Knowledge Utilization Initiatives Knowledge Utilization Initiatives from Associations: from Associations: AWHONN’s CVH for Women and AWHONN’s CVH for Women and NAPNAP’s HEAT InitiativesNAPNAP’s HEAT Initiatives

Knowledge Utilization/Transfer: From Theory to PracticeKU-03 Colloquium, Quebec

September 25-26, 2003

Karen KellyThomas, PhD, RNC, FAANExecutive Director, NAPNAP

Cherry Hill, NJ

ObjectivesObjectives

• Describe an association based theory, Describe an association based theory, program model and strategy that promotes program model and strategy that promotes and advances evidence-based clinical and advances evidence-based clinical practicepractice

• Describe ways to achieve desired Describe ways to achieve desired organizational and health outcomes in organizational and health outcomes in communities served by association memberscommunities served by association members

• Compare commonalities and differences in Compare commonalities and differences in application of KU/translation theory and application of KU/translation theory and models among associations and other models among associations and other groupsgroups

DisclosureDisclosure

• Karen Kelly Thomas was an employee of AWHONN during the time this model and program were developed. She is now employed by NAPNAP.

• AWHONN applies for and receives federal grants and government service contracts.

• In addition, AWHONN seeks and receives unrestricted grants and contributions from multiple sources, including but not limited to Johnson & Johnson, Procter & Gamble, and Pfizer.

• As Executive Director of NAPNAP, Karen Kelly Thomas seeks and receives unrestricted grants and contributions from multiple sources, including those listed above and others.

Be not afraid of going slowly, be only afraid of standing still.

Chinese Proverb

Ever tried. Ever failed. No matter.

Try again. Fail again. Fail better. Samuel

Beckett

AWHONN RBP Program PurposeAWHONN RBP Program Purpose• Advance evidence-based clinical practice in women’s

health, obstetric and neonatal nursing• Measure clinical efficacy and effect on health outcomes

of project guideline• Meet standard bearer and guideline development

responsibility• Transfer specific research-based knowledge and

innovation into practice to improve clinical practice of nurses and other health care providers for the care of women and newborns and to evaluate the effectiveness of that transfer of knowledge (Gennaro, 1994)

Making the unknown known is the important thing – Making the unknown known is the important thing – and keeping the unknown always beyond you. and keeping the unknown always beyond you. Georgia O’KeeffeGeorgia O’Keeffe

AssumptionsAssumptions• FitFit with AWHONN mission,

strategy, focus areas and goals

• Available body of validated body of validated knowledge readyknowledge ready for transfer into practice

• MembersMembers committed to improve practice to ensure high quality nursing care

Theoretical InfluencesTheoretical Influences• Change

– Behavioral (Prochaska & DeClemente)

– Organizational (Deming)• Research Utilization

– Clinical nursing (Stetler, Horsley, Haller)

– Clinical practice (Oxman)– Knowledge and innovation diffusion (Rogers)– Adult learning (Knowles)

• Other– Interpretative research (Denzin, Diekelman, Benner)– Project management/logistics (Block)– Translation research– Synchronicity (Jung)

Jung’s SynchronicityJung’s Synchronicity

• An acausal connecting principle

• As ‘meaningful coincidences’

• Not dismissing irrational data, rather attempting to integrate them by whatever means are at hand

• Interpretation for KU?

Jung, 1969

Clinical Expertise

AWHONN Emerging ModelAWHONN Emerging Model

Research Evidence

Patient Preferences and Actions

Health Care Practice Environment

Clinical Context

Clinical Site and Circumstances

Adapted from Haynes et al (2002)

Identifies clinical

topic RC

STOP

Phase IPlanning

Defining focus & scopeSecuring Funds

Appoints science team (RC/AS)

Phase IIImplementation

Phase III: Evaluation/Decision Making

Phase IV:Dissemination

Refining scope of science and writing clinical question for project (ST)

Reviewing & scoring science base (ST)

Writing evidence-base considered for project guideline (STL)

Developing project guideline (ST)

Presenting evidence-base For project guideline (ST)

Selecting sites

•Training site coordinators (ST)•Collecting baseline data (SC)•Implementing project guideline (SC)•Collecting data after guideline implementation (SC)

•Analyze final data and recommendations (ST)

•Redefining guideline (ST)

•Writing outcome report (STL)

Topic to guideline teams

•EBP Guideline Flowchart•Dissemination•Use

KeyAS – AWHONN StaffAP – Advisory PanelsRC – Research CommitteeST – Science TeamSTL – Science Team Leader

Guidance for Practice Validated

no

yes

P r o c e s s F l o w C h a r tP r o c e s s F l o w C h a r t

OutcomesOutcomes

• Measurable progress toward AWHONN strategic plan and goals

• Measures of project effect on health and lives of women and newborns

• Disseminate and diffuse association experience’s effect on clinical practice

AWHONN Evidence-Based Clinical Practice AWHONN Evidence-Based Clinical Practice Guideline (EBG) Development ProgramGuideline (EBG) Development Program

• Inception in 1998 as a result of collaborative effort of AWHONN Practice, Research and Education Committees

• AWHONN framework for guideline development based on American Nurses Association Manual to Develop Guidelines (Marek, 1995)

• AWHONN Evidence-Based Clinical Practice Guidelines have been accepted for inclusion in Agency for Healthcare Research and Quality (AHRQ) National Guideline Clearinghouse

Why Evidence-Based Why Evidence-Based Clinical Practice Guidelines?Clinical Practice Guidelines?

• Promotes nursing profession’s commitment to practice based on best available evidence

• Provides clinical practice recommendations and rationale based on current evidence “at-a-glance”

• Enhances credibility with evidence-based “talking points” to facilitate collaboration with other health care providers about pertinent patient care issues

• Provides stimulus for further reading and research • Provides basis for continuing education programs • Provides basis for CQI projects and outcomes

evaluation

AWHONN’s Cardiovascular AWHONN’s Cardiovascular Health for Women InitiativeHealth for Women Initiative

• Third stage, DHHS contracts to specific regions

• Trained several tiers and types of nurses to implement specific strategy

• Implemented in practice setting community and consumer groups

• CQI effort continues with recruitment and 4 follow-ups assessments regarding smoking cessation, nutrition, activity, and stress management

Great works are Great works are performed, not by strength, performed, not by strength,

but by perseverance.but by perseverance.Samuel Johnson

ProductsProducts

• Articles in refereed journals

• Presentations at conventions and meetings

• Presentation packages

• Clinical practice monographs with CE

• Online CE learning

• Workshops

• ACG specific products

NAPNAP’s Healthy Eating and NAPNAP’s Healthy Eating and Activity Together (HEAT) InitiativeActivity Together (HEAT) Initiative

• Reduce prevalence of overweight and obese children by 5% (1994 baseline=11% of 6-19 year olds are overweight or obese)

• Multi-year, multiple components addressing advocacy, education, research and practice improvement

• Organizing resources and tools on web and print• Testing ‘do-ability’ factors and effect on BMI• Led by a Steering Work Group with 7 core work

groups• Strategic and tactical alliances being made during

next three months; funding sought; EB committed

Opportunities and ThreatsOpportunities and Threats• Opportunities

– Walking among giants– Members are best of the bestMembers are best of the best– Commitment to test “do-ability factor”– Welcoming creativity

• Threats– HIPPA fears of unknown– IRBs and human subjects protection– Data sharing– Funding

We are each born so creative – then we forget our purpose, our mission. We believe our doubts and fears, and slowly stop ‘being creative’ as though it was a separate thing. Sark

Riding the dragonRiding the dragon

Every problem has two handles. You can grab it by the handle of fear or

the handle of hope.Margaret Mitchell

Key FacilitatorsKey Facilitators

• Volunteer members

• Association commitment

• Project support staff/liaison

• Site organization support

• Human subject protection templates

• Money

• Creativity

A Path to Seeking and A Path to Seeking and Achieving Desired OutcomesAchieving Desired Outcomes

• Competence development

• Research utilization

• Clinical practice outcomes

• Health outcomes in community

• Patient information and education

Creating Real RolesCreating Real Roles

• Champion and leader

• Truth seeker and teacher

• Logician and magician

Be not afraid of going slowly, be only afraid of standing still.

Chinese Proverb

Ever tried. Ever failed. No matter.

Try again. Fail again. Fail better. Samuel

Beckett