- Email: [email protected]
Bridging the Research-to-Practice Gap: The Role of the Nurse Scientist
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Seminars in Oncology Nursing, Vol 31, No 4 (November), 2015: pp 298-305
BRIDGING THE RESEARCH-TO-PRACTICE GAP: THE ROLE OF THE NURSE SCIENTIST JEANNINE M. BRANT OBJECTIVES: To describe the emerging role of the nurse scientist in health care organizations. Historical perspectives of the role are explored along with the roles of the nurse scientist, facilitators, barriers, and future implications.
DATA SOURCES: Relevant literature on evidence-based practice and research in health care organizations; nurse scientist role; interview with University of Colorado nurse scientist.
CONCLUSION: The nurse scientist role is integral for expanding evidence-based decisions and nursing research. A research mentor is considered the most important facilitator for a successful nursing research program. IMPLICATIONS
FOR
NURSING PRACTICE: Organizations should consider
including the nurse scientist role to facilitate evidence-based practice and expand opportunities for nursing research.
KEY WORDS: Nurse scientist, evidence-based practice, research, magnet
Jeannine M. Brant, PhD, APRN, AOCNÒ, FAAN: Oncology Clinical Nurse Specialist and Nurse Scientist, Billings Clinic, Billings, MT; Assistant Affiliate Professor, Montana State University College of Nursing, Bozeman, MT. Address correspondence to Jeannine M. Brant, PhD, APRN, AOCNÒ, FAAN: Oncology Clinical Nurse Specialist and Nurse Scientist, Billings Clinic, 2800 10th Avenue North, Billings, MT 59101. e-mail: [email protected] Ó 2015 Elsevier Inc. All rights reserved. 0749-2081/3104-$36.00/0. http://dx.doi.org/10.1016/j.soncn.2015.08.006
H
ealth care organizations across the United States are striving to bridge the gap between research and evidence-based practice (EBP), with hopes to improve patient outcomes, further quality of care, and lower health care expenditures. Nurses are the largest health care work force and are responsible for around-the-clock nursing care in the hospital. They have an increasing role in ambulatory settings, especially in oncology clinics and inpatient units where nurses deliver chemotherapy, provide patient education, and provide supportive care throughout the cancer continuum. The Institute of Medicine, whose aim is to achieve 90% of clinical decisions to be
BRIDGING THE RESEARCH-TO-PRACTICE GAP
evidence-based by 2020, recognizes the leadership of nurses to bridge this research and EBP chasm.1 The organizational nurse scientist is an evolving role, designed to bridge the gap between research and EBP. The nurse scientist can be especially beneficial in the oncology setting where evidence evolves rapidly; therefore a need exists to quickly translate research into practice. This article describes the background of the nurse scientist role, the functional components of the role, barriers and facilitators of the role, and strategies for role integration and stimulation of research and EBP within an organization. Successful implementation of the role is highlighted through exemplary models.
NURSE SCIENTIST ROLE: HISTORICAL ASPECTS EBP and research have provided the foundation of nursing since its inception. Florence Nightingale is considered the first nurse scientist because she explored environmental factors that contributed to patient wellness, including ventilation, noise, light, cleanliness, and therapeutic communication.2 While nursing research evolved throughout the 20th century, nurse scientists were primarily employed in academia, conducting research in collaboration with health care organizations but employed outside of the health care setting. In many ways, the bridge between research and practice widened as nurse scientists moved further from the bedside. In the 1980s, nursing leaders began to recognize that nursing knowledge accrued over time at the bedside had gone uncharted and unstudied. A distinction between practical and theoretical knowledge was essential in moving nursing science forward. Dr. Patricia Benner published her work From Novice to Expert, and acknowledged the clinical expertise and practical knowledge of nurses that evolves over time.3 Both tapping into clinical expertise at the bedside to discover new knowledge and translating evidence into practice at the bedside provide a mechanism to close the research-to-practice gap. Ongoing interaction with clinically expert nurses at the bedside is a foundational role of the nurse scientist. The Magnet Program marks another progressive move toward the nurse scientist role. In 1983, the American Academy of Nursing Task Force on Nursing Practice in Hospitals identified hospital environments that promoted quality patient care
299
and had an innate ability to recruit and retain nurses. In 1994, the University of Washington in Seattle became the first Magnet-designated organization. Magnet’s recognition of nursing science quickly evolved through recognition of new knowledge, innovations and improvements, which are key components of the Magnet model.4 Within this model domain, EBP and research are integrated into both clinical and operational processes. This requires nurses to be educated about EBP and research to provide safe, quality care to patients. Nurses are also expected to generate new knowledge within the organization by conducting independent research. Innovations in patient care, nursing, and the practice environment are the hallmark of organizations receiving Magnet recognition. Establishing new ways of achieving high-quality, effective, and efficient care is the outcome of transformational leadership, empowering structures and processes, and exemplary professional practice in nursing.4 One study indicates that Magnet organizations report that the professional practice environment mediates the relationship between being ‘‘Magnet’’ and nurse-reported quality of care.5 Health care organizations around the globe are now examining creative approaches to increase nursing EBP and research at the bedside. Four models that exist include: 1) Collaboration and guidance from Academic Researchers, 2) Contracted nurse scientist, 3) Nurse scientist embedded within the organization, or 4) Shared model between the health care organization and the College of Nursing.6 The first two models involve collaborative relationships with nurse scientists employed outside of the organization. The embedded nurse scientist is employed solely by the organization and has the advantage of an ongoing presence in the organization. The fourth model includes nurse scientists who are employed part-time by the organization and part-time by the College of Nursing with presence noted in both the health care environment and the academic setting.
ROLES OF THE NURSE SCIENTIST The nurse scientist is engaged in an overabundance of roles within the organization and often
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represents professional nursing outside of the organization as well, at the College of Nursing and through community and professional organization activities. Overall, the nurse scientist, in collaboration with nursing leadership, is integral in shaping the culture of inquiry and research within the organization, which is imperative to bridge the gap between research and EBP.7 Overall, the culture of inquiry is one in which new ideas are highly valued and where research is used to support clinical decisions. Policies and procedures are evidence-based and are referenced according to the most recent studies from the literature. Nurses within a culture of inquiry should also have time to reflect on their practice, stay current in their fields of expertise, and share new knowledge on an ongoing basis that can be implemented into practice. Nursing Research Councils (NRCs) emerged as part of the Magnet initiative to promote EBP and research at the bedside. While not all organizations have NRCs, they operate through a nurse-led, selfgoverning structure that encourages nurses to have ownership for EBP and research within the organization. The NRC plays an integral role in creating a culture of inquiry within an organization, and the nurse scientist may facilitate the NRC or closely collaborate with this council. NRCs are instrumental in building research infrastructure by developing an EBP and research-focused mission statement, setting research goals for the organization, and adopting a model to guide research into practice.8 These activities promote the scientific integrity of nursing research in the clinical setting.9 Research translation models are also used to translate research into practice. Models including the Stetler,10 Roger’s Diffusion Model,11 and the Iowa Model12 are examples of EBP translation models. The starting point for any EBP integration is the clinical question. The PICO framework (Patient population, Intervention, Comparison, and Outcome) is often used to formulate research questions that are priority for the organization13 and then new evidence is appraised, projects are prioritized according to the organization, and implementation is piloted on a nursing unit. Implementation of new knowledge occurs throughout the organization as the final step. It is helpful for a member of the NRC to also be a member of the Institutional Review Board (IRB) so that regulatory standards can be communicated to nurses and the IRB member can be a liaison with the NRC. Mentorship is a primary role of the nurse scientist. The nurse scientist may be the only PhD
nurse in the organization, and thereby, should emulate professional nursing throughout the organization and identify nurses to mentor for EBP projects and research. Often, nurses will selfidentify themselves by attending NRC and may participate in other EBP activities. Encouraging these nurses to pursue EBP and research projects is essential, ensuring them mentorship through each step of the process.9 Additional roles for the nurse scientist include adjunct faculty for the local college of nursing, magnet team representative, cancer committee member, and principal investigator (Table 1). Maintaining a culture of inquiry and an environment where EBP and research is welcome and encouraged is no easy task. In essence, the nurse scientist often fulfills the role of ‘‘cheerleader’’ within the organization, reminding nurses of new evidence that exists and stimulating EBP and thoughtful research endeavors. Finding nurse champions to initiate and continue projects is challenging with the lack of time recognized as a major barrier. Building recognition into the EBP and research program through incentives or career development programs can make nurses feel validated for their efforts. Making research meaningful and fun can fuel interest as well. Some of the activities that can invigorate EBP and nursing research include nursing grand rounds presentations, unit-based practice council discussions, newsletter information and updates, science fairs featuring nurse-led research, and research symposiums that feature nationally recognized speakers. Participation in National Cancer Institute (NCI) National Clinical Trials Network offers another opportunity for the nurse scientist. Research bases, formerly called cooperative groups, are hubs that design and conduct NCIsponsored multisite studies for prevention, control, screening, post-treatment surveillance, and cancer care delivery research through the NCI Community Oncology Research Program.14 Nurse scientists have led study teams focusing on symptom management, quality of life, patient-reported outcomes, and care delivery systems. Nurses can work with these larger systems to access larger populations, collaborate with other sites to accrue patients more quickly, and make findings more generalizable.15 Cancer care delivery research is a newer addition to the NCI structure and supports a community-based research network to address cancer disparities
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TABLE 1. Roles of the Nurse Scientist Role
Description
Promote a culture of inquiry Nursing Research Council (NRC) chair/facilitator
Conduct nursing grand rounds on EBP and research Provide NRC leadership Mentor NRC chair and members Facilitate discussion to enhance scientific discussions Identify nurses who are interested in EBP and research Collaborate with local nursing faculty to advance nursing science Provide instruction at the college of nursing as needed Represent nursing science within the Magnet organization Identify projects that reflect new knowledge and innovation outcomes required by Magnet Facilitate abstract submission to promote dissemination Provide data for cancer care outcomes and report to cancer committee Maintain program of research Serve as a role model for other investigators Obtain grant funding for research conducted Facilitate abstract submission to Magnet and other professional organizations Encourage dissemination of EBP projects and research through podiums, poster presentations, and manuscripts
Mentor Adjunct faculty college of nursing Magnet team representative
Cancer committee member Principal investigator
Promote dissemination of findings
and translational research questions that are separate from the traditional pharmacologic clinical trials. Nurse scientists are well-suited to serve as principal investigators and leaders of many of these new initiatives.
FACILITATORS AND BARRIERS OF EBP AND RESEARCH Multiple facilitators and barriers for EBP and research exist throughout the country. A survey of 160 hospitals revealed that the number one facilitator was the presence of a research mentor, which is a primary role of the nurse scientist. Lack of a research mentor was also listed as the number one barrier.16 Other facilitators included having a higher nursing education level in the organization, along with a culture that supports nursing research. A research program established by a nursing research leader was also listed as a key strategy for success. Lack of nurses with a higher education and lack of a supportive culture were barriers for EBP and research. Another study of 2,441 nurses in the US found that Magnet organizations had fewer barriers to EBP.17 EBP practices were found most among nurses with higher educational levels, those with specialty certification, and those engaged in a clinical career development program.18 Additional barriers to the role should be recognized. Costs, for example, pose a common barrier,
as organizations weigh the costs of hiring a nurse scientist with the benefits (which are often indirect and intangible). Lack of funds to support the nurse scientist role and research endeavors can also exist because of lack of time for staff to complete projects. In addition, being the only PhD nurse in the organization can lead to professional loneliness, thereby it is important for the nurse scientist to interact with other interdisciplinary scientists, for example, at the College of Nursing. Additional facilitators and barriers for the nurse scientist role are included in Table 2.
SUCCESSFUL IMPLEMENTATION OF EBP Because of the novelty of the organizational nurse scientist role, few successful nurse scientist models exist. Below are case examples of nurse scientist programs. Developed in 1998, the University of Colorado has one of the earliest and most successful models. The team is comprised of four nurse scientists who share time between the health care organization and the university. The scientists are diverse in their specialties to provide guidance and expertise for all nursing services throughout the organization. Their roles include collaborating or conducting studies independently, supporting and mentoring nurses in research, EBP, quality improvement or education projects, assisting in planning journal clubs, leadership on the NRC
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TABLE 2. Facilitators and Barriers of Nursing Science Research Components Infrastructure
Culture
Programmatic criteria
Facilitators
Barriers
Nurses have BSN or higher Magnet designation Library resources Local IRB support Supportive of research Leadership support Relevance to EBP activities Culture of inquiry Mission statement for EBP and research Nurse scientist or research mentor Dedicated time and financial resources NRC Integration of research into job descriptions or clinical ladder Research procedures Nursing representation on IRB EBP and research education for nurses
Non-Magnet Lack of data resources
Intimidated by research Research not a priority Lack of time to conduct EBP projects and research Competing priorities Lack of designated nursing research program Lack of a nurse scientist or research mentor Lack of time and fiscal resources Lack of NRC No recognition of EBP and research as part of the daily nursing role
Abbreviations: BSN, Bachelor of Science in Nursing; EBP, evidence-based practice; IRB, Institutional Review Board; NRC, Nursing Research Council.
and other councils, coordinating an annual research symposium, teaching research and EBP classes, mentoring for publication, and coordi-
nating an annual research competency. They are guided by their Colorado Patient-Centered Interprofessional EBP Model that was developed by
FIGURE 1. The Colorado patient-centered interprofessional EBP model. (Used with permission of the University of Colorado Hospital).
BRIDGING THE RESEARCH-TO-PRACTICE GAP
nursing leaders and nurse scientists in the organization. The model includes organizational support, leadership, mentorship, and facilitation components and focuses on integrating evidence that is truly patient-centered (Fig. 1). They have widely disseminated their model through presentations at Magnet and other professional meetings and through the literature.19,20 The University of California, San Francisco is another model that recognizes the value of the ‘‘on site’’ nurse scientist. They use nurse scientists to improve on previously tested interventions to ensure that the research-to-practice gap is overcome. Because most nursing care occurs in the hospital, having nurse scientists available is considered essential in this setting. As the Chief Nursing Officer stated, ‘‘The beauty of the nurse scientist is that he or she is close to patients and able to constantly push for ways to treat those patients better.’’21 The Yvonne L. Munn Center for Nursing Research at Massachusetts General Hospital is another nurse
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scientist model. Doctorally prepared nurse scientists, along with many master’s prepared mentors, assist nursing staff, faculty, students and others with nursing research initiatives. Research is driven through an agenda of high-focus areas that include workforce evaluation, symptom management, palliative care, older adult care, EBP, ethics and clinical decision making, transitional care, and healing and complementary therapies. Staff nurses can seek mentors to assist in research activities and EBP. Annually, a nursing research day is held during Nurse Recognition Week and includes presentation of original research, EBP, and quality improvement activities.22 One of the successful and tangible outcomes for the nurse scientist is dissemination of EBP and research findings (Table 3).23 When conducting research as the principal investigator, the nurse scientist assumes the first author role and presents findings, keeping in mind the support of other nurses on the research team. Most rewarding is when nurses throughout an
TABLE 3. Nurse Scientist’s Examples of EBP and Research Dissemination EBP Project or Research Study Patient and caregiver satisfaction with cancer survivorship plans Quality-of-life trajectories of breast cancer and lymphoma survivors enrolled in a survivorship program Distress screening within a community cancer center – challenges and opportunities Colorectal cancer screening in American Indians An oncology-specific preceptor program: a path to oncology nurse knowledge, commitment, and retention Prevention of cerebellar toxicity from cytosine arabinoside (Ara-C): development of a nurse educational training program and assessment protocol A nurse-led symptom management clinic Success at home starts in the hospital: ‘‘transition day’’ Discharge isn’t the end: we’re still watching Increasing clinical trial accrual: out of the box strategies Electronic PRO-generated supportive care planning: patient perspectives Integrating little people into a big world Empowering the bedside nurse: development of an end of life toolkit Patient reported outcomes research: lessons learned from launching a novel electronic platform (OnQ) Creating comfort zones by administering the right dose of patient education Nurse dyads: partnering to increase clinical trial participation and staff satisfaction
Dissemination ONS Connections: Advancing Care Through Science Podium Abstracts 201226 ONS Connections: Advancing Care Through Science Podium Abstracts 201227 ONS Connections: Advancing Care Through Science Podium Abstracts 201228 ONS Connections: Advancing care Through Science Podium Abstracts 201229 ONS Congress 201230 ONS Congress 201331
ONS Congress 201332 ONS Congress 201433 ONS Congress 201434 ONS Congress 201435 ONS Congress 201536 ONS Congress 201537 ONS Congress 201538 ONS Congress 201539 ONS Congress 201540 ONS Congress 201541
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organization lead their own projects and disseminate findings with the nurse scientist serving as mentor and taking the last author role. A staff nurse who recently participated in a research study stated, ‘‘The entire research process makes me feel like a professional nurse. I am so excited about our progress and how our project improved patient care. I really want to do this again!’’ This is the ultimate reward and measure of success for the nurse scientist.
FUTURE IMPLICATIONS As the need for the nurse scientist role expands, concern exists regarding the shortage of doctorally prepared nurses around the country. This is particularly apparent in oncology nursing.18 Nursing faculty are reaching retirement age, and doctorally prepared nurses are also choosing roles outside of academia for better salaries and more diverse roles. Therefore, the training ground for
nurse scientists is dwindling. As nurses take on nurse scientist roles within organizations, an urgent need exists for better collaboration with colleges of nurses to train more nurse scientists and maintain high-quality education with the discovery of new knowledge and ongoing translation of findings into practice.24,25 In summary, the nurse scientist role is expanding but is still in its infancy. As more organizations strive to reach the Institute of Medicine’s goal to achieve 90% of clinical decisions to be evidence-based by 2020, the number of organizational nurse scientists will likely increase. Abundant opportunities exist for furthering the role, such as developing rolespecific competencies, providing better networking opportunities for nurse scientists around the country, and expanding funding opportunities to explore the influence of the role on nursing outcomes. The success of the role will be fully appreciated when clinical decisions are evidence-based and reflective of high-quality patient care.
REFERENCES 1. Institute of Medicine. The future of nursing: leading change, advancing health. 2010. Available at: http://www. thefutureofnursing.org/IOM-Report (accessed August 9, 2015). 2. Nightingale F. Notes on nursing. New York, NY: Dover Publications; 1969. 3. Benner P. From novice to expert. Menlo Park, CA: Addison-Wesley; 1984. 4. American Nurses Credentialing Center (ANCC). History of the Magnet program. ANCC, 2015. Available at: http://www. nursecredentialing.org/magnet/programoverview/historyofthem agnetprogram (accessed July 23, 2015). 5. Stimpfel AW, Rosen JE, McHugh MD. Understanding the role of the professional practice environment on quality of care in Magnet(R) and non-Magnet hospitals. J Nurs Adm 2014;44:10-16. 6. Wilson B, Kelly L, Reifsnider E, Pipe T, Brumfield V. Creative approaches to increasing hospital-based nursing research. J Nurs Adm 2013;43:80-88. 7. Scott-Findlay S, Golden-Biddle K. Understanding how organizational culture shapes research use. J Nurs Adm 2005;35:359-365. 8. Stanley T, Sitterding M, Broome ME, McCaskey M. Engaging and developing research leaders in practice: creating a foundation for a culture of clinical inquiry. J Pediatr Nurs 2011;26:480-488. 9. Barrett R. Strategies for promoting the scientific integrity of nursing research in clinical settings. J Nurses Staff Dev 2010;26. 200-205; quiz 60-67. 10. Stetler CB, Ritchie JA, Rycroft-Malone J, Schultz AA, Charns MP. Institutionalizing evidence-based practice: an organizational case study using a model of strategic change. Implement Sci 2009;4:78. 11. Rogers EM. A prospective and retrospective look at the diffusion model. J Health Commun 2004;9(Suppl 1):13-19.
12. Titler MG, Kleiber C, Steelman VJ, et al. The Iowa model of evidence-based practice to promote quality care. Crit Care Nurs Clin North Am 2001;13:497-509. 13. Melnyk BM, Gallagher-Ford L, Long LE, FineoutOverholt E. The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews Evid Based Nurs 2014;11:5-15. 14. McCaskill-Stevens W, Lyss AP, Good M, Marsland T, Lilenbaum R. The NCI community oncology research program: what every clinician needs to know. American Society of Clinical Oncology educational book/ASCO American Society of Clinical Oncology Meeting 2013. Available at: http://meetinglibrary. asco.org/content/100-132 (accessed July 23, 2015). 15. Bruner DW, O’Mara A. Nurse scientists in cancer cooperative groups. Semin Oncol Nurs 2014;30:4-10. 16. Kelly KP, Turner A, Gabel Speroni K, McLaughlin MK, Guzzetta CE. National survey of hospital nursing research, part 2: facilitators and hindrances. J Nurs Adm 2013;43: 18-23. 17. Wilson M, Sleutel M, Newcomb P, et al. Empowering nurses with evidence-based practice environments: surveying MagnetÒ, Pathway to ExcellenceÒ, and non-Magnet facilities in one healthcare system. Worldviews Evid Based Nurs 2015;12:12-21. 18. LoBiondo-Wood G, Brown CG, Knobf MT, et al. Priorities for oncology nursing research: the 2013 national survey. Oncol Nurs Forum 2014;41:67-76. 19. Goode CJ, McCarty LB, Fink RM, et al. Mapping the organization: a bibliometric analysis of nurses’ contributions to the literature. J Nurs Adm 2013;43:481-487. 20. Goode CJ, Fink RM, Krugman M, Oman KS, Traditi LK. The Colorado Patient-Centered Interprofessional Evidence-
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Based Practice Model: a framework for transformation. Worldviews Evid Based Nurs 2011;8:96-105. 21. Schwartz A. The value of ‘‘why’’ drives the growth of on-site nurse scientists science of caring 2014. Available at http:// scienceofcaring.ucsf.edu/future-nursing/value-%E2%80%9Cwhy% E2%80%9D-drives-growth-site-nurse-scientists (accessed June 9, 2015). 22. Yvonne L. Munn Center for Nursing Research. Massachusetts General Hospital, 2015. Available at: http://www.mghpcs. org/MunnCenter/index.asp (accessed June 9, 2015). 23. McLaughlin MK, Gabel Speroni K, Kelly KP, Guzzetta CE, Desale S. National survey of hospital nursing research, part 1: research requirements and outcomes. J Nurs Adm 2013;43:10-17. 24. Moore IM, Badger TA. The future of oncology nursing research: research priorities and professional development. Oncol Nurs Forum 2014;41:93-94. 25. Peek GJ. Two approaches to bridging the knowledgepractice gap in oncology nursing. Oncol Nurs Forum 2015;42:94-95. 26. Blaseg K, Brant JM, Aders K, Oliver D. Patient and caregiver satisfaction with cancer survivorship plans [abstract 1420122]. Oncol Nurs Forum 2012;39:E562. 27. Brant JM, Blaseg K, Oliver D, Aders K. Quality of life trajectories of breast cancer and lymphoma survivors enrolled in a survivorship program [abstract 1418496]. Oncol Nurs Forum 2012;39:E540. 28. Oliver D, Blaseg K, Weber A, Brant J. Distress screening within a community cancer center – challenges and opportunities [abstract 1421272]. Oncol Nurs Forum 2012;39:E570. 29. White N, Brant JM. Colorectal cancer screening in American Indians [abstract 1414819]. Oncol Nurs Forum 2012;39:E553. 30. Anderson C, Gradwohl R, Nelson L, Brant JM. An oncology specific preceptor program: a path to oncology nurse knowledge, commitment, and retention [abstract 132978]. Oncol Nurs Forum 2013;40:E265.
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31. Nichols K, Anderson C, Gradwohl R, Gall D, Brant JM. Prevention of cerebellar toxicity from cytosine arabinoside (Ara-C): development of a nurse educational training program and assessment protocol [abstract 135139]. Oncol Nurs Forum 2013;40:E215. 32. Weber A, Waitman K, Blaseg K, Brant JM. A nurse-led symptom management clinic: serving cancer patients across the continuum [abstract 118286]. Oncol Nurs Forum 2013;40: E199. 33. Biggins B, Skogen K, Henneberry M, Gradwohl R, Brant JM. Success at home starts in the hospital: ‘‘transition day’’ [abstract 121]. Oncol Nurs Forum 2014;41:E132. 34. Henneberry M, Skogen K, Biggins B, Gradwohl R, Brant JM. Discharge isn’t the end: we’re still watching [abstract 67]. Oncol Nurs Forum 2014;41:E67. 35. Montgomery T, Wilkinson K, Brant JM. Increasing clinical trial accrual: out of the box strategies. Oncol Nurs Forum 2014;41:E138. 36. Brant JM, Hirschman K, Jacobsen P, Stricker C. RN electronic PRO-generated supportive care planning: patient perspectives. Oncol Nurs Forum 2015;42:E230. 37. Christofanelli A, Scaramuzzo L, Brant JM. Integrating little people into a big world. Oncol Nurs Forum 2015;42: E172. 38. Kunze K, Scaramuzzo L, Nichols K, Brant JM. Empowering the bedside nurse: development of an end of life toolkit. Oncol Nurs Forum 2015;42:E187. 39. Phillips K, Miller J, Brant JM. Patient reported outcomes research: lessons learned from launching a novel electronic platform (OnQ). Oncol Nurs Forum 2015;42:E195. 40. Scaramuzzo L. Creating comfort zones by administering the right dose of patient education. Oncol Nurs Forum 2015;42:E193. 41. Wilkinson W, Montgomery T, Brant JM. Nurse dyads: partnering to increase clinical trial participation and staff satisfaction. Oncol Nurs Forum 2015;42:E182.
Seminars in Oncology Nursing, Vol 31, No 4 (November), 2015: pp 298-305
BRIDGING THE RESEARCH-TO-PRACTICE GAP: THE ROLE OF THE NURSE SCIENTIST JEANNINE M. BRANT OBJECTIVES: To describe the emerging role of the nurse scientist in health care organizations. Historical perspectives of the role are explored along with the roles of the nurse scientist, facilitators, barriers, and future implications.
DATA SOURCES: Relevant literature on evidence-based practice and research in health care organizations; nurse scientist role; interview with University of Colorado nurse scientist.
CONCLUSION: The nurse scientist role is integral for expanding evidence-based decisions and nursing research. A research mentor is considered the most important facilitator for a successful nursing research program. IMPLICATIONS
FOR
NURSING PRACTICE: Organizations should consider
including the nurse scientist role to facilitate evidence-based practice and expand opportunities for nursing research.
KEY WORDS: Nurse scientist, evidence-based practice, research, magnet
Jeannine M. Brant, PhD, APRN, AOCNÒ, FAAN: Oncology Clinical Nurse Specialist and Nurse Scientist, Billings Clinic, Billings, MT; Assistant Affiliate Professor, Montana State University College of Nursing, Bozeman, MT. Address correspondence to Jeannine M. Brant, PhD, APRN, AOCNÒ, FAAN: Oncology Clinical Nurse Specialist and Nurse Scientist, Billings Clinic, 2800 10th Avenue North, Billings, MT 59101. e-mail: [email protected] Ó 2015 Elsevier Inc. All rights reserved. 0749-2081/3104-$36.00/0. http://dx.doi.org/10.1016/j.soncn.2015.08.006
H
ealth care organizations across the United States are striving to bridge the gap between research and evidence-based practice (EBP), with hopes to improve patient outcomes, further quality of care, and lower health care expenditures. Nurses are the largest health care work force and are responsible for around-the-clock nursing care in the hospital. They have an increasing role in ambulatory settings, especially in oncology clinics and inpatient units where nurses deliver chemotherapy, provide patient education, and provide supportive care throughout the cancer continuum. The Institute of Medicine, whose aim is to achieve 90% of clinical decisions to be
BRIDGING THE RESEARCH-TO-PRACTICE GAP
evidence-based by 2020, recognizes the leadership of nurses to bridge this research and EBP chasm.1 The organizational nurse scientist is an evolving role, designed to bridge the gap between research and EBP. The nurse scientist can be especially beneficial in the oncology setting where evidence evolves rapidly; therefore a need exists to quickly translate research into practice. This article describes the background of the nurse scientist role, the functional components of the role, barriers and facilitators of the role, and strategies for role integration and stimulation of research and EBP within an organization. Successful implementation of the role is highlighted through exemplary models.
NURSE SCIENTIST ROLE: HISTORICAL ASPECTS EBP and research have provided the foundation of nursing since its inception. Florence Nightingale is considered the first nurse scientist because she explored environmental factors that contributed to patient wellness, including ventilation, noise, light, cleanliness, and therapeutic communication.2 While nursing research evolved throughout the 20th century, nurse scientists were primarily employed in academia, conducting research in collaboration with health care organizations but employed outside of the health care setting. In many ways, the bridge between research and practice widened as nurse scientists moved further from the bedside. In the 1980s, nursing leaders began to recognize that nursing knowledge accrued over time at the bedside had gone uncharted and unstudied. A distinction between practical and theoretical knowledge was essential in moving nursing science forward. Dr. Patricia Benner published her work From Novice to Expert, and acknowledged the clinical expertise and practical knowledge of nurses that evolves over time.3 Both tapping into clinical expertise at the bedside to discover new knowledge and translating evidence into practice at the bedside provide a mechanism to close the research-to-practice gap. Ongoing interaction with clinically expert nurses at the bedside is a foundational role of the nurse scientist. The Magnet Program marks another progressive move toward the nurse scientist role. In 1983, the American Academy of Nursing Task Force on Nursing Practice in Hospitals identified hospital environments that promoted quality patient care
299
and had an innate ability to recruit and retain nurses. In 1994, the University of Washington in Seattle became the first Magnet-designated organization. Magnet’s recognition of nursing science quickly evolved through recognition of new knowledge, innovations and improvements, which are key components of the Magnet model.4 Within this model domain, EBP and research are integrated into both clinical and operational processes. This requires nurses to be educated about EBP and research to provide safe, quality care to patients. Nurses are also expected to generate new knowledge within the organization by conducting independent research. Innovations in patient care, nursing, and the practice environment are the hallmark of organizations receiving Magnet recognition. Establishing new ways of achieving high-quality, effective, and efficient care is the outcome of transformational leadership, empowering structures and processes, and exemplary professional practice in nursing.4 One study indicates that Magnet organizations report that the professional practice environment mediates the relationship between being ‘‘Magnet’’ and nurse-reported quality of care.5 Health care organizations around the globe are now examining creative approaches to increase nursing EBP and research at the bedside. Four models that exist include: 1) Collaboration and guidance from Academic Researchers, 2) Contracted nurse scientist, 3) Nurse scientist embedded within the organization, or 4) Shared model between the health care organization and the College of Nursing.6 The first two models involve collaborative relationships with nurse scientists employed outside of the organization. The embedded nurse scientist is employed solely by the organization and has the advantage of an ongoing presence in the organization. The fourth model includes nurse scientists who are employed part-time by the organization and part-time by the College of Nursing with presence noted in both the health care environment and the academic setting.
ROLES OF THE NURSE SCIENTIST The nurse scientist is engaged in an overabundance of roles within the organization and often
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represents professional nursing outside of the organization as well, at the College of Nursing and through community and professional organization activities. Overall, the nurse scientist, in collaboration with nursing leadership, is integral in shaping the culture of inquiry and research within the organization, which is imperative to bridge the gap between research and EBP.7 Overall, the culture of inquiry is one in which new ideas are highly valued and where research is used to support clinical decisions. Policies and procedures are evidence-based and are referenced according to the most recent studies from the literature. Nurses within a culture of inquiry should also have time to reflect on their practice, stay current in their fields of expertise, and share new knowledge on an ongoing basis that can be implemented into practice. Nursing Research Councils (NRCs) emerged as part of the Magnet initiative to promote EBP and research at the bedside. While not all organizations have NRCs, they operate through a nurse-led, selfgoverning structure that encourages nurses to have ownership for EBP and research within the organization. The NRC plays an integral role in creating a culture of inquiry within an organization, and the nurse scientist may facilitate the NRC or closely collaborate with this council. NRCs are instrumental in building research infrastructure by developing an EBP and research-focused mission statement, setting research goals for the organization, and adopting a model to guide research into practice.8 These activities promote the scientific integrity of nursing research in the clinical setting.9 Research translation models are also used to translate research into practice. Models including the Stetler,10 Roger’s Diffusion Model,11 and the Iowa Model12 are examples of EBP translation models. The starting point for any EBP integration is the clinical question. The PICO framework (Patient population, Intervention, Comparison, and Outcome) is often used to formulate research questions that are priority for the organization13 and then new evidence is appraised, projects are prioritized according to the organization, and implementation is piloted on a nursing unit. Implementation of new knowledge occurs throughout the organization as the final step. It is helpful for a member of the NRC to also be a member of the Institutional Review Board (IRB) so that regulatory standards can be communicated to nurses and the IRB member can be a liaison with the NRC. Mentorship is a primary role of the nurse scientist. The nurse scientist may be the only PhD
nurse in the organization, and thereby, should emulate professional nursing throughout the organization and identify nurses to mentor for EBP projects and research. Often, nurses will selfidentify themselves by attending NRC and may participate in other EBP activities. Encouraging these nurses to pursue EBP and research projects is essential, ensuring them mentorship through each step of the process.9 Additional roles for the nurse scientist include adjunct faculty for the local college of nursing, magnet team representative, cancer committee member, and principal investigator (Table 1). Maintaining a culture of inquiry and an environment where EBP and research is welcome and encouraged is no easy task. In essence, the nurse scientist often fulfills the role of ‘‘cheerleader’’ within the organization, reminding nurses of new evidence that exists and stimulating EBP and thoughtful research endeavors. Finding nurse champions to initiate and continue projects is challenging with the lack of time recognized as a major barrier. Building recognition into the EBP and research program through incentives or career development programs can make nurses feel validated for their efforts. Making research meaningful and fun can fuel interest as well. Some of the activities that can invigorate EBP and nursing research include nursing grand rounds presentations, unit-based practice council discussions, newsletter information and updates, science fairs featuring nurse-led research, and research symposiums that feature nationally recognized speakers. Participation in National Cancer Institute (NCI) National Clinical Trials Network offers another opportunity for the nurse scientist. Research bases, formerly called cooperative groups, are hubs that design and conduct NCIsponsored multisite studies for prevention, control, screening, post-treatment surveillance, and cancer care delivery research through the NCI Community Oncology Research Program.14 Nurse scientists have led study teams focusing on symptom management, quality of life, patient-reported outcomes, and care delivery systems. Nurses can work with these larger systems to access larger populations, collaborate with other sites to accrue patients more quickly, and make findings more generalizable.15 Cancer care delivery research is a newer addition to the NCI structure and supports a community-based research network to address cancer disparities
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TABLE 1. Roles of the Nurse Scientist Role
Description
Promote a culture of inquiry Nursing Research Council (NRC) chair/facilitator
Conduct nursing grand rounds on EBP and research Provide NRC leadership Mentor NRC chair and members Facilitate discussion to enhance scientific discussions Identify nurses who are interested in EBP and research Collaborate with local nursing faculty to advance nursing science Provide instruction at the college of nursing as needed Represent nursing science within the Magnet organization Identify projects that reflect new knowledge and innovation outcomes required by Magnet Facilitate abstract submission to promote dissemination Provide data for cancer care outcomes and report to cancer committee Maintain program of research Serve as a role model for other investigators Obtain grant funding for research conducted Facilitate abstract submission to Magnet and other professional organizations Encourage dissemination of EBP projects and research through podiums, poster presentations, and manuscripts
Mentor Adjunct faculty college of nursing Magnet team representative
Cancer committee member Principal investigator
Promote dissemination of findings
and translational research questions that are separate from the traditional pharmacologic clinical trials. Nurse scientists are well-suited to serve as principal investigators and leaders of many of these new initiatives.
FACILITATORS AND BARRIERS OF EBP AND RESEARCH Multiple facilitators and barriers for EBP and research exist throughout the country. A survey of 160 hospitals revealed that the number one facilitator was the presence of a research mentor, which is a primary role of the nurse scientist. Lack of a research mentor was also listed as the number one barrier.16 Other facilitators included having a higher nursing education level in the organization, along with a culture that supports nursing research. A research program established by a nursing research leader was also listed as a key strategy for success. Lack of nurses with a higher education and lack of a supportive culture were barriers for EBP and research. Another study of 2,441 nurses in the US found that Magnet organizations had fewer barriers to EBP.17 EBP practices were found most among nurses with higher educational levels, those with specialty certification, and those engaged in a clinical career development program.18 Additional barriers to the role should be recognized. Costs, for example, pose a common barrier,
as organizations weigh the costs of hiring a nurse scientist with the benefits (which are often indirect and intangible). Lack of funds to support the nurse scientist role and research endeavors can also exist because of lack of time for staff to complete projects. In addition, being the only PhD nurse in the organization can lead to professional loneliness, thereby it is important for the nurse scientist to interact with other interdisciplinary scientists, for example, at the College of Nursing. Additional facilitators and barriers for the nurse scientist role are included in Table 2.
SUCCESSFUL IMPLEMENTATION OF EBP Because of the novelty of the organizational nurse scientist role, few successful nurse scientist models exist. Below are case examples of nurse scientist programs. Developed in 1998, the University of Colorado has one of the earliest and most successful models. The team is comprised of four nurse scientists who share time between the health care organization and the university. The scientists are diverse in their specialties to provide guidance and expertise for all nursing services throughout the organization. Their roles include collaborating or conducting studies independently, supporting and mentoring nurses in research, EBP, quality improvement or education projects, assisting in planning journal clubs, leadership on the NRC
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TABLE 2. Facilitators and Barriers of Nursing Science Research Components Infrastructure
Culture
Programmatic criteria
Facilitators
Barriers
Nurses have BSN or higher Magnet designation Library resources Local IRB support Supportive of research Leadership support Relevance to EBP activities Culture of inquiry Mission statement for EBP and research Nurse scientist or research mentor Dedicated time and financial resources NRC Integration of research into job descriptions or clinical ladder Research procedures Nursing representation on IRB EBP and research education for nurses
Non-Magnet Lack of data resources
Intimidated by research Research not a priority Lack of time to conduct EBP projects and research Competing priorities Lack of designated nursing research program Lack of a nurse scientist or research mentor Lack of time and fiscal resources Lack of NRC No recognition of EBP and research as part of the daily nursing role
Abbreviations: BSN, Bachelor of Science in Nursing; EBP, evidence-based practice; IRB, Institutional Review Board; NRC, Nursing Research Council.
and other councils, coordinating an annual research symposium, teaching research and EBP classes, mentoring for publication, and coordi-
nating an annual research competency. They are guided by their Colorado Patient-Centered Interprofessional EBP Model that was developed by
FIGURE 1. The Colorado patient-centered interprofessional EBP model. (Used with permission of the University of Colorado Hospital).
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nursing leaders and nurse scientists in the organization. The model includes organizational support, leadership, mentorship, and facilitation components and focuses on integrating evidence that is truly patient-centered (Fig. 1). They have widely disseminated their model through presentations at Magnet and other professional meetings and through the literature.19,20 The University of California, San Francisco is another model that recognizes the value of the ‘‘on site’’ nurse scientist. They use nurse scientists to improve on previously tested interventions to ensure that the research-to-practice gap is overcome. Because most nursing care occurs in the hospital, having nurse scientists available is considered essential in this setting. As the Chief Nursing Officer stated, ‘‘The beauty of the nurse scientist is that he or she is close to patients and able to constantly push for ways to treat those patients better.’’21 The Yvonne L. Munn Center for Nursing Research at Massachusetts General Hospital is another nurse
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scientist model. Doctorally prepared nurse scientists, along with many master’s prepared mentors, assist nursing staff, faculty, students and others with nursing research initiatives. Research is driven through an agenda of high-focus areas that include workforce evaluation, symptom management, palliative care, older adult care, EBP, ethics and clinical decision making, transitional care, and healing and complementary therapies. Staff nurses can seek mentors to assist in research activities and EBP. Annually, a nursing research day is held during Nurse Recognition Week and includes presentation of original research, EBP, and quality improvement activities.22 One of the successful and tangible outcomes for the nurse scientist is dissemination of EBP and research findings (Table 3).23 When conducting research as the principal investigator, the nurse scientist assumes the first author role and presents findings, keeping in mind the support of other nurses on the research team. Most rewarding is when nurses throughout an
TABLE 3. Nurse Scientist’s Examples of EBP and Research Dissemination EBP Project or Research Study Patient and caregiver satisfaction with cancer survivorship plans Quality-of-life trajectories of breast cancer and lymphoma survivors enrolled in a survivorship program Distress screening within a community cancer center – challenges and opportunities Colorectal cancer screening in American Indians An oncology-specific preceptor program: a path to oncology nurse knowledge, commitment, and retention Prevention of cerebellar toxicity from cytosine arabinoside (Ara-C): development of a nurse educational training program and assessment protocol A nurse-led symptom management clinic Success at home starts in the hospital: ‘‘transition day’’ Discharge isn’t the end: we’re still watching Increasing clinical trial accrual: out of the box strategies Electronic PRO-generated supportive care planning: patient perspectives Integrating little people into a big world Empowering the bedside nurse: development of an end of life toolkit Patient reported outcomes research: lessons learned from launching a novel electronic platform (OnQ) Creating comfort zones by administering the right dose of patient education Nurse dyads: partnering to increase clinical trial participation and staff satisfaction
Dissemination ONS Connections: Advancing Care Through Science Podium Abstracts 201226 ONS Connections: Advancing Care Through Science Podium Abstracts 201227 ONS Connections: Advancing Care Through Science Podium Abstracts 201228 ONS Connections: Advancing care Through Science Podium Abstracts 201229 ONS Congress 201230 ONS Congress 201331
ONS Congress 201332 ONS Congress 201433 ONS Congress 201434 ONS Congress 201435 ONS Congress 201536 ONS Congress 201537 ONS Congress 201538 ONS Congress 201539 ONS Congress 201540 ONS Congress 201541
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organization lead their own projects and disseminate findings with the nurse scientist serving as mentor and taking the last author role. A staff nurse who recently participated in a research study stated, ‘‘The entire research process makes me feel like a professional nurse. I am so excited about our progress and how our project improved patient care. I really want to do this again!’’ This is the ultimate reward and measure of success for the nurse scientist.
FUTURE IMPLICATIONS As the need for the nurse scientist role expands, concern exists regarding the shortage of doctorally prepared nurses around the country. This is particularly apparent in oncology nursing.18 Nursing faculty are reaching retirement age, and doctorally prepared nurses are also choosing roles outside of academia for better salaries and more diverse roles. Therefore, the training ground for
nurse scientists is dwindling. As nurses take on nurse scientist roles within organizations, an urgent need exists for better collaboration with colleges of nurses to train more nurse scientists and maintain high-quality education with the discovery of new knowledge and ongoing translation of findings into practice.24,25 In summary, the nurse scientist role is expanding but is still in its infancy. As more organizations strive to reach the Institute of Medicine’s goal to achieve 90% of clinical decisions to be evidence-based by 2020, the number of organizational nurse scientists will likely increase. Abundant opportunities exist for furthering the role, such as developing rolespecific competencies, providing better networking opportunities for nurse scientists around the country, and expanding funding opportunities to explore the influence of the role on nursing outcomes. The success of the role will be fully appreciated when clinical decisions are evidence-based and reflective of high-quality patient care.
REFERENCES 1. Institute of Medicine. The future of nursing: leading change, advancing health. 2010. Available at: http://www. thefutureofnursing.org/IOM-Report (accessed August 9, 2015). 2. Nightingale F. Notes on nursing. New York, NY: Dover Publications; 1969. 3. Benner P. From novice to expert. Menlo Park, CA: Addison-Wesley; 1984. 4. American Nurses Credentialing Center (ANCC). History of the Magnet program. ANCC, 2015. Available at: http://www. nursecredentialing.org/magnet/programoverview/historyofthem agnetprogram (accessed July 23, 2015). 5. Stimpfel AW, Rosen JE, McHugh MD. Understanding the role of the professional practice environment on quality of care in Magnet(R) and non-Magnet hospitals. J Nurs Adm 2014;44:10-16. 6. Wilson B, Kelly L, Reifsnider E, Pipe T, Brumfield V. Creative approaches to increasing hospital-based nursing research. J Nurs Adm 2013;43:80-88. 7. Scott-Findlay S, Golden-Biddle K. Understanding how organizational culture shapes research use. J Nurs Adm 2005;35:359-365. 8. Stanley T, Sitterding M, Broome ME, McCaskey M. Engaging and developing research leaders in practice: creating a foundation for a culture of clinical inquiry. J Pediatr Nurs 2011;26:480-488. 9. Barrett R. Strategies for promoting the scientific integrity of nursing research in clinical settings. J Nurses Staff Dev 2010;26. 200-205; quiz 60-67. 10. Stetler CB, Ritchie JA, Rycroft-Malone J, Schultz AA, Charns MP. Institutionalizing evidence-based practice: an organizational case study using a model of strategic change. Implement Sci 2009;4:78. 11. Rogers EM. A prospective and retrospective look at the diffusion model. J Health Commun 2004;9(Suppl 1):13-19.
12. Titler MG, Kleiber C, Steelman VJ, et al. The Iowa model of evidence-based practice to promote quality care. Crit Care Nurs Clin North Am 2001;13:497-509. 13. Melnyk BM, Gallagher-Ford L, Long LE, FineoutOverholt E. The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews Evid Based Nurs 2014;11:5-15. 14. McCaskill-Stevens W, Lyss AP, Good M, Marsland T, Lilenbaum R. The NCI community oncology research program: what every clinician needs to know. American Society of Clinical Oncology educational book/ASCO American Society of Clinical Oncology Meeting 2013. Available at: http://meetinglibrary. asco.org/content/100-132 (accessed July 23, 2015). 15. Bruner DW, O’Mara A. Nurse scientists in cancer cooperative groups. Semin Oncol Nurs 2014;30:4-10. 16. Kelly KP, Turner A, Gabel Speroni K, McLaughlin MK, Guzzetta CE. National survey of hospital nursing research, part 2: facilitators and hindrances. J Nurs Adm 2013;43: 18-23. 17. Wilson M, Sleutel M, Newcomb P, et al. Empowering nurses with evidence-based practice environments: surveying MagnetÒ, Pathway to ExcellenceÒ, and non-Magnet facilities in one healthcare system. Worldviews Evid Based Nurs 2015;12:12-21. 18. LoBiondo-Wood G, Brown CG, Knobf MT, et al. Priorities for oncology nursing research: the 2013 national survey. Oncol Nurs Forum 2014;41:67-76. 19. Goode CJ, McCarty LB, Fink RM, et al. Mapping the organization: a bibliometric analysis of nurses’ contributions to the literature. J Nurs Adm 2013;43:481-487. 20. Goode CJ, Fink RM, Krugman M, Oman KS, Traditi LK. The Colorado Patient-Centered Interprofessional Evidence-
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Based Practice Model: a framework for transformation. Worldviews Evid Based Nurs 2011;8:96-105. 21. Schwartz A. The value of ‘‘why’’ drives the growth of on-site nurse scientists science of caring 2014. Available at http:// scienceofcaring.ucsf.edu/future-nursing/value-%E2%80%9Cwhy% E2%80%9D-drives-growth-site-nurse-scientists (accessed June 9, 2015). 22. Yvonne L. Munn Center for Nursing Research. Massachusetts General Hospital, 2015. Available at: http://www.mghpcs. org/MunnCenter/index.asp (accessed June 9, 2015). 23. McLaughlin MK, Gabel Speroni K, Kelly KP, Guzzetta CE, Desale S. National survey of hospital nursing research, part 1: research requirements and outcomes. J Nurs Adm 2013;43:10-17. 24. Moore IM, Badger TA. The future of oncology nursing research: research priorities and professional development. Oncol Nurs Forum 2014;41:93-94. 25. Peek GJ. Two approaches to bridging the knowledgepractice gap in oncology nursing. Oncol Nurs Forum 2015;42:94-95. 26. Blaseg K, Brant JM, Aders K, Oliver D. Patient and caregiver satisfaction with cancer survivorship plans [abstract 1420122]. Oncol Nurs Forum 2012;39:E562. 27. Brant JM, Blaseg K, Oliver D, Aders K. Quality of life trajectories of breast cancer and lymphoma survivors enrolled in a survivorship program [abstract 1418496]. Oncol Nurs Forum 2012;39:E540. 28. Oliver D, Blaseg K, Weber A, Brant J. Distress screening within a community cancer center – challenges and opportunities [abstract 1421272]. Oncol Nurs Forum 2012;39:E570. 29. White N, Brant JM. Colorectal cancer screening in American Indians [abstract 1414819]. Oncol Nurs Forum 2012;39:E553. 30. Anderson C, Gradwohl R, Nelson L, Brant JM. An oncology specific preceptor program: a path to oncology nurse knowledge, commitment, and retention [abstract 132978]. Oncol Nurs Forum 2013;40:E265.
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31. Nichols K, Anderson C, Gradwohl R, Gall D, Brant JM. Prevention of cerebellar toxicity from cytosine arabinoside (Ara-C): development of a nurse educational training program and assessment protocol [abstract 135139]. Oncol Nurs Forum 2013;40:E215. 32. Weber A, Waitman K, Blaseg K, Brant JM. A nurse-led symptom management clinic: serving cancer patients across the continuum [abstract 118286]. Oncol Nurs Forum 2013;40: E199. 33. Biggins B, Skogen K, Henneberry M, Gradwohl R, Brant JM. Success at home starts in the hospital: ‘‘transition day’’ [abstract 121]. Oncol Nurs Forum 2014;41:E132. 34. Henneberry M, Skogen K, Biggins B, Gradwohl R, Brant JM. Discharge isn’t the end: we’re still watching [abstract 67]. Oncol Nurs Forum 2014;41:E67. 35. Montgomery T, Wilkinson K, Brant JM. Increasing clinical trial accrual: out of the box strategies. Oncol Nurs Forum 2014;41:E138. 36. Brant JM, Hirschman K, Jacobsen P, Stricker C. RN electronic PRO-generated supportive care planning: patient perspectives. Oncol Nurs Forum 2015;42:E230. 37. Christofanelli A, Scaramuzzo L, Brant JM. Integrating little people into a big world. Oncol Nurs Forum 2015;42: E172. 38. Kunze K, Scaramuzzo L, Nichols K, Brant JM. Empowering the bedside nurse: development of an end of life toolkit. Oncol Nurs Forum 2015;42:E187. 39. Phillips K, Miller J, Brant JM. Patient reported outcomes research: lessons learned from launching a novel electronic platform (OnQ). Oncol Nurs Forum 2015;42:E195. 40. Scaramuzzo L. Creating comfort zones by administering the right dose of patient education. Oncol Nurs Forum 2015;42:E193. 41. Wilkinson W, Montgomery T, Brant JM. Nurse dyads: partnering to increase clinical trial participation and staff satisfaction. Oncol Nurs Forum 2015;42:E182.