Taking action to close the research/practice divide

In this paper we focus at the level of individual project to explore aspects of the nexus between research and practice. Using a research project that sought to explore and understand care transitions for older people as the vehicle for our discussion, we examine how the process by which a research project itself is thought about, conceptualized, developed and conducted influences knowledge translation and ways to get research into practice, and conversely practice into research. Processes and strategies we engaged in throughout this research project to promote the transfer of knowledge both among and between researchers, practitioners and the wider practice community are highlighted.     

Research and Practice in an Academic Community Nursing Center

Purpose: To identify issues and describe strategies used in developing a successful program of clinical research focused on the vulnerale populations served by one urban academic nursing center. Academic community nursing centers provide ideal settings to implement programs of research. Understanding the challenges when integrating research into these practices and the strategies used is important.
Setting and Scope: The University of Wisconsin-Milwaukee Silver Spring Community Nursing Center has provided primary health care services to a low-income urban population since 1987. A team of advanced practice nurse clinicians, community health nurses, and other health care professionals and community residents implemented a broad range of innovative, community-focused, clinical inteventions that are routinely studied throughan integrated program of nursing research. Their strategies for research implementation are analyzed.
Conclusions and Implications: Factors affecting the integration of research into the center include (a) community mistrust, (b) the need for participatory recruitment strategies, and (c) the need for multiple data collection methods. Meeting these challenges requires that research agendas and methods are consonant with community goals. The inclusion of clinicians, other providers, and community residents as active members of research teams is critical to success. Reframing research and practice roles in terms of team effort that incorporates the community can strengthen research and practice-and benefit professionals and the populations they serve.     

Optimal Bladder Management Following Spinal Cord Injury: Evidence,Practice and a Cooperative Approach Driving Future Directions in Australia

We examined spinal cord injury (SCI) catheterization practices in Australia to understand practice patterns and consistency with research evidence. A national facilitated discussion forum was held during the annual Australian and New Zealand Spinal Cord Society conference attended by 66 conference delegates. Initially, presentations were given on the latest laboratory research examining bladder changes following SCI; an overview of evidence-based recommendations indicating that intermittent catheterization is best practice; and results of a single-center practice audit that demonstrated substantial delay in transition between acute SCI and intermittent catheterization. The ensuing discussion covered current catheterization practices in both inpatient SCI units and the community and highlighted gaps between evidence and practice, with considerable variation in practice between centers and settings. Reported challenges to implementing best practice included social, economic, and resource factors. A disconnect between hospital and community practice was also identified as an important barrier to long-term uptake of intermittent catheterization following acute SCI. The discussion identified 3 proposed activities: (1) explore current practice and bladder health following SCI in greater depth across SCI units and in local communities through audits and standardized biochemical analysis; (2) determine the behavioral drivers of current practice; and (3) develop a knowledge translation strategy to better align practice with current clinical practice guidelines.     

An Evaluation of How Well Research Reports Facilitate the Use of Findings in Practice

PURPOSE: To analyze how research is reported in journal publications as a potential barrier to use of research findings in practice. DESIGN: Content analysis of 46 reports of diabetes self-management interventions published between 1993 and 2004. METHODS: Data were extracted from the publications using a coding scheme based on concepts from Rogers' theory of the diffusion of innovations. FINDINGS: Authors provided only some of the information potential users need to progress through Roger's stages of adopting an intervention and implementing it in practice. Authors provided only limited information on the target population; frequency, number, and duration of patient contacts; expertise and training required to deliver the intervention; intervention protocol; and the process of adapting and implementing interventions in practice settings. CONCLUSIONS: To close the gap between research and practice, authors should offer more information to help readers decide whether and how to adopt and implement interventions.     

Addressing domestic violence through maternal-child health home visiting: what we do and do not know

Domestic violence (DV) has been described as a public health epidemic. Health care providers of all disciplines encounter victims of DV in every practice setting. However, the vast majority of DV health care research has focused on care provided to victims in traditional acute care and clinic settings. Few investigators have conducted studies with community health nurses (CHNs) who visit DV victims in their homes. CHNs, providing preventive maternal-child health (MCH) care through home visits with families, have been described by some as key providers in DV prevention. However, there is a dearth of knowledge about the actual practice and related outcomes of these nurses when working with families experiencing DV. The purpose of this article is to provide a baseline view of the current state of knowledge on which nurses may begin building future research that leads to evidence-based practice. The article describes the potential role of home-visiting MCH nurses in DV prevention and intervention, provides a critical review of the existing research, identifies primary gaps in scientific knowledge, proposes future research priorities, and makes recommendations for practice.     

Implementation fidelity in community‐based interventions

Implementation fidelity is the degree to which an intervention is delivered as intended and is critical to successful translation of evidence‐based interventions into practice. Diminished fidelity may be why interventions that work well in highly controlled trials may fail to yield the same outcomes when applied in real life contexts. The purpose of this paper is to define implementation fidelity and describe its importance for the larger science of implementation, discuss data collection methods and current efforts in measuring implementation fidelity in community‐based prevention interventions, and present future research directions for measuring implementation fidelity that will advance implementation science.© 2010 Wiley Periodicals, Inc. Res Nurs Health 33:164–173, 2010     

Mental health: what do we know,how did we find it out and what does it mean for nurses?

As part of a qualitative study exploring the health needs of gay men, undertaken in the Lothian area of Scotland (Robertson & Hutcheson 1995), the mental health needs of gay men were elicited through focus groups and individual interviews. A grounded theory approach (Glaser & Strauss 1967) was used to analyse the responses from a sample of 37 gay men. This research followed a social interactionist approach and examined from the respondents' stance the effects of being perceived as deviant and the subsequent impact on self-identity and self-esteem. The findings were that there is a reluctance amongst gay men to disclose their sexuality in health care settings which results in mental health needs remaining unrecognized by health professionals. The research also showed that the respondents faced profound social difficulties when coming to terms with their sexuality, a process that can occur throughout their life time. Those who were married faced the strain of living two lives and cited alcohol misuse and depression amongst the effects of this stressful lifestyle.     

Menopausal hormone therapy: what we know now

OVERVIEW: This article describes the findings and limitations of the major research thus far on hormone therapy, particularly that of the Women's Health Initiative; examines practice recommendations; clarifies common terminology related to menopause and hormone therapy; and provides the implications for nurses. This is part one of a four-part series on postmenopausal health. KEYWORDS: bioidentical hormones, combined estrogen and progestogen therapy, estrogen, estrogen therapy, hormone therapy, menopause, menopausal transition, postmenopause, progestin, progestogen, women's health, Women's Health Initiative.     

Developing evidence-based clinicians

Evidence-based care has heralded an advancement for health with extensive rhetoric and incentives encouraging clinicians to become active participants in practice change. This paper explores two mechanisms-research utilization and systematic reviews--as processes to develop empowerment in clinicians, and develop an ethos of basing practice on research. The intent of these approaches is to create an environment that enables clinicians to seek solutions to practice problems, inform practice decisions and develop practice policy using evidence from research. The goal is to develop evidence-based clinicians who remain active and interested in their practice and who are committed to promoting the application of research to practice. The strengths and weaknesses of these methods are explored within two case studies where they are applied to the management of hypothermia and the efficacy of postoperative observations. Key points of application for each of the methods are outlined in the conclusions.     

Translational research: Connecting evidence to clinical practice

Translational research can be conceptualized within several blocks or spheres of knowledge transfer and focused on closing the gap between new discoveries and their endpoint application to clinical practice, health decision‐making, and health policy. Although support for type 1 translational research (the classical bench‐to‐bedside paradigm) is common, it is types 2 and 3 that have the ultimate impact on sustaining important changes in clinical practice as health decision‐making and policy are changed to support the practice innovation. The Clinical Translational Science Centers (issued by the National Institutes of Health in the USA) provide many successful examples in which nurses are key stakeholders in achieving these translational goals for the improvement of clinical practice.     

Empathy: we know what we mean, but what do we teach?

This article resulted from a paper, presented by the author, at the Hildegard Peplau seminar on the interpersonal role of psychiatric nurses, given at the Highland College of Nursing and Midwifery, Inverness. It discusses empathy — the ability to see things from another person's point of view. That ability is held to be the core characteristic of a helping relationship, but a review of the literature reveals that there is little agreement about how empathy should be defined. Consequently, it is argued that there is a need for nurse teachers to define what they mean by empathy. Failure to do so may result in confusion about what is being taught. Furthermore, it is proposed that all teachers should be trained in experiential teaching methods, and that the effects of structured empathy training should be investigated within an experimental research design.     

Evidence‐based Reviews and Databases: Are They Worth the Effort? Developing Evidence Summaries for Emergency Medicine

A broad range of relevant evidence-based resources within and outside of emergency medicine (EM) collates and summarizes research evidence pertaining to many questions relevant to clinical emergency care. Such resources may or may not constitute the equivalent of health care recommendations, and their relationship to clinical decision-making may be complex. Many efforts in evidence-based medicine resource development, and their products, are marginally relevant to EM practice but may serve as useful models for parallel EM relevant efforts. A trade-off exists between synthesis quality and ease of practitioner access and use. Keeping all such resources up to date is a major challenge. Although observational evidence suggests that dynamic interactivity and information retrieval technology may enhance practitioner utilization, little evidence exists supporting the absolute or comparative effectiveness of different kinds of resources and databases in enhancing evidence uptake or changing clinician behavior.     

Universal donor education and consent: what we know and where we should go

Each day thousands of blood donors across the country are given educational materials and sign a consent form, thus fulfilling two blood collection accreditation requirements. Very few donors will experience a documented adverse event, although a disproportionate number of these events occur in the youngest donor cohort. The literature reflects this disproportion and suggests mitigation strategies. Studies describe subjective, undocumented donor reactions and decreased donor return rates after a documented or subjective reaction. Additionally, studies have shown donor consent form variability among blood collection facilities and that donor comprehension of the educational materials and consent is limited. There are few standardized donor education materials or consent documents. Current accreditation standards for educational materials are limited to aspects of transfusion‐transmitted diseases and for donor consent process and documentation are vague and nonspecific. Recent experiences with young donors and current research compel our community to engage in creating standardized, expanded donor educational materials and standardized donor consent processes and documents.     

The 2014 National Nursing Research Roundtable: The science of caregiving

The National Nursing Research Roundtable (NNRR) meets annually to provide an opportunity for the leaders of nursing organizations with a research mission to discuss and disseminate research findings to improve health outcomes. In 2014, the NNRR addressed the science of caregiving, a topic of increasing importance given that more people are living with chronic conditions and that managing chronic illness is shifting from providers to individuals, their families, and the communities where they live. The NNRR consisted of scientific presentations in which leading researchers discussed the latest advances in caregiving science across the life span and breakout sessions where specific questions were discussed. The questions focused on the policy and practice implications of caregiving science and provided an opportunity for nursing leaders to discuss ways to advance caregiving science. The nursing community is ideally positioned to design and test caregiver health interventions and to implement these interventions in clinical and community settings.     

A decade of research in locus of control: what have we learned?

Locus of control has received considerable attention from nurse researchers over the past decade. A review of nursing studies related to locus of control reveals that the collective results of this research have yielded little information that is useful for nursing practice. It is noted that many of the criticisms levelled at locus of control research at the beginning of the decade are still problematic. For example; most studies are correlational in design; instruments used to measure the construct suffer from reliability and validity problems; researchers have failed in many cases to consider the multidimensional nature of the construct; and in most studies the value of the reinforcer is ignored. If future research in this area is to lead to useful results, nurse researchers must be prepared to move to experimental designs, and must pay greater attention to issues of reliability and validity.     

Communicating with Communities about Emergency Research

The challenge of effectively communicating with communities about research is particularly salient for investigators who are conducting emergency research with an exception from informed consent. The authors discuss the ethical basis for the community consultation requirement and describe the nature and extent of the consultative process required to achieve these ethical purposes. The findings of the consensus conference are summarized as follows. 1) The requirements for community consultation and public disclosure for exception from informed consent studies serve important ethical purposes and should be retained. 2) Community consultation allows investigators and institutional review boards to obtain input from the community regarding planned research. The process serves to facilitate understanding, promote trust, ensure justice, and protect research participants. 3) Community consultation is a process that requires active participation by community members; however, it does not require their approval, consent, or consensus. The practical challenges involved in conducting meaningful community consultation are also discussed: defining the community and its appropriate representatives, methods to actively engage the community, the lack of uniformity among institutional review boards in required community consultation activities, and the lack of measures to evaluate the adequacy and appropriateness of community consultation. The recommendations of the consensus conference regarding future research about community consultation are summarized. Priorities include identifying best practices; defining effectiveness and developing measures to evaluate community consultation; evaluating alternative models and potential infrastructures to facilitate, conduct, and/or oversee effective community consultation processes; and developing educational modules for community members to empower their active participation in discussions about emergency research in their communities.     

Examining the process of community development

AIM OF THE STUDY: To present the results of evaluation research investigating a successful community development project. RATIONALE: Many governments, health care agencies, and organizations require community participation in health care. As a result, nurses and other health professionals are often required to practice using a philosophy of community development. Although the theoretical, philosophical, and practical components of community development are well articulated, there is little evidence that exemplifies the experience of initiating and participating in a community development project. This paper provides evidence of how one organization successfully engaged the broader community on a respite care project. METHOD: Using qualitative research methods and guided by the principles and practices of participatory action research, this evaluation engaged with the community in data collection, analysis, dissemination of finding, and in promoting effective change. RESULTS: Four themes emerged that provide insight into how one HIV/AIDS organization successfully undertook community development. These themes include: (a) identifying a community need; (b) addressing the various components identified in the community development process; (c) highlighting the strategies used to engage in successful community development; and (d) attending to factors that influence community development. CONCLUSION: The results of this research contribute to the body of knowledge related to engaging in the process of community development. By highlighting the experiences of one community group, it is hoped that nurses can learn and incorporate this knowledge into practice.     

First aid for jellyfish stings: Do we really know what we are doing?

Jellyfish stings remains a common envenoming, and yet confusion appears to exist in the community as to the correct first aid. Current guidelines from the Australian Resuscitation Council still recommends ice for most jellyfish stiings, although there appears to belittle evidence to support this. There is more evidence supporting the use of hot water. More research is required to simplify first aid for jellyfish stings.     

Some Theoretical Underpinnings of Knowledge Translation

A careful analysis of the definition of knowledge translation highlights the importance of the judicious translation of research into practice and policy. There is, however, a considerable gap between research and practice. Closing the research-to-practice gap involves changing clinical practice, a complex and challenging endeavor. There is increasing recognition that efforts to change practice should be guided by conceptual models or frameworks to better understand the process of change. The authors conducted a focused literature search, developed inclusion criteria to identify planned action theories, and then extracted data from each theory to determine the origins, examine the meaning, judge the logical consistency, and define the degree of generalizability, parsimony, and testability. An analysis was conducted of the concepts found in each theory, and a set of action categories was developed that form the phases of planned action. Thirty-one planned action theories were identified that formed the basis of the analyses. An Access database was created, as well as a KT Theories User's Guide that synthesizes all the planned change models and theories, identifies common elements of each, and provides information on their use. There are many planned change models and frameworks with many common elements and action categories. Whenever any planned change model is used, change agents should consider documenting their experiences with the model so as to advance understanding of how useful the model is and to provide information to others who are attempting a similar project.