Professional nursing practice holds each nurse accountable for incorporating research-based knowledge into critical thinking about patient care (Crane, 1995). Research utilization (RU) refers to the process of using research as the basis of practice innovations (Funk, Champagne, Wiese & Tornquist, 199Ia). Applying research to practice is at the core of the University of Iowa Hospitals and Clinics (UIHC) Research Utilization Residency Program for geriatric nurse practitioners and gerontological nurse specialists.
The University of Iowa Gerontological Nursing Interventions Research Center (GNIRC) was developed as a result of a grant from the National Institute of Nursing Research (Tripp -Reimer, 1997). The Research Development and Dissemination Core of the GNIRC provides opportunities for nurses to share research findings directly with health care providers and consumers. A Research Utilization Nursing Residency was implemented as part of the work of the Center University of Iowa Hospitals and Clinics, 1997),
The RU residency is an intensive, 80-hour, hands-on program for up to two applicants who have identified areas of RU for their practice organizations. Criteria for acceptance into the program and components provided for the resident by the Center are found in the Table. Designed for advanced practice nurses in roles serving geriatric populations, the RU residency program outcomes for residents include (University of Iowa Hospitals and Clinics, 1997):
* Learn the process of research utilization.
* Critique research and develop a research-based policy, procedure, or protocol in an area selected by the resident.
* Implement a new research-based initiative.
* Submit a manuscript to a specialty journal related to the residency.
For this author, a discharge planning coordinator, the RU residency program provided an opportunity to examine existing research to inform a project designed to improve continuity of care. The resulting experience affected not only the author's practice; it enhanced the overall professional practice of nursing at the author's home institution, as well as UIHC. This article relates how this residency experience provided support to apply scientific nursing knowledge to outcomes of a dischargeplanning program. The residency resources from both clinical and academic settings are discussed within the context of the author's experience.
RESIDENT CRfTERIA FOR ACCEPTANCE AND COMPONENTS PROVIDED TO THE RESIDENT BY THE UNIVERSITY OF IOWA GERONTOLOGICAL NURSING RESEARCH INTERVENTIONS CENTER
Submitting the residency plan was the initial step in the admission process. Having little prior exposure to research utilization, this applicant's learning objectives were to:
* Improve the RU skills through critiquing research articles on risk screens for complex discharge planning; determining if the research base was adequate to guide nursing practice in screening patients for complex discharge planning; and developing the evaluation component for a research utilization project.
* Gain confidence in the ability to conduct research.
* Increase exposure to the process of writing for publication.
The specific project goal was to identify a discharge planning screening tool that was brief, easy to administer and score, valid and reliable, and used data available at the time of admission. Such a screening tool would allow planned interventions such as patient and family teaching, coordination of informal support, and formal referral to community agencies to occur in a timely manner. The anticipated outcomes were early identification of patient needs and enhanced patient care planning. This would decrease length of stay, increase adherence to the medical treatment plan, and decrease recidivism.
To enhance the success of the residency project, UIHC required signed support from the applicant's immediate supervisor on the plan. In this manner, support of the project and commitment of resources were engendered by the home institution prior to beginning the program.
Each of the resi d encie s provides for on-site experience with an assigned mentor at one of two academic medical centers- UIHC or the Univer-sity of Colorado Hospital, As an incentive for committing to participate in such an intensive program, the residency pays the applicant's employing organization for 80 hours of release time. The mentor for this experience was Dr. Marita Titler, PhD, RN, FAAN, Director, Nursing Research and Quality Management at the UIHC. Kathleen Buckwalter, PhD, RN, FAAN, Associate Provost for the University of Iowa and Colleen Goode, PhD, RN, FAAN, Associate Vice Presi-dent, Patient Services, Univer-sity of Colorado Hospital, Denver, Colorado, also serve as residency mentors. The role of the mentor is to design on-site experiences to meet the resident's learning ob j ectives and assist in removing any impediments in the RU process.
Program Outcome No. 1: Learn the Process of Research Utilization
Collaboration between the University of Iowa Hospitals and Clinics and the University of Iowa College of Nursing brings together the clinical emphasis on patient care and the academic emphasis on generation of new knowledge (Titler, 1997). Thus, resources derived from both settings provide a bridge from research findings to practice application. The academic setting provides orientation and access to the health sciences library, computer, and audiovisual resources. The literature was easily obtainable on site, and sufficient time was built in for reading. For any nurse pursuing a RU project in a clinical setting, time to devote to research may be limited, research articles may not be readily accessible, and knowledgeable colleagues with whom to discuss the findings may be few. The resident's dedicated time at the UIHC is specifically designed to remove these barriers.
This resident met with and discussed the discharge planning screening tool concept with many practitioners. These included advanced practice nurses, those in UIHC's Clinical Outcomes and Resource Management Division, and those working in inpatient and outpatient geriatric practice settings with experience in using the Iowa RU model (Figure). The resident also met and discussed the project idea with faculty in the College of Nursing whose areas of expertise included outcomes measurement, screening, and geriatrics. Dialogue with experienced staff nurses enhanced this resident's understanding of the RU process. Clarification of the Iowa RU model and input regarding application of the model to the resident's specific clinical setting helped achieve individual residency objectives.
Discussions in both academic and clinical settings generated an atmosphere of comprehensive discovery. The process mutually benefited the resident and UIHC staff, as both explored the resident's project idea and literature review. A brief, valid and reliable, high-risk discharge planning screen was also of interest to the staff at UIHC. Thus, as part of the residency, current UIHC discharge planning screening methods and tools were examined, as well as related literature reviews on instrument testing, case management, and discharge planning.
Program Outcome No. 2: Critique Research and Develop a Research-based Policy, Procedure, or Protocol
Although articles on discharge planning screening are available, the majority of the screens are lengthy, and based on variables derived from local experience with no further testing beyond the setting of origin (Blaylock & Cason, 1992; Bone, Palmer, & Mamón, 1988; Kino & Dale, 1985; Rasmusen, 1984). The literature yielded little information regarding sensitive and specific screens for highrisk discharge planning. After critically reviewing the literature, the next step in the Iowa RU model is to determine whether there is enough scientific evidence on which to base practice. If there is an insufficient research base, research questions are generated and addressed through the conduct of research.
A research protocol was therefore developed, involving testing of the association between scores on a screening instrument developed to predict community dwelling elders' (65 years and older) re-admissions to hospitals (Holland et al., 1998) and the need for complex discharge planning. The program mentor and other UIHC nurses gave valuable feedback on the protocol. Advice on procuring external funding for the study was also received.
Program Outcome No. 3: Implement a New Researchbased Initiative (or Conduct Research)
Availability of doctorally prepared nurses for consultation and mentoring was key to approval of the resulting research protocol by the home institution's nursing research committee and institutional research review board. Although the research was performed at the resident's home institution, the UIHC site also gained through the staff's participation in the review of literature, understanding the framework for testing the screen in a discharge planning population, and continued dialogue as the study progressed.
The purpose of the study conducted as part of the RU residency was to assess the association between scores obtained by using the screen on all hospitalized adults and their need for complex discharge planning, length of stay, and disposition at discharge. A sample of 1,000 patients allowed for stratification of results by diagnosis and age. Subjects were invited to enroll within 24 hours of admission, and the screen was administered at the time of enrollment.
The institution's discharge planning coordinators reviewed each subject's need for complex discharge planning without knowledge of their screen score (Holland et al., 1998). Data collection for the study is completed and data analysis is currently underway. Although statistically the screen appears to differentiate between hospitalized patients who require complex discharge planning and patients who do not, preliminary analysis reveals that the lack of specificity negates the overall usefulness of the screen. Certain individual items on the screen show promise as significant predictors and will be further studied (Holland, Closson, Matt-Hensrud, & Severson, 2001).
Program Outcome No. 4. Submit a Manuscript to a Specialty Journal Related to the Residency
The conduct of research or the implementation of a research-based initiative is of littie value if the results are not disseminated (Titler, 1998). Support, advice, and mentoring continued throughout the study and were extended to the publishing process. This type of assistance in authoring a manuscript is highly valued by clinicians in non-academic settings. As of this date, the study has also been presented three times as part of locally sponsored seminars and twice nationally at interdisciplinary conferences on continuity of care.
IMPLICATIONS FOR NURSING PRACTICE
A gap continues between production of clinically relevant knowledge and its actual use in nursing practice (Carroll et al., 1997; Funk, Champagne, Wiese & Tornquist; 1991b; Goode, Lovett, Hayes, Sc Butcher, 1987; Graydon et al., 1993; Liehr & Weeks, 1995; Lindquist, Brauer, Lekander, & Foster, 1990). The UIHC Research Utilization Nursing Residency Program for Geriatric Nurse Practitioners or Gerontological Clinical Nurse Specialists served as a catalyst for scientific inquiry by providing resources, experiences, and role models that facilitated and enhanced the application of research processes to outcomes of discharge screening for geriatric patients.
This program benefited the resident nurse, the resident's home institution, staff of the University of Iowa Hospitals and Clinics, and geriatric nursing practice as a whole. It is a hallmark, prototypical, interinstitutional model for successful nursing research development and dissemination of nursing knowledge.
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RESIDENT CRfTERIA FOR ACCEPTANCE AND COMPONENTS PROVIDED TO THE RESIDENT BY THE UNIVERSITY OF IOWA GERONTOLOGICAL NURSING RESEARCH INTERVENTIONS CENTER