International Journal of Nursing Sciences 4 (2017) 296e302

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International Journal of Nursing Sciences

journal homepage: http://www.elsevier.com/journals/international-journal-of-
nursing-sciences/2352-0132

Original Article

Improve nursing in evidence-based practice: How Chinese nurses'

read and comprehend scientic literature
Fei-Fei Huang a, Na Zhang b, Xuan-Ye Han c, Xiao-Na Qi d, Li Pan e, Jing-Ping Zhang f, *,
Hong Li a, **
a
School of Nursing, Fujian Medical University, Fuzhou, China
b
Division of Behavioural Science, School of Public Health, The University of Hong Kong, Hong Kong, China
c
Department of Neurosurgery, Second Afliated Hospital of Harbin Medical University, Harbin, China
d
Department of Nursing, Harbin Medical University Cancer Hospital, Harbin, China
e
Department of Nursing, Traditional Chinese Medicine Hospital of Hainan Province, Haikou, Hainan, China
f
Nursing Psychology Research Center, Xiangya School of Nursing, Central South University, Changsha, China

a r t i c l e i n f o a b s t r a c t

Article history: Objectives: To examine Chinese nurses' practice of reading and understanding scientic literature and
Received 28 August 2016 elucidate the motivating and deterring factors.
Accepted 10 May 2017 Methods: This is a cross-sectional study conducted between March and June 2015. A random sample of
Available online 11 May 2017
853 full-time registered nurses from three tertiary and two secondary hospitals in China lled out a set of
self-administered questionnaires, including literature habit questionnaire(41 items), the situational
Keywords:
motivation scale and the socio-demographic and professional characteristics questionnaire(15 items).
China
Results: Signicant majority (89.2%) of the respondents reported perception of barriers to keeping up to
Evidence-based nursing
Nurses
date with literature. The language barrier was the most prominent, followed by poor presentation and
Questionnaires readability of articles. Using simpler language when writing articles, improving ones' foreign language
prociency and getting education or training on nursing research were raised as the top facilitators.
Additionally, reading and understanding literature was signicantly associated with the nurses' educa-
tional background, motivation, genders and work settings.
Conclusions: The survey of the current status of literature education among Chinese nurses suggests that
providing protected time, training for critical thinking, and incentive mechanisms will help improve
nurses' engagement in literature and create a culture of academic inquiry.
2017 Chinese Nursing Association. Production and hosting by Elsevier B.V. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction improvement activities in their institutions [4]. Unfortunately

With increasing societal expectation for high quality and
outcome driven medicine, nursing care is moving away from rituals
and traditions toward evidence-based delivery models [1]. Nurses
are expected to understand and apply research evidence into
clinical practice. This process not only enhances the clinical effec-
tiveness and improves patient outcomes, but also facilitates per-
sonal and professional growth for nurses [2,3]. Nurses are also
encouraged to partake in and initiate research and quality
* Corresponding author.
** Corresponding author.
E-mail addresses: pt860315@163.com (F.-F. Huang), jpzhang1965@163.com
(J.-P. Zhang), leehong99@126.com (H. Li).
Peer review under responsibility of Chinese Nursing Association.
despite abundant clinical and health services research production,
the translation of research ndings into practice remains slow and
haphazard [5e7], resulting in a so-called research-practice gap.
As a profession dedicated to the front lines of healthcare, nurses are
uniquely situated to close this gap by harnessing and contributing
to knowledge in the scientic literature.
One of the major challenges in professional development for
nurses is nurturing of the ability to understand and evaluate
research articles for potential practical application [8]. The read-
ability and comprehensibility of articles have been frequently re-
ported to contribute to nurses' perceived barriers to research
utilization [9e11]. For example, the amount of information pre-
sented can be overwhelming and the nurses do not know how to
distinguish and retrieve the relevant pieces [6]. The statistical an-
alyses can be mystifying; applicable research ndings can be

http://dx.doi.org/10.1016/j.ijnss.2017.05.003
2352-0132/ 2017 Chinese Nursing Association. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
 F.-F. Huang et al. / International Journal of Nursing Sciences 4 (2017) 296e302
hidden and inaccessible; the content of the article can be obscure
and unrelated to daily clinical practice; and the articles can be
poorly written or presented [3,12]. As most articles are published in
English, language barrier can be a signicant obstacle for nurses in
China and other non-English speaking regions [3,13].
Reading and understanding research articles is essential for
nurses to acquire up-to-date knowledge and apply it to improve
patient care [13]. Nurses may rarely read scientic articles due to a
variety reasons, including lack of time or interest [4]. Some nurses
may have the desire and intention to read, but are prevented from
doing so by shortages in foundation knowledge and language
barriers. To date, factors involved in nurses' engagement with
literature have not been well explored and there is limited insights
into how to improve nurses' capacity to effectively digest and use
information found in the literature.
China has one of the largest cohort of nurses in the world [6]. It
is imperative to bridge the gap between research and practice in
China under the policy of High Quality Nursing Care [14]. The
quantity and quality of research periodicals have rapidly grown,
providing nurses with valuable resources. There are more than 20
Chinese nursing journals [15]. One study showed that 84% Chinese
nurses read articles routinely; however the nding cannot be
readily generalize as the sample size was limited [15]. In order to
encourage research utilization, more research is needed to examine
the reading motivations, habits, and barriers, and formulate facili-
tating strategies.
The aim of this study was to examine factors associated with
reading and understanding literature among Chinese registered
nurses working in the hospital setting. The specic objectives were
to: 1) investigate the reading habits of nurses; 2) identify the bar-
riers that hinder the reading and understanding of literature among
nurses; 3) examine the level of motivation for nurses to read
literature; 4) explore modifying factors for the barriers and facili-
tators of reading and understanding literature; and 5) suggest ways
to promote familiarity with literature. This study may contribute to
the design and delivery of targeted nursing education or inter-
vention program to improve nurses' ability of reading and under-
standing literature.
2. Methods
2.1. Study design
This is a cross-sectional study conducted between March and
June 2015.
2.2. Setting and sample
A cluster sample of registered nurses were recruited from three
tertiary hospitals (500 beds each) and two secondary hospital
(300e500 beds) in Changsha, Haikou and Harbin, China. A total of
900 full-time registered nurses were selected from the staff lists
randomly (200 nurses recruited from each tertiary hospital and 150
nurses from each secondary hospital) and asked to complete a
condential self-administered questionnaire.
2.3. Ethical considerations
This study was approved by the Institutional Review Board of
CSU (Grant Number: 2015036). The front page of the on-line
questionnaire included an explanation of the purpose of the
study and a guarantee of anonymity and condentiality of the in-
formation provided. The completion of the questionnaire was taken
as consent to participation.
297
2.4. Data collection
2.4.1. Literature habit questionnaire
This questionnaire was developed based on literature review
(e.g., [9]), semi-structure interview with 15 registered nurses and
10 experts. The questionnaire had good internal validity with
Cronbach's a of 0.85 and content validity index of 0.81. In addition
to the reading habits (including frequency, quantity, and goals of
reading), participants were asked whether they thought each item
constituted a barrier or facilitator for reading and understanding
literature and provide reasons for not reading more. Participants
were asked to rank items they considered as the top three barriers,
reasons and facilitators. They were also invited to leave additional
comments and insights.
2.4.2. The situational motivation scale (SIMS)
The Chinese version of the SIMS [16] was used to evaluate the
motivation of reading literature among registered nurses. The SIMS
contains 16 items covering four domains, including situational
intrinsic motivation, identied regulation, external regulation, and
motivation. A seven-point Likert-type scale (ranging from 1,not at
all to 7,exactly) is used to assess why someone currently engages
in an activity. The published Cronbach's a of the SIMS was
0.76e0.83 [16]. In this study, Cronbach's a of the SIMS was 0.83.
2.4.3. The socio-demographic and professional characteristics
questionnaire
Background information collected include age, gender, marital
status, level of education, religion, position, professional title, years
of experience working as a nurse, institution, hospital, ward,
research and teaching experience, tutor and previous training on
nursing research.
2.5. Data analysis
All statistical analyses were conducted using SPSS version 16.0.
Frequency, mean and standard deviation were used to describe the
socio-demographic characteristics of the nurse respondents and to
summarize the questionnaire scores. Pearson correlation analysis
was used to examine the relationship between the barriers/facili-
tators of reading literature and reading motivation. Independent t-
test and one-way ANOVA were used to compare the scores for
barriers and facilitators among different demographic groups.
Multilinear stepwise regression was performed to assess factors
associated with barriers or facilitators. The dependent variable was
the total scores of barriers and facilitators. Independent variables
were the socio-demographic and professional factors shown to
have signicance in the independent t-test or one-way ANOVA.
Statistical signicance was established at P < 0.05. As categorical
variables, gender, level of education, years of experience working as
a nurse, religion, institution, hospital, professional title, and ward
were transformed into dummy variables in linear regression with
male, master's degree or above,
21, no religious faith, secondary
(level 2) hospital, non-teaching hospital, senior nurse, and assist
ward as the reference group.
3. Results
3.1. Participant characteristics
A total of 900 questionnaires were distributed, and 860 were
returned. Seven were incomplete and discarded, yielding 853 (666
from tertiary centers, 187 from secondary hospitals) for analysis
(response rate 94.8%). The respondents' mean age was 28.82 6.49
years. The vast majority (96.1%) was female, 78.1% was primary
298 F.-F. Huang et al. / International Journal of Nursing Sciences 4 (2017) 296e302

nurses, and 50.8% was married. Academic qualication ranged from
certicates (technical school, (15.2%), diploma/associate's degree
(30.1%), bachelor's degree (53.1%), to master's degree and above
(0.8%). Only 10.7% endorsed religious faith. A small percentage
(6.9%) was unit managers. On average, the respondents have been
working as nurses for 8.15 7.33 years. Slightly more than half
(54.4%) have received training on research, but only 15.4% had
research experiences (Table 1).
3.2. Habits of reading literature
As summarized in Table 2, a small proportion of nurses read
literature regularly on a daily (3.5%), weekly (9.8%) or monthly
(9.3%) basis. Ten percent never read and the remaining 66.0% only

Table 1
Socio-demographic characteristics of Chinese nurses and associated univariate analyses (n 853).

Characteristics n(%) Barriers Facilitators

Z/c2 (P) Z/c2 (P)

Age (years) 25 317(37.2)

26e35 390(45.7)

36 132(15.5)
Missing 14(1.6)
Gender Female 820(96.1) 2.21(0.027)
Male 33(3.9)
Marital status Single 403(47.2)
Married 433(50.8)
Divorce 12(1.4)
Widowed 1(0.1)
Missing 4(0.5)
Level of education Certicate (technical school) 130(15.2) 19.00(0.000) 11.73(0.008)
Diploma (associate's degree) 256(30.1)
Bachelor's degree 453(53.1)
Master's degree or above 7(0.8)
Missing 7(0.8)
Religion Buddhist 66(7.7)
Taoism 6(0.7)
Christian 26(3.0) 10.37(0.016)
No religious faith 723(84.8)
Declined to answer 25(2.9)
Missing 7(0.8)
Experience working as a nurse (years) 1e5 421(49.4) 14.34(0.002)
6e10 206(24.2)
11e20 143(16.8)

21 80(9.4)
Missing 3(0.2)
a
Institution Tertiary (level 3) hospital 666(78.1) 2.11(0.035)
Secondary (level 2) hospital 187(21.9)
Hospital Teaching 750(87.9) 3.11(0.002) 4.21(0.000)
Non-teaching 103(12.1)
Ward Surgery 176(20.6) 24.89(0.002) 60.25(0.000)
Internal medicine 282(33.1)
Obstetrics and Gynecology 53(6.2)
Pediatrics 36(4.2)
Operating room 62(7.3)
Intensive care unit 96(11.3)
Emergency 86(10.1)
Outpatient 25(2.9)
Assist b 26(3.0)
Missing 11(1.3)
Position General nurse 794(93.1)
Unit manager or above 59(6.9)
Professional title Primary nurse 666(78.1) 20.07(0.000)
Junior nurse 151(17.7)
Senior nurse 31(3.6)
Missing 5(0.6)
Nursing research experience Yes 131(15.4)
No 716(83.9)
Missing 6(0.7)
Teaching experience No 469(55.0)
School teaching 24(2.8)
Clinical teaching 354(41.5)
Missing 6(0.7)
Tutor No 846(99.2)
Yes 7(0.8)
Training on nursing research No 378(44.3)
Systematic training 119(14.0)
Short-term training 345(40.4)
Missing 11(1.3)

Note. a The Chinese public hospitals are graded into three levels by size and technical complexity (MOH, 1989). Level 3 hospitals are the large, high-tech hospitals (500 beds)
and Level 2 hospitals are those with medium size and technology (300e500 beds). b Include the nuclear medicine department and outpatient chemotherapy infusion center.
 F.-F. Huang et al. / International Journal of Nursing Sciences 4 (2017) 296e302 299

Table 2
The status quo of reading literature among Chinese nurses(n 853).

Variable Yes opinion(%)

The frequency of reading literature Never 92(10.8)

Everyday 30(3.5)
Every week 84(9.8)
Every month 79(9.3)
When necessary 568(66.6)
The number of literature published in foreign language you have read in the past 3 months 0 549(64.4)
1e5 208(24.4)
6e10 49(5.7)
11e20 23(2.7)

21 22(2.6)
Missing 2(0.2)
The number of Chinese literature you have read in the past 3 months 0 241(28.3)
1e5 430(50.4)
6e10 95(11.3)
11e20 43(5.0)

21 37(4.2)
Missing 7(0.8)
Part of the literature which is your major focus Abstract 345(40.4)
Introduction 41(4.8)
Methods 138(16.2)
Results 63(7.4)
Discussion and conclusion 182(21.3)
Don't know 79(9.3)
Missing 5(0.6)
Part of the literature you read rst Abstract 521(61.1)
Introduction 134(15.7)
Methods 47(5.5)
Results 41(4.8)
Discussion and conclusion 59(10.7)
Don't know 52(6.1)
Missing 5(0.6)
The major sources of reading literature Newspapers or magazines 335(39.2)
Online search 369(43.2)
academic databases 149(17.5)
The type of literature you read most frequently Summaries of clinical experience 569(64.6)
Reviews 194(20.5)
Research monographs 90(8.4)
a
The main purpose of reading literature Publication 359(42.1)
Project Application 74(8.7)
Looking for research ideas 74(8.7)
Being familiar with hot topics in nursing research 267(31.3)
Necessary for clinical practice and teaching 357(41.9)
Others b 43(5.0)
Barriers to reading literature Yes 761(89.2)
No 92(10.8)
a
Note. Multiple response. b for self interest, knowledge supplement, self-study.

read when needed. When asked about the type of literature read in
the past three months, 64.4% only read Chinese articles, and 28.3%
only read foreign language articles. The abstract was regarded as
the rst (61.1%) and major (40.4%) content to read. The main
sources of articles were newspapers and magazines (39.2%), online
searches (43.2%) and academic databases (17.5%). The majority of
nurses (64.6%) read articles on empirical clinical research, with
goals for publication (42.1%), clinical or teaching requirement
(41.9%), and familiarizing with hot topics (31.3%).
as the top three greatest barriers did not complete match the bar-
riers with the most number of supporters. While deciency in
foreign language (66.8%) and statistics (27.0%) were still the top
two, Too much literature on the same topic, don't know which one
to choose (15.1%) came in as the third most important barrier. No
one reported any additional barrier.

3.4. Reasons for not reading literature

3.3. Perceptions of barriers to reading literature
The majority (89.2%) of nurses reported some barriers to reading
literature (Table 3). All perceived barriers were substantiated by
more than 50% of the respondents. When reading literature,
nurses feel strenuous because of the deciency in foreign language
was the most frequently reported barrier, endorsed by 96.0% of the
respondents, followed by because of the deciency in statistics
knowledge, it is difcult to understand the research results
(85.4%), and It is difcult to understand the scientic or academic
terms in literature (82.9%). Interestingly, what the nurses weighed
Nurses reported that they do not read because of deciency in
foreign language for reading literature (91.1%), too busy with
work, don't have time to read literature (78.0%), lack of education
or training in nursing research and literature retrieval (77.6%),
feeling that reading literature is not useful (33.3%), among others
(Table 4). The top three reasons ranked by nurses to have the
greatest impact were lack of time (34.0%), deciency in foreign
language (26.2%), and lack of training (14.0%). Additional reasons
raised include lack of access to research opportunities, and
perceived irrelevance of articles to clinical practice.
300 F.-F. Huang et al. / International Journal of Nursing Sciences 4 (2017) 296e302

Table 3
The barriers and facilitators of reading literature among Chinese nurses(n 853).

Rank Barriers Yes Facilitators Yes

order opinion(%) opinion(%)

1 When reading literature, nurses feel strenuous because of the 819(96.0) Use simple language in literature to improve the readability 768(90.0)
deciency in foreign language
2 Because of the deciency in statistics knowledge, it is difcult to 728(85.4) Improve self foreign language prociency 751(88.1)
understand the research results
3 It is difcult to understand the scientic or academic terms in literature 707(82.9) Get education or training on nursing research and literature 743(87.1)
retrieval
4 Too much literature on the same topic, don't know which one to choose 676(79.3) Organize seminars on reading nursing literature 736(86.3)
5 It is difcult to understand the research methods in literature 647(75.8) Establish some incentive mechanisms to encourage readers and 732(85.8)
communicators
6 Unable to scientically evaluate the value and practicability of research 624(73.2) Ask for help when having difculties in reading literature 732(85.8)
results in literature
7 Nurses don't know the key points needed to read, due to the 572(67.1) When reading literature published in foreign language, make use 728(85.3)
overwhelming of information in the literature of dictionary or translation software
8 Unable to make judgment for conicting results reported in the 530(62.1) Reading scientic papers as a part of nurses' career development. 726(85.1)
literature
9 The research content is difcult to understand 529(62.0) Subscribe journals in department 707(82.9)
10 The readability of the literature is poor or the literature is unclearly 476(55.8) Provide or establish peer support networks or mechanisms 705(82.7)
reported

Table 4
The reasons why less or no reading literature among Chinese nurses(n 853).

Rank order Reasons Yes opinion(%)

1 Deciency in foreign language for reading literature 777(91.1)

2 Too busy with work, don't have time to read literature 431(78.0)
3 Lack of education or training in nursing research and literature retrieval 662(77.6)
4 No awareness or habit of reading literature 618(72.5)
5 Insufcient resources of literature retrieval 577(67.7)
6 No awareness of nursing research 554(65.0)
7 Lack of condence in nursing research 531(62.3)
8 Not convenient to get literature 501(58.7)
9 Don't know how to get literature 464(54.4)
10 Nor interested in literature on nursing research 457(53.6)
11 The prospect of being a nurse is not good, unwilling to make efforts for further study 317(37.2)
12 Feel that reading literature is not useful 284(33.3)

Note. Other reasons: no opportunity to contact nursing research, some literature lack of practicability and meaning.

3.5. Facilitators of reading literature
The facilitators received support from greater than 80.0% of the
respondents. Use simple language in literature to improve the
readability (90.0%) was by far the most common, followed by
improve one's foreign language prociency (88.1%), and get ed-
ucation or training on nursing research and literature retrieval
(87.1%). These were also ranked as the three most inuential fa-
cilitators. Notably, the facilitators presented a mirror image of the
barriers and reasons for not reading. No additional facilitator was
mentioned.
3.6. Relationship between barriers/facilitators and reading
motivation
Negative correlation was noted between the total score of bar-
riers and intrinsic motivation (r 0.10, P 0.003), and between
the total score of facilitators and amotivation (r 0.10, P 0.001),
respectively. Additionally, there was positive association between
the total score of barriers and amotivation (r 0.11, P 0.001),
between the total score of facilitators and intrinsic motivation
(r 0.08, P 0.016) and identied regulation (r 0.10, P 0.006).
3.7. Factors inuencing the barriers and facilitators of reading
literature
Low educational level and lack of intrinsic motivation was
associated with greater number of perceived barriers to reading
literature. Female nurses and nurses working in non-teaching
hospitals perceived more signicant barriers. Nurses with reli-
gious faith or higher levels of education and reading motivation
reported more facilitators for reading literature. These factors
accounted for 4.3% and 6.1% of the total variance in perceptions of
barriers and facilitators, respectively (Table 5).
4. Discussion
To the best our knowledge, this was the rst study in Mainland
China to examine registered nurses' perceived barriers to, reasons
for and facilitators for reading literature in clinical practice. Our
data showed that although more than half of nurses read literature
out of necessity, only less than 10% read regularly. In comparison,
65% of Australia nurses read journals monthly or more frequently
[17]. So did 84% of Chinese nurses reported by Zhou et al. [15]. We
found that the majority of Chinese nurses (89.2%) felt signicant
barriers to reading literature, higher than Hong Kong (69%), and US
and UK (65%). This may be related to the lack of research-related
education or training (54.4%) and participation (15.4%) as re-
ported by our respondents. As the current situation of literature
reading is suboptimal in China, research utilization initiatives are
likely to be more successful if the reading habits of nurses improve
[17].
Since English is not their native language, Chinese nurses re-
ported language as the greatest barrier to reading literature, similar
 F.-F. Huang et al. / International Journal of Nursing Sciences 4 (2017) 296e302 301

Table 5
Independent predictors for the total scores of Barriers and Facilitators in Chinese nurses (n 853).

Adjust R2 F Standardized beta Standardized error t P

Predictors for total scores of Barriers 0.04 10.43a

Bachelor's degree 0.15 0.21 4.45 0.000
Intrinsic motivation 0.09 0.44 2.67 0.008
Female 0.08 0.61 2.30 0.022
Non-teaching hospital 0.07 0.40 2.06 0.040
Predictors for total scores of Facilitators 0.06 8.93a
No religious faith 0.09 0.33 2.60 0.010
Intrinsic motivation 0.11 0.26 3.23 0.001
Bachelor's degree 0.10 0.53 3.07 0.002
Identied regulation 0.09 0.23 2.51 0.012
a
Note. P < 0.01.

to other non-English-speaking countries in Europe and Asia [18].
Because most research papers are published in English [6,18], lan-
guage insufciency may prohibit the digestion and application of
research ndings. It would be important to improve the nurses'
English comprehension, possibly through tools (e.g., dictionary,
translation software) designed for academic reading.
Many nurses noted that the results or methods in research ar-
ticles are difcult to understand because of academic jargons,
contributing to the poor presentation and readability of literature.
Some nurses did not know how to search and retrieve articles or
choose the best evidence from the overwhelming collection of in-
formation. We found that inadequate foundation of research
knowledge and educational background inuence perceptions of
both barriers and facilitators of reading literature. Despite the
advancement in information technology and nursing education in
China, the lack of training on research and evidence-based practice
remains a concern. Often research curricula are only available for
candidates of bachelor's or higher degrees, and not for diploma or
associate programs that are the main producer of new nurses [6].
Nurses with a higher educational background tend to pursue higher
academic achievement, want challenges, and possess positive
attitude and interest toward research, a nding consistent with
previous studies [6,19]. These results highlight the importance of
training in nursing research, either as part of the academic program
or continuous nursing education. Hospital or department may
organize seminars on reading articles, or subscribe to journals. On
the other hand, improving the presentation and readability of
literature by authors, editors, and publishers may also help.
The three top reasons for not reading were deciency in foreign
language, lack of time, and inadequate research training. The lack of
time for reading literature while balancing daily clinical duties has
been a common and recurrent problem reported both nationally
and internationally [20]. Although the evidence-based health care
policies has been stipulated by the Ministry of Health in Mainland
China [3], the shortage of nurses, and their overwhelming workload
[21], make it impossible to regularly read and keep up with the
increasing numbers of publications [22]. We still have a long way to
explore realistic and effective strategies to make the necessary
changes to the work pattern of nurses.
Another interesting nding is that reading motivation was
associated with both perceived barriers and facilitators. According
to the self-determination theory [23], motivation depends on self-
determination, intrinsic motivation, extrinsic motivation, identied
regulation and amotivation. In this study, intrinsic motivation and
identied regulation played more important roles in nurses' liter-
ature reading than extrinsic motivation. Intrinsic motivation refers
to performing a behavior for their own sake, deriving pleasure and
satisfaction in the process [24]. Identied regulation implies an
option as it occurs when the behavior is considered important for
the subject's goals [24]. Motivation generates consequences.
Intrinsic motivation is mostly associated with positive outcomes
(e.g., persistence) followed by identied regulation [25]. Nurses
may read literature or engage in research for difference purposes.
For example, Cheng et al. [26] reported that 52.9% nurses conduct
research for job promotion, 37.2% for developing the eld of
nursing. Thus, motivation may become a catalyst for literature
reading and further research utilization.
How can we stimulate intrinsic motivation and identied
regulation to encourage nurses to read literature and even apply
the ndings to evidence-based clinical practice? We suggest that
nurses must rst acknowledge that research is essential for
ensuring high quality patient care and optimize benets to all
parties in the health care system and take research as a career re-
sponsibility. Nurses in our sample recognized facilitating strategies,
including establishing incentive mechanisms, incorporating
reading to career development, and peer support. Additionally,
nurses can ask for help when having difculty reading literature, to
reduce frustration.
The type of hospital was an important factor affecting barriers to
reading literature. We speculate the following reasons. Compared
with community hospitals, nurses in teaching hospitals are more
likely to have higher educational background and more opportu-
nities and avenues to access articles or updated research informa-
tion. Organizational culture could also guide the attitude and
behavior of individual members [6]. A culture that encourages
nurses to get continuing education or training on research can
empower nurses to study independently and to conduct research
[3].
5. Limitations
This study was a cross-sectional survey, thus, we could not
conclude any causal relationships. Self-administered question-
naires might not be robust enough to objectively present the values
involved, such as the motivation for reading. Therefore, further
studies using mixed-method approaches are needed.
6. Conclusions
This study evaluated the current situation of Chinese registered
nurses' literature reading and understanding, and the underlying
barriers, reasons, and facilitators. The nurses' educational back-
ground, reading motivation, gender, and work setting had signi-
cant association with their reported behavior and perceived
barriers and facilitators. Therefore, we suggest that it is necessary to
improve research education for nurses, establish incentive mech-
anisms or academic atmosphere for readers and communicators.
302 F.-F. Huang et al. / International Journal of Nursing Sciences 4 (2017) 296e302
7. Implications and recommendation
This study provides an insight into the barriers to reading
literature, and the reasons why nurses don't read. It also highlights
factors perceived by nurses to facilitate reading. Language de-
ciency, lack of time, inadequate training, poor presentation and
readability of literature, and low level of education and reading
motivation, contributed to nurses' reading habits. We suggest that
hospitals, medical institutions, and health professional managers
should make a concerted effort to explore ways to provide pro-
tected time, create a research-friendly climate, and establish sys-
tems for nurses to read, communicate, evaluate and utilize research
articles. Moreover, it is crucial to equip nurses with essential
research knowledge and skills through training.
Conict of interest
There is no potential conict of interest.
Acknowledgements
Sincerely thank all the nurse participants without whom this
study would have not been possible, and the nurse managers of
those hospitals, who assist in the data collection of the study. We
also sincerely grateful for the help of Qing Yang(MD, Department of
anesthesia, Massachusetts general hospital, Boston, United States),
who help to check and revise the language usage, spelling, and
grammar of the manuscript.
Appendix A. Supplementary data
Supplementary data related to this article can be found at http://
dx.doi.org/10.1016/j.ijnss.2017.05.003.
References
[1] McSherry R, Simmons M, Abbott P. Evidence-informed nursing: a guide for
clinical nurses. London, UK: Routledge; 2002.
[2] Estabrooks CA, Wallin L, Milner M. Measuring knowledge utilization in health
care. Int J Policy Eval Manag 2003;1:3e36.
[3] Chien WT, Bai Q, Wong WK, Wang H, Lu X. Nurses' perceived barriers to and
facilitators of research utilization in Mainland China: a cross-sectional survey.
Open Nurs J 2013;7:96e106.
[4] Wu HY, Song CY, Hu Y. Application of KJ method in qualitative research on
inuence factors of nursing staff in scientic research activities. Chin Nurs Res
2015;29(3A):808e12.
[5] Estabrooks CA, Dersken L, Winther C, Lavis JN, Scott SD, Wallin L, et al. The
intellectual structure and substance of the knowledge utilization eld: a
longitudinal author co-citation analysis, 1945 to 2004. Implement Sci 2008;3:
49.
[6] Wang LP, Jiang XL, Wang L, Wang GR, Bai YJ. Barriers to and facilitators of
research utilization: a survey of registered nurses in China. PLoS One
2013;8(11):1e9.
[7] Squires JE, Hutchinson AM, Bostro m AM, O'Rourke HM, Cobban SJ,
Estabrooks CA. To what extent do nurses use research in clinical practice? A
systematic review. Implement Sci 2011;6:21.
[8] Johnson JM, Reineck C, Daigle-Bjerke A, Goupil NM, Captain C. Understanding
research articles. A pilot study of critical reading of research publications.
J Nurs Staff Dev 1995;11(2):95e9.
[9] Chau JPC, Lopez V, Thompson DR. A survey of Hong Kong nurses' perceptions
of barriers to and facilitators of research utilization. Res Nurs Health
2008;31(6):640e9.
[10] McKenna H, Ashton S, Keeney S. Barriers to evidence-based practice in pri-
mary care. J Adv Nurs 2004;45(2):178e89.
[11] Pravikoff D, Tanner A, Pierce S. Readiness of US nurses for evidence-based
practice. Am J Nurs 2005;105(9):40e51.
[12] Funk SG, Champagne MT, Wiese RA, Tornquist EM. Barriers: the barriers to
research utilization scale. Appl Nurs Res 1991;4(1):39e45.
[13] Anazawa R, Ishikawa H, Park MJ, Kiuchi T. Online machine translation use
with nursing literature: evaluation method and usability. Comput Inf Nurs
2013;31(2):59e65.
[14] National health and family planning commission of the people's republic of
China. 2010 [cited 2014 May 5]. Available from: http://www.nhfpc.gov.cn/
mohyzs/s7659/201001/45756.shtml.
[15] Zhou YP. An investigation on clinical nurses' reading and utilization of pro-
fessional literature. Bull Sci Technol 2010;26(3):473e6.
[16] Zeng HX, Dai XY. The psychometric evaluation of situational motivation scale.
The ninth annual seminar of psychological assessment professional commit-
tee of the Chinese association for mental health; 2011.
[17] Retsas A. Barriers to using research evidence in nursing practice. J Adv Nurs
2010;31(3):599e606.
[18] Kang H. Geriatric hospital nurses' perceived barriers to research utilization
and empowerment. Asian Nurs Res 2015;9(1):65e72.
[19] Thompson C, McCaughan D, Cullum N, Sheldon T, Raynor P. Barriers to
evidenced-based practice in primary care nursing- why viewing decision-
making as context is helpful? J Adv Nurs 2005;52(4):432e44.
[20] Veeramah V. The use of evidenced-based information by nurses and midwives
to inform practice. J Clin Nurs 2016;25(3e4):340e50.
[21] Zhu XW, You LM, Zheng J, Liu K, Fang JB, Hou SX, et al. Nurse stafng levels
make a difference on patient outcomes: a multisite study in Chinese hospitals.
J Nurs Sch 2012;44(3):266e73.
[22] Zhou F, Maier M, Hao Y, Tang L, Guo H, Liu H, et al. Barriers to research uti-
lization among registered nurses in traditional Chinese medicine hospitals: a
cross-sectional survey in China. Evid Based Complement Altern Med 2015.
PMID:26649060.
[23] Deci EL, Ryan RM. Intrinsic motivation and self-determination in human
behavior. New York: Plenum; 1985.
[24] Martn-Albo J, Nn ~ ez JL, Navarro JG. Validation of the Spanish version of the
situational motivation scale (EMSI) in the educational context. Span J Psychol
2009;12(2):799e807.
[25] Guay F, Vallerand RJ, Blanchard C. On the assessment of situational intrinsic
and extrinsic motivation: the Situational Motivation Scale (SIMS). Motiv Emot
2000;24(3):175e213.
[26] Cheng JL, Chu YP, Han SF, Shi HR, Dong XJ. Research on motives and inuence
factors of scientic research of nursing staff. Chin J Med Sci Res Manage
2012;25(6):366e71.