The Literature On Knowledge Translation And Barriers To Evidence-Based Practice
A brief statement from you about what you have found surprising in this topic
Evidence-based practice improve patient outcomes through conducted researches on various medical problems. However, most registered nurses have not engaged in continuous evidence-based practice, because of resistance from nurse leaders, politics, and organizational cultures. Despite the benefits realized from evidence-based practice such as introduction of new medicine, there are still no mentors to guide older personnel in nursing profession on how to conduct evidence-based practice. Other nurses who joined the profession many years ago resist to various changes brought by recently graduating nurses. Evidence based practice reduces complications among patients and reduces cost of health care. Despite efforts to increase awareness on evidence-based practice, few organizations report using evidence-based practice while caring for their patients. The most surprising fact is that experienced nurses who have served longer sentences in health care are least interested in learning evidence-based practices. Other health care centers do not allocate funds to finance evidence-based practices in their budgets.
It is surprising that some nurses are conservatisms who refuse to change to new cultures. Culture is a huge problem affecting health facilities where many nurses explain that evidence-based practice is not their culture when confronted to conduct the exercise. They claim that evidence-based practice was not originally integrated in the nursing profession and thus will be hard to introduce it along the way. Proper methods of knowledge translation involves exchange, synthesis, and application of ethical knowledge when users and researchers are interacting. It is important to note that evidence-based practices require effective methods of knowledge translation to assess review and utilize scientific research when conducting evidence based practices. It is surprising that many nurses have not learnt effective methods of knowledge translation, which acts as the major barrier of passing knowledge from researchers to users.
2 What you understand evidence-based practice to be
Duke University medical center (2) explains that evidence based practice is the integration of patient values, clinical expertise and best researched evidence into the process of making decision while taking care of patient. The accumulated experience of clinicians, their skills, and education is their professional expertise. Patients forward their unique concerns, values and expectations to the nurses who use evidence researched using sound methodology to give the appropriate treatment and medication. Evidence based practice is the combination of best research evidence, clinical expertise and values of patients and their preferences. Evidences gained supports patient care and creates opportunity to achieve optimal outcomes and quality life Patient encounters trigger evidence based practice because questions are generated from varied experiences, especially on effects of therapy, diagnostic tests utility, disease prognosis and etiology of various disorders. Clinicians require having new skills such as efficiency in searching literature, formal rules application while using evidence to evaluate clinical literature (p.1).
Steps involved in EBP process
Evidence based practice begins with assessing the problem of the patient which raises questions from care given to the patient Duke University medical center (2). The nurses constructs informed clinical questions from the case. A good question clinically contains the problem of the patient, defining their important characteristics such as primary problems experienced, existing conditions of the disease, their ages and gender that are important to diagnoses of disease and treatment. The question contains methods of intervention, prognostic factor, and exposure considered, drugs prescribed preferred surgery and tests.
The comparison with the intervention is indicated either between two drugs. The question lists what should be accomplished, symptoms to be eliminated, and methods of reducing adverse effects (p.1).
Acquiring the evidence is the third step where nurse selects appropriate resources and conducts appropriate research. Evidence is acquired through conducting various studies including case series and case reports, which include report collections concerning treatment of individual patients. However, they have minimal statistical validity. Case control studies involve patients with specific conditions compared with normal persons. Researchers identifies factors related to the illness. Medical records are used to recall when collecting data. Cohort studies deals with patients taking particular treatments or exposed to certain conditions. The outcomes are compared with other persons not exposed to the treatment. Randomized controlled clinical trials are experiments carefully planned introducing treatment with an aim of studying the effect on real patients. Methodologies such as randomization and blinding reduce bias and allow researcher to compare between control and intervention groups Duke University medical center (2), (p.5).
Randomized control trial provides sound evidence of effect and cause. Systematic reviews focuses on critical questions answering each question. The process involves conduction of extensive search of literature to select studies having sound methodologies. Studies are reviewed and assessed for their quality while results are summarized according to criteria of the question under review. Meta-analysis analyses varied studies on specific topic and using statistical methodology to combine results and report them. Cross-sectional studies define relationships of diseases among other factors in defined populations. They lack timing information, exposure and outcome while only including prevalent cases. They commonly compare diagnostic tests. Qualitative research answers questions regarding responses of humans towards potential problems of health, describing, exploring, and explaining health phenomena under study (p.6).
The fourth step is appraisal of the evidence to determine its validity and usefulness in clinical practice. The nurses then gets back to the patent to discuss their preferences while integrating evidence with clinical expertise as well as applying it into practice (Duke University Medical center (2)(p.6). The last step is self-evaluation where the nurse assess the performance with the patient.
3 Choose one area of your practice, critically reflect, and articulate what currently underpins or drives it. You can be honest here, it may be that it is underpinned by best evidence or by habit ‘this is the way it has always been done’
Policy, research, and ethical frameworks underpinning practice of dietetics
Guiding principles underpinning professional conduct include beneficence (taken actions should aim at doing well). Non-maleficence principle explains that dietitians should take steps that prevent causing harm to others. Justice principle ensures fair treatment of people. Fidelity aims at becoming faithful to promises made to others while autonomy principle describes that individuals have the right to choose freely their own direction and their consequences
Dietitians must support and protect health of persons using the service, and health of the community at large. They are required to behave in ways that justify trust and public confidence. They are required to enhance and uphold a good professional reputation. Dietitians are accountable for practice individually, thus responsible of answering omissions, actions, directions and advice from other professionals (Douglas(1). They must care for service users entitled to competent and safe care. They are required to adhere to country laws.
Dietitians understand limits within their area of practice and be in a position to look for advice and refer other professionals. They practice within legal and ethical boundaries required in their profession by understanding the need of respecting and upholding their rights, values, and dignity. They derive best care standards even when there is personal incompatibility (p.1).
4 Critically reflect on what have you learned from the literature on knowledge translation and barriers to evidence-based practice, (specifically Grol and Wensing 2004; Strauss, Tetroe and Graham 2009) that you can take with you in your practice? If you had to change practice in your setting tomorrow, what would be uppermost in your mind?
Dietitians require knowledge on Knowledge translation (KT), to synthesis information, exchange it, and apply it in ethical situations when interacting with users, researchers, policy makers, managers, planners in healthcare and public care, as well as researchers across disciplines. More interactive groups include providers of health care across formal and informal settings, private sectors such as venture capital firms, distributors, and manufacturers. Dietitians are involved in knowledge translation to create new information and apply it in respective fields to yield beneficial outcomes in the society. Dietitians use KTstrategies to define research questions, formulate hypotheses, identify best research methods, conduct research, interpret findings, and contextualize findings. Dietitians apply findings to resolve problems and practical issues (National center for the dissemination of disability research (5) (p.1). KT continues dialogs, interactions, and partnerships between different knowledge groups. KT knowledge translation is an interactive process, a nonlinear process, requires multidirectional communications in multiple activities and ongoing collaboration among dietitians. It is oriented in impact and makes use of diverse knowledge of users.
Knowledge translation and evidence-based practice
KT moves knowledge based on research into practice, matching with engagement of evidence-based practice (EBP) among dietitians. Diet Practitioners make decisions in their practice depending on integration of research evidence added with clinical expertise and unique values of patients (Sudsawad (3) (p.1).
Models of knowledge translation
Dietitians use CIHR model of knowledge translation to identify a research cycle where interactions, communications, and partnerships occur. Dietitians begin by defining research questions and methodologies, conducting research, publishing research findings in accessible formats and plain language. They place research findings in sociocultural norms and other knowledge, making decisions and taking actions from research findings, and influencing rounds of research depending on impacts brought by use of knowledge (Sudsawad(3)(p.3).
Barriers to evidence-based practice
Dietitians avoid practicing evidence-based practice because of barriers such as lack of enough education and skills as well as knowledgeable mentors, tools required and adequate resources to engage in EBP. Moreover, lack of time and organizational culture are additional barriers to EBP. Health managers fail to provide enough support to nurses to conduct EBP. Workshops and seminars are not availed to train nurses on processes to follow and skills needed along with ways of their implementation (Laura(3) (p.1).
If you had to change practice in your setting tomorrow, what would be uppermost in your mind?
Evidence-based practice requires effectiveness from nurses and other healthcare professionals. Organizing workshops and seminars frequently will be the foremost practice to include in health care. Most healthcare workers joined the medical profession more than twenty years when evidence-based practice were not introduced, thus welcoming mentors in workshops and seminars will equip them with necessary skills required in practicing evidence-based practice.