Discussion: Use of Research in Clinical Practice Note: Post a three paragraph (at least 250–350
Discussion: Use of Research in Clinical Practice
Note: Post a three paragraph (at least 250–350
words) response. At least 2 APA style references
Throughout this course, you have examined and considered how the research process contributes to the field of clinical nursing practice. More than just an exercise in developing a research question, searching the literature to guide future research, and performing actual data collection/data analysis, the conclusions you draw from your research findings are useful in helping to develop and enact effective clinical practice. In essence, the process of conducting research contributes to positive social change in that the solutions that you might propose as a nurse researcher and professional will likely impact quality of care and patient safety.
For this Discussion, read the book chapter by Titler (2008) presented in this week’s resources that describes evidence-based practice and translational science, as well as the kind of research needed for both. Then, reflect on how the knowledge you gained about research will support your effort as a nursing professional to improve patient quality and safety.
Describe how you will use evidence-based practice to improve patient quality and safety in your health care setting. Be specific and provide examples. Then, explain how the knowledge gained about research in this course will support your role in practice as a nursing professional. Then, describe how you will use evidence-based practice to improve patient quality and safety. Be sure to include in your Discussion any unanswered questions that need to be considered by your classmates and/or Instructor.
Titler, M. G. (2008). Chapter 7. The evidence for evidence-based practice implementation. In R.G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (Vol. 1, 113–116). Rockville, MD: Agency for Healthcare Research and Quality.
Chapter 7. The Evidence for Evidence-Based PracticeImplementationMarita G. TitlerBackgroundOverview of Evidence-Based PracticeEvidence-based health care practices are available for a number of conditions such as asthma,heart failure, and diabetes. However, these practices are not always implemented in caredelivery, and variation in practices abound.1–4Traditionally, patient safety research has focusedon data analyses to identify patient safety issues and to demonstrate that a new practice will leadto improved quality and patient safety.5Much less research attention has been paid to how toimplement practices. Yet, only by putting into practice what is learned from research will care bemade safer.5Implementing evidence-based safety practices are difficult and need strategies thataddress the complexity of systems of care, individual practitioners, senior leadership, and—ultimately—changing health care cultures to be evidence-based safety practice environments.5Nursing has a rich history of using research in practice, pioneered by Florence Nightingale.6–9Although during the early and mid-1900s, few nurses contributed to this foundation initiatedby Nightingale,10the nursing profession has more recently provided major leadership forimproving care through application of research findings in practice.11Evidence-based practice (EBP) is the conscientious and judicious use of current bestevidence in conjunction with clinical expertise and patient values to guide health caredecisions.12–15Best evidence includes empirical evidence from randomized controlled trials;evidence from other scientific methods such as descriptive and qualitative research; as well asuse of information from case reports, scientific principles, and expert opinion. When enoughresearch evidence is available, the practice should be guided by research evidence in conjunctionwith clinical expertise and patient values. In some cases, however, a sufficient research base maynot be available, and health care decisionmaking is derived principally from nonresearchevidence sources such as expert opinion and scientific principles.16As more research is done in aspecific area, the research evidence must be incorporated into the EBP.15Models of Evidence-Based PracticeMultiple models of EBP are available and have been used in a variety of clinical settings.16–36Although review of these models is beyond the scope of this chapter, common elements of thesemodels are selecting a practice topic (e.g., discharge instructions for individuals with heartfailure), critique and syntheses of evidence, implementation, evaluation of the impact on patientcare and provider performance, and consideration of the context/setting in which the practice isimplemented.15, 17The learning that occurs during the process of translating research intopractice is valuable information to capture and feed back into the process, so that others canadapt the evidence-based guideline and/or the implementation strategies.1
Patient Safety and Quality: An Evidence-Based Handbook for Nurses: Vol. 1A recent conceptual framework for maximizing and accelerating the transfer of researchresults from the Agency for Healthcare Research and Quality (AHRQ) patient safety researchportfolio to health care delivery was developed by the dissemination subcommittee of the AHRQPatient Safety Research Coordinating Committee.37This model is a synthesis of concepts fromscientific information on knowledge transfer, social marketing, social and organizationalinnovation, and behavior change (see Figure 1).37Although the framework is portrayed as aseries of stages, the authors of this framework do not believe that the knowledge transfer processis linear; rather, activities occur simultaneously or in different sequences, with implementation ofEBPs being a multifaceted process with many actors and systems.Steps of Evidence-Based PracticeSteps of promoting adoption of EBPs can be viewed from the perspective of those whoconduct research or generate knowledge,23, 37those who use the evidence-based information inpractice,16, 31and those who serve as boundary spanners to link knowledge generators withknowledge users.19Steps of knowledge transfer in the AHRQ model37represent three major stages: (1)knowledge creation and distillation, (2) diffusion and dissemination, and (3) organizationaladoption and implementation. These stages of knowledge transfer are viewed through the lens ofresearchers/creators of new knowledge and begin with determining what findings from thepatient safety portfolio or individual research projects ought to be disseminated.Knowledge creation and distillationis conducting research (with expected variation inreadiness for use in health care delivery systems) and then packaging relevant research findingsinto products that can be put into action—such as specific practice recommendations—therebyincreasing the likelihood that research evidence will find its way into practice.37It is essentialthat the knowledge distillation process be informed and guided by end users for research findingsto be implemented in care delivery. The criteria used in knowledge distillation should includeperspectives of the end users (e.g., transportability to the real-world health care setting,feasibility, volume of evidence needed by health care organizations and clinicians), as well astraditional knowledge generation considerations (e.g., strength of the evidence, generalizability).Diffusion and disseminationinvolves partnering with professional opinion leaders and healthcare organizations to disseminate knowledge that can form the basis of action (e.g., essentialelements for discharge teaching for hospitalized patient with heart failure) to potential users.Dissemination partnerships link researchers with intermediaries that can function as knowledgebrokers and connectors to the practitioners and health care delivery organizations. Intermediariescan be professional organizations such as the National Patient Safety Foundation ormultidisciplinary knowledge transfer teams such as those that are effective in disseminatingresearch-based cancer prevention programs. In this model, dissemination partnerships provide anauthoritative seal of approval for new knowledge and help identify influential groups andcommunities that can create a demand for application of the evidence in practice. Both masscommunication and targeted dissemination are used to reach audiences with the anticipation thatearly users will influence the latter adopters of the new usable, evidence-based research findings.Targeted dissemination efforts must use multifaceted dissemination strategies, with an emphasison channels and media that are most effective for particular user segments (e.g., nurses,physicians, pharmacists).End user adoption, implementation, and institutionalizationis the final stage of theknowledge transfer process.37This stage focuses on getting organizations, teams, and individuals2
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