Skip to content

Oct 21

1 Comment

Shadowing Nurse Middle Managers


Our current featured article is titled “Nurse Middle Managers’ Dispositions of Habitus: A Bourdieusian Analysis of Supporting Role Behaviors in Dutch and American Hospitals” by P. C. B. Lalleman, MA; G. A. C. Smid, PhD; M. D. Lagerwey, PhD; L. Oldenhof, PhD and M. J. Schuurmans, PhD. While it is featured, you can access this article at no charge on the ANS website, and welcome your comments here! Pieterbass Lalleman has prepared this video, followed by a blog message about this work:

The current featured article in ANS focuses on supporting roles of nurse middle managers. The paper is part of a larger Dutch study on nurse middle managers daily work. The main goal is to better understand the role of nurse middle managers in hospitals and their leadership. We wondered: What gives these nurse managers authority in their daily

work? Most literature on nurse managers advocate American nurse managers work within Magnet hospitals as the best practice model.

The study has been initiated by the Dutch HU University of Applied Sciences and the Dutch Nurses Association. We decided to investigate practices of nurse middle managers in Magnet, Magnet-related and non-Magnet hospitals in both the Netherlands and the United states. Our grant proposal has been awarded $300.000. This allowed us to have a close look at the work of nurse managers in both the Netherlands and the United States This funding made it possible to conduct research and shadow nurse managers in New York and Michigan for one year.

Based on this ethnographic work (560 hours shadowing), we made an interpretation of the work of nurse middle managers using Bourdieu’s tools of dispositions and habitus (or second nature), field and capital. In this ANS article we describe first describe some essential findings: the eight dispositions of habitus of nurse middle managers. A caring, clinical and scientific disposition seemed vital. In the next part we describe how a different configuration of dispositions of habitus of nurse middle managers influenced their authority in each of the four participating hospitals. In forthcoming articles, we will analyze how these configurations influence the emergence of nurse middle manager’s leadership.

In this blog we zoom in on two aspects of our research that were more on the background: 1) living and doing research in the U.S. and 2) the importance of doing research together.

Big Friendly Giant

I used to work as a nurse and manager in a hospital, and now I work as a lecturer and researcher in an University of Applied Sciences in The Netherlands. We choose to move with my family to the U.S. for one year and take our time to understand living and working in the U.S. from a Dutch perspective (and not fly alone to the U.S. for 4-5 times and conduct the shadowing in slots of 2-3 weeks). This was a lucky choice. Doing ethnography demands a deep and robust understanding of the world you are investigating. Living in New York, walking my two youngest daughters to PS 8, the Robert Fulton School in the morning, followed by a bike trip across the Brooklyn Bridge to drop-off my eldest daughter at the Lower Manhattan Community Middle School at 26 Broadway , helped me in understanding and comprehending what I saw during my days shadowing the nurse managers. Although every hospital looks alike on first sight, especially during quick visits or tours, deeper insight is created by ‘hanging around’ for a longer time. Both shadowing as a research method for ethnography and moving to the U.S. were crucial for describing the habitus or second nature of these nurse managers. As a shadower I literally have been in the shadow of these, mostly women, that I followed during work. I am 6 feet and 5 inches tall a rather large shadow for these nurse managers. On a particular day a staff nurse of the hospital in Queens came to me smiling and said: ‘there you have the Big Friendly Giant again’. This reference to Roald Dahl expressed exactly how I felt in the strange new world that I thought I knew so well (both the hospital world and the U.S from the hundreds of articles, movies and TV shows). These kinds of encounters and also the experiences of my children and my partner helped me with making sense of the work of nurse managers in their hospitals and reflect on my own presence and interpretations. My work would not have been possible if I just have been visiting for a couple of weeks.

Reflection on wheels: the importance of ‘member check’ and collaborative research

This research project was an ethnography inspired by action research. The grant money gave us the opportunity to organize member check sessions with the nurse managers to report on the preliminary findings and discuss the meaning of these. The first session was organized in The Netherlands after we finished shadowing at the two Dutch sites. A very interesting finding of that session was that the nurse managers from the two sites requested to shadow each other. Their main motivation was that being shadowed helped them with the recognition of habitus as a second nature, their routine behavioral repertoire became exposed during shadowing. Shadowing someone else who was doing the same job enhanced their understanding of their daily work and habitus. The objects of this study, the nurse managers, became researchers (or subjects) of their own work. This movement became even more visible when the eight Dutch nurse managers (and my Dutch PhD supervisors) joined me in the U.S. for a one-week research trip to the two American hospitals. The 6-day trip started on a Sunday at NYU’s Institute of Public Knowledge were I met these Dutch managers and discussed the program with them. On Monday and Tuesday, we would visit the partner university and the hospital I shadowed in New York. On Wednesday we had a 733 miles’ bus trip from New York to Western Michigan. On Thursday and Friday, we visited the hospital and university in the Mid-West.

For me, as a researcher it was great to finally share all my observations with the nurse managers of the Netherlands, show them the U.S. system in full color. It also, helped me reflect on my findings and putting them in perspective. After two full days of New York, (Live in New York City once, but leave before it makes you hard) the 10 hour coach ride was one of the greatest reflective experiences I had during this PhD project. The drive through the state of New York, Pennsylvania, Ohio, Indiana and Michigan was superb. It gave us a change to reflect on all the impressions of New York and prepared us ready for the friendly Mid-West. I had the chance to talk the Dutch managers, interview them, record their experiences and illustrations. They did not only talk about the U.S., they also talked about home, how nursing and nurse management is organized in their own institutions. Travels like these can be very inspirational and valuable. Travelling enhances reflection. It creates new insights and helps both researcher and participants in making sense of the phenomenon under investigation.

In sum, PhD research tracks like these are like journeys in which both researcher and participants of the study collaborate to find the answers to complex challenges. To accomplish this the researcher, have to be close to the subject, live and work with them to fully grasp and comprehend the essence of what is seen. Both shadowing, member checking sessions and an international research trip contribute to these outcomes.

I would like to thank all the nurse managers and my supervisors for realizing this first publication on nurse middle managers daily work.

Oct 14

Personal Narrative in Phenomenology


The current featured ANS article provides an example of an approach to knowledge development that delves deeply into the narrative of the lived experience of a single person.  The article is titled “Being the Mother of an Adolescent Suffering From a Spinal Cord Injury: Possibilities of a Personal Narrative in Phenomenology.”  The author, Sanne Angel, PhD, RN, is from Aarhus University in Denmark.  Here is her message reflecting on this method and its potential for developing nursing knowledge: 

From a decade of studying life after spinal cord injury I draw attention to the craft of the single story. Its force in relation to develop a caring attitude is unsurpassed. Maybe this should be used more, both in relation to the professionals in charge for the patient and the

Sanne Angel

Sanne Angel

politician responsible for the needed resources. Thus in its own right, the individual analysis invites us to lend such an ear to the possibility of how others might experience this phenomenon, here  “Being the mother of an adolescent suffering from a spinal cord injury”. And that is the real thrust of the study here. 

Further as a methodological contribution, I am suggesting that the move from one person’s experience to others’ is itself supported by the implicit “eidos” of the single. From the analysis of the single story it is possible to extract what could be true for other people in similar situations. This move from one to another lived context requires an act that is not unlike Husserl’s own move from one case to his imagined variations.

However, performing an imaginary variation is what is done also when more than one single case, and may take a very talented researcher (which I do not claim to be). This calls for external validation judging whether this is done successfully, and I welcome you readers to engage therein.

Please visit the ANS site while this article is featured and available for free download!  We welcome your comments and ideas in response to this thought-provoking article!

Oct 7

Nurse Continuity: Improving Care with Health Information Technology


The current featured article in ANS focuses on using health information technology to improve care for people who suffer hospital-acquired pressure ulcers.  The article is titled “Proposing a New Conceptual Model and an Exemplar Measure Using Health Information Technology to Examine the Impact of Relational Nurse Continuity on Hospital-Acquired Pressure Ulcers” by Janet Stifter, PhD, RN; Yingwei Yao, PhD; Karen Dunn Lopez, PhD, MPH, RN; Ashfaq Khokhar, PhD; Diana J. Wilkie, PhD, RN, FAAN and Gail M. Keenan, PhD, RN, FAAN.  Dr. Stifter shared this message about her work and additional information about the article:

The story of this manuscript began with my decision to go back to school to earn my PhD, 24 years after gaining my MSN and 30 years long years after gaining my BSN (my midlife “brain re-energizer” event). In 2011 I reached a career crossroads that led to a transition into graduate school as a full time PhD student at the University of Illinois in Chicago (UIC), College of Nursing.

Stifter_Janet

Dr. Stifter

In my position immediately prior to entering the PhD program I was a Chief Nursing Officer (CNO) of a 300 bed community based teaching hospital who grappled daily with decisions around nurse staffing. Like many CNOs I was overseeing clinical areas operating under financial constraints and trying to meet or exceed a productivity metric at the 25% while maintaining high levels of quality, safety, and patient satisfaction. A significant source of frustration was the absence of real time, readily accessible, meaningful data to help me demonstrate to non-nursing executive leadership the possible association between our staffing decisions (floating; downsizing/ consolidating, and closing units; use of temporary and part-time personnel) and possible adverse patient outcomes.

At the same time, a second major imperative driving both the budget, manpower issues, and discussions around patient care outcomes was our uptake of a new electronic health record (EHR). I felt strongly that the answer to my data deficit was there in the new EHR, but how to access it? I wanted to work smarter and become more knowledgeable about engaging in this new world of EHR big data science. With the UIC doctoral program I recognized a clear synergy between my clinical issues, research interests, and the work of Dr. Gail Keenan and the HANDS (Hands On Automated Nursing Data System) team. Dr. Keenan’s HANDS database, an electronic nursing plan of care system, actualized my vision of using the EHR, with data being collected as part of routine nursing documentation, to begin examining the influence of nurse staffing on patient outcomes.

My specific focus on nurse continuity as a critical nurse staffing variable evolved out of a discussion with members of the HANDS team one day in our simulation lab at the university. Dr. Yingwei Yao, the statistician for the HANDS team, had created schematic diagrams using bands of color to visually depict the poor continuity of caregivers in sample admissions found in the HANDS database. A startling finding in these random examples was how few RN staff actually had the opportunity to care for the same patient within the same admission. What was also startling was that almost everyone around the table participating in the discussion could relate a similar story of having a family member, friend or themselves cared for with little to no continuity of nurse caregivers while hospitalized. Finally, a key driver to my study of nurse continuity was how little was published in the nurse staffing literature on this topic.

Despite the fact that it seems to be such a clearly held assumption by RNs that continuity in nurse staffing would lead to better outcomes, there is little data to substantiate this hypothesis, and in many institutions our staffing priorities are leading to anything but nurse continuity at the bedside. These early discussions and the lack of studies in the literature were the seeds to my PhD dissertation, an examination of the association of nurse staffing variables, including nurse continuity, on the development of hospital-acquired pressure ulcers, using HANDS as the data source to operationalize my study variables.

The genesis of this manuscript was the discovery during my literature review that some of the difficulties that arise from studying nurse continuity is due to the diverse definitions of the term and the absence of systematic methods for copyrightjscolorCOCdiagram600measuring the influence of continuity. I was also unable to locate a conceptual model that depicted continuity as I felt it operated – both as a direct influence on patient outcomes as well as a moderating influence on other nurse-staffing variables such as experience, education, and nurse-to-patient ratios. Thus, the purpose of this manuscript is to summarize the available research on nurse continuity and to present a framework and an innovative method for research regarding the influence of nurse continuity on patient outcomes.

Working with the HANDS team and this program of research has allowed me to blend 34 years of clinical experience with an academic inquiry around the issues of technology, nurse staffing, and patient outcomes. I have been exposed to the worlds of patient centered outcomes research, big data science, and data mining techniques through a research team that includes engineers, computer scientists, and nurses experts. I have also had the opportunity to create a conceptual model that moves nurse continuity into the mainstream of discussion around nursing staffing variables and patient outcomes. The next steps for this research program and the HANDS team includes a comparative analysis of indices used for measuring continuity and a replication study examining the influence of nurse continuity and other nurse-staffing variables on pain outcomes.

I hope you will enjoy this manuscript and look forward to your comments. Janet

I join Janet in inviting you to download this important article while it is available at no cost, read it, and return here for some good online conversation!

shift

Oct 4

Improving Outcomes of Care – Evidence-Based Implementation


Our current featured article addresses one of the great concerns in health care today — evidence-based Intervention (EBI), or  the adoption and implementation of practices that are supported by research evidence.  The title of the article is “Synthesizing Marketing, Community Engagement, and Systems Science Approaches for Advancing Translational Research.” by Shawn M. Kneipp, PhD, RN, ANP-BC, APHN-BC, FAANP; Jennifer Leeman, DrPH, MDIV; Pamela McCall, BSN, RN, MPH; Kristen Hassmiller-Lich, PhD; Georgiy Bobashev, PhD; Todd A. Schwartz, DrPH; Robert Gilmore, BS; Scott Riggan, BA; and Benjamin Gil. This is a thought-provoking article that adds significantly to the ongoing discussion of the meaning of “evidence,” and the issues surrounding the links between and among research, theory and practice.  Here is the abstract of the article:

The adoption and implementation of evidence-based interventions (EBIs) are the goals of translational research; however, potential end-users’ perceptions of an EBI value have contributed to low rates of adoption. In this article, we describe our application of emerging dissemination and implementation science theoretical perspectives, community engagement, and systems science principles to develop a novel EBI dissemination approach. Using consumer-driven, graphics-rich simulation, the approach demonstrates predicted implementation effects on health and employment outcomes for socioeconomically disadvantaged women at the local level and is designed to increase adoption interest of county program managers accountable for improving these outcomes in their communities.

I invite you to read this article and consider ways the ideas might advance our collective interest in strengthening the connections between evidence and practice.  Visit the ANS web site today to download itt, and return here to add your comments and responses!

Sep 30

Advancing Dignity: NonViolent Social Transformation


Just released ahead of print – a very timely article that addresses one of the most urgent social issues of our time and how nursing can play a role in addressing the challenges.  The article is titled “Transcendent Pluralism: A Middle-Range Theory of Nonviolent Social Transformation Through Human and Ecological Dignity” by Donna J. Perry, PhD, RN.  Dr. Perry has sent this message for ANS readers:

Even a casual scan of daily headlines makes evident widespread global suffering. In recent weeks Transcendent-pluralism-blog-2-smdistressing images have highlighted the desperate plight of refugees trying to escape violence in Syria, Afghanistan and Iraq. There is an urgent need to change global conditions of injustice, violence and environmental damage. Only when these underlying conditions are addressed will we be able to achieve a sustainable health for humanity. In recent years there have been numerous scientific reports linking social conditions such as violence and social injustice to health. This summer, agreement was reached on language for a draft United Nations (UN) agreement on the Sustainable Development Goals, a new agenda for human development through the year 2030. The document, Transforming our World: The 2030 Agenda for Sustainable Development, will be finalized and adopted at a special UN summit in September. https://sustainabledevelopment.un.org/post2015/transformingourworld

This visionary document makes clear the interdependence of multiple domains including health, peace, education and ecology. Nursing will be a critical force in achieving sustainable development over the next fifteen years. The article in the current issue of Advances in Nursing Science, “Transcendent Pluralism: A Middle-Range Theory of Nonviolent Social Transformation through Human and Ecological Dignity”, provides a framework for nurses to use in advancing nonviolent social transformation. Although it is written primarily from the context of societal issues I envision the theory as something nurses can use when working for institutional change within health care settings as well.

Working together we can truly transform the world and build a sustainable healthy global community.

You can access this article in the PAP (Published Ahead-of-Print) section of our web site!  Please read it, and return here to share you ideas!

Sep 23

Enacting Social Justice Practice


Nancy Murphy, NP, PhD is the author of our current featured article titled “Advancing the Interdisciplinary Collaborative Health Team Model: Applying Democratic Professionalism, Implementation Science, and Therapeutic Alliance to Enact Social Justice Practice.” In the article she examines three foundational pillars of social justice practice: democratic professionalism, implementation science, and therapeutic alliance to advance this practice. Dr. Murphy has provided this description of her work:

I can’t recall when I have not been thinking about interdisciplinary collaborative team work, its value, its challenges, and the ongoing effort to keep the patient in the center of care!  As my early career coincided with the emergence of the HIV/AIDS epidemic, I was fortunate to be part of dynamic and

Dr. Nancy Murphy

Dr. Nancy Murphy

creative interdisciplinary work, both in the hospital and the community setting.   The early HIV models of care were immediately collaborative, as it was clear that one discipline alone could never provide all of what was needed.  The “team” went beyond clinicians to include not only patients and families, but friends, communities, legal advocates, spiritual providers, and many other ‘partners in care.’ 

Decades later I am still at it, now hoping the application of democratic professionalism, implementation science and therapeutic alliance may advance and improve the Interdisciplinary Collaborative Health Team model. The ideas of task sharing, thoughtful and strategic implementation, and therapeutic alliance among and between colleagues, patients, families, communities, and systems are extremely timely, especially as the US ventures into reorganization of health care financing: Affordable Care Act, Accountable Care Organizations, Bundled Payments, etc. Burwell, the Secretary of HHS, has set forth a range of upcoming changes in reimbursement that are claimed to reward value over volume.  The question is open as to whether these strategies are able to fulfill the social justice goal of both improving individual health outcomes and health disparities while simultaneously addressing larger health inequities (social, political, economic) that drive the negative social determinants of health.  

I continue to rely on Audre Lorde’s advice and offer it here for others to consider, “Only within the interdependency of different strengths, acknowledged and equal, can the power to seek new ways of being in the world generate, as well as the courage and sustenance to act where there are no charters” (Sister Outsider, 1986, p. 111).

Visit the ANS web site now to download your copy of this thought-provoking article while it is featured!  We welcome your comments and ideas!

Sep 21

Authorship


Unless you are preparing a manuscript all alone with absolutely no other person involved in any way, you are likely faced with the challenges involved in deciding who actually qualifies as an author, and once that decision is made, deciding whose name should be first, second, third and beyond.  The first and vitally important guideline for this process is this: early discussion and open negotiation among all parties involved.  This discussion can be initiated by any individual involved in a project – and hopefully that person is already familiar with the resources presented here as guidelines for the discussion.

This is no simple challenge.  In fact, matters of authorship are the most common cases presented for discussion by COPE (Committee on Publication Ethics).  Their excellent discussion paper on Authorship should be at the top of your reading, and re-reading list every time you embark on a new project!  When you initiate an early discussion with your collaborators who might also become authors, if you start with a review of the widely accepted guidelines for authorship described here, you by-pass, or at least lessen the temptation to get involved in arguments and disagreements based purely on personal preferences and motivations.

For ANS, we subscribe to the guidelines for authorship provided by ICMJE (International Committee of Medical Journal Editors), which require that anyone who is included as an author on a manuscript must meet four essential criteria:

  1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND
  2. Drafting the work or revising it critically for important intellectual content; AND
  3. Final approval of the version to be published; AND
  4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

During the submission process for ANS, all authors must confirm that they meet these four criteria, and soon, you will also be required to include a statement for each author that describes the specific contributions that they have made to the work (criteria #1).  The fact remains that there are typically people who have made a contribution of some type to the conception or design of the work, but have not participated in all of criteria 2, 3 or 4; thus they do not qualify as an author, but they should be acknowledged as non-author contributors in the “acknowledgements” that are published with the article.

The matter of the order in which authors’ names appear is even more difficult to determine. The earlier you can settle this matter, the better for all concerned.  Further, whatever the decision, you will have a much more comfortable working relationship throughout the entire process if everyone involved is fully “on board” with the order in which authors’ names appear.  You can base this decision on the relative contributions of each person, or, if all contributions are roughly equal, you can use an alphabetical or reverse-alphabetical order.

There is a specific situation that many ANS authors face – that of the role of the dissertation or thesis committee members who have worked with a student who ultimately is expected to produce publishable manuscripts based on the scholarly project required for the degree.  The ANS editorial and publishing team concur with the recommendations that have emerged from ICMJE and COPE – faculty advisors do not qualify for authorship based on their advisory role alone. Even though it is typically the case that faculty advisors make significant contributions to the development of the dissertation project, and in turn the content that emerges in a publishable article, faculty advisors rarely meet all of the criteria 2, 3 and 4 above.  Therefore they should be acknowledged for their contribution as an advisor to the project required for the degree, but not as authors.  Of course, in the event that faculty advisors do actively participate and meet all four criteria, they should be authors. However, in my opinion, the student (or former student), as the sole author of the dissertation or thesis, would typically be named as the first author based on their relative investment in the project.

I welcome your comments and responses related to this important issue!  Leave your ideas below – I will respond!

Sep 15

Future Issue Topics


You may have noticed a shift that is gradually emerging in ANS – the “mix” of articles, some of which focus on an issue topic, and some of which represent a wide range of nursing scholarship that have been submitted as “ANS General Topic” articles.  The ultimate “profile” for each issue depends on the response that our planned issue topics elicits!  Our issue topics have been an important ANS feature, calling forth creative and important works that have influenced the emergence of nursing’s disciplinary focus.  Even though it is time to shift to a new model, we will continue to invite articles that focus on a specific topic.  Here are the topics we have planned for the forthcoming issues:

Women & Girls
Vol 39:2 –   June 2016
Manuscript Due Date: October 15, 2015
In 2011, the United Nations declared October 11th an annual “International Day of the Girl Child.” We are dedicating the mid-year 2016 issue of ANS in anticipation of the October 2016 international observance focusing on girls. We seek manuscripts that address nursing perspectives on health care for girls and women, their families and communities. We welcome research reports that provide evidence for nursing practice, theoretical and philosophic perspectives, or methodologic issues related to investigating health issues and nursing concerns for women and girls. We particularly welcome manuscripts with an international focus.

Palliative Care
Vol 39:3 –   September 2016
Manuscript Due Date: January 15, 2016
All health care providers encounter situations that call for palliative care, but nurses are at the center of care when palliative care is the approach that is agreed to be the best choice. This issue will focus on all aspects of nursing knowledge that influence the decisions and the approaches that shape palliative care. We welcome manuscripts containing research reports that provide evidence for practice, theoretical and philosophic perspectives, or methodologies that are well suited to this area of inquiry.

Toxic Stress
Vol 39:4 – December 2016
Manuscript Due Date: April 15, 2016
Toxic stress, unlike positive or tolerable stress, can result in life-long health challenges. For this issue of ANS we seek manuscripts that focus on the contributions that nurses are making to understanding the dynamics of toxic stress, and nursing approaches that demonstrate effective outcomes for children and adults suffering the effects of toxic stress. Articles that provide research outcomes, theoretic and philosophic constructions, practice models, or educational programs related to toxic stress are welcome. Implications for the development of nursing knowledge must be emphasized.

ANS Retrospective
Vol 40:1 – March 2017
Manuscript Due Date: July 15, 2016
This issue of ANS marks the beginning of the 40th year since ANS first appeared in print! Throughout the journal’s history, we have featured issue topics that focus on “Critique and Replication” – calling for informative and cutting-edge scholarship that builds on previously published work in ANS. For this issue of ANS we invite the submission of manuscripts that follow our “Critique and Replication” tradition. Manuscripts can take any form of scholarship, such as critical reviews of past ANS publications, data-based research based on prior reports found in ANS, or qualitative explorations that extend ideas addressed in past ANS articles. We especially welcome manuscripts that challenge prior assumptions and that open new perspectives that contribute to the development of nursing knowledge.

Family & Community Health
Vol 40:2 – June 2017
Manuscript Due Date: October 15, 2016
For this issue of ANS we seek articles that embrace the integral nature of family and community health, particularly in the context of changing family compositions and geographic location patterns. We are interested in exploring, for example, factors such as urbanization, adoption, surrogacy, socio-economic and/or racial segregation, and ideologic polarization. Articles must reflect scholarly merit and a clear focus on nursing knowledge development. We welcome all forms of scholarship, including qualitative or quantitative research, philosophic or theoretic constructions, critical integrative reviews, and models developed to guide practice.

ANS General Topic
Manuscripts considered any time
Manuscripts submitted as “ANS General Topic” are expected to address the purposes of ANS, which are to contribute to the development of nursing science and to promote the application of emerging theories and research findings to practice. We expect high scholarly merit, and encourage manuscripts that challenge prior assumptions and that open new perspectives that contribute to the development of nursing knowledge.

 

Sep 9

Integrated Knowledge Translation: Addressing the Knowing/Doing Gap


Gweneth Hartrick Doane and Sheryl Reimer-Kirkham have been working with a team of nursing scholars for several years, exploring the philosophic underpinnings and the practice implications of translational research.  The current issue of ANS features two articles based on their work.  The current featured article is “(Re)theorizing Integrated Knowledge Translation: A Heuristic for Knowledge-As-Action” authored by Gweneth Hartrick Doane, PhD; Sheryl Reimer-Kirkham, PhD; Elisabeth Antifeau, MSN and Kelli Team600Stajduhar, PhD.  The second article which will appear as a featured article starting on September 19th, is titled “Translational Scholarship and a Palliative Approach: Enlisting the Knowledge-As-Action Framework” authored by Sheryl Reimer-Kirkham, PhD; Gweneth Hartrick Doane, PhD; Elisabeth Antifeau, MSN; Barbara Pesut, PhD; Pat Porterfield, MSN; Della Roberts, MSN; Kelli Stajduhar, PhD; and Nicole Wikjord, MSN. Dr. Doane and Dr. Reimer-Kirkham provided this message about their work for ANS readers:

We have been engaged in translational scholarship—under the umbrella of “knowledge translation” for some time, interested in its philosophic underpinnings on the one hand and its practice orientation on the other. The two papers in the ANS 38:3 issue were developed in the context of a research-practice collaborative in British Columbia (iPANEL) that shares a common goal of advancing the further integration of a palliative approach into the healthcare system. We are indebted to the many nurses engaged in this initiative as investigators, clinicians, and affiliates and to Michael Smith Foundation for Health Research (MSFHR) for their generous funding.

Within the knowledge translation (KT) literature how to actually do interactive and integrative KT has been identified as the primary question researchers are currently facing. It has become increasingly clear that something beyond instrumental, prescriptive approaches that arise out of externally-driven knowledge concerns, and impose directives for evidenced-based ‘best’ practice are needed to affect meaningful change at the practice level.

As we have conducted our various KT research projects and pondered possibilities, three key insights that offer a different KT approach (at the conceptual and practical level) have emerged. First, we have come to see the fundamental importance of KT being an inquiry process. Taking an inquiry approach involves working between the existing (what is known) and the emergent (what is not fully known and/or what might be needed). Structuring KT as a process of inquiry and working ‘in-between’ what is known/not known focuses attention on the specific features of a situation and highlights that the question “How best to proceed?” can only be answered within those particularities.

Typically KT is focused toward ‘filling a knowledge gap.’ It is assumed that ‘the problem’ is one of knowledge—people simply lack the latest research knowledge. However, that assumption has not held up in our research. As we describe in our papers, even when the latest research evidence is known there may still be a gap between the care that should be provided and the care that is offered. Subsequently a second insight we propose is that KT is not about filling a gap as much as working in the gap—the gap between the real and the ideal, between realities and possibilities— and seeing that practice gap as a fruitful site for the development of knowledge and practice capacity. It is this gap between real and ideal practice that is of utmost concern to patients, nurses and other health practitioners and that serves as the greatest impetus for practice change. Orienting KT toward a shared practice concern (i.e., the gap between real and ideal care) serves to align practitioners’ deeply felt concerns with their capacity to address those concerns. Moreover, it enables practice concerns to be heard and shared and knowledge to be enlisted to effect change. It also democratizes the knowledge process and knowledge milieu, fostering inclusivity and responsiveness to multiple forms of knowledge.

Finally our third insight is the importance of having a KT process in which nurses and other health practitioners play a central role. And this is where the KITE heuristic, the Knowledge-AS-Action Framework (see Figure below), that we describe in our papers comes in. If the goal of KT is to have the most up-to-date knowledge inform and reshape practice, is it not the practitioners who need to be supported to take the active and central role of determining the relevance and usability of any research knowledge—and, moreover, of determining the direction of the KT process itself? The KITE heuristic opens the space for practitioners to put their own expertise to work. At the same time the heuristic structure serves to identify the multiple forms of knowledge that exist, the further knowledge that might be needed as well as directions for action. The heuristic by its very nature provides an integrated way of thinking about practice development and change that is grounded in explicit and shared values and goals.

While our papers discuss the use of the KITE heuristic in integrating a palliative approach into nursing practice, we believe the heuristic may have utility across a range of practice contexts and concerns. As part of the blog discussion we invite you to consider that possibility and respond to what we have proposed—even consider trying out the heuristic in your area of nursing practice and/or with a current concern. We look forward to hearing your thoughts and experiences.

Indeed, these two articles provide compelling insights and possibilities for practice in many clinical situations. I hope you will visit the ANS web site, download these articles while they are featured, and then return here to add your responses and ideas!

Design by University Communications, Trinity Western University

Design by University Communications, Trinity Western University

Aug 31

Translating Public Health Policy into Practice


Ogbolu-2013-2-web

Yolanda Ogbulo

The current featured article in the  July/September 2015 issue of ANS provides an overview of an issue that has been sadly neglected – how to get public health policies into practice.  This challenge is particularly acute because the policies are well documented to result in significant improvement in health outcomes for many people and communities.  The article is by authored by Yolanda Ogbolu, PhD, CRNP, faculty member at the University of Maryland School of Nursing, and Grace A. Fitzpatrick, BSN, RN, FNP candidate and is titled “Advancing Organizational Cultural Competency With Dissemination and Implementation Frameworks: Towards Translating Standards into Clinical Practice.” The authors describe the content of their article in the abstract as providing “an active, strategic approach to enhance uptake of public health standards; reviews dissemination and implementation concepts; poses a systematic model to adoption, implementation, and dissemination; and concludes with recommendations for hospital-based implementation teams and complementary interprofessional collaboration.”

This article has far-reaching implications for policy implementation not only in public health, but in all areas of healthcare.  You can download this article at no cost while it is featured  – check it out and share your comments and feedback here!

← Older Entries
Newer Entries →