Knowledge translation and implementation research in nursing
Introduction
Knowledge translation and implementation research is an emerging field in healthcare science. It is certainly not a new idea. The use of research has been on the healthcare agenda for a long time, but has only received greater notability during the past two decades. It is a research field with significance for all healthcare professionals and has immense global implications (Sanders and Haines, 2006). A striking example is the estimation that up to 70% of the 4 million infants that die each year in the neonatal period could be saved if basic evidence-based practices were used (primarily nursing care interventions) (Lawn et al., 2005, Darmstadt et al., 2005). Another example is the persistent problem of pressure ulcers in hospitalized patients. Inadequate compliance to existing guidelines results in a high prevalence of ulcers, leading to patient suffering, prolonged hospitalization, a need for continued intensive care and a financial burden on the health care system (Laat et al., 2006). The Institute for Healthcare Improvement in the US has added pressure ulcers prevention as 1 of 12 interventions to reach the campaign goal of saving 5 million lives from medical harm (IHI, 2006). In a widely cited report based on data from the US and the Netherlands Grol and Grimshaw (2003) reported that 30–40% of all patients do not receive healthcare based on current relevant knowledge and as much as 20–25% of all patients receive harmful or unnecessary care. These figures largely concern medical treatment, but there is no reason to assume that nursing care would prove to be more evidence based if such information were available. The World Health Organization (WHO) has realized the serious nature of this situation, stating “stronger emphasis should be placed on translating knowledge into action to improve public health by bridging the gap of what is known and what is actually done” (WHO, 2004, p. V). This urgent request conveys implications for nursing research. It is no longer reasonable to predominantly do research on, for example, patients’ experiences of healthcare or surveys on working conditions of the nursing staff. I am well aware that qualitative research is essential in understanding and improving nursing care. However, internationally there is a growing demand for more intervention research in order to establish evidence on the effectiveness of various nursing practices (Rahm-Hallberg, 2006). It is indeed necessary to raise the level of evidence on the impact of nursing though it is also appropriate to take that reasoning one step further. For evidence-based knowledge to be used, intervention research is needed on how to implement such knowledge. In joint efforts researchers, decision-makers and practitioners need to enhance our understanding of how to get evidence into practice and, through that, improve processes in and outcomes of healthcare. Thus, the aim of this paper is to present a discussion on issues in the field of knowledge translation and implementation research. The discussion is primarily based on the literature of the past 3–4 years and by that strategy adds to Titler's (2004) paper on methods in translation science.
Section snippets
Concepts and definitions
A large number of terms are used in the literature for the process of getting knowledge into practice, including knowledge utilization, knowledge transfer, evidence-based practice and innovation diffusion (Graham et al., 2006, Estabrooks et al., 2006). Terms vary depending on the discipline from which they originate and thus may differ slightly in meaning. This paper uses the concepts of knowledge translation (KT) and implementation research (IR). The Canadian Institutes of Health Research
Nursing and research uptake— what do we know?
The use of evidence in nursing practice is a field that has received increased attention over the years. This growth can be noted in the appearance of journals as Evidence-Based Nursing and Worldviews of Evidence-Based Nursing, in the increasing number of systematic reviews on various clinical topics and in the very large number of publications on evidence-based practice. There is a history of 40 years of research on research utilization in nursing and a marked increase of reports from the
Implementation strategies
Several systematic reviews have been published on interventions for changing practitioners’ behaviour (e.g. Bero et al. (1998), Grimshaw et al. (2001), Grol and Grimshaw (2003) and Grimshaw et al., 2004). A range of implementation interventions appear to be useful (see Box 1) although at present researchers are unable to make recommendations on when to use a specific intervention to support implementation in a specific setting (Grimshaw et al., 2004). These reviews, however, were largely
Implementation research in nursing—thoughts and suggestions
The observant reader has probably already noticed my point of view; if we want to understand what strategies are working in changing practice to be more evidence-based, then we must test these strategies. There are, however, a number of issues to consider in evaluating complex KT interventions, including the level of knowledge on the clinical topic of interest and its change priority, the design of the study, linkage to theory, the influence of contextual factors and measurement and outcomes.
Conclusions
The current overview has examined some of the recent literature in the knowledge translation and implementation research field in nursing. It shows that progress is being made in several important areas, but researchers still need to contend with a number of challenging issues in moving the field from descriptive research to intervention studies on implementation strategies. Compared to Titler's (2004) paper on methods in translational science many of the issues discussed remain unchanged. The
Conflict of interest
None.
Funding
This article was written through financial support from The Centre for Health Care Science at Karolinska Institutet.
Ethical approval
None.
Acknowledgement
I would like to thank Anna Ehrenberg for useful comments in processing this manuscript.
References (97)
- et al.
The impact of nurse-directed protocolised-weaning from mechanical ventilation on nursing practice: a quasi-experimental study
International Journal of Nursing Studies
(2007) - et al.
Evidence-based, cost-effective interventions: how many newborn babies can we save?
Lancet
(2005) - et al.
Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings
Journal of Clinical Epidemiology
(2005) - et al.
Evaluation of a multiple component intervention to support the implementation of a ‘therapeutic relationships’ best practice guideline on nurses’ communication skills
Patient Education and Counseling
(2006) - et al.
BARRIERS: the barriers to research utilization scale
Applied Nursing Research
(1991) - et al.
From best evidence to best practice: effective implementation of change in patients’ care
Lancet
(2003) - et al.
4 million neonatal deaths: when? Where? Why?
Lancet
(2005) - et al.
Can just-in-time, evidence-based “reminders” improve pain management among home health care nurses and their patients
Journal of Pain Symptom Management
(2005) - et al.
The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials
Lancet
(2001) - et al.
Using peer feedback to improve handwashing and glove usage among Thai health care workers
American Journal of Infection Control
(2000)