Academic journal article Research and Theory for Nursing Practice

Translation Science and Context

Academic journal article Research and Theory for Nursing Practice

Translation Science and Context

Article excerpt

Evidence-based health care practices are available for a number of conditions such as asthma, smoking cessation, heart failure, and management of diabetes. However, these practices are not routinely implemented in care delivery and variations in practices abound. Implementing evidence-based practices (EBPs) is challenging, and difficulties implementing evidence may be largely explained by contextual factors. Thus, strategies are needed that address the complexity and systems of care, individual practitioners, senior leadership, and ultimately changing health care cultures to promote an evidence-based practice environment. To advance knowledge about promoting and sustaining adoption of EBPs in health care, translation science needs more studies that test translating research into practice (TRIP) interventions; studies are needed that investigate what TRIP interventions work, for whom, in what circumstances, in what types of settings, and studies that explain the underlying mechanisms of effective TRIP interventions. According to the Translation Research Model, adoption of innovations, such as EBPs, are influenced by the nature of the innovation (e.g., the type and strength of evidence; the clinical topic), and the manner in which it is communicated (disseminated) to members (e.g., physicians, nurses) of a social system (organization, nursing profession). This article discusses the importance of context in translation using this framework as a guide.

Keywords: evidence-based practice; translation science; implementation science; context; adoption; use of evidence

Evidence-based health care practices are available for a number of conditions such as asthma, smoking cessation, heart failure, and management of diabetes. However, these practices are not routinely implemented in care delivery, and variations in practices abound (Centers for Medicare & Medicaid Services, 2006; Institute of Medicine, 2001; McGlynn et al., 2003; Ward, Evans, Spies, Roberts, & Wakefield, 2006).

Implementing evidence-based practices is challenging, and difficulties implementing evidence may be largely explained by contextual factors (Scott, Plotnikoff, Karunamuni, Bize, & Rodgers, 2008; Wallin, 2009). Thus, strategies are needed that address the complexity and systems of care, individual practitioners, senior leadership, and ultimately changing health care cultures to be evidence-based practice environments (Leape, 2005). Little is known, however, about which implementation interventions work for which clinical or administrative topics, in what context, and the mechanisms by which these interventions are effective (Institute of Medicine [IOM], 2007).

Translation/implementation science is the investigation of methods, interventions, and variables that influence adoption of evidence-based practices (EBPs) by individuals and organizations to improve clinical and operational decision-making in health care (Eccles & Mittman, 2006; Kovner, Elton, & Billings, 2000; Rubenstein & Pugh, 2006; Titler & Everett, 2001; Walshe & Rundall, 2001). This includes testing the effect of translating research into practice (TRIP) interventions on promoting and sustaining adoption of EBPs. Examples of translation studies include describing facilitators and barriers to knowledge uptake and use, organizational predictors of adherence to evidence-based practice guidelines, attitudes toward evidence-based practices, and defining the structure of the scientific field (Dykes, 2003; Estabrooks, 2004; Kirchhoff, 2004; Titler, 2004a). In contrast, evidence-based practice is the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions (Cook, 1998; Jennings & Loan, 2001; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000; Titler, 2009). Simply put, EBP is the process of integrating evidence into health care delivery, whereas translation science is the study of how to promote adoption of evidence in health care. …

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