NURS 836 Week 1 Discussion Board Forum 1 on the Research-to-Practice Gap Example

Discussion Board Forum 1: Mind the Gap Between Evidence and the OR Table

NURS 836 Translational Research in Health Care, Discussion Board Forum 1

Thread by [Student Name]

The hospital and the classmates replied to are composites written for a model discussion; the textbook and studies cited are real.

Last month a 68-year-old man left our operating room after a seven-hour spine fusion with a new stage 2 injury over his sacrum. Two shelves away, in the core supply room, sat boxes of soft silicone foam dressings designed to prevent exactly that injury. Our evidence-based practice proposal in NURS 716 showed that the dressings work. They were stocked. They were not used.

Brownson et al. (2018) define the field this course studies in two parts. Dissemination is the targeted distribution of evidence to a specific audience, so that it is understood and used; implementation is the use of strategies to adopt and integrate an evidence-based practice within a setting. Our hospital has had dissemination of a weak kind: the guideline is posted, and the dressings were introduced at a supply fair. It has not had implementation.

The gap is old and well measured. Morris et al. (2011), reviewing studies of time lags in health research, found that the frequently quoted figure of seventeen years from discovery to practice is an average with wide variation, and that lags depend heavily on how start and end points are defined. The perioperative dressing evidence is younger than seventeen years, but the pattern is familiar. The effect is not small: a meta-analysis of eleven studies found that silicone dressings reduced sacral pressure injuries by about 70% compared with usual care (risk ratio 0.30), with no significant difference between intensive care and other settings (Rahman-Synthia et al., 2023). Strong evidence and a stocked shelf are not a practice; a practice is what people do at 7 a.m. when the first case is late.

Brownson et al. (2018) argue that evidence does not spread by its own weight, which is why a separate science of dissemination and implementation exists. In our case the barriers are concrete: no one owns the decision to apply the dressing, the preoperative checklist does not mention it, surgeons worry about the dressing shifting under prep solution and the cost appears on the operating room's supply budget while the savings appear on the inpatient units. This course gives me tools to plan for each, which is why I am glad to be carrying the NURS 716 topic forward. My working hypothesis for the term is that the evidence is ready and our system is not, and that the work of this course is to make the system ready: to give the dressing an owner, a place on the checklist, an answer to the surgeons' concern and a budget line that recognizes where the savings fall.

Reply to Danielle

Danielle, your medication reconciliation project faces the same gap between a good protocol and daily practice. One concept from this week that may help is that implementation is about strategies, not information. Brownson et al. (2018) frame implementation as the deliberate use of strategies to integrate a practice, which is a different task from informing people about it. A compilation of implementation strategies developed through expert consensus offers 73 discrete strategies, from audit and feedback to changing record systems and identifying champions (Powell et al., 2015). For reconciliation at admission, strategies that change the record system, such as a required field, may matter more than another in-service. Which step of reconciliation fails most often on your unit?

Reply to Jordan

Jordan, you wrote that once a national guideline recommends a practice, hospitals generally follow it. The evidence suggests otherwise. Morris et al. (2011) show that the time from evidence to routine practice is long and uneven, and guidelines are only one step in that process. In my own topic, the international pressure injury guideline has supported prophylactic dressings for years, yet our use remains low. The updated Consolidated Framework for Implementation Research helps explain why: success depends not only on the innovation but on four other domains as well: forces outside the organization, the organization's own culture and structure, the people who must change and the way the change is carried out (Damschroder et al., 2022). A guideline changes the innovation domain but leaves the other four untouched. What would your unit need besides the guideline to change its practice?

References

Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2018). Dissemination and implementation research in health: Translating science to practice (2nd ed.). Oxford University Press.

Damschroder, L. J., Reardon, C. M., Widerquist, M. A. O., & Lowery, J. (2022). The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science, 17(1), Article 75. https://doi.org/10.1186/s13012-022-01245-0

Morris, Z. S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: Understanding time lags in translational research. Journal of the Royal Society of Medicine, 104(12), 510-520. https://doi.org/10.1258/jrsm.2011.110180

Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., & Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10(1), Article 21. https://doi.org/10.1186/s13012-015-0209-1

Rahman-Synthia, S. S., Kumar, S., Boparai, S., Gupta, S., Mohtashim, A., & Ali, D. (2023). Prophylactic use of silicone dressing to minimize pressure injuries: Systematic review and meta-analysis. Enfermería Clínica, 33(1), 4-13. https://doi.org/10.1016/j.enfcle.2022.05.002