521731 research-article2014
JFNXXX10.1177/1074840714521731Journal of Family NursingBell
Editorial
Knowledge Translation in Family Nursing: Gazing Into the Promised Land
Journal of Family Nursing 2014, Vol. 20(1) 3–12 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1074840714521731 jfn.sagepub.com
Minutes before the 10th International Family Nursing Conference in Kyoto, Japan, was about to begin in 2011, my Canadian family nursing colleague, Dr. Fabie Duhamel, founder and co-director of the Center of Excellence in Family Nursing, University of Montreal, offered an intriguing invitation: What if we were to invite some of our international family nursing colleagues to meet briefly at this conference in Kyoto to discuss the possibility of developing an initiative to advance knowledge translation in Family Systems Nursing? Could you help me organize a meeting?
This was not the first time that the topic of knowledge translation in family nursing has crossed my radar screen, but increasingly there is a sense of urgency and deep hunger for finding answers to at least two burning questions: (a) How can we best translate family nursing practice knowledge to insure it is applied and sustained in every-day nursing practice and (b) what are the larger systems processes that facilitate or constrain making family nursing “usual practice” in health care? With this issue, the Journal of Family Nursing celebrates 20 years of extending knowledge about families in health and illness with the goal of transforming nursing practice with families. Our global family nursing community has devoted decades of research, education, and practice scholarship to create and disseminate knowledge about how to be helpful to families by restoring and promoting family health and inviting family healing. Yet, I continue to experience firsthand (and hear stories from others) that “usual health care” often does not routinely include families, nor acknowledge family experience and preferences, nor inquire about illness suffering. Family nursing science has grown in scope and sophistication over the past 20 years, yet we still have a gap between what we know and how we apply this knowledge in practice with families. It reminds me of the Bible story of Moses who led the Israelites through the desert for 40 years on a journey to the Promised Land. Moses was given a glimpse of the Promised Land but, in his lifetime, he never actually inhabited it. In this editorial, I will highlight an International Research Collaboration for Knowledge Translation in Family Systems Nursing, funded by the
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Canadian Institutes for Health Research and led by Dr. Fabie Duhamel, which evolved from the impromptu meeting in Kyoto. I will also briefly point to some exciting, innovative projects that are attempting to account for translation of family nursing knowledge in clinical practice settings. But first, a word about knowledge translation science.
Knowledge Translation Science Family Systems Nursing scholars and practitioners are influenced by several theoretical and practice frameworks that privilege: an ability to think about the reciprocal influence between multiple systems levels that influence health and healing (i.e., the individual, the family, the nurse/health care provider, the health care system, culture, society, etc.); a preference for multiple realities and collaborative relationships; curiosity about beliefs and illness suffering; and a focus on strengths rather than deficits (Bell, 1996, 2009; Wright & Bell, 2009; Wright & Leahey, 2013). Intervention is directed through therapeutic conversation to the systems level where there might be the greatest leverage for change with the intention of softening illness suffering (Bell & Wright, 2011). Family Systems Nursing research has examined the outcomes of offering an educational intervention to practicing nurses, beginning with the early work of Maureen Leahey and her colleagues Harper-Jaques, Stout, and Levac (1995) and the research of LeGrow and Rossen (2005); Leahey and Svavarsdottir (2009); Martinez, D’Artois, and Rennick (2007); Simpson, Yeung, Kwan, and Wah (2006); and Sveinbjarnardottir, Svavarsdottir, and Saveman (2011). A growing number of models and frameworks that map the complexities of knowledge translation have recently been outlined by Rycroft-Malone and Bucknall (2010). Knowledge translation, as we are coming to understand, involves more than offering a well-designed educational intervention to a control group of practicing nurses and then skillfully measuring the outcomes of the intervention by collecting data about nurse and family variables (for more information about research instruments, see Bell, 2011b, June 24). The science of translating knowledge in health care settings for the purpose of practice change in a specific context is complex and attempts to systematically account for multiple processes when implementing and sustaining practice change (Chesla, 2008; Duhamel, 2010; Duhamel & Dupuis, 2011; Graham & Tetroe, 2010; Kitson, 2009). At the heart of knowledge translation science is a collaborative effort co-led by knowledge users and researchers, which attempts to account for various kinds of knowledge translation strategies used to change practice which influence and are influenced by the multiple systems levels within which they occur, that is, the patient/family, nursing practice, interprofessional practice, and the health care organization (Duhamel, 2013a; Pentland et al., 2011).
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For a curated list of current literature related to knowledge translation, see Bell (2012, September 03). I have also curated a current list of publications related to the conceptual and empirical literature of Family Systems Nursing (Bell, 2011a, December 12).
IFSYNC: International Family Systems Nursing Collaboration for Knowledge Translation Research The 2011 impromptu meeting in Kyoto of interested Family Systems Nursing colleagues resulted in a formal 2-day meeting of international participants from six countries who met in Montreal, Quebec, Canada, in October 2012. The goal of the meeting was to develop an international agenda for knowledge translation in Family Systems Nursing. Funding for the meeting of 32 researchers and knowledge users from Canada, Iceland, Japan, Sweden, Thailand, and the United States was successfully obtained from the Canadian Institutes of Health Research (Dr. Fabie Duhamel, principal investigator). The Glen Taylor Institute for Family and Society also provided generous financial support. Formal sharing about existing programs of research and clinical scholarship resulted in increased understanding about Family Systems Nursing developments and intervention research in each member country. The group made a decision to design future knowledge translation research that examines processes and outcomes of a brief therapeutic conversation educational intervention based on the 15-Minute Family Interview (Wright & Leahey, 2013). The need to conduct integrative reviews about existing Family Systems Nursing research was also identified. A follow-up meeting was held 8 months later on June 18, 2013, prior to the 11th International Family Nursing Conference in Minneapolis, Minnesota, with eight partner countries in attendance (Spain and Switzerland joined the group). A decision was ratified to collaborate in research that documents larger systems outcomes, patient/family/nurse outcomes, and interprofessional practice outcomes using similar methods and instruments. Findings will be collated from individual studies with the hope of a developing a multinational, multi-site study in the future (Duhamel, 2013b).
Examining the Translation of Family Systems Nursing Interventions in Practice Settings Several colleagues around the world have been examining the outcomes of a brief therapeutic conversation Family Systems Nursing educational intervention with practicing nurses. There are three programs of pioneering research in this area I would like to highlight.
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Exemplar: Fabie Duhamel, RN, PhD, University of Montreal, Canada Dr. Fabie Duhamel has long held a passion for increasing the capacity of practicing nurses to care for families. At the beginning of her academic appointment at the University of Montreal in the early 1990s, she established a family nursing practice/education/research unit (modeled after the Family Nursing Unit, University of Calgary) where clinical teams of graduate students and faculty participate in therapeutic conversations in the French language with families experiencing illness. Live supervision and video recordings of the therapeutic conversations provide students and faculty an opportunity to expand their Family Systems Nursing assessment and intervention skills. Annual Family Nursing Externship workshops conducted by Dr. Duhamel have allowed the ideas of Family Systems Nursing to be spread throughout the international French-speaking nursing community. Dr. Duhamel and her colleagues initially pioneered translation research in neighboring hospitals outside of the “university practice unit” by examining the outcomes of a family nursing educational intervention with practicing nurses in perinatal care (Goudreau & Duhamel, 2003), cardiovascular care (Duhamel & Talbot, 2004), cancer care (Duhamel & Dupuis, 2004), and psychiatric care (Goudreau, Duhamel, & Ricard, 2006). A practical “Genograph” family nursing tool (http://www.familynursingresources.com/genogram.htm) was developed for use by practicing nurses and students to help them “think family” in busy practice environments. With the establishment of a Center of Excellence in Family Nursing at the University of Montreal in 2010, Dr. Duhamel and her colleagues have designed an ingenious knowledge translation method of inviting selected nurse practice leaders from four hospitals in Montreal to participate as clinical team members in the “university practice unit” and then return to their hospital settings to coach and mentor practicing nurses’ ability to care for families using brief therapeutic conversations (Duhamel, 2010; Duhamel & Dupuis, 2011). They have had extensive experience with the joys and challenges of fostering ongoing relationships with knowledge-user groups of practicing nurses.
Exemplar: Peggy Simpson, RN, PhD, Providence Health Care, Vancouver, Canada Dr. Peggy Simpson distinguished herself early in her advanced practice career by offering coaching and mentoring to practicing nurses that targeted knowledge translation of Family Systems Nursing and larger systems change (Bell, 2013a). She conducted research about a unique knowledge to action
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process she designed and implemented using Participatory Action Research and appreciative inquiry with practicing nurses in acute care and inpatient mental health settings at the Foothills Hospital in Calgary, Alberta, Canada (Vosburg & Simpson, 1993); Castle Peak Hospital in Hong Kong (Simpson et al., 2006) and, most recently, at Providence Health Care in Vancouver, British Columbia, Canada (Simpson, 2013). In 2012, the British Columbia Ministry of Health conducted a survey of patient satisfaction of all of the mental health units across the province. Dr. Simpson’s “knowledge translation pilot unit” at St. Paul’s Hospital in Vancouver received the highest patient satisfaction score in the province of British Columbia. Her knowledge translation work with practicing nurses in mental health settings has caught the attention of senior health care administrators and politicians. She co-developed a measurement tool to examine nurses’ perceptions of their family nursing practice and has used this as one of the pre–post outcome measures of the educational intervention process. The Family Nursing Practice Scale (Simpson & Tarrant, 2006) is now being used in research projects around the world and psychometric development is ongoing.
Exemplar: Dr. Erla Svavarsdottir, Landspitali University Hospital Family Nursing Implementation Project (2007-2011), Reykjavik, Iceland Dr. Erla Svavarsdottir provided visionary leadership for the unprecedented Landspitali University Hospital Family Nursing Implementation Project (2007-2011) where Family Systems Nursing was implemented at an institutional level—on every unit of a large 900 bed university hospital in Iceland (Svavarsdottir, 2008; Svavarsdottir & Sigurdardottir, 2011). A Steering Committee of practice leaders developed and implemented the educational intervention focused on teaching practicing nursing the skill of offering brief therapeutic conversations to families (Konradsdottir & Svavarsdottir, 2013). Guided by the Calgary Family Assessment Model and Calgary Family Intervention Model (Wright & Leahey, 2013), brief therapeutic conversations were offered to families in every unit of the hospital. I had the pleasure of awarding the Chief Nursing Officer of the hospital, Anna Stefánsdóttir, RN, MSc, along with key members of the Steering Committee: Anna Ólafía Sigurðardóttir, RN, MS; Elísabet Konráðsdóttir, RN, MSc; and Eydís Kristín Sveinbjarnardóttir, RN, MSN, an Innovative Contribution to Family Nursing Award from the Journal of Family Nursing in 2009 for their courageous leadership in implementing an ambitious knowledge translation project in an entire hospital (Bell, 2010). The scope of this Family Systems Nursing knowledge translation project is the largest of its kind in the world.
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The results of this carefully designed knowledge translation project are now beginning to appear in the published literature with Dr. Erla Svavarsdottir and her doctoral students, Dr. Eydís Sveinbjarnardóttir and Anna Ólafía Sigurðardóttir serving as co-authors of several of the research publications. The publications to date focus on small sample, randomized controlled studies of families who received brief therapeutic conversations from nurses during the hospitalization of a family member (Konradsdottir & Svavarsdottir, 2011; Sigurdardottir, Svavarsdottir, Rayens, & Adkins, 2013; Svavarsdottir & Sigurdardottir, 2013). A variety of families and illness concerns are represented in this data set (Halldorsdottir & Svavarsdottir, 2012; Kamban & Svavarsdottir, 2013; Svavarsdottir, Tryggvadottir, & Sigurdardottir, 2012; Sveinbjarnardottir, Svavarsdottir, & Wright, 2013). The project also resulted in the psychometric development of two new research instruments: the Iceland-Expressive Family Functioning Questionnaire (ICE-EFFQ; Sveinbjarnardottir, Svavarsdottir, & Hrafnkelsson, 2012a); and the IcelandFamily Perceived Support Questionnaire (ICE-FPSQ; Sveinbjarnardottir, Svavarsdottir, & Hrafnkelsson, 2012b). Both of these instruments have been derived from the Calgary Family Assessment and Intervention Models (Wright & Leahey, 2013). (For more information about this project and a curated list of publications related to this project, see Bell, 2013b, September 15).
Concluding Thoughts: Still Gazing Into the Promised Land On this 20th anniversary of the Journal of Family Nursing, I yearn to inhabit the “Promised Land”—a land of ideal health care where family nursing is “usual care,” where families are included and welcomed, where family preferences are invited, and where family illness suffering is softened. Because of the pioneering knowledge to action research that has been conducted to date, we know that practicing nurses can learn the skills of Family Systems Nursing and these practices make a difference to families and also to the nurses who deliver this kind of care. We have a beginning glimpse of the individual, interprofessional, and larger systems factors and processes that are needed for the “Promised Land” of family nursing as “usual care” to be realized. This important work requires partnerships, collaboration, and strong relationships between researchers and knowledge users. We have learned through trial and error that the shape and form of the educational intervention for practicing nurses needs to be co-evolved with practicing nurses themselves. We know that simply offering and then examining the effect of a brief educational intervention without coaching and mentoring is usually not sufficient for practice change. We have also learned that a clear vision, articulated by senior
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health care administrators about the importance of caring for families, provides the crucial mission and endorsement—without which knowledge translation projects fail. A variety of methodologies for examining the knowledge to action process (Graham & Tetroe, 2010) require further testing and use by Family Systems Nursing scholars. Finally, we still need to better understand the organizational and contextual processes, policies, and beliefs that sustain practice change with families in health care once it has begun. The Promised Land of family care as “usual care”—there are still a few more miles to travel on this challenging but very worthwhile journey before we reach our destination. How much longer till we get there? Janice M. Bell, RN, PhD Editor, Journal of Family Nursing References Bell, J. M. (1996). Advanced practice in family nursing: One view [Editorial]. Journal of Family Nursing, 2, 244-247. doi:10.1177/107484079600200302 Bell, J. M. (2009). Family Systems Nursing re-examined [Editorial]. Journal of Family Nursing, 15, 123-129. doi:10.1177/1074840709335533 Bell, J. M. (2010). Innovative Contribution to Family Nursing Award 2009: Anna Stefánsdóttir, RN, MSc; Anna Ólafía Sigurðardóttir, RN, MS; Elísabet Konráðsdóttir, RN, MSc; and Eydís Kristín Sveinbjarnardóttir, RN, MSN [Editorial]. Journal of Family Nursing, 16, 3-7. doi:10.1177/1074840709357683 Bell, J. M. (2011a, December 12). Bibliography: Family Systems Nursing [Web log page]. Retrieved from http://www.janicembell.com/bibliography-familysystems-nursing/ Bell, J. M. (2011b, June 24). Family nursing research instruments developed by family nurses [Web log post]. Retrieved from http://www.janicembell.com/2011/06/ family-nursing-research-instruments-developed-by-family-nurses/ Bell, J. M. (2012, September 3). Knowledge translation in family nursing: Selected bibliography [Web log post]. Retrieved from http://www.janicembell.com/2012/09/ knowledge-translation-in-family-nursing-selected-bibliography/ Bell, J. M. (2013a). Peggy Simpson, RN, PhD: Excellence in Nursing Research Award. Journal of Family Nursing, 19, 401-402. doi:10.1177/1074840713496128 Bell, J. M. (2013b, September 15). Tribute to Family Systems Nursing in Iceland: The Landspitali University Hospital Family Nursing Implementation Project 20072011 [Web log post]. Retrieved from http://www.janicembell.com/2013/09/ tribute-to-family-systems-nursing-in-iceland-the-landspitali-university-hospitalfamily-nursing-implementation-project-2007-2011/ Bell, J. M., & Wright, L. M. (2011). The Illness Beliefs Model: Creating practice knowledge for families experiencing illness suffering. In E. K. Svavarsdottir & H. Jonsdottir (Eds.), Family nursing in action (pp. 15-51). Reykjavik, Iceland: University of Iceland Press.
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Chesla, C. (2008). Translational research: Essential contributions from interpretive nursing science. Research in Nursing & Health, 31, 381-390. doi:10.1002/ nur.20267 Duhamel, F. (2010). Implementing family nursing: How do we translate knowledge into clinical practice? Part II: The evolution of 20 years of teaching, research, and practice to a Center of Excellence in Family Nursing. Journal of Family Nursing, 16, 8-25. doi:10.1177/1074840709360208 Duhamel, F. (2013a, June). Knowledge translation in Family Systems Nursing: What is translation research and how is it different from intervention research? Paper presented at the 11th International Family Nursing Conference, Minneapolis, MN. Duhamel, F. (2013b). Partnering to advance the practice of family nursing in health care services: An international research collaboration (Final Report of the Montreal meeting: September 30-October 2, 2012). Montreal, Quebec, Canada: Faculty of Nursing, University of Montreal. Duhamel, F., & Dupuis, F. (2004). Guaranteed returns: Investing in conversations with families of cancer patients. Clinical Journal of Oncology Nursing, 8, 68-71. doi:10.1188/04.CJON.68-71 Duhamel, F., & Dupuis, F. (2011). Towards a Trilogy Model of Family Systems Nursing knowledge utilization: Fostering circularity between practice, education and research. In E. K. Svavarsdottir & H. Jonsdottir (Eds.), Family nursing in action (pp. 53-68). Reykjavik, Iceland: University of Iceland Press. Duhamel, F., & Talbot, L. (2004). A constructivist evaluation of family interventions in cardiovascular nursing practice. Journal of Family Nursing, 10, 12-32. doi:10.1177/1074840703260906 Goudreau, J., & Duhamel, F. (2003). Interventions in perinatal family care: A participatory study. Families, Systems, & Health, 21, 165-180. doi:10.1037/10917527.21.2.165 Goudreau, J., Duhamel, F., & Ricard, N. (2006). The impact of a Family Systems Nursing educational program on the practice of psychiatric nurses: A pilot study. Journal of Family Nursing, 12, 292-306. doi:10.1177/1074840706291694 Graham, I. D., & Tetroe, J. M. (2010). The knowledge to action framework. In J. Rycroft-Malone & T. Bucknall (Eds.), Models and frameworks for implementing evidence based-practice: Linking evidence to action (pp. 207-221). West Sussex, UK: Wiley-Blackwell. Halldorsdottir, B., & Svavarsdottir, E. K. (2012). Purposeful therapeutic conversations: Are they effective for families of individuals with COPD? A quasi-experimental study. Vård i Norden/Nordic Journal of Nursing Research, 32, 48-51. Kamban, S., & Svavarsdottir, E. K. (2013). Does a therapeutic conversation intervention in an acute paediatric setting make a difference for families of children with bronchiolitis caused by respiratory syncytial virus (RSV)? Journal of Clinical Nursing, 22, 2723-2733. doi:10.1111/j.1365-2702.2012.04330.x Kitson, A. (2009). The need for systems change: Reflection on knowledge translation and organizational change. Journal of Advanced Nursing, 65, 217-228. doi:10.1111/j.1365-2648.2008.04864.x
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Konradsdottir, E., & Svavarsdottir, E. K. (2011). How effective is a short-term educational and support intervention for families of an adolescent with type 1 diabetes? Journal for Specialists in Pediatric Nursing, 16, 295-304. doi:10.1111/j.17446155.2011.00297.x Konradsdottir, E., & Svavarsdottir, E. K. (2013). The role of advanced nurse practitioners in offering brief therapeutic conversation intervention for families of children and adolescents with Type 1 diabetes. Vård i Norden/Nordic Journal of Nursing Research, 109, 33, 44-47. Leahey, M., Harper-Jaques, S., Stout, L., & Levac, A. M. (1995). The impact of a Family Systems Nursing approach: Nurses’ perceptions. The Journal of Continuing Education in Nursing, 26, 219-225. Leahey, M., & Svavarsdottir, E. K. (2009). Implementing family nursing: How do we translate knowledge into clinical practice? Journal of Family Nursing, 15, 445-460. doi:10.1177/1074840709349070 LeGrow, K., & Rossen, B. E. (2005). Development of a professional practice based on a Family Systems Nursing framework: Nurses’ and families’ experiences. Journal of Family Nursing, 11, 38-58. doi:10.1177/1074840704273508 Martinez, A.-M., D’Artois, D., & Rennick, J. E. (2007). Does the 15 Minute (or less) Family Interview influence family nursing practice? Journal of Family Nursing, 13, 157-178. Pentland, D., Forsyth, K., Maciver, D., Walsh, M., Murray, R., Irvine, L., & Sikora, S. (2011). Key characteristics of knowledge transfer and exchange in healthcare: Integrative literature review. Journal of Advanced Nursing, 67, 1408-1425. doi:10.1111/j.1365-2648.2011.05631.x Rycroft-Malone, J., & Bucknall, T. (Eds.). (2010). Models and frameworks for implementing evidence-based practice: Linking evidence to action. Indianapolis, IN: Sigma Theta Tau International. Sigurdardottir, A. O., Svavarsdottir, E. K., Rayens, M. K., & Adkins, S. (2013). Therapeutic conversations intervention in pediatrics: Are they of benefit for families of children with asthma? The Nursing Clinics of North America, 48, 287-304. doi:10.1016/j.cnur.2013.01.007 Simpson, P, (2013, April). The Family Systems Nursing – Relational Practice Model: A family centered approach to mental health. Paper presented at the 8th Annual Family Conference, Family Involvement in the Mental Health System, Vancouver, British Columbia, Canada. Simpson, P., & Tarrant, M. (2006). Development of the Family Nursing Practice Scale. Journal of Family Nursing, 12, 413-425. doi:10.1177/1074840706290806 Simpson, P., Yeung, K. K., Kwan, T. Y., & Wah, W. K. (2006). Family Systems Nursing: A guide to mental health care in Hong Kong. Journal of Family Nursing, 12, 276-291. doi:10.1177/1074840706291436 Svavarsdottir, E. K. (2008). Excellence in nursing: A model for implementing Family Systems Nursing in nursing practice at an institutional level in Iceland. Journal of Family Nursing, 14, 456-468. doi:10.1177/1074840708328123 Svavarsdottir, E. K., & Sigurdardottir, A. O. (2011). Implementing family nursing in general pediatric nursing practice: The circularity between knowledge translation
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and clinical practice. In E. K. Svavarsdottir & H. Jonsdottir (Eds.), Family nursing in action (pp. 161-184). Reykjavik, Iceland: University of Iceland Press. Svavarsdottir, E. K., & Sigurdardottir, A. O. (2013). Benefits of a brief therapeutic conversation intervention for families of children and adolescents in active cancer treatment. Oncology Nursing Forum, 40(5), E346-E357. doi:10.1188/13. ONF.E346-E357 Svavarsdottir, E. K., Tryggvadottir, G. B., & Sigurdardottir, A. O. (2012). Knowledge translation in family nursing: Does a short-term therapeutic conversation intervention benefit families of children and adolescents in a hospital setting? Findings from the Landspitali University Hospital Family Nursing Implementation Project. Journal of Family Nursing, 18, 303-327. doi:10.1177/1074840712449202 Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Hrafnkelsson, B. (2012a). Psychometric development of the Iceland-Expressive Family Functioning Questionnaire (ICE-EFFQ). Journal of Family Nursing, 18, 353-377. doi:10.1177/ 1074840712449204 Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Hrafnkelsson, B. (2012b). Psychometric development of the Iceland-Family Perceived Support Question naire (ICE-FPSQ). Journal of Family Nursing, 18, 328-352. doi:10.1177/ 1074840712449204 Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Saveman, B. I. (2011). Nurses attitudes towards the importance of families in psychiatric care following an educational and training intervention program. Journal of Psychiatric and Mental Health Nursing, 18, 895-903. doi:10.1111/j.1365-2850.2011.01744.x Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Wright, L. M. (2013). What are the benefits of a short therapeutic conversation intervention with acute psychiatric patients and their families? A controlled before and after study. International Journal of Nursing Studies, 50, 593-602. Vosburg, D., & Simpson, P. (1993). Linking family theory and practice: A family nursing program. Image: The Journal of Nursing Scholarship, 25, 231-235. doi:10.1111/j.1547-5069.1993.tb00787.x Wright, L. M., & Bell, J. M. (2009). Beliefs and illness: A model for healing. Calgary, Alberta, Canada: 4th Floor Press. Wright, L. M., & Leahey, M. (2013). Nurses and families: A guide to family assessment and intervention (6th ed.). Philadelphia, PA: F.A. Davis.
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JFNXXX10.1177/1074840714521731Journal of Family NursingBell
Editorial
Knowledge Translation in Family Nursing: Gazing Into the Promised Land
Journal of Family Nursing 2014, Vol. 20(1) 3–12 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1074840714521731 jfn.sagepub.com
Minutes before the 10th International Family Nursing Conference in Kyoto, Japan, was about to begin in 2011, my Canadian family nursing colleague, Dr. Fabie Duhamel, founder and co-director of the Center of Excellence in Family Nursing, University of Montreal, offered an intriguing invitation: What if we were to invite some of our international family nursing colleagues to meet briefly at this conference in Kyoto to discuss the possibility of developing an initiative to advance knowledge translation in Family Systems Nursing? Could you help me organize a meeting?
This was not the first time that the topic of knowledge translation in family nursing has crossed my radar screen, but increasingly there is a sense of urgency and deep hunger for finding answers to at least two burning questions: (a) How can we best translate family nursing practice knowledge to insure it is applied and sustained in every-day nursing practice and (b) what are the larger systems processes that facilitate or constrain making family nursing “usual practice” in health care? With this issue, the Journal of Family Nursing celebrates 20 years of extending knowledge about families in health and illness with the goal of transforming nursing practice with families. Our global family nursing community has devoted decades of research, education, and practice scholarship to create and disseminate knowledge about how to be helpful to families by restoring and promoting family health and inviting family healing. Yet, I continue to experience firsthand (and hear stories from others) that “usual health care” often does not routinely include families, nor acknowledge family experience and preferences, nor inquire about illness suffering. Family nursing science has grown in scope and sophistication over the past 20 years, yet we still have a gap between what we know and how we apply this knowledge in practice with families. It reminds me of the Bible story of Moses who led the Israelites through the desert for 40 years on a journey to the Promised Land. Moses was given a glimpse of the Promised Land but, in his lifetime, he never actually inhabited it. In this editorial, I will highlight an International Research Collaboration for Knowledge Translation in Family Systems Nursing, funded by the
4
Journal of Family Nursing 20(1)
Canadian Institutes for Health Research and led by Dr. Fabie Duhamel, which evolved from the impromptu meeting in Kyoto. I will also briefly point to some exciting, innovative projects that are attempting to account for translation of family nursing knowledge in clinical practice settings. But first, a word about knowledge translation science.
Knowledge Translation Science Family Systems Nursing scholars and practitioners are influenced by several theoretical and practice frameworks that privilege: an ability to think about the reciprocal influence between multiple systems levels that influence health and healing (i.e., the individual, the family, the nurse/health care provider, the health care system, culture, society, etc.); a preference for multiple realities and collaborative relationships; curiosity about beliefs and illness suffering; and a focus on strengths rather than deficits (Bell, 1996, 2009; Wright & Bell, 2009; Wright & Leahey, 2013). Intervention is directed through therapeutic conversation to the systems level where there might be the greatest leverage for change with the intention of softening illness suffering (Bell & Wright, 2011). Family Systems Nursing research has examined the outcomes of offering an educational intervention to practicing nurses, beginning with the early work of Maureen Leahey and her colleagues Harper-Jaques, Stout, and Levac (1995) and the research of LeGrow and Rossen (2005); Leahey and Svavarsdottir (2009); Martinez, D’Artois, and Rennick (2007); Simpson, Yeung, Kwan, and Wah (2006); and Sveinbjarnardottir, Svavarsdottir, and Saveman (2011). A growing number of models and frameworks that map the complexities of knowledge translation have recently been outlined by Rycroft-Malone and Bucknall (2010). Knowledge translation, as we are coming to understand, involves more than offering a well-designed educational intervention to a control group of practicing nurses and then skillfully measuring the outcomes of the intervention by collecting data about nurse and family variables (for more information about research instruments, see Bell, 2011b, June 24). The science of translating knowledge in health care settings for the purpose of practice change in a specific context is complex and attempts to systematically account for multiple processes when implementing and sustaining practice change (Chesla, 2008; Duhamel, 2010; Duhamel & Dupuis, 2011; Graham & Tetroe, 2010; Kitson, 2009). At the heart of knowledge translation science is a collaborative effort co-led by knowledge users and researchers, which attempts to account for various kinds of knowledge translation strategies used to change practice which influence and are influenced by the multiple systems levels within which they occur, that is, the patient/family, nursing practice, interprofessional practice, and the health care organization (Duhamel, 2013a; Pentland et al., 2011).
Bell
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For a curated list of current literature related to knowledge translation, see Bell (2012, September 03). I have also curated a current list of publications related to the conceptual and empirical literature of Family Systems Nursing (Bell, 2011a, December 12).
IFSYNC: International Family Systems Nursing Collaboration for Knowledge Translation Research The 2011 impromptu meeting in Kyoto of interested Family Systems Nursing colleagues resulted in a formal 2-day meeting of international participants from six countries who met in Montreal, Quebec, Canada, in October 2012. The goal of the meeting was to develop an international agenda for knowledge translation in Family Systems Nursing. Funding for the meeting of 32 researchers and knowledge users from Canada, Iceland, Japan, Sweden, Thailand, and the United States was successfully obtained from the Canadian Institutes of Health Research (Dr. Fabie Duhamel, principal investigator). The Glen Taylor Institute for Family and Society also provided generous financial support. Formal sharing about existing programs of research and clinical scholarship resulted in increased understanding about Family Systems Nursing developments and intervention research in each member country. The group made a decision to design future knowledge translation research that examines processes and outcomes of a brief therapeutic conversation educational intervention based on the 15-Minute Family Interview (Wright & Leahey, 2013). The need to conduct integrative reviews about existing Family Systems Nursing research was also identified. A follow-up meeting was held 8 months later on June 18, 2013, prior to the 11th International Family Nursing Conference in Minneapolis, Minnesota, with eight partner countries in attendance (Spain and Switzerland joined the group). A decision was ratified to collaborate in research that documents larger systems outcomes, patient/family/nurse outcomes, and interprofessional practice outcomes using similar methods and instruments. Findings will be collated from individual studies with the hope of a developing a multinational, multi-site study in the future (Duhamel, 2013b).
Examining the Translation of Family Systems Nursing Interventions in Practice Settings Several colleagues around the world have been examining the outcomes of a brief therapeutic conversation Family Systems Nursing educational intervention with practicing nurses. There are three programs of pioneering research in this area I would like to highlight.
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Exemplar: Fabie Duhamel, RN, PhD, University of Montreal, Canada Dr. Fabie Duhamel has long held a passion for increasing the capacity of practicing nurses to care for families. At the beginning of her academic appointment at the University of Montreal in the early 1990s, she established a family nursing practice/education/research unit (modeled after the Family Nursing Unit, University of Calgary) where clinical teams of graduate students and faculty participate in therapeutic conversations in the French language with families experiencing illness. Live supervision and video recordings of the therapeutic conversations provide students and faculty an opportunity to expand their Family Systems Nursing assessment and intervention skills. Annual Family Nursing Externship workshops conducted by Dr. Duhamel have allowed the ideas of Family Systems Nursing to be spread throughout the international French-speaking nursing community. Dr. Duhamel and her colleagues initially pioneered translation research in neighboring hospitals outside of the “university practice unit” by examining the outcomes of a family nursing educational intervention with practicing nurses in perinatal care (Goudreau & Duhamel, 2003), cardiovascular care (Duhamel & Talbot, 2004), cancer care (Duhamel & Dupuis, 2004), and psychiatric care (Goudreau, Duhamel, & Ricard, 2006). A practical “Genograph” family nursing tool (http://www.familynursingresources.com/genogram.htm) was developed for use by practicing nurses and students to help them “think family” in busy practice environments. With the establishment of a Center of Excellence in Family Nursing at the University of Montreal in 2010, Dr. Duhamel and her colleagues have designed an ingenious knowledge translation method of inviting selected nurse practice leaders from four hospitals in Montreal to participate as clinical team members in the “university practice unit” and then return to their hospital settings to coach and mentor practicing nurses’ ability to care for families using brief therapeutic conversations (Duhamel, 2010; Duhamel & Dupuis, 2011). They have had extensive experience with the joys and challenges of fostering ongoing relationships with knowledge-user groups of practicing nurses.
Exemplar: Peggy Simpson, RN, PhD, Providence Health Care, Vancouver, Canada Dr. Peggy Simpson distinguished herself early in her advanced practice career by offering coaching and mentoring to practicing nurses that targeted knowledge translation of Family Systems Nursing and larger systems change (Bell, 2013a). She conducted research about a unique knowledge to action
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process she designed and implemented using Participatory Action Research and appreciative inquiry with practicing nurses in acute care and inpatient mental health settings at the Foothills Hospital in Calgary, Alberta, Canada (Vosburg & Simpson, 1993); Castle Peak Hospital in Hong Kong (Simpson et al., 2006) and, most recently, at Providence Health Care in Vancouver, British Columbia, Canada (Simpson, 2013). In 2012, the British Columbia Ministry of Health conducted a survey of patient satisfaction of all of the mental health units across the province. Dr. Simpson’s “knowledge translation pilot unit” at St. Paul’s Hospital in Vancouver received the highest patient satisfaction score in the province of British Columbia. Her knowledge translation work with practicing nurses in mental health settings has caught the attention of senior health care administrators and politicians. She co-developed a measurement tool to examine nurses’ perceptions of their family nursing practice and has used this as one of the pre–post outcome measures of the educational intervention process. The Family Nursing Practice Scale (Simpson & Tarrant, 2006) is now being used in research projects around the world and psychometric development is ongoing.
Exemplar: Dr. Erla Svavarsdottir, Landspitali University Hospital Family Nursing Implementation Project (2007-2011), Reykjavik, Iceland Dr. Erla Svavarsdottir provided visionary leadership for the unprecedented Landspitali University Hospital Family Nursing Implementation Project (2007-2011) where Family Systems Nursing was implemented at an institutional level—on every unit of a large 900 bed university hospital in Iceland (Svavarsdottir, 2008; Svavarsdottir & Sigurdardottir, 2011). A Steering Committee of practice leaders developed and implemented the educational intervention focused on teaching practicing nursing the skill of offering brief therapeutic conversations to families (Konradsdottir & Svavarsdottir, 2013). Guided by the Calgary Family Assessment Model and Calgary Family Intervention Model (Wright & Leahey, 2013), brief therapeutic conversations were offered to families in every unit of the hospital. I had the pleasure of awarding the Chief Nursing Officer of the hospital, Anna Stefánsdóttir, RN, MSc, along with key members of the Steering Committee: Anna Ólafía Sigurðardóttir, RN, MS; Elísabet Konráðsdóttir, RN, MSc; and Eydís Kristín Sveinbjarnardóttir, RN, MSN, an Innovative Contribution to Family Nursing Award from the Journal of Family Nursing in 2009 for their courageous leadership in implementing an ambitious knowledge translation project in an entire hospital (Bell, 2010). The scope of this Family Systems Nursing knowledge translation project is the largest of its kind in the world.
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The results of this carefully designed knowledge translation project are now beginning to appear in the published literature with Dr. Erla Svavarsdottir and her doctoral students, Dr. Eydís Sveinbjarnardóttir and Anna Ólafía Sigurðardóttir serving as co-authors of several of the research publications. The publications to date focus on small sample, randomized controlled studies of families who received brief therapeutic conversations from nurses during the hospitalization of a family member (Konradsdottir & Svavarsdottir, 2011; Sigurdardottir, Svavarsdottir, Rayens, & Adkins, 2013; Svavarsdottir & Sigurdardottir, 2013). A variety of families and illness concerns are represented in this data set (Halldorsdottir & Svavarsdottir, 2012; Kamban & Svavarsdottir, 2013; Svavarsdottir, Tryggvadottir, & Sigurdardottir, 2012; Sveinbjarnardottir, Svavarsdottir, & Wright, 2013). The project also resulted in the psychometric development of two new research instruments: the Iceland-Expressive Family Functioning Questionnaire (ICE-EFFQ; Sveinbjarnardottir, Svavarsdottir, & Hrafnkelsson, 2012a); and the IcelandFamily Perceived Support Questionnaire (ICE-FPSQ; Sveinbjarnardottir, Svavarsdottir, & Hrafnkelsson, 2012b). Both of these instruments have been derived from the Calgary Family Assessment and Intervention Models (Wright & Leahey, 2013). (For more information about this project and a curated list of publications related to this project, see Bell, 2013b, September 15).
Concluding Thoughts: Still Gazing Into the Promised Land On this 20th anniversary of the Journal of Family Nursing, I yearn to inhabit the “Promised Land”—a land of ideal health care where family nursing is “usual care,” where families are included and welcomed, where family preferences are invited, and where family illness suffering is softened. Because of the pioneering knowledge to action research that has been conducted to date, we know that practicing nurses can learn the skills of Family Systems Nursing and these practices make a difference to families and also to the nurses who deliver this kind of care. We have a beginning glimpse of the individual, interprofessional, and larger systems factors and processes that are needed for the “Promised Land” of family nursing as “usual care” to be realized. This important work requires partnerships, collaboration, and strong relationships between researchers and knowledge users. We have learned through trial and error that the shape and form of the educational intervention for practicing nurses needs to be co-evolved with practicing nurses themselves. We know that simply offering and then examining the effect of a brief educational intervention without coaching and mentoring is usually not sufficient for practice change. We have also learned that a clear vision, articulated by senior
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health care administrators about the importance of caring for families, provides the crucial mission and endorsement—without which knowledge translation projects fail. A variety of methodologies for examining the knowledge to action process (Graham & Tetroe, 2010) require further testing and use by Family Systems Nursing scholars. Finally, we still need to better understand the organizational and contextual processes, policies, and beliefs that sustain practice change with families in health care once it has begun. The Promised Land of family care as “usual care”—there are still a few more miles to travel on this challenging but very worthwhile journey before we reach our destination. How much longer till we get there? Janice M. Bell, RN, PhD Editor, Journal of Family Nursing References Bell, J. M. (1996). Advanced practice in family nursing: One view [Editorial]. Journal of Family Nursing, 2, 244-247. doi:10.1177/107484079600200302 Bell, J. M. (2009). Family Systems Nursing re-examined [Editorial]. Journal of Family Nursing, 15, 123-129. doi:10.1177/1074840709335533 Bell, J. M. (2010). Innovative Contribution to Family Nursing Award 2009: Anna Stefánsdóttir, RN, MSc; Anna Ólafía Sigurðardóttir, RN, MS; Elísabet Konráðsdóttir, RN, MSc; and Eydís Kristín Sveinbjarnardóttir, RN, MSN [Editorial]. Journal of Family Nursing, 16, 3-7. doi:10.1177/1074840709357683 Bell, J. M. (2011a, December 12). Bibliography: Family Systems Nursing [Web log page]. Retrieved from http://www.janicembell.com/bibliography-familysystems-nursing/ Bell, J. M. (2011b, June 24). Family nursing research instruments developed by family nurses [Web log post]. Retrieved from http://www.janicembell.com/2011/06/ family-nursing-research-instruments-developed-by-family-nurses/ Bell, J. M. (2012, September 3). Knowledge translation in family nursing: Selected bibliography [Web log post]. Retrieved from http://www.janicembell.com/2012/09/ knowledge-translation-in-family-nursing-selected-bibliography/ Bell, J. M. (2013a). Peggy Simpson, RN, PhD: Excellence in Nursing Research Award. Journal of Family Nursing, 19, 401-402. doi:10.1177/1074840713496128 Bell, J. M. (2013b, September 15). Tribute to Family Systems Nursing in Iceland: The Landspitali University Hospital Family Nursing Implementation Project 20072011 [Web log post]. Retrieved from http://www.janicembell.com/2013/09/ tribute-to-family-systems-nursing-in-iceland-the-landspitali-university-hospitalfamily-nursing-implementation-project-2007-2011/ Bell, J. M., & Wright, L. M. (2011). The Illness Beliefs Model: Creating practice knowledge for families experiencing illness suffering. In E. K. Svavarsdottir & H. Jonsdottir (Eds.), Family nursing in action (pp. 15-51). Reykjavik, Iceland: University of Iceland Press.
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Chesla, C. (2008). Translational research: Essential contributions from interpretive nursing science. Research in Nursing & Health, 31, 381-390. doi:10.1002/ nur.20267 Duhamel, F. (2010). Implementing family nursing: How do we translate knowledge into clinical practice? Part II: The evolution of 20 years of teaching, research, and practice to a Center of Excellence in Family Nursing. Journal of Family Nursing, 16, 8-25. doi:10.1177/1074840709360208 Duhamel, F. (2013a, June). Knowledge translation in Family Systems Nursing: What is translation research and how is it different from intervention research? Paper presented at the 11th International Family Nursing Conference, Minneapolis, MN. Duhamel, F. (2013b). Partnering to advance the practice of family nursing in health care services: An international research collaboration (Final Report of the Montreal meeting: September 30-October 2, 2012). Montreal, Quebec, Canada: Faculty of Nursing, University of Montreal. Duhamel, F., & Dupuis, F. (2004). Guaranteed returns: Investing in conversations with families of cancer patients. Clinical Journal of Oncology Nursing, 8, 68-71. doi:10.1188/04.CJON.68-71 Duhamel, F., & Dupuis, F. (2011). Towards a Trilogy Model of Family Systems Nursing knowledge utilization: Fostering circularity between practice, education and research. In E. K. Svavarsdottir & H. Jonsdottir (Eds.), Family nursing in action (pp. 53-68). Reykjavik, Iceland: University of Iceland Press. Duhamel, F., & Talbot, L. (2004). A constructivist evaluation of family interventions in cardiovascular nursing practice. Journal of Family Nursing, 10, 12-32. doi:10.1177/1074840703260906 Goudreau, J., & Duhamel, F. (2003). Interventions in perinatal family care: A participatory study. Families, Systems, & Health, 21, 165-180. doi:10.1037/10917527.21.2.165 Goudreau, J., Duhamel, F., & Ricard, N. (2006). The impact of a Family Systems Nursing educational program on the practice of psychiatric nurses: A pilot study. Journal of Family Nursing, 12, 292-306. doi:10.1177/1074840706291694 Graham, I. D., & Tetroe, J. M. (2010). The knowledge to action framework. In J. Rycroft-Malone & T. Bucknall (Eds.), Models and frameworks for implementing evidence based-practice: Linking evidence to action (pp. 207-221). West Sussex, UK: Wiley-Blackwell. Halldorsdottir, B., & Svavarsdottir, E. K. (2012). Purposeful therapeutic conversations: Are they effective for families of individuals with COPD? A quasi-experimental study. Vård i Norden/Nordic Journal of Nursing Research, 32, 48-51. Kamban, S., & Svavarsdottir, E. K. (2013). Does a therapeutic conversation intervention in an acute paediatric setting make a difference for families of children with bronchiolitis caused by respiratory syncytial virus (RSV)? Journal of Clinical Nursing, 22, 2723-2733. doi:10.1111/j.1365-2702.2012.04330.x Kitson, A. (2009). The need for systems change: Reflection on knowledge translation and organizational change. Journal of Advanced Nursing, 65, 217-228. doi:10.1111/j.1365-2648.2008.04864.x
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Konradsdottir, E., & Svavarsdottir, E. K. (2011). How effective is a short-term educational and support intervention for families of an adolescent with type 1 diabetes? Journal for Specialists in Pediatric Nursing, 16, 295-304. doi:10.1111/j.17446155.2011.00297.x Konradsdottir, E., & Svavarsdottir, E. K. (2013). The role of advanced nurse practitioners in offering brief therapeutic conversation intervention for families of children and adolescents with Type 1 diabetes. Vård i Norden/Nordic Journal of Nursing Research, 109, 33, 44-47. Leahey, M., Harper-Jaques, S., Stout, L., & Levac, A. M. (1995). The impact of a Family Systems Nursing approach: Nurses’ perceptions. The Journal of Continuing Education in Nursing, 26, 219-225. Leahey, M., & Svavarsdottir, E. K. (2009). Implementing family nursing: How do we translate knowledge into clinical practice? Journal of Family Nursing, 15, 445-460. doi:10.1177/1074840709349070 LeGrow, K., & Rossen, B. E. (2005). Development of a professional practice based on a Family Systems Nursing framework: Nurses’ and families’ experiences. Journal of Family Nursing, 11, 38-58. doi:10.1177/1074840704273508 Martinez, A.-M., D’Artois, D., & Rennick, J. E. (2007). Does the 15 Minute (or less) Family Interview influence family nursing practice? Journal of Family Nursing, 13, 157-178. Pentland, D., Forsyth, K., Maciver, D., Walsh, M., Murray, R., Irvine, L., & Sikora, S. (2011). Key characteristics of knowledge transfer and exchange in healthcare: Integrative literature review. Journal of Advanced Nursing, 67, 1408-1425. doi:10.1111/j.1365-2648.2011.05631.x Rycroft-Malone, J., & Bucknall, T. (Eds.). (2010). Models and frameworks for implementing evidence-based practice: Linking evidence to action. Indianapolis, IN: Sigma Theta Tau International. Sigurdardottir, A. O., Svavarsdottir, E. K., Rayens, M. K., & Adkins, S. (2013). Therapeutic conversations intervention in pediatrics: Are they of benefit for families of children with asthma? The Nursing Clinics of North America, 48, 287-304. doi:10.1016/j.cnur.2013.01.007 Simpson, P, (2013, April). The Family Systems Nursing – Relational Practice Model: A family centered approach to mental health. Paper presented at the 8th Annual Family Conference, Family Involvement in the Mental Health System, Vancouver, British Columbia, Canada. Simpson, P., & Tarrant, M. (2006). Development of the Family Nursing Practice Scale. Journal of Family Nursing, 12, 413-425. doi:10.1177/1074840706290806 Simpson, P., Yeung, K. K., Kwan, T. Y., & Wah, W. K. (2006). Family Systems Nursing: A guide to mental health care in Hong Kong. Journal of Family Nursing, 12, 276-291. doi:10.1177/1074840706291436 Svavarsdottir, E. K. (2008). Excellence in nursing: A model for implementing Family Systems Nursing in nursing practice at an institutional level in Iceland. Journal of Family Nursing, 14, 456-468. doi:10.1177/1074840708328123 Svavarsdottir, E. K., & Sigurdardottir, A. O. (2011). Implementing family nursing in general pediatric nursing practice: The circularity between knowledge translation
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and clinical practice. In E. K. Svavarsdottir & H. Jonsdottir (Eds.), Family nursing in action (pp. 161-184). Reykjavik, Iceland: University of Iceland Press. Svavarsdottir, E. K., & Sigurdardottir, A. O. (2013). Benefits of a brief therapeutic conversation intervention for families of children and adolescents in active cancer treatment. Oncology Nursing Forum, 40(5), E346-E357. doi:10.1188/13. ONF.E346-E357 Svavarsdottir, E. K., Tryggvadottir, G. B., & Sigurdardottir, A. O. (2012). Knowledge translation in family nursing: Does a short-term therapeutic conversation intervention benefit families of children and adolescents in a hospital setting? Findings from the Landspitali University Hospital Family Nursing Implementation Project. Journal of Family Nursing, 18, 303-327. doi:10.1177/1074840712449202 Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Hrafnkelsson, B. (2012a). Psychometric development of the Iceland-Expressive Family Functioning Questionnaire (ICE-EFFQ). Journal of Family Nursing, 18, 353-377. doi:10.1177/ 1074840712449204 Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Hrafnkelsson, B. (2012b). Psychometric development of the Iceland-Family Perceived Support Question naire (ICE-FPSQ). Journal of Family Nursing, 18, 328-352. doi:10.1177/ 1074840712449204 Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Saveman, B. I. (2011). Nurses attitudes towards the importance of families in psychiatric care following an educational and training intervention program. Journal of Psychiatric and Mental Health Nursing, 18, 895-903. doi:10.1111/j.1365-2850.2011.01744.x Sveinbjarnardottir, E. K., Svavarsdottir, E. K., & Wright, L. M. (2013). What are the benefits of a short therapeutic conversation intervention with acute psychiatric patients and their families? A controlled before and after study. International Journal of Nursing Studies, 50, 593-602. Vosburg, D., & Simpson, P. (1993). Linking family theory and practice: A family nursing program. Image: The Journal of Nursing Scholarship, 25, 231-235. doi:10.1111/j.1547-5069.1993.tb00787.x Wright, L. M., & Bell, J. M. (2009). Beliefs and illness: A model for healing. Calgary, Alberta, Canada: 4th Floor Press. Wright, L. M., & Leahey, M. (2013). Nurses and families: A guide to family assessment and intervention (6th ed.). Philadelphia, PA: F.A. Davis.
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