Jo Logan

Lost in Knowledge Translation: Time for a Map?

&NA; There is confusion and misunderstanding about the concepts of knowledge translation, knowledge transfer, knowledge exchange, research utilization, implementation, diffusion, and dissemination. We review the terms and definitions used to describe the concept of moving knowledge into action. We also offer a conceptual framework for thinking about the process and integrate the roles of knowledge creation and knowledge application. The implications of knowledge translation for continuing education in the health professions include the need to base continuing education on the best available knowledge, the use of educational and other transfer strategies that are known to be effective, and the value of learning about planned‐action theories to be better able to understand and influence change in practice settings.

Toward a Comprehensive Interdisciplinary Model of Health Care Research Use

Numerous health care disciplines have noted that insufficient research evidence is used in clinical practice. This situation denies optimal care to patients and potentially increases system costs. A practical theoretical framework for policymakers intent on promoting an evidence-based approach to the transfer and use of research findings in clinical practice settings is presented. The Ottawa Model of Research Use (OMRU) has a comprehensive interdisciplinary focus and consists of six key elements: the practice environment, potential adopters of the evidence, the evidence-based innovation, research transfer strategies, the evidence adoption, and health-related and other outcomes. Model elements and the interactive relationships among them are described.

Aboriginal Healing: Regaining Balance and Culture

This ethnographic study explored the question, How do urban-based First Nations peoples use healing traditions to address their health issues? The objectives were to examine how Aboriginal traditions addressed health issues and explore the link between such traditions and holism in nursing practice. Data collection consisted of individual interviews, participant observations, and field notes. Three major categories that emerged from the data analysis were: following a cultural path, gaining balance, and sharing in the circle of life. The global theme of healing holistically included following a cultural path by regaining culture through the use of healing traditions; gaining balance in the four realms of spiritual, emotional, mental, and physical health; and sharing in the circle of life by cultural interactions between Aboriginal peoples and non-Aboriginal health professionals. Implications for practice include incorporating the concepts of balance, holism, and cultural healing into the health care services for diverse Aboriginal peoples.

Development and evaluation of a decision aid for patients with stage IV non-small cell lung cancer.

Although guidelines for treating stage IV non‐small cell lung cancer suggest that the patient’s values should be considered in decision‐making, there are no practical tools available to assist them with their decision‐making.

Clinical practice guidelines: necessary but not sufficient for evidence-based patient education and counseling

While clinical practice guidelines provide direction for the management of specific diseases or particular clinical problems, there are major gaps between guidelines and their implementation. The purpose of this paper is to illustrate how an existing guideline can be used to develop an evidence-based patient education program. Congestive heart failure (CHF) represents a range of complex, chronic illnesses which offer little hope of cure yet require symptom management by health care providers, patients, and their families. Successful self-monitoring, self-care, and decision making are based on acquisition of appropriate knowledge and management skills. We describe a comprehensive teaching program in which the content was built on the clinical evidence from the Agency for Health Care Policy and Research recommendations for CHF, and the implementation process was built on adult education evidence, adapted to health issues and patient learning challenges.

Promoting ventilator independence: a grounded theory perspective.

This qualitative study describes a distinctive nursing perspective on the process of ventilator weaning that is not well documented in current literature. The investigators used interviews with expert critical care nurses to reveal the knowledge, judgments, and actions used by nurses to promote ventilator independence. The authors identify a nursing diagnosis and three themes that offer a theoretical framework for ventilator weaning and suggest nursing interventions that promote successful ventilator weaning.

Linking Aboriginal Healing Traditions to Holistic Nursing Practice

With a phenomenal expected growth in the Canadian Aboriginal population and the fact that less than 1% of Canadian health professionals are of Aboriginal ancestry, there is an increased need for culturally competent health professionals. This article explains diverse healing traditions and links those traditions to holistic nursing practice. Respect for culturally sensitive care is necessary for understanding Aboriginal peoples in different contexts. We suggest that nursing practice, which takes into consideration the understanding of Aboriginal healing traditions, strengthens the intention of nurses to be holistic. Holism in nursing allows the profession to be on the fore-front of understanding Aboriginal healing traditions; the linking of holistic nursing practice with Aboriginal healing traditions offers a foundation on which to build culturally competent care.

Quality improvement, research, and evidence-based practice: 5 years experience with pressure ulcers

“The first requirement of a hospital is that it should do the sick no harm.” Florence Nightingale (1863) Skincare, a fundamental component of basic patient care, reflects on the overall quality of care that a patient receives in hospital. Quality care aimed at preventing and minimising skin breakdown and pressure ulcers has been identified as a nursing research priority.1 During the past 5 years, we have undertaken a large research utilisation effort focused on skincare and pressure ulcers involving more than 20 nursing units at a Canadian university affiliated teaching institution. Diverse activities were undertaken to address the barriers to evidence-based practice with efforts occurring across the setting and at many levels of the organisation. The initiative began in 1993 when an increase in the incidence of pressure ulcers was perceived in our setting. There had been more referrals to the enterostomal therapist and to plastic surgery, and sporadic reporting by clinical staff of their suspicions that skin breakdown was increasing in their areas. At that time no unit based mechanism for capturing reliable data on pressure ulcers was in place nor was it possible to retrieve data from the hospital information system. Even though it is a quality issue, the pressure ulcer initiative was set in a larger context of professional practice by linking it to the existing nursing quality improvement, research, and education infrastructures. The nurse specialists for quality improvement and research and evaluation took the lead on the project with support from several clinical nurse educators and managers. Critical to the success of the project was the support of the chief nursing officer who was vice president of patient services. A multidisciplinary task force developed and implemented a skincare programme. Two key initiatives ran concurrently: design and implementation of skincare programmes on the clinical units and …

Methodological Issues Encountered in a Study of Hospitalized COPD Patients

A study with hospitalized chronic obstructive pulmonary disease (COPD) patients determined the feasibility of providing and evaluating a tailored education program. This article describes two methodological issues encountered. Issues included recruitment and retention, and selection of outcome measures. The COPD Self-Efficacy Scale (CSES) and Dartmouth Functional Health Status (FHS) charts provided data on evaluation and outcome measurements. Of 67 patients, 55% met eligibility criteria, 73% (n = 27) agreed to participate, and 74% (n = 20) completed the study. Results revealed acceptance and satisfaction with the educational intervention. The median CSES score, significantly (z = 3.51,p = .004) improved from 53% to 82%. In FHS, a 20% improvement occurred in all except social support. Methodological concerns with the CSES reinforced the need for further investigation of the reliability and validity for hospitalized COPD patients. Researchers’ observations may assist in planning educational interventions and program evaluations with hospitalized COPD patients.