and patient preferences for patient care” [1,2]. One of the subsets of EBP was research utilization which is defined as an application process of evidenced-based knowledge into everyday practice [3], and the need for research as source of current best practices and other innovations [4]. Other scholars defined research utilization as “thorough use of theory-derived, research-based information in making clinical decisions about healthcare delivery to patients needs and preferences” [5] which comes more relevant if not of utmost importance in the present world predicament as the Covid-19 virus has affected more than the majority of countries and territories regardless of military or economic might. Research utilization has been recognized by the healthcare community and governing authorities as a critical step in providing quality and safe nursing practice [3]. The advantages of applying evidence-research into everyday practice elevates quality of care and professional growth of nurses [5,6]. The growing body of nursing research refines and increase the current knowledge and has the potential to contribute in the improvement of nursing practice more importantly during the most critical part of humanity’s history expecting every profession (just like nursing) to contribute and make a difference not now but in the most immediate time possible.

In Saudi Arabia, the volume of research is increasing in the medical and nursing fields. It has been reported evidenced-based research and research utilization for dental and medical context. Similarly with other countries, nurses in Saudi Arabia needed to utilize research findings in practice to achieve optimum levels of EBP; and the quality of healthcare Nursing research has advanced significantly throughout recent years expecting the use of research findings to promote and improve healthcare quality [7,8]. Participation in any research activities could lead to a better condition of health care through the utilization of finding focused on innovative care approaches. It was such a long time ago that a pandemic condition affected humanity and the world, and when it did in the many past decades ago the conditions were different in terms of technology and scientific advancement. It led to deaths of monumental counts and it should not happen now as advantages are at hand having technological and scientific advancement showed more than many ways of improved health care practices through relevant researches and activities. And still according to current updates, World Health Organization (WHO) showed the total confirmed cases at more than 298 million, and death toll at 5.4 million despite a 9.1 billion doses of vaccine administered already.

Studies conducted in other countries concluded that positive attitudes, availability, and support for research utilization can contribute to greater use of research in nursing practice, and above half (50%) of the nurses considered they had access to research findings at work but the percentage of time to read about research on duty was lower (Moe & Enmarker, 2020). Consistent favorable consideration of research utilization attitude can lead to appreciable changes in practice though results tended to just show half of practitioners, there can be room for improvement and still must require a necessity to find out what seemed to be reasons to the contrary by the other half of the practitioners. Additionally, Kyalo Mutisya et al. found out in their own research findings that half of the studies conducted were implementing research findings to practice [9].

Barriers to research utilization have been reported and analyzed by qualitative and quantitative methods in several countries. In Saudi Arabia, the most perceived barriers to research utilization among nurses were organizational factors considering support from managers [10,11] including “…lack of financial support from the institution, shortage of manpower or personnel not having enough time, unable to understand research reports, lack of validity and reliability, and lack of knowledge and dependence of nurses among physicians and managers…” [12, 5 ]. How to further improve research utilization eventually improving general healthcare delivery and management can also mean focusing on hindrances and difficulties faced by practitioners themselves. On the actual practice scenario, these difficulties may easily be brushed off totally disregarding each and every concern as experienced while delivering the necessary care needed to improve patient conditions. It might not just entirely be the practitioners themselves who had faced these barriers but others (e.g., managers and administrators) might have contributed or facilitated unknowingly. A major challenge is to gain better understanding of factors that facilitate or serve as a barrier in the implementation and utilization research including individual and organizational factors. Although, the trend of nursing research in Saudi Arabia is increasing, for our present study we faced a little information or obsolete research about nurses utilizing research results in the kingdom.

Thus, this study aims to identify research utilization among nurse practitioners and possibly find barriers to research utilization during practice in a government medical city in Saudi Arabia so especially that experience was focused during the Covid-19 Pandemic era.

Methods

The questionnaire-based study used a cross-sectional quantitative design as it included participants from different segments of a chosen large group of respondents pre-determined by design.

Participants and Procedures: The study participants were recruited from one of the largest government medical cities in the City of Riyadh during the height of Covid-19 Pandemic of 2020. Having gained the approval and support of the health institution’s managers and administrators agreeing with the physical limitations found in the IRB approved document (King Saud University – IRB Approval No. E-20-4653), data gathering was done through online using the google form to seek everyone’s participation. From about 1700 nurses in the hospital, there were 303 nurses who participated in the online data gathering understanding the schedule and physical load they were having during the middle of 2020. Data gathering went through several follow ups spanning 4-6 months just to be able to finally decide and accommodate the 303 complete responses. As hoped, the consideration of acceptable was based on the minimal representation from the different hospital wards in the said university medical city.

Research Instrument: The study designed a data gathering instrument with three parts which are as follows:

(1) Demographic features grouped into two (personal variables and professional variables),

(2) Research Utilization Questionnaire with 29 items to be rated using 4-point Likert scale (1-strongly disagree, 2-disagree, 3-agree, and 4-strongly agree)

(3) Barriers to Research Utilization Questionnaire with 30 items to be rated with 4-point Likert scale (1-strongly disagree, 2-disagree, 3-agree, and 4-strongly agree).

Research Utilization Questionnaire. Barriers to Research Utilization Scale was developed in the year 1987 [13,14] used by hundreds of researchers translated into different major languages in different many research activities. Permission to use was declared for public and academic use through an expressed letter of request which was complied with. The general internal consistency Cronbach α coefficient of the scale was 0.87 and the scale was accepted as reliable [15].

Data Analysis: The data used in this study were analyzed using IBM SPSS Version 23. Descriptive statistics was utilized to characterize all participating nurse practitioners presented through frequency, percentages and crosstabulation as data were categorical in nature including mean and standard deviation measures. The same were used in the analyses of rated research utilization and possible barriers where a 4-point Likert scale were assigned as follows: research utilization statements used 1-strongly disagree, 2-disagree, 3-agree, and 4-strongly agree; while possible research barriers statements used 1-no extent, 2-little extent, 3-moderate extent, and 4- great extent. Chi-square test of association was utilized to examine significant relationships between identified personal and professional variables against research utilization and possible barriers mean ratings. Also, non-parametric Mann-Whitney U test was used to evaluate significant difference in the ratings when the original demographic features were transformed into its bivariate form. All levels of significance were set at p ≤ .05 in this study as while p ≤. 01 was considered even better in some results.

Ethical consideration: As the data gathering was done online, informed consent was obtained from the professional participants and that their actual participation showed proof of their consent to participate as it is voluntary. There was also an IRB (Institutional Review Board) that reviewed the proposal and eventually provided an approval strictly emphasizing the indirect and impersonal approach of data gathering procedure. Participants were accorded the right to refuse or to withdraw from the study in any time they want reassuring them all that data collected will be held in utmost confidentiality. Data shall be kept by the primary and corresponding author at his present institutional affiliation and availability is may be accorded to external parties upon written request to the same. Conveniently, datasets used and/or analyzed during the current study are available in the Synapse Repository with Synapse ID: syn24606750 and DOI: 10.7303/syn24606750.

Results

The results of this study are presented as follow: characteristics of the participants obtained in clustered variables like (1) personal variables which included age, sex, civil status and nationality, and (2) professional variables which included educational background, work tenure or service in years, professional role, and area of assignment. Followed by the respondents’ perception on research utilization and barriers with equivalent ratings. Another major result are the possible relationships existing between demography and research utilization or the barriers. Lastly, the possible differences in the ratings given on the identified dependent variables considering bivariate demographic features.

Demography: Table 1 shows the basic characteristics of the participants grouped into personal and professional variables. Considering the highest frequencies, the pool of participants was mostly aged between 31-40 years old (n = 171; 56.4%) with the youngest participant as 21 years old and the oldest as more than 60 years old, female dominated (n = 232; 76.6%), married (n = 204; 67.3%), and mostly non-Saudis (n = 208; 68.6%). Professional features included a majority respondents being bachelor level graduates (n = 167; 55.1%), with more than 6 years of professional experience (n = 225; 74.3%) in a staff level position (n = 241; 79.5%). Highest participated came from those who were assigned in non-critical area like the Psychiatric Department (n = 86; 28.4%).

Table 1: Demographic Data.

Research Utilization: Participants were asked about research utilization which had the following results: Dimension 1 on “attitude index” showed a mean rating of 2.55 (SD = 0.521) which corresponded to “moderate extent”, Dimension 2 on “availability and support index” showed a mean rating of 2.58 (SD = 0.521) which corresponded to “moderate extent”, Dimension 3 on “research use index” showed a mean rating of 2.48 (SD = 0.602) which corresponded to “a little extent”, and the over-all research utilization average rating of 2.71 (SD = 0.638) which corresponded to “moderate extent”. Additionally, Dimension 1 majority items (7 of 13 items) were found at moderate extent like their belief that research may be put to practice, that research is understandable, and their clinical team supported research utilization. Three (3) items were rated at great extent believing that research is stimulating and interesting, and professionally advantageous. In Dimension 2, more than half (4 of 7 items) had that moderate extent of perception specifically on their unit manager’s support, use of research in the work place and community, and that there is research education right at the workplace. On the actual research use index under Dimension 3, a great majority (7 of 9 items) were found at a moderate extent rating focused on practice based professional activities, research findings are applied in clinical practice, or an active participation to seek out related researches to clinical practice.

Table 2: Dimensions of Research Utilization among the respondents; n=303; Ranges: 1.00 - 1.75 To no extent; 1.76 - 2.50 To a little extent; 2.51 - 3.25 To a moderate extent; 3.26 - 4.00 To a great extent.

Table 2 shows that the over-all research utilization rating is at a moderate extent putting a positive appreciation of research utilization in nursing practice among the participants’ actual professional practice attitude wise, availability and support presence, and an actual research use in their daily clinical practice.

Research Utilization Barriers: On the research barriers variable, there were four (4) factors according to the instrument used. Factor 1 refers to barriers coming from the nurses’ research values, skills and awareness with 6 of 8 items being rated at “little extent” and the other 2 at “moderate extent”. It had a mean rating of 2.43 (SD = 0.585) equivalent to “little extent”. Factor 2 refers to barriers from organizational settings, barriers and limitations with 7 of 8 items being rated at “moderate extent”. It had a mean rating of 2.69 (SD = 0.577) equivalent to “moderate extent”. Factor 3 refers to the barriers from innovations or qualities of research with 4 of 6 items being rated at “moderate extent”. It had a mean rating of 2.56 (SD = 0.543) equivalent to “moderate rating”. Factor 4 refers to the barriers from communication or presentation and accessibility of the research with half of the 6 items being rated at “moderate extent” while the other half at “little extent”. It had a mean rating of 1.80 (SD = 0.428) equivalent to “little extent”. Table 3 shows that the over-all research barrier mean rating is 2.54 (SD = 0.510) equivalent to a “moderate extent”.

Table 3: Dimensions of Research Barriers among the participants; n=303;Ranges:1.00 - 1.75 To no extent;1.76 - 2.50 To a little extent; 2.51 - 3.25 To a moderate extent;3.26 - 4.00 To a great extent.

Demography and Research Utilization/Barriers:

Test of Association: Demography of the respondents were classified under personal and professional variables each having their own specific features. All of these were tested for possible associational value with the chosen dependent variables, e.g., research utilization ratings, and research barriers ratings. Chi-square test of independence was performed to examine the relationship between research utilization rating averages (RURA) with the following personal variable like age, sex, civil status and nationality, it showed no significant associations (age and RURA: p =.059; sex and RURA: p =. 45; civil status and RURA: p =.702; nationality and RURA: p=.14). The same were the results when another Chi-square test of independence was performed to examine research utilization rating averages with the professional variables like education, experience, professional role, and area of assignment (education and RURA: p=.67; experience in years and RURA: p=.49; professional role and RURA: p=.57; area of assignment and RURA: p=.19) (See Table 4 for details). However, Table 5 showed four (4) demographic variables with outcomes directly and differently when tested against research barriers rating averages (RBRA). A chi-square test of independence was performance to examine the relationship between sex and RBRA. The relationship between these variables was significant, X² (3, n = 232) =18.330, p=.001 where women were more likely to identify research barriers than men. The same test was applied between nationality and RBRA, the relationship between the variables was significant also, X² (3, n = 208) =16.130, p=.001 where non-Saudi respondents were more likely to identify research barriers than Saudi respondents. Among the professional variables, there were also two that came with the same results. Using the same test between education and RBRA, the association was significant X² (9, n = 167) =20.480, p=.015. The same was done with experience in years and RBRA, the association was significant X² (6, n = 225) =14.452, p=.025. Bachelor level respondents were more able to identify research barriers in practice just like those with more than 6 years of service.

Table 4: Association between Demographic Variables VS Research Utilization Ratings & Research Utilization Barriers.

Table 5: Significant Difference in the Research Utilization and Barriers Rating VS Dichotomized Demography; n=303; α = .05.

Demography and Research Utilization/Barriers:

Test of Significant Difference: To test possible differences in the rating averages made by the respondents both on research utilization and barriers, the demographic features were re-grouped into a bivariate situation from the original more than 2 categories as shown in Tables 4 and 5. A Mann-Whitney U test was performed in the different bivariate personal variables and only “nationality” came out to have significant difference in their research utilization rating averages (RURA). The result indicated that the difference was statistically significant, U(N_Saudi=95, N_Non-Saudi=208) = 8710.0, z=-1.954, p<.050. The same was the case in one of the professional variables which is area of assignment. The result indicated that the difference was statistically significant, U(N_{Critical area}=62, N_{Non-critical area}=241) = 6408.0, z=-2.042, p<.0410. As regards the research barrier rating averages (RBRA) and the bivariate demographic features, more interesting results came out. Among the personal variables in bivariate form, sex and nationality came out to have significant differences in their own respective subcategories. Considering the sex the result indicated that the difference was statistically significant, U(N_male=71, N_Female=232) = 6158.0, z=-3.522, p<.001 while nationality the difference was statistically significant at U(N_Saudi=95, N_Non-Saudi=208) = 7343.0, z=-3.926, p<.001. From among the professional variables, there showed significant results in education U(N_{Bachelor level} =251, N_{Post graduate level}=52) = 5404.5, z=-2.136, p<.033) and professional role U(N_{Staff position}=241, N_{Managerial/Admin position}=62) = 6380.0, z=-1.942, p<.050).

Discussion

In general, the need for research in practice had been a topic near to the heart of clinical nurse educators and practitioners alike as it was found to have relevance in improved health care delivery and even in practical clinical applications from all clinicians like nurses [16]. This study aimed to identify the perception on research utilization and possible barriers of its usage in practice among nurses in Saudi Arabia and whose opportunity came during the current pandemic situation affecting the world. There may be value in the discovery of research utilization separate from the more popular research studies on research utilization barriers and both entirely supported by prevailing known reference literature though evidence-based practice came as infrequently, superficially, or even misused [17]. Present study results obtained during the pandemic months will be discussed side-by-side citing sources conferring and/or contradict pre-pandemic similar studies both local and international. In Saudi Arabia, the volume of research is increasing in the medical and nursing fields relevant to reported evidenced-based research and research utilization for dental and medical context [7]. Similarly with other countries, nurses in Saudi Arabia needed to utilize research findings in practice to achieve optimum levels of evidence-based practice (EBP); and the quality of healthcare Nursing research has advanced significantly throughout recent years expecting the use of research findings to promote and improve healthcare quality [8] in general whether there are existing health emergencies but more so believed during such situations.

Note that cited studies in the foregoing discussions utilized published articles during the pandemic period (2019-present) but still were utilized during the “pre-pandemic discussions” because their actual data gathering were all checked to have happened during pre-pandemic months.

Research Utilization: In this study, there was a general moderate extent of research utilization among the respondents as showed in the average rating given. Attitude-wise, nurse practitioners that participated had that highest belief research is “stimulating, and interesting, and that it helped them professionally” to quote that very words used in the data gathering tool. It surely was a positive appreciation and research utilization attitude by the respondents as can be observed even during the very upsurge of Covid-19 Pandemic where there was as well an upsurge of publication and research studies [18]. It was even emphasized that research utilization during the pandemic period was significantly influenced by the nurses’ competency and beliefs or as positive attitude [19]. Studies conducted in other countries concluded that positive attitudes, availability, and support for research utilization can contribute to greater use of research in nursing practice, and about half (50%) of the nurses considered they had access to research findings at work but the percentage of time to read about research on duty was lower [20]. Consistent favorable consideration of research utilization attitude can lead to appreciable changes in practice though results tended to just show half of the same practitioners in that same study did show negative appreciation. Alternative perspective to negative attitude was the low appreciation or even the lack of evidence-based practice utilization [20]. These can be room for improvement and still must require that necessity to find out what seemed to be the reasons for such adverse behavior towards research and its utilization. The professional development or continuing education of nurses through research utilization has an inherent power to increase quality of healthcare [21]. In the United States, research utilization was included in job description and nurses who utilized research to solve clinical problem were recognized and rewarded [22]. This could be the pandemic situation considering the perception of respondents about research utilization.

Prior to Covid-19 Pandemic considering different publications with that much related topic on research utilization in their practice, the foregoing shall constitute enough consideration to show status and comparison from the previously mentioned discussion. To start, studies showed a resounding appreciation of research [23] in their practice highlighted by more than majority practicing evidence-based nursing along with some 20% participation in research work while more than half have utilized research findings in their daily work [9]. Though fraught with different barriers, another study suggested a general “positive attitude” towards research utilization in practice but mostly by the more senior nurse practitioners like nurse educators and clinical nurse specialist [24]. In an international conference presentation by Abujaber and Nashwan,[25] though there is appreciation and participation among nurses in general, there was this existing “time lag between generation of evidence and putting it into clinical practice” which could take about 15-20 years as concurred by Melnyk [26] and Pitsillidou et al. [27] studies that specified the 15 instead of 17 years of evidence-based practice gap calling for urgent action on the said matter. On some other studies, there showed research utilization’s unpopularity among nurse practitioners [28] focusing much concerns on setting-related barriers and access to electronic databases as major barriers. Language of the article (particularly English) was mentioned in another study that led to a negative appreciation and usability of research results affecting “empowerment among nurses” [29]. While in another study, the negative attitude seemed to be rooted on the “unfavorable competencies for implementing research results in practice” [30] and not directly on research utilization which intrinsically at that instance may appear a better condition and not an outright rejection of the same. All in all and on the issue of comparison regarding research utilization before and during the pandemic, there seemed to say very little changes and differences but could have showed appreciable increase as maybe because of the need to be aware on practices and innovations that can abate pandemic spread. These findings could lead to professional development which can worked also as continuing medical education of the nurses. The complexity of nursing care requires transitioning from skill-based competencies to research evidence-based practice to provide a high quality of healthcare. In the future where technology will integrate data about patients’ treatment plan and research evidence, nurses must be knowledgeable and equipped to address complex clinical issues. Nurses have a key role in planning treatment of patients and will have access to health-related resources. Participation in any research activities could lead to a better condition of health care through the utilization of findings focused on innovative care approaches.

Research Utilization Barriers: On the issue of research utilization barriers, participants of the study showed a moderate level of extent on the general perception on perceived prevailing barriers in the nursing practice. Specifically, the same moderate extent was seen on Factor 2 or the barriers from organizational settings, and Factor 3 or the different innovations or qualities of researches. These two factors will be covered mostly on the succeeding relevant discussions but must be mentioned as well the other two areas that participants rated with very little extent of effect as being barriers to research utilization and will be done for transparencies purposes (e.g., Factor 1 or research skills, values, and awareness, and Factor 4 or communication and accessibility of research). These said barriers come in different forms and affected by different factors [31,32]. In a more detailed description of results concerning research utilization barriers related to “organizational settings and limitations”, nurses seemed to have found time as a major constraint; specifically of having no time to read relevant research materials, and insufficient time to implement new ideas or innovative but applicable research findings. Time was specifically identified as “top-ranked barrier” according to another study [33] which became for their respondents’ perception as major obstacle in the integration of reliable research innovations in nursing practice in general.

Consistently, aforementioned barriers were compounded further with two (2) major perceptions of inadequacies like (1) nurse practitioners had no “enough authority” to change current prevailing practice considering new innovations, and (2) results are not even “generalizable” to their own local situation. Dagne & Tebeje [34] research study provided descriptions like “non-intentional research utilization” questioning their “belief towards research utilization” that must have meant both the process and output. On some other aspects serving as barriers to research utilization in practice, physicians, administration and other staff were felt uncooperative and have even prevented implementation, and the presence of perceived inadequate facilities to support relevant implementable research results. Abuhammad al et al. [35] study conducted in the same middle eastern region concurred the same results even emphasizing that showed the highest concerns on the topic. Duff et al. [22] and Ozga et al. [15] studies showed conforming these barriers results thereby stating the importance of education, hands-on training and knowledge infrastructure to be as critical as active team facilitation by senior nurses and other administration officers who all can make that big difference in overcoming this particular research utilization barriers. Another study plainly stated access to literature as a major problem and its provision as part of professional education may be a way to acquire knowledge and appropriately utilize current innovations [36].

In the pre-pandemic view on research utilization barriers among nurses, contrasting discussions will focus not just on the two factors identified barriers perceived as having moderate effect on the respondents but also will include the two other factors having the least effect according to this same present perception study. In some viewpoints, organization was highlighted as either a leading barrier or included in the list of barriers to research utilization in practice. Organizational members regardless of rank greatly affect reception and perception of research utilization in practice [37]. Additionally, the contextual factors by which organization will utilize (or not utilize) research results in practice depends entirely on internal situation as determined by administration officers implementing policies and even in the possible revisions of the same satisfying organization needs [38]. In a systematic study that covered the years 2000 to 2018 on nurses’ barriers against research utilization, “organizational barrier” remained consistent and identified as main barrier over the said time period covering the publications on five continents focused on nurse practitioners [39]. Consistently with Benton et al. [40], organizational policy issues relevant to the nurses’ utilization of research result was not just a barrier identified but a factor affecting the larger issues of universal health coverage as supported by different bibliometric analysis such as this one. In Li et al. [24] study, these two were recognized as main barriers while Mahaki et al. [41] itemized the following in their study: institutional barriers, lack of knowledge, lack of motivation, time management. In addition to time as main barrier, access to internet leading to access to relevant publications as source of innovations in practice was highlighted in CEBECİ et al. [42] explaining the eventual poor utilization of research in among the respondents.

The perception over the belief on research results, inadequacies in research methodologies, inability to ascertain proper action on conflicting research results, and the likes were supposedly addressed by formal education from the undergraduate to postgraduate preparations. Just as it is, one study [43] even highlighted “higher RN educational achievements has the potential to enhance the RN’s ability to provide improved quality of patient care” proving that it could lessen barriers with higher education [44]. Succeeding study emphasized the necessity for nurse practitioners’ capability to seek research knowledge in the same hope to close the gap between theory and practice through application [45]. This same line of thing was blatantly opposed in another study directly stating a condition of “limited evidence in the relationship between postgraduate study and improved patient outcomes” [46]. In the last months before the advent of the present pandemic, a systematic review study covering the period 2000-2018 on the same topic mentioned the main themes or categories emerging as results. Shayan et al. [47] stated in that study scanty resources, limited access to information, inadequate staffing, and lack of institutional support.

Other Significant Findings: Analysis of the findings included the test for significant associations to and differences of some identified variables. The study found no association between research utilization and nurses’ demographic factors. Conflicting results were found in some studies during the same Covid-19 Pandemic period iterating statistical association of research utilization to age, attitude to EBP and knowledge (pertaining to educational preparation) according to Dagne et al. [18] study. Other factors or variables were identified as well as associated like civil status, and work experience (e.g., referring to number of years in the practice) afforded by the study done by Aynalem et al. [20]. On the other hand, significant association was found between research barriers and some demographic variables. Specifically, personal variables like sex and nationality and professional variables like educational level and years of experience were all found to have significant relationship with the perceived barriers on research and research utilization among the respondent nurse practitioners. The same results were found in the Abuhammad et al. [35] study focusing on personal variable like age and nationality while additional professional factor was highlighted which is professional experience. Age of respondents when divided between younger practitioners and those more than 10 years in the profession showed to have significant difference in their views on research utilization as emphasized by one study [33]. Exactly it was found out that the younger professionals tended to appreciate more research utilization in the practice and are more open to its application in daily practice which came as the opposite for the other older group.

Pre-covid period published researches showed strong importance and support to the direct use of innovative research results in the nursing practice [32], and even have introduced strategies to empower nurse practitioners on evidence-based practices [44,48]. Though this present study found no factors (personal and professional) correlated to research utilization, contrary was found in some others. In the Yoo et al. [23] study, there was positive correlation of research utilization to beliefs, knowledge of EBP, and the readiness of the organization which in the later discussion will eventually connect with some factors made available in this current study. One personal factor like age and length of professional experience were specifically found to confirm that both did not show significant association [49] corroborating the results of this present study. Another study even proved more identified factors (educational qualification, years of nursing practice, gender, and professional rank) to showing the same no correlation to the research utilization [42,50]. However, there were some variables that showed significant correlation but to a low level like in the study of Forsman et al. [1] identifying work place or work setting, professional role, and sex again. One interesting result from one study showed improved research utilization (e.g., improved EBP implementation), it had no direct effect in job satisfaction, group cohesion, or attractiveness. However, with improved EBP beliefs (e.g., research utilization) had direct effect on improvements in job satisfaction and group attractiveness [51]. These results are very important as any improvement in EBP practices or research utilization in practice, there were substantial indications of improvements in several patient outcomes (Melnyk et al., 2016). Whether there is pandemic or not, improved professional practice leading to better patient care and outcomes are hoped to be achieved. When variables were transformed into its relevant bivariate forms, results of the study tended to present defining features that might shed light on questions associated with known conditions affecting research utilization and its barriers among the respondents. On the research utilization ratings, personal variable like nationality (e.g., Saudi vs non-Saudi) and professional variable like area of assignment (e.g., critical areas vs non-critical areas) presented significant differences. While on research barriers ratings, personal variables like sex (e.g., male vs female) and nationality (e.g., Saudi vs non-Saudi) including professional variables like level of education (e.g., bachelor level vs post-graduate level) and professional role (e.g., staff position vs managerial or administration officer position) tended to also show significant differences in their views and perceptions on the study focus. Supporting other study showed experience (e.g., beginning professionals were more open to research utilization as opposed to the more senior practitioners who showed more barriers in research utilization), educational level (e.g., those with postgraduate studies saw application of research in practice than those with only the bachelor degree), and professional rank [52].

Summary and Conclusions

In conclusion, overall, this present study confirmed the perception of nurses to research utilization and foremost barriers in implementing research such as from organizational settings (lack of support, time to read, and implementation issues) and personal issues low knowledge and feeling of uncertainty about research results, of research methodological inadequacies, and publication-related issues. The findings also present several factors that could influences nurses and their role in research utilization such as individual and organization factors. This could be useful in formulating strategies to limit or overcome barriers in research utilization. Based on this assessment, programs that can help nurses’ ability to implement research-based practice are needed. The willingness and interest of nurses in the present study are proving positive attitudes to deal with the identified barriers. Lack of sufficient knowledge in implementing research-findings is the utmost barriers and necessity in the present study that needs rapid and comprehensible action.

Relevance to Clinical Nursing Practice

With the increasing research activities in the Kingdom, it must be emphasized that its utilization can provide valuable improvement both in the actual practice and general health care delivery. There were mentioned areas of strength in research utilization as practiced especially starting on attitude among nurses. At a greater extent, professionally understanding research and research being both interesting and stimulating must be entertained before those dies out for non-use or missed support. Though at moderate extent, improvements might be done on availability and support, and towards actual research utilization in practice as such will surely intensify changes in health care delivery services. On the other hand, rated highest as the source of barriers in research utilization came as organizational factors whose possible reversal can just be counted upon if and when policies and administrative focus were changed to be more responsive to actual research implementation and applications. The study and the relevant learnings obtained only were hoped and geared towards improving EBP in nursing practice and general health care delivery at par with the international practice. Consistently, the results are comparable with previously conducted study. It has produced information about research utilization and utilization barriers that could be used in formulating general strategies in implementing research findings or evidenced-based practice in Saudi Arabia whether or not there is ongoing pandemic situation but is especially so when there is.

Limitations of the Study

This study identified some limitations. Foremost, the cross-sectional design of study which limits causality application and consideration. Another, the small sample size and the use of convenience sampling which may result to bias and may not be generalizable to population perspective. Additionally, the study was carried out in a large university hospital considered teaching and research health facility and for this reason might not be applicable to other Saudi hospitals in the Kingdom.

Acknowledgements

We, all the authors, are grateful for the participation of the different nurse practitioners from the different department of King Khalid University Hospital including and especially the facilitation done by their managers and administrators despite over-loaded schedule each one had during the Covid-19 Pandemic months.

Authors’ Contributions

GMP: Study design, data analyses, and manuscript writing.

RPC: Study design, communications, and IRB documentations.

IMR: Related studies review, manuscript drafting, and analyses.

MSA: Data gathering, and data coding.

JMA: Data gathering, and data coding.

The authors read and approved the final manuscript.

Funding

The authors have been employed as cited and primarily supported by those institutions with working time spent during the entire research implementation.

Availability of data and materials

The datasets obtained and used in this research endeavor may be made available upon request from the primary and corresponding author and conveniently be accessed available in the Synapse Repository with Synapse ID: syn24606750 and DOI: 10.7303/syn24606750.

Ethics approval and research consent

The Institutional Review Board of the King Saud University at the College of Medicine deemed the application to conduct research was consented and approved through Research Project No. E-20-4760 dated 02/09/2020.

Competing Interest

The authors declare NO competing interests whatsoever.

References

1. Forsman H, Rudman A, Gustavsson P, Ehrenberg A, Wallin L (2012) Nurses’ research utilization two years after graduation-a national survey of associated individual, organizational, and educational factors. Implement Sci 7:46
2. Thomas A, Law M (2013) Research Utilization and Evidence-Based Practice in Occupational Therapy: A Scoping Study. Am J Occup Ther 67: e55-e65.
3. Omer T (2012) Research Utilization in a Multicultural Nursing Setting in Saudi Arabia. J Nurs Res 20: 66-73.
4. Fineout-Overholt E, Melnyk BM, Schultz A (2005) Transforming Health Care from the Inside Out: Advancing Evidence-Based Practice in the 21st Century. J Prof Nurs 21: 335-344.
5. Boström F, Maier M, Hao Y, Tang L, Guo H, et al. (2015) Barriers to Research Utilization among Registered Nurses in Traditional Chinese Medicine Hospitals: A Cross-Sectional Survey in China. Evidence-Based Complementary and Alternative Medicine 1-8.
6. Youssef NF, Alshraifeen A, Alnuaimi K, Upton P (2018) Egyptian and Jordanian nurse educators’ perception of barriers preventing the implementation of evidence-based practice: A cross-sectional study. Nurse Educ Today 64: 33-41.
7. Parentela GM (2021) Mental health research studies in Saudi Arabia for the years 2009–2019; a systematic scoping review. Arch Psychiatr Nurs 35: 232-241.
8. Ul Haq I, Ur Rehman S, Al-Kadri HM, Farooq RK (2020) Research Productivity in the Health Sciences in Saudi Arabia: 2008-2017. Ann Saudi Med 40:147-154.
9. Kyalo Mutisya A, KagureKarani A, Kigondu C (2015) Research Utilization among Nurses at a Teaching Hospital in Kenya. J Caring Sci 4: 95-104.
10. Alsubaie N, Bugis B (2021) The Attitudes and Perceived Barriers Regarding the Practice of Evidence-Based Management Among Healthcare Managers in Saudi Arabia. Internet Journal of Allied Health Sciences and Practice.
11. Hamaideh SH (2016) Sources of Knowledge and Barriers of Implementing Evidence-Based Practice Among Mental Health Nurses in Saudi Arabia. Perspect Psychiatr Care 53: 190-198002E
12. Tan M, Akgün Sahin Z, Kardas Özdemir F (2012) Barriers of research utilization from the perspective of nurses in Eastern Turkey. Nurs Outlook 60: 44-50.
13. Boström AM, Kajermo KN, Nordström G, Wallin L (2008) Barriers to research utilization and research use among registered nurses working in the care of older people: Does the BARRIERS Scale discriminate between research users and non-research users on perceptions of barriers? Implement Sci 3: 24.
14. Funk SG, Champagne MT, Wiese RA, Tornquist EM (1991) Barriers: The barriers to research utilization scale. Appl Nurs Res 4: 39-45.
15. Ozga D, Krupa S, Mędrzycka-Dąbrowska W, Penar-Zadarko B (2022) Adaptation and validation of the Barriers to Research Utilization (BARRIERS scale) questionnaire among Polish nurses and midwives: Cross-sectional study. Appl Nurs Res 63:151547.
16. Schoonover H (2009) Barriers to Research Utilization Among Registered Nurses Practicing in a Community Hospital. J Nurses Staff Dev 25:199-212.
17. Damschroder LJ (2020) Clarity out of chaos: Use of theory in implementation research. Psychiatry Res 283: 112461.
18. Dagne AH, Beshah MH, Kassa BG, Dagnaw EH (2021) Implementation of evidence-based practice and associated factors among nurses and midwives working in Amhara Region government hospitals: a cross-sectional study. Reprod Health 18: 36.
19. Alshammari MS, Alshurtan R, Alsuliman G, Alshammari M, Alhamazani H, et al. (2021) Factors Affecting the Implementation and Barriers to Evidence-Based Practice among Nurse Practitioners in Hail Region, Saudi Arabia. Nurse Media Journal of Nursing, 11: 187-196.
20. Aynalem ZB, Yazew KG, Gebrie MH (2021) Evidence-based practice utilization and associated factors among nurses working in Amhara Region Referral Hospitals, Ethiopia. PLOS ONE 16: e0248834.
21. Dagne AH, Ayalew MM (2020) Factors affecting research utilisation of nurses and midwives working in North Gondar and West Gojjam Zone public hospitals, Ethiopia: a cross-sectional study. BMJ Open 10: e039586.
22. Duff J, Cullen L, Hanrahan K, Steelman V (2020) Determinants of an evidence-based practice environment: an interpretive description. Implement Sci Commun 1: 85.
23. Yoo JY, Kim JH, Kim JS, Kim HL, Ki JS (2019). Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PLOS ONE 14: e0226742.
24. Li S, Cao M, Zhu X (2019) Evidence-based practice. Medicine 98: e17209.
25. Abujaber A, Nashwan AJ (2018) Promoting research utilization among Nurses: Barriers, facilitators and strategies. Journal of Nursing & Patient Care, 03.
26. Melnyk BM (2021) The Current Research to Evidence‐Based Practice Time Gap Is Now 15 Instead of 17 Years: Urgent Action Is Needed. Worldviews Evid Based Nurs 18: 318-319.
27. Pitsillidou M, Roupa Z, Farmakas A, Noula M (2020) Barriers to the adoption of evidence-based practice among nurses. Kontakt 22: 85-91.
28. Shawky Abed El Maksod E, Faisal Fakhry S, Fathy Saad N (2019) Facilitators and Barriers for Research Utilization among Bachelor Nurses. Egyptian Journal of Health Care 10: 1-15.
29. Kang H (2015) Geriatric Hospital Nurses’ Perceived Barriers to Research Utilization and Empowerment. Asian Nursing Research 9: 65-72.
30. Ferreira MBG, Santos Felix MM, Souza Lopes RA, Haas VJ, Galvão CM, et al. (2021) Barriers to research utilization influencing patient safety climate: A cross‐sectional study. International Journal of Nursing Practice, 27: e12959.
31. Renolen S, Hjälmhult E, Høye S, Danbolt LJ, Kirkevold M (2019) Evidence‐based practice integration in hospital wards-The complexities and challenges in achieving evidence‐based practice in clinical nursing. Nurs Open 6: 815-823.
32. Spruce L (2015) Back to Basics: Implementing Evidence-Based Practice. AORN Journal 101: 106-114.e4.
33. Da’seh A, Rababa M (2021) Military nurses’ perspectives towards research utilization barriers. Heliyon 7: e08181.
34. Dagne AH, Tebeje HMD (2021) Research utilisation in clinical practice: the experience of nurses and midwives working in public hospitals. Reprod Health 18: 62.
35. Abuhammad S, Alzoubi K, Khabour O, Mukattash T (2020) Jordanian National Study of Nurses’ Barriers and Predictors for Research Utilization in Clinical Settings. Risk Manag Healthc Policy 13: 2563-2569.
36. Hines S, Ramsbotham J, Coyer F (2021) The Experiences and Perceptions of Nurses Interacting with Research Literature: A Qualitative Systematic Review to Guide Evidence‐Based Practice. Worldviews Evid Based Nurs 18: 371-378.
37. Renolen S, Høye S, Hjälmhult E, Danbolt LJ, Kirkevold M (2018) “Keeping on track”-Hospital nurses’ struggles with maintaining workflow while seeking to integrate evidence-based practice into their daily work: A grounded theory study. Int J of Nurs Stud 77: 179-188.
38. Edward KL (2015) A Model for Increasing Appreciation, Accessibility and Application of Research in Nursing. J Prof Nurs 31: 119-123.
39. Berthelsen C, Hølge‐Hazelton B (2021) The Importance of Context and Organization Culture in the Understanding of Nurses’ Barriers Against Research Utilization: A Systematic Review. Worldviews Evid Based Nurs 18: 111-117.
40. Benton D, Watkins M, Beasley C, Ferguson S, Holloway A (2020) Evidence‐based policy: nursing now and the importance of research synthesis. Int Nurs Rev 67: 52-60.
41. Mahaki B, Bahadori M, Raadabadi M, Ravangard R (2016) The barriers to the application of the research findings from the nurses’ perspective: A case study in a teaching hospital. J Educ Health Promot 5:14.
42. CEBECİ F, ÇATAL E, SUCU DAĞ G, KARAZEYBEK E, AKSO YN (2019) Nurses’ Research Utilization Barriers, Facilitators and Determination of Affecting Factors. Turkiye Klinikleri Journal of Nursing Sciences 11: 129-139.
43. Abraham PJ, Gohan LDDM, Pfrimmer DM (2015) Retaining Master and DNP Registered Nurses in Direct Patient Care: Utilizing Nurses to the Fullest Extent of Their Education. Nurse Leader 13: 70-74.
44. Wilson M, Sleutel M, Newcomb P, Behan D, Walsh J, et al. (2015) Empowering Nurses with Evidence-Based Practice Environments: Surveying Magnet®, Pathway to Excellence®, and Non-Magnet Facilities in One Healthcare System. Worldviews Evid Based Nurs 12: 12-21.
45. Mackey A, Bassendowski S (2017) The History of Evidence-Based Practice in Nursing Education and Practice. J Prof Nurs 33: 51-55.
46. Clark L, Casey D, Morris S (2015) The value of Master’s degrees for registered nurses. Br J Nurs 24: 328-334.
47. Shayan SJ, Kiwanuka F, Nakaye Z (2019) Barriers Associated with Evidence‐Based Practice Among Nurses in Low‐ and Middle‐Income Countries: A Systematic Review. Worldviews Evid Based Nurs 16: 12-20.
48. Wonder AH, Martin EK, Jackson K (2017) Supporting and Empowering Direct-Care Nurses to Promote EBP: An Example of Evidence-Based Policy Development, Education, and Practice Change. Worldviews Evid Based Nurs 14: 336-338.
49. Chau JP, Lopez V, Thompson DR (2008) A survey of Hong Kong nurses’ perceptions of barriers to and facilitators of research utilization. Res Nurs Health 31: 640-649.
50. Nkrumah I, Atuhaire C, Priebe G, Nambile Cumber S (2018) Barriers for nurses’ participation in and utilisation of clinical research in three hospitals within the Kumasi Metropolis, Ghana. Pan Afr Med J 30: 24.
51. Kim SC, Ecoff L, Brown CE, Gallo AM, Stichler JF, et al. (2017) Benefits of a Regional Evidence-Based Practice Fellowship Program: A Test of the ARCC Model. Worldviews Evid Based Nurs 14: 90-98.
52. Saunders H, Vehviläinen-Julkunen K (2016) Nurses’ Evidence-Based Practice Beliefs and the Role of Evidence-Based Practice Mentors at University Hospitals in Finland. Worldviews Evid Based Nurs 14: 35-45.