'Adding to the Evidence Base' Column to Transition.
Having recently retired from my full-time nursing faculty position at Xavier University, I also made the decision to retire from this column. This will be my final column of "Adding to the Evidence Base," taking editorial license to reflect and say thank you to all who encouraged me over the years. It has been my honor to be included in the important work this journal and its parent organization accomplish.
The first "Adding to the Evidence Base" column appeared in the February 2006 issue, and during most years, this column was published three to six times each year in the journal. The "charge" given to this author by the editor and Editorial Board in the fall of 2005 was to examine at least one selected original research study and determine its contribution to the evidence base. Over the past 11 years, more than 40 "Adding to the Evidence Base" columns were published in Urologic Nursing to accomplish that purpose. The columns have considered numerous topics, including urinary incontinence, many aspects of prostate cancer, drug therapies, practitioner capabilities, and quality-of-life issues, to name a few. This author has witnessed the positive change of the evidence over time. Researchers are very careful to be certain their studies are conducted in a manner that is not only necessary, but that assures their studies have internal validity.
From a design perspective, both qualitative and quantitative studies have contributed to what we know about the variety of topics considered. Many who engage in research have typically thought quantitative research contributed to the evidence base more than qualitative research findings. It is the opinion of this author that this thought is changing as it has for this column. Both quantitative and qualitative findings have been added to the evidence base of Urologic Nursing over the past 11 years.
In 2013, this author was asked to present a session at a SUNA annual conference in Savannah, Georgia. During that presentation, findings from seven studies, six from prior columns on urinary uncontinence and one that had not been reviewed, were synthesized. Five studies were qualitative or mixed-method, and two studies were quantitative in their approach. While further research may be needed due to the placement of the evidence on the hierarchy (Johns Hopkins Hospital/Johns Hopkins University, 2016; Melnyk & Fineout-Overholt, 2015; Polit & Beck, 2012), findings from all studies speak powerfully to practitioners. It is necessary and essential to embrace all research findings for the benefit of patients.
Over time, an increase in studies that are Level I or Level II on the hierarchy of evidence (Johns Hopkins Hospital/Johns Hopkins University, 2016; Melnyk & Fineout-Overholt, 2015; Polit & Beck, 2012) has been noted, indicating an increase in rigor of quantitative studies. While descriptive, correlational, and other quantitative studies have an important contribution to make to the evidence, nursing in general is increasing the numbers of randomized studies (RCTs), a fact that is also noted in Urologic Nursing.
Previous reviews have considered development, translation, and use of research instruments; their validity and reliability; and the importance of those concepts to a research study. One instrument translation study in a very early column was revealing for this author and provided unanticipated learning. Not only was the researcher able to reach those who might not have been included in a study without such a language translation, but the learning for the community of individuals who answered the instrument facilitated their health outcomes due to their increased knowledge of prostate cancer. Thus, research on language translation of an instrument can and did provide patient benefit during the process of assuring quality of a research instrument, as well as examining the data collected after the research study was concluded.
Those who review research to add it to the evidence base often find evaluation of statistics to be challenging. Many different statistical applications have been examined in this column to determine their appropriateness for the data they analyze, and also for the interpretations and conclusions that can be drawn from the use of the applications. This author hopes the information provided allayed some of the anxiety that can interfere with finding good evidence.
The evidence from all studies will help practitioners make important practice change decisions, improving care and outcomes for patients in their care. Ultimately, that is the reason nurses conduct research and review the evidence so patients have the best experience in a cost-effective manner, giving them the best chance to improve their health outcomes (Lewis, 2014).
For the future of this column, it is this author's hope that the past 11 years have been a beginning and that what follows helps to move evidence-based practice (EBP) to its rightful place in nursing practice. Bernadette Melnyk said in one of her webinars a few years ago that teaching research and EBP was not easy because many faculty lack knowledge of EBP. She was not indicting faculty, but addressing that EBP is still in its infancy, as is the understanding of those of us who try to help our students manage this information. While writing a column is not the only way to learn about evidence and EBP, it certainly allowed me that opportunity. Subsequent to this learning is the practice integration, which is the next challenge for practitioners and academicians.
Although we analyze and synthesize evidence, it does not mean we can easily include those changes in practice. There are often many other considerations, including the patient, cost, and institution and clinician needs that must be addressed prior to translating the evidence and creating a change. A future columnist will be able to advance not only the placement of evidence on the hierarchy, but also the translation of the evidence into best practice guidelines that make sense in the care of our patients because of our growth in understanding EBP over the past 15 to 20 years.
I wish all of you well in your learning about the evidence, and how it can support the quality and safety of your practice. "A journey of a thousand miles begins with a single step" (Lao-Tzu). Enjoy your journey! And thank you again for being a part of mine.
Key Words: Evidence-based practice, nursing research.
Johns Hopkins Hospital/Johns Hopkins University. (2016). Johns Hopkins Nursing Evidence-Based Practice Model--Appendix C: Evidence level and quality guide. Retrieved from http://www.hopkinsmedicine.org/evidence-basedpractice/jhn_ebp.html
Lewis, N. (2014). A primer on defining the Triple Aim. http://www.ihi.org/communities/blogs/_layouts/15/ihi/com munity/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e89d9-14d88ec59e8d&ID=63
Melnyk, B., & Fineout-Overholt, E. (2015). Evidence based practice in nursing and healthcare: A guide to best practice (3rd ed). Philadelphia, PA: Wolters Kluwer/Lippincott, Williams and Wilkins.
Polit, D., & Beck, C. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.
Cynthia M. Sublett, PhD, RN, CNL, is Former Associate Director, DNP and CNL Programs, Xavier University, Cincinnati, OH.
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|Title Annotation:||Translating Evidence into Clinical Practice|
|Author:||Sublett, Cynthia M.|
|Date:||Sep 1, 2017|
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