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Translational Research: from bench to bedside Cecelia L. Crawford RN, MSN. DNP(c) Kaiser Permanente SCAL Regional Nursing Research Program May 10, 2012 June L. Rondinelli RN, MSN
Translational Research:
from bench to bedside
Cecelia L. Crawford RN, MSN. DNP(c)
Kaiser Permanente SCAL Regional Nursing
Research Program May 10, 2012
June L. Rondinelli RN, MSN
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
(Omery, 1998)
Data Facts Information Knowledge
Analysis
Systematic Process
(Organized Data)
The research process IS the systematic process that produces scientific knowledge
Scientific
Synthesis
(Structured & Integrated Facts that are meaningful)
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
“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
systematic investigation
generalizable knowledge clinical practice
evidence
Translational Research
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
Cecelia L Crawford, RN,MSN Project Manager III
Joyce A Johnson, PhD, RN-BC Director of SCPMG Nursing Education and Research
Regina M Valdez, MA Senior Research Analyst
June L Rondinelli, RN,MSN, CNS Project Manager III
Anna K. Omery, RN, DNSc, NEA-BC Director of KP SCAL Regional
Nursing Research
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
T1
Basic Science; Theory
development/ Basic Research
Basic Science
New Knowledge
T2
Test evidence-based
interventions in practice
Evaluation of findings of
Integrative Reviews/ Systematic Reviews in a
Population
Outcome Improvement
in populations
T3
Implement and test
systems change; best practice considering
consumer factors
Guideline Development
and Testing
Systems Change
TR Structure
T1
T3 T2
TR Process T1
T2 T3
Structure + Process T1
T2 T3
T1
T3 T2
TR Processes • Conceptual Phase • Design & Planning • Collection of Data • Analysis • Dissemination of Findings
TR Outcomes T1O
T2O T3O
T1O
T2O T3O
T1
T3 T2
TR Model
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
“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
Basic Science
New Knowledge
Basic Science; Theory
Development/ Basic Research
T2: Improving Population Outcomes
“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
Outcome Improvement in Populations
Test evidence-based
interventions in practice
Evaluation of findings of Integrative Reviews/
Systematic Reviews in a Population
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
“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
Systems Change
Implement and test systems change;
best practice considering
consumer factors
Guideline Development and Testing
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
Integration of scientific
discoveries into nursing
practice
T1O
T2O T3O
T1
T3
T2
Research studies & EBP Projects no longer viewed as separate entities Distinct research studies which are seeking clearly defined outcomes Able to differentiate quality improvement projects from research studies
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
Cecelia L. Crawford, RN, MSN Project Manager III
Translational Research
KP SCAL Regional Nursing Research Program
626-405-5802
Anna K. Omery, RN, DNSc
Director of Nursing Research
KP SCAL Regional Nursing Research Program
626-405-6346
Gretchen J. Summer
Director of Nursing Research
KP NCAL Regional Nursing Research Program
510-987-3639
For more information please contact:
http://nursingpathways.kp.org/scal/research/index.html
http://nursingpathways.kp.org/ncal/research/nursingresearchprogram/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
NIH (National Institutes of Health) http://nihroadmap.nih.gov/clinicalresearch/overview-
translational.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
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/researchseries/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/researchseries/index.html#supplementary Polit, D. & Beck, C. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice, 8th 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 4th Edition. St. Louis, Missouri: Saunders. Harris, M. & Taylor, G. (2008). Medical Statistics Made Easy, 2nd Edition. Oxfordshire: Scion Publishing
©2009 Kaiser Permanente Southern California Nursing Research
