Meso-Level Solutions

Application of evidence into nursing or clinical practice is unlikely unless it is integrated into workflow (Bakken et al., 2008). Institutional support for the integration of research into practice can come through the development of computer information systems (CIS). Information systems that provide immediate access to databases with synopses of best evidence that is relevant and has undergone critical review are necessary for practitioners to make informed or evidence-based choices. CIS with embedded guidelines can prompt the clinicians to integrate EBP into clinical decision making.

The development of CIS should be a collaborative effort between the clinicians and the institution rather than the institution purchasing a system that may or may not meet the needs of the practitioner. APRNs who have been prepared at the DNP level or who have expertise in informatics have the skills necessary to be members of the CIS design team. If they are not directly involved in CIS design, APRNs should work with institutions when decisions are being made to purchase or design informatics systems for enhancing clinical services.

Institutional investment in human capital is important if research is to be translated into clinical services. This investment includes such activities as training staff, cultivating and supporting research implementation, mentoring, and providing resources (time and fiscal support) for developing a research agenda.

Armed with the knowledge of health care systems, APRNs can function as change agents within organizations. They have the leadership skills to garner institutional support, engage the stakeholders, and institute changes that support EBP at all levels of care delivery.

As computer information systems develop, best practices are becoming integrated into some of these systems. As clinical doctoral programs develop, APRNs will be more knowledgeable about information systems and can participate in their development.

Macro-Level Solutions

Health care providers do not function in a vacuum. Practitioners must function within an economic and political system. Health care is governed by the "cost of doing business." When they are considering the adoption of new practices, clinicians are forced to consider the cost to the patient. Obviously, if the cost exceeds the patient's resources, often the intervention will not be followed or will be unsuccessful. Even if the evidence supports a new technology or drug, the feasibility is determined by the economic impact.

The issue of cost transcends the individual patient and permeates all health care delivery systems. On a systems level, administrators have to evaluate the fiscal impact of new interventions. Administrators must weigh the new method against the old and determine the added value of the new treatment plan. If APRNs believe that a new intervention is in the best interest of patient care, these clinicians must be prepared to evaluate the cost-benefit ratio of new practice.

APRNs should also become astute fiscal managers. They must appreciate that EBP does not suggest that all new evidence can or should be the standard of care. Most APRNs have been trained to focus on the delivery of care to the individual patient; however, in the current health system, with its limited resources, the emphasis must shift to a population perspective and cost containment.

Politicians are not health care experts and rely on multiple sources for information regarding EBP. In general, the goals of the politician are to allocate limited resources to accomplish the greatest good and to regulate health care systems and providers to protect the public from harm.

As members of the nursing profession and as part of the largest health care provider network, APRNs have considerable political clout and should use this power to influence politicians. When advocating for the adoption of new evidence, the APRN must be mindful of the goals of the policy makers.

SUMMARY

Becoming competent practitioners requires not only the acquisition of clinical skills but the ability to use research to guide practice. With the proliferation of new evidence, APRNs must be able to critically analyze and evaluate the evidence and appraise its utility. Applying the skills acquired during their educational experience, APRNs can and should become the translators of research into practice and policy.

APRNs have the skill set to understand the research process, and they are effective change agents. Therefore, they are in the position to identify the determinants of the clinician's and patient's behaviors and to design models that will not only facilitate the transfer of knowledge into clinical practice but assist in the implementation process. APRNs, particularly those prepared at the clinical doctorate level, can become interpretive researchers or context adaptors (Chelsa, 2008). This role consists of applying new interventions designed in academic research centers to primary care clinics.

Even when research is adapted to the primary care setting, there is no guarantee that this will facilitate implementation. As discussed earlier, the models that currently exist to promote adoption and implementation of research into practice are inadequate. The evidence is clear that provider education, computerized clinical support, and financial incentives have minimal or modest effect on increasing the use of EBP. The answer may be in using the best of all models and formulating a new paradigm to bridge the gap between research and practice.

The DNP expands the APRN's skill set to include becoming a change agent, understanding and developing informatics systems, and appreciating the operations of health care systems. Therefore, APRNs prepared at the doctoral level are in the position to expand and put into operation the previously discussed systems engineering and social innovation models for the dissemination and application of research. In this way, they can further elaborate the translation of research into practice.

As APRNs assume leadership roles in health care, they should become proactive in removing the barriers to translating research into practice. Now and in the future, APRNs can and should be the innovators in health care delivery systems through research.