Journal of Nursing Management, 2017, 25, 243–245
Guest Editorial
Barriers to research awareness among nurses in Italy
The achievement and spread of evidence-based prac-
tice, of which research use is a key factor, is challenging
and requires more than desire and enthusiasm (Rickbeil
& Simones 2012). Using research in nursing practice
requires research awareness. Research awareness has
been determined as having not only having a good
understanding about the principles of research; but the
confidence and authority to use research (McSherry
et al. 2006). While little is known empirically about
Italian nurses’ confidence and authority with regard to
research, anecdotally both are low (Bressan et al.
2016). In keeping with international trends (Timmins
et al. 2012, Gerrish and Clayton 2004) nurses’ research
awareness in Italy is anecdotally affected by a lack of
resources, confidence, knowledge, and the lack of a
strategic leadership (Sasso et al. 2013). In some Italian
health care settings, there are also reports of a culture
that is not attuned to the use of research use, and in
some cases there is limited managerial support.
Additionally it has been acknowledged internation-
ally that competing demands in an under-resourced
health care environment place nurses in a position
whereby they prioritise care and thus miss out some
aspects that could be deemed of lesser priority (Kalisch
et al. 2009). A recent Italian study found that up to
41% of care that nurses were expected to perform was
missed (Sasso et al., 2016a,b).Within this context it has
been found that nurses [understandably] prioritise the
most urgent nursing tasks (usually tangible clinical
tasks) at the expense of less tangible aspects of nursing
(such as communication, developing relationships and
patient education) (Sasso et al., 2016a,b, Aiken et al.
2012, Sermeus et al. 2011). However of greater con-
cern is that the percentage of this ‘missed care’ is higher
in Italy compared with other countries most likely due
to a much lower staff/patient ratio than many European
counterparts (Sasso et al., 2016a,b). While research
awareness is not specifically measured within these
studies it is very likely that is given a low priority due to
the aforementioned constraints. There are also few
national or local financial incentives for research and
clear leadership within the discipline is lacking (Bag-
nasco et al. 2014). While there has been an impetus at
national level towards setting up a national nursing
research strategy this has never translated into a reality
DOI: 10.1111/jonm.12494
ª 2017 John Wiley & Sons Ltd
(Sansoni 2001). At the same time key nursing figures in
Italian universities are actively working towards build-
ing research capacity (Bagnasco et al. 2014). As a result
while published research in nursing was notably weak
in the past, and mostly led by non-nurses, this situation
is improving with an increasing number of robust
nurse-led research and publications, with direct rele-
vance to clinical nursing practice (Marucci et al. 2013).
A further compounding factor in the use of research
is limited access to libraries and Information Technol-
ogy (IT) resources and the language barrier (Bressan
et al. 2016, Sasso et al. 2013). As English is considered
to the language of the health sciences this creates diffi-
culty for Italian nurses who struggle with English com-
prehension (da Silva et al. 2009). At the same time
publications in Italian do not always highlight the
practical implications of the findings and/or the recom-
mendations often have a limited evidence base (Fazzini
2012). Dissemination of Italian nursing research results
in English peer reviewed is therefore essential to create
a robust body of literature (Marucci et al., 2015, San-
soni et al. 2006). This would facilitate the exchange of
knowledge and information with international col-
leagues, encourage debate and facilitate cultural
exchange and dissemination (Marucci et al. 2013).
One additional barrier to research in nursing is that
some local regional research ethics committees are
notoriously bureaucratic and frequently refuse or return
applications made by nurse researchers on the grounds
that they are not considered to be pertinent for the
ethics committee. The need for qualitative research is
not fully understood, for example, nor is it perceived as
warranting ethical approval (Gallagher et al. 2014).
While this does not necessarily hinder research on
patients or nurses, Italian nurses as a result have diffi-
culty getting their research published in prominent peer
reviewed international journals without the necessary
ethical approval. This issue affects not only professional
confidence and international development but also the
circulation and development of national research.
For research-based practice to become a reality it
needs to proceed through four distinct phases: research;
communication of the research; reading and under-
standing the research; and research utilization (Jacob-
son 2000), and we have highlighted above that there are
243
Guest Editorial
issues with nursing research in Italy across all of these
phases. The process of utilization requires a thoughtful
systematic process that is adopted both by an organisa-
tion and the individual. However, nurses working in an
organisation may not have sufficient authority to bring
about the necessary changes required to implement
research based practice and require the support of their
organization, managers, and university faculty staff
(Staffileno & Carlson 2010). Indeed constraints within
organisations, such as lack of managerial support and
time constraints have predominated as reasons for non-
utilisation of research (McSherry et al. 2006, Gerrish
and Clayton 2004). Research based practice is a time
consuming activity. There are many approaches cited in
the literature that can facilitate use and implementation
of research in practice (Fazzini 2012). We believe that it
may be important for the Italian healthcare system to
select a common approach and standardized modality
for evaluating research interventions that may be used
to inform evidence based practice. This would simplify
the process for nurses and other healthcare staff and
lead to the ability to immediately compare results
obtained. Experience within research teams would also
be useful for Italian nurses to improve their research
awareness. Protected time and formal mentorship for
Italian nurses as part of healthcare research teams could
help them develop interprofessional research skills and
lead to important benefits in their understanding
through participation in research (Hager et al. 2016).
The extent of research awareness among nurses Italy
is uncertain, as there has been little exploration of this
topic. It is widely acknowledged that developing a
research culture in nursing requires attainment of PhDs
by substantive numbers of nurses, financial support and
strong national and local leadership (Begley et al.
2014). However there are low numbers of nurses in
Italy with PhDs, even within the universities. While
research is certainly taught at undergraduate level the
extent to which this translates into use and understand-
ing of research in healthcare practice is unclear. The
funds and investments for nursing research in Italy are
scarce, and this is mainly due to the persistence of a
culture that gives little emphasis to the importance of
nursing research. This slows down the development of
nursing research that could have major impact on
health care. Unlike other countries, such as the USA
and some countries of northern Europe, resources for
nursing research are limited in Italy. In the aforemen-
tioned areas there are enviable national nursing organi-
sations and health policy systems that each year fund
nursing research projects to improve patient outcomes
and health care. none of which are features of the
244
current Italian healthcare system (Hinshow & Grady
2011). Financial and other support for nursing research
in Italy is crucial, in addition to the support of Faculty
and the employment of tenured Professors at both a
university and clinical level. Support and encourage-
ment is also needed from international colleagues
within nurse education settings, particularly those with
the skill set and influence required to support the
required changes ahead. Networking at international
conferences is essential to learn ideas and gain support,
and colleagues need to be aware of the disparity that
exists internationally (Hackmann 2000) and offer sup-
port where appropriate. Certainly, within one Italian
university, the University of Genoa, these steps are
already in place (Watson 2015) with promising initial
results. While some of the aforementioned restrictions
are frustrating, the impetus and motivation of nurses in
Italy is driving momentum.
Ethical approval
Ethical approval was not required for this paper.
Source of Funding
There was no funding obtained for this paper.
VALENTINA BRESSAN P h D , M N S , B N S , R N
Nurse, Department of Otolaryngology/Head & Neck
Surgery, University Hospital Santa Maria della Misericordia,
Azienda Sanitaria Universitaria Integrata di Udine,
Udine, Italy
ANNAMARIA BAGNASCO P h D , M E d S c , R N
Assistant Professor of Nursing and Researcher, Department
of Health Sciences, University of Genoa, Genoa, Italy
MONICA BIANCHI P h D , E M B A , M N S , B N S , R N
Lecturer-Researcher, Department of Business Economics,
Health and Social care, University of Applied Science and
Arts of Southern Switzerland, Manno, Switzerland
SILVIA ROSSI M N S , B N S , R N
PhD Student, Department of Health Sciences, University of
Genoa, Genoa, Italy
FRANCESCA MOSCHETTI M N S , R N
PhD Student, Department of Health Sciences, University of
Genoa, Genoa, Italy
MICHELA BARISONE M N S , B N S , R N
PhD Student, Department of Health Sciences, University of
Genoa, Genoa, Italy
ª 2017 John Wiley & Sons Ltd
Journal of Nursing Management, 2017, 25, 243–245

RAMONA PELLEGRINI M N S , B N S , R N
PhD Student, Department of Health Sciences, University of
Genoa, Genoa, Italy
GIUSEPPE ALEO P h D , M A
Research Fellow and Lecturer of Scientific English,
Department of Health Sciences, University of Genoa,
Genoa, Italy
FIONA TIMMINS PhD, MSc, MA, FFNRCSI, BNS, BSc (Open
Health & Social Care), BA (Open), RNT, RGN
Associate Professor of Nursing, School of Nursing and
Midwifery, Trinity College Dublin, Dublin, Ireland
E-mail: Fiona.timmins@tcd.ie
LOREDANA SASSO M E d S c , M S c , R N , F A A N
Associate Professor of Nursing, Department of Health
Sciences, University of Genoa, Genoa, Italy
References
Aiken L.H., Sermeus W., Van den Heede K. et al. (2012) Patient
safety, satisfaction, and quality of hospital care: cross sectional
surveys of nurses and patients in 12 countries in Europe and
the United States. British Medical Journal 344, e1717.
Bagnasco A., Ghirotto L. & Sasso L. (2014) Theoretical sam-
pling. Journal of Advanced Nursing 70 (11), e6–e7.
Begley C., McCarron M., Huntley-Moore S., Condell S. & Hig-
gins A. (2014) Successful research capacity building in aca-
demic nursing and midwifery in Ireland: an exemplar. Nurse
Education Today 34, 754–760.
Bressan V., Tolotti A., Barisone M. et al. (2016) Perceived barri-
ers to the professional development of modern nursing in Italy
– a discussion paper. Nurse Education in Practice 17, 52–57.
Fazzini U. (2012) Strategie e strumenti per incrementare l’uti-
lizzo dell’Evidence-Based Practice: revisione della letteratura.
L’Infermiere 5.
Gallagher A., Sasso L., Bagnasco A. & Aleo G. (2014) Profess-
ing nursing research: the Italian experience. Nursing Ethics
21 (8), 857–858.
Gerrish K. & Clayton J. (2004) Promoting evidence-based prac-
tice: an organizational approach. Journal of Nursing Manage-
ment 12 (2), 114–123.
Hackmann M. (2000) Development of nursing research in Ger-
many in the European context. International Journal of Nurs-
ing Practice 6, 222–228.
Hager K., St Hill C., Prunuske J., Swanoski M., Anderson G.
& Lutfiyya M.N. (2016) Development of an interprofes-
sional and interdisciplinarycollaborative research practice
for clinical faculty. Journal of Interprofessional Care 30
(2), 265–267.
Hinshow A.S. & Grady P.A. (2011). Shaping Health Policy
Through Nursing Research. Springer Publishing Company,
New York, NY.
ª 2017 John Wiley & Sons Ltd
Journal of Nursing Management, 2017, 25, 243–245
Guest Editorial
Jacobson A.F. (2000) Research utilisation in nursing: the power
of one Orthopedic. Nursing 19 (6), 61–65.
Kalisch B.J., Landstrom G.L. & Hinshaw A.S. (2009) Missed
nursing care: a concept analysis. Journal of Advanced Nursing
65 (7), 1509–1517.
Marucci A.R., De Caro W., Petrucci C., Lancia L. & Sansoni J.
(2015) ICNP-Classificazione internazionale per la pratica
infermieristica: origini, strutturazione e sviluppo. Professioni
Infermieristiche 68 (2), 131–140.
Marucci A.R., De Caro W., Rivoli M., Trezza T., Miriello D.
& Sansoni J. (2013) The status of the art of scientific articles
in Italy between 2003–2009: an analysis of articles published
by nursing Italian journals. Professioni Infermieristiche 66
(2), 67–74.
McSherry R., Artley A. & Halloran J. (2006) Research aware-
ness: an important factor for evidence-based practice? World
Views on Evidence Based Nursing 3 (3), 103–115.
Rickbeil P. & Simones J. (2012) Overcoming barriers to imple-
menting evidence-based practice: a collaboration between aca-
demics and practice. Journal for Nurses in Staff Development
28 (2), 53–56.
Sansoni J. (2001) Strategy and priority for nursing research in
Italy. Professioni Infermieristiche 54 (1), 62–65.
Sansoni J., Comerci S. & Marucci A.R. (2006) Nurses and
research: analysis of two international nursing journals. Pro-
fessioni Infermieristiche 59 (1), 41–48.
Sasso L., Bagnasco A. & Aleo G. (2013) Science for action
based nursing. Journal of Advanced Nursing 69 (11), 2373–
2374.
Sasso L., Bagnasco A., Zanini M. et al. (2016a) RN4CAST@IT:
why is it important for Italy to take part in the RN4CAST
project? Journal of Advanced Nursing 72, 485–487. https://
doi.org/10.1111/jan.12709.
Sasso L., Bagnasco A., Zanini M. et al. (2016b) The general
results of the RN4CAST survey in Italy. Journal of Advanced
Nursing. https://doi.org/10.1111/jan.13066.
Sermeus W., Aiken L.H., Van den Heede K. et al. (2011)
RN4CAST consortium. Nurse forecasting in Europe
(RN4CAST): rationale, design and methodology. BMC Nurs-
ing 10 (1), 6.
^
da Silva M.P., Egry E.Y., Angelo M. et al. (2009) Nursing
knowledge production: from the research idea to the publish-
ing in a qualified. Journal Revista da Escola Enfermagen 43,
1341–1345.
Staffileno B.A. & Carlson E. (2010) Providing direct care nurses
research and evidence-based practice information: an essential
component of nursing leadership. Journal of Nursing Manage-
ment 18 (1), 84–89.
Timmins F.Mc., Cabe C. & McSherry R. (2012) Research
awareness among nurses in the Republic of Ireland. Journal
of Nursing Management 20 (2), 224–235.
Watson R. (2015) Watcast: Roger Watson’s Podcasts Genoa
May 2015 Day 2. Available at: http://rwatson1955.
podbean.com/e/genoa-may-2015-day-2/, accessed 15 March
2017.
245