Stillwell, Susan B, MSN, RN, CNE

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Lehigh Valley Health Network: LVHN Scholarly Works

Copyright, Susan B Stillwell, 2007Copyright Susan B Stillwell  2007Knowledge Mastery…Improving Patient OutcomesKnowledge Translation: What It Is and Isn’tSusan B Stillwell MSN RN CNEEBP MentorClinical Associate ProfessorCenter for the Advancement of Evidence-based PracticeArizona State University College of Nursing & Healthcare InnovationCopyright Susan B Stillwell  2007Knowledge Translation● the exchange, synthesis and ethically sound application of knowledge ● within a complex system of interactions among researchers and users-● to accelerate the capture of the benefits Canadian Institutes of Health Research.  Knowledge translation framework. www.cihr-irsc.gc.ca/about_cihr/organization/knowledge_translation/kt_framework_prelim_e_shtml#definition© Stillwell 2007Knowledge TranslationAccording to Szeben (2003), “… deliberate means where information is diffused with an implementation stratagem to ensure that information is reaching a desired population and subsequently being used in current practices” (p 134)Copyright, Susan B Stillwell, 2007© Stillwell 2007Knowledge Translation…scientific study of the methods for closing the knowledge-to-practice gap, and the analysis of barriers and facilitators inherent in this process.Straus, S. & Mazmanian, P. (2006) Knowledge translation: Resolving the confusion. Journal of Continuing Education in the Health Professions 26(1) 3-4.© Stillwell 2007Is knowledge translation really needed?Journal of Associated Score ofPersonal AngstBMJ 1995;311:1666-1668 (23 December)© Stillwell 2007● Ambivalent about renewing your Journal subscriptions?● Do you feel Anger toward prolific authors?● Do you ever use journals to help you Sleep?● Are you surrounded by piles of Periodicals?● Do you feel Anxious when your journals arrive?BMJ 1995;311:1666-1668 (23 December)Copyright, Susan B Stillwell, 2007© Stillwell 2007Delays of Evidence into Practice Doherty S (2005). History of evidence-based medicine. Oranges, chloride of lime and leeches: Barriers to teaching old dogs new tricks. Emergency Medicine Australasia. 17: 314-321●James Lind (1716 – 1794)●James Lancaster (1551)Data published 175440 years later……….© Stillwell 2007Delays of Evidence into PracticeDoherty S (2005). History of evidene-based medicine. Oranges, chloride of lime and leeches: Barriers to teaching old dogs new tricks. Emergency Medicine Australasia. 17: 314-321Ignatz Semmelweis1846 puerperal feverMortality rate 18% to 1.2%© Stillwell 2007That Was Then…..What About Now?A recent survey with a random sample of 1097 registered nurses in the U.S. indicated that:● Besides time, the greatest personal barrier in using information in practice was “lack of value for research”● The greatest organizational barrier to using information in practice was “presence of other goals with a high priority”Source: Pravikoff, Pierce, & Tanner (2005). Nursing Outlook, 53 (1), 49-50Copyright, Susan B Stillwell, 2007© Stillwell 2007Conclusion from the AAN Expert Panel StudyRNs in the United States aren’t ready for evidence-based practice ● information literacy●computer skills● limited access to high quality information resources●attitudes toward researchPravikoff, Pierce, & Tanner (2005). Nursing Outlook, 53 (1),  p.50© Stillwell 2007Readiness of US Nursesfor EBP (Pravikoff et. al, AJN, 2005)Reported Findings●39% reported needing info to support care seldom or 1-2X month●58% never used a research report●82% never used a hospital library●57% had a library●77% had never had instruction in electronic searches●19% confident in using CINAHL; 36% MedlineStratified random sample of 3,000 nurses (37% response rate; 51% ADN/Diploma)© Stillwell 2007Research is of little value unless the findings are used in practice to improve care (Schultz, 2006)Copyright, Susan B Stillwell, 2007© Stillwell 2007Is KT really really needed?Problems for decision-makersVolume of scientific findingsComplexity of designChoi, B. (2005) Understanding basic principles  of knowledge translation. J Epidemiol. Community Health. 59: 93© Stillwell 2007Cochrane Database of Systematic Reviewshttp://www.cochrane.org/reviews/impact/cdsrpubgraph1995present.htm© Stillwell 2007Integration and SimplificationChoi, B. (2005) Understanding basic principles  of knowledge translation. J Epidemiol. Community Health. 59: 93Copyright, Susan B Stillwell, 2007© Stillwell 2007Smoking makes you ugly© Stillwell 2007World Health OrganizationKnowledge ManagementFocus : National Policy Makers, WHO Programs and Health Professionals● Improve access to world’s health information● Translate knowledge into policy and action● Leverage eHealth in countrieshttp://www.who.int/kms/en/© Stillwell 2007Santesso et al (2006) Knowledge transfer to clinicians and consumers by the Cochrane Musculoskeletal Group. The Journal of Rheumatology 33:11● From blobbogramNumber out of 100Relative RiskCopyright, Susan B Stillwell, 2007© Stillwell 2007Santesso et al (2006) Knowledge transfer to clinicians and consumers by the Cochrane Musculoskeletal Group. The Journal of Rheumatology 33:11Plain Language  Summaries1 min5 min15 min© Stillwell 2007Founded 2000Mission:Develop, test, and implement evidence-based knowledge translation strategies and to bridge the gap between research evidence and practice.Knowledge Translation ProgramFaculty of Medicine  - University of Toronto© Stillwell 2007The BLACK BoxCopyright, Susan B Stillwell, 2007© Stillwell 2007Cochrane Effective Practice and Organisation of Care Group http://www.epoc.cochrane.org/en/index.html© Stillwell 2007Do I Know What I Do? Do I Do What I Know?000Printed materials+ss++Local opinion leaders+ModModReminder systems+ssModModMinMinAudit and feedback+++Academic detailing8C7C6C54C3C21StudySummary of supportive evidence  used  by Trowbridge & Weingarten Chapter 54 of AHRQ Report© Stillwell 2007A few words about…Beliefs Copyright, Susan B Stillwell, 2007© Stillwell 2007Nurses’ Perceived Knowledge, Beliefs, Skills, and Needs Regarding EBP: Implications for Accelerating the Paradigm ShiftMelnyk, Fineout-Overholt, Feinstein, Li, Small, Wilcox, Kraus (2004) Nurses’ Perceived Knowledge, Beliefs, Skills, and Needs Regarding EBP: Implications for Accelerating the Paradigm Shift Worldviews on Evidence-based Nursing 1(3):185-193© Stillwell 2007Findings: Correlations among beliefs, knowledge and EBPNurses held strong beliefs that EBP would improve clinical care and patient outcomes (r=.32’ p=.000).Knowledge (r = 42; p=.000) and beliefs (r = .4; p = .000) about EBP are related to the extent that nurses engage in EBP.The extent to which nurses’ practices were evidence based were correlated with having a mentor that facilitates EBP (r = .21; p =.05)© Stillwell 2007Copyright, Susan B Stillwell, 2007© Stillwell 2007Pilot Testing of the ARCC ModelUnpublished data Rona F. Levin, PhD, RN, Paula Scharf Kohn, PhD, RN Lienhard School of Nursing; MaryJo Vetter, MS, RN, NPC Visiting Nurse Service of New York; Bernadette M. Melnyk, PhD, RN, CPNP/NPP, FAAN, FNAP Arizona State University (ASU) College of Nursing Ellen Fineout-Overholt, PhD, RN ASU College of Nursing; Michael Barnes, Assoc. Prof., Clinical Psychology, Hofstra University, New YorkFostering EBP in a Community Health Setting● Major findings: Nurses in the 16 week ARCC intervention program, compared to comparison intervention nurses, had significantly higher beliefs about EBP; higher EBP implementation, and increased group cohesion● Preliminary support of the ARCC modelKnowledge alone does not change nurses beliefs about EBP Mentoring and immersion in EBP is essential to facilitate and maintain attitude  change© Stillwell 2007Translating clinicians’ beliefs into implementation interventions (TRACII): a protocol for an intervention modeling experiment to change clinicians’ intentions to implement evidence-based practiceEccles, Johnston, Hrisos, Francis, Grimshaw, Steen & Kaner (2007) Implementation Science 2007, 2:27© Stillwell 2007Knowledge TranslationHealthcare systems and individuals adapt and apply best clinical evidenceOUTCOME: patient (individual, family, community, population) is the ultimate recipient of benefits related to closing the gap between evidence and practice (Davis, D. 2006. Continuing education, guideline implementation, and the emerging transdisciplinary field of knowledge transplation. J of Con education in Health Professions 26: 5-12)Copyright, Susan B Stillwell, 2007© Stillwell 2007The BLACK Box

Knowledge Translation: What It Is and Isn’t

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Knowledge Translation: What It Is and Isn’t

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