Currently, healthcare services provided to people of all ages and at all points on the health-illness continuum are fragmented, expensive, and rarely grounded in evidence. Nurses have been at the forefront in addressing the complex health and social challenges that increasingly diverse individuals, families, and communities confront by developing and rigorously testing innovative solutions. A substantial body of evidence has demonstrated the positive contributions of nurses as leaders and core members of healthcare teams in assuring high value healthcare. However, wide-scale use of these evidence-based solutions has been substantially limited by well recognized barriers. Key among these is the ability to effectively and efficiently translate research findings into practice. The amazing multidisciplinary team that I lead has been attempting to respond to this barrier for more than a decade. Our team’s experience reinforces many of the lessons embedded in this series of papers.
To set the stage for the key “takeaways” captured in these papers, permit me to provide some background on our team’s journey. Over the course of more than a decade, findings from multiple National Institute of Nursing Research funded randomized controlled trials conducted by our team had consistently demonstrated the capacity of the nurse-led, team-based, Transitional Care Model (TCM) to improve the care and outcomes of chronically ill older adults while reducing their healthcare costs (Hirschman, 2015; Naylor et al., 2013). These findings were published in highly respected, peer reviewed journals and received considerable media attention. The Coalition for Evidence-Based Policy identified the TCM as a ‘top-tiered’ evidence-based approach that, if scaled, could have a positive impact on the health and well-being of chronically ill older adults across the United States, while assuring wiser use of societal resources (Coalition for Evidence Based Policy, 2010). Given increased evidence of the human and economic toll associated with poor management of this population’s complex care needs, our team was surprised (shocked!) to learn that very few organizations were testing the implementation of the TCM in their systems or using the TCM evidence as basis to redesign their healthcare systems.
Motivated by the desire to have a timely, positive impact on this complex population and their family caregivers, our team launched a major effort to translate this body of research into practice. We were fortunate to engage leaders of health systems, payers, and foundations to join us in blazing this trail. What we lacked was a blue print to guide our path and, as a result, our earlier efforts were characterized by a series of spectacular failures. We had little understanding about what it took to test the implementation of research-based interventions in “real world” systems.
Over time, we designed and tested a set of tools essential for effective translation such as webinars to prepare teams to deliver the TCM. Only then were we positioned to conduct rigorous translational studies. Fortunately, our efforts increased our understanding of implementation strategies that improved uptake and, ultimately, we demonstrated that the clinical and economic outcomes observed in NIH trials could be replicated. Currently, we are partnering with health systems committed to enhance the care and outcomes of older adults living with complex health and social needs in their communities through research translation. Without question, this phase of our journey has been the most gratifying but such efforts must be accelerated if we are to maximize on the potential of nurses and other health team members to respond to people’s healthcare needs.
In “Translation Research in Practice: An Introduction,” Marita Titler reminds us that shared understanding of language is essential to advance translational science (also known as implementation science). Importantly, she distinguishes between the science of translation and the use of evidence-based practices (EBPs). The former, Titler notes, is research focused on rigorous testing of implementation strategies in “real world settings;” the aim of translational research is to identify which strategies are more effective in promoting uptake and use of evidence among diverse patient groups in various contexts. A related but distinct concept, EBPs, refers to application of proven interventions in such settings, often guided by expert clinicians. In addition to clarifying core terms, Titler provides a comprehensive review of key theories, models and strategies associated with translational science. To maximize on advances in the emerging field of translational science, scientists require common language and frameworks to effectively collaborate, build upon each other’s work, address gaps in knowledge, and communicate findings for use by clinical partners.
Deborah Trautman and colleagues offer valuable insights on the importance of partnership in translational research, emphasizing the potential for PhD and DNP prepared nurses to contribute their unique gifts in advancing this field. The importance of teams in accelerating knowledge development is well established. In, “Advancing Scholarship through Translational Research: The Role of PhD and DNP Prepared Nurses,” the authors make the case for emerging teams to include nurses with both types of preparation. Both groups of nurses are committed to improving the health and healthcare of the populations of interest. Each group has a unique but complimentary approach to scholarship, with PhD prepared nurses focusing on the discovery of new knowledge and DNP prepared nurses emphasizing application of this knowledge in practice environments. The authors suggest multiple strategies to maximize on this important, collaborative relationship.
Critical to developing and sustaining the field of translational science is building the capacity of nurse scientists to conduct and lead such programs of research. In “Connecting Translational Nurse Scientists Across the Nation—The Nurse Scientist Translational Research Group (NS-TRIG),” Elizabeth Gross Cohn and colleagues describe the evolution of a multi-year effort to enhance the contributions of nurse scientists to this field. Initially established to support nurse scientists who are part of the National Institutes of Health funded Clinical and Translational Science Awards program, the NS-TRIG has expanded to include other nurse investigators committed to translational research. Through a series of carefully constructed learning opportunities including monthly webinars that employ a unique round-robin discussion and special focus workgroups, over 350 members benefit from access to a network of the leading nurse scientists in translational research. Multiple accomplishments, including high-impact papers and national presentations, have resulted from the efforts of this workgroup. The NS-TRIG is an exemplar for capacity building, one that is positioning nurse scientists to assume leadership roles in the evolution of translational science.
“Evidence for Psychiatric and Mental Health Nursing: An Update (2011 through 2015),” describes findings from a review of intervention studies published in psychiatric nursing journals during a recent five-year period, compared to similar earlier reviews. Addressing the mental health challenges of populations both overall and within distinct subgroups is a significant societal priority. Nurses play a key role in the design, testing, and implementation of these important solutions. When compared to prior years, the review conducted by Abir Bekhet and his colleagues reveals an overall increase in the number of mental health intervention studies, with a higher proportion focused on multidimensional solutions. Notably, this review also identifies a greater focus on interventions targeting mental health professionals. To position this important work for research translation, a robust synthesis of the evidence from the quantitative and qualitative studies uncovered in this review, complemented by findings from reported studies in interdisciplinary journals, is essential.
As noted earlier, several key lessons emerge from these articles that could accelerate future developments in the field of translational science and advance healthcare solutions in which nurses play central roles. First, a robust body of evidence targeting a major societal problem should serve as the basis for investing in translational research. Second, translational science efforts should be grounded in a shared understanding of the aims and the appropriate methods to achieve these aims. Third, developing this emerging field will require capacity building, partnerships with all stakeholders, and nursing leaders committed to a learning health system. Finally, and from my perspective most important, an unwavering focus on the ultimate goal of translational science, improving the health and healthcare of the people who are counting on us, is essential. The journal editors invite you to share your response to this OJIN topic addressing Translational Research either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic which has been initiated by these introductory articles.
Mary D. Naylor, PhD, RN, FAAN
Coalition for Evidence-Based Policy. (2010). Top tier evidence initiative: Evidence summary for the Transitional Care Model. Available from: http://toptierevidence.org/wp-content/uploads/2013/12/TransitionalCareModelTT.pdf
Hirschman K.B., Shaid, E., McCauley, K., Pauly, M.V., & Naylor, M.D. (2015). Continuity of care: The transitional care model. OJIN: The Online Journal of Issues in Nursing, 20(3), Manuscript 1. doi:10.3912/OJIN.Vol20No03Man01
Naylor M.D., Bowles, K.H., McCauley, K.M., Maislin, G., Pauly, M.V., & Krakauer, R. (2013). High-value transitional care: Translation of research into practice. Journal of Evaluation in Clinical Practice, 19(5). 727-733. doi:10.1111/j.1365-2753.2011.01659.x.