Week 5: Introduction to the Science of Translation
From your experience, what are the roadblocks to change? What keeps stale practices in place when fresh approaches are needed? And when innovations are introduced, what influences how they are viewed and accepted? What conditions can create subpar results or mediocre outcomes?
When considering how to initiate and lead an evidence-based practice quality improvement project, these are not academic questions. The success of an initiative can depend on understanding the variables involved in introducing a practice change. As science supports finding the evidence, other applications of theory provide insight into “the interrelationships and complex organizational dimensions that are relevant to the translation of research or new knowledge into practice” (White, Dudley-Brown, & Terhaar, 2019, p. 34)—and, importantly, routes to action.
This week you will explore translation frameworks and models, with the goal of identifying one that is the best fit for your Module 3 EBP QI project.
Learning Objectives
Students will:
Evaluate translation science frameworks and models for application to practice problems
Apply implementation science frameworks/models for evidence-based practice quality improvement projects
Learning Resources
Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)
Optional Resources (click to expand/reduce)
Discussion: Translation Models and Frameworks
Collaboration offers the advantage of other experiences and viewpoints to confirm or challenge your own. Discussions can do the same and for some topics, getting early feedback is especially valuable. This Discussion is one such example. As you dig into the science of translation and select a framework or model for your proposed EBP QI project, you can look to your class colleagues for a check on your choice and your reasoning.
Week 5: Introduction to the Science of Translation
To prepare:
Review the Week 5 Learning Resources. Pay particular attention to the featured frameworks/models, below, in the White, Dudley-Brown, and Terhaar text.
Identify the translation science framework or model that is most relevant to your practice problem from among the following three models and consider your reasoning:
Roger’s Diffusion of Innovations (pp. 36–39);
Knowledge-to-Action (pp. 42–45);
Theory of Reasoned Action (pp. 66–67).
Assess your understanding of “translation science” and how you would explain it in the context of evidence-based practice and quality improvement.
**Selected Framework: Knowledge-to-Action**
**Reasoning:**
For my proposed Evidence-Based Practice (EBP) Quality Improvement (QI) project, I believe the Knowledge-to-Action framework is the most relevant. My project aims to implement evidence-based guidelines for improving medication adherence in elderly patients with chronic conditions in a primary care setting. The Knowledge-to-Action framework emphasizes the dynamic process of moving knowledge into action, which aligns with the goals of my project.
**Understanding of Translation Science:**
Translation science involves the systematic process of translating scientific discoveries into real-world applications to improve healthcare outcomes. In the context of evidence-based practice and quality improvement, translation science focuses on bridging the gap between research evidence and clinical practice. It encompasses the dissemination, implementation, and sustainability of evidence-based interventions to enhance patient care and healthcare delivery.
**Explanation in Context:**
In the context of my EBP QI project, translation science would involve translating research findings on effective medication adherence interventions into actionable strategies within the primary care setting. This includes disseminating evidence-based guidelines to healthcare providers, implementing tailored interventions to improve medication adherence, and continuously evaluating and adapting the interventions based on outcomes and feedback. The Knowledge-to-Action framework provides a structured approach to facilitate this translation process, guiding the steps from knowledge creation to application in practice, ultimately leading to improved patient outcomes.
By utilizing the Knowledge-to-Action framework, I can systematically address the key components of translation science, including knowledge creation, synthesis, dissemination, application, and evaluation, thereby maximizing the impact of my EBP QI project on enhancing medication adherence and quality of care for elderly patients with chronic conditions.
With these thoughts in mind …
By Day 3 of Week 5
Post an explanation of the translation science framework or model that you selected and explain why it is most relevant to your practice problem. Be specific and provide examples.
The Knowledge-to-Action (KTA) framework is particularly relevant to my practice problem of improving medication adherence in elderly patients with chronic conditions in a primary care setting. The KTA framework, developed by Graham and colleagues, provides a comprehensive approach to bridging the gap between knowledge creation and application in healthcare practice.
Here’s why the KTA framework is the most suitable for my practice problem:
**Knowledge Creation:** In the first phase of the KTA framework, knowledge creation involves synthesizing evidence from research studies, clinical guidelines, and best practices related to medication adherence interventions. For my project, this could include reviewing systematic reviews and meta-analyses on effective adherence strategies, as well as examining guidelines from organizations like the American Geriatrics Society.
**Knowledge Synthesis:** The next step involves synthesizing the knowledge into actionable messages or guidelines that are relevant to the target population and setting. For instance, based on the evidence, I may identify key interventions such as medication reminders, simplification of medication regimens, and patient education materials tailored to elderly patients with chronic conditions.
**Knowledge Tools/Resources:** In this phase, the synthesized knowledge is transformed into tools and resources that can facilitate its application in practice. For example, I might develop educational materials for both healthcare providers and patients, including brochures, posters, and decision aids, to promote understanding of the importance of medication adherence and strategies for improving it.
**Knowledge Products:** These tools and resources are then disseminated to relevant stakeholders, including healthcare providers, patients, and administrators, through various channels such as workshops, presentations, and electronic health record systems. For instance, I could conduct training sessions for primary care providers on implementing evidence-based medication adherence interventions during patient visits.
**Knowledge Application:** The implementation phase involves putting the synthesized knowledge into action in real-world practice settings. For my project, this could involve integrating medication adherence assessment and intervention protocols into routine primary care workflows, such as medication reconciliation processes and chronic disease management visits.
**Monitoring/Evaluation:** Finally, ongoing monitoring and evaluation are essential to assess the effectiveness and sustainability of the implemented interventions. This involves collecting data on medication adherence rates, patient outcomes (e.g., hospitalizations, disease exacerbations), and healthcare utilization over time. Regular feedback loops allow for continuous improvement and adjustment of strategies based on emerging evidence and stakeholder feedback.
In summary, the Knowledge-to-Action framework provides a structured approach to translating evidence into practice, which is crucial for addressing the complex issue of medication adherence in elderly patients with chronic conditions. By systematically applying the steps outlined in the KTA framework, I can develop, implement, and evaluate evidence-based interventions that have the potential to improve medication adherence and ultimately enhance the quality of care for this vulnerable population.
Read a selection of your colleagues’ posts.
By Day 6 of Week 5
Respond to at least two colleagues on 2 different days, with preference to colleagues who selected different translation science frameworks or models from the one you chose. Recommend another framework/model they might consider and/or clarify their explanation of translation science. Cite sources to support your posts.
**Response to Colleague 1:**
I appreciate your thorough explanation of why you chose the Knowledge-to-Action (KTA) framework for your EBP QI project. It seems well-suited to your goal of improving medication adherence in elderly patients with chronic conditions. However, I would like to offer an alternative framework that you might consider complementing the KTA framework: Roger’s Diffusion of Innovations.
Roger’s Diffusion of Innovations framework focuses on the process by which new ideas, technologies, or interventions spread through a population over time. It emphasizes factors influencing the adoption and diffusion of innovations, such as the characteristics of the innovation, communication channels, social networks, and the adopter’s characteristics.
In the context of your project, using Roger’s framework could help you understand the factors influencing the adoption of medication adherence interventions among primary care providers and patients. For example, you could assess the relative advantage of different adherence strategies (e.g., medication reminders vs. simplified regimens), the compatibility of these strategies with existing workflows and patient preferences, and the role of opinion leaders or champions in promoting their adoption.
By considering both the KTA framework and Roger’s Diffusion of Innovations framework, you can gain a comprehensive understanding of how to effectively translate evidence-based medication adherence interventions into practice.
*Source: Rogers, E. M. (2003). Diffusion of Innovations (5th ed.). Free Press.*
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**Response to Colleague 2:**
Your choice of the Knowledge-to-Action (KTA) framework for your EBP QI project on improving medication adherence in elderly patients with chronic conditions is well-reasoned and appropriate. The KTA framework indeed provides a structured approach to bridging the gap between knowledge creation and application in healthcare practice.
However, I would like to clarify one aspect of your explanation of translation science. You mentioned that translation science involves the systematic process of translating scientific discoveries into real-world applications to improve healthcare outcomes. While this is certainly a part of translation science, it’s essential to note that translation science encompasses a broader scope.
Translation science also includes the dissemination, implementation, and sustainability of evidence-based interventions, as well as the study of factors influencing the uptake and impact of these interventions in real-world settings. It encompasses both the process of moving evidence into practice (T1 translation) and the process of moving practice-based evidence into broader practice and policy (T2 translation).
By understanding this broader perspective of translation science, you can more effectively navigate the complexities of implementing evidence-based practices and driving quality improvement initiatives in healthcare settings.
*Source: National Center for Advancing Translational Sciences (NCATS). (n.d.). What is Translational Science?*
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 5 Discussion Rubric
Week 5: Introduction to the Science of Translation
Post by Day 3 of Week 5 and Respond by Day 6 of Week 5
To Participate in this Discussion:
Week 5 Discussion
Module 3 Assignment: Exploring EBP Quality Improvement
Continue to develop the Module 3 Assignment you began in Week 4. This week, identify or confirm the translation science framework or model you would use to implement an EBP Quality Improvement project to address a hypothetical practice problem.
Be aware that you are not limited to the three frameworks/models you examined for the Week 5 Discussion. Select the translation science framework/model that is the best fit for your practice problem and be prepared to explain your reasoning.**Title: Implementing Evidence-Based Practices to Improve Medication Adherence in Elderly Patients with Chronic Conditions: A Translation Science Approach**
**Introduction:**
Improving medication adherence in elderly patients with chronic conditions is a critical aspect of healthcare delivery, as non-adherence can lead to adverse health outcomes and increased healthcare costs. This Module 3 Assignment aims to further develop the EBP Quality Improvement project initiated in Week 4 by identifying the most suitable translation science framework/model for implementation.
**Translation Science Framework:**
After careful consideration, the Consolidated Framework for Implementation Research (CFIR) is selected as the most appropriate translation science framework for this project. CFIR provides a comprehensive and flexible approach to understanding the multi-faceted factors influencing the implementation of evidence-based practices in healthcare settings.
**Reasoning:**
**Complexity of the Practice Problem:** Medication adherence in elderly patients with chronic conditions is a complex issue influenced by various factors, including patient characteristics, healthcare provider behaviors, organizational context, and intervention characteristics. CFIR’s emphasis on the interplay of these factors aligns well with the multifaceted nature of the practice problem.
**Comprehensive Assessment:** CFIR offers a systematic framework for assessing the contextual factors that may facilitate or impede the implementation of medication adherence interventions. By considering domains such as intervention characteristics, outer setting, inner setting, characteristics of individuals, and the process of implementation, CFIR enables a comprehensive analysis of the implementation context.
**Flexibility and Adaptability:** CFIR allows for flexibility in tailoring the implementation strategies to fit the unique needs and contexts of different healthcare settings. It recognizes that interventions may need to be adapted to local circumstances to achieve successful implementation, which is essential given the variability in primary care practices and patient populations.
**Facilitation of Stakeholder Engagement:** CFIR emphasizes the importance of engaging stakeholders throughout the implementation process. By involving key stakeholders such as healthcare providers, patients, caregivers, and administrators in assessing barriers and facilitators to medication adherence, CFIR facilitates collaborative decision-making and promotes buy-in for the proposed interventions.
**Conclusion:**
The Consolidated Framework for Implementation Research (CFIR) is the chosen translation science framework for implementing evidence-based practices to improve medication adherence in elderly patients with chronic conditions. Its comprehensive approach, flexibility, and emphasis on stakeholder engagement make it well-suited to address the complexities of the practice problem and facilitate successful implementation in diverse healthcare settings.
**References:**
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. *Implementation Science, 4*(1), 50.
There is no submission this week.
Photo Credit: [Steve Hix/Fuse]/[None]/Getty Images
Submit your Assignment by Day 7 of Week 6.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.
What’s Coming Up in Week 6?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week you will complete your Module 3 Assignment, which requires a written paper describing the three sites you are exploring for a future EBP QI project and the PowerPoint presentation you would make to stakeholders at one of those sites. Although you will not make your presentation as part of this course, your work now can support a future presentation. Approach your preparation with the seriousness that a presentation to a Quality Improvement office or executive administrators, as well as senior nursing staff, would demand.
There is no discussion so that you can devote the week to completing the Assignment. Refer to the Module 3 Assignment Rubric for grading expectations.
Next Week
Week 5: Introduction to the Science of Translation
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