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Your assignment is to choose an evidence-based practice/research translation model and write a critical appraisal of the model. Include who developed the model, its purpose, steps and strengths, and weaknesses of the model. You do not need an abstract. Please provide references you use.

Write a critical appraisal of an evidence-based translation model including steps, strengths, and weaknesses of the model.

The importance of research knowledge in improving healthcare services

Research is key to providing evidence upon which medical practice is based. Research knowledge is widely used in the health sector to enhance quality and improve healthcare services. Such knowledge is derived from robust scholarly available information for its implementation and success. There are several available health-related materials (about 2 million) published in over 20,000 healthcare journals every year (Masic & Milinovic, 2012). In addition to the journals, there is an increasing number of electronic databases availing healthcare data to the healthcare practitioners. This plethora of information hints at the provision of improved healthcare services that are informed by available evidence if it is appropriately used in healthcare decision making and practice. More than accessing research information is the translation of this knowledge and evidence into practice for effective and efficient services that quench customer needs and desires. According to Fry et al. (2018), translation of knowledge is a process by which research knowledge is created, circulated and adopted into healthcare service practice. In a broad sense, knowledge translation (KT) is "the synthesis, exchange, and ethically sound application of knowledge within a complex system of interactions among researchers and users to accelerate the capture of the benefits of research… through improved health, more effective service and products, and a strengthened health care system." (Palmer & Kramlich, 2011). There is a continuous development of new information by the healthcare professionals to aid healthcare practitioners in providing the best practice to their customers (Palmer & Kramlich, 2011). The availability and utilization of this information does not necessarily translate to the advancement of the healthcare services. In fact, improvement or advancement of healthcare services is slow and inconsistent due to the ineffective translation of research outcomes into practice (Grimshaw et al., 2012). An assessment of quality care has proven that the healthcare system exhibits a below-par performance on its ability to translate knowledge into practice (Steven, 2013). Research conducted in the US and Netherlands show that 40-30% of the patients do not receive health care based on current evidence (Grimshaw et al., 2012). Many strategies have been devised to enhance the implementation of research evidence however, many of them lack a conceptual framework (Palmer & Kramlich, 2011). Therefore, the translation models become difficult for some user to comprehend. Also, these models have proved to be insufficient since they fail to integrate empirical knowledge and the tacit knowledge of the healthcare practitioner. In this article, the new translation model that ameliorates knowledge translation hurdles called the Multisystem Model of Knowledge Integration and Translation (MKIT), will be described and appraised. Further, its advantages and limitations will be discussed.

Challenges of knowledge translation in healthcare

MKIT is a model designed by Palmer and Kramlich that guides healthcare professionals through the innovation and implementation phases of generating knowledge, incorporation and its translation (Palmer and Kramlich, 2011). Recognizing that the efforts of coming up with medical knowledge had made tremendous progress as opposed to knowledge implementation, the authors carried out an extensive literature research coupled with interviews and came up with this comprehensive model addressing systemic implementation of information in healthcare. The healthcare practitioners always have the desire to improve the quality of their services however, they face the challenge of utilizing the available research to this course. Also, the researchers carry out studies on topics of their individual interests and passions which may conflict the hospital administrations' plans. The MKIT considers the aforementioned hurdles to enhance the implementation and sustainability of evidence oriented practice in healthcare facilities by providing appropriate guidelines for responding to the needs of changing practices (Camargo et al., 2017). The authors of MKIT further argues that a social relationship among the researchers, researcher utilizers, and the facility management is influential in achieving EBP. Furthermore, a simple and understandable process of translation research evidence into practice by integrating both tacit (clinician experience) and explicit (Knowledge obtained from research) knowledge is necessary for effective knowledge translation (Palmer & Kramlich, 2011). In this course, Palmer and Kramlich identified the use of communities of practice (CoP) conceptual framework for effective knowledge integration and translation (Palmer & Kramlich, 2011).

The CoP is defined as a team of persons that have a specific concern, set of challenges and passion on a given area or topic in common who intend to expand their professionalism and knowledge through continuous interaction (Krishnaveni & Sujatha, 2012).  Communities of practice involve three elements namely domain, community and practice whose relation facilitates informal interactions, information sharing and networking (Saint-Onge & Wallace, 2012). In pursuit of a research domain, members group themselves through joint activities, networking and sharing of information even though they do not work together thereby building relationships that form a community. Within this community, they develop and share experience, resources, and tools that are aimed at checking recurrent issues and in the process they share their practices (Palmer & Kramlich, 2011). The combination of these three elements cultivates CoP that provides social frameworks which enable people to learn with and from each other (Palmer & Kramlich, 2011). With this conceptual framework the healthcare professional develop a collective responsibility for managing knowledge, easily create a connection between learning and performance that enables them to tackle changing aspects of knowledge creation and sharing. In the contemporary complex healthcare system, the CoP creates an innovation enabling environment and social networking for effective knowledge translation (Succar & Kassem, 2016). The use of CoP to facilitate effective translation of evidence has been explored and ascertained that it leads to quality improvement of the healthcare services. For example, the Australian National Institute of clinical studies implemented CoP by forming a group of people on a voluntary basis who are willing to share information. The formed groups utilized the already existing knowledge and through the CoP, the information-practice gaps significantly reduced leading to improved patient results (Thomson, Schneider & Wright, 2013). Also, a research by the Canadian Institute of Health Research has provided evidence for the successful application of CoP in human health program and exhibited improved results (Meagher-Stewart et al., 2012).

Multisystem Model of Knowledge Integration and Translation (MKIT)

The communities of practice support the MKIT model as it fosters networking and information sharing in a healthcare microsystem. Here, the microsystem is a clinical concept where patients, families and the healthcare team interact in the process of care delivery (Lucey, 2013). The microsystem is the basic unit that is committed to direct care provision within the healthcare system (Von Krogh, Nonaka & Rechsteiner, 2012). Another intermediate unit, the mesosystem, and functions in providing leadership to both the microsystem and the highest level of the system, the macro-system (Bender, 2016). In healthcare organization, the macro-system is tasked with the responsibility of resource provision for the success of the mesosystem and microsystem within the clinical system (Bender, 2016).

The MKIT has been applied during a clinical situation for effective knowledge translation to practice. The model was used in guiding the development and establishment of healthcare regulations to accommodate the presence of a family in the event of resuscitation of their patient (Palmer & Kramlich, 2011). The nurse researcher began with a reflective inquiry which is the initial step of the model, the knowledge seeker step. At this stage, the healthcare giver identified the absence of a formal framework for guidance whenever a family desired to witness the resuscitation of their loved one. From the researcher’s experience, the individual decision on such instances has led to confusion and anxiety for those involved (Palmer & Kramlich, 2011). Further, staff members that occasionally allowed the presence of family members during the resuscitation process experienced negative outcomes for they lacked support from other staff members. Therefore, the nurse recognized the necessity for instituting a conventional guideline to provide solutions in such instances which propagated a research for evidence to back up the intended change.

The second step is the integration of knowledge and evidence in which the researcher conducts both qualitative and quantitative analysis of available evidence relating to the expected practice change. A change in practice needs to convince all the stakeholders that are, the patients, family members, other staff members and the hospital management on its associative benefits for it to receive the support it requires (Schmidt, 2014). In this case, the researcher should be aware of the negative repercussions for the presence of the family during nursing processes. For example, family interferences increase stress levels on the healthcare providers and increase the possibilities of medical-legal litigations due to the family presence in an ongoing nursing procedure (Dwyer & Friel, 2016). A methodical approach was adopted in coming up with the evidence to support its establishment to counter the associated negative impacts. Therefore, it was important to involve the stakeholders throughout the different levels of clinical system organization, the micro, and macro levels, by formulating a multidisciplinary CoP. Also, families that have ever been present during the resuscitation of their loved ones were interviewed. Literature research on the topic of concern merged with the outcomes of the interviews and meeting conducted to ascertain the possible advantages and disadvantages of change of practice. In fact, family presence during resuscitation was more advantageous than its absence. Studies prove that family presence during this nursing event facilitates the grieving process, family members can offer critical information that can aid the admission of appropriate care. Furthermore, there is no literature to prove litigation cases as a result of family presence (Oczkowski, Mazzetti, Cupido & Fox-Robichaud, 2015). Moreover, research showed that presence of families during resuscitation increases professionalism among the healthcare providers during the procedure since they can request for termination of any injurious efforts (Dwyer & Friel, 2016). A comprehensive report from the findings of the interviews together with proceeding from staff meetings about the topic was analyzed by the facility's institutional review board and found to be coherent. The information was then utilized by the CoP in developing guidelines for the presence of family during resuscitation (Palmer & Kramlich, 2011). After a series of reviews, the guidelines were acceptable to all the stakeholders which prepared them to support the change of practice for effective implementation of research info.

Communities of practice (CoP) in facilitating effective knowledge translation

The third and fourth stage is implementation and monitoring phase respectively. At this stages, extensive education of the staff and implementation trials of the guidelines is carried out to enhance effective translation of evidence into practice (Palmer & Kramlich, 2011). Besides repeated sensitization of the staff members through various platforms such as information posting on bulletin boards, a pilot design of the practices is established and assessed. Data from the pilot test is analyzed and assess the suitability as well as the sustainability of the practices. The necessary amendments are made before the final implementation phase. In our case, family presences during resuscitation exhibited no negative impacts but rather it was supported by positive reports from the staff and family members (Palmer & Kramlich, 2011). The positive implication of implementing the change propagated the ultimate goal of the model, translating knowledge into practice, thereby leading to the final phase of this program in the macro-system.

Dissemination and transformational leadership form the last steps of knowledge translation. At this level, the changes to practice are adopted by the management and implemented at the macro-system level. Proper leadership, that can activate transformation and sustains it within the facility, is crucial without which the change cannot live long. Also, the management should be able to provide necessary resources for the full establishment of practice change. After, a one-year pilot study, the guidelines for family presence during resuscitation was established within the institution and became part of its culture (Palmer & Kramlich, 2011). Satellite healthcare facilities of this institution recognized the importance of the MKIT model in translating information into practices and vastly requested for training on its use (Plamer & Kramlich, 2011).  The success achieved through the use of the multisystem knowledge integration and translation attracted national interest from other institutions (Palmer & Kramlich, 2011).

The multisystem knowledge and integration model is advantageous for it provides a circular and continuous process of information translation as opposed to a unidirectional model. The process of translation of information from the first stage of reflective inquiry should progress to other stages without cuts. Moreover, the model recognizes knowledge translation is a long-term process, therefore, employing a circular of continuous approach (Palmer & Kramlich, 2011). Furthermore, the model incorporates the CoP conceptual framework that supports sharing of experience or practice which not only can generate new information but also enhances the establishment of research evidence. The incorporation of the communities of practices framework in the model makes it easy for all the healthcare stakeholders to understand and follow the translation model. Personal experiences and knowledge are brought into consideration and integrated with research evidence to formulate an appropriate change of practice. The ability to combine both tacit and explicit knowledge gives this model an advantage since other models fail to recognize the importance of individual knowledge and experience (Palmer & Kramlich, 2011). The ease of using the model to translate knowledge allows even the young healthcare practitioners to effectively apply research evidence thereby improving healthcare services.

Improving the quality of healthcare services

However, using the model to translate new knowledge into practice is challenging (Palmer & Kramlich, 2011). The second stage of the model requires extensive research using both the qualitative and qualitative means. If there is scant literature to support a certain practice, a new knowledge per se, it might not meet the criteria of this model for adopting an evidence into practice. Some other data sourcing techniques involved such as interview and staff meeting are resource demanding which makes the model expensive. Prior to implementation of any evidence, there is a pilot test which as much as it ensures effective translation of knowledge, it is time-consuming and can lead to resource wastage in case it provides negative results.

In summary, the multi-system knowledge integration and translation model provides an advanced method of effective knowledge translation since it contains a conceptual framework, the CoP. The model serves as a mechanism for knowledge generation, integration, and implementation at both the individual and the organizational levels. The model has demonstrated success in the already implemented cases, therefore ready for use in other institutions to improve healthcare outcome.

References

Bender, M. (2016). Clinical nurse leader integration into practice: developing theory to guide best practice. Journal of Professional Nursing, 32(1), 32-40.

Camargo, F. C., Iwamoto, H. H., Galvão, C. M., Monteiro, D. A. T., Goulart, M. B., & Garcia, L. A. A. (2017). MODELS FOR THE IMPLEMENTATION OF EVIDENCE-BASED PRACTICE IN HOSPITAL BASED NURSING: A NARRATIVE REVIEW. Texto & Contexto-Enfermagem, 26(4).

Dwyer, T., & Friel, D. (2016). Inviting family to be present during cardiopulmonary resuscitation: Impact of education. Nurse education in practice, 16(1), 274-279.

Fry, M., Fitzpatrick, L., Considine, J., Shaban, R. Z., & Curtis, K. (2018). Emergency department utilisation among older people with acute and/or chronic conditions: a multi-centre retrospective study. International emergency nursing, 37, 39-43.

Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J., & Squires, J. E. (2012). Knowledge translation of research findings. Implementation science, 7(1), 50.

Krishnaveni, R., & Sujatha, R. (2012). Communities of practice: an influencing factor for effective knowledge transfer in organizations. IUP Journal of Knowledge Management, 10(1), 26.

Lucey, C. R. (2013). Medical education: part of the problem and part of the solution. JAMA internal medicine, 173(17), 1639-1643.

Masic, I., & Milinovic, K. (2012). On-line BiOmedical dataBases–the Best sOurce fOr Quick search Of the scientific infOrmatiOn in the BiOmedicine. Acta Informatica Medica, 20(2), 72. 

Meagher-Stewart, D., Solberg, S. M., Warner, G., MacDonald, J. A., McPherson, C., & Seaman, P. (2012). Understanding the role of communities of practice in evidence-informed decision making in public health. Qualitative health research, 22(6), 723-739.

Oczkowski, S. J., Mazzetti, I., Cupido, C., & Fox-Robichaud, A. E. (2015). Family presence during resuscitation: A Canadian Critical Care Society position paper. Canadian respiratory journal, 22(4), 201-205.

Palmer, D., & Kramlich, D. (2011). An introduction to the multisystem model of knowledge integration and translation. Advances in Nursing Science, 34(1), 29-38.

Saint-Onge, H., & Wallace, D. (2012). Leveraging communities of practice for strategic advantage. Routledge.

Schmidt, R. (2014). Connecting in Crisis: Family Presence in Resuscitation (Doctoral dissertation, University of Calgary).

Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. OJIN: The Online Journal of Issues in Nursing, 18(2), 4.

Succar, B., & Kassem, M. (2016, May). Building Information Modelling: Point of Adoption. In CIB World Congress, Proceedings…, Tampere Finland.

Thomson, L., Schneider, J., & Wright, N. (2013). Developing communities of practice to support the implementation of research into clinical practice. Leadership in Health Services, 26(1), 20-33.

Von Krogh, G., Nonaka, I., & Rechsteiner, L. (2012). Leadership in organizational knowledge creation: A review and framework. Journal of Management Studies, 49(1), 240-277.

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