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Barriers to research awareness among nurses in Italy.

The achievement and spread of evidence-based practice, 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 internationally 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 concern 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 (Bagnasco 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 (Sansoni 2001). At the same time key nursing figures in Italian universities are actively working towards building 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 relevance to clinical nursing practice (Marucci et al. 2013). A further compounding factor in the use of research is limited access to libraries and Information Technology (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 difficulty for Italian nurses who struggle with English comprehension (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 recommendations 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, Sansoni et al. 2006). This would facilitate the exchange of knowledge and information with international colleagues, 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 difficulty 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 understanding the research; and research utilization (Jacobson 2000), and we have highlighted above that there are