Scientific research ability of specialist nurses in Guangxi Zhuang Autonomous Region, China: A cross‐sectional study

Abstract Aim This study investigated the scientific research ability of Chinese specialist nurses (SNs) in the Guangxi Zhuang Autonomous Region and its influencing factors. Design A cross‐sectional design. Methods A total of 652 SNs in the Guangxi Zhuang Autonomous Region were investigated from March to October 2021. The nursing scientific research ability level was measured using the Nursing Research Competence of Nurses Self‐evaluation Scale. Descriptive statistics, univariate analysis and ordinal logistic regression analysis were used to evaluate factors affecting the scientific research ability of SNs. Results The median score of scientific research ability of SNs was 31 (interquartile range: 19–41). Approximately 74.8% of clinical speciality nurses had low scientific research ability. Educational background, working hospital level, being the first author of a published paper and successful application for scientific research projects were identified as factors influencing scientific research ability score.


| INTRODUC TI ON
Clinical nurse specialist (CNS) refers to the Registered Nurse (RN) who has obtained the corresponding specialist nurse (SN) qualification certificate after systematic training and examination; has profound nursing theoretical knowledge, expert nursing skills and rich clinical experience in a specific nursing field; and can skilfully use specialist nursing knowledge and skills to provide professional nursing services for patients (Chen & Li, 2015). Nursing scientific research ability refers to the ability of nursing staff to continuously discover general laws and explore truth in the field of nursing. It is an important means to explore nursing theory, nursing method, and nursing technology innovation and improve the quality and efficiency of nursing work (Gao, 2013). The scientific research level and ability of SNs determine whether they can find, analyse and solve clinical nursing problems from a specialist perspective in clinical nursing work, and play the role of nursing experts in practice (Mo et al., 2020a(Mo et al., , 2020b.

| BACKG ROU N D
Nursing research refers to the use of scientific methods to explore clinical nursing practice, evaluation, management and education (Polit & Beck, 2017). It is an important part of professional nursing.
Research results can be used to develop and change nursing practice. Evidence-based medicine has been advocated in the clinical environment for many years and has been widely accepted in nursing and related medical fields (Mackey & Bassendowski, 2017). Nursing practice is based on nursing research. Nurses are required to formulate evidence-based guidelines and establish and implement research and clinical policies and standards. In 2011, the discipline of nursing was established as a national level 1 discipline. Its establishment requires nurses to have solid nursing expertise, and a strong sense of research and research ability (Wang et al., 2015). Nursing scientific research ability refers to the ability to carry out research.
It is also used to evaluate the ability of nurses to evaluate, synthesise and implement research results, including mastering the basic knowledge of nursing scientific research, basic scientific research methods, literature retrieval skills, health statistics knowledge, statistical software operation, scientific research paper writing and other abilities (Liu, 2004;McCance et al., 2007).
SNs are senior practitioners of clinical nursing and promoters of evidence-based nursing practice (Nie et al., 2019). The international literature has no consistent terminology for advanced practice nurses (Jokiniemi et al., 2012). Since the beginning of advanced nursing practice, SNs have been implemented in various healthcare settings and medical specialities and positively impact patient outcomes and access to healthcare services (Coster et al., 2018;Woo et al., 2017). According to the International Council of Nurses (ICN), a CNS is "an advanced practice nurse who provides expert clinical advice and care based on established diagnoses in specialised clinical fields of practice along with a systems approach in practicing as a member of the healthcare team" (ICN, 2020). A CNS is usually at least one master-ready nurse whose roles include advanced responsibilities, specialisation and extended practice (ICN, 2020). CNSs of different specialities in the United States have profound theoretical knowledge, rich clinical experience and superb clinical skills in specific clinical nursing. CNSs are required to obtain a master's degree in nursing and play an active role as expert advisors to other nurses to enhance the professionalism of the nursing staff (Zhang, Yan, et al., 2020;. In Denmark, Iceland and Finland, the minimum CNS education is at the master's level (Jokiniemi et al., 2019;Studienaevnet for Sundhedsvidenskab, 2019; The Directorate of Health, 2019). In Japan, the training goals of CNS and CN specialised nursing talents are nursing practice experts, but the education level is different. The combination of CNS and master's degree mainly plays a role in nursing practice, consultation and guidance (Meng, 2019). CNSs in Korea are required to complete a postgraduate specialist nursing education program offered by an institution accredited by the Ministry of Health and Welfare (Kang, 2005;Kim et al., 2010). National Health Commission of the People's Republic of China (2017), which 48 points out that, by 2020, a group of SNs will be trained in a planned manner to meet the needs of clinical nursing, develop a team of SNs and improve the level of specialist nursing (Nie et al., 2019). Specialised nurses play an increasingly important role in China's clinical work.
SNs in China must be RNs, with a Junior degree or above, with 3 years or more of nursing work experience and 2 years or more of specialist work experience, completed in 2-7 months. After training and passing the relevant examinations, nurses can obtain the certificate of the relevant SN (Zhao & Sheng, 2019). In developed countries, SNs are mostly positioned as CNSs, and the educational requirements are relatively high. Compared with developed countries, China still has a big gap (Guo et al., 2015). This large gap may be related to the late development of SNs and their training system in China. In China, entry criteria for SNs vary depending on the area of specialist care. Provinces and municipalities have also developed different entry criteria in their SNs training systems, resulting in uneven competencies and low recognition of SNs across the country (Ma et al., 2019;Zhang et al., 2012).
The scientific research level and ability of SNs determine whether they can find, analyse and solve clinical nursing problems from the perspective of speciality and play the role of nursing experts in practice (Mo et al., 2020a(Mo et al., , 2020b. In China, SNs undertake the work of specialist outpatient clinics, consultations, teaching and scientific research. According to the survey (Gan et al., 2014;Jing et al., 2016), the scientific research ability of Chinese nurses is at medium and low levels and shows a polarisation trend. The impact of nursing research in China is smaller than that in other countries (Uys et al., 2013). In the past two decades, nurses in Chinese academic institutions and large hospitals have been committed to improving their research ability, such as improving nurses' research awareness, involving nurses in research and improving research productivity (Zhang, Yan, et al., 2020;. Guangxi Zhuang Autonomous Region is

| Design
For data collection, a cross-sectional questionnaire survey was conducted from March to October 2021. The manuscript was developed using the STROBE checklist for cross-sectional studies.

| Assessment instruments
The survey consists of two parts: demographic characteristics and a self-assessment scale of scientific research ability.

| Demographic characteristics
We used a self-designed demographic questionnaire to collect the information of participants, including gender, age, nursing work experience, educational background, professional title, level of working hospital and whether they have published papers as the first author and successfully applied for scientific research topics. These factors were selected based on previous research (Wang & Li, 2020;Wu et al., 2021;Yuan, 2017).

| Nursing Research Competence of Nurses Self-evaluation Scale
The self-assessment scale designed by Pan and Cheng (2011) was used for assessing the scientific research ability of nursing staff.
It has good reliability and validity. The Cronbach's α coefficient of this scale was 0.861, and the test-retest reliability was 0.902. The Cronbach's α for subscales ranged from 0.655 to 0.760, whereas the RMSEA value in the confirmatory factor analysis was 0.095.
The scale has 6 dimensions and 30 items, and responses are scored on a five-point Likert scale. The dimensions are problem discovery ability (three items), literature review ability (five items), scientific research design ability (five items), scientific research practice ability (six items), data processing ability (five items), and thesis writing ability (six items). The total score ranges from 0 to 120, with higher scores indicating the stronger scientific research ability of nurses.

| Data collection
A paper version of the questionnaire was distributed to the SNs surveyed between March and October 2021. The two persons responsible for the survey received uniform training to understand fully the purpose of the survey and the meaning of each question in the questionnaire. All participants were required to sign an informed consent form before answering the questionnaire. The respondents completed the questionnaire independently and returned on the spot after completing the questionnaire. After the investigation, two investigators were responsible for checking the questionnaires and eliminating the questionnaires with missing items or logical contradictions. All personal information was encoded, and participants were made anonymous using a reference number system. Their data were then stored safely in an encrypted database. For the sample size, the recommendations of between five and ten subjects for each item on the questionnaire were considered (Zhan et al., 2020).
Considering that 10% are invalid questionnaires, a minimum of 209 SNs was required. Finally, 665 SNs completed the questionnaire, and 13 invalid questionnaires were excluded. These invalid questionnaires were mainly because of incomplete questionnaires. A total of 652 valid questionnaires were recovered, with a completion rate of 98.05%.

| Statistical analysis
The obtained data were entered and analysed using statistical analysis software SPSS version 17.0. Two research assistants rechecked the data, and the questionnaires that did not meet the inclusion criteria were excluded from the analysis. The normality tests were used to observe whether the data conform to normal distribution. The median (interquartile range) was used to describe data because of their skewed distribution. Classification data were calculated by frequency and proportion. Wilcoxon rank-sum test or Kruskal-Wallis H-test was used to determine the difference in median values among different groups. The score of scientific research ability was set as the dependent variable, and it is divided into low, medium and high levels. Finally, we performed ordinal logistic regression analysis using all potential factors identified early in univariate analysis. For all statistical tests, the significance level was set at 0.05.

| Ethics
All participants agreed and voluntarily participated in the survey, and the investigators ensured the anonymity and confidentiality of the data. The study was reviewed and approved by the university research ethics review committee.

| RE SULTS
Six hundred and fifty-two SNs are from 14 prefecture-level cities in Guangxi Zhuang Autonomous Region, including Nanning City

| Participant characteristics
The characteristics of the respondents are presented in Table 1.
Approximately 97.1% (n = 633) of the participants were women, and most of the SNs were aged 30-39 years (n = 478, 73.3%). SNs working for 10-14 years comprised the largest group (n = 282, 43.3%) and 346 participants were from tertiary hospitals (n = 54.1%). Most SNs have undergraduate degree (n = 513, 78.7%) and only a few have a master's degree or above (n = 9, 1.4%). More than half of the SNs have primary professional titles (n = 346, 53.1%) and most of them have not published papers as the first author (n = 530, 81.3%) and completed projects (n = 631, 96.8%). Table 2 shows that the total score of scientific research ability of specialised nurses is low, and the median score is 31 (interquartile range: 19-41), among which the score of scientific research design ability is the lowest. The scores were divided into three levels: low (n = 488, 74.8%), medium (n = 156, 23.9%) and high (n = 8, 1.2%). Table 3 provides the responses to each question.

| Influencing factors of scientific research ability of SNs
In Table 4, the univariate analysis findings indicated statistically  (Table 5).

| Current situation of scientific research ability of SNs
The scientific research ability of nurses is an important factor used to measure the quality of nursing education .
This study shows that the scientific research ability of SNs is generally at a low level, consistent with the investigation of Guo and Zhang (2016) and Lv et al. (2018). This finding may be because of the lack of scientific research knowledge and methods, especially knowledge related to scientific research design and data processing (Kelly et al., 2016). In the present work, the problem-finding ability is the highest, and the scientific research and design ability is the lowest, consistent with the research results of Wang and Li (2020) and Wu et al. (2021) to make a qualitative change in the scientific research ability of SNs.
Although hospitals or schools will set up relevant courses on nursing research, some problems persist, such as short class hours, unsystematic teaching content and incomplete knowledge structure.   (2015) and Shang et al. (2018). The reason is that, in the process of publishing papers and applying for topics, nurses need to consult a large number of nursing journals, obtain extensive information and timely understand the new trends of nursing development at home and abroad, which will expand their clinical scientific research thinking and accumulate a certain scientific research foundation. Furthermore, in writing academic papers and applying for scientific research topics, clinical SNs can continuously learn scientific research knowledge and finally improve their scientific research ability through literature review, data processing and paper writing.
However, to publish papers and declare topics, clinical SNs should also have certain research abilities (Corchon et al., 2010) and actively participate in the research process (Walker, 2006), which requires high-quality research training and guidance (Bournes, 2013)

| LI M ITATI O N S
The findings of this regional survey should be interpreted cautiously because of the following limitations. Firstly, this study was conducted in the Guangxi Zhuang Autonomous Region, with different numbers of SNs in each prefecture-level city and no additional data from other provinces. Therefore, the results cannot be generalised to all Chinese SNs. Secondly, this study is a self-report survey method, which may lead to inflated or underestimated scores on the measurement scale, and possible inherent bias cannot be ruled out.
Finally, only the SNs in 2021 were selected for the survey, and SNs from other years and disciplines will be included in the survey in the future.

| CON CLUS ION
The overall level of scientific research ability of SNs in Guangxi

ACK N OWLED G M ENTS
We would like to thank the Guangxi Education Department and the Innovation Project of Guangxi Graduate Education for their support.
We thank all specialist nurses for participating in the study.

This study was supported by Education Department of Guangxi
Zhuang Autonomous Region (Grant Number: 2020JG147) and Innovation Project of Guangxi Graduate Education (Grant Number: JGY2020051).

CO N FLI C T O F I NTE R E S T S TATE M E NT
The authors declare no conflicts of interest.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data sets generated for this review are available on reasonable request to the corresponding author.

E TH I C S S TATEM ENT
This study maintains the anonymity of all the participants, who can opt whether or not to participate. Formal written consent was obtained from all participants. We further guaranteed that the identity of the participants will not be disclosed and that their answers will be confidential. Ethical approval for the project was gained from the ethics committees of the Guangxi Medical University.