Nursing, research, knowledge and practice


knowledgeI had a really interesting Twitter conversation yesterday.  It was about research and evidence, stemming from a conversation where I said I would be unlikely to attend a research conference. I suspect that I am now also going to appear very stupid although I am not sure I am – I know I can synthesize information and indeed reach robust conclusions from information presented to me – but I often find understanding research papers challenging.

I find the way many research papers are written impenetrable. They use language where I have to look up the research terminology to enable me to understand. And I just don’t get it – surely passing on the knowledge is the single most important thing that you have to do? Research that adds little value as its meaning is lost in complex and obfuscated language is also adding less value than a well written and clear piece of research?  That is, of course, assuming the research is well constructed, undertaken, analysed and presented!

I know I can understand the evidence, after all I scored well at University having done a systematic review and I actually enjoyed my dissertation once I got going but some of the research papers just do not hold my attention if I have to work too hard to find and evaluate the meaning.
There are materials around that can help – I came across this blog by Calvin Moorley, that is clearly written and helpful but understanding these things isn’t necessarily the answer. This assumes research papers are well articulated and clear – but often in my experience they are not!

magazinesAlmost everything we do in nursing should be based on knowledge – that is the critical space between experience and applied evidence. The speed at which new evidence and materials comes available is also a challenge – how can I possibly keep up to date in all the areas of nursing practice that I am interested in, and synthesise it with my existing knowledge?

When I started writing this blog I went to explore some evidence to see what I could find to illustrate points but I found some good stuff, stuff I didn’t know, and I could understand, but I would never have found had I not been writing this blog! It’s impossible to be on top of the whole evidence base and live and work! It would be a full-time job 😦

So what does it all mean? Well, I think this is now about nursing knowledge management; an area of practice that we discuss little in nursing but I believe is increasing in importance. Benner describes the development of skills through novice to expert but in 2014 the ability to practice at expert level taking account of new emerging evidence is challenging.  We need knowledge workers to help us find meaning from new emerging areas of research.

There are some bright spots on the horizon. The recent find of the Evidently Cochrane blog site has encouraged and motivated me to be more engaged with research. The knowledge management part is taken care of, studies assessed and evaluated on my behalf in order that I can assimilate the research evidence quickly and develop knowledge in my practice. For example, I have always been cynical about risk assessment, always feeling that perhaps it wasn’t quite doing what it intended to do, and up pops my friends at Cochrane bringing my attention to this work that was debated on a great @wenurses chat recently – you can see the chat here. Another example of taking evidence and using a twitter chat to increase nursing knowledge.  I also value highly the KCL Policy+ that is published regularly, aimed at current areas of policy focus for nursing.

So what does this all mean? It means that researchers need to write research findings in an accessible way that can be quickly turned into knowledge by practitioners and we need more knowledge brokers like the brilliant Cochrane people who work hard to help everyone access new evidence. Writing in simple accessible language is not dumbing down, in fact I think it’s much harder to write clearly in non-technical jargon so perhaps that’s the real reason research papers are often difficult to understand – writing simply and well is much too hard! The Cochrane site aims to translate evidence in to meaningful understanding for everyone and thank goodness I found it!knowledge 2

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19 thoughts on “Nursing, research, knowledge and practice

  1. This is a problem all academic disciplines, driven to a degree by the peer review via journal culture. However, more than ever before it is possible to assimilate the key information locked inside academic papers thanks to those using social media to digest and re-present them. Although caveats surround taking one person’s analysis, it is often the subsequent debate that serves to crystallize the important issues.
    Great blog as always Annie.

  2. Thanks. My area of work often takes me into either technical evidence or social science too and then it gets even harder to understand #gulp
    And I agree, following eminent people on twitter has helped me find things that are ‘good quality’ more easily and quickly. social media at its best!

  3. I think one of the other problems (quite apart from language issues) is that those of us researching within academia are under a lot of pressure to submit to ‘quality’ academic journals with a high impact factor, in order to be considered for the REF (Research Excellence Framework), but what academia classes as ‘impact’ is, in my view, different from impact in practice. These journals are also, by and large, inaccessible to practitioners who are not also current students with access to a university library. I am a health visitor (although not currently researching in that area), and if I was doing HV-related research my own view is that the publication where it would reach the largest number of practitioners and thus likely have the biggest impact in terms of influencing practice would be ‘Community Practitioner’ (the monthly peer-reviewed journal of the CPHVA which is sent out each month to all CPHVA members). However, because Community Practitioner does not have an impact factor, any article therein wouldn’t count towards the REF, and so I would not be encouraged to publish there. It is why I am seriously considering my next step, and am considering looking at research within an NHS rather than academic setting.

  4. I did know that, of course, but I still don’t feel that it makes anything any better as, if evidence rarely manifests itself in practice, or if it takes a long time to filter through, it is less use overall to patients and isn’t that what matters? I know that you think it is so am asking a rhetorical question really.
    Wrote the blog as I am so fed up of preaching evidence based practice to young professionals only to find it less than accessible 😦

  5. Great blot Annie. Honest and open as always. I absolutely agree that we need to ensure that research articles, presentations and protocols are accessible but this isn’t just the individual researcher’s/author’s responsibility. Research needs to be embedded in our education and in our practice so that we become familiar with the principles and terminology at an early stage rather than them being shrouded in mystery only to be hurled at us when we least expect it and are not in the best position to engage. I don’t think you’re a numpty at all, any more than you would think I was if I started to ask what are probably ridiculous questions about informatics, though I probably find that language similarly challenging. Many of the clinical staff I spoke to during my doctoral research claimed that they did not have the intellectual capacity to ‘do’ or engage with research, but also admitted to an element of ‘fear’, (of the unknown) which I believe is a greater barrier, and one that I believe can be overcome by greater integration of research in education and in the clinical environment. Other factors of course are time and resources but that’s a whole other story 🙂

  6. Of course education plays a key role and I am a big advocate of graduate profession – however I can show you some shocking papers. I do not agree that it is not the authors responsibility! If NICE can write for patients so should we!

  7. Thanks Annie – I’d better start updating the blog again! Could be just the prompt I need! (am on maternity leave so at least I have a good excuse for distraction this time!).

    Some really fascinating comments here! Although I think authors do have the prime responsibility for communicating their research, there is also the academic culture to negotiate – I am not convinced that if I wrote something in language that was suitable for (say) Nursing Times, it would not need considerable rewriting with additional ‘academese’ in order to appear in many academic journals. Sometimes I think academia needs to remove its metaphorical head from its metaphorical nether regions and think about its wider purpose – at the moment it is often just a talking shop for those in the academy, and forgets about the fact that research in health care needs to be applied by those who are in clinical practice and policy making.

    I do though also think that we need to rethink how we present research/evidence based practice in practitioner education – when I was training it was all very dry and dull, and I have worked in clinical areas where as soon as people heard I was into research it was all rolled eyes and “booooorrrriiiinnnggg!”, like it was an optional extra they didn’t need to worry about; if it can be shown *why* it’s so important and relevant early on in a way that is engaging then maybe that will prompt a bit more interest from practitioners and policy makers. And at that point I totally agree with you, research does need to be presented in an accessible and engaging manner. I think we all have work to do here.

  8. Great points from everyone. I agree it’s a problem. Largely to do with the differences between writing for communication and engagement and writing for academic recognition.

    For researchers, all the benefit comes from publication in academic journals – kudos, status, promotion and increased salary. Academic journals tend to be aimed at other academics and use the language expected by that group. Jackie makes the points very well.

    As a senior manager in higher education I expect research staff to be publishing in those journals that will bring the most benefit to the Faculty – academic benefit in terms of REF recognition, reputation, and finance. This means journals that may not necessarily be read by the average practitioner. And I agree that those journals are often not easy to read if you are not steeped in research terminology and methods. And most researchers will also want to publish in those journals – that’s how they build their careers.

    What I don’t understand is why we have never found the space for a user friendly ‘digest’ of recent research. Something that takes the original research and interprets it for those who want to know what it means and if it should be widely applicable, or if it’s just ‘interesting’. Why don’t we have that?

    When I was doing a lot if writing, I had to make a conscious choice – did I use my postgrad dissertation to publish two or three papers in academic journals or did I do something with greater reach? At that time I had no ambitions to be a researcher and no intention of building a career in academia. What I did want to do was influence the profession and reach as many nurses as possible. So I published a series of articles in the popular nursing press and a book. Twenty years later those ‘informal’ publications are still remembered and sometimes still used by practitioners, but they have counted for nothing in academic terms. It’s the way things are in academia, and I made a good decision.

    It is interesting though, how these things are polarised and there is no middle ground – academics who dismiss the accessible popular professional press and practitioners who dismiss the inaccessible academic press. It’s so ‘nursey’ isn’t it? Why can’t those who publish in the research journals also publish something tailored for the popular press? Why would anyone expect the average practitioner to be familiar with all the original research papers? On the other hand, why wouldn’t any professional want to engage with the evidence of their profession? Even if it makes their head hurt? We are, as usual, missing some pragmatic middle way.

    Who knows where a conversation like this might lead?

  9. Oh no, I certainly don’t think it’s NOT the author’s responsibility – there’s no point in writing – even for the author – if no one understands. I just don’t think it’s one sided and education, right from the start, has a big part to play. Believe me, I’ve seen plenty of papers I can’t make head or tail of either – obfuscation helps no one.

  10. Great comment June. But you have to start where the research is surely? I understand ( but on principle disagree) with the academic position. I would go so far as saying we should not fund research unless there is a commitment to support transfer into practice if relevant.
    Whilst i play down my understanding for purpose for my blog i do try to engage with some of the most difficult materials as most of my work is additionally cross discipline which adds complexity.
    My point about knowledge management is exactly what you describe – the whole profession, collectively, need to respond to this gap and knowledge workers are the ones who can help.
    But we have to admit this is the true position 🙂
    My blog was designed to provoke exactly these debates – thank you 🙂

  11. Thanks. The academic position is the same for every subject area, whether it’s medicine or medieval history. If nursing didn’t conform then that would be a problem in itself.

    As you say, it’s the translation into practice that is sometimes difficult, quite often as a result of the research findings not being promoted in practice. You could say that researchers do their bit by publishing their findings and your point about funding is usually covered by that. Funders expect publication. It’s the notion of impact that is troublesome as it is interpreted entirely differently by service and academe.

    I like your idea of knowledge brokers, and in some universities their are strides towards this. E.g in my faculty we have a post for the public understanding of science and I have long been an advocate of something similar for nursing. However, this wouldn’t deal with our ‘accessibility’ problem for the profession and it’s engagement with formal research findings.

    Academia needs to accept the need for ‘accessible’ publication, service needs to accept the responsibility for implementation. Both need to find a way of identifying what’s really useful. This is worth continuing the conversation.

  12. A single article reporting the results of research should not really be used to change clinical practice. That is why NICE, Cochran & SIGN exist – to appraise all the evidence (published & unpublished) & do the complex meta-analysis etc. Then they should write, in plain english for us all to read, the summary & recommendations that lead to changes in practice.
    There are books available, such as the new edition of ‘How to Read a Paper’ By Trish Greenhalgh that should be compulsory reading for all clinicians & managers. Dont forget ‘Bad Science’ as well. Both are easy to read.
    Remember also that many clinicians use langauage that is unfamiliar (and scary) to patients & carers. But I don’t have to tell you that.

  13. Great blog and great discussion. I think all research should be written up as clearly as possible whoever the intended audience. Jargon always gets in the way of clear communication I think. Any thoughts people have about how Cochrane reviews can be made more readable and accessible gratefully received – we are ALWAYS looking for how to do this.

    In terms of impact, I don’t agree that academics are looking for a different kind of impact – impact on practice and patients is EXACTLY what counts for the REF – the problem is it is so difficult to capture, measure and report in a valid, reliable way. The NIHR which funds most of the nursing relevant research in the UK absolutely expects that our research finds its way into practice and we have to do all we can to increase the chance that this will happen. Working closely with NHS partners from research idea to implementation of the findings is a key way to make this happen (remove the division between people who DO research and people who USE it).

    Re. the user friendly research digest idea – this is crucial I think. We started the journal Evidence Based Nursing back in 1996 with exactly this in mind. Teams of researchers at McMaster University in Canada scanned the journals to find the highest quality research with a message for nurses, then re-wrote a user friendly, accessible summary of the research and a clinician wrote a commentary of it. Sometimes the summary involved re-presenting the results in a more intuitive way and calculating statistics that were more clinically meaningful. BMJ Publications then moved the contract for the journal AWAY from McMaster and last time I looked at the EBN it seemed quite different with less obvious quality filtering on the research and less emphasis on representing the research in a user-friendly format.

    A great resource from McMaster however is the MORE Rating service: http://hiru.mcmaster.ca/more_new/index.html and the related PLUS service http://plus.mcmaster.ca/np/Default.aspx

    You can sign up for free and get emailed summaries of the top quality research/reviews for nursing. You can also search the resource online. Excellent!

  14. its a great blog Annie and I agree that in searching for practical truths the research community can become too attached to the purity of the methods etc.

    For me its about the decision that I / we need to make and the rigour of the research needed and the uncertainty around this. Its as if we are trying to pace out a football pitch for a quick kick about but measuring it to the nearest .001cm! I see many people either falsely passing over nonrobust methodology and making decisions and others completely inhibited to make a decision because of what they believe to be not pure methodology.

    I agree with others on the blog that the skills of being able to critically appraise a paper and know where the weaknesses are then the practical people can get on and use this knowledge in practice understanding the uncertainty.

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