BuildingtheClinicalBridgetoSupportNursing EffectivenessSciencedownloads.hindawi.com/journals/nrp/2012/194147.pdf · advance professionalization and inﬂuence of nursing in care decisions,

Hindawi Publishing CorporationNursing Research and PracticeVolume 2012, Article ID 194147, 3 pagesdoi:10.1155/2012/194147

Editorial

Building the Clinical Bridge to Support NursingEffectiveness Science

Kathleen Potempa,1 John Daly,2 and Marita G. Titler3

1 University of MI School of Nursing, Ann Arbor, MI 48109-5482, USA2 World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development,Faculty of Nursing, Midwifery & Health, University of Technology Sydney, Sydney, Australia

3 UMHS, University of Michigan School of Nursing, Ann Arbor, MI 48109-5482, USA

Correspondence should be addressed to Kathleen Potempa, [email protected]

Received 5 April 2012; Accepted 5 April 2012

Copyright © 2012 Kathleen Potempa et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

1. Background

Several forces in the US, including the need to controlrising health care costs, are converging to require qualityand safety outcomes as a factor in reimbursement for healthcare services. Many of the established outcomes, includingnosocomial decubitus ulcers, falls with injury, medicationerrors, and self-care management are quality indicatorssensitive to nursing care. Requirements for transparency inreporting outcomes as well as the rapid expansion of elec-tronic health records (EHRs) are producing opportunitiesto study clinical care processes and outcomes as heretoforenot possible. The ability of nurse researchers to define thedatabase structures of EHRs, access these data and set forthanalyses for health systems to improve care is a compellingreason to build solid relationships between academic andhealth care institutions. But perhaps more compelling isthe opportunity to fully advance the professionalization ofnursing through the unification of missions, ultimately forthe betterment of patient care and the improved educationof new generations of nurses.

Other professions, especially physicians, have long expe-rienced the benefits of uniting their tripartite missions ofpatient care, education, and research. They have utilized the“power” of the Academic Medical Center to fuel discovery,innovation and the rapid translation to clinical care. Medicalstudents and postgraduate trainees benefit from this envi-ronment; their mentors are faculty with significant researchprograms, attending physicians responsible for patient care,leaders within the health system administrative structures

driving policy, and teachers of the next generation. Theopportunity of a unification model of varying types, toadvance professionalization and influence of nursing incare decisions, policy, and the discovery and translation ofknowledge to care practices is essential for us to leverage this“new age” where much is expected of nurses and nursing inthe evolution of health care within countries and in the US,health care reform.

The future of nursing requires that we employ a unifiedapproach in research, education, and practice. Consequently,there is an imperative (1) for nurses to practice to thefullest extent of their education and training; (2) to improveeducational systems that offer seamless progression to higherlevels of education; (3) for nurses to be full partners withphysicians and other healthcare professionals to transformhealthcare delivery; and (4) to meet work force demands fornurses globally [1].

1.1. Effectiveness Science. One of the emerging sciences thatwill benefit from a unified academic-practice environmentis “effectiveness science.” Effectiveness science, essential toimproving quality and cost of healthcare, includes testinghealth care interventions in real world settings, advancing useof research findings by diverse populations, and training andcareer development for the next generation of investigators inthe field. Effectiveness science uses comparisons, subgroups,and context to determine what health care treatments workfor whom and in what setting. This includes comparisons oftreatments as well as models of care delivery [2].

2 Nursing Research and Practice

Effectiveness science is receiving increasing attention inhealthcare [3]. The purpose of effectiveness research is tohelp consumers, clinicians, purchasers, and policy makersto make informed decisions that will improve health careat the individual and population level [4]. Findings fromeffectiveness research are designed to strengthen health caresystems by ensuring that care delivered is based on the bestpossible evidence and informed decisions.

Nurses are optimally positioned to address many definedpriorities in effectiveness science. These research prioritiesinclude testing the effectiveness of (1) primary preventionmethods in preventing falls in older adults at varyingdegrees of risk; (2) dissemination and translation strategiesto promote use of research findings by patients, clinicians,payers, and others; (3) strategies for reducing healthcareassociated infections; (4) comprehensive care coordinationprograms in managing children and adults with chronicillness, especially in populations with known health dispari-ties; (5) school based interventions involving meal programs,vending machines, and physical education, at differentlevels of intensity, in preventing and treating overweightand obesity in children and adolescents; and (6) variousstrategies (e.g., clinical interventions, social interventions)to prevent obesity, hypertension, diabetes, and heart diseasein at-risk populations such as the urban poor and NativeAmericans/American Indians [4]. Nurse scientists have builtand will continue to build programs of research in theseand other important areas of need and must interface withthe larger national and international effectiveness agendato inform priorities for effectiveness science, and garnerfunds for their research. Additionally, nurse scientists havemethodological expertise essential to move forward thisnational and international agenda; these include meta-analysis, research synthesis, large dataset analysis, and exper-imental and observational research methods.

Our professional contributions to effectiveness sciencecan best be achieved through unification models of edu-cation, practice, and research in which practice issuesinform the effectiveness research agenda, researchers testinterventions in real world settings, and practitioners,learners, and investigators can simultaneously understandwhy some healthcare interventions work in some settings,and with some populations, but not others. This deeperunderstanding of the mechanisms to improve health, patientoutcomes, and healthcare systems will benefit consumers,payers, and public policy stakeholders. If we are to meetthe healthcare challenges of today and into the future, ourprofession can no longer afford to isolate practice clinicians,educators and scientists and treat learners as guests inpractice settings during their educational experience. Wemust unify to promote clinical inquiry, maximize the impactof research, promote excellence in patient care, and build aprofessional culture of life-long learning.

2. Overview of Papers

In this special edition, you will find papers related to different“views and levels” of the “clinical bridge,” processes to

consider in building the bridge, some preliminary outcomesof unification in sample environments, as well as specificexamples of the research that the faculty immersed in clinicalenvironments can generate with application to clinical care.

2.1. Process of Partnership and Emerging Outcomes. Threepapers focus on processes and outcomes of building theclinical bridge between academia and practice. The inte-grative review by J. A. Beal describes what is empiricallyknown about academic-service partnerships in nursing.Analysis of publications revealed that empirical knowledgeabout academic-service partnerships is in the areas ofprerequisites for successful partnerships, types and benefitsof partnerships, and workforce development with themesof academic-practice progression and educational redesign.Most publications about academic service partnerships weredescriptive in nature but did not include formal evaluationof outcomes. Future empirical work in this area shouldaddress the effectiveness of these partnerships using rigorousevaluation methods.

Development of a robust clinical bridge in Australia,through jointly funded positions at the professorial level, isdescribed by M. Wallis and W. Chaboyert. The evolutionof this unique model of building a clinical bridge andexpanding to several practice environments provides anexemplar for others interested in creating partnershipsbetween practice and academia. The impact on researchproductivity, dissemination of research findings, and changesin practice are described.

The paper by M. Svjeda and colleagues describe the pro-cess and outcomes of a partnership between the University ofMichigan School of Nursing (UMSN) and nursing servicesat the University of Michigan Health System (UMHS)entitled “the Initiative for Excellence in Clinical Education,Scholarship and Practice.” The partnership is designed toleverage the resources and expertise of both organizationsto advance the three missions of education, research, andpractice. The whole-scale change process was used to bringfaculty and practice stakeholders together for this initiative.An innovative model of clinical education was developed,piloted, and is now fully implemented in the undergraduatecurriculum. Key findings of this model are provided. Thispaper addresses the processes, lessons learned, and successesof using an innovative method of education through buildinga clinical bridge between academia and practice.

Collectively, these 3 papers point out the importance ofevaluating these innovative academic-practice partnershipsand lessons learned from these experiences. These exemplarsare helpful to guide others interested in addressing thebuilding of clinical bridges between academia and practiceto maximize student learning, improving quality of care, andimproving outcomes of learners.

2.2. Context Issues and Effectiveness Science. Two studiesfocus on context factors in effectiveness science. In aneffort to understand communication among clinicians, akey variable that impacts patient outcomes, D. Tschannenand E. Lee explored the impact of nursing characteristics

Nursing Research and Practice 3

(e.g., job category, education, experience, and expertise) onperceptions of communication in the acute care setting.Specifically, the more positive the environmental values(e.g., high trust, respect), the greater the perception ofcommunication openness among nurses. They also foundthat nurses’ experience was significantly related to opennessof communication among nurses and physicians. Workenvironments that foster trust, respect, status equity, andtime availability create an atmosphere where communicationcan flourish.

D. Wilson and colleagues compared the perceptions ofnursing units’ safety culture between charge nurses and staffnurses. The charge nurse was defined as a frontline nursingunit leader who makes shift-by-shift decisions about staffing,personnel, and unexpected events that impact patient care.They found that nurses with no charge experience had morepositive overall perceptions of patient safety as comparedto those with some charge experience. Charge nurses withone or more years of experience were less positive aboutteamwork, overall perceptions of safety, and number ofsafety events reported. These two papers draw attentionto the importance of factors in the clinical environment,such as trust and characteristics of clinicians, that should beconsidered in conducting effectiveness science.

2.3. Interventions and Technologies. Two papers address theeffectiveness of interventions and technologies. L. L. Sheverand M. G. Titler examined factors that contribute toadverse incidents of hospitalized older adults, using a modelthat included patient characteristics, clinical conditions,nursing unit context of care variables, medical treatments,pharmaceutical treatments, and nursing treatments. Thisexploratory observational study used data from electronichealth records as well as other electronic repositories anddemonstrated that the type of nursing treatments associatedwith adverse incidents were diverse. This study illustratesthe importance of partnering between academic and practicesites that have electronic data to address nursing effectivenessresearch questions.

P. A. Abbott addresses the challenges and opportunitiesin effective use of technology. This study evaluated howa specific technology (mobile clinical computing applianceconsolidating numerous technological functions), designedto address technology crowding, is used in the real-worldenvironment. Studies that compare how health IT is actuallyused, versus how the device was designed to be used, arenecessary. This paper is a useful illustration of examiningeffectiveness of technology to assure usability and patientsafety.

2.4. Knowledge Application and Education. Three papersaddress innovations in knowledge application and edu-cation. A. Pearson and colleagues describe the nature ofevidence-based healthcare and translation science, proposea reconceptualization that brings together these two concep-tual areas, and asserts the existence of a third fundamentalgap that is rarely addressed: the gap between knowledge needand discovery. They argue that if the evidence-based healthcare movement is to progress and make any real impact

on health outcomes, it is imperative that the nature andprocesses of these two enterprises are integrated.

M. Aebersold and colleagues evaluate the effectivenessof virtual reality simulation, using two virtual simulationscenarios, to improve undergraduate student’s performanceregarding interpersonal skills (e.g., communication, profes-sional behavior). The use of second life and creation of avirtual inpatient unit are among the innovative interventionsused in this educational approach. Virtual world simulationenvironments offer a unique and potentially cost-effectivemethod of teaching leadership and management skills.

Moss and colleagues describe an innovative nursingresearch training model, the HOMInG Device, for doc-toral education. This model and approach to researchtraining focuses students on the interrelationships amongfour domains of their research enterprise—the substantiveresearch topic, their interests as researchers, the researchcontext, and particular research approach. Working withthis model means that students engage consistently withthese inter-relationships: from initial ideas and planning,to dissemination and positioning of the newly generatedknowledge within clinical practice. Evaluative data suggestthat this model facilitates doctoral education and researchtraining.

In summary, papers in this special issue are a sourcefor generating greater understanding of how to proceed andwhat to expect along the path of development in buildingpartnerships between academia and practice. The impor-tance of such unified models provides benefits for effective-ness science, and application of innovative approaches toresearch, education, and practice. It should be noted thatwhile these papers refer to work in hospital settings, thebenefits of unification transcend specific environments andcan and should benefit communities and populations withappropriate organizational partners.

Kathleen PotempaJohn Daly

Marita G. Titler

References

[1] Institute of Medicine, The Future of Nursing: Leading Change,Advancing Health, The National Academies Press, Washington,DC, USA, 2011.

[2] L. A. Simpson, L. Peterson, C. M. Lannon et al., “Special chal-lenges in comparative effectiveness research on children’s andadolescents’ health,” Health Affairs, vol. 29, no. 10, pp. 1849–1856, 2010.

[3] M. G. Titler and S. J. Pressler, “Advancing effectiveness science:an opportunity for nursing,” Research and Theory for NursingPractice, vol. 25, no. 2, pp. 75–79, 2011.

[4] Institute of Medicine, Initial National Priorities for ComparativeEffectiveness Research, The National Academies Press, Washing-ton, DC, USA, 2009.

Submit your manuscripts athttp://www.hindawi.com

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014


Gastroenterology Research and Practice

Breast CancerInternational Journal of


HematologyAdvances in


ScientificaHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014

PediatricsInternational Journal of



Advances in

Urology

HepatologyInternational Journal of


InflammationInternational Journal of


The Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014


Computational and Mathematical Methods in Medicine


BioMed Research International


Surgery Research and Practice

Current Gerontology& Geriatrics Research

Hindawi Publishing Corporationhttp://www.hindawi.com

Volume 2014


NursingResearch and Practice

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com

HypertensionInternational Journal of


Prostate CancerHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014


Surgical OncologyInternational Journal of

Documents

BuildingtheClinicalBridgetoSupportNursing EffectivenessSciencedownloads.hindawi.com/journals/nrp/2012/194147.pdf · advance professionalization and inﬂuence of nursing in care decisions,