Knowledge Translation in Nursing and Healthcare

A Roadmap to Evidence-informed Practice

Margaret B. Harrison, Ian D. Graham, Ian D. Graham

• Publisher: Wiley-Blackwell
• Year: 2021
• Print ISBN: 9780813811857
• eBook ISBN: 9781119123323
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Knowledge Translation in Nursing and Healthcare provides authoritative guidance on the implementation of evidence-informed practice, covering issue identification and clarification, solution building and implementation, evaluation, and sustainment. Integrating theory, empirical research, and experiential knowledge, this hands-on resource assists nurses and healthcare practitioners in collecting quality evidence, transforming it into a useable, customized recommendation, and then applying best practice in various point-of-care settings.

Written by highly experienced implementation researchers working with practitioners, the book demonstrates how the synthesis and translation of evidence supports improvement of existing care and service delivery models, and produces increased benefit for both patients and health services. Examples drawn from the authors' first-hand experience—such as pressure injury prevention in acute care, transition of care for people with heart failure, and community leg ulcer care—illustrate the use of best practice in addressing care and quality issues. This important reference and guide:

• Outlines a planning framework that activates research and evidence in practice settings, moving knowledge into action and sustaining the use of best practice
• Introduces the framework that enables effective evidence-informed methodology and decision-making
• Features numerous illustrative field examples of both successful and unsuccessful implementations in a variety of practical situations
• Offers perspectives on best practice implementation from experienced practitioners and researchers

Knowledge Translation in Nursing and Healthcareis a must-have for those wanting to implement, evaluate, and sustain best practice in the delivery of evidence-informed healthcare to patients, families, and communities.

1
Introduction

Introduction

Using research evidence in day‐to‐day practice is a lofty and much touted goal found in mission statements of health care organizations and in nursing and other health professionals' associations. Incidentally it began in Florence Nightingale's time with her use of statistics to demonstrate mortality related to the context of care in hospital versus home deliveries for women (Nightingale 1871). Her many frustrations in trying to change policy and practices based on documented evidence have been well studied (McDonald 2001). Those were different times and there were roadblocks related to being a woman, as well as the control of the medical powers of the era. Yet, the reality nearly a century and a half later, is that the effective uptake of research in practice and policy continues to elude us. This is despite modern health care systems, large‐scale investment in research including implementation science, development of international groups committed to synthesizing evidence, and in more recent decades, bodies dedicated to guideline development and translating evidence into practice recommendations.

Good quality evidence that is synthesized and then transformed into recommendations for practice provides the basis for evidence‐informed practice (EIP). On the surface this seems like a simple enough task for practitioners and clinical managers to action, but why is it so difficult to do when the evidence that should be applied at the point‐of‐care is now widely available?

As nurses well know, the point‐of‐care environment is tremendously complex and dynamic with multiple internal and external influences. These complexities face the “simple” task of using evidence housed in a single evidence‐informed recommendation, or even more complicated, a guideline consisting of multiple, sometimes dozens of recommendations. For example, consider the one recommendation commonly found in most guidelines, for a daily head‐to‐toe skin assessment for pressure injury prevention with complex patients. Factors at play include the patient's condition, nurse's time, team workload, ward environments, availability of a second set of hands for turning, other unscheduled admissions, more urgent duties related to attending to high‐tech equipment, patient/family considerations, the nurse's skill and knowledge of risk scales, as well as organizational documentation and referral procedures in the presence of unacceptable risk. On the surface a straightforward task, yet in the field, away from the guideline expert table it involves a quagmire of challenges.

Our journey implementing evidence at the point‐of‐care in healthcare settings started in the midst of the “best” practices movement in the late 1990s to the early 2000s. Our implementation work brings together the theory and research of Knowledge Translation (KT) with our actual experience with initiatives across sectors encompassing community nursing and hospital practice and transitional issues. Much of this work addresses system aspects as well as point‐of‐care practice issues. We have learned how to activate good quality evidence efficiently and effectively. For nurses and others that we worked with, evidence was viewed as a “means to an end” in improving the quality and efficiency of care and patient health outcomes. For them, and for us, the beginning step was basing practice and health services reorganization on the best available external evidence while considering “local” evidence about the context where implementation was to occur. The journey often included research processes such as environmental scanning to understand the available resources (or lack thereof), or undertaking a prevalence, incidence and population profile enquiry to determine the magnitude of the health issue (i.e. the evidence‐practice gap) and determining patients' characteristics and their preferences. For successful uptake, collecting data about the local context is absolutely essential in order to align the external best practice evidence with the local context and population(s).

At the time, knowledge tools such as high‐quality guidelines or other evidence‐informed protocols were becoming plentiful ‐ the quest was to use them to guide day‐to‐day practice. Without fail, there was a sense that “we can do better” and maybe even be more efficient. Improvement in patient outcomes was foremost, but outcomes for practitioners themselves and the settings in which they practiced were also important. Thus, another underlying motivation was to improve professional practice and satisfaction with the care nurses delivered and accomplish it in the most cost‐efficient manner. Believe it or not, this is possible as you will see in some of our examples.

The mantras of the day, “best practices,” “research‐based practice,” “evidence‐based practice” and “evidence‐informed practice” were being integrated in quality portfolios and mission statements at the organizational level of hospitals and home nursing agencies, as well as at the team level across the continuum of care. It was during this time as researchers that we were actively involved with groups striving to meet this mandate and finding ourselves engaged in the day‐to‐day practice of settings. In this way we discovered how teams move forward with this mission, how they built strategic alliances, engaged decisions‐makers, and understood the range and types of reorganization necessary to deliver evidence‐informed care. At the time there was a lack of implementation tools for our practitioner colleagues to support the transformation. They typically found it exceedingly complex to successfully align and activate external evidence with their local context.

After being approached to help, we began developing frameworks and tools to bring structure to the evidence‐to‐practice process. We referred to it as the knowledge to action process (Graham et al. 2006), since it is almost always about more than research evidence. This is a point to ponder. The external evidence available from the research literature, syntheses, and knowledge tools such as guidelines, is a starting point. But much more goes into the process of implementing them that includes what we refer to as “local evidence.” This is about the population and context, the experiential knowledge, and ethical knowing about the context. All of these contribute to best practices and their implementation and must be taken into consideration for success.

The purpose of this book is to build on the current state of implementation knowledge by integrating theory and empirical knowledge with experiential knowledge that we have gained in facilitating implementation of evidence in practice settings. It is intended to create a “how to” for nurses and others wanting to, or being responsible for, facilitating the uptake of evidence in practice or de‐implementation of ineffective practices (Hanrahan et al. 2015; Montini and Graham 2015; Niven et al. 2015; Helfrich et al. 2018; Rietbergen et al. 2020). Our aim is to provide a practical resource for those wishing to put into service best practices at the point‐of‐care. The specific objectives for the book are to:

1. Outline a general planning framework that activates knowledge (research, evidence) in practice settings.
2. Provide an action plan with strategies to engage the necessary alliances for decision‐making, methodological, and practical support.
3. Describe in operational terms, strategies to move knowledge into action and to sustain the change.
4. In Call Out boxes we offer examples from implementation efforts (successful and not so successful) to illustrate the process.

Activating Evidence in Practice

Evidence‐based nursing or practice is described as “integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities who are served” (Sigma Theta Tau International 2005–2007 Research and Scholarship Advisory Committee 2008). As DiCenso et al. (2005, p. 9) argued some time ago, evidence‐based nursing is focused on more than empirical knowing. Drawn from Carper (1978) four ways of knowing (empirical, personal, ethical and aesthetic) as a foundation, Dicenso et al. (2005) also articulate the importance of clinical experience and knowledge, patient preferences and values, and resource implications for EIP in nursing. Melnyk and Fineout...

Table of contents

• Cover
• Table of Contents
• Title Page
• Copyright Page
• Dedication Page
• About the Authors
• Acknowledgments
• Foreword
• Glossary Terms (Alphabetical): Related to the Implementation of Evidence‐Informed Practice
• 1 Introduction
• 2 Perspectives from the Field
• 3 Guiding Theories, Models, and Frameworks
• 4 A Roadmap for Implementing Best Practice
• Part 1: Phase I: Issue Identification and Clarification
• Part 2: Phase II: Build Solutions
• Part 3: Phase III: Implement, Evaluate, and Sustain
• Index
• End User License Agreement