nursing experts translating the evidence

nursing experts translating the evidence

Enhancing the Translation of Evidence by Nursing Experts

1. Introduction to Evidence Translation in Nursing Practice

Pronovost identifies how a cultural and systemic failure occurs when there is a lack of translation of what we know works in healthcare and the improvement of what we do every day. This excellent perspective highlights the difficulties faced by anyone in healthcare seeking to enhance the quality, safety, and experience of care delivery. Knowledge linked to clinical practice underpins all nursing activities. Nursing relies on the best evidence to enhance patient outcomes, calculating, reporting, sharing, learning from nursing knowledge and evidence, and how this can be used in clinical practice to further improve patient outcomes is paramount. There is some evidence to suggest that nurse-delivered or led interventions can have a positive effect on patient outcomes, but that their effectiveness can be significantly limited when nurses’ evidence translation is not enhanced.

Many barriers for enhancing the translation of evidence into nursing practice exist, and this affects the ability of nurses to provide patients with the best care by which to achieve optimal outcomes. These barriers not only vie with the delivery of care but also with how care is assessed and the increasing demand to demonstrate that safe, high-quality care is given, and the improvement of the clinical service productivity in terms of reliability and responsiveness facilitate the growth and development of nurses’ skills. As nurse involvement in the design and implementation of evidence-based practice activity grows, it is important to value the ways by which the evidence generated is then used to enhance the nursing delivery of these activities into clinical practice. Using evidence to fully realize the potential of nursing care delivery is increasingly important. In order to address and improve the amount and quality of evidence that is used to transform patient outcomes, Hamric discusses nursing being a key player in the process of considering the drivers of current transformation effected by disruptive innovation in higher education, the use of evidence-driven decision-making in clinical settings, and the increased demand for skilled healthcare workers.

2. Challenges and Barriers Faced by Nursing Experts

There are many barriers specific to the clinical, education, and administration roles of nursing that all nursing personnel struggle with, including physical, mental, and financial well-being. These issues can lead to reluctance to be involved in evidence-based practice in healthcare settings as well as in nursing education. This section will identify some of the key factors across nursing roles that interact to interfere in ways that obscure efforts to bring the most critical information and expertise learned by nursing in practice to the movement of evidence into healthcare settings. There are high moral and ethical standards in nursing fields. There are two key promises to the public: first, do no harm; and second, promote the well-being of our patients to the best of our individual ability. The anecdotal and evidence-based experiences tackling each subsection of this section speak to the dissolution of these moral and ethical challenges faced by experienced practitioners, educators, and administrators.

Nurses with expertise have developed specific skills in how to react to various clinical situations. Their nursing knowledge comes from the real work context where meaning exists in the actions and interactions with those to whom they are assigned. Second, nurses embody clinical thinking processes and develop them in their areas of practice. This ability to reflect-in-action requires significant tacit knowledge of themselves and the context in which they act. This is the clinical thinking ability built from the meaningful engagement that differentiates a novice from an expert nurse. Third, nurses have a high degree of involvement with the medical or healthcare problems affecting care recipients, their families, and with having improved patient outcomes. The nursing orientation toward problem-solving, preserving patient dignity, and offering superior care are central to nursing’s moral practice. These key expert-nursing attributes are developed and ingrained during years of direct contact with care recipients and colleagues. However, at the same time, a problematic irony regarding work has emerged.

3. Strategies and Best Practices for Effective Evidence Translation

A synthesis of the literature focusing on research translation (RT) addressed the growing consensus of methods and best practices used by researchers whose work facilitates the movement of scientific evidence into practice and policy arenas. Five strategies emerged: (a) actively engage both scientific experts and stakeholders in the research, (b) identify and collaborate with those who can have an influence on RT, (c) involve experts in the RT process, (d) create and foster relationships and networks with stakeholders who influence the scale, speed, and sustainability of RT, and (e) communicate and interact with end users. Activities associated with effective translation can be accomplished by individuals or research teams and academic organizations. Regardless of who performs the activities, adherence to the principles of scientific rigor, relevance, and reach is critical. This chapter, focusing on nursing experts, extends this previous body of work.

In order to narrow the wide gap that exists between research and practice, there is growing emphasis on strategies to encourage evidence-based nursing practice. Some nursing scholars advocate a focus on the role of nursing content experts in moving evidence into policy and practice, leading to an improved balance of patient-relevant evidence with widely felt clinical problems. However, the potential actions that can be taken by researchers are less well defined. Nurses most often cite journal reading as their main resource. For evidence to be used, there must be a motivated audience for empirical evidence, high quality, and relevant work from a trusted source available. Historical responses include collaboration, consultation, and specialist clinical roles. In the context of deepening specialty knowledge bases, peer support and consulting services are time-consuming, complex and costly uses of educational resources. Providing quality over quantity is preferable as the main function of the academic field. On the basis of this understanding, much recent nursing and midwifery educational policy debate, particularly in doctoral education, has focused on the generation of nurse academics who have a specialist research role, contrasting with developments in the nursing profession where the value of clinical experts or expert generalists is matched with the specialty education and development of practitioners. Data derived from in-depth interviews and a focus group involving nurses, nurse educators, health service researchers, and managers, specialists, and expert generalists will be used to explore the research literacy needs and the sources of research expertise used, or called upon, by specialist and expert generalist nurses alike. The implications for the development of clinical research expertise on advanced clinical pathways will be outlined in conclusion.

4. The Role of Technology in Facilitating Evidence Translation

Barriers to using research in practice can be mitigated with electronic technology, which can increase accessibility and prevent the duplication of efforts. The computer brings information to the analysis and judgment of the professional. How health professionals access information beyond memory can be structured and stored in print and other learning resources that have been published. The increasing volume and complexity of these resources make them too extensive for health professionals to understand in a timely way. However, evidence suggests that this is the most effective way to use evidence-based knowledge to help plan healthcare decisions. Therefore, there is no doubt as to the appropriateness of individuals, organizations, and healthcare systems using information systems and the appropriate tools for their staff to make research decisions or questions when needed.

Research offers a motivating way to improve nursing practice within the framework of evidence-based nursing. The development of information and recommendations faced by nurses is an essential step in evaluating new technologies developed for nursing practice. There have been significant innovations in the way organizations and certain nurses can manage the use of information systems to make research decisions. The current goals of health services research for information are ambitious, as they include enabling good visualization at the point of care by providing objective and reliable research and forming the basis for transparency of knowledge. Technological advances will accompany the challenges in creating that capacity and translating the evidence together.

5. Future Directions and Recommendations for Nursing Experts

From this review, it is clear that nursing experts have a great deal to offer the field of evidence-based practice and health care in general by adding layers of important knowledge, experience, and insights to existing efforts focused on knowledge translation. The need for these perspectives and insights is endorsed in the discussions around the pressing need for rigor and sensitivity to clinical context in evidence translation efforts. Nursing experts who work as advanced practice or specialty nurses (nurse practitioners, clinical nurse specialists, and nurse midwives) or who are engaged in leadership roles such as chief nursing officers or directors of nursing are also well positioned to influence and improve health care policy, support effective evaluation of practice changes, and ensure that organizational mandates and resources are aligned to support evidence translation activities that are led by nurses involved in direct care.

With technology solutions being increasingly offered as ways to further enable stakeholder participation in complex decision processes, including making sense of scientific evidence and context, taking advantage of the growing range of expertise across this stakeholder continuum is becoming less logistically challenging. As a result, it is now feasible for nursing experts to deliver training and support services via telementoring, telecoaching, or other online facilitation methods and also potentially tap into extended networks to promote ongoing accelerated changes in practice. By demonstrating and sharing the ways that they are able to contribute meaningfully to team activities related to interpretation, application decision making, and evaluation of scientific evidence, nursing experts will bolster their position within both the evidence-based practice decision-making process and the health care system.