隐性知识在护理临床实习带教中的应用

目的 探讨护理隐性知识在临床带教工作中的应用.方法 严格选拔临床带教老师；护理隐性知识培训；护理隐性知识开发、整理归类,使其显性化,建立科内隐性知识的共享机制；组织各种活动,提供交流的机会,促使护理隐性知识的传递和共享.结果 护生临床分析问题和解决问题的能力有了明显的提高；理论考试和操作考核成绩令人满意；病人满意度提高；在教与学双向测评中优良率逐年提高.结论 临床实习是护理隐性知识传递和转化的主要过程,在护理教学中护理隐性知识教育占有相当重要的地位,隐性知识的传播对于提高护理临床教学质量具有重要的意义.     

知识转化的概念及理论框架

知识转化是将临床研究证据或以研究证据为依据的临床实践指南运用于临床实践当中,改善临床实践,促进执行者行为改变,提高患者服务质量。知识转化在国外发展迅速,而国内对知识转化的认识刚起步。为了促进知识转化在我国的发展,本文将重点阐述知识转化的概念及理论框架等内容,探讨其对临床实践的重要价值。     

推动证据向临床转化 (二)如何选择知识转化理论模式

本文作为证据临床转化方法学系列文章的第二篇,旨在详细阐述如何选择合适的知识转化理论模式,以指导和促进证据向临床的转化。本文分析了理论、模式和概念框架的内涵,并介绍了5个知识转化领域最常用的理论模式,包括KTA知识转化框架、渥太华研究应用模式、PARIHS框架、复旦循证护理路径图和基于证据的持续质量改进模式图。在此基础上,分析了在推动证据临床转化的过程中,选择合适的知识转化理论模式的重要性、依据及应注意的问题。     

知识转化理论在临床实践中的应用进展

综述了知识转化定义、分类、理论框架以及目前在临床实践中的应用,旨在鼓励我国护理人员将循证知识转化为临床实践,并为其提供理论框架、转化思路和方法指导。     

社区居民乙型肝炎患者自我保健知识的调查研究

目的 了解城市社区居民中乙型肝炎(以下简称乙肝)患者自我保健知识的程度。方法 采用Slno-MONICA方案。对城市社区自然人群15～74岁177例乙肝患者进行乙肝自我保健知识问卷调查，并对资料作相应的KAB值分析。结果 城市社区居民中乙肝患者自我保健知识平均知晓率为31．78％、信念率86．63％、行为率65．26％；对乙肝自我保健知识的KAB值随着文化程度的递增而升高，且呈线性关系。结论 对城市社区居民中乙肝患者自我保健知识教育需区分不同文化层次对象进行，并进行反复强化与教育，以提高KAB值；使社区中乙肝患者的自我保健能力转化为一种自觉性、常规性、随时性的保健行为。     

基于SECI知识转化模型的护士核心能力培养

目的:探讨基于组织层面、全局的护士核心能力的培养方法,营造培养护士核心能力的组织氛围。方法:阐述了知识的定义和分类(显性知识和隐性知识两类),介绍了显性知识和隐性知识相互转化的4种形式即SECI知识转化模型,分析了护理核心能力的知识属性。结果:分别从知识社会化、知识外显化、知识组合化和知识内隐化角度提出了培养护士核心能力的具体措施。结论:SECI知识转化模型为培养护士核心能力提供了理论依据,使培养方法能够站在组织和全局的高度,更具有系统性。     

证据转化中心简介及应用

证据转化中心(Clearinghouse)在西方发达国家的知识转化中发挥着重要作用。其运用特定主题,针对特定的目标人群,以其严格的评价标准持续不断地向用户提供最新证据。证据转化中心要求客观透明地评价研究证据的科学性及实用性,为不同服务实践者提供当前最佳证据。其注重从"知识生产"到"知识转化"过程的这一特点,有效填充了研究与实践之间的鸿沟,未来必将在知识转化方面发挥重要作用。本文详细介绍了证据转化中心的历史、特征及其应用,举例说明中国儿童与老年健康证据转化数据库的建立,更加充分地体现其应用现状,为我国的知证决策提供参考。     

EB病毒转化外周血淋巴细胞建立永生细胞系方法的研究

目的保存家族性疾病家系成员特有的基因组资源，为进一步研究奠定物质基础。方法应用EB病毒（Epstein-BarrVirus）转化外周血B淋巴细胞建立永生细胞系，分别采用4种方法：（1）外周血淋巴细胞转化法；（2）外周血淋巴细胞冻存转化法；（3）微量全血转化法；（4）微量全血冻存转化法。结果4种方法建系结果分别为：外周血淋巴细胞转化培养20株；外周血淋巴细胞冻存转化培养4株；微量全血转化培养4株；全血冻存转化培养4株，总计32株建系均获成功。成功转化的细胞体积增大，形态多样，增生的细胞多聚集成团。所有的细胞株冻存后复苏的成功率为100％。结论该研究提供了家族性疾病永生细胞系的建立方法，同时也为在分子水平上揭示家族性疾病的发病机理提供了DNA材料。     

护理研究成果在临床应用中阻碍因素的调查分析

摘要：目的 探寻护理研究成果应用中的阻碍因素，以促进护理成果的转化。方法 对从事临床护理工作的４８６名护士进行问卷调查，并对阻碍护理研究成果应用的因素进行统计分析。结果 没有权力更新护理常规或技术操作规程、护理研究可信度不高、对护理研究缺乏认识、没有知识丰富的同事共同讨论新观点、没有时间去阅读护理文献及试用成果分别占９２．６％、８３．５％、７０．０％、６０．７％、５１．０％及５３．５％，是重要的阻碍因素。结论 管理部门应重视护理成果的转化，及时更新护理常规及技术操作规程，组建成果应用合作团队等，以加速成果的转化。关键词：护理学；　研究成果；　应用；　阻碍因素中图分类号：Ｒ４７；Ｃ９３１　　文献标识码：Ｃ　　文章编号：１００１-４１５２（２００７）１５-００５８-０２     

提高临床护士解决问题能力的方法探究

在临床工作中，许多新护士存在着机械地记录并向医生反应有关病人的某些症状，护士缺乏独立思考能力，不能独立地运用护理知识为病人解决常见的护理问题，显示出强烈的依赖性和盲目性。从1995年8月～2000年8月我们共对210名低年资护士进行系统的解决问题能力培训。（1）加强解决问题的态度训练，通过培养护士高度的责任心和事业心，靠自己的思维决策为病人解决问题，树立护士的专业自信心等三个方面进行态度训练；（2）把思维训练和护理学科相结合；（3）从病人整体状况出发把握局部与整体之间的关系；（4）注重基本知识学习，促进知识的迁移；第五，促进新手向专家的转化。通过上述方法培训，提高了护士对临床问题思考、推理及综合利用知识的能力，大大提高了护理质量和护士的整体素质。     

From Evidence-Based Practice to Knowledge Translation: What Is the Difference? What Are the Roles of Nurse Leaders?

ObjectivesNurses, as the largest healthcare workforce, are well-positioned to apply knowledge translation. The role of nursing leadership in facilitating evidence-based practice has been extensively discussed in the literature, but this is not the case for knowledge translation. The objective of this study was to examine the potential role of nurse leaders in applying knowledge translation across health settings.Data SourcesWe reviewed the existing literature for evidence-based practice as best practice in clinical care; examined how a complex systems approach to knowledge translation may extend beyond evidence-based practice, and considered nursing leadership approaches including transformational leadership.ConclusionIn this discursive article, we discuss the differences between evidence-based practice and knowledge translation, highlight the promise of transformational leadership in facilitating knowledge translation through a complex systems lens, and argue for the importance of nurse leaders in facilitating and supporting complex knowledge translation across healthcare settings.Implications for Nursing PracticeAlthough future research is needed to test our ideas, we argue that the advanced conceptual understanding generated in this article should inform a roadmap toward a future in which nurse leaders initiate, participate and advocate for complex knowledge translation across healthcare settings.     

Examining Appreciative Inquiry as a knowledge translation intervention in pain management

Despite a solid evidence base for pain management, pain is not always well managed in practice. Interventions to implement pain management evidence need to be shifted from a focus on individual characteristics to knowledge translation strategies that are grounded in theory and attend to the organizational context and social dimension of translating evidence into practice. The authors examine Appreciative Inquiry (AI) as an innovative knowledge translation intervention in the area of pain management in nursing. Their aims are to advance the current state of knowledge translation interventions in pain management and to examine the usefulness of potential interventions based on their congruence with theory. The theory and practice of AI are compared to the concept of knowledge translation and the elements of the Promoting Action on Research Implementation in Health Services framework. Discussion is grounded in pain management in nursing.     

Using consciousness-raising principles to inform modern knowledge translation practices in women's health

In traditional models of knowledge translation in health care, the "expert" researcher disseminates empirical knowledge in a top-down manner to practitioners. Newer approaches extend our view of who needs to be involved in knowledge translation, what counts as evidence, and how knowledge exchange can be facilitated. Multisectoral participation and processes for collective synthesis of evidence increase the potential for the application of knowledge in practice and policy in ways that are mutually reinforcing and address structural inequities. The author examines the use of feminist consciousness-raising practices in virtual communities of practice as a viable framework for knowledge translation on complex health issues. Using the preliminary findings ofa study, she discusses how collective analysis in collaborative processes--which is at the heart of feminist action research--leads to engaged action by participants.     

The need for systems change: reflections on knowledge translation and organizational change

Title.  The need for systems change: reflections on knowledge translation and organizational change.
Background.  Despite over 40 years' work on general systems theory, informed by critical social science, there is a mismatch between the theories used to explain and influence clinical practice in nursing and the way in which transferring new knowledge into practice is articulated.
Data sources.  The analysis and emerging propositions were based on a critique of seminal texts published in English up to 2008 covering critical social science, action science, diffusion of innovations, practice development and the management of innovations.
Discussion.  There is an implicit adherence to the world view that healthcare systems operate like machines, and much of the science generated around knowledge translation research tends to be logico-deductive. This is in direct contrast to the prevailing arguments of general systems theorists, who view the system more as an organism. Five propositions are posited: knowledge translation is a necessary but not sufficient mechanism to transform systems; the 'system-as-machine' metaphor is profoundly unhelpful to knowledge translation; the healthcare system is best viewed as a complex entity; successful innovation is a function of the level of local autonomy experienced by individuals, teams and the unit involved; innovation is most effective when it involves key stakeholders.
Conclusion.  The purposeful integration of systems theory with knowledge translation theories and models may enable the application of research and new knowledge to practice to be speeded up.     

Easing the transition between hospital and home: translating knowledge into action

Knowledge translation is an interactive, dynamic approach to the uptake of evidence-based knowledge. In this article, the authors present a collaborative model for knowledge translation that grew out of a program of research focusing on the experiences of patients from ethnoculturally diverse groups as they were discharged home from hospital. Research findings highlight issues around gaps in the continuity of services and language and communication. The authors discuss a number of knowledge translation initiatives that were developed to address these gaps. Key to the success of this process has been a collaborative relationship between researchers and practitioners that is grounded in the shared goal of knowledge translation to support ethically sound decision-making in the delivery of health-care services.     

Translational research: essential contributions from interpretive nursing science

Translating research into practice is a central priority in the National Institutes of Health Roadmap. Nurse scientists must reevaluate how proposed research fits within and contributes not only to the development of new knowledge, but to the translation of that knowledge to the care of diverse communities and populations. Key barriers to the translation of evidence based practices in health programs and initiatives have been identified in the health services and nursing literature. Contributions that interpretive research approaches enable in addressing those barriers are articulated.     

Pursuing common agendas: a collaborative model for knowledge translation between research and practice in clinical settings

There is an emerging discourse of knowledge translation that advocates a shift away from unidirectional research utilization and evidence-based practice models toward more interactive models of knowledge transfer. In this paper, we describe how our participatory approach to knowledge translation developed during an ongoing program of research concerning equitable care for diverse populations. At the core of our approach is a collaborative relationship between researchers and practitioners, which underpins the knowledge translation cycle, and occurs simultaneously with data collection/analysis/synthesis. We discuss lessons learned including: the complexities of translating knowledge within the political landscape of healthcare delivery, the need to negotiate the agendas of researchers and practitioners in a collaborative approach, and the kinds of resources needed to support this process.     

Knowledge Translation: The Bridging Function of Cochrane Rehabilitation

Cochrane Rehabilitation is aimed to ensure that all rehabilitation professionals can apply Evidence Based Clinical Practice and take decisions according to the best and most appropriate evidence in this specific field, combining the best available evidence as gathered by high-quality Cochrane systematic reviews, with their own clinical expertise and the values of patients. This mission can be pursued through knowledge translation. The aim of this article is to shortly present what knowledge translation is, how and why Cochrane (previously known as Cochrane Collaboration) is trying to reorganize itself in light of knowledge translation, and the relevance that this process has for Cochrane Rehabilitation and in the end for the whole world of rehabilitation. It is well known how it is difficult to effectively apply in everyday life what we would like to do and to apply the scientific knowledge in the clinical field: this is called the know-do gap. In the field of evidence-based medicine, where Cochrane belongs, it has been proven that high-quality evidence is not consistently applied in practice. A solution to these problems is the so-called knowledge translation. In this context, Cochrane Rehabilitation is organized to provide the best possible knowledge translation in both directions (bridging function), obviously toward the world of rehabilitation (spreading reviews), but also to the Cochrane community (production of reviews significant for rehabilitation). Cochrane is now strongly pushing to improve its knowledge translation activities, and this creates a strong base for Cochrane Rehabilitation work, focused not only on spreading the evidence but also on improving its production to make it more meaningful for the world of rehabilitation.     

A thematic analysis of theoretical models for translational science in nursing: mapping the field

The quantity and diversity of conceptual models in translational science may complicate rather than advance the use of theory. This paper offers a comparative thematic analysis of the models available to inform knowledge development, transfer, and utilization. Literature searches identified 47 models for knowledge translation. Four thematic areas emerged: (1) evidence-based practice and knowledge transformation processes, (2) strategic change to promote adoption of new knowledge, (3) knowledge exchange and synthesis for application and inquiry, and (4) designing and interpreting dissemination research. This analysis distinguishes the contributions made by leaders and researchers at each phase in the process of discovery, development, and service delivery. It also informs the selection of models to guide activities in knowledge translation. A flexible theoretical stance is essential to simultaneously develop new knowledge and accelerate the translation of that knowledge into practice behaviors and programs of care that support optimal patient outcomes.