Translating Research into Practice in Nursing Homes: Can We Close the Gap?

This paper addresses a question that continues to challenge researchers, practitioners, and regulators: How do we translate what has been learned from research into daily practice in nursing homes (NHs)? Numerous studies and reports have documented this translation gap in a wide range of NH care areas (Chu, Schnelle, Cadogan, & Simmons, 2004; Schnelle et al., 2003; Simmons et al., 2003; Thakur & Blazer, 2008). The literature also identifies numerous reasons for this gap. Lack of staff knowledge, high turnover rates, understaffing, inconsistent regulatory practices, poor or no financial incentives to improve care, and weak management caused in part by inaccurate information systems—all have been cited and examined in the literature as barriers to evidence-based practice in NHs (Donoghue, 2010; Harrington et al., 2000; Jones et al., 2004; Wiener, 2003). Another reason for the gap is that we have only limited evidence about the best ways to translate NH research in to day-to-day practice. As we discuss in this review article, a number of researchers, funders, and improvement advocates currently are engaged in translating research into practice in NHs, in the United States as well as other countries, including Europe (Meesterberends, Halfens, Lohrmann, & de Wit, 2010), Canada (Estabrooks et al., 2009), and Australia (Bartlett & Boldy, 2001). Although a few case studies have profiled facets of their work (Yuan et al., 2010) and other studies have called for improved dissemination of best practices (Ouslander, 2007), none has critically analyzed the translation process, that is, the steps or approaches these change agents take to disseminate evidence-based practices by NH providers. This represents a missed opportunity: A thoughtful evidence-based approach to translation could mitigate the hampering effects of NHs’ organizational barriers to change, making large-scale improvements more likely. Such an approach is also fiscally prudent at a time when funders are looking for results from their substantial development investments in new care interventions. This review aims to fill this knowledge gap by examining NH translation efforts through Rogers’ conceptual model for disseminating new interventions (Rogers, 2003; see also Gladwell, 2002; Green & Kreuter, 1999; Rowe, de Savigny, Lanata, & Victora, 2005; Titler, 2008). In his text, The Diffusion of Innovations (Fifth Edition), Rogers (2003, p. 6) describes innovation dissemination as a process that leads to “social change.” For the purposes of this paper, effective translation strategies are those strategies, actions, and programs that lead to the adoption of evidence-based or recommended practices that in turn are associated with change, as measured by improvements in NH processes or outcomes. Rogers further describes innovation dissemination as a process involving four elements: (a) an innovation (e.g., a new or previously untried idea or practice) disseminated to (b) members of a social system via (c) a communications channel (d) over time. Research across multiple disciplines has led to a body of general evidence-based principles about how innovations spread through this process. The findings also show that each dissemination area influences the other elements of the process. Thus, for example, an innovation’s attributes can influence how quickly it is adopted; similarly, characteristics of a target group can affect its intervention adoption rate (Rogers, 2003). Because the four elements are interrelated, how the dissemination process works in practice depends on the specific context (Rowe et al., 2005; Titler, 2008); an innovation that works in one environment may perform differently in another. With this in mind, this review’s first section discusses the four-part dissemination process as it applies to known characteristics of the NH system in the United States. This allows us to make some initial assumptions about the ability of NHs to adopt new interventions and to gain insight into how external change agents—those NH researchers, advocates, funders, and policy makers working to bridge the gap between research and practice—should structure their work for best results. We then assess the extent to which this group’s present efforts align with key principles of innovation dissemination. In part two, we discuss strategies for strengthening the work of change agents.