Research Implementation and Dissemination Flashcards
Ways to implement evidence
instrumental
Use of evidence to alter specific actions.
Nurse/agency adopts a “let’s make a change” attitude
ways to implement evidence
conceptual
Use of evidence to stimulate discussion, questioning, and further research.
Nurse/agency adopts a “wait and see” attitude.
Knowledge creep
The process of transferring the evidence in the research to the practice setting
decision accretion
The layering of evidence which is required for the final “push” for a change.
Tipping point
Research-Practice Gap
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.
Educational responsibilities
AD
Be aware, identify problems, assist
Educational responsibilities
BSN
Read, interpret, and evaluate research
Identify problems
Implement findings
Gather data and share findings
Educational responsibilities
MSN
Develop hypotheses
Provide clinical expertise
Facilitate investigations
Assist in application
Educational responsibilities
PhD
Develop theories, designs, and methods Conduct research Share findings Facilitate others investigations Educate
Benefits reflected in:
Assessment Diagnosis Planning Implementation Evaluation
Roger’s Theory of Knowledge Diffusion and Integration
innovation
a new idea
Roger’s Theory of Knowledge Diffusion and Integration
communication channels
multiple
Roger’s Theory of Knowledge Diffusion and Integration
other elements:
Time requirement
Social system
The organization
The opinion leaders
Roger’s Theory of Knowledge Diffusion and Integration
Process:
Knowledge—persuasion—decision—implementation—confirmation
Barriers to Implementation of Evidence
Organizational culture
Nurse’s belief systems
Research related barriers
Organizational Culture
adequate resources
Library utilization
Journals
Organizational Culture
support and encoragement
Collaboration
Organizational Culture
job expectation
Be given time
Ask why and expect an answer—demand an evidence base
Cost : benefit, value, quality, satisfaction
Organizational Culture
formal committe structure
In-services/conferences
Encourage dissemination of findings
role of nursing research committees
Provide leadership Provide consultation Conduct seminars Establish guidelines Seek solutions Share findings Interact with nurses Seek out resources
nurses’ beliefs
Resistance to change
Lack of educational focus on research
Personalities
Research Related
Difficulty in reading and interpreting
Jargon
Statistics
Poor studies
Ways to Foster Change
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
Kotter’s phases of change
Establish urgency Create coalition Develop vision Communicate vision Empower action Generate short term gains Consolidate gains and produce more gains Anchor approaches
Historical Attempts to Increase Utilization of Evidence
WICHE
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
Historical Attempts to Increase Utilization of Evidence
CURN
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
Historical Attempts to Increase Utilization of Evidence
RARIN
Retrieval and Application of Research in Nursing (California)
To facilitate transfer from research to practice.
Stimulated organizational changes to increase value in research.
Implementation Models
Provide some guidance for integrating research into practice on several levels:
Clinical Scholars Model (see lecture on theory)
Johns Hopkins Model (see lecture on theory)
Stetler
Iowa
Stetler Model
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).
Stetler Model
Preparation
select an appropriate articles
Stetler Model
Validation
is evidence sound, sufficient, and credible?
Stetler Model
Comparative/Decision Making
assess if reliable and valid, organize, condense, label, and determine meaning,
Stetler model
Translation and application
is it suitable for this organization, cost/benefit, how will info be used and evaluated?
Stetler model
evaluation
impact, was it successful?
Iowa model
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
Considerations for Clinical Trials
Replication needed? Sound research base? Applied to real situations? Significance? Nursing control? Contribution to care? Contribution to knowledge?
Evidence based practice centers
Designated by the AHRQ
Topic specific
Role is to develop evidence based guidelines for practice.
Also develop tools for measurement.
other national and international organizations
Development of evidence based practice guidelines for individual specialties.
Development of evidence based nursing protocols for incorporation into education and practice.
Examples:
STTI
AWHONN
Dissemination
The 3 Ps of Dissemination
Posters
Presentations
Papers
Posters
Attend a conference
Present a poster on completed or work in progress
Allows for interactions with others interested in the topic
Allows for brainstorming
Process for posters
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
poster design
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
Oral presentations
At a conference or staff in-service
Power point presentation
Have handouts
About 15 minutes + question time
Papers in journals
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 .
Ethics of dissemination
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)
