Learning to engage in clinical research: a qualitative study developing a behavioural pathway model among nurses in...

Developing the capacity of health professionals to engage in research and practice improvement is an important goal of health professions education. In nursing, research literacy is considered a key capability that enables clinicians to understand research, formulate practice-based questions, and initiate research or quality improvement activities. In China, rapid expansion of nursing education has strengthened academic preparation; however, the ability of clinical nurses to translate clinical problems into research or improvement initiatives remains uneven across practice settings. Little is known about how nurses develop research literacy in clinical environments and how workplace conditions shape their engagement in research-related practice.

This qualitative study used semi-structured interviews with 20 clinical nurses from multiple departments in a tertiary teaching hospital in China. Participants were purposively sampled to capture variation in career stage, educational background, and research exposure. Interviews explored how nurses understood research, interacted around research ideas, evaluated research value, and attempted to initiate or sustain research or improvement projects. Data were analysed using reflexive thematic analysis, informed by sensitising concepts from research literacy theory and the Capability-Opportunity-Motivation-Behaviour (COM-B) behavioural framework.

Four interrelated themes were identified. Nurses commonly accessed research evidence but often relied on conclusion-oriented interpretation rather than methodological appraisal, which limited their ability to adapt evidence to local practice. Research-related dialogue was mediated by hierarchy, professional positioning, team climate, and perceived psychological safety. Participants distinguished clinically meaningful research from "formalistic" projects perceived as procedural, symbolic, or driven mainly by institutional requirements. This distinction suggested that nurses were not rejecting research itself, but were critically judging whether research activity was clinically meaningful, morally legitimate, and feasible within everyday practice.Translating clinical concerns into research or improvement activities emerged as a fragile and non-linear pathway: ideas could be initiated, stalled, faded, or reactivated depending on workload pressures, leadership support, organisational opportunity, psychological safety, and perceived clinical meaning.

Engaging in research in clinical nursing appears to be a socially situated professional practice rather than an individual technical skill. Research engagement develops through the interaction of research literacy, professional positioning, psychological safety, motivational commitment, and organisational opportunity within clinical workplaces. Based on these findings, the study proposes a heuristic behavioural pathway model describing how nurses move from interpreting research and recognising clinical problems to evaluating research value and attempting research or improvement action. The model highlights that this process is recursive and contingent rather than a stable linear progression, and may help identify where research engagement is likely to be interrupted or sustained in clinical nursing practice.