A Question?

CC000552Here we are midway through January already and what a busy start to the year but I have just managed to find a spare moment to breathe, so all is ok with the world! With my breathing now done (and ticked off my to do list) I find myself with a spare 5 minutes (yes a whole 5 minutes!) to write this blog post – only 2014 is starting pretty much where 2013 ended, with lots of questions! So I thought I would try something new – I would like to see what you think please.  Below is a question / problem that has been bothering me a little of late and I would like to know your thoughts.  The reason I want to pose the question here rather than on twitter is that I want to talk beyond 140 characters on this and I want to hear considered thoughts and responses. I would like to hear everyone’s perspective not just nursing leaders but also student nurses, nurse educators, patients and service users and social media buffs too …. Everyone adds value.

So here it is, the thing that has been bothering me:

How do we bring more sharing of evidence into our #NurseCommunity? But it’s not only the sharing of evidence that concerns me but also how do we enable and empower ourselves to take this evidence and use it to inform their practice? AND how do we then facilitate the feedback and share what we have learned throughout this process?

I would love to hear all of your thoughts and encourage you to share them below:

23 thoughts on “A Question?

  1. I have a quote which says it takes 14yrs to implement 17% of evidence (or it might be the other way round). There are many factors (human factors) why this happens – no-one likes change, the ‘evidence’ happened somewhere else so it won’t work here, ‘that’s all very well but we’re too busy to do that’.

    Innovation and implementation of best practice, and therefore new evidence, takes a long time and requires dedicated, resilient leaders.

    It seems to me the best way is to take one, new evidence based intervention and ask the nursing community to implement it out in their ward/team – one nurse, one patient; one nurse, two patients etc – it will still be slow, however if this happened every month for a year at the end of the year we would have 12 new intervention which are evidence based, implemented in practice. At a guess I’d say that would be quite a bit more than if we simply waited for osmosis to occur. There again perhaps Helen Bevan and the radicals would have a more direct approach!

  2. As a third year student nurse we are focusing on evidence based practice during our time in university.
    We have been looking at modern and appropriate ways of disseminating evidence to ensure nurses and other health care professionals are practicing using the best and most up to date available evidence.
    Sometimes evidence can be missed for many different reasons meaning that the evidence doesn’t make an implication on practice. Due to this we have been discussing in seminars at university the different ways of dissemination.
    One of way is through the use of twitter and other social media networks. Twitter has become a way of helping many nurses to network and share ideas therefore evidence may be more accessible through twitter.
    The use of online and printed posters showing the main aspects of new evidence could be an easy way of sharing evidence with a large and growing nurse online community.
    Another way could be internet links to journal articles/ research papers that are attached to a ‘tweet’ and shared around the nurse community.
    The use of modern day technology and resources has to help and aid the dissemination of research and make sure it reaches practitioners.

  3. Hi Derek, Whichever way around that is still pretty slow!! Thanks for your comments, I like the thought of one evidence based intervention, one nurse, one patient – it underlines that evidence based practice doesn’t have to mean sweeping change or something big. The twitter community are quite a proactive lot – so maybe instead of just waiting for osmosis to happen a few seeds planted and nudges in the right direction we could cut down that 14 year (or 17 year!) period.

  4. Hi Rebekah, Thank you for sharing your discussions. I like the idea of an online poster … how would this work ? and how would we prove that it did the job of ultimately getting evidence used in practice? I also agree that Twitter is a great platform for sharing evidence in the form of journal articles etc and its wide and fast dissemination is definitely an asset but again we have the problem of closing the cycle and proving that it is being taken into practice. Some evidence is already being shared during twitter discussions which is great – so we are definitely on the right track.

  5. I know it’s probably done somewhere but some kind of online ‘journal club’ type thing where there’s space/discussion particularly based around new research. Maybe a part of the blog where people can be encouraged to write short posts summarising things they’ve done/read and opening up comments. Even something like bullets as a starting point if people don’t want to write a ‘full on’ post – or a multi-author post where people can add to a thread.

  6. The evidence base: how to share it and get it off the paper and into action??

    My initial thoughts. There’s a lot of “evidence” out there. Who would be responsible for sorting the wheat from the chaff? I’d like to think that the strongest forms of evidence find their way in to our policies and guidelines because it has been sorted by central bodies such as NICE. I’d be interested to know how quickly this occurs. But what about the small fry stuff and empirical studies??

    This then begs the question does your average frontline nurse follow to the letter ALL the policies and guidelines that are out there? Have they even read one in full?

    Breaking it down to key messages might be useful. Bite sized chunks with reference to the original source; should the user have the time and inclination to delve deeper.

    It is possibly down to the leaders to share these key messages and see that they are put into action.

    How to share? Good old fashioned talking to people is rather useful to literally sell the ideas: networking, education, forums, meetings. Then of course we now have the benefit of social media so that key messages go viral and can be presented in a number of imaginative and creative ways thus backing up the crazy lone leader who keeps banging on about the latest trend.

    I’m not sure if I have answered your question. I have probably asked more questions in the process. Hope it’s useful!

  7. Hi Teresa,
    This is an interesting and historical dilemma, I agree that the translation of evidence into practice can be slow as can its production or development in the first place. We have a few things to think about here, Although the tides are changing we have been plagued by our nursing community undertaking very good quality yet small scale studies. This is changing at a pace but if we agree that the translation into practice is slow then if we look backwards we may see that we have a lack of large scale evidence to implement into practice. Much has been published about nurses who have undertaken research lacking the skills to get it out there – i.e. publish. This can be much improved by developing writing groups, Publishing for the first time is nervewracking because you are basically offering yourself and your ideas/work for critical review. Many who do send papers out to publish don’t pursue this following feedback from the publishers. This is a real shame – so we need to equip ourselves and each other with the skills, determination and safety (as in group writing in that you can support each other) to publish findings of studies – NO MATTER WHAT THE SIZE. There’s a good account of this here: http://www.ncbi.nlm.nih.gov/pubmed/23623744

    Next in the discussion is the ability for our nurses to be able to look at the quality, reliability and efficacy of the evidence. It is completely a no no for a nurse to read a paper in a journal paper and then have a go at implementing it into practice – in essence this changes our patients into guinea pigs without any form of ethical approval, patient consent or institutional guidance or overview. Couple this with novice skills in critical appraisal = DANGEROUS practice! Sounds a bit far fetched but its absolutely true. Not everything thats published is correct and we have learned over time by our mistakes with this.
    So – assuming then that we are undertaking larger scale studies, and the results are published we should then be linking with those who are skilled at evidence appraisal to be sure that the results the researchers concluded are in fact correct and safe and suitable for translation into practice resulting in larger scale change.

    Sadly, this is not something we can do as an individual or ward based team BUT it is absolutely right that if you see something that you think would be beneficial to your patients/patient group then you should take that to your Trust/Institutional quality improvement teams. Of equal importance are ideas borne from your patients themselves. This is another discussion but patients are now becoming the drivers of change – and why not? They are at the centre of everything we do 24 hours a day. Thats why are are all here.
    Testing change is a complicated process but needs to be undertaken in order to change practice on a larger scale. It must be said though that it could be your published evidence, along with others with a similar focus that could be included in the tests of change. I think the majority of Trusts will now have departments working with clinicians of all levels engaging in the testing and implementing of change. This is a fantastic and exciting development and is actually improving the scale and pace of evidence informing practice.
    The sharing of evidence via publication, conference/poster presentation or via twitter chats and blogs is essential to the communication of evidence. The sharing of ideas and best practice is now becoming more accessible – it gets people talking about it and that’s the starting point.
    So, in summary we need the evidence in the first place. If you have an idea try to team up with others who have some expertise in the area and also in research itself. All academics have a commitment to investigation and the development of change and regularly work collaboratively with clinicians of all fields.
    If you have identified an area requiring change and have located some evidence take this to your relevant practice development leads/academic links or quality improvement team. You maybe in at the start of some very exciting change.
    If you Trust is engaged in change programmes try to get involved (following discussions with your manger) so you can see how all the cycles work.
    Lastly, its just brilliant to see that this is now so much higher on our agenda rather than the old ‘sitting next to Nellie’ style of development http://www.oxfordreference.com/view/10.1093/oi/authority.20110803100509169
    …. its not sitting next to Nellie that’s the issue – its what evidence Nellie was basing her practice on.
    These are my thoughts anyway. Now I have 3 dogs looking at me – our for a walk now in the Manchester rain.

  8. Having hosted a Tweetchat via Wenurses on pressure ulcer prevention, the subject of evidencing the potential improvements to nursing practice is something I have been musing over. Although the Tweetchat was held in November 2013, I have yet to trial the idea of visual cues to alert nurses to patients needing pressure area relief/care. When I do go live with the trial, I will involve the Trust’s TV SpNurse & do a trial & audit. The results will be documented & published & wider support would be sought to implement its use across the Trust. I would need to seek permissions to publish findings on the internet, but perhaps a blog or via Wenurses community blog?

  9. Hi Teresa this is a great question and I would like to add a few thoughts. Taking the evidence and using it to inform practice has to be reliant upon ensuring that it is the best evidence for practice? Therefore my suggestion would be that initially, we only use evidence that is obtained from Joanna Briggs, Cochrane or NICE in the first instance and then try to determine, through a tweetchat, eg, where and how this is being used/applied in the practice setting. Also, do we think globally or locally as the twittershere is far reaching. However, this way it is specific to an area, ie the wide range of adult care, children and young people/CAMHS, mental health/learning disability and midwifery/neonatal care. I like Derrek’s idea about 12 key issues for the year but this would need to be drilled down more specifically and perhaps linked to the key policy areas in the DH. One month, one issue, 3 weeks to discuss, explore, then conclude with one week feedback & examples? Becky’s idea of a poster could easily be tweeted. We could even invite Ben Goldacre to get involved? If the key issue is about using best evidence to impact on patients/clents lives then we have to give it a go?

  10. Hi Ermintrude – Thank you for your suggestions, yes I also feel that having some sort of forum or “journal club” to share may work, the key is how to do this without putting people off & as Moira and Toirbird state further down what constitutes sound evidence, how do we sort the good from the bad. Great that you echo my thoughts so thank you

  11. Thank you Toribird79 – you raise a very important point about sorting the evidence, what constitutes good evidence & how can we evaluate it? and yes i like to think too that the best evidence finds its way into practice eventually .. However going on Dereks post above eventually can be 14 years !!! Its great that we are raising more questions as this does deserve thought and we all have a differing perspective with valuable questions and thoughts that will hopefully make up a solution.

  12. Hi Kim, Thats really great to hear that you have this on the agenda and I cant wait to see what becomes of it all. I really hope you do share it and would be happy to add it to the wenurses blog

  13. Moira – you have some really interesting thoughts here, tying together some of the key thoughts from previous comments. I agree the “what evidence” question is an important one as not only as you mention above, does it need to be sound but also it needs to be user friendly – otherwise people will just not participate as it wont capture imaginations (talking here from a social media perspective) I too like Dereks 12 key issues and Rebekahs poster – maybe a plan of what will be discussed shared and disseminated the a facility to allow people to feedback and share … think this is a longer game and not the instant gratification we get from ordinary twitter chats.

  14. Thank you all for your comments – some have confirmed my own thoughts and some have given me a new perspective, and some have posed more questions … but all are progress, so thank you for taking the time to respond and share your expertise.

  15. Be clear about the purpose of the change?
    What evidence: You need valid evidence, critically appraised, relevant to the population you are working with.
    What change in practice: Involve all stakeholders (inc patients) in the development of the change & keep them participating.
    Implementation: Involve all stakeholders (inc patients) in the development of the implementation plan for the change from the beginning of the process and throughout the process (see above).
    Change: Do little things in small teams and measure the outcomes often to see if it works. If things take too long everyone loses enthusiasm. 90 days per project max.
    Have clear outcomes and measures.

  16. Hi Teresa,

    I cant see my offering from earlier this morning. Is it stuck in the aether?

  17. Hi Teresa, you are asking exactly the questions I have been thinking of recently; how to disseminate good information to frontline staff. I have to say I am thinking of interesting articles, comments & blogs that provoke thought, changes in practice, or address team working & leadership issues. I have been printing off short articles & putting on an education board in the staff room – decided not to put up anything too long or ‘dry’ give references for full documents or write a précis. All of my initiative is in it’s infancy but I agree with the above for evidence based practice it’ll generally come through current policies/guidelines/national initiatives. One thing I have found is that it is vital that we share our resources & get the information out to people asap not hold on to it. Stimulate discussion & thoughts include staff & invite feedback, it may just make the policies more realistic/user friendly/palatable/jargon free?!
    Not sure I have been helpful, just thinking out loud really. I have found your blog & replies very interesting. Keep us posted with your thoughts, thanks.

  18. Hi Teresa

    I’ve been doing some thinking recently on enabling collaboration and knowledge sharing across the NHS. Have you considered enterprise social networks, such as Yammer? 

    From my perspective, some of the traditional methods work very well, but there is n increasing need to be able to share, discuss and learn more flexibly at a time that is convenient. Some thoughts on enterprise social networks and benefits below:

    - Enterprise social networks are private networks so may engage some of those who are still a little uncomfortable with external social media and enable you to share information that you may not feel comfortable sharing through external social media;

    - The networks allow you to create a slightly more permanent “learning environment”. I love Twitter, but it is difficult to keep a conversation flowing over time and reflect on responses without going to the effort of using ANOTHER tool;

    - Similarly to external social media, users can interact directly through apps at a time that is convenient to them and also allows you to reach those often difficult to reach. 

    - Many of the enterprise social networks allow you to create Groups for particular communities of practice;

    - Trusts and other NHS organisations may be able to contribute to the same place enabling the sort of “cross-fertilisation” that the external networks offer;
    The networks could be used to form the initial discussion, share progress and reflect on the process. It’s also a way to informally document the learning process and results to share with others… And then hopefully get others on board by demonstrating the value.

    I know Dorset HealthCare Univiersity NHS FT have implemented a similar platform but more targeted at ideas sharing and innovation – but very similar elements: http://bit.ly/1mjvrO1

    Hope this provides some useful insight. Realise it’s a bit more involved, but something to aim towards perhaps? I’m working on/inputting into a couple of projects at the minute with similar objectives – I’ll be sure to share any progress we make.

    Chris

  19. Hi,

    There needs to be clarity about what you want to achieve. Is it raising awareness of research that’s out there? Is it identifying researchd interventions and encouraging implementation? Is it developing critiquing skills so that nurses can identify what constitutes good, useable research?

    My guess is all three need doing, but whether you can deal with all three through one mechanism I’m not so sure.

    I would see a Journal Club as perhaps the simplest start point. Members bringing specific articles of interest and discussing the appropriateness of methodology, findings, generalisability etc. It can be a good way of introducing novices to the basics of reviewing a research study and judging whether it is more generally applicable.

    Then there is the model of NICE guidelines – you could provide a ‘warehousing’ operation for NICE guidelines that are very applicable to nursing/therapy and draw attention to them, encouraging use and awareness.

    Medicine has the benefit of Cochrane reviews http://goo.gl/BuZ0V- this is where researchers will be funded to review all of the literature on a particular intervention or treatment and make a digest of that evidence available so that actions can always be based upon the best most up to date evidence. At the moment nursing/therapy doesn’t have anything like this, but there could be a case to lobby the Cochrane Centres to include this.

    I’m still thinking.

  20. Hi Bill – Thanks for your comments, I like the structure that you have outlined, this may prove very useful. We are still very much at the scoping phase .. not even at the planning phase as yet !! So early days. Your structure is very much appreciated though so thank you

  21. Hi Tori, Yes that is really useful and nice to hear someone else approaching it differently but with the same aim in mind. I am glad that you confirm my thoughts regarding making evidence “friendly” for want of a better word .. so your post is very useful indeed. Thank you

  22. Hi Chris,

    I have to admit to being a social media fan through and through. This is because of 1. the accessibility (its in the palm of your hand) 2. Its open and transparent nature allowing for sharing across geographical locations and hierarchical boundaries 3. Its free 4. Its very easy to use

    This is not to say that platforms such as yammer don’t have their place in the dissemination of information and evidence – as I can clearly see that they may well do .. however i remain always and forever a social media fan :)

  23. Hi June,

    Thank you for taking the time to comment – I think you are right … all three !! However maybe one step at a time. I like the idea of using NICE guidelines and using social media as a platform to raise awareness and bring novices (such as myself) up to speed with this whole process.

    One things that concerns me though is what are we saying is evidence ? Is it just journal papers ? Are we ruling out videos, slideshares etc? What about patient feedback etc? Are we confusing evidence with research ? … My simple brain is mulling things over and just seems to produce more and more questions!!!

    Still lots and lots of food for thought here !!

    Thank you so very much

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