Translating evidence into practice: next steps.

Evidence-based practice is something we constantly strive to achieve. Rehabilitation nurses have a responsibility to be informed about the strongest evidence available to guide our practice. Unfortunately, not all of the available evidence consists of systematic reviews of the literature, metaanalyses, or randomized controlled trials. It is readily apparent that evidence evolves over time and what, for instance, may have been an accepted practice in the past (i.e., saline IV flushes, milking chest tubes, or air bolus to check NG placement) is no longer supported as quality care. The key is to be current, aware, and always looking for new, available, and trusted evidence to guide us. Frequently, we do not have the highest level of evidence to guide all patient assessments and interventions. Plus, not all clinical practices are supported by current evidence. It is still your professional responsibility to remain up-to-date and cognizant of what is available in the literature (especially the last 5 years). Furthermore, one should always be trying to identify reliable sources of evidence such as Agency for Healthcare Research and Quality (AHRQ) or the Centers for Disease Control and Prevention (CDC) e-mail alerts and/or ARN Network. If you haven’t already, consider becoming a member of a journal club, taking a continuing course(s) focusing on evidence-based practice, finding a role model/mentor who has had success translating and sustaining best evidence into practice, or consider getting involved in a unit-based research project that keeps you abreast of the new science affecting your decision-making and resultant care outcomes. Central to developing skills in the translation of evidence into practice is an ability to locate, synthesize, apply, and evaluate the outcomes associated with evidence-based care. While examining the scientific evidence, several key questions should be asked. • What is the strength of the evidence and how well does it fit with my patient population? • Given the quality of the evidence, my clinical skills, and my patient population, should the evidence be translated into practice guidelines? • Should the evidence be implemented into a practice recommendation for my setting? Why or why not considering the facilitators and barriers within your setting? • Would this evidencebased change improve clinical outcomes, improve the patient experience, or nurse satisfaction? • Would this evidencebased practice change reduce the cost of care or improve the operations of our practice setting? Within the literature, one should review the numerous frameworks designed to help translate evidence into practice such as the Iowa Model, Star Model, Roger’s Theory of Diffusion of Innovations, Theory of Reasoned Action, and the newly developed Agency of Healthcare Research and Quality Model (Titler, 2008; White & Dudley-Brown, 2012). Once again, given the variety of translational frameworks, take a class, discuss with colleagues what framework they like including its strengths and limitations, as well as read Rehabilitation Nursing and other journals and books and make informed decisions. There is no perfect framework to assist in the translation of evidence into practice and a multitude of factors such as the topic, the state and quality of the science pertaining to that topic (randomized control trials versus a case study of one patient), individual and organizational adoption of the evidence, how well the evidence is implemented into practice, and how well the evidence-based interventions and outcomes are sustained across time (preferably a year or longer). Within this issue are a variety of articles that expand our knowledge and confidence related to improving the nutritional intake of patients participating in physical rehabilitation (Baer, 2013), the insomnia treatment of Iraq and Afghanistan veterans (Epstein et al., 2013), how to manage agitated behavior in the traumatic brain injury patient (Poulsen et al., 2013), how interdisciplinary teams function (White & Dudley-Brown, 2012), and other relevant topics. As you contemplate the evidence presented in this issue, consider its applicability to your practice area. Practitioners play a key role in changing practice and moving evidence-based care changes forward. Take