Research Implementation and Dissemination

Question 1

Ways to implement evidence

instrumental

Answer 1

Use of evidence to alter specific actions.

Nurse/agency adopts a “let’s make a change” attitude

Question 2

ways to implement evidence

conceptual

Answer 2

Use of evidence to stimulate discussion, questioning, and further research.
Nurse/agency adopts a “wait and see” attitude.

Question 3

Knowledge creep

Answer 3

 The process of transferring the evidence in the research to the practice setting

Question 4

decision accretion

Answer 4

 The layering of evidence which is required for the final “push” for a change.
 Tipping point

Question 5

Research-Practice Gap

Answer 5

 Many studies reveal that nurses do not keep up with the current research.
 Lack of critical review of research articles results in little or no knowledge creep.
 Education level of many practicing staff nurses may not emphasize the need for critical review of research.

Question 6

Educational responsibilities

AD

Answer 6

Be aware, identify problems, assist

Question 7

Educational responsibilities

BSN

Answer 7

Read, interpret, and evaluate research
Identify problems
Implement findings
Gather data and share findings

Question 8

Educational responsibilities

MSN

Answer 8

Develop hypotheses
Provide clinical expertise
Facilitate investigations
Assist in application

Question 9

Educational responsibilities

PhD

Answer 9

Develop theories, designs, and methods
Conduct research
Share findings
Facilitate others investigations
Educate

Question 10

Benefits reflected in:

Answer 10

Assessment
Diagnosis
Planning
Implementation
Evaluation

Question 11

Roger’s Theory of Knowledge Diffusion and Integration

innovation

Answer 11

a new idea

Question 12

Roger’s Theory of Knowledge Diffusion and Integration

communication channels

Answer 12

multiple

Question 13

Roger’s Theory of Knowledge Diffusion and Integration

other elements:

Answer 13

Time requirement
Social system
The organization
The opinion leaders

Question 14

Roger’s Theory of Knowledge Diffusion and Integration

Process:

Answer 14

Knowledge—persuasion—decision—implementation—confirmation

Question 15

Barriers to Implementation of Evidence

Answer 15

 Organizational culture
 Nurse’s belief systems
 Research related barriers

Question 16

Organizational Culture

adequate resources

Answer 16

 Library utilization

 Journals

Question 17

Organizational Culture

support and encoragement

Answer 17

 Collaboration

Question 18

Organizational Culture

job expectation

Answer 18

 Be given time
 Ask why and expect an answer—demand an evidence base
 Cost : benefit, value, quality, satisfaction

Question 19

Organizational Culture

formal committe structure

Answer 19

 In-services/conferences

 Encourage dissemination of findings

Question 20

role of nursing research committees

Answer 20

	Provide leadership
	Provide consultation
	Conduct seminars
	Establish guidelines
	Seek solutions
	Share findings
	Interact with nurses
	Seek out resources

Question 21

nurses’ beliefs

Answer 21

 Resistance to change
 Lack of educational focus on research
 Personalities

Question 22

Research Related

Answer 22

 Difficulty in reading and interpreting
 Jargon
 Statistics
 Poor studies

Question 23

Ways to Foster Change

Answer 23

Know the environment
Assess
Focus on immediate change needs
Engage stakeholders
Acknowledge worth of current system but focus on positive aspects of change
 Cue into and attend to emotional responses

Question 24

Kotter’s phases of change

Answer 24

	Establish urgency
	Create coalition
	Develop vision
	Communicate vision
	Empower action
	Generate short term gains
	Consolidate gains and produce more gains
	Anchor approaches

Question 25

Historical Attempts to Increase Utilization of Evidence WICHE

Answer 25

 Western Interstate Commission for Higher Education  6 year (mid 70s) study involving regional collaboration  Looked at target and non-targeted research and utilization.  Resulted in push for research to be included in all BSN programs

Question 26

Historical Attempts to Increase Utilization of Evidence CURN

Answer 26

 Conduct and Utilization of Research in Nursing  Michigan Nurse’s Association  5 year project  Looked at dissemination of findings, facilitating organizational changes, and encouraging collaborative research.  Found that research needs to be disseminated widely and must be relevant to nurse’s job  Resulted in a 9 volume series of research

Question 27

Historical Attempts to Increase Utilization of Evidence RARIN

Answer 27

 Retrieval and Application of Research in Nursing (California)  To facilitate transfer from research to practice.  Stimulated organizational changes to increase value in research.

Question 28

Implementation Models | Provide some guidance for integrating research into practice on several levels:

Answer 28

 Clinical Scholars Model (see lecture on theory)  Johns Hopkins Model (see lecture on theory)  Stetler  Iowa

Question 29

Stetler Model

Answer 29

 Based on Stetler & Marram  Evaluates both products and processes of EBP  Individual nurses must read research and use evidence based practice (tricky because the evidence keeps changing).

Question 30

Stetler Model | Preparation

Answer 30

select an appropriate articles

Question 31

Stetler Model | Validation

Answer 31

is evidence sound, sufficient, and credible?

Question 32

Stetler Model | Comparative/Decision Making

Answer 32

assess if reliable and valid, organize, condense, label, and determine meaning,

Question 33

Stetler model | Translation and application

Answer 33

is it suitable for this organization, cost/benefit, how will info be used and evaluated?

Question 34

Stetler model | evaluation

Answer 34

impact, was it successful?

Question 35

Iowa model

Answer 35

Focus on organization as a whole Answers questions Is there sufficient evidence? Is the change appropriate for adoption? Process: Selection of a clinical problem or theoretical issue Literature review for scientific merit and sufficiency as a basis for change. Assessment and planning Examine transferability, feasibility, and cost:benefit ratio Implementation and evaluation Pilot or clinical trial Examine process, barriers, outcomes

Question 36

Considerations for Clinical Trials

Answer 36

``` Replication needed? Sound research base? Applied to real situations? Significance? Nursing control? Contribution to care? Contribution to knowledge? ```

Question 37

Evidence based practice centers

Answer 37

Designated by the AHRQ Topic specific Role is to develop evidence based guidelines for practice. Also develop tools for measurement.

Question 38

other national and international organizations

Answer 38

Development of evidence based practice guidelines for individual specialties. Development of evidence based nursing protocols for incorporation into education and practice. Examples: STTI AWHONN

Question 39

Dissemination | The 3 Ps of Dissemination

Answer 39

Posters Presentations Papers

Question 40

Posters

Answer 40

Attend a conference Present a poster on completed or work in progress Allows for interactions with others interested in the topic Allows for brainstorming

Question 41

Process for posters

Answer 41

Watch for call for abstracts Submit abstract as requested Plan graphic poster in format determined by the conference Design poster with power point or other graphic program Produce a few handouts of poster information Usually stand beside poster for discussions during the session

Question 42

poster design

Answer 42

Lettering that can be read from 4-6 feet away Only necessary charts Pictures for attracting interest Sufficient white space so it doesn’t overwhelm the visual senses Contents Arrangement

Question 43

Oral presentations

Answer 43

At a conference or staff in-service Power point presentation Have handouts About 15 minutes + question time

Question 44

Papers in journals

Answer 44

``` Pilot your information first as a poster or oral presentation Consider authorship order Review submission guidelines Send editor a query letter Follow guidelines exactly Have a colleague read for feedback Revised based on feedback of colleague Submit for review Revise, resubmit, revise, resubmit, revise . ```

Question 45

Ethics of dissemination

Answer 45

Original work Acknowledge appropriately No “salami slicing” (writing the same article over and over again, but changing it slightly before submitting it.) No “data dredging”(trying to find SOMETHING that's correlated, SOMETHING significant from your results)