The following address was delivered at INS 2016 in Ft. Lauderdale, Florida, on May 19, 2016.
Health care today is not the health care of yesterday, and it will continue to be reworked to align with health care indicators developed for health care reform. The responsibility for implementation belongs to all of us.
Technology is revolutionizing health care. The insights gained using technology in health care have been shown to promote the delivery of affordable, safer patient care. Technology also has improved research and the ability to share knowledge. Today, there is an ongoing need for innovative thinking that will drive health care to the next level. At the core of innovation is knowledge, and building knowledge requires a human element that goes beyond reliance on technology or machines.1
The nursing profession is an applied discipline, which simply means that knowledge and practice are reciprocally linked. When knowledge changes so, too, should practice, and as practice changes so, too, should knowledge. The nursing profession continually needs new knowledge brought about by new technology, innovative thinking, and research.1,2
While research helps generate new knowledge or validates existing knowledge, nurses typically rely on evidence-based practice, which stems from research, to implement the best evidence available when making patient care decisions. Studies have shown improved patient outcomes when the best evidence is used in the delivery of patient care.1 However, executing and sustaining evidenced-based practice in the practice environment can be challenging. Creating new professional standards of practice doesn't guarantee that practitioners know the standards exist-or the use of best evidence when establishing practice polices. It does not imply that if you create it they will listen. The time and effort put into studies, research, and best evidence are simply words on a page unless the knowledge is put into practice.
At one time or another, many of us have faced the challenge of presenting new or updated evidenced-based practice, research, or a quality initiative, and integrating the information into a practice setting. There are a multitude of barriers that can impede engaging and motivating colleagues and gaining their approval.
Nurses need to understand the value and the importance of integrating best evidence into practice, and work within an environment that encourages and supports using current best practices. In 2012, the American Nurses Association recognized that practicing nurses often lack information technology skills, as well as the ability to locate and use online evidence. Health care facilities need to ensure that nurses have the access and knowledge required to explore and implement best practices.1 Before establishing new practices, it is also important to have an organization-wide plan for education that provides oversight of all educational activities. Recognizing and understanding the organization's culture is essential to avoid information overload and projects that compete for nurses' attention. Too much information at 1 time can conclude with the failure of knowledge transfer. To improve the implementation of new knowledge, include a well-designed pilot or test to identify the need for additional improvements to lower the risk of failure and increase engagement.3 In addition, consider using staff development specialists, interactive and collaborative education sessions that build on the learners' existing experience, and partnering with academic organizations for simulation strategies.4 It is also important to consider the impact that change brings about. Change is a threat to the security and comfort of the norm, established habits, behaviors, bias, and individual values. Change can expose a lack of knowledge or skill; require a commitment of time or energy to learn something new. It can also remove control and create fear of what's to come or failure.5
In any of these situations, change can have an impact on a plethora of negative emotions, affecting and raising stress levels that impede the ability to move forward. Those who try to embrace change tell themselves they need to grasp onto the unknown and accept the inevitable, but most of our thoughts and actions are hardwired to the status quo, making it difficult to have an optimistic outlook and creating a feeling that another new task is impossible. This can make change slow, frustrating, and painful. Nurses who can manage negative emotions effectively will be able to maximize their performance and productivity.
As nurses, we know that the American Nurses Association identifies professional development as an individual responsibility to the profession. Many organizations support professional development with residency programs, clinical ladders, and tuition assistance. This puts a positive spin on change and growth by providing encouragement and motivation, as well as a process to recognize and reward practitioners for their achievements. Incorporating more programs that support and sustain knowledge could be beneficial.
In 2009, Andriessen and Van Den Boom6 developed a journey metaphor for the study of the knowledge process in organizations. Here is their claim:
Knowledge is not a given prearranged body of data and information, but a discovery-like process with hindrances, obstacles, reluctances, as well as positive stimuli: denial that the current familiar position no longer holds, stepping out of the box, leaving one's position and the current knowledge environment, persuasion by others and the need of help from others, breakthrough experience of something completely new.6(p402)
It's important to think about how to improve the transfer of knowledge into practice. How do we accept change, and how can we support others through change?
To empower our specialty, we need savvy change agents and leaders-agents with a compass to identify organizational direction, insight into how to connect education and change that embraces new technology, research, and evidence-based practice. We need the ability to take best practice to the patient and keep it there.
The final aspect of transferring knowledge into practice includes monitoring outcomes.7 This step is often forgotten, but it is essential. Measuring outcome data defines whether the new knowledge and skills have met the educational objectives and achieved the anticipated impact on patient outcomes. Without evaluating outcomes, the transfer of knowledge is an incomplete process. After you have successfully completed transferring the knowledge and keeping it in place, perhaps you would be willing to share your story, because we always need more studies and research.
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