In the last decade, the movement toward integrating evidence-based practice in nursing has grown tremendously. The purpose of integrating research findings at the bedside is to reduce variations in practice, improve quality of care, and enhance patient safety and outcomes. In 2 recent editorials, guest editors Drs Barbara Given and Ruth McCorkle skillfully and colorfully called researchers into action to facilitate the use of research findings in patient care. To conclude this series on researchers becoming activists for findings with implications for clinical care, we now add a focus on how we, as researchers and clinicians, can quite literally move old information out of our minds and replace it with new information.

In recent clinical studies involving the use of qualitative methods (observations, interviews, case comparisons, extensive time in the studied setting), the authors noted that clinicians' practice was not in agreement with available and known evidence-based practice guidelines but instead by that of "mindlines."1-3 Mindlines are shared beliefs derived from social spheres of influence, chiefly from colleagues, that endure despite other sources of stronger evidence, in part because of the desire to meet or conform to expectations of colleagues, to avoid making clinical mistakes, or to avoid disappointing patients and their preferences. Mindlines represent very powerful beliefs, so powerful that in one study, clinicians repeatedly diagnosed and treated an illness in children, which was not the reason for the presenting symptoms.2 Other studies show that nearly 30% to 40% of patients do not receive care based on scientific evidence and that nearly 20% to 25% of care is unnecessary or potentially harmful.4 Regrettably, opinion leaders in a clinical setting can effectively dissuade colleagues from the use of new information. Furthermore, interactions with clinical colleagues are more likely to reinforce the use of commonly accepted practices rather than evidence-based practice guidelines. Researchers report that the most frequent source of information used by nurses is a peer or colleague rather than evidence-based research findings.5

So how can we, as a scientific journal, help nurses in clinical settings to be the opinion leaders who are armed with new information and who can insert this information skillfully into clinical situations? Cancer Nursing is already a credible source of new and confirmed research findings. That certainly helps provide a clinician with a reputable source of information, but according to those who have studied mindlines, information source reputation alone is insufficient. In addition, a credible source must provide findings in a clearly stated way-even when findings are equivocal. We do this now in the journal in paragraphs labeled "practice implications," but this, too, according to mindlines, is insufficient to achieve the purpose of clearly stated findings translating into clinical care. Most importantly, findings need to be offered in a way whereby the old information that once constituted practice is identified, clearly stated, and then contrasted with the new findings-or "out with the old and in with the new." Researchers need to be able to identify the current clinical care mindset, name it, and then clearly state the replacement information and how practice would be different as a result. We must do this in a way whereby the new information mentally replaces the former practice information and nests the new information into the clinical context to make it believable, convincing, and most likely to be adopted into clinical practice. We must compete with personalized, individualized knowledge that has been reinforced by coworkers, patient preferences, or personal professional experiences over time.

We want Cancer Nursing to be an activist journal on behalf of science and clinical care designed to benefit all ages of cancer patients, their family members, and their healthcare providers. To better support our efforts to be an activist journal in this way, we are establishing a new expectation for all Cancer Nursing authors. In the manuscript section of "practice implications," authors will be expected to explicate (1) what new information has been learned or what information has been confirmed in their study (also know as "in with the new") and (2) what now dated but currently held information needs to be mentally replaced by the new information (also know as "out with the old"). Activist authors, combined with an activist cancer journal (Cancer Nursing) and clinical opinion leaders who seek research-based information, can bring clearly articulated information to all points of care for cancer patients.

Our very best to you,

Pamela Petto, BSN, RN, CPON

Chair, Nursing Innovation Council

Children's National Medical Center

Washington, DC

Pamela S. Hinds, PhD, RN, FAAN

Editor in Chief, Cancer Nursing(TM)

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