Translating Research into Practice

According to the Agency for Healthcare Research and Quality (AHRQ), the lead agency charged by the U.S. Department of Health and Human Services to support research to improve the quality of health care, patient safety, and efficiency, it takes up to two decades to translate research findings to directly improve patient care (AHRQ, 2001). Also of concern is that only 10%Y15% of clinicians in the United States consistently implement evidence-based care. This lack of standardization increases the costs of care up to 30% due to inadequate interventions (www.IHI.org). These data illustrate gaps in patient care that professional nurses, who represent the largest group of healthcare providers in the United States, can positively affect through translating research into practice (TRIP). Professional development specialists, as knowledgeable and expert evidence-based mentors, play a key role in helping nurses translate research into practice using evidencebased methods to improve patient care. AHRQ has published a knowledge transfer framework to guide the implementation of evidence into practice, identifying three steps to follow: knowledge creation, diffusion of the evidence, and dissemination and adoption (institutionalizing) the change (Nieva et al., 2005). Although many authors have published some of these steps into their own frameworks, it is important to know and understand the AHRQ framework because it is a national model used by multiple disciplines and contains the scientific language of TRIP. One prominent nurse researcher, Titler (2007), linked the AHRQ model to the Iowa Model that she and colleagues developed at the University of Iowa, providing detailed information on the concepts of TRIP as well as an example of its use. When professional nurses and professionals in other disciplines use TRIP, they are usually starting with the review of existing literature on knowledge already created, then continuing the steps through the stages of diffusion, dissemination, and adoption to translate the research into practice. A recent clinical example that clearly outlines the methodology using this scientific framework is the publication by Duff, Walker, and Omari (2011) titled ‘‘Translating venous thromboembolism (VTE) prevention evidence into practice: Amultidisciplinary evidence implementation project. ’’ This article documents the evidence, steps to translation, challenges of changing clinician behaviors to adopt the evidence, outcomes and also highlights the role of a clinical nurse research fellow working with a doctorally prepared nurse and physician partner on the team. Many healthcare settings are now actively working to translate research into practice using the steps of an evidence-based practice model. Throughout the decades, however, the most significant barriers to successful changes in practice happens in the final phase: adopting (institutionalizing) the change in practice. One of the first nurses to recognize and publish the barriers reported results of a funded project to teach clinical nurses how to use research in practice (Horsley, Crane, & Bingle, 1978). Horsley and colleagues reported lack of administrative support, insufficient time provided to carry out project work, and inadequate resources as barriers to adopting change in practice. These barriers have continued to hold true over time for over four decades by numerous studies. Glasgow and Emmons (2007) published a comprehensive analysis of the barriers in chart format, identifying over 30 types of barriers. This review may be useful to professional development specialists who are feeling frustrated when progress toward successful evidence-based project implementation does not occur. A significant barrier is lack of peer engagement in the change process, often underestimated in the process. Peer issues may relate to a knowledge gap, lack of understanding of why the change needs to happen, resistance to change, comfort with the current practice culture, or indifference. Peer-to-peer engagement using champion teams led by local opinion leaders (peers) is a proven strategy to reduce these barriers (Flynn & Fink, 2001, Kelleher, Moorer, & Makic, 2012; Titler, 2007; Titler & Everett, 2001). Our hospital has eight such teams. Clinical nurses representing their units gain confidence leading evidence-based practice initiatives such as preventing Mary Krugman, PhD, RN, NEA-BC, FAAN, is Director, Professional Resources, University of Colorado Hospital, Denver, Colorado. E-mail: mary.krugman@uch.edu.