Back to search

HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

Implementation and Action for Knowledge Translation (IMPAKT) in practice and education

Alternative title: IMPlementering og Aksjon for KunnskapsTranslasjon (IMPAKT) i praksis og utdanning

Awarded: NOK 9.9 mill.

A gap continues to exist between what is known and what is provided of professional health care services, commonly referred to as the knowledge-to-action gap. Most initiatives have fallen short in solving this pressing issue. The aim of the IMPAKT project is to facilitate the implementation and translation of new knowledge into action among current and future healthcare professionals. Many efforts to implement knowledge translation strategies have failed, perhaps due to lack of stakeholder involvement in the research process. The IMPAKT project is underpinned by integrated knowledge translation (i-KT) where researchers and clinical practice work as partners throughout the research process. Participating knowledge end-users collaborated in the refinement of research questions, selection of the methodology, data collection and tool development, selection of outcome measures, interpretation of findings, crafting of messages and dissemination of results. This project addressed the knowledge-to-action gap from two different sectors, nursing homes and higher education. The knowledge-to-action gap is a challenge in both of these sectors and across them. Both current and future healthcare personnel are in a need for competencies in identifying, appraising and making use of reliable research findings in their daily practice. Nursing homes are under constant pressure to improve quality of care, while at the same time undertaking care that was previously provided by specialist healthcare. Staff in nursing home, including leaders, may have educational needs and support in finding ways to implement new practices. In a systematic review of effects of interventions to improve the implementation of guidelines in nursing homes it became clear that this is a research area of scarcity. That is why we developed and carried out an intervention, where researchers and leaders in nursing homes worked in a partnership to define needs, stakeholders and possible solutions. This exploration took place using a mix of methods to map contextual factors, roles and learning needs. The intervention had two main components: In the first, a common capacity building program in evidence-based practice and knowledge translation, was offered healthcare professionals in nine intervention nursing homes. In the second, practice development nurses in each intervention nursing home, took a lead in applying what they learnt, under facilitation of researchers. Based in a systematic and joint effort, a decision was made to implement NEWS2, a tool developed to detect and act upon early signs of deterioration in nursing home residents. Nine public nursing homes made up the intervention group, and ten others the control group. The intervention period lasted for a year. Prior to the IMPAKT intervention, none of the nursing homes applied NEWS2 in their practice, even if this was the recommended in clinical guidelines. Afterwards, both intervention and control groups had increased their use, but significantly more in the intervention group. We concluded that the IMPAKT intervention, consisting of KT competence and facilitation, was a highly effective implementation strategy. Institutions of higher education have a societal mandate to educate candidates with life-long learning competencies to keep up with new knowledge. Little is known about levels of these competencies among candidates. Through IMPAKT we have translated and validated a questionnaire and surveyed 3rd year students in bachelor healthcare programs. The students find Evidence-based practice relevant, but reported low levels of understanding of terms, low confidence in skills and very little use of it in clinical situations. These findings serve as an important baseline for the implementation of new national guidance for bachelor programs.

Vi har gjennomført en stor og kompleks implementeringsintervensjon, med et robust studiedesign, hvor effekten var svært stor (per sluttrapport i NFR er RCT’en ennå ikke publisert). I internasjonal implementeringslitteratur er ofte effekten av implementeringsstrategier små til moderate. At vi lykkes i IMPAKT skyldes trolig en lang utviklingsperiode hvor forskere og praksisfelt jobbet sammen og systematisk for å skreddersy intervensjonen til akkurat den aktuelle konteksten, nemlig sykehjem. Potensielt kan samme effekt oppnås andre steder, med tilsvarende innsats. IMPAKT prosjektet har involvert totalt sett svært mange deltakere som representerer høyere utdanning, forskning og klinisk praksis. Dette har vært et eksempel på "kunnskapstriangelet" i praksis, og kanskje bør det legges til rette for mer formelle partnerskap mellom akademia og praksisfelt. Tilbydere av utdanning i kunnskapsbasert praksis bør vurdere om implementering har god nok plass i undervisning og veiledning i kunnskapsbasert praksis. Dette var en av justeringene vi gjorde i intervensjonen i IMPAKT og dette var trolig en viktig sukksessfaktor. Tidlig i kunnskapsbasert praksis sin æra, var det en artikkel som delte inn brukere av forskning i «doers, users and replicators of EBP». Denne bør det børstes støv av og undervisningen bør skreddersys deretter. Hva slags kompetanse i KBP ulikt helsepersonale behøver, avhenger av rollen deres i praksis. Implementeringsforskning er et ungt forskningsfelt og med IMPAKT har vi i vesentlig grad tilført kompetanse på dette i Norge. Vi har bidratt til å øke kompetansen i implementeringsforskning, gjennom en rekke metodiske tilnærminger. Basert på erfaringen med IMPAKT har vi tatt med oss mange av erfaringene inn i utdanning. Vi har re-designet emnene i implementering på mastergradsprogrammet i kunnskapsbasert praksis. Implementeringsprosjektet i IMPAKT kunne vært gjennomført i hvilken som helst helsetjenestesetting. Vi valgte sykehjem, fordi dette var en etat som var villig til å jobbe tett og forpliktende sammen med forskere om en felles problemstilling. Sammen avdekket vi roller, behov og kontekstuelle faktorer som vi adresserte i en intervensjon bestående av kompetanseheving og fasilitering. Resultatet av en robust randomisert kontrollert studie, viste at implementeringsstrategien var svært effektiv. Nå er håpet at andre vil teste ut implementeringsstrategien i andre deler av helsetjenesten. Det er av betydning for kvaliteten i helsetjenesten at vi knekker koden for hvordan sikre at forskningsbasert kunnskap tas i bruk. Nå håper vi tilsvarende prosjekter kan gjennomføres andre steder.

A gap continues to exist between what is known and what is provided of professional health care services, commonly referred to as the knowledge-to-action gap. This project aims to address the knowledge-to-action gap from the perspectives of two different sectors - nursing homes and higher educational institutions. Addressing the gap has implications crossing both sectors. The nursing homes are under constant pressure to improve quality of care at the same time as it is expected to undertake additional tasks previously provided in specialist care. Staff in nursing homes have educational needs and are dependent upon an organisational context that acknowledges and supports these needs. Institutions of higher education have a societal mandate to educate candidates with life-long learning competencies to keep up with new knowledge. Little is known about levels of competencies among candidates. Regardless of what the students learn in school, what they experience in clinical practice weighs more. The knowledge-to-action gap exists across sectors and consequently both healthcare personnel and students in educational programs need to learn how to become effective knowledge consumers and to transfer this knowledge into practice. An important premise is to have a dual focus on the field of practice and education, which this project addresses. Involvement of end users as partners throughout the entire research process is clearly incorporated in this project as it is based on the concept of integrated knowledge translation. Participants as knowledge users will collaborate in refinement of research questions, selection of the methodology, data collection and tool development, selection of outcome measures, interpretation of findings, crafting of messages and dissemination of results. The project makes use of mixed methods to strengthen the quantitative and qualitative methodologies and increase the breadth and depth of our understanding.

Publications from Cristin

No publications found

Funding scheme:

HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester