Kaiser Permanente SCAL Regional Nursing Research Program May 10, 2012 June L. Rondinelli RN, MSN Cecelia L. Crawford RN, MSN. DNP(c) Translational Research: from bench to bedside
Learning Objectives At the end of this presentation, the learner will be able to: Outline the research process Describe two differences between Quality Improvement, Evidence-Based Practice, Research, and Translational Research Discuss the structure, process, and outcomes involved in Translational Research
The Concept of Research Research is not isolated activities or tasks Surveys, interviews, and observations Data collection Statistical analysis Improvement processes Evidence-based practice changes Research is a rigorous, reproducible, and systematic process that may involve all or part of the above
The Process of Knowledge Development Analysis (Omery, 1998) Data Facts Information Systematic Process Knowledge (Organized Data) Synthesis (Structured & Integrated Facts that are meaningful) Scientific The research process IS the systematic process that produces scientific knowledge
Confusion over Research Confusion exists concerning the differences and similarities of Research Process Quality Improvement Process Evidence-Based Practice Process The different intents, structures, processes, and outcomes is what separates QI from EBP from Research Who, what, when, where, why, and how What are the differences?
Quality Improvement A structured process that Evaluates a specific system s strengths & limitations, systems parts, and resulting outcomes Overarching intent of QI initiatives is to improve system specific (i.e. local) processes and patient outcomes Asks What is happening and can it be improved? Final product = information, not new knowledge
QI Example A structured evaluation process with an iterative flow IHI Small Tests of Change PDSA (Plan, Do, Study, Act) What is happening? Can it be improved? Resulting process and outcome information is evaluated Changes made for further improvement of processes and outcomes Revised processes are re-evaluated and changed on a continuous basis for further improvement
Evidence-Based Practice A systematic process Implements and evaluates interventions stemming from new knowledge generated by research Overarching intent of EBP changes is to integrate scientific discoveries into healthcare practice Asks What is known? and What can be done with this knowledge? Final product = systems change and outcome improvement in patient populations
EBP Example Meade et al. (2006) Effects of Nursing Rounds on Patients Call Light Use, Satisfaction, and Safety What is known: Hourly rounding by nurses resulted in decreased patient call light use increased patient satisfaction reduced patient falls Systematic integration of the new knowledge into nursing practice Implementation of hourly rounding intervention Final product Nurse rounding protocols Manager rounding protocols Leadership rounding protocols American Journal of Nursing, September 2006, 106(9), 58-70
Research A rigorous & systematic process Generates new knowledge through the application of basic scientific principles and theory development Overarching intent of research is description, prediction, and control Asks What is not known? Final product = new knowledge that can be generalized in appropriate patient populations
Research Examples A systematic process What is not known: Unavoidable Pressure Ulcers: A Causal Model (Primary Investigator: Anna K. Omery, 2010; Gretchen Summer, NCAL Primary Investigator) Retrospective chart review Adult ICU patients Statistical analysis of variables Descriptive, predictive, & controlled Scientific knowledge via a rigorous and systematic research process Data Facts Synthesized Information Knowledge Final product = New knowledge that can be generalized for adult ICU patients in the United States at risk of development HAPU
What is Translational Research? Research that translates scientific discoveries and advances from the bench or laboratory into a clinically germane application National Institutes of Health Scientific investigation of methods, interventions, and variables that influence adoption of evidence-based practice by individuals and organizations to improve clinical and operational decision making in health care. This includes testing the effect of interventions on promoting and sustaining evidence based practice Titler, 2004
Translational Research A systematic investigation that has as its purpose the development of generalizable knowledge that explains or improves clinical practice(s) sourced from evidence (including theory testing) or previous research. Southern California Nursing Research Program, 2008
Transitioning to Translational Research Most researchers use a two model worldview to frame research Research Studies Evidence-Based Practice (EBP) Projects In 2008, the Kaiser Permanente (KP) Southern California Nursing Research Program moved to an single model format Translational Research
Translational Research Prioritizes Nursing Research Program personnel activities Highlights the sophistication of KP nurses researchers Aligns nursing research program & current KP projects with the community to expand grant funding & publication opportunities Assists in the dissemination of Nursing Research beyond nursing venues
Translational Research Model Development Team Anna K. Omery, RN, DNSc, NEA-BC Director of KP SCAL Regional Nursing Research Joyce A Johnson, PhD, RN-BC Director of SCPMG Nursing Education and Research Cecelia L Crawford, RN,MSN Project Manager III June L Rondinelli, RN,MSN, CNS Project Manager III Regina M Valdez, MA Senior Research Analyst
Translational Research Model Uses the definition to embed EBP into a model illustrating Translational Research (TR) Areas of Consensus: Team-centered with individuals who: Have different areas of expertise Come from multiple disciplines Uses an iterative process from the Laboratory to the Patient and back Aims to move knowledge from journals or academic setting to healthcare practitioners
TR Model Creation Structure + Process = Outcomes (Donabedian, 1972) Donabedian s model proposes that each component has a direct influence on the next STRUCTURE PROCESS OUTCOMES
TR Model Components Translational Research is divided into three types o T1: Basic science potentially affecting practice bench to bedside/laboratory to human o T2: New knowledge tested in the clinical setting bedside to community/evidence to practice o T3: Implementation of evidence beyond the pilot and population(s) with testing systems change organizational or professional impact
TR Model Components Structure/ Type of Research Process Outcome/ Product of Research T 1 Basic Science; Theory development/ Basic Research Basic Science New Knowledge T 2 Test evidence-based interventions in practice Evaluation of findings of Integrative Reviews/ Systematic Reviews in a Population Outcome Improvement in populations T 3 Implement and test systems change; best practice considering consumer factors Guideline Development and Testing Systems Change
TR Structure T 1 T 3 T 2
TR Process T 1 T 3 T 2
Structure + Process TR Processes Conceptual Phase Design & Planning Collection of Data Analysis Dissemination of Findings T 1 T 1 T 3 T 3 T 2 T 2
TR Outcomes T 1 O T 3 O T 2 O
T 3 O T 2 O TR Model T 1 O T 1 T 3 T 2
TR Model in Action Current Southern California KP nursing research studies are evaluated and assigned a T-type, based on the type of research was being conducted
T1: New Knowledge Basic Science; Theory Development/ Basic Research Basic Science New Knowledge Effectiveness of an intervention in prevention of falls among patients in home health Effectiveness of an educational intervention Increase nurse and patient awareness of fall prevention in the home Improve knowledge-base for effective interventions for patients at high risk for falls
T2: Improving Population Test evidencebased interventions in practice Outcomes Evaluation of findings of Integrative Reviews/ Systematic Reviews in a Population Outcome Improvement in Populations A Recipe for Excellent Nutrition: An Enteral Feeding Bundle Consistent selection of bundle elements every patient, every time Validate that standardization of the feeding process can greatly benefit patients and improve clinical outcomes
T1/ T2: New Knowledge + Outcomes Improvement Pre-albumin Screening to Decrease Hospital Acquired Pressure Ulcers Decrease rate of hospital acquired pressure ulcers by Monitoring pre-albumin levels Intervening timely and appropriately by maximizing patients nutritional regimen Overall goal is to improve the patient's quality of life, decrease pain, decrease cost & length of stay
T3: Systems Change Implement and test systems change; best practice considering consumer factors Guideline Development and Testing Systems Change Hourly Rounding: An Action Research Study Identify successful structures, tools, and processes in both implementing and sustaining rounding behaviors by staff nurses Study Aim: present generated evidence of valuable hourly rounding strategies to providers who care for a variety of hospitalized populations
T2/ T3: Outcomes Improvement + Systems Change CalNOC Partners to Reduce Patient Falls Project (TRIP) Testing an evidence-based intervention to create a systems change A multi-site study aimed to reduce the incidence of patient falls and severity of falls using evidence based coaching, education, and consultation to implement assessment and prevention methods based on clinical effectiveness data
TR Model Implementation Development and implementation of models such as the TR Model can result in a strategic infrastructure giving a voice to nursing research activities within large integrated healthcare systems Adaptation and dissemination through the Southern California KP Nursing Research Website Poster/Podium/Web Presentations Publications Quarterly Update at Nursing Research Committee Meeting http://nursingpathways.kp.org/scal/research
TR Model Implementation Research studies & T 3 O T 1 O EBP Projects no longer viewed as separate entities Distinct research studies which are seeking clearly defined outcomes T 1 Able to differentiate quality improvement T T 3 projects 2 from research studies Integration of T 2 O scientific discoveries into nursing practice
Research Success Connecting with other Translational Research Programs Department of Research & Evaluation, KP Southern California, SCPMG Southern California Clinical & Translational Science Institute, USC
Research Success Successful research studies always have these two elements: A committed research team (not one or two people) with a passion for the clinical problem Teams members with various talents, expertise, and research experience An expert researcher to ensure a systematic and research-based approach, who is either: Part of the research team OR A consult for the research team
Contact Information Anna K. Omery, RN, DNSc Director of Nursing Research KP SCAL Regional Nursing Research Program 626-405-6346 Anna.K.Omery@kp.org Cecelia L. Crawford, RN, MSN Project Manager III Translational Research KP SCAL Regional Nursing Research Program 626-405-5802 Cecelia.L.Crawford@kp.org Gretchen J. Summer Director of Nursing Research KP NCAL Regional Nursing Research Program 510-987-3639 Gretchen.J.Summer@kp.org
For more information please contact: Nursing.Research@ kp.org http://nursingpathw ays.kp.org/scal/res earch/index.html Gretchen.J.Summer @kp.org http://nursingpathw ays.kp.org/ncal/re search/nursingres earchprogram/ind ex.html
QUESTIONS?
References Chesla, C. A. (2008). Translational research: Essential contributions from interpretive nursing science. Research in Nursing Health, 31, 381-390. Donabedian, A. (1972). Models for organizing the delivery of health services and criteria for evaluating them. Milbank Quarterly, 50,103-154. Mitchell, P. H. (2008, April 17). Knowledge That Matters: Integrating Research, Practice and Education. Proceedings of the Communicating Nursing Research Conference and WIN assembly April 17-19th at the Hyatt Regency Orange County, Garden Grove, CA. Annual Publication of the Western Institute of Nursing. Mitchell, P.H. (2004, July-August). Research: Lost in Translation? Journal of Professional Nursing, 20(4), 214-215
References NIH (National Institutes of Health) http://nihroadmap.nih.gov/clinicalresearch/overviewtranslational.asp Titler, M.G. (2004). Overview of the U.S. Invitational Conference Advancing Quality Care Through Translation Research. Worldviews on Evidence-Based Nursing, 1(Sept), (s1suppl), S1-S5. Whittemore Robin; Grey Margaret (2002). The systematic development of nursing interventions. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau 2002;34(2):115-20. Woolf, S. H. (2008, January 9/16). The meaning of translational research and why it matters. JAMA, 299(2):211-213 (doi:10.1001/jama.2007.26). retrieved 7.22.08
References Agency for Healthcare Research & Quality (AHRQ) (2008). Improving Patient Safety Through Simulation Research. Available at http://www.ahrq.gov/qual/simulproj.htm Albert, N. M., & Siedlecki, S. L. (2008). Developing and implementing a nursing research team in a clinical setting. Crawford, C. (2010). Part 17 translating knowledge into nursing practice: The translational research model. Kaiser Permanente Nursing Research Series. Available at http://nursingpathways.kp.org/scal/research/resources/research series/index.html#supplementary Feinstein Institute (2009). Quality management/quality improvement (qm/qi) activities vs. research activities subject to irb review. Available at http://www.feinsteininstitute.org/feinstein/irb+guidance Institute of Medicine (IOM) (2001). Crossing the quality chasm: A new health system for the 21st century. Committee on Quality of Health Care in America Washington, D.C.: National Academies Press.
References Omery, A. K. (1998). The process of knowledge development. Kaiser Permanente Nursing Research Series. Available at http://nursingpathways.kp.org/scal/research/resources/resear chseries/index.html#supplementary Polit, D. & Beck, C. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice, 8 th Edition. Philadelphia: Lippincott Williams & Wilkins. Rourke, L., Schmidt, M., & Garga, N. (2010). Theory-based research of high fidelity simulation use in nursing education: A review of the literature. International Journal of Nursing Education Scholarship, 7(1), Article 11, 1-13. Starkweather, A. R., & Kardong-Edgren, S. (2008). Diffusion of innovation: Embedding simulation into nursing curricula. International Journal of Nursing Education Scholarship, 5(1), Article 13, 1-11.
References Titler, M., Kleiber, C., Rakel., B., et al. (2001). The Iowa model of evidence-based practice to promote quality care. Critical Care Nursing Clinics of North America, 13(4), 497-509. Titler, M. (2007). Translating research into practice. American Journal of Nursing, 107(6) Supplement, 26-33. Waldner, M. H., & Olson, J. K. (2007). Taking the patient to the classroom: Applying theoretical frameworks to simulation in nursing education. International Journal of Nursing Education Scholarship, 4(1), Article 18, 1-13. Wilson, C. & Sylvanus, T. (2005). Generating enthusiasm for nursing research. Journal of Nursing Administration, 35(5), 220-222.
References to Consider Burns, N. & Grove, S.K (2007). Understanding Nursing Research, building an Evidence-Based Practice 4 th Edition. St. Louis, Missouri: Saunders. Harris, M. & Taylor, G. (2008). Medical Statistics Made Easy, 2 nd Edition. Oxfordshire: Scion Publishing 2009 Kaiser Permanente Southern California Nursing Research