Cheryl A. Fisher

A thematic analysis of theoretical models for translational science in nursing: Mapping the field

The quantity and diversity of conceptual models in translational science may complicate rather than advance the use of theory. This paper offers a comparative thematic analysis of the models available to inform knowledge development, transfer, and utilization. Literature searches identified 47 models for knowledge translation. Four thematic areas emerged: (1) evidence-based practice and knowledge transformation processes, (2) strategic change to promote adoption of new knowledge, (3) knowledge exchange and synthesis for application and inquiry, and (4) designing and interpreting dissemination research. This analysis distinguishes the contributions made by leaders and researchers at each phase in the process of discovery, development, and service delivery. It also informs the selection of models to guide activities in knowledge translation. A flexible theoretical stance is essential to simultaneously develop new knowledge and accelerate the translation of that knowledge into practice behaviors and programs of care that support optimal patient outcomes.

Clinical research nursing: A critical resource in the national research enterprise

Translational clinical research has emerged as an important priority for the national research enterprise, with a clearly stated mandate to more quickly deliver prevention strategies, treatments and cures based on scientific innovations to the public. Within this national effort, a lack of consensus persists concerning the need for clinical nurses with expertise and specialized training in study implementation and the delivery of care to research participants. This paper reviews efforts to define and document the role of practicing nurses in implementing studies and coordinating clinical research in a variety of clinical settings, and differentiates this clinical role from the role of nurses as scientists and principal investigators. We propose an agenda for building evidence that having nurses provide and coordinate study treatments and procedures can potentially improve research efficiency, participant safety, and the quality of research data. We also provide recommendations for the development of the emerging specialty of clinical research nursing.

Searching for proof: Creating and using an actionable PICO question.

www.nursingmanagement.com Nursing Management • August 2014 9 A clearly stated research question or hypothesis is one of the critical first steps in designing a research study that can actually produce usable results. The question outlines where the study will be conducted, defines the population of interest, and determines the types of interventions that may be tested. It also helps the researcher select the measures that will be used to collect data and sets the stage for analysis methods. The question that guides a search of research evidence to support or refine management practice also plays a key role, similar to a research question, in structuring and guiding the search process. This guiding question is called a PICO question: (P) patient, population, or process of interest, (I) intervention or best practice to be assessed, (C) comparison group or unit, and (O) outcome or effect of interest. A format using the time factor (PICOT) is also sometimes used. The variable of time (T) is helpful if, for example, you’re interested in looking at the effect of an intervention over a particular period of time. For example: “In the adult oncology postoperative surgical patient population (P) is patient-controlled analgesia (I) compared with PRN medication (C) more effective (O) within the first 24 hours after surgery (T)?” In this example, the nurse leader is only interested in looking at the first 24 hours after surgery on an inpatient unit, so it’s appropriate to use time in the question to help narrow the search. If the time frame isn’t an important factor, stay with the PICO question format so as not to limit the search. When developing the PICO question for an evidence-based nursing management issue, the critical task is to ask the question using the correct terminology so that these key words can then be used to create a literature search with useful solutions. It’s a challenge to find the most relevant and useful information in the vast sea of databases and Internet information that now exists.1,2 Finding the right information in the most efficient manner is vital to successfully practicing evidence-based decision making in management and leadership. Knowing what key components to use in a search strategy will not only help develop that efficiency, but also guide the nurse leader in setting up an evaluation strategy to assess the impact of practice changes.

Developing Competency to Sustain Evidence-based Practice

Organizations must ensure that nursing care delivery is based on best evidence. This article describes how a clinical research hospital used a competency-based approach to structure the development and execution of a strategic plan and integrated evidence-based practice concepts into the activities of nurses at all levels. The article will also describe the process for developing and implementing the competency across our department including outcomes achieved.

Clinical Research Nursing: A New Domain of Practice

Abstract This chapter will describe the roles and contributions of nurses in the clinical research enterprise and will define the emerging specialty practice domain of clinical research nursing. The broad scope of practice settings in which nurses may engage in the care of participants in clinical research will be described, as will the legal and ethical issues related to nursing practice in clinical research. Tools and resources that principal investigators and research project managers can use when incorporating nurses on a clinical research team will be presented based on work from the National Institutes of Health Clinical Center and from collaborators in the National Clinical and Translational Science Award consortium and the International Association of Clinical Research Nurses.

Meaningful strategies for retention.

www.nursingmanagement.com Nursing Management • October 2015 21 As part of the National Institutes of Health Clinical Center Nursing Department (CCND), nurses are required to master specific competencies and gain an understanding of unique requirements when caring for research participants, as well as the clinical needs of our patients. We’re specifically interested in retaining qualified nurses because of the intense training needed to work in a highly specialized research setting. This additional investment in staff training means that the cost related to turnover is of particular concern. Utilizing evidence to address retention, the CCND has operationalized a multifaceted approach to retention from onboarding with a newly revised orientation program to a residency program for new graduates and the development of a recognition program that celebrates and highlights employee accomplishments.

Extending evidence through shared governance.

16 July 2015 • Nursing Management www.nursingmanagement.com T he National Institutes of Health Clinical Center nursing department implemented evidence-based practice (EBP) in 2007 as a problem-solving approach that incorporates evidence, practitioner experience, and patient values into clinical decision making.1 Because we utilize a shared governance approach to guide clinical practice, the associated committees were quickly identified as vehicles by which the principles of EBP would diffuse through the organization. Our intent was to enhance the functioning of our shared governance model through the incorporation of EBP principles into the processes of each standing committee and facilitate their successful integration into the intellectual framework of nursing within the Clinical Center. To accomplish this initiative, it was necessary to target key individuals with influence throughout all levels of our organization. (See Figure 1.)

Creating a culture of EBP: what's a manager to do?

www.nursingmanagement.com Nursing Management • October 2014 21 Despite the Institute of Medicine’s call for improving patient safety in the publication To Err is Human, and its 2001 recommendation for all professionals to deliver patientcentered care emphasizing evidence-based practice (EBP), struggles to implement and sustain EBP continue to exist.1 Daily challenges plague managers regarding urgent operational issues and increasing budgetary and resource constraints. However, managers remain in the ideal position to create and support an environment that provides evidence-based care. Nurse managers play a major role in establishing a unitbased culture in which nursing practice is guided by evidence. To do this, we must establish expectations supported by departmental policy that encourage clinical nurses to actively incorporate evidence into daily decision making. This can produce challenges for the often overburdened manager who must overcome the frequently sited barriers to EBP implementation: lack of time, inadequate knowledge and skills, lack of EBP mentors, and resistance to change.2 Utilizing a participative leadership style in which decisions are made with the most feasible amount of participation from those who are affected by the decisions, in addition to support at the organizational level (top down) and the unit level (bottom up), the nurse manager can have significant influence in overcoming these barriers and role model opportunities for seamless incorporation of new practice behaviors.3 The nurse managers at the National Institutes of Health (NIH) Clinical Center have formalized the role of the manager in designing a unit culture to facilitate EBP for clinical staff. Help from the top Organizational support for the adoption of EBP is a prerequisite for implementation throughout the organization. It’s becoming more evident through the research that the leadership behaviors of nurse managers and administrators play an important role in successfully transferring research evidence into clinical nursing.4 Because responsibility for the practice environment rests with the nurse manager, we must first demonstrate an understanding and appreciation of EBP to foster an environment that promotes its implementation and adoption. One study found that clinical nurses observed the most significant managerial support to take place when the manager was aligned with the organization and exhibited behaviors of stimulating and guiding staff in research and EBP activities.5 Looking first to the organization for support, the NIH Clinical Center incorporated EBP expectations into the annual nursing performance evaluation, noting accomplishments of staff members choosing to take on more responsibility as they teamed up with clinical nurse specialists (CNSs) or nurse managers to improve practice. The inclusion of an EBP element on the clinical nurses’ annual performance plan highlights the importance of EBP in their practice and holds the clinicians accountable for this practice. Another significant contribution from the organizational level was a five-level competency developed by the EBP steering committee. This competency was tiered based on the novice-to-expert framework and was required for all nurses within the department to complete at least to level III. The CNSs and nurse managers were required to complete the competency at the more advanced levels IV and V, with the expectation that they would guide the projects and take on a champion role. The competency provided the framework for working through the steps of EBP and provided a resource for staff to refer back to for reference. The development and validation of the competency helped foster the adoption of EBP and has provided a way for all new staff to Creating a culture of EBP: What’s a manager to do?