In this third issue of the new JWOCN, it is time to reflect on the changes. As the journal's Editor, I believe I can speak for the WOCN Board when I say that we are delighted with our new publisher, LWW, and hope that you are equally pleased with the new product-your journal. Compare your May 2003 issue to the May 2004 issue. We welcome your impressions of the new layout: the cover, page layout, color in the articles, table of contents, supplements, Web site (WOCN.org-Publications), and any other impressions you have. Please e-mail us at [email protected], and give us feedback on what you like or what you would like improved. Although we cannot guarantee that all suggestions will result in changes, they will all be taken seriously. Look for the upcoming special issues: pediatrics in July 2004, bariatrics in November 2005 (see call for manuscripts in this issue), and ostomy in 2006.
When in the mood for evaluating, consider the abstracts included in this issue and prepare for the 36th Annual Conference in Tampa in June. You can also check abstracts on the Web site at WOCN.org. The conference is a time for networking, education, and critical appraisal of one's practice. Ask yourself: Since attending WOCN Annual conferences, what have I changed or reconsidered in my own practice? Have you changed anything? Has any of the research presented at the conference been implemented into your practice? For example, 2 years ago, Dr Kathy Getliffe presented a fine evidence-based review of management of long-term catheters and subsequently published the paper in JWOCN.1 This article is indexed on Medline and CINAHL and is readily accessible to all WOCN members through the JWOCN Web site or through PubMed. Nevertheless, questions on catheter management continue. I receive many calls and e-mails from nurses in home care and long-term care asking advice about catheter management, and the WOC forum often has questions about catheter management. Why is it that so often, research findings do not make their way to the practice setting?
Implementing research into practice, or knowledge utilization, is the topic of a series of Spotlights on Research that were launched in the January 2004 issue. These Spotlights, combined with the Evidence-Based Report Cards, particularly the March issue on Advanced Concepts for WOC Nursing Practice, are tools to assist in critiquing both the literature and one's own practice. Dr Gray and colleagues presented ways to read the literature that also apply to reading the research abstracts and the research posters at the conference.2 They provided the pneumonic PICO + M to remember when reviewing a manuscript or conference abstract. P indicates patient or problem, I indicates intervention, C indicates a comparison between or among treatment alternatives, and O indicates outcome. A fifth letter, M, occasionally is added, and it represents method. Issues related to research method are critical when applying evidence-based query techniques to generate knowledge for clinical practice.
However, implementing research into practice goes far beyond an individual nurse identifying a potential issue on a research poster, no matter how significant the idea. For example, based on a review of the literature and conference presentations, there is good evidence that in rehabilitation settings, the incidence of bacteriuria and symptomatic urinary tract infection is no different between patients who use sterile or clean intermittent catheterization. Armed with this information, a small group of nurses in one rehabilitation setting agreed that there was enough evidence to change from sterile to clean intermittent catheterization (clean gloves and container and sterile single-use catheter).3 As with any change, buy in from nursing and medical staff was required, particularly infection control. This was achieved without major difficulty, but surprisingly strong resistance came from the central supply department, with an unexpected concern that clean technique and, thus, use of fewer sterile supplies would result in job loss. Weekly meetings with all staff concerned and the development of a pilot project eventually eased the anxiety. However, once the pilot project was completed, further concerns arose, particularly from nurses who held strong views about sterile technique and from patients who were being transferred from acute care who believed that clean technique placed them at risk. Several months were dedicated to education, making a video, changing the orientation program for both staff and new patients, and meeting regularly with all concerned. Finally, 2 years after the initial idea to change practice, clean intermittent catheterization was established as standard practice at the rehabilitation center.
Barriers to research implementation are many, and implementation of research-based practice is not straightforward, nor is it for the faint-hearted. The greatest barriers to implementing are time constraints, lack of awareness of the available literature and skills at critical reviews of the literature, insufficient individual authority to implement change, and lack of peer support for implementing change. Perhaps a conference session or further articles on being a change agent would be helpful to advance the implementation of evidence-based practice in WOC nursing. E-mail us at [email protected] if more strategies on implementing research into practice would be of interest in upcoming issues of JWOCN. Finally, enjoy the annual conference, review the evidence in the presentations and posters using Table 1, and have fun.
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