Micro-Level Solutions

Table of Contents:

Possible solutions for addressing the barriers to translating research into practice on the micro level require an examination of patient and clinician perspectives. Although much of the previous discussion has focused on the practitioner, a brief discussion of the patient's interface with the clinician's decision making is in order.

Patient Perspective

From the patient's perspective, the clinician is a repository of information, and the underlying assumption is that the clinician's expertise is based on current and accurate information. The role of the clinician is to present the relevant information, risks, and benefits of interventions so that the patient can make an informed decision. Often, this information is complex and is presented in a way that does not empower the patient to participate in the decision-making process (Col, 2005). Ultimately, the result of this type of interaction leads to miscommunication and withdrawal of the patient from active participation.

APRNs are skilled in the art of communication and have a fundamental understanding of adult learning principles. With this skill set, APRNs can reduce the flow of misinformation by serving as interpreters of information from lay media sources or other health care professionals. Informed patients can make appropriate health care decisions and can become participants in their own health care.

Practitioner Perspective

From a practitioner's perspective, the failure to use research to guide practice is governed by attitudes about research and its relevance to clinical practice. To increase the relevance of research, the patient population's needs should be the driving force for the research agenda. As articulated earlier, the flow of information should be bidirectional between the researcher and clinician. APRNs should be the link between the researcher and the patient population. They should assist the researcher design studies that answer clinical questions that are relevant to patients and clinicians. APRNs play a vital role in implementing new interventions or guidelines; therefore, they should be active participants in constructing and testing implementation models and delivery systems (Kottke et al., 2008). Furthermore, the APRN needs to recognize that when there are gaps in the evidence, the patient's exposure to unnecessary risks and expenditures increases.

Clinical faculty or preceptors, who are often practicing APRNs, can have a profound influence on APRN students' opinions about research and its relationship to practice (Jeffers, Robinson, Luxner, & Redding, 2008). When EBP is incorporated into clinical experiences, attitudes are changed, and the APRN students' skills in research translation and utilization are increased (Singleton, 2008; Singleton & Levin, 2008).

Translating research into practice requires changes not only in attitudes but also in behavior. Most models for clinical practice change, such as Promoting Action on Research in Health Services, Rosswurm and Larrabee's Model for Change to Evidence-Based Practice, or the Iowa Model of Evidence-Based Practice (Eastwood, O'Connell, & Gardner, 2008), advocate the development of collaborative interprofessional teams to promote changes in practice. The members of these teams are variable and dependent on the practice site, the expertise of the individual members, and the current problem or patient issue being examined.

For many years, APRNs have been the bridge between nursing, medicine, and other health care professionals and patients. APRNs should assume a major role in interprofessional collaborative teams. They can serve as mentors for nursing staff and allied health care professionals in the implementation of EBP and can function as the translators or interpreters of research in these teams.

 
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