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With awareness comes choice: only part of the picture.

With awareness comes choice--is this really as easy as it sounds? A key assumption in the often heard exhortation to publish nursing research is that practice can be developed by the transfer of new knowledge into evidence based health care. I would argue that the vision of even high quality information seamlessly flowing into clinical practice is naive. Knowledge transfer is seldom a one way process of passive diffusion.

Exploring the concept of knowledge transference also requires an appreciation of what counts as valid knowledge or evidence and why. Knowledge transfer in my view therefore requires the application of scholarly nursing. Scholarly nursing builds on Ernest Boyer's notion of scholarship and requires appreciation of a broader construct of knowledge for practice which incorporates experiential and ethical knowing with the rigour of an intellectual base and commitment to a service base (Riley, Beal, Levi, & McCausland, 2002). Putting this another way, scholarly nursing practice requires nurses to exercise rigour when considering the epistemological assumptions of knowledge development and transfer from a variety of standpoints (practice experience, ethics, intellect and service commitment) before practice development occurs.

The imperative for nursing scholarship in the context of knowledge transfer is obvious when we consider the Canadian Institutes of Health Research (2012) assertions that around 30% of patients do not get access to proven effective treatments, 25% get care that is not needed or is potentially harmful and 75% of patients do not get the information they need for decision making. In New Zealand, the recently launched patient safety campaign Open for Better Care (http://www.open.hqsc.govt.ns/) creates a compelling case for using knowledge transfer to actively reduce patient harm. The requirement for evidence based nursing management of patient care and scholarly practice is clearly articulated in Domain Two of the Nursing Council's competencies (Nursing Council of New Zealand, 2007). This level of practice is evident in the articles presented in this issue of Nursing Praxis.

In preparing for this editorial and having been asked to write about knowledge transfer I have discovered that the concept has many synonyms in the literature which can be confusing (e.g. knowledge translation or knowledge utilisation). There is often a conceptualisation of a hierarchical and linear process flowing from researcher to practitioner in the literature.

Knowledge translation is most commonly used in reference to the Canadian Institutes of Health Research (CIHR) definition of a dynamic and iterative process that includes the synthesis, dissemination, and exchange along with the ethically-sound application of knowledge with the aim of improving health outcomes through more effective health services (Canadian Institutes of Health Research, 2012). Knowledge translation often results in the development of tools for application such as clinical guidelines or care pathways. Knowledge utilisation on the other hand can be seen as picking up from where translation leaves off. Work in this area includes consideration of the various stakeholders in both practice and policy decision making and the process of diffusion of technology and innovations in health service organisations (Estabrooks et al., 2008).

Knowledge transfer definitions are congruent with these concepts but with the valuable addition, in my view, of a broader non-linear process involving researchers, educators, clinicians and policy makers right from the agenda setting and idea generation stage through to the implementation of initiatives. From this perspective nurses in all areas of practice have responsibility for generating questions as well as implementing proven solutions. The Canadian Nursing Health Services Research Unit (NHSRU) (2004) website has a useful definition of knowledge transfer that captures this intent well.

In summary, knowledge transfer does not occur by passive diffusion but rather a complex dynamic process that can be cyclic or multidimensional. The complexity of the clinical practice environment requires that a comprehensive organising framework is utilised. This requires more than just a practitioner's ability to critically appraise evidence and make rational decisions. Effective knowledge transfer depends on the achievement and sustainability of significant and planned change involving individuals, teams, and organisations.

There are a number of models developed to support effective knowledge transfer in the literature, however no single framework provides all the answers. What is clear is the nurse needs to consider multiple facets such as the appraisal of the knowledge for transfer in terms of its worth and fit, the specific context of practice as well as multiple strategies to support implementation. The Promoting Action on Research Implementation in Health Services (PARIHS) framework developed by Rycroft-Malone and colleagues is an often referenced example of scholarly practice. The PARIHS framework focuses on implementing research for evidence-based practice, attending to the characteristics of the elements of evidence (including research, clinical experience, and patient experience), context (covering culture, leadership, and evaluation) and facilitation (clarifying purpose, role, and skills/attributes) and has a recently developed supporting guide for practitioners (Stetler, Damschroder, Helfrich, & Hagedorn, 2011).

In my own work promoting web-based resources to provide access to knowledge relevant to scholarly nursing practice, I make the assumption that whilst awareness does not guarantee choice, ignorance certainly limits it. I believe that we owe it to the population that we serve to mindfully keep ourselves as current as possible so as to provide accessible information for others to have a sound awareness of the choices they can make in their own health care.

References

Canadian Institutes of Health Research. (2012). Knowledge translation & commercialisation. Retrieved from http:// www.cihr-irsc.gc.ca/

Canadian Nursing Health Services Research Unit. (2004). Knowledge transfer. Retrieved from http://nhsru.com/ knowledge-transfer

Estabrooks, C., Derksen, L., Winther, C., Lavis, J., Scott, S., Wallin, L., & Profetto-McGrath, J. (2008). The intellectual structure and substance of the knowledge utilisation field: A longitudinal author co-citation analysis, 1945 to 2004. Implementation Science, 3(1), 49. doi:10.1186/1748-5908-3-49

Nursing Council of New Zealand. (2007). Competencies for the registered nurse scope of practice. Wellington: Author Retrieved from www.nursingcouncil.org.nz.

Riley, J. M., Beal, J., Levi, P., & McCausland, M. P. (2002). Revisioning nursing scholarship. Journal of Nursing Scholarship, 34(4), 383-389. doi:10.1111/j.1547-5069.2002.00383.x

Stetler, C., Damschroder, L., Helfrich, C., & Hagedorn, H. (2011). A guide for applying a revised version of the PARIHS framework for implementation. Implementation Science, 6(1), 99. doi:10.1186/1748-5908-6-99

Dr Kathryn Holloway, PhD, RN, FCNA(NZ) Dean, Faculty of Health, Whitireia. N.Z.
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Title Annotation:knowledge transfer in nursing
Author:Holloway, Kathryn
Publication:Nursing Praxis in New Zealand
Article Type:Editorial
Geographic Code:8NEWZ
Date:Jul 1, 2013
Words:1047
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