Metka Skubic, PhD, Anita Jug Došler, PhD, Tita Stanek Zidarič
Experiences and Barriers to Participatory 
Research in Midwifery and Nursing Care
DOI: https://doi.org/10.55707/jhs.v10i1.136
Original scientific article
UDC 614.253.5+001.891
KEYWORDS: midwifery, nursing, participatory rese-
arch, professional development
ABSTRACT – Participatory research is gaining atten-
tion. In midwifery and nursing, emphasis is often pla-
ced on clinical practice but the needs of researchers 
are neglected. A comparative questionnaire survey 
was conducted using the quantitative-descriptive re-
search methods of empirical research. The data were 
collected using a questionnaire based on a sample 
of 228 midwives and nurses. Data analysis inclu-
ded basic descriptive statistics with calculations of 
frequencies and percentages. Statistically significant 
differences were determined by the χ2-test. More than 
half of the respondents did not have experience with 
research in their own work practices. Most of them 
expressed an interest in the content-planning phase 
when performing research, while the least desired 
phase was reporting the study findings. The biggest 
barriers were the lack of research training and a 
lack of knowledge about research methodology. The 
results highlight the importance of the establishment 
of research groups that help employees acquire rese-
arch experience. Our findings increase awareness re-
garding the barriers to participatory research among 
nurses and midwives. A persistent preoccupation 
with identifying the barriers to EBP is there mostly 
because midwives and nurses persist in not applying 
research evidence in practice. 
Izvirni znanstveni članek
UDK 614.253.5+001.891
KLJUČNE BESEDE: babištvo, zdravstvena nega, 
participativno raziskovanje, profesionalni razvoj
POVZETEK – Participativno raziskovanje pridobiva 
pozornost. V babištvu in zdravstveni negi je poudarek 
pogosto dan klinični praksi, potrebe raziskovalcev 
pa so zanemarjene. Primerjalna anketna raziskava 
je bila izvedena z uporabo kvantitativnih deskriptiv-
nih raziskovalnih metod empiričnega raziskova-
nja. Podatki so bili zbrani z vprašalniki, vzorec pa 
je obsegal 228 babic in medicinskih sester. Analiza 
podatkov je vključevala osnovne opisne statistike z 
izračuni frekvenc in odstotkov. Statistično pomembne 
razlike so bile določene z χ2-testom. Več kot polovica 
anketirancev ni imela izkušenj z raziskavami v lastni 
delovni praksi. Večina jih je izrazila zanimanje za 
stopnjo načrtovanja vsebin, najmanj želena stopnja 
pa je bilo poročanje o ugotovitvah študije. Največje 
ovire so bile pomanjkanje izobraževanja na področju 
raziskovanja in pomanjkanje znanja o raziskovalnih 
metodologijah. Rezultati poudarjajo pomen ustano-
vitve raziskovalnih skupin, ki bi zaposlenim poma-
gale pridobiti raziskovalne izkušnje. Naše ugotovitve 
povečujejo ozaveščenost glede ovir za participativno 
raziskovanje med babicami in medicinskimi sestra-
mi. Skrb za identifikacijo ovir pri uvajanju praks, ki 
temeljijo na dokazih, je prisotna predvsem zato, ker 
babice in medicinske sestre vztrajajo pri neuvajanju 
na dokazih temelječih praks. 
1 Introduction
The term evidence-based practice (EBP) has emerged in the last two decades and 
its use has become widespread in the nursing and midwifery disciplines (Whitehead 
et al., 2020). EBP is applying or translating research findings into daily patient care 
practices and clinical decision-making. As pointed out by De Leo et al., (2021) the evi-
dence-to-practice gap continues to persist in healthcare and there is limited knowledge 
Prejeto/Received: 23. 1. 2023
Sprejeto/Accepted: 28. 5. 2023
Besedilo/Text © 2023 Avtor(ji)/The Author(s)
To delo je objavljeno pod licenco CC BY Priznanje avtorstva 4.0 Mednarodna. 
/ This work is published under a CC BY Attribution 4.0 International license.
https://creativecommons.org/licenses/by/4.0/
Metka Skubic, PhD, et al.: Experiences and Barriers to Participatory ...
4 Revija za zdravstvene vede (1, 2023)
and use of effective strategies to support the implementation of evidence-based practi-
ces in a clinical setting. 
EBP provides the best care for patients and considers the best evidence gained 
from clinical research (Bal, 2017; Mallion and Brooke, 2016; McVay, 2016). As ou-
tlined by Soh et al. (2011) and Whitehead et al. (2020), constructing new research 
and translating its evidence-based findings into clinical practice can improve both 
nursing and midwifery standards as well as overall clinical care. Moreover, healthcare 
professionals have an ethical obligation to participate in professional development 
(Hemberg and Hemberg, 2020). If the research evidence is not implemented into pra-
ctice, there is a risk that the divide between actual clinical practice and EBP will grow. 
Therefore, healthcare professionals should address the theory-practice gap. This can 
be accomplished through a number of research approaches that are applicable in the 
nursing and midwifery professions. 
In the paper, we focus on an approach called participatory research, the design 
of which links theory with practice (Whitehead et al., 2020). With its origins in soci-
al psychology, participatory and action research was first described after the Second 
World War by Lewin and gained popularity across different disciplines (Soh et al., 
2011; Deery, 2011). Donovan (2006) outlined the expansion of its use, particularly in 
nursing and midwifery, while McVicar et al. (2012) reported that participatory rese-
arch has been promoted in the United Kingdom for research in health and social care 
disciplines. Researching one’s own practice provides an insight into midwifery and 
nursing practice, as it develops and improves methods of work in nursing and midwi-
fery and assesses their efficiency inside the existing practice of a certain system (Baba 
et al., 2020; Whitehead et al., 2020; Arnold et al., 2022). Research and evidence are 
the bases for current scientific medicine and a grounding for professionalism (Sheehy 
et al., 2019; Oyelade et al., 2019). Therefore, we presumed that researching one’s own 
midwifery and nursing practice is a component of their professional development. For 
this reason, the University Medical Centre Ljubljana (Slovenia) established a group 
for research in midwifery and nursing with the purpose of selecting research appli-
cations, documenting the research register, and maintaining a network of midwifery 
and nursing researchers (Klančnik Gruden, 2013). Polit and Beck (2020) posit that we 
should not expect that every nurse will become a researcher. However, all nurses are 
expected to practice on the basis of evidence (Cusack et al., 2018). Participatory action 
research is a method of inquiry that promotes a collaborative approach to knowledge 
creation, highlighting the areas of improvement that such approaches might offer to 
researchers and scientists in the nursing field (Effendy et al., 2022). Moreover, they 
should support research with their behavior, which is only possible if they have a good 
basic knowledge regarding the importance of research and the advancement of the 
profession. A survey conducted by Strojan et al. (2012) found that nursing education 
does not exert a statistically significant impact on one’s relationship to research. On 
the other hand, the method by which lecturers introduce the meaning of research to 
students in higher education affects students’ perceptions toward research. Research 
has shown that an increase in the level of education, in terms of the number of ho-
5Metka Skubic, PhD, et al.: Experiences and Barriers to Participatory ...
urs of research content in the undergraduate study programs, has a statistically sig-
nificant impact on the respondents’ opinions. The research education gained during 
their studies, such as literature searches and critical analysis of previously conducted 
and published research, affects research activity, improving professionalism overall. 
A considerable amount of literature exists defining participatory research as a com-
ponent of the individual’s practice (Brito, 2018; Ehde et al., 2013; Franks - Meeks, 
2020; Skela Savič, 2014; Cusack et al., 2018). Consistent with professional values, 
this type of research leads to improvements in practice. The researcher is simultaneo-
usly a practitioner and needs to be present in the process. As pointed out by Andersson 
(2018), participatory research offers an alternative to simple knowledge translation 
where a researcher passes research products to a knowledge user who acts on the evi-
dence. Furthermore, participatory research results are changing the understanding of 
the individual’s professional practice (Bish et al., 2013; MacLeod Dyess et al., 2013). 
It requires a flexible research plan and consists of several action steps or phases. The 
research-relevant features of participatory research are substantiated on the basis of 
the following advantages (Bish et al., 2013; Fawcett, 2015; Jug Došler et al., 2015; 
MacLeod Dyess et al., 2013; Milton, 2012; Arnold et al., 2022):
 □ The possibility of monitoring the professional operation of employees through a 
process of research reflection (the subject’s own reflection leads to new ideas and 
perspectives).
 □ The possibility of determining the rules of behavior, the rules of maintaining a par-
ticular system/institution, and the subjective theories that direct the professional 
operation of employees. If we directly monitor their operation, we can determine 
the laws according to which they work, the rules of behavior that exist as social 
and developmental norms, and the subjective theories linked to specific behaviors, 
which we confront with declarative theories through an insight into the context.
 □ The possibility of deepening the perception, knowledge and behaviors within par-
ticipatory research, and on this basis, of modifying and shaping grounded theories. 
Evaluation of the quality of (one’s own) practice and research of the selected phe-
nomenon directs the individual professional toward the establishment of a groun-
ded theory, where the transfer of this practice to new frameworks presupposes an 
understanding of the contextual conditions of the new frameworks and includes 
reflection on the consequences that it has for the application of current practices 
in the new context.
 □ The possibility of testing in practice the appropriateness of alternative orientations 
of practical operation, and on the basis of the results, evaluating the possibility of 
incorporating these orientations into future action measures.
 □ The possibility of transforming personal beliefs with the aid of the methods and 
techniques of participatory research (self-observation, critical evaluation and 
analysis, studying documentation, etc.). Understanding the operational context of 
the professional also includes his or her subjective behavior, the critical analysis 
of which is an important method for raising his or her awareness and achieving an 
appropriate connection between theory and practice. It is in the relationship betwe-
en theory and practice that the methods and techniques of action research can help 
6 Revija za zdravstvene vede (1, 2023)
employees become aware of and recognize their (unconscious) assumptions, the 
subjective theories that influence their decisions and everyday work practices.
 □ The possibility of integrating participatory research into the very process of (self-)
reflection and the (self-)evaluation of the professional work of employees in a 
particular institution. 
The purpose and objectives of the research described in the paper are to analyze 
the experiences and potential barriers to midwifery and nursing research participation. 
The research questions were:
 □ What experiences have midwives and nurses from Slovenia had with research in 
their own clinical practice (Table 1, χ2-test)? 
 □ In which phase of the research process would they most like to participate (Table 
2, χ2-test)?
 □ What are the potential barriers to midwifery and nursing research participation 
(Table 3, χ2-test)?
2 Methods
The study was based on an empirical survey research approach. A comparative qu-
estionnaire survey was conducted using the quantitative descriptive research methods 
of empirical research (Harvey and Land, 2016). The data were collected using a pre-
designed questionnaire that was tested in advance on a pilot sample. The pilot sample 
consisted of 10 examinees and provided an overview regarding the understandability 
of the questionnaire. Questionnaires were distributed to participants from September 
2017 to January 2021. The sample was random. The research design and ethical mea-
sures of the study were approved by the faculty committee.
The questionnaire included questions about demographical data (age, education) 
in addition to three open- and closed-ended questions with a variety of answers that 
referred to the views and attitudes of midwives and nurses regarding research in their 
own clinical practice. We utilized factor analysis to assess validity and reliability; the 
questionnaire was found to have acceptable validity (the first factor explained 26.3% 
of variance) and reliability (the outcome of factor analysis outlined three factors that 
explained 61.9% of variance). The adequacy of the correlation matrix for factoriza-
tion was assessed with the KMO test (a value of 0.802) and Bartlett’s test (a value of 
804.201; p = 0.039). We used the classical test theory in interpreting reliability. If the 
reliability coefficient was over 0.75, our interpretation was that 75% of the variance 
was true, and consequently there was a 25% possibility of error in the observed va-
riance. For reliability, we did not use the square of the correlation coefficient or the 
coefficient of determination. Instead, we used the reliability coefficient itself to assess 
the degree of measurement error. Validity is understood as a judgement of the degree 
to which empirical evidence and theoretical rationales support the appropriateness of 
test-score interpretations (Messick, 1995; Harvey and Land, 2016).
7Metka Skubic, PhD, et al.: Experiences and Barriers to Participatory ...
The study sample consisted of 228 individuals, including 72 midwives (31.6%) 
and 156 nurses (68.4%), from Slovenia. The sample was not representative. The av-
erage age of midwives was 35.7 years, while that of nurses was 37.2 years. Of the 72 
midwives, 7 (10%) had a postgraduate degree, 28 (40%) had a BSc in midwifery, 22 
(31.4%) had a BSc in nursing after graduating from a secondary school of midwifery, 
and 13 (18.6%) had graduated from a secondary school of midwifery. Among the 
nurses, 22 (14.9%) had a postgraduate degree, 89 (60.1%) had a BSc in nursing and 
37 (25%) had graduated from a secondary school of nursing. We are aware that the 
sample of the study was not representative, but nevertheless it indicates a certain trend 
that gives us an insight into participatory research in midwifery and nursing practice.
The ethical aspects of this survey were appropriately considered. All of the parti-
cipants signed a written statement regarding their voluntary participation and privacy 
policy. Participation was voluntary, and we ensured anonymity. 
Descriptive statistics were used for the data analysis. The χ2-test was calculated 
to measure the significant differences between midwives and nurses. The measured 
differences between midwives and nurses were accepted as statistically significant at 
a value of p = 0.05. The data were processed using the SPSS 20.0 software package.
3 Results
The results are presented in the same sequence as the study questions. First, we 
asked the question: “Do you have any experience researching your own work practi-
ce?”. More than half of the midwives (51.4%) and nurses (60.1%) clearly answered 
that they did not have any experience with research during their professional work 
(Table 1). There was no statistically significant difference between nurses and midwi-
ves in terms of their experience (χ2 = 1.473, g = 1, p = 0.225); however, the frequency 
distribution showed that nurses had slightly more experience in researching their own 
clinical practice. 
Table 1 
Experience in Participatory Research/Izkušnje s participativnim raziskovanjem
Do you have any experience researching 
your own work practice?
Midwives*
f, f (%)
Nurses*
f, f (%)
Total
f, f (%)
No 36 (51.4%) 89 (60.1%) 125 (57.3%)
Yes 34 (48.6%) 59 (39.9%) 93 (42.7%)
Total 70 (100%) 148 (100%) 218 (100%)
Legend: f – Frequency, f (%) – Percentage/f - frekvenca, f (%) - odstotek
*Completed questionnaires/*Izpolnjeni vprašalniki
The second aspect of the study focused on the attitudes of Slovenian midwives and 
nurses regarding the various phases of participatory research (Table 2). The data in-
dicated that most of the midwives were interested in participating in content planning 
(27.1%, R = 1); 21.4% (R = 2) reported that they were interested in data collection; 
8 Revija za zdravstvene vede (1, 2023)
15.7% (R = 3) would like to inform their colleagues and the general public about the 
study results; and 14.3% (R = 4) would like to implement the new research findings 
into practice. Among the nurses, a large number wanted to join in the content planning 
of research (25.5%, R = 1); 18.8% (R = 2) would like to inform their colleagues and 
the general public about the study results; 18.2% (R = 3) would like to implement the 
new research findings into their own clinical practice; and 17.7% (R = 4) would like 
to join in the process of data collection. The least desired phase of research among 
both groups was collaboration in the last stage of research; only 1.4% (R = 8) of 
midwives and 1.8% (R = 8) of nurses showed willingness to prepare the study report. 
One statistically significant difference emerged between midwives and nurses: more 
midwives than nurses reported that they would like to participate in the preparation of 
the research instrument for data collection (χ2 = 37.448, g = 1, p = 0.041).
Table 2 
Willingness to Participate in the Participatory Research Process Phase/Pripravlje-
nost za sodelovanje v fazah participativnega raziskovalnega procesa 
In which phase of the 
research process would you 
most like to participate?
Midwives* Nurses* Total
f, f (%) R f, f (%) R f, f (%) R
Content planning 
(setting the aim and 
objectives, and content work)
38 (27.1%) 1 49 (25.5%) 1 87 (26.2%) 1
Research methodology 
planning
(action plan, methods)
6 (4.3%) 6 19 (9.9%) 5 25 (7.5%) 5
Preparation of research 
instruments for data 
collection
18 (12.9%) 5 1 (0.5%) 8 19 (5.7%) 6
Process of data collection 30 (21.4%) 2 34 (17.7%) 4 64 (19.3%) 2
Processing and interpretation 
of the gathered data 4 (2.9%) 7 14 (7.3%) 6 18 (5.4%) 7
Preparation of the study 
report 2 (1.4%) 8 4 (2.1%) 7 6 (1.8%) 8
Informing colleagues and 
the general public about the 
study results
22 (15.7%) 3 36 (18.8%) 2 58 (17.5%) 3
Implementation of new 
research findings into 
practice
20 (14.3%) 4 35 (18.2%) 3 55 (16.6%) 4
Total 140 (100%) 192 (100%) 332 (100%)
Legend: f – Frequency, f (%) – Percentage, R – Rank (values in ascending order)/f - frekvenca, f (%) - 
odstotek, R - rang (vrednosti v naraščajočem vrstnem redu)
*Completed questionnaires; option to choose multiple answers./*Izpolnjeni vprašalniki; možnost 
izbire več odgovorov.
Finally, the potential barriers preventing midwives and nurses from participating 
in research were examined in Table 3. The results showed that the biggest barrier to all 
types of research in both groups was the lack of research training (midwives 21.9%, 
R = 1; nurses 26.5%, R = 1). The second barrier identified in the study was the lack of 
9Metka Skubic, PhD, et al.: Experiences and Barriers to Participatory ...
knowledge regarding research methodology obtained during their studies (midwives 
17.2%, R = 2; nurses 22.9%, R = 2). Furthermore, 15.4% of midwives (R = 3) and 
20% of nurses (R = 3) expressed that they do not have sufficient technical assistan-
ce. Other factors identified in the study was the perception among midwives (0.9%, 
R = 8) and nurses (1.6%, R = 8) that they do not attend enough events where they 
could present and discuss their own findings. There were statistically significant diffe-
rences showing that midwives perceive greater barriers in performing research, inclu-
ding work organization (χ2 = 28.145, g = 1, p = 0.042), lack of management support 
(χ2 = 30.674, g = 1, p = 0.031), and lack of cooperation between faculties and other 
health institutions (χ2 = 25.954, g = 1, p = 0.048).
Table 3 
Possible Barriers Preventing Midwives and Nurses from Doing Research/Možne ovi-
re, ki babice in medicinske sestre odvračajo od raziskovalnega dela
What are the potential 
barriers that prevent 
you from conducting 
participatory research?
Midwives* Nurses* Total
f, f (%) R f, f (%) R f, f (%) R
Work organization 30 (12.9%) 6 13 (5.3%) 7 43 (9%) 6
Lack of management support 32 (13.7%) 5 14 (5.7%) 6 46 (9.6%) 5
Researching the practice and 
presentation of the findings 
is not evaluated with license 
credit points
8 (3.4%) 7 25 (10.2%) 4 33 (6.9%) 7
Lack of training for different 
research approaches that 
could help improve the 
working conditions
51 (21.9%) 1 65 (26.5%) 1 116 (24.3%) 1
Lack of conferences and 
professional education 
programs, where the research 
findings could be reported on 
a regular basis
2 (0.9%) 8 4 (1.6%) 8 6 (1.2%) 8
Lack of research cooperation 
between faculties and clinical 
health education institutions
34 (14.6%) 4 19 (7.8%) 5 53 (11.1%) 4
Lack of knowledge regarding 
the research methodology 
obtained during studies
40 (17.2%) 2 56 (22.9%) 2 96 (20.1%) 2
Lack of sufficient technical 
assistance 36 (15.4%) 3 49 (20%) 3 85 (17.8%) 3
Total 233 (100%) 245 (100%) 478 (100%)
Legend: f – Frequency, f (%) – Percentage, R – Rank (values in ascending order)/f - frekvenca, f (%) - 
odstotek, R - rang (vrednosti v naraščajočem vrstnem redu)
*Completed questionnaires; option to choose multiple answers/*Izpolnjeni vprašalniki; možnost 
izbire več odgovorov.
It is evident from the results that the Slovenian midwives and nurses included in 
the survey do not have enough opportunities to conduct research. Therefore, future 
efforts should promote participatory research among these professionals.  
10 Revija za zdravstvene vede (1, 2023)
4 Discussion
Even though there is an increased focus on research and health outcomes, science 
lags behind practice (Wallerstein et al., 2020). The results of the present study showed 
that more than half of the midwives and nurses included in the survey did not have 
any experience with research in their own professional fields. At the same time, there 
is a great deal of literature showing that the research experience of midwives and 
nurses is important for their further research and clinical work. In clinical practice, 
participatory research is a way to expand the reach of research through collaboration 
with women, but as it turns out it is underutilized in midwifery research (Buchanan et 
al., 2022). Some recent international studies have shown that research experience is 
important for midwives and nurses for their further active engagement in researching 
and for changing their own clinical practice (Ehde et al., 2013). Midwives and nurses 
that have such experience are often also qualified for a reflection and evaluation of 
their practice, as well as for the implementation of the evidence-based findings from 
other research into their own clinical settings (Ehde et al., 2013; Smith et al., 2008). In 
our study more than half of midwives (51.4%) and nurses (60.1%) clearly answered 
that they did not have any experience with research during their professional work. 
These findings should be considered when designing undergraduate and postgraduate 
study programs for future midwives and nurses, and when planning the cooperation of 
educational institutions with health professionals in clinical environments. 
Midwives and other healthcare providers, who are aware of their obligation to pra-
ctice evidence-based care, report difficulty implementing the latest evidence into eve-
ryday practice (Bayes et al., 2016; McVay et al., 2016; Oyelade et al., 2019). Accor-
ding to Hines (2016), a persistent preoccupation with identifying the barriers to EBP 
is there mostly because midwives and nurses persist in not applying research evidence 
in practice. There are several factors that hinder healthcare professionals’ participation 
in and utilization of research, and their utilization of evidence-based practice: mostly 
lack of time at work, lack of knowledge, lack of funding, a poor attitude/perception 
towards research, and lack of research support services (Leão et al., 2013; Mallion and 
Brooke, 2016; Nkrumah, 2018; Oluwatosin, 2014). Our research indicated that most 
of the midwives were interested in participating in content planning (27.1%); 21.4% 
reported that they were interested in data collection; 15.7% would like to inform their 
colleagues and the general public about the study results; and 14.3% would like to 
implement the new research findings into practice. Among nurses, a large number 
wanted to join in the content planning of research (25.5%); 18.8% would like to in-
form their colleagues and the general public about the study results; 18.2% would like 
to implement the new research findings into their own clinical practice; and 17.7% 
would like to join in the process of data collection. The least desired phase of rese-
arch among both groups was collaboration in the last stage of research; only 1.4% of 
midwives and 1.8% of nurses showed a willingness to prepare the study report. We 
can conclude that midwives and nurses need more knowledge and practice in basic 
research methodology. 
11Metka Skubic, PhD, et al.: Experiences and Barriers to Participatory ...
The results also showed that the biggest barrier to all types of research in both 
groups was the lack of research training (midwives 21.9%, nurses 26.5%). The second 
barrier identified in the study was the lack of knowledge regarding research metho-
dology obtained during their studies (midwives 17.2%, nurses 22.9%). Furthermore, 
15.4% of midwives and 20% of nurses expressed that they do not have sufficient 
technical assistance. Other factors identified in the study was the perception among 
midwives (0.9%) and nurses (1.6%) that they do not attend enough events where they 
could present and discuss their own findings. According to the findings of the present 
study, a large proportion of midwives and nurses would like to join in the research pro-
cess in the content planning phase. It is clear that midwives and nurses would like to 
cooperate in participatory research with other researchers. Regardless of their previous 
research experience, both midwives and nurses were willing to join in other phases of 
research, including informing their colleagues and the general public about the study 
results, implementing the new research findings into practice, and participating in data 
collection. There was a statistically significant difference in a greater willingness on 
the part of midwives compared to nurses to be included in the process of preparing 
the research instruments. This might be because of their awareness that Slovenian 
midwifery practice is not yet well-studied; few research articles have been published 
internationally regarding the Slovenian midwifery model. The least desirable phase of 
research was the process of writing the research report, which might be due to a lack 
of skill in interpreting the results and critically communicating the findings. 
Participatory research is, according to several autors (Smith et al., 2008), a planned 
and systematic process in which every phase nearly comprises an individual survey. 
Due to its complex methodology, participatory research can be time-consuming, espe-
cially if the goal is to implement all of the findings into practice (Ehde et al., 2013; 
Bish et al., 2013; Thyer, 2006). Therefore, the fact that midwives and nurses do not 
want to write research reports is completely understandable. The solution might lie 
in research groups, in which the phases of research are divided and assigned to the 
individuals who find the phase appealing. 
The midwives and nurses included in the survey reported several barriers to re-
search in their own practice: (1) a lack of training in different types of research; (2) a 
lack of appropriate knowledge of research methodology gained during their studies; 
and (3) a lack of technical assistance. These are consistent with other research findin-
gs that showed the importance of personal engagement and competence for condu-
cting effective research (Janssen et al., 2013; MacLeod Dyess et al., 2013; Moore et 
al., 2012; Nixon et al., 2013; Smith et al., 2008). Statistically significant differences 
between midwives and nurses were found for three factors: work organization, lack 
of management support, and lack of research cooperation between faculties and other 
health institutions. The results, especially in midwives, highlight the need for and 
the importance of intensive cooperation with employers that can facilitate research 
by creating research groups that help employees gain research experience. Another 
recommendation for practice is to include and implement research activities in un-
dergraduate study programs. Moreover, the active involvement of midwives and nur-
12 Revija za zdravstvene vede (1, 2023)
ses in various interdisciplinary research groups during their studies would help imp-
rove their research abilities and empower them to engage in scientific arguments to 
change their practice (Skela Savič, 2008).
5 Conclusion
The paper focuses on the importance of participatory research to aid midwives and 
nurses in constantly improving their own practice. In this way, participatory research 
can facilitate the continuous professional development of midwives and nurses and al-
low them to practice in an evidence-based manner. A review of the literature (Janssen 
et al., 2013; Moore et al., 2012; Nixon et al., 2013; Reason and Bradbury, 2001; Smith 
et al., 2008) and the results of our study from the perspective of content structuring, 
research aims and methodological participatory research approach, lead us to conclu-
de that almost all of the studies are based on participatory research. The background 
of this can be traced to segments of action or evaluation research, as well as research 
using the methods of deconstruction and redefinition of personal thinking and beliefs 
that direct the individual’s professional operation on the basis of critical awareness 
and reflection processes. High-quality professional work, including participatory rese-
arch, can only be ensured when it is derived directly from practice, from practitioners 
who, in addition to possessing appropriate research knowledge and behaviors, evalu-
ate the health professional’s practice and their role in it through participatory research 
and reflection. This is a precondition for the professional development of health profe-
ssionals. There are several factors that hinder healthcare professionals’ participation in 
and utilization of research, and the utilization of evidence-based practice. Mostly lack 
of time at work, lack of knowledge, lack of funding, a poor attitude towards research, 
and lack of research support services. A persistent preoccupation with identifying the 
barriers to EBP is there mostly because midwives and nurses persist in not applying 
research evidence in practice. The results, which cannot be generalized to the national 
population because the sample was not representative, which is also a limitation of our 
research, have demonstrated the existing situation regarding the beliefs of Slovenian 
midwives and nurses about participatory research. Appropriate knowledge and expe-
riences can positively influence the nurses’ and midwives’ willingness to perform re-
search; therefore, considering the barriers to research identified by study participants, 
study programs should incorporate additional knowledge and research skills. Future 
nurses and midwives in Slovenia need to be educated on the basic principles of the 
participatory and evidence-based research process (Skela Savič, 2008). Furthermore, 
these students should be actively involved in research activities. Collaboration with 
educational institutions, where members of the profession have more research expe-
rience, should be promoted through the educational process. Our non-representative 
research showed that the knowledge and competences gained during studies, such as 
the use and applicability of research in practice, and the conduct of research, impa-
ct self-confidence, cognitive functioning, and perceptions of evidence-based activity 
and participatory research. Overall, participatory research improves professionalism. 
13Metka Skubic, PhD, et al.: Experiences and Barriers to Participatory ...
It is an important component of professional development in nursing and midwifery 
professions.
Dr. Metka Skubic, dr. Anita Jug Došler, Tita Stanek Zidarič
Izkušnje in ovire pri participativnem raziskovanju 
na področju babištva in zdravstvene nege
Načrtovanje in izvajanje raziskav ter uvajanje sprememb v klinično prakso lahko 
izboljša standarde zdravstvene nege in oskrbe babic. Participativne raziskave pri-
dobivajo pozornost pri različnih raziskovalnih pristopih po vsem svetu. V različnih 
poklicih na področju babištva in zdravstvene nege je več poudarka na izvajanju in op-
timizaciji klinične prakse, ob čemer je pri razvoju specifičnih znanj in spretnosti babic 
in medicinskih sester pogosto spregledana potreba po participativnem raziskovanju, 
ki je prav tako ena od njihovih poklicnih zavez. Da bi še naprej zagotavljali najboljšo 
možno oskrbo, obe poklicni skupini potrebujeta raziskovalce praktike, ki razmišljajo 
kritično in ustvarjalno ter v klinični praksi izvajajo raziskave in s tem ustvarjajo novo 
znanje in pomembne spremembe v praksi ter manjšajo razkorak med teorijo in pra-
kso. Med raziskovalci lastne delovne prakse se vzpostavlja struktura sistema, ki teži 
k združevanju raziskovanja in delovne prakse v pomenu kritične strokovne refleksije 
o ciljih, nalogah in procesu strokovnega dela babice in medicinske sestre. To je tudi 
eden izmed argumentov, na podlagi katerega predpostavljamo, da je participativno 
raziskovanje raziskovalni pristop, s pomočjo katerega lahko spreminjamo in izboljšu-
jemo obstoječo delovno prakso ter tako pripomoremo k dvigu kakovosti profesional-
nega dela medicinskih sester in babic. Ocenjujemo, da je lahko eden izmed dejavni-
kov njihovega profesionalnega razvoja. Metodologija participativnega raziskovanja 
lastne prakse nam omogoča uporabo kombiniranih raziskovalnih metod, pristopov in 
tehnik zbiranja podatkov, katerih izbor poteka glede na poklicno področje dela babice 
in/ali medicinske sestre. Merilo uspešnosti raziskovanja lastne prakse je usmerjeno 
k spreminjanju in izboljševanju prakse, ki ima aplikativno vrednost. Raziskovanje in 
vrednotenje (lastne) prakse in dela, ki ga opravlja babica in medicinska sestra, babico 
oz. medicinsko sestro usmerja k vzpostavljanju na dokazih temelječe prakse. Visoko-
kakovostno strokovno delo, ki vključuje tudi raziskovanje lastne prakse, je mogoče 
zagotoviti le, če izhaja neposredno iz prakse, od izvajalcev zdravstvenih storitev, ki so 
neposredno v stiku z uporabniki, uporabnicami in njihovimi otroki, ki poleg ustrezne-
ga raziskovalnega znanja in vedenja vrednotijo svojo lastno zdravstveno strokovno 
delo in svojo vlogo v njem. Slednje je tudi pomemben dejavnik za rast in strokovni 
razvoj zdravstvenih delavcev. Ob tem ne gre pozabiti na dejstvo, da so babice in me-
dicinske sestre zavezane s kodeksom etike k stalnemu obnavljanju znanja, sledenju in 
upoštevanju na dokazih temelječe prakse in sodelovanju pri raziskovanju. Hkrati pa 
se je potrebno zavedati, da ne moremo pričakovati, da se bo vsaka medicinska sestra 
podala v raziskovanje. V Univerzitetnem kliničnem centru Ljubljana so prepoznali po-
14 Revija za zdravstvene vede (1, 2023)
men in potrebo po raziskovanju v babištvu in zdravstveni negi in so ustanovili Skupino 
za raziskovanje v zdravstveni in babiški negi. Namen skupine je med drugim zbiranje 
in obravnava prejetih prijav za izvedbo raziskav, vodenje raziskovalnega registra in 
vzdrževanje mreže raziskovalcev s področja babištva in zdravstvene nege.
Raziskava je osnovana z uporabo kvantitativnih deskriptivnih raziskovalnih metod 
empiričnega raziskovanja in je potekala od aprila 2017 do novembra 2021. Podatki 
so bili zbrani z anketnim vprašalnikom, ki temelji na naključnem vzorcu 228 babic 
in medicinskih sester. Od tega je bilo 72 (31,6 %) babic in 156 (68,4 %) medicinskih 
sester. Povprečna starost babic je bila 35,7 leta, medicinskih sester pa 37,2 leta. Vzo-
rec naše raziskave je sicer premajhen, da bi lahko ugotovitve kakorkoli posploševali. 
Slednje je tudi omejitev naše raziskave. A ne glede na to so rezultati pokazali na do-
ločen trend oziroma obstoječe stanje v Sloveniji v zvezi s proučevano problematiko. 
Analiza podatkov je vključevala osnovno deskriptivno statistiko z izračuni frekvenc in 
odstotkov. Statistično pomembne razlike so bile preverjene z χ2-preizkusom. Namen 
naše raziskave je bil na osnovi ankete analizirati izkušnje in ugotoviti možne ovire za 
raziskovanje lastne prakse s strani babic in medicinskih sester ter kakšne so in kje jih 
vidijo. Raziskovalna vprašanja, ki smo si jih zastavili, so bila: 
(1) Kakšne izkušnje imajo babice in medicinske sestre iz Slovenije z raziskovanjem 
klinične prakse?
(2) V kateri fazi raziskovalnega procesa bi najraje sodelovali? 
(3) Katere so možne ovire za sodelovanje v raziskavah babištva in zdravstvene 
nege? 
Rezultati raziskave so pokazali, da več kot polovica anketirancev (babic in medi-
cinskih sester) ni imela izkušenj z raziskovanjem lastne prakse (tabela 1) (med babica-
mi in medicinskimi sestrami pri tej spremenljivki nismo zasledili statistično značilnih 
razlik). Večina jih je izrazila zanimanje za fazo raziskovalnega dela, ki vključuje načr-
tovanje raziskovanja lastne prakse, najmanj želena faza raziskovalnega dela pa je po 
mnenju babic in medicinskih sester poročanje o zaključnih ugotovitvah raziskovalne-
ga dela. Kar 21,4 % babic je poročalo, da jih zanima zbiranje podatkov. 15,7 % bi jih 
želelo o rezultatih študije seznaniti svoje sodelavce in širšo javnost, 14,3 % pa bi jih 
želelo nova spoznanja raziskave uporabiti v svoji delovni praksi. Med medicinskimi 
sestrami bi se jih največ, 25,5 %, želelo vključiti v vsebinsko načrtovanje raziskave, 
18,8 % pa bi se jih v okviru raziskovalnega dela želelo vključiti v fazo, ko z rezultati 
študije obvestijo svoje sodelavce in širšo javnost. 18,2 % medicinskih sester bi si že-
lelo sodelovati pri implementaciji raziskovalnih ugotovitev v lastno prakso. 17,7 % 
medicinskih sester bi se želelo vključiti v proces zbiranja podatkov. Najmanj zaželena 
faza raziskovanja med obema skupinama je bila priprava na sodelovanje v zadnji fazi 
raziskave; le 1,4 % babic in 1,8 % medicinskih sester je pokazalo pripravljenost za 
pripravo poročila o raziskovanju lastne prakse. Med babicami in medicinskimi sestra-
mi se je pokazala statistično pomembna razlika: več babic kot medicinskih sester je 
izjavilo, da bi želele sodelovati pri pripravi raziskovalnega instrumenta za zbiranje 
podatkov (χ2 = 37,448, g = 1, p = 0,041) (tabela 2). 
15Metka Skubic, PhD, et al.: Experiences and Barriers to Participatory ...
Največje ovire (tabela 3), o katerih so poročale medicinske sestre in babice pri 
raziskovanju lastne prakse, so bile: pomanjkanje usposabljanj (21,9 % babic in 
26,5 % medicinskih sester), ki so vezana na področje raziskovanja lastne prakse, in 
pomanjkanje znanj o raziskovalni metodologiji (17,2 % babic in 20 % medicinskih se-
ster). Poleg tega je 15,4 % babic in 20 % medicinskih sester izrazilo, da pri raziskova-
nju lastne prakse nimajo zagotovljene zadostne tehnične pomoči in podpore. Statistič-
no značilne razlike so se pokazale pri naslednjih spremenljivkah: da babice zaznavajo 
več ovir pri izvajanju raziskav, organizacija dela v delovni organizaciji (χ2 = 28,145, 
g = 1, p = 0,042), pomanjkanje podpore vodstva (χ2 = 30,674, g = 1, p = 0,031) 
ter pomanjkanje sodelovanja med fakultetami in drugimi zdravstvenimi institucijami 
(χ2 = 25,954, g = 1, p = 0,048). Iz dobljenih podatkov (tabela 1, tabela 2 in tabela 3) 
je razvidno, da se slovenske babice in medicinske sestre, vključene v to raziskavo, sre-
čujejo z določenimi izzivi in ovirami in nimajo dovolj možnosti za izvajanje raziskav. 
Naše ugotovitve izpostavljajo potrebo po ozaveščenosti in premostitvi ovir za izvaja-
nje raziskovanja lastne prakse v kliničnem okolju, ki je potrebno za profesionalizacijo 
stroke, optimizacijo in na dokazih temelječo klinično prakso (ang. Evidence based 
practice) babic in medicinskih sester.
Rezultati poudarjajo pomen intenzivnega sodelovanja z delodajalci za lažje us-
tanavljanje raziskovalnih skupin, ki zaposlenim pomagajo pri pridobivanju in imple-
mentaciji raziskovalnih izkušenj, znanj in spretnosti neposredno v delovno okolje. 
Obstaja več dejavnikov, ki ovirajo raziskovanje lastne prakse zdravstvenih delav-
cev in sodelovanje med njimi, kot so: pomanjkanje časa, pomanjkanje znanj in spret-
nosti za raziskovalno delo, pomanjkanje financiranja, slab odnos do raziskovanja in 
pomanjkanje podpornih storitev delodajalca. Skrb za identifikacijo ovir pri uvajanju 
praks, ki temeljijo na dokazih, je prisotna predvsem zato, ker babice in medicinske 
sestre vztrajajo pri neiskanju in neuvajanju na dokazih temelječih praks. Slednje pa 
spodbuja ravno participativno raziskovanje. Znanstveniki s področja babištva in 
zdravstvene nege pomembno prispevajo k trajnosti poklica, na posameznih babicah in 
medicinskih sestrah, strokovnih združenjih, regulatornih organih in financerjih pa je, 
da to pomembno dejavnost podprejo. Bodoče medicinske sestre in babice v Sloveniji je 
treba izobraževati o osnovnih načelih participativnega raziskovalnega procesa. Poleg 
tega bi morali biti ti že v času študija aktivno vključeni v raziskovalne dejavnost. Tudi 
skozi izobraževalni proces je nujno spodbujati sodelovanje z različnimi ustanovami, 
ki ponujajo zdravstvene storitve in kjer ima tamkajšnja stroka že več raziskovalnih 
izkušenj.
Na podlagi pregleda obstoječe literature, rezultatov naše in tujih raziskav smo 
pokazali, da usposobljenost in izkušnje, ki jih imajo babice in medicinske sestre z razi-
skovalnim delom, vplivajo na njihovo kasnejšo pripravljenost za raziskovanje. Ob tem 
pa ne smemo pozabiti, da je za kakovost študija in strokovnega dela babic in medicin-
skih sester zelo pomemben sam prenos oziroma pretok strokovnih znanj med fakulteto, 
ki jih izobražuje, in delovnim okoljem. Menimo, da so izsledki pričujoče raziskave 
pomembni pri nadaljnjem razmisleku, kako urejati in posodabljati programe izobra-
ževanja in nadaljnjega usposabljanja babic in medicinskih sester. In še več, kako jih 
16 Revija za zdravstvene vede (1, 2023)
pri raziskovalnem delu povezati z delovnimi organizacijami, ki babice in medicinske 
sestre zaposlujejo. S tem bi naredili pomemben korak k strokovnemu razvoju in na-
predku, saj tovrstno raziskovanje lastne prakse še ni razširjen standard dela v klinični 
praksi, kjer poklicno delujejo babice in medicinske sestre. Participativno raziskovanje 
je pomembno za nadaljnji strokovni razvoj na področju babištva in zdravstvene nege.
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Dr. Metka Skubic, predavateljica na Zdravstveni fakulteti Univerze v Ljubljani
E-mail: metka.skubic@zf.uni-lj.si
Dr. Anita Jug Došler, asistentka na Zdravstveni fakulteti Univerze v Ljubljani 
E-mail: anita.jug@zf.uni-lj.si
Tita Stanek Zidarič, višja predavateljica na Zdravstveni fakulteti Univerze v Ljubljani 
E-mail: tita.zidaric@zf.uni-lj.si