Translation to Practice: Breaking Down the Barriers
Evidence-based practice is the cornerstone of nursing practice. It enables professionals to initiate interventions based on research and provide quality care to clients.
However, translating evidence-based knowledge and implementing this knowledge into practice is recognised as a difficult process due to the complexity of healthcare systems (Greenhalgh & Papoutsi, 2018).
In nursing, some recognised challenges that prevent the translation of new evidence and research into practice are:
- Understanding the complex nature and terminology of research;
- Debunking complex statistics; and
- A lack organisational support to initiate changes
(Rycroft-Malone et al., 2004).
It must be recognised that change in healthcare can often be a slow process. In some cases, it has been found that the translation of research into practice can take up to 17 years (Morris, Wooding & Grant, 2011). The CareTrack study (Runciman et al, 2012) on healthcare encounters in Australia confirmed this, highlighting a gap in the translation of knowledge into the clinical setting.
However, these barriers can be overcome.Organisational Drivers of Change
Practice guidelines and standards are strong drivers of change in healthcare organisations. However, Pronovost (2013) has highlighted the gap between practice guidelines and practice measurements, with clinicians often failing to follow published guidelines.
Increasingly, these guidelines are growing in number and length, however they may not necessarily prioritise the most important therapies in each clinical setting (Pronovost, 2013).
A study by Landrigan et al., (2010) highlighted a lack of evidence-based safety protocols being implemented in health systems, supporting electronic record keeping, clinical notes and medical orders for integrated care delivery.
While professional standards are there to set evidence-based recommendations for safe and quality care, these are not always adhered to during care provision (Schuster, McGlynn & Brook, 1998). This was also seen in the CareTrack study (Runciman et al, 2012) on healthcare encounters in Australia, which demonstrated varied compliance with the clinical standards.
When developing or reviewing new clinical guidelines or health systems, the nurse educator must question whether the key safety points should be signposted at the start of the document for the users in order to facilitate translation to practice.Embracing Interprofessional Healthcare Teams
Engaging with interprofessional healthcare teams can assist with the translation of best practice into the clinical arena and avoid the slow translation of research into practice (Morris, Wooding and Grant, 2011).
Brock et al., (2013) demonstrated the importance of communication and collaboration across interprofessional healthcare teams.
The complexity of the healthcare system calls for a networked process for the translation of research-based knowledge into practice (Kitson et al., 2018).Diffusion of Innovations
At the local level, don’t underestimate the importance of the role of clinical champions.
Clinical champions are the drivers who throw everything behind an innovation in an attempt to increase uptake of a new idea in their ward or amongst their peers (Rogers, 1995).
The role modelling aspect of these drivers of change has a positive impact across the team.
Another aspect of team culture is garnering the support of the opinion leaders, who can lead and influence others through their behaviour and actions to engage with the practice change (Rogers, 1995).
These interpersonal networks within team cultures are vital in the adoption or rejection of an innovation or practice change.Professional Development and Transformative Learning
Providing nurses with opportunities for continuing education is essential. It facilitates learning about practice innovations, training and development, and provides practical strategies to enable learners to change clinical practice accordingly.
A transformative learning approach provides a way to mobilise new knowledge and engage clinical reasoning and decision making for a patient-centred health system (Frenk et al., 2010).
In transformative learning, the acquisition of knowledge and skills are part of professional development and are essential for the adoption of change (Frenk et al., 2010).
Simulation can provide an educational approach that facilitates transformative learning and also encourages interprofessional practice.
It can assist teams in identifying and understanding the key focus points of clinical knowledge development, situational awareness monitoring, mutual support, and communication (King et al., 2008).
Collaborative team-based simulation in the workplace or learning environment is now considered part of routine interprofessional training with a ‘practice like you play’ educational approach (Schmitt, Gilbert, Brandt, & Weinstein, 2013).Translation to Practice and De-Adoption
Understanding barriers to the de-adoption of practices that may be out of date and lacking in evidence is also essential to meet best-practice standards.
Furthermore, embedded practices mired in a ‘because it has always been done this way’ philosophy are difficult to displace and so the de-implementation of practice can be a lengthy process (Morris, Wooding and Grant, 2011; Niven et al., 2015).
An analysis of an adoption and de-adoption strategy in clinical practice by Niven et al. (2015) investigated whether tight glycaemic control (supporting adoption) and NICE-SUGAR trial (supporting deadoption) was influencing the practice of glycaemic control in adult ICU’s.
Niven et al. (2015) concluded that following the publication of a clinical trial that suggested benefit in tight glycaemic control there was a slow but steady adoption into clinical practice.
But following a subsequent trial that demonstrated harm there was little to no de-adoption of the strategies initiated.
This highlights the difficulty and the need to understand and promote de-adoption of ineffective clinical practices.Summary
Change within healthcare is not without its challenges, but a culture that values education and encourages interprofessional training may aid the continued development of clinical practice.
The mass of information available to healthcare professionals may be hindering the translation of evidence into practice. The nursing profession must strive to ensure it is equipped to interpret and deliver healthcare reforms.
A consumer-focused healthcare system where ineffective practice and value-added care remains a key objective in health reform is key to the effective translation of knowledge into practice.References
- Brock, D., Abu-Rish, E., Chiu, C.R., Hammer, D., Wilson, S., Vorvick, L., Blondon, K., Schaad, D., Liner, D., Zierler, B. (2013). Interprofessional education in team communication: Working together to improve patient safety. BMJ Quality & Safety, 22(5), 414.
- Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., … & Kistnasamy, (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet, 376(9756), 1923-1958.
- Greenhalgh, T., Howick, J., & Maskrey, N. (2014). Evidence based medicine: a movement in crisis?. BMJ, 348, g3725.
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- Niven, D. J., Rubenfeld, G. D., Kramer, A. A., & Stelfox, H. T. (2015). Effect of published scientific evidence on glycemic control in adult intensive care units. JAMA Internal Medicine, 175(5), 801-809.
- Pronovost, P. (2013). Enhancing physicians' use of clinical guidelines. JAMA, 310(23), 2501-2.
- Rogers, E. M. (1995) Diffusion of Innovations. (5th ed.) Simon and Schuster, New York, USA. [summary article]
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- Schmitt, M. H., Gilbert, J. H., Brandt, B. F., & Weinstein, R. S. (2013). The coming of age for interprofessional education and practice. The American Journal of Medicine, 126(4), 284-288.
- Schuster, Mark A., McGlynn, Elizabeth A., & Brook, Robert H. (1998). How good is the quality of health care in the United States? The Milbank Quarterly, 76(4), 517-563
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