With the continued focus on evidence-based practice (EBP) and translational research, nurses find themselves in the midst of discussions on how best to disseminate the results of both clinical outcomes and traditional research projects. We continue to ask how best to narrow the actual and perceived gaps between research and practice. We look for ways to better mobilize knowledge. To roughly paraphrase one of our research colleagues, DaiWai Olson, we have to prove, by using evidence, that we "own the bedside." We must better negotiate the move from science to service.
No one questions the important role research plays in improving nursing care and patient outcomes. The gaps between research and practice may be the result of a host of factors, including "limited time and resources of practitioners, insufficient training, lack of feedback and incentives for those who implement evidence-based practices, and inadequate infrastructure and systems [horizontal ellipsis] to support translation" (Glasgow, Lichtenstein, & Marcus, 2003, p. 1261). The challenge is not to do the research but to disseminate it. What exactly does this mean? Dissemination is an active process that moves evidence-based interventions from research settings to the practice arena. Dissemination is the process that puts evidence into action.
Barriers to research dissemination in nursing have also included questions about the merits of some research studies, relevance to real-life, direct-care practice, the readiness of the findings for use, and lack of replication. And, despite the wealth of research and evidence-based findings available as practitioners move the mouse and click, many nurses still report feeling inadequately prepared to access reports, read and critique them, and then apply the results to their specific patient populations. We are forced to ask ourselves whether the current mechanisms for dissemination are adequate.
Many of us rely on nursing journals and professional research conferences as the mainstays of research dissemination. Although these mechanisms provide a means of relaying information to a relatively wide audience-particularly through journals-they are far from perfect and may leave many practitioners and research studies themselves "out of the loop." Only a small percentage of all of the nursing research conducted is ever published; the time lag between the actual research and its publication may be delayed by several years. The technical reporting style of many studies may be difficult to understand and from which to draw clinical significance. For example, how many of us actually think about odds ratios or Kaplan-Meier analyses on a daily basis? Not I, and I edit a journal that regularly publishes research findings and evidence that supports knowledge growth.
So, how do we move forward? How do we use research and evidence to demonstrate our ownership of the bedside? We could take our cue from the National Cancer Institute. In 2004, they sponsored a series of meetings-Dialogue on Dissemination-to discuss the development of research and implementation agendas for dissemination. Although the group identified two very broad areas that would create changes in how research is moved from science to service-building onto existing infrastructures such as the Agency for Healthcare Research and Quality (AHRQ) Practice-Based Research Networks and building an agreed-on set of conceptual models-they also delineated more specific, and perhaps more immediately useful, strategies we can continue to use today. The following strategies might provide us with additional ways to mobilize knowledge:
* Increasingly demand and encourage a culture of EBP within all healthcare organizations.
* Support senior-level executives and managers who are willing, and able, to serve as champions of EBP.
* Strengthen team-based approaches to process and practice improvement.
* Support systems assessments that encourage practitioners to modify their care in response to new knowledge.
* Ask organizations that develop evidence-based guidelines to engage stakeholders in the processes used to synthesize the evidence so the knowledge is grounded in both science and practice.
* Support work that studies the factors that motivate middle-to-late adopters to change their clinical practice and that looks at agents for change.
* Support work that studies contextual reinforcers (e.g., models of care that are team focused, ways to protect autonomy and clinical judgment in the face of evidence-based standardization of interventions).
To successfully move research findings (science) to our patients' bedsides (service) and to consequently build knowledge, we must read, question, reread, experiment and talk to each other.
Reference