Knowledge Translation (KT): What's next for healthcare professionals?
Blog post by InspireNet Knowlege to Action Team Co-Leader, Anastasia Mallidou
Background
• From Florence Nightingale’s early work, evidence was used to inform care delivery for soldiers and, later, for patients in hospitals.
• From “evidence-based medicine” in 1992 and over the years, research courses were incorporated into all healthcare professionals’ (including nurses’) education to develop skills for practicing in an evidence-based practice (EBP) environment.
What are KT objectives?
Defined as application of research findings to professionals’ routine activities, knowledge translation aims to
• Improve care delivery and the final product of healthcare services, that is, health outcomes related to patients/citizens, populations, and society.
• Evaluate effectiveness and efficiency of already implemented interventions and sustain improved quality of care.
• Identify the most important and modifiable determinants of the effectiveness of knowledge translation interventions such as time spent on the internet, levels of emotional exhaustion, collaboration, workplace environments.
• Mitigate barriers to change and integrate multiple clinical issues and stakeholders for future research.
• Reduce health care costs.
What is the current picture?
• Researchers publish a large amount of new knowledge (research findings) every year.
• Clinician nurses use the best available research knowledge years after publication. For example, we may all remember the hand washing practice before examination based on a number of research studies and how many years later this became mandatory practice for all healthcare professionals. Even today, there are some practitioners who do not obey this simple and evidence-based practice that can save patients’ lives, minimize the likelihood of an infection, and reduce the cost of healthcare by reducing the use of antibiotics. Why?
There are several reasons for this behavior such as:
- Limited research knowledge. Clinical nurses need sound knowledge and skills to read and assess research findings, and in turn routinely use the best and most useful findings.
- Limited access to the workplace libraries. Nurses, as knowledge workers, need regular and systematic access to their workplace library during working time.
- Lack of research champions (research facilitators/opinion leaders) in healthcare organizations is a barrier for using the best available practice guidelines.
What is the relation between research skills and EBP?
• Some nursing schools organize their programs into two separate tracks: one for clinicians and one for researchers.
• Nurse students wonder about the relevance of research courses to their role as care providers.
To be able to support EBP in their routine activities, nurses need research knowledge and skills. Involvement of nurse students and young practitioners with the research process is a substantial strategy for learning and being research competent. Nurses as researchers and research consumers need to improve their own research skills for conducting clinical (applied) research, for reading and understanding research findings, and for implementing the best available knowledge.
How can new knowledge be transferred?
1. To improve dissemination, uptake, and application of health research findings, nurse researchers need to focus on several basic tactics to:
• Change culture by conducting good quality research
• Involve clinician nurses into research teams for better and more knowledge use
• Disseminate their research findings in a more digestible way for nurses and patients/citizens
• Bridge the cultural gap between the communities of researchers and practitioners/clinicians.
2. Nurse educators may use educational interventions, learning activities, and other effective strategies to increase research literacy, caregivers’ performance, and health care outcomes. These strategies include student needs’ assessment, interactive communication among students and instructor, application of various educational methods, and integration of learning and behavioral objectives. Change to healthcare professionals’ performance needs not only knowledge (a necessary but not sufficient condition), but reflection, interaction, and clinical scenarios and vignettes to increase relevance and applicability of research findings. In addition, evidence shows that distance education techniques such as web-based/online courses, videos, audio casts, and online communities of practice (e.g., InspireNet) may be superior to the traditional ways of learning.
3. Informatics interventions are other KT tools that can also improve learning, provide high-quality resources for healthcare professionals and patients, and affect caregiver behavior. Additionally, healthcare organizational interventions relevant to KT seem to be important factors in productivity, effectiveness, and quality of care. These organizational interventions include culture change programs (at an organizational level), care providers’ empowerment (at an individual level), interprofessional relationships (at a team level).
What is next?
Limited studies exist relevant to KT at an international level. Future research directions may include
• Distance education techniques that may increase accountability, competency, and better performance, as well as mechanisms and their impact on clinical outcomes.
• Impact of informatics interventions on clinical outcomes (i.e., patient outcomes): Limited evidence exists, even though their effects on learning and performance process are understandable.
• Healthcare services research such as organizational change programs, systems research and KT, and context attributes that facilitate use of research findings.
• Development and evaluation of tools measuring healthcare professionals’ research competencies and knowledge use.
References
Casebeer, L. L., Kristofco, R. E., Strasser, S., Reilly, M., Krishnamoorthy, P., Rabin, A., Zheng, S., Karp, S., Myers, L. (2004). Standardizing evaluation of on‐line continuing medical education: Physician knowledge, attitudes, and reflection on practice. Journal of Continuing Education in the Health Professions, 24(2), 68-75.
Dopson, S., & Fitzgerald, L. (2005). Knowledge to action: Evidence-based health care in context. Oxford, UK: Oxford University Press.
Estabrooks, C. A. (1999). The conceptual structure of research utilization. Research in Nursing & Health, 22(3), 203-216.
Estabrooks, C. A. (2003). Translating research into practice: implications for organizations and administrators. Canadian Journal of Nursing Research, 35(3), 53-68.
Estabrooks, C. A., Midodzi, W. K., Cummings, G. G., & Wallin, L. (2007). Predicting research use in nursing organizations: A multilevel analysis. Nursing Research, 56(4 Suppl), S7-S23.
Fordis, M., King, J. E., Ballantyne, C. M., Jones, P. H., Schneider, K. H., Spann, S. J., Greenberg, S. B., Greisinger, A. J. (2005). Comparison of the Instructional Efficacy of Internet-Based CME With Live Interactive CME Workshops. JAMA: The Journal of the American Medical Association, 294(9), 1043-1051. doi: 10.1001/jama.294.9.1043
Hutchinson, A. M., Mallidou, A. A., Toth, F., Cummings, G. G., Schalm, C., & Estabrooks, C. A. (2010) Review and synthesis of literature examining characteristics of organizational context that influence knowledge translation in healthcare: Technical Report (10-01-TR). Edmonton, AB: University of Alberta, Faculty of Nursing. (ISBN: 978-1-55195-269-7)
Straus, S., Tetroe, J., & Graham, I. D. (2009). Knowledge translation in health care: Moving from evidence to practice. West Sussex, UK: Willey-Blackwell Publishing.
Wenghofer, E. F., Way, D., Moxam, R. S., Wu, H., Faulkner, D., & Klass, D. J. (2006). Effectiveness of an enhanced peer assessment program: Introducing education into regulatory assessment. The Journal of continuing education in the health professions, 26(3), 199-208.
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Anastasia A. Mallidou, PhD
Assistant Professor (limited term)
School of Nursing
University of Victoria
E-mail: mallidou@uvic.ca
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